Lim Wee Kiak
Singapore
“" The point I want to make here is that given that we have one of the longest lifespans in the world now, and there is a correlation with an ageing population and chronic diseases, are there plans to explore and develop the emerging fields of regenerative medicine and healthy longevity?”
“Can I ask, in light of the fact that we have a smoking cessation clinic, is there a vaping cessation clinic, whereby the public can surrender themselves and say, "I have been vaping. I wish to have some help"? And how does the Ministry of Health (MOH) handle this?”
“May I ask how the Government decided on these targets, and what steps will Singapore take to achieve them? I would like to highlight, this year, the Government announced a 2035 climate target to reduce emissions to "between 45 and 50 million tonnes of carbon dioxide equivalent by 2035". Are we on track to meet our 2030 target?”
“Building upon this progress, I encourage individuals with innovative ideas and a passion for contributing to this vital green industry to step forward.”
“While mandating sustainable aviation fuel for departing flights is a commendable way, what other strategic initiatives are planned across different sectors to leverage on our hub position? How will such initiatives affect Singapore's economic competitiveness as a travel hub?”
“Sir, I would like to thank the Minister of State for the reply. I would like to ask two supplementary questions. First is that, is the Government happy with the state of affairs of the current SFC utilisation? Is 50% of the of the population using SFC the target?”
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“During the 2019 National Day Rally, Prime Minister revealed an ambitious $100 billion or more project to build ponders and sea walls not only to protect our low-lying areas from rising sea levels but also to create new land with exciting possibilities. Prime Minister Lee said working on climate change defences should be done steadily over the years and will be over several generations. But do we have the luxury of time as the climate change clock is ticking away and seems faster? Can we accelerate the construction of the ponder and help our local enterprise who are in this field to develop their capabilities in this new growth area? Bring forward the timeline for climate change defences projects will also create new land for Singapore and other new developments to enhance our attractiveness as a city to attract talent? In conclusion, Mdm Deputy Speaker, I agree that this Budget is centred around building resilience. I have outlined in my speech three areas on resilience building, that is, energy, economic as well as environment. I support the Budget.”
“If Singapore’s economic engine loses power, how long can we survive relying on our precious reserves? The last topic is on climate change – on environmental resilience. Today, we are seeing more extreme weather events happening globally. Europe experienced an unprecedented cold winter, while nearer to home, Australia was hit by severe flooding caused by heavy rainfall. New Zealand declared a national emergency after being battered by Cyclone Gabrielle. There has been widespread flooding, landslides and huge ocean swells that forced evacuations. Last year, in the US, it was the third wildest year in terms of extreme weather events and it cost over US$1 billion in overall damages. Here, we are not spared as we are seeing heavier downpours with water ponding occurring more frequently. It rained almost continuously in the last two weeks of January and into February, with a surge of strong winds and more days with temperatures falling to low 20°C. Certainly, we need to pay more attention to the changing weather conditions and speed up our efforts to build infrastructure to protect our low-lying areas. What can we do to cope with the extremes in weather conditions? What can we do to become a climate-resilient society? Are our people and our businesses prepared to cope with sudden severe weather conditions? Do we need to review, tighten and enhance surveillance checks on our buildings to ensure that everything is stable? Are claddings on high-rise office buildings and shopping malls checked for stability to withstand increased incessant rain and heavy wind surges? Our underground gas pipes, power cables – are they able to withstand any undue soil movement underground? Do we have the necessary resources on standby?”
“Hence, we must not let this pandemic pass without learning its lessons. As we learn to live with the COVID-19 virus, international trade and travel are gradually re-opening. We are now beginning to breathe a little bit easier, but the business environment has also changed. Today, companies are confronted with a lot of new challenges, from workers preferring to work from home and interactions with colleagues and clients through e-meeting platforms, to the rise of e-commerce and e-banking. They are faced with huge rising costs in doing business, such as higher interest rates on their loans, higher rentals, a very tight labour market, higher wages due to our Progressive Wage Model (PWM) as well, a higher CPF ceiling coming up and more leaves for their workers because of childcare and paternity leave. Companies, particularly our small- and medium-sized enterprises (SMEs), that account for more than half of our local employment, can only continue to thrive if they can innovate, increase productivity through continual digital transformation and reduce their reliance on intensive manpower. Just as our country undergoes a transformation in the post-COVID-19 era, companies need to go back to the drawing board as well. We need to identify the weaknesses of our local companies when confronting black swan events and help them better prepare them for the future. There has been a significant shift in the business environment. Mdm Deputy Speaker, I hope our Government can double its efforts to support our SMEs and explore areas where they need to innovate and transform how they conduct their businesses. Even for today, many are still struggling to get both feet on firm ground. Economic resilience is key and critical to Singapore's future.”
“How are we progressing in making Singapore a key LNG hub by empowering private players to build, own and operate offshore LNG terminals? Next, on economic resilience. The COVID-19 pandemic has been a wake-up call for many businesses and company owners who have been operating under Singapore's very stable economic and political environment without worrying about the possibility of a black swan event. The Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 took only months to be reined in and for normalcy to return. However, the impact of the COVID-19 pandemic was unlike that of SARS. It was more prolonged, severe and had a greater transmission rate, with the virus easily spreading from human to human. It ravaged the global economy and forced countries to close their borders. Factories were closed due to sick workers as well as quarantine measures. Travel, both air, land and sea, came to a standstill as a result of lockdowns and supply chains disrupted, with goods and produce stacked up in warehouses, unable to move. If not for our Government's timely intervention, spending billions from our reserves to assist Singapore companies to tide through the difficult period, our economy could have suffered a deeper and more severe decline. Companies were kept afloat by various forms of reliefs such as grants, cash flow assistance, business loan schemes, tax rebates, rental rebates and job-support schemes. The Government also rolled out innovative schemes to give Singaporeans vouchers to support our heartland retailers, hotels and local tourist attractions. Despite all these efforts, there were still casualties. In 2022, last year, 205 companies were wound up, a higher number than in 2021 and 2020 when 119 and 201 companies respectively were shut for good.”
“Currently, France is the forerunner in the development of underwater nuclear reactor technology with DCNS prototyping a 100-meters cylindrical small nuclear power reactor called the Flexblue. This is one of the possibilities we can explore. The Energy 2050 Committee has identified three pathways that Singapore could take to achieve net-zero by 2050, one of which includes the use of nuclear energy. I understand the Ministry of Trade and Industry (MTI) has been closely monitoring developments in nuclear energy, studying building capabilities to better understand and assess their safety, security and environmental implications. It normally takes about 10 to 15 years to build a nuclear power plant. Singapore should be prepared if nuclear energy becomes an inevitable option. Therefore, I would like to ask is there a timeline in pursuing this option? It is crucial for us to set a clear target date as we evaluate the feasibility of using nuclear energy for Singapore. At present, we are planning to import renewable energy from our Southeast Asian neighbours, which is a positive development, but it does not enhance our energy resilience significantly as we are still very vulnerable as such supply can be interrupted by the export country anytime. Currently, we are relying on imported natural gas to generate around 95% of our electricity. What is the risk of our natural gas source being interrupted? What is the current capacity of our liquefied natural gas (LNG) terminal and how long can this storage sustain us in the unlikely event of a natural gas disruption? In addition, just as we prioritise food security, we must focus on supply diversification to reduce our reliance on piped natural gas.”
“For example, we could offer grants to private home owners for the installation of solar panels or provide grants to companies to use the rooftops of their industrial and commercial buildings for solar power generation. Additionally, I would like to boldly suggest that the Building Control Authority (BCA) can consider revising its building code to make the installation of solar panels mandatory as part of its Minimum Environmental Sustainability Standard for all new building projects. Next, what about the use of nuclear energy for Singapore? Monday, 5 December 2022, was an important day in science. On 5 December last year, US scientists at the National Ignition Facility in California generated more energy from a nuclear fusion reaction than they put in. The experimental result is a massive nuclear energy breakthrough in a century-long quest to unlock the power of the sun on Earth. With more research and financial investment, researchers now believe we are just a few decades away from producing 100% clean and limitless energy. The possibility of using nuclear energy in Singapore has been under discussion for many years. It is also time for us to make a bold decision, whether this is one of our best options to ensure our energy resilience. Naturally, we should consider factors such as cost, technology and safety, particularly since we lack the significant open space. But we have never shied away from challenges due to Singapore's limited size constraints. We can explore building a nuclear power plant on an offshore island or on a man-made rig in the sea. We can also consider building it deep underground, or even on the seabed.”
“Mdm Deputy Speaker, I rise in support of the Budget. I would like to thank Deputy Prime Minister and Finance Minister Lawrence Wong for setting out Budget 2023 which addresses so many facets of our economy as well as the additional support for young couples. The baby bonus as well as incentives are just further enhanced and paternal leave is increased by 100%. I hope with these incentives, coupled with the power of the zodiac dragon year next year in 2024, Singapore will see a record number of babies born next year. Hot-button issues like inflation and public housing are also being addressed. This is a budget that recognises the impact of high inflation on our cost of living and how we should embrace ourselves to face challenges ahead as we restructure and seek to re-energise our economy beyond the COVID-19 pandemic era. Madam, I would like to focus my speech about resilience in three areas, now the three "E"s – energy, economic and environment. For energy resilience. This month marks the one-year anniversary of the Russia-Ukraine war. The war has resulted in severe disruption of gas and oil supply causing huge increases and fluctuations in the prices of energy and fuelled global inflation as well. It exposed our vulnerability due to our over-reliance on natural gas and oil for our energy needs. I suggest we need to urgently explore more ways to expand and ramp up our adoption of solar energy. Every time I look out at our buildings – residential, commercial and industrial – from a high vantage point, I noticed there are many, many roof tops that we could have used to install solar panels and increase our national solar energy production. We should do more to expedite and increase our solar energy production.”
“Thank you, Sir. I would like to ask the Minister one supplementary question regarding whether the policy governing the use of AI, especially in relation to cheating, is very clearly spelled out now for all the schools? And do the students know this as well? In what way has the communication been done? And finally, have any cases been detected so far and what are the penalties?”
“Thank you. I have one supplementary question. It is not just New Zealand. Even Malaysia is looking at this. The question is apart from doing a generation ban, we have moved up the age limit to 21 years. Is MOH considering moving the age limit even higher?”
“Thank you, Mr Speaker. I would like to ask one supplementary question regarding whether has the scheme achieved the initial target? Will the Ministry consider further extension of this scheme? The feedback from the commercial users is that it has been extremely helpful for them for the conversion. If this scheme is removed, then their cost will go up.”
“Thank you, Mr Speaker. Sir, I would like to know, for those who are retrenched, it was mentioned that seven out of 10 can find jobs in quite a short period of time. I think the big question is, of course, when they find jobs, are they equivalent jobs or are they of the same salary? If MOM does not track at the point of time of the retrenchment, the salary, then I would like to ask MOM, why not? Would MOM start tracking now, so we will roughly know what is the gap that they are facing? And then, at least the Government can provide some assistance in this way, so that they can lessen or cushion the impact of retrenchment.”
“Sir, let me thank Minister of State Low Yen Ling for the reply. The Government recently also announced that hydrogen could supply up to half of our power needs by 2050. Can MTI now share more on how this can be achieved and what is Singapore's target for the adoption of low-carbon hydrogen? How much hydrogen is Singapore expected to import in 2050? And to meet this net-zero goal by 2050, how soon and how fast can we expect to scale up hydrogen adoption, especially green hydrogen?”
“Okay. What is the estimated backlog for elective surgeries that we are currently facing now? And what is MOH doing now about this and when we clear this backlog?”
“Sir, I welcome the Minister's announcement to our new direction, instead of ringfencing beds, we will treat it as almost an endemic situation. I would like to ask three supplementary questions. One is, what is the estimated backlog of —”
“The pandemic has pushed the stress faced by healthcare workers to a breaking point. As we recover, we must ensure that Singapore continues to be a safe, conducive and inviting place for all our healthcare workers, including our GPs. With that, Mdm Deputy Speaker, I support the White Paper.”
“What will happen to patients who require medical care when their GP clinic is closed? What is the contingency plan if the GP is away for an extended period of time, be it for professional or personal reasons? Are enrolled clinics required to have more than one GP? Would they have to hire a standby and inform MOH if they will be away? Will there be a backup – a first-line GP and a second-line GP? Instead of appointing one, you have to appoint two, which means that one is on standby. To get a clearer picture on the GPs' interest in the "One Resident, One Doctor" scheme, we need more statistics. Currently, how many GPs are practising on a part-time basis? These GPs may not be able to accept major cases or cases requiring commitment for long-term follow-up. How many GPs are participating in the Primary Care Network? What percentage of GPs nationwide does this constitute? In conclusion, Mdm Deputy Speaker, good health is our personal capital asset. Responsibility for health should be a collaborative effort among individuals and the society that we live in. We all have to look after our health. At the same time, many may not be well-versed in healthcare matters and would greatly benefit from having a healthcare professional by their side to walk them through this healthcare journey. We cannot put this plan into execution without strong support from our GPs. During the pandemic, widespread burnout caused an exodus of healthcare staff around the world. Singapore experienced our highest turnover rate of healthcare workers over the past two years. Yet, even before that, healthcare workers have voiced their discontentment with long, inflexible working hours, and the abuse and disrespect they faced from patients.”
“According to data from the British Medical Association (BMA), the overall number of GP partners has been on the decline in recent years. Since 2017, the number of GPs working full-time hours or more in GP practice-based settings has been steadily decreasing. More GPs choose to work part-time as they have better control of their hours and workload, to improve work-life balance and reduce stress and burnout. Besides loathing the heavy workload and long hours, NHS GPs have expressed their unhappiness with how their contributions and abilities have been undervalued, compared to specialists. They also face increasing abuse from patients as well. We must learn from these countries with similar models and recognise the benefits but see how we can avoid the pitfalls. For the shift in our healthcare policy to be successful, we need adequate GPs to be working regular and reasonable hours to minimise burnout and to ensure that all our patients will be able to receive timely and adequate care. How will MOH monitor the situation to ensure that GPs are well-equipped to deal with increasing workload? Will there be a support channel for both patients and GPs to share feedback? This is not to encourage patients to complain, but for MOH to seek meaningful feedback and to provide necessary support if the clinics are facing difficulties coping. The last thing we want is for the national care standards to drop and patients to be left in the lurch. Will MOH now require GPs enrolled under this scheme to operate a certain number of hours on specific days or specific times of the day? There are clinics that are open only half a day on certain days of the week. Many do not operate on weekends and public holidays.”
“The incentive for GPs may not be worth the extra time and effort because, in July 2023 – that is, next year – the solo GP and his clinical assistant must do an enormous amount of work. While clusters can help him and his patients to connect to the social and community partners, he still has to see patients in an efficient and timely manner and ensure outcome indicators as well. This can be a daunting task for many GPs. They will not receive payment for their work right away, it may be a year later. So, we need to walk this journey with the GPs and scope this launch very carefully. The next topic I want to talk about will be the participation from the healthcare clusters. I note that the three healthcare clusters will be involved in keeping the resident population healthy and will be step up as regional health managers. Can the Ministry share what are the specific KPIs for the health clusters and how will these KPIs be tracked? I would also like to raise the concern that small GP groups as well as independent GPs may find themselves at a disadvantage, compared to the big groups which have clinics spanning all three clusters, because their market will be very limited. Last of all, is preventing GP burnout. I echo some of my Parliamentary colleagues here. In the UK's National Health Service (NHS) system, GPs form the bedrock of their entire healthcare system. The healthcare journey for every patient starts with the GP first. In recent years, GP practices across the UK face significant and growing strains with the declining number of GPs, rising demand and struggling to recruit and trying to retain staff as well. This translates into longer waiting times and poorer service for patients.”
“" Many GPs are concerned about the remuneration model as they believe that the new scheme will add considerably more workload for them. MOH has announced that there will be an annual service fee for each enrolled resident, which will vary according to the risk profile, scope of care as well as progress made. The fees are based on the patient's progress rather than service, which I think could be challenging to measure objectively. I think the argument on what KPIs to set, how to measure, has already started in this House. A younger patient who is more receptive to advice will naturally make more progress than an older patient with more chronic health problems and who may be more resistant to changing their lifestyle. Can the Ministry provide a clearer outline on how GPs will be remunerated? While I believe that most doctors want to make a difference to their patients' lives. However, if they feel that they are not compensated reasonably for their time and effort, some will choose not to participate in this particular scheme. In short, my concerns are how do we empower GPs and how do we make sure that GPs do not cherry-pick at the end of the day? That is the tough part, the tough balance that you have to make. In terms of drug pricing – drug pricing to be made comparable to polyclinics needs to be handled carefully as GPs do earn from the sale of proprietary drugs. The uneven rollout of drug pricing by January 2024 may lead to residents preferring to be seen in polyclinics instead of GPs. That is one feedback that I got from most of the GPs. I also want to voice the concerns from my GP colleagues about the IT-enabler for GPs.”
“Of course, we also want to make sure that chronic diseases are well managed, they do not progress to become more serious in the first place. Last of all, is encouraging participation. Free medical checkups and vaccinations are, undoubtedly, attractive for boosting participation, yet there will be residents who are unconvinced. Even for our free COVID-19 vaccination programme, which it comes to their mind, there are people who will refuse the vaccination. There are also regular functional medical screenings via Project Silver Screen that is held in the heartlands, free for seniors over 60. Not everybody will sign up. I have older folks who do take care of their health through good lifestyle habits like regular exercise and eating healthily but there is an aversion when it comes to asking them to go for medical screenings or seeing a doctor, especially when they are not feeling unwell. Preventive healthcare does require commitment on the patients' part. It is unlike a simple medical consultation where patients see the doctor because they have symptoms. After they have their symptoms seen, they get treated, they go home with a medical prescription and that is the end of the transaction, whereas preventive healthcare is a long-term journey. The concept itself is relatively recent. What else can you do, as a Government now, to encourage the active participation of the population in preventive healthcare because it is really a big paradigm shift for all our residents. A big part of it is funding. I shall talk a little bit on remuneration for GPs. This, I must, first, not take credit for myself. I must credit my GP colleagues who have emailed me when I asked them for their feedback on the Healthier SG White Paper. The first thing they asked me was, "How is the funding model?”
“I am afraid that when this enrolment starts, the very popular GPs will be all fully booked out. Just like the good schools, MOH may have to start a balloting system for patients to book their favourite GPs. Last of all, can GPs choose their patients? Are they allowed to reject patients who choose them in the first place? If that is the case, then, yes – by right, GP groups and GPs can cherry-pick. They can choose patients who are well, who do not need so much care, who are much more cooperative, compared to those who are not so cooperative. As for the age of entry, disease prevention, especially for chronic diseases, is the focus of the White Paper. I was wondering why the Ministry choose 60 and above as the entry age for the programme. In fact, 60 and above is where chronic diseases start. At 60 and above, like what my Parliamentary colleague Sharael Taha just mentioned, one out of 10 will be having early dementia. It is a bit too late. If you want to prevent dementia, you should encourage them to start walking at 40 years old. If you walk 4,000 steps a day, it reduces your risk by 20%. If you walk 10,000 steps a day, it halves your risks straightaway. In that case, you do not need to build so many expensive dementia management centres if you start the programme early. So, the question is – of course, ideally – that the implementation age should be 40 years old and younger – not older. The earlier you start, the easier it is to manage chronic diseases. In fact, we are here not to manage chronic diseases, but trying to prevent chronic diseases. By the time you hit 60, you are actually managing chronic diseases. So, there is a difference there. The essence of the White Paper is to prevent disease from forming.”
“Some patients would prefer doctors who are not in their health cluster – not within their area of residence. I think the Minister has mentioned that they can switch GPs. If the patient can switch GPs, can they also switch cluster? That is the next question. Can the Minister also help clarify whether GPs in a particular health cluster can refer patients to specialists in other clusters, especially for existing patients who have been seeing a doctor at a particular hospital for a long time? This is important as patients may want to exercise more choice over their preferred specialists. The reverse is also true, in the sense that with specialists, can they refer patients now to GPs or polyclinics within their health cluster for step-down care? If the patient requests to go to their preferred GP, will this cross-referral and transfer of medical history be conducted seamlessly? Will cross clustering further complicate funding of the programmes as it is funded by clustering? Then, there are the patients who go to their company's medical group to utilise their company's medical benefits. Employees these days are spending fewer years working with the same company. This means that it would be very difficult to forge the long-term relationship that we hope to achieve through this "One Resident, One Doctor" scheme if they are switching doctors every few years under the company's scheme. How does the Government plan to counter this? The enrolment of one-to-one GP will still allow patients to use their CHAS card at other GP clinics and this does not allow for "stickiness" to one GP and patients will still go GP-hopping. This is the feedback that I got from my GP colleagues. Of course, GPs are GPs. There will be GPs that are very popular.”
“It is very similar to the current polyclinic system now, whereby my residents always complain that when they go to the polyclinic, they see different doctors all the time. The only thing that held everything together is good medical records. When you have good medical records, then it makes a big difference. So, I think the key thing now is your IT. It is to make sure that the medical records are seamless so that patients do not need to repeat everything, doctors do not need to look through a lot of other records in order to find out how to manage this particular patient or resident. In established healthcare systems in developed countries like the UK and Switzerland, access to healthcare starts from a regular GP or family doctor. When doctors have a good long-term working relationship with their patients, they can harness the power of these relationships to solve problems beyond what may be too complex for other healthcare professionals, such as those pertaining to social and lifestyle challenges as well. As a doctor with regular patients, I can certainly attest to the effectiveness of such working relationships where both parties have mutual respect, trust and confidence, which is the most important. As I mentioned earlier on, many GPs are now in group practices. GPs rotate themselves between clinics. If patients are enrolled with a particular doctor, they may find it very difficult to reach this doctor at the preferred location on certain days or certain times. Under such circumstances, of course, the patients would be attached to the clinics instead. If the enrolment is based on the clinic and patients see different doctors, then the question, of course, is what is the value of the doctor-patient relationship?”
“First, let me just congratulate MOH for taking this very bold step, one small step ahead, but it is bold step for the nation. I totally agree with the White Paper and support the White Paper. All those proposed initiatives are commendable, but there are many areas of concerns, like my Parliamentary colleagues have raised. The details are always in the execution and the problems are always there. I would like to focus my speech on two areas – the "One Resident, One Doctor" scheme and how this will potentially affect the patient, as well as the GPs. Like many of my Parliamentary colleagues, I do have my family doctor, Dr Tan in the Nee Soon Clinic that looked after me and my family when I was young. I am very grateful for that. That one GP clinic looked after my entire extended family – my grandmother, grandfather – he was the one who came and signed the death certificate for my grandfather, and for my grandmother as well. So, I think we are quite familiar with the relationship of one good GP to a family and what a good family physician can do. The current White Paper now dictates that it should be one family doctor to one resident. I think it is a good idea. But our current GP practices now are no longer like those which were in Nee Soon village. They are no longer solo practices. Most of them are in group practices now. In fact, they are big group practices whereby doctors always change. So, you may not see the same doctors all the time. If the scheme now is to be attached to the clinic, then does it defeat the purpose of this White Paper, in the sense that you do not build a relationship between the doctor and patient, but it is just between the clinic and the patient. So, I am not sure how that changes the paradigm.”
“Thank you, Mdm Deputy Speaker. First, let me declare my interest as a member of the medical profession – I am a practising ophthalmologist in the private sector. I would like to also commend and congratulate Minister Ong Ye Kung and the team over at MOH for a very bold and forward-looking Healthier SG White Paper. You know it is a good paper when many, many Members suddenly rise to the occasion and start to claim credit for it. So, everybody would quote their own previous Adjournment Motion, COS debate and so on. At this juncture, I think I would like to join them as well. Let me claim credit for putting forward the suggestion that there must be an adult immunisation schedule. This paper itself will transform our health care system into one that is preventive. It is a paradigm shift. A paradigm shift because most of us, most of the patients, only when they are ill, will they see a doctor. If you are not ill, you should not see a doctor at all. Most of the doctors will only see patients when they are ill. If the patients are well, they do not see the patients. So, it is very, very different. I am not sure if we should even call them patients in the first place because now, they are not ill at all. So, it is a complete paradigm shift. Maybe clinics will have to change their name, they should not be called clinics, they should be called wellness centres, because they are there for wellness, they are not there for the sick. In the transition, that is the difficulty. To have a paradigm shift, you have to change the mindset of both patients, as well as the GPs, as well as the population. I think that is the enormous task that MOH have now, ahead of them.”
“Thank you, Deputy Speaker. I would like to ask the Senior Minister of State that since WHO declared monkeypox as a global health emergency on 23 July and New York City has just declared monkeypox as a public health emergency two days ago, what is the status of the monkeypox threat in Singapore with the rising numbers and when will it become a public health emergency in Singapore? And if it ever does become one, what are the measures that MOH will take?”
“Monkeypox has been endemic in Congo and certain parts of Africa. But what is the main factor responsible for this very elusive viral disease starting to spread to Europe as well as, now, to Asia? Although the current risk assessment by MOH of monkeypox is that it is still low to the general public, with the ongoing transmission, is there a risk that this virus may mutate into something more like its own cousin, smallpox, which had resulted in higher morbidity as well as mortality? Last of all, how is MOH preparing for this? Is smallpox vaccination now available in Singapore? If not, when will it be made available, especially to vulnerable groups as well as healthcare workers who are dealing with this disease?”
“I would like to thank the Senior Parliamentary Secretary for the reply. I would like to ask, since we know that once the policy is changed and companies can drop the drug price by as much as 60%, is this not proof of profiteering? What actions are taken against this company for profiteering? My second supplementary question is on patients who have rare cancers and are requiring those drugs which are not on the list currently. Is there a mechanism for them to appeal for them to be added on to the ad hoc list? And what is the timeframe for that?”
“Thank you, Sir. I would like to ask one clarification from both Ministers, with regard to the Statement they have made to say that if inflation were to go up higher, the Government stands ready to help both the residents as well as the businesses. Currently, inflation is already very high. So, the big question is, how high, what is the threshold that you are waiting for before more help can be delivered and what is the help that the businesses and the citizens can expect?”
“Chairman, I thank the Minister for showing the healthier way forward. I have three clarifications. First is on infrastructure. Over the next 10 years, will new hospitals be built, just like the last 10 years that the Minister has just painted? So, if there are going to be new hospitals, how about the private sector-wise? Will there be new private hospitals as well? So, that is something I would like to know. Second, since we need more medical manpower, from that itself, will current medical school enrolment numbers increase? There are many Singaporeans who aspire to study medicine but just because they cannot get into our local medical schools, many of the parents have to spend lots of money to send them overseas. So, will that be expanded? Third, regarding the S+3M framework, I agree with the Minister that that is the bedrock for healthcare financing now. But as healthcare cost goes up, how will this structure change? When was the last time we reviewed this framework? Will we review it again?”
“Why is the adult vaccination schedule not given more limelight? Can the Government make it more comprehensive as well as easily accessible and affordable and promote it more? Perhaps MOH can consider sending reminders to Singaporeans who have missed their scheduled vaccinations and also provide some incentives, such as MediSave top-ups for those who have their vaccinations updated? Then this would definitely encourage more to consider vaccination.”
“Chairman, I spoke on adult immunisation last year and, this year, I will again broach this topic. Getting vaccinated has been a buzzword since the outbreak of the COVID-19 pandemic and we have seen so much effort put in by governments and health authorities globally. In Singapore, we have been very lucky and very successful in our vaccination exercise during this pandemic and we are pushing harder for the younger Singaporeans now to get themselves vaccinated. Vaccination is important, not just for this pandemic, but for many other diseases. Most adult Singaporeans would have been more familiar with Influenza vaccine and perhaps also hepatitis B, measles, mumps and rubella. The National Adult Immunisation Schedule (NAIS) was set up in 2017 to provide guidance on vaccinations that anyone aged 18 and above should adopt to protect themselves against vaccine-preventable diseases. Eleven diseases were identified, namely, Influenza, pneumococcal diseases, human papillomavirus, tetanus, diphtheria, pertussis, mumps, measles, hepatitis B and varicella, which is the chickenpox virus. The question is how many adult Singaporeans have kept up with their vaccinations according to this schedule? What is MOH's plan to encourage more adults to keep their vaccinations up-to-date to protect themselves? Even in this House, I am sure many Members have not heard about this particular programme, let alone be up-to-date for the vaccinations. The COVID-19 pandemic has highlighted the importance of preventive health through vaccination. In Singapore, we have a well-developed childhood immunisation programme. Adult Singaporeans should be encouraged to get their immunisations updated periodically to protect themselves against diseases.”
“When we discuss healthcare financing, our famous 3Ms healthcare financing framework comes to mind – our current MediSave, MediSheid and MediFund. Are they working well? When was the last time we refined, or changed or augmented our current framework? Will we see an increase in our MediSave contribution rates, an increase in MediSave limit and an increase in our MediShield premiums as healthcare costs increase? To help Singaporeans cope with healthcare costs, especially those with chronic illnesses, can the Government raise the MediSave limit we can use for both inpatient as well as outpatient for these diseases? Can the MediSave limit be relaxed for those who are older, especially for those who have significant savings in their CPF MediSave account? They always lament that "I have money in my MediSave account, why do I need to use my hard-earned cash to pay for my medical bills, as I stretch my dollar? So, with that, I hope the Government can continue to work towards a healthier Singapore. Healthcare Workforce Transformation”
“Can MOH consider more similar incentives to Singaporeans to encourage them to embrace preventive health? Perhaps Government can offer a discount to our MediShield and CareShield premiums as incentives for those who adopt regular health screening and healthy lifestyle. Healthcare Affordability and Financing We all have heard the saying on the ground that "one can die but cannot afford to be sick". Healthcare costs and affordability is a real concern for many as our population ages rapidly. The Government has swiftly addressed some of these concerns over the years by introducing various medical subsidy schemes, including Pioneer Generation, Merdeka Generation health benefits, CHAS cards for middle and lower-income groups to cushion the impact of rising healthcare costs. But are these enough? Healthcare expenditure has tripled to $11.3 billion in 2019, from $3.7 billion in 2010, over a 10-year period. And with the current spending in this sector, excluding COVID-19 related expenditure, it is expected to rise and hit $27 billion by 2030, which means that in another decade, it will triple again. These are very sobering figures. What is the Government doing to slow down the rise of healthcare expenses? What are the main drivers of rapidly rising healthcare costs in Singapore? In this Budget, one of the reasons given by the Government for the GST hike is to fund the expected increase in healthcare due to the ageing population. How will the Government use the increase in revenue collected through the GST hike to improve healthcare delivery to our ageing population? What can Singaporeans expect to see in our healthcare infrastructures and services in a decade from now?”
“Chairman, I declare my interest as a practising eye doctor in the private sector. The adage "Prevention is better than cure" still holds true and is even more relevant today as we face rapidly increasing healthcare costs. Many of us take health for granted and only start to regret when we lose it. Those who own a car will know the importance of preventive maintenance for their beloved cars but how many of these drivers actually do preventive health for themselves? Preventive healthcare is certainly a hard sell. It is especially challenging when someone feels, “Why do I need to spend the money or the time, or worry about my health when I am feeling alright?” Little do they appreciate and, often, until it is too late, that preventive healthcare means catching potential problems before they become real big problems. Many do not realise that it is more cost effective to do regular preventive health checks than to seek help when a problem arises. What is the response to MOH’s various health screening programmes and campaigns in the past five years? In what areas of preventive health is MOH going to focus on? What is the longer-term plan for preventive health for a healthier Singaporean population? What can be done to encourage and promote preventive health in our community? Has any study been done to understand the reasons why people generally avoid preventive healthcare? Can Government put more subsidies into preventive health to make it more accessible and affordable to all Singaporeans? Currently, there are insurance companies who incentivised their insured to practise good and safe driving habits using various apps and offering discounts to the premiums for renewal and also offer e-vouchers for the insured to adopt healthy lifestyle.”
“Chairman, I have two clarifications regarding disposable plastic bag charges. I would like to ask the Minister when we implement this plastic bag charges, because plastic bag charges, the cost price, which is actually very low. It is a fraction of a cent. So, when we charge $0.05 per bag means that the profit margin is quite high. I know you are saying that it is not purely for profit, but does it mean that any other shops, including convenience store, if they decide they want to charge for plastic bags, is it legitimate do so straightaway. Is it considered profiteering? This is something, especially in this climate of rising inflation, many of the residents are all very concerned about cost. The Minister also mentioned that the cost itself, that is the profit that is – or rather the revenue that is collected from this will be channelled towards other social causes. Is this mandatory or is this voluntary? Which means, how would we ensure that this cost is really channelled towards helping the environment and those of a lower socioeconomic group. Previously, I also asked before how do we help our lower socioeconomic cope with this increase in the cost now even though is just $0.05 per bag.”
“Chairman, plant-based meat is increasingly taking its place on our supermarket shelves, and I generally believe there is a gradual acceptance of this alternative meat substitute for real animal meat. Food security is important for Singapore. We are reliant on many countries to supply many essential items including meat. And if we are able to develop such alternative meat products locally, this would address some of our concerns in this area. Besides, meat substitutes which are produced in laboratory by cell culture would contribute to our efforts to address climate change issue as well. According to the Good Food Institute, an international US-based non-profit re-imagining meat production, animal agriculture takes up 77% of all agricultural land on Earth despite supplying only 17% of humanity’s food supply. This inefficiency drives the need for agricultural expansion, which is the single largest driver for ecosystem damage on land. They reported that plant-based meat emits 30% to 90% less greenhouse gases than conventional meat production and animal agriculture contributes to more climate change than exhaust emissions from the entire transport sector. Thus, to meet the nutritional needs of a growing population and, at the same time, protect earth's fauna and flora, and fight against climate change, we need to consider and promote food products like meat substitute that are manufactured using plant-based products and meat produced in the laboratory by cell culture, instead of from animals in farms. This can form part of our 30 by 30 plan. What is Singapore's role in this new emerging sector? How can we promote and grow this sector to benefit from this sector? Progress of Singapore 30 by 30 Plan”
“Malaysia intends to introduce a new law to ban smoking and the possession of tobacco products, including electronic vaporisers, for people who are born after 2005, as a "Generational End Game" for smoking in the country. In 2019, the smoking prohibition was introduced and Orchard Road was designated Singapore’s first NSZ. Does the Ministry intend to roll out more NSZs and prohibit smoking in more places to protect the public from the harmful effects of second-hand tobacco smoke? Do we have plans to introduce "end game" laws to snuff out cigarette smoking completely for our young Singaporeans? What is the results and lessons learnt from the 2014 Nee Soon South pilot project to ban smoking in public? I urge the Government to take bold steps to extend more NSZs and finally also to consider smoking completely banned in all HDB estates. Smoking Prohibition”
“Chairman, the COVID-19 pandemic has rightly raised our concerns because of the toll it takes on innocent lives and the suffering of those who were inflicted with the disease. Globally, since the outbreak of the pandemic, there were some 5.9 million deaths, and it is still rising. There is another pandemic that is also claiming lives, but it is somewhat given a back seat. This is the scourge of smoking. According to WHO, the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than 7 million of those deaths are as a result of direct tobacco use while 1.2 million are the result of non-smokers being exposed to second-hand smoke. The economic costs of tobacco use are substantial, for example, costs for treating the diseases caused by tobacco use as well as the loss of human capital that is a result from tobacco-attributed morbidity and mortality. There are studies that shows that smoking is highly likely to worsen the severity of COVID-19 and the risk of dying from infection, according to a UK Biobank study published online in the respiratory journal of Thorax. Despite all the health risks, cigarette smoking is one of the most common forms of tobacco use and it is one of the leading preventable risk factors for premature deaths, including non-smokers who are exposed to second-hand smoke. We have been taking various steps to control cigarette smoking. But some countries, like New Zealand, are taking bolder steps to ban smoking. New Zealand plans to raise the legal smoking age by one year every year, effectively banning the sales of tobacco products to people born after 2008.”
“Chairman, last month I watched an interesting CNA documentary titled "Lost Waterfronts" which relate the history of Singapore’s former coastlines and waterfronts, which is now replaced by man-made landscapes such as Marine Parade, Changi Airport and MBS. I was amazed by the tremendous transformation that our little island has undergone. What was formerly our coastlines and beaches have all disappeared and replaced with land and development. I wonder in 50 or 100 years from now, will our descendants be watching a different version of a similar documentary titled "The Lost Land", featuring the sea and describing what used to be a huge Changi airport and HDB Marine Parade estates is now replaced by sea. If we do not do anything to protect our low-lying areas against the rising sea level, that may become reality. I still remember the graphic presentation during Prime Minister's National Day Rally in 2019, on Singapore's map showing all the low-lying areas which will be reclaimed by a rising sea level if nothing is done. And what Prime Minister said, that our descendants may ask: "why did we not do anything when we had a chance?" I, and many, are impressed by the ambitious plans shown during the presentation on building polders and a sea wall, not only to protect the low-lying areas but also to create new land and new possibilities. Can the Minister give an update on our progress to safeguard Singapore's low-lying areas against the threat of rising sea level? Can the studies on the protection measures be speed up, so that it could mitigate the work needed to protect our shorelines? What interim measures can be done now? And how does the Government ensure that the coastal adaptation measures are cost-effective and adequately resourced? Flood Mitigation and Coastal Adaptation”
“How will this affect the cost of living, especially the lower socio-economic group? What can be done to mitigate the cost for this group? Apart from plastic bags, in fact, the current COVID-19 pandemic has brought about another set of problems with the use of plastics, that is, millions of discarded single-use plastic food containers. How are we dealing with the disposal of all these plastics in the current pandemic?”
“Chairman, when it comes to using plastic bags, Singapore is among the top. We are using 2.5 billion plastic bags a year, according to NEA. This can be translated to be about 450 plastic bags per person each year. And in 2019 and 2020, NEA pointed out households and trade premises in Singapore threw away 200,000 tonnes of disposables per year, two-thirds of which are disposable bags. In 2018, in a Singapore Environment Council study, it found shoppers take 820 million disposable carrier bags from supermarkets a year, or an average of 146 bags per person. If we look back at our past, we can understand why Singaporeans have such a voracious appetite for plastic bags. Many of us grew up with them from around the 1970s. Admittedly, they come in very useful when you are at the wet market when buying fish, vegetables and many other uses. Many of us justify taking plastic bags from the supermarket because plastic bags can be reused for disposal of household rubbish. Thus, these plastic bags become an omnipresent product, which can be found in the remotest of places from the seabed to the summit of Mount Everest. This poses major environmental challenges. MSE has announced that it would implement a disposable carrier bag charge at supermarkets, which was one of the recommendations submitted by the Citizens Workgroup on Reducing the Excessive Consumption of Disposables. Implementing a plastic bag charge will certainly reduce excessive plastic bags consumption but such implementation will also add to the increased cost of living, especially for lower socio-economic group. Can the Minister share details on the model of this impending bag charge? How has the Ministry consulted stakeholders to develop the model for the disposable carrier bag charge?”
“The events in Europe are a good eye-opener of how energy prices shot up amidst the disruption and the supply of gas and because of conflicts between countries. However, only France seems to be in a better place than the rest of Europe because its electricity supply is supplied by its own nuclear power plants and this accounts for more than two-thirds of its total electricity generation in 2021. In the Far East, Hong Kong, which is slightly bigger than us, about 1,106 square kilometres, gets its electricity generated from coal, natural gas and also nuclear energy. Hong Kong gets its electricity from a nuclear power plant that is in Guangdong, the Daya Bay Nuclear Power Station. I have raised this question previously before, that was before the nuclear incident in Japan occurred, whether will Singapore consider nuclear energy. I also raised this question in a written Parliamentary Question (PQ) as well to MTI earlier this year and Minister Gan Kim Yong has replied as a written reply to say that Singapore supports the international effort to strengthen the global nuclear safety as well as the security architecture. But the question is: how far are we from there? I appreciate the response, that Singapore can give some priority to review the tapping of nuclear energy as part of our option to use clean energy, to meet our commitment to the global community on environmental sustainability, technological advances in micro nuclear reactors will enhance safety, reliability as well as cost effectiveness. We need to keep an open mind and tap this option in the future to enhance our energy security and resilience and reduce our dependence on other countries. With that, Mr Speaker, I do support the Budget.”
“Since the Government need to increase revenue to support the long-term needs of an ageing population, why were sin taxes, such as gambling, alcohol and cigarette taxes, not increased in this Budget? Increasing sin taxes will encourage Singaporeans to adopt a healthier lifestyle and help our Government to support the revenue. My last topic will be on sustainability and clean energy. I agree with Dr Tan Wu Meng on what he said yesterday. Singapore is a small city state of just over 700 square kilometres. The limited size that we have also limits the amount of renewable energy that we can harvest. Even if we put a solar panel on the whole island, we will still not generate enough energy to meet our daily needs. So, my next question is: is it realistic for Singapore to aim for carbon zero? Between land for housing, transport, security, healthcare, education and a whole suite of economic infrastructure, we also push out land for infrastructure for Electric Vehicles (EVs) in public and private housing estates, office buildings, public roads and carparks. I know we have embarked on tapping solar energy and explored many other avenues to reduce our carbon footprint, but is it enough? I know that the Government has been working to import clean energy from ASEAN and various countries. All these are fine, as long as the relationship between countries are good and stable and the supply countries do not face any disruption or any sudden domestic needs increase. With climate change causing a heightened frequency and intensity of climate disasters in our supply countries, this is a real threat. The concerns over our energy security, as well as resilience, arises if we are significantly rely and depend on external supplies.”
“Should we have done more to make property tax more progressive, especially for the top-end properties like in this category? Our tax system is based on the annual value of the property which is as I understand is computed based on the imputed rental value of the property. Because of the land area of GCB compared with a high-rise and more densely populated condominium, the property tax levied on GCB is comparatively lower. The expanse of land for a condominium would include the many facilities and car parks, but the density is much higher, even for HDB blocks. They could be paying much more property tax per square foot than a GCB. So, my question is – Singapore has only 728 square kilometres of land, of which 14% is allocated for residential housing. What is the total amount of property tax on residential property that the Government collects every year from this? And what is the distribution of this property tax going by housing type, such as GCB, various landed properties, low and high-rise condominiums as well as HDB properties? Besides this, I would like to ask whether there is a differentiation between a freehold and lease hold property in the computation of property tax? If not, why? I would like to ask about property developers who sell their housing projects on a 99-year lease basis but using their freehold or 999-year lease land. Do these companies pay any tax on the value that they are holding since the ownership of the land will go back to them after the expiry of the 99-year lease? Otherwise, it would seem that these companies or developers are allowed to hold value without paying any taxes for 99 years.”
“Are we chasing our own tail? As we push for more wage increase for Singaporeans especially the lower-income group, business cost will also have to go up and inflation will increase and erode the purchasing power of these workers. Mr Speaker, I am glad to hear that the Government has pledged to do more, if inflation becomes more persistent and more serious than expected. I would like to raise the question: what is the projected acceptable medium and long-term inflation numbers? If inflation goes up, it hits people's savings especially the poor, the elderly and retirees. They would feel the drop in their buying power, and everything is more expensive for them. Those with savings would find themselves digging deeper, further into their savings than before. What may previously be an adequate amount of retirement funds could now become insufficient. How are we to manage wage increases to go up in tandem with this inflation? Otherwise, the Government's efforts in helping the workers and employers with the Wage Credit Scheme would be a futile effort. We need to examine this carefully and how are we to manage inflation when the GST rise kicks in. Next, on the tax system. The big question is that is it progressive enough or is this just the beginning? Mr Speaker, I agree that progressive tax changes include the latest income tax levied. But there is one area where I feel we should take a closer look; that is the property tax. I feel that there is more room for adjustment. From the current Budget, I do not see how the Government can recover the expenses that the Government requires in the coming years in order to reduce the deficit. Recently, we kept hearing news of record transacted prices of Good Class Bungalows.”
“I take reference from the MAS "50 Years of Inflation Experience in Singapore" that was published by Macroeconomic Review October last year. In 2003, GST was raised to 4% and again to 5% in 2004, and it was up again from 5% to 7% in 2007. In the latter half of the 2000s, exchange rate policy was generally tightened as Singapore's headline inflation rose rapidly, from 0.5% to 6.6% in 2008. This increase was attributed to the backdrop of strong global commodity prices and also partly due to the China's rapid economic growth and other emerging economies. According to MAS, this was estimated to add around 0.4% to 0.5% to headline inflation each year in 2007 and 2008. During this period, the price of crude oil increased significantly due to heightened uncertainty, leading to a short bout of high inflation. In 2008, the Consumer Price Index (CPI) rose above 5% for two months due to skyrocketing gas prices – sounds déjà vu again. By the third quarter of 2008, the effect of the US banking crisis impacted our economy. This resulted in Singapore being hit by recession. By allowing our Singapore currency to appreciate, it will help to cushion the inflation of imported goods and services but it will also harm our businesses by making our exports more expensive and reduce our competitiveness. While Singaporeans note that the Government has an offset package in place to cushion the effect of the GST rise, they argued that this offset package is only temporary. The inflationary effect on the cost of living is permanent. And they worry for their children and grandchildren having to live with this high costs. And, for businesses, their biggest overheads – wages, rental and property prices, only go one way – they will go up. Once business costs go up, this will also affect all consumers.”
“Even throwing rubbish cost for now, as refuse removal fees was increased; and soon, even the plastic bags will cost some money, if you collect plastic bags from the supermarket. And having a sugary drink itself may cost more if the Government decides to implement a sugar tax. Inflation is making in-roads into the pockets of the man-on-the-street, especially the lower socio-economic groups. We have heard rumblings of higher cost of living as the people struggle to adjust with the cost to the loss of purchasing power. Salaries, if there had been any increases at all, are unable to fend off the rise in the cost of transport, cost of food, as well as other essential household items and healthcare services. And this Budget, we will see a higher GST next year, a higher carbon tax next year, which fuel inflation to an even higher level. The combined effects of the trio – GST increase, carbon tax increase and wages increase – cannot be underestimated. The cost of running businesses is rising rapidly, although there are various packages from the Government to cushion the impact on the operational overheads. Yes, under the 2012 Progressive Wage Model (PWM), the salaries of local lower-wage workers were increased. Employees' salaries went up by 3.3% in 2021 compared to 3.6% in 2019 and it is expected to rise by 3.5% in 2022, according to Mercer's 2021 Total Remuneration Survey (TRS). However, Singapore's headline inflation in 2021 was 3.9% to 4%. So, these numbers show how inflation is eating into the worker's income. GST was first introduced in 1994, with a 3% rate. Headline inflation then was 3.1% in 1994, and it dipped to 1.7% in 1995. MAS allowed the currency to appreciate steadily during this phase. This helped to contain overall domestic inflationary pressures.”
“Mr Speaker. First, let me just say thank our Finance Minister Lawrence Wong, as well as the team from MOF for putting up this particular Budget that is forward-looking as we move towards the post-pandemic phase to build a greener, as well as more inclusive Singapore. During the last financial crisis in 2008, the Government dipped into our national reserves to support the economy and the amount utilised was probably returned when the economy rebounded strongly, post-crisis. This time, the Government has again deep into our national reserves for the pandemic, and the amount utilised is actually much larger compared to the last crisis. Using the same lyrics that was from last year's National Day song – that "we did it before and we'll do it again" – or just wondering whether will the Government be doing it again, and how and when the Government will be able to recoup and return the drawdowns that have been made during the pandemic so that we can return the reserves to our future generations. I will focus my speech now on three areas that affects the poor, the rich and all. First, inflation. Second, the tax system. Last, clean energy. On inflation, we are already feeling the pinch of inflation even before the Budget statement was made. The rise in petrol prices, the higher electrical tariffs, supply chain disruption, higher labour costs arising from the pandemic have triggered across-the-board rise in the cost of living. HDB resale price went up, private property prices went up. Public transport fares were increased last year. School bus transport fees were increased. Childcare services fees were also increased and taxi fares are all going up. Cooking oil and eggs prices are also moving up.”
“Thank you, Mr Speaker. I have two clarifications. One is on Ukrainians who are currently in Singapore. I would like to know how are we providing assistance to them if their Social Pass or work pass expires. Are we going to help them to extend, while their country is currently in crisis now? Does the Minister have the numbers as to how many Ukrainians are currently in Singapore, for whatever reasons? Number two, what is the proper channel for us to channel resources to help now? The Minister mentioned about Red Cross is one resource. Will the Government have a concerted effort to have fundraising efforts from the public to help the Ukrainian, rather to have multiple websites and we do not know which is the one that is approved and authorised? Also, currently, the Ukrainian President is calling for the foreign legion to help the country, for fighters to come in. If any Singaporeans were to volunteer to become a fighter to go to Ukraine, will the Government object or will the Government stop them? What is the stand on these things?”