Michael Lim Chun Leng
Singapore
“Mr Speaker, Sir, I would like to ask the Minister, in the light of scientific evidence to show that as many as half of the people who are presented with a heart attack at a hospital do not have any critical stenosis or narrowing in the heart artery, but actually only have a very minor narrowing in the heart artery, and as a result of tear…”
“My question is: in the light of things evolving, whether for specific high-risk individuals, we should actually look at other means of identifying them. On the second point about AED, if we reach the A&E for a sudden cardiac death, of course, your mortality is more than 90% because it takes a long time to reach it.”
“Clinical practice guidelines help doctors to manage patients in the most optimal way. They do not help doctors manage patients in a most cost-effective manner. Ultimately, most Singaporeans want to have the cake and eat it. Let us not raise the expectations too high. Let us keep healthcare bills in the public sector affordable.”
“The Ministry had spent millions of dollars on IT cost, man-hours and employing new staff. Yet, till this day, few believe that it has translated to any real tangible improvements in the healthcare delivered to the man-in-the-street.”
“Mr Speaker, Sir, I am getting a bit confused here. I am trying to understand the process. Can I check with the Minister? Does it mean that an operator can seek approval from PTC and PTC, based on a certain set of criteria, has approved the routes or what they are supposed to do, and then the operator can decide not to follow what PTC has…”
“Sir, I would like to ask the Minister how can there be more predictability if one took an express bus from point A and reach point B on the same express bus vis-a-vis someone who has to take a bus to the MRT station, drop off at another MRT station and then take another bus to his destination. How can there be more time predictability?”
The complete record
Every one of 361 lines we hold for Michael Lim Chun Leng, in date order, each linked to its source. Free to read, in full, without an account. Page 5 of 8.
“However, in the general election, they were tempted by the material benefits offered by the PAP Government and voted against their will. Under the high-handed governing by the PAP Government, the Singaporean people have already lost their souls. So where lies the National Soul?" Mr Speaker, Sir, Singapore is a small nation. Our population is much smaller than our neighbouring country. So if Singaporeans feel that they have been divided into two camps, it is a crisis to our nation. This would enable the other countries to instigate our people and further weaken the cohesiveness of our people and our national unity. In the conclusion of the President's Address, he pointed out that we should be more confident when we face our future competition because we are stronger than what we were in 1965. However, in the recent conflict between Singapore and Malaysia, Malaysia threatened to review the supply of water to Singapore, and the Malaysian Prime Minister, Dr Mahathir, had alleged that our Government has asserted pressure on Malaysia to give up their rights on the Malayan Railway land in Tanjong Pagar. I feel that these are two major issues which Singapore has to face and resolve in the 21st century. Water supply has a great effect on the livelihood of our people and also on our economic development. The problem of the Malaysian Railway has a great effect on our national defence and security. The Government should announce its specific long-term solution to the matters and at the same time explain the details of the agreement signed between the Singapore Government and the Malayan Government on the use of the railway land so that the Government of Malaysia may not make use of these two issues as a stake against us.”
“The Government is conveniently making use of the power vested in them to allocate the national resources, such as the HDB upgrading and asset enhancement, etc. to its advantage. They are using it to win votes. By using such a method to win the election, would it not give the foreigners a misconception that so long as we give some benefits to the Singaporeans they will just succumb to such benefits. This will have adverse effect in the future on conducting our foreign relations and in the area concerning our international living space. I have received a letter which was addressed to Mr Bai Shi De of the Lianhe Zaobao with regard to an article written by him entitled Where lies the National Soul. Let me read from this letter. It says: "Mr Bai, I have read your article in the Lianhe Zaobao entitled Where lies the national soul? I feel that you do not understand the Singaporeans. With more than 38 years of continuous ruling of Singapore, the PAP Government has full control of the people of Singapore. Now in Singapore many Government and quasi-Government departments have become tools for the PAP Government to control the people. Political right is now the monopoly of the PAP. Under such a situation, the young people know only how to study hard to get good results and to get a good job eventually. For the adults, they only know how to work hard to earn more money and to get the best material enjoyment. Singaporeans are already becoming apathetic. Who cares about the affairs of the nation? The PAP Government has divided the people into those who support the Government and those who support the opposition. How are they going to unite Singaporeans when there is a crisis? Most Singaporeans wish to have an opposition in Parliament.”
“Prime Minister Goh himself has threatened the voters during the election, that if they did not vote for the PAP, then when Singapore progressed very rapidly, the constituencies which voted for the opposition parties would be lagging behind and degraded into slums. This is to deliberately neglect the areas that do not benefit the PAP. PM Goh also used the counting by precinct mechanism to threaten the voters. He said that even in those constituencies where PAP candidates were returned, the precincts which voted for opposition parties will be given low priority in upgrading. So they are causing our people to drift apart. I condemn the PAP's method which has caused our people to drift. Singapore is an independent country. We are all citizens of Singapore. We are all masters of the nation. However, if the people are having fear for the Government and feeling that they are totally helpless on the policies of the Government, then they feel that they would have no choice but to bow and submit to the Government. How could they have a sense of belonging? In the construction of public facilities, such as the MRT, library and the polyclinics, the Government has deliberately neglected the opposition wards. For example, in the previous election, they threatened to close down the kindergartens in the opposition constituency and children living in the opposition constituency had to get the endorsement by the grassroots leaders before they could be admitted to the kindergartens. So these people are beginning to feel as though they are not citizens of Singapore. This sort of policy or strategy that caused the people to drift apart is very bad.”
“However, there is one thing that deserves some introspection, ie, since independence, have our people developed a sense of belonging and do they feel that they are the masters of the nation? Apart from the political consensus on independence and sovereignty, has the Government developed in the people any political consciousness that can sustain Singapore's unity and the sense of belonging of our people? This is a major challenge that we have to face in the 21st century. In the early days of nation building, the problem facing us was how to continue to survive. Today, we do not only expect a stable life. We are also concerned with how the Government is going to allocate national resources, how to make decisions affecting the people's livelihood and whether these decisions are reasonable and convincing. If the PAP Government insists on using the past practice of leaving the Government to decide and the people just follow to exchange for a stable life, and hoping that we can develop a sense of belonging for our people, then the PAP Government is just simply being complacent and conservative. They are locking themselves in the political pace of the 60s. Identity is one of the processes of ideology. Our people must agree on how to allocate our resources before they can develop unity and a sense of belonging. In the President's Address, it was stated that "no part of Singapore should be left behind as we progress." He also said that "if some segments of society feel neglected or alienated, Singapore will start to unravel". Unfortunately, the election strategy used by the PAP has already caused Singapore to start to unravel.”
“Political stability, a transparent legal framework, an efficient civil service, highly skilled workforce and a developed infrastructure all contribute to our competitiveness. The last `C' is cohesion. Singaporeans will have to sink their roots into the country. Parents must inculcate in their children a sense of pride in the nation. A new generation has grown up which have not experienced the tumultuous years during the birth of Singapore and yet they have not been educated on the history of that period. It is time for us to take an active interest in the history of our nation. We must gel together as a nation and stand united as a nation to succeed. Singaporeans will no doubt want their Members of Parliament to raise local issues affecting their living environment. However, Singaporeans will have to look beyond these issues and be able to see their Members of Parliament as helping them to make these `Cs' as issues relevant to them. In the new Parliament, Members of Parliament must apply their minds and hearts not only to the task of helping their constituents but also perceive their role as catalysts to help all Singaporeans work together to meet the challenges of the coming century. We have succeeded in more difficult times and with less resources. If we remain united and committed, with our present significantly better resources, we will continue to succeed. Mr Low Thia Khiang (Hougang)( In Mandarin): Mr Deputy Speaker, Sir, we are crossing into the 21st century soon. From the basis of national defence and the conditions for survival of our national economy, we are indeed stronger now than in 1965.”
“We must create Singapore brand names. Government agencies and statutory boards must not be prejudiced against locally developed products and services which are of good quality and pass them over in favour of other foreign products and services of similar quality. We should instead be actively identifying good quality local products and services and help them by recognising them for their high quality and support them. EDB and PSB have performed well in their areas but to increase our competitive edge, they should be more active in not only helping the bigger companies succeed but also promote any high quality Singaporean product or service. We must learn to be proud of the Singapore brand name. Our aim should be to create quality Singapore brand names that will be no less reputable than any competing Japanese or American brand names. We must move beyond a centre of excellence for producing foreign products. The next big economic leap is to establish Singapore as a centre of excellence in producing Singapore brand products that can be accepted all over the world. The fifth `C' is the competitive environment. Rising labour costs and land costs are major factors that can erode our competitive edge. If we want to continue to have increasing wages, it is inevitable that productivity must increase. However, other costs such as land costs and levies have to be dealt with in innovative ways so that we do not price ourselves out of competition. Government should be careful about unhealthy increases in commercial and industrial land prices that will increase business cost unnecessarily. Regional economies have cheaper labour and land costs. We may not have lower labour and land costs but at the end of the day, the total business cost must be competitive.”
“Government should be the catalyst in helping the average adult use the software efficiently. Government, through the National Computer Board or People's Association, should consider setting up neighbourhood computer centres where residents can enrol in classes at affordable cost and be proficient in commonly used software. These centres can also function as training centres for multimedia software. For these centres to succeed, they should not just have a few computers and ad hoc programmes at perhaps the community clubs, but they should have full-time staff and a structured and systematic set up, and programmes. Government agencies, statutory boards and private companies should not be pulling apart in opposite directions and spend tremendous amount of resources competing against each other unnecessarily. There must be avenues to draw them together and pool their strengths together, so that they can be excellent in their core business and can compete efficiently in the global economic environment. We should have strategic planning committees which not only involve key Government agencies and key private sector companies or individuals, we should also consider allowing other private sector companies who want to contribute to this process to participate. It is also about time that the Ministry of Trade and Industry should look into a more formal and systematic means of gleaning and collating from the experiences of Singaporean businessmen in different countries so that our businessmen do not have to learn lessons the hard way again and again. We may not have the formula to ensure success for all our businessmen all the time, but by learning from the experiences of others, there will be less mistakes and increased likelihood for success.”
“Recently, a prominent successful middle-aged professional whom I know and who has benefited from the economic success of Singapore expressed his pessimism in the future of Singapore to me. He had already invested in a house in Australia and felt that his children may have a better future there. Yes, there will be such views despite the economic success of Singapore. However, such perceptions should not be taken lightly lest they become prevalent. We must not only help Singaporeans understand the difficult challenges but they must also be made to understand the solutions so that we can instill confidence in them. Otherwise, the vacuum created by the absence of confidence will be filled with despair and pessimism. However, in instilling confidence, we must be careful not to allow arrogance to breed. Fourth `C' is centre of excellence. To continue to breed success, we must be a centre of excellence in all areas. Investment in manpower is the basis for success. Singaporeans will have to continually upgrade themselves educationally and invest time in the acquisition of new skills through training. Manpower is the foundation of our success and hence investment in education and skills will enhance the quality of this resource tremendously. In this age of information technology, all Singaporeans will have to learn and grow to be accustomed to the tools of information technology and avail themselves of the opportunities available for them to be familiar with information technology. The Government should consider extending computer literacy and familiarity beyond the schools into the housing estates. We can encourage the use of computers, but there must be opportunities for working adults to be proficient in computer software.”
“Mr Deputy Speaker, Sir, thank you for allowing me to join in the debate on the President's Address. The Ninth Parliament of Singapore will see Singapore in an increasingly competitive global environment. Parliament will not only need to focus on local policies and legislation, but will also have to examine the broader issues of helping Singapore succeed. Towards achieving this goal, we will have to pay attention to certain `Cs'. The first `C' is complacency. Singaporeans are so accustomed to hearing Singapore rated first in many areas that they are lulled into a sense of complacency. This may reduce their drive and competitive keenness. We do not have to look far to realise that competing nations in the region are fast catching up with us. If we want to stay ahead, we must remove this complacency. The second `C' is challenges. By understanding the constraints Singapore faces in terms of limited land, water and airspace resources, and the economic competition we face, we will have to provide avenues by which all Singaporeans can be given the opportunity to understand these challenges. We must make efforts to understand and be aware of the progress that competing economies have achieved. The Government may want to consider having a regular programme perhaps entitled "Economic Competition" in the civil service and the statutory boards to keep their staff aware of the achievements of competing economies in the different areas. The first step towards success is to know and understand the competition and challenges. The third `C' is confidence. Having removed the complacency and understanding the challenges, we must inspire and provide confidence.”
“Sir, an employer tries to repatriate his maid and at the airport the maid threatens suicide. It is not possible for the employer to send the maid back but has to get the help of an agency. The agency gives a written undertaking to repatriate the maid. Is the employer still held responsible for the abscondment of the maid in the event that it happens?”
“Sir, in the event the maid is missing and the employer is able to get news, it is often not possible for the employer to physically drag the maid to his or her home. Which department would be able to assist? Would it be the Immigration or the Police? Because some residents have said that when they approached the Police, they say it is the Immigration. When they approached the Immigration, they say it is not their duty. Which is the right agency to assist them in this task of getting the absconded maid back?”
“Sir, in the event that the employer has exercised all due responsibility, including provision of the air tickets and having sent the domestic worker to the employment agency and while in the care of the employment agency, the maid absconds, whose responsibility is it? Will the security deposit be forfeited from the employer, or is it the maid agency's responsibility?”
“This can sometimes be rather difficult. Furthermore, if the opinions differ, the patient is referred to a committee of three specialists who will then make the decision. Good medical decisions cannot be made solely by sitting on a table and examining the case-notes alone. Will the Ministry ensure that the appointed specialists from the panel be present together to review every patient at the bedside when the situation arises? One of the major concerns of this legislation is that it has opened the medical profession to the possibility of a fine and/or conviction, as stated in clause 15. Prior to this, a decision on the care of terminally-ill patients would have been purely a medical one made in consultation with the family and the patient with no legal sword of Damocles hanging over their heads. I think that the law must distinguish between divulging this information for dishonest intentions and not punish medical practitioners who may divulge this information unwittingly with no ill intent. Although there are some safeguards in subsection 2, nevertheless, we have placed upon them this potential threat. Any court action can result in dire consequences for any medical professional. In the administration of this Bill, I would urge the Ministry to exercise due care and concern so that medical practitioners do not get excessively burdened. If this act becomes too burdensome, many medical practitioners will register themselves as objectors and the advance medical directive may become an act which may not be acted upon. This will defeat the purpose of the Bill. In conclusion, I support the Bill but I urge the Ministry to give due consideration to the points highlighted.”
“Mr Deputy Speaker, Sir, the Advance Medical Directive Bill is timely -- it seeks to lay down the ground rules on the artificial prolongation of the dying process in a terminally-ill patient. With the advances in science, many in the lay public believe that doctors can do wonders and expect all sorts of extraordinary measures to be taken, even though there is no hope at all. The end result is the same -- the patient will eventually die. However, the bill will be enormous. Doctors have always erred on the side of safety and if there is any doubt that life can be prolonged, they will always continue with measures which they think will prolong life. And I think no member of the public need worry that doctors will err on the other side and shorten life unnecessarily. The Bill has also been very carefully scrutinised by Singaporeans from various walks of life and the Select Committee has also gone through it with a fine tooth-comb. However, the success of a piece of legislation depends not only on how well it has been crafted but also in its implementation. The legislation has focused mainly on the rights and protection of the patient which it should rightly do so. However, ultimately, the success of the Bill will require support of the medical professionals who are intimately involved in the implementation of the Bill. In implementing the Bill, the process of administering the Bill should not be burdensome and create more difficulties for medical practitioners whose main aim is to practise good rational medicine. The involvement of more doctors in the process of determining what situation constitutes a terminally-ill condition will mean that doctors who were not involved in the medical care of the patient will also be involved in the decision-making process.”
“Sir, I thank the Minister for his reply and beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Improving trafficability in expressways must not be at the expense of congestion on other roads. For example, the proposed implementation of Road Pricing System in future in the CTE and PIE has significant implications. If there are no adequate alternative routes, it may just be transferring the jams to other roads. Even by having special traffic lights and special bus lanes, buses still need to change lanes. Hence, if roads are congested, public transport system will also be affected. Even if there are special express buses plying the expressways, this will not solve the problem of travelling time as it will cater to only certain areas within the estate. The large majority may not benefit from it. Hence better trafficability at the expressways should not be at the expense of the travelling time of the majority of bus commuters. At the end of the day, what counts to the commuters is not just comfort but, more importantly, reduced travelling time. The biggest task that will face LTA is to achieve the twin aims of reducing travelling time and yet maintain an affordable public transport system. I will appreciate the Minister's views on these issues.”
“Just as we look into buying better buses and building better roads, we must also ensure that our public transport providers are better trained, and have good working conditions. They should not be unduly stressed by the quest for efficiency. In trying to achieve efficiency by having bus drivers meet predicted arrival times, bus drivers may be under stress as the drivers hasten to drive faster to meet the time schedules. Hence it is important that the needs and limitations of public service providers be taken into account in the provision of good public transport system. What are the measures that are taken by the Ministry to ensure that as we strive for better efficiency, road safety and welfare of public transport providers are not compromised? The North-East MRT line was good news to all those living in the North-East corridor. However, the success of the North-East line will also depend on good integration with the public transport system of buses. Efficiency of the pubic transport system can be improved by working closely with the grassroots organisations. The Ministry may want to consider getting feedback from the grassroots organisations in planning for the integration of bus services and MRT stations. The planners may do the best they can but they will never know as well as those using these services daily. In restructuring the bus services, bus companies may also want to consider an intermediate service between a trunk service and a feeder service that will serve the routes in the estate. This type of service will have the effect of reducing the number of feeder services within an estate and hence reduces the manpower requirement of bus companies and residents will also benefit as they do not have to change buses or use trunk routes to get round the estate.”
“Sir, I beg to move, That the total sum to be allocated for Head I of the Main Estimates be reduced by $100. Sir, the recent White Paper on a World Class Transport System was debated in Parliament and it leaves no doubt as to the great length in which the Government will take to ensure that Singaporeans can look forward to an excellent Land Transport System. To achieve this aim, the Land Transport Authority (LTA) was set up. Although the plans covered by the White Paper were very comprehensive, there are some areas in which LTA should and can improve on. The LTA should not only plan for major roads and expressways but also look into the overall planning and development of roads, including those in the housing estates. Currently, for estates that have been developed, there are often traffic jams within the estate itself because of the limited access roads to the main arterial road. The problem can be alleviated if LTA was given authority to plan new access roads, and to hasten and speed up the construction of access roads. This should be done even though the adjacent areas may not have been fully developed. The LTA must be able to plan from the drawing board to the completion of all roads and not just assume responsibility from authorities like HDB or URA when roads are completed. Most of the developments in the Land Transport System are concentrated on infrastructure, hardware and equipment. However, for the Land Transport System to be successful, one must not forget the human factor, ie, the people. The recent spate of bus accidents is a good illustration. Efficiency must not be imposed at the expense of road safety.”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Point of clarification, Sir. I brought this up because a doctor, who is actually a geriatrician, raised this issue that he was told by the administrator that when the hospital moves to a new building, the administrator is not very interested in developing the geriatric services, but if he wants to come along, he can come along. But he is not interested in developing these services. That is my point.”
“The Methodist Welfare Services (MWS) had wanted to expand the Methodist Home for the Aged Sick to meet increasing demands. The Ministry indicated that it was willing to assist with a larger piece of land if the MWS were willing to work on a larger project for 150 to 200 residents. MWS agreed to the project in 1993 but till now there is yet no definitive confirmation of a site, and at the same time MWS is also unable to obtain Government funding for renovation. They are now in a bind as they are also unable to expand. Voluntary groups feel that the Ministry should expedite the process of expanding facilities for the aged. I agree. The Ministry should also consider using Toa Payoh Hospital and Changi Hospital for elderly health care services when the move to Eastern General Hospital is complete. The need for health care services for the elderly will continue to increase. The effort put in by the Ministry must also increase correspondingly. We are fortunate that there are many voluntary groups who are willing to devote time, effort and finances to provide such services. The Ministry should not delay their efforts but must not only encourage them, but do all it can to assist them.”
“The elderly population will continue to grow from 7.1% in the year 2000 to 20.1% in the year 2030. I share the Government's philosophy that the family must play a primary role in caring for the elderly and, as far as possible, the elderly should live in a community rather than an institution. However, we have to face the reality that in a small family where both the husband and wife are working, there will be a significant social strain if an elderly parent is seriously ill or disabled. The Ministry has done much to develop a whole range of health care services for the elderly, like the community hospitals, nursing homes, day care centres, home care services, and hospices. However, more can be done. In the hospitals, it is important not to neglect the provision of geriatric services. Hospitals should not just pay lip service to the development of geriatric services. As new hospitals are built, and as hospitals move from old buildings to new ones, the Ministry should oversee the transition to ensure that these services are also provided for in the new hospitals. The Ministry should also consider increased funding for community hospitals. At the present moment, community hospitals receive a 50% subvention of the operating cost. Some of the administrators have voiced difficulties in raising funds to meet the other 50% of the operating cost. The Ministry may want to consider their request for increased funding, with a caveat that this increase should also be passed on to the patients. This will allow them to concentrate on their primary task of providing medical rehabilitative and respite services for the elderly. The Ministry should also be more active in assisting voluntary groups who provide services for the elderly and sick. Let me illustrate with one example.”
“Nevertheless, I am happy that the Ministry has always shown that it has continually improved the quality of health care but never at the expense of affordability. Recently, I had raised to the attention of the Ministry the article in the New Democrat entitled "The truth about the health care cost" which was addressed by the Minister just now. The article claims that the health care costs are hardly subsidised at all. It is obvious that whoever wrote the article was either totally ignorant and did not bother to check the facts or the person was out to distort facts. Any responsible publication would certainly check its facts before making unfounded allegations. I am not certain if this article was conceived out of ignorance or malice. But I am glad that the Ministry has addressed the untruth in this article so that Singaporeans will not get misled by false allegation masquerading as facts.”
“Sir, I beg to move, That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PE 1500. Many Singaporeans may not be aware that we have an extremely affordable health care service both at the primary health care level and in the hospitals. At the primary health care level, the sheer number of GP clinics in an HDB neighbourhood centre ensures that residents enjoy long hours of service seven days a week and yet pay less than the cost of a meal in a restaurant to have their health restored by a doctor who has spent several years training to develop the skills and knowledge required of him. Presently, a GP starting up in an HDB estate who purchases clinic space will have monthly overheads of about $15,000-$20,000. He will have to see about 40 patients daily just to cover overheads. For new GPs it will be difficult to even make the salaries that they would have earned in a hospital in the initial years. I am surprised that Mr Ling has claimed that the GP makes a 50% profit from each visit. I am not certain what is the basis for his claim, but I am also surprised that the GPs themselves have not made any response to his claims. Singaporeans may also not appreciate that the subsidised services in a hospital provide a good quality of specialist care at an extremely affordable rate. With Medisave, MediShield and Medifund, no Singaporean needs to worry that he will be denied of health care because of the lack of financial resources. However, Singaporeans must understand that if they want to have all the best medical therapies available at their doorstep, it must be that health care cost will increase.”
“Yes, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.”
“Sir, just now the Minister made some comments which I thought were very significant. I would like to seek some clarification. The Minister said that the Ministry was considering allowing doctors in the restructured hospitals to actually do private practice in a private type of setting. I think that was what he meant. This has several implications. Firstly, I wonder if a situation arises where there is an emergency in a private hospital and a public hospital at the same time, which hospital takes priority? Secondly, if only some members of the hospital are allowed this privilege, would it be bad for the morale of the other members? Thirdly, I think the role of restructured hospitals is to provide for those who are in the B2 and C classes. I worry that if this becomes a major incentive, there will be more people who will not have time for the B2 and C class patients.”
“The disappointments, frustrations and the constructive criticisms do not find a listening ear. The Ministry should have a structured feedback system that is accessible to all its staff in the restructured hospitals. Feedback should also be taken positively and not negatively. Many doctors feel that the policy changes affecting doctors occur ever so often without any consultation. Worse still, some consider that some of these changes benefit mainly the chosen few in the hospital. To retain staff, the Ministry must give them an open avenue to express their concerns and give feedback to enhance their working environment. The Minister and the Senior Minister of State have always been open to feedback but not many have access to them. Therefore, we should have a structured system. Despite these concerns, we have a good and cost effective public health care service. However, if we do not address the concerns of these dedicated hospital staff, I fear that our public health care services will suffer. I hope that it will not be too little too late.”
“Although some positive measures have been taken by the Ministry, by and large, it is perceived that in some hospitals piecemeal measures have been taken and in others not much has happened. The Ministry should consider having an independent committee with a clear agenda to review the health policies in the restructured hospitals. Secondly, the restructured hospitals must have clear directions and objectives. Although I know that the Ministry believes that cost recovery must never be the primary objective of hospitals, this must filter down to the restructured hospitals. Restructured hospitals are beginning to contract their services outside the hospital premises. And from the example cited by the Minister just now, I think the concern is not so much just the provision of services but that these services should not just cater for paying patients but also for subsidised patients as well. And some of these hospitals have not only established primary health care services but some of the administrators have spoken to the GPs and have considered expanding these primary health care services within the hospital. Family practitioners have voiced concerns that some hospitals which are moving into the primary health care arena may not be utilising valuable hospital resources optimally. Also in shifting to the new hospitals when they are ready, some doctors have voiced concerns that the less glamorous disciplines may receive little or scant attention by administrators. It is essential that the autonomy given to the restructured hospitals be tempered by clear directions and objectives. Lastly, the feedback system must be improved. Many hospitals are concerned mainly with feedback from patients but they do not look forward to feedback from their own staff.”
“Sir, I beg to move, That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PD 1500. In the next few years, we will be seeing several new hospitals including the Eastern General Hospital, Kandang Kerbau Hospital, Tan Tock Seng Hospital and Phase III, NUH. Bent on being a regional medical centre, hospitals are aggressively acquiring the latest in high-tech medicine. These measures will help to enhance the quality of medicine, increase the range of medical services available and also provide a better environment for the patients. Whether these measures also translate into better health care for patients depend significantly on the medical service providers in the hospitals such as doctors, nurses, pharmacists, technologists and other para-medical staff. Even if we have the newest hospitals and the best equipment, the outcome may be less than optimal if the technology is not properly used. There are many excellent dedicated doctors, nurses and para-medical staff in the restructured hospitals. Unfortunately, many continue to leave as they become disillusioned or unhappy with the working environment. They work hard but they feel that the system does not care for them. They feel that the system cares mainly for the chosen few. Many feel that it is pointless or next to impossible to raise these issues within the hospital, let alone to the Ministry. Today, I hope to raise some of their concerns and provide some constructive views. Firstly, the Ministry should take a more structured and organised approach towards creating a better working environment.”
“If all road users pay for the use of roads through road taxes, COEs, petrol taxes, it does appear fair that the same principle should apply to everyone, including statutory bodies or departments that occupy road lanes for an extended period of time. The LTA should consider levying a charge for the use of the roads and impose a penalty for those who occupy road lanes for unnecessarily long periods. Everyone who uses the roads must exercise responsibility and it will be difficult to justify making exemptions. By applying a financial disincentive on road usage by these entities, it may help them to be more aware of the need to minimise road congestion. If we want Singapore to have a world class transport system, everyone must play a part. Sir, I support the motion.”
“Even if the construction of the North-Eastern MRT line were to commence shortly, its completion will take several years. The White Paper has spelled out several measures in improving the transport system in the interim. Though wide-ranging, there is one important source of traffic congestion that has not been addressed by the White Paper, ie, the occupation of road lanes in major roads by contractors, statutory boards and even Government bodies which are involved in the laying of pipes, cables and other similar types of work. The Government can spend millions or even billions of dollars in carrying out the measures in the White Paper, but these measures can come to nought and their beneficial effects nullified by the occupation of road lanes during road works of this nature. A good example is the section of Lornie Road leading from Farrer Road to Upper Thomson Road. The pipes there are not only long but have been there equally long. I have lost count of the number of months it has been there. I can understand that there is a need to do certain essential work, but it is very difficult to understand why there is a need to leave the pipes there for such an extended period. Although I am certain that it is not because it is cheaper to use the road as a storage space, it might be wrongly perceived by the public that this is so. There is a need for entities or departments doing such work to have a responsibility to the public. As if this was not bad enough, they have commenced work on the other side of the road so that drivers driving along Lornie Road can now have the unenviable luxury of enjoying traffic jams on the way to work and on the way home.”
“Mr Speaker, the White Paper sets out an excellent plan on the integrated development of the land transport system in land scarce Singapore. It addresses both the needs of the car owners and the non-car owners. It is inevitable that a small island like Singapore, land transportation has to be well-managed to maximise the use of the limited land. I am glad that the Government has stated clearly in the White Paper that it believes that the MRT/LRT system will be the backbone of the public transport system. The Government has also revised the financing framework for the replacement assets to make it more operationally viable to operate the MRT line. This move by the Government shows that it is committed to accelerating the construction of the North-Eastern line. The delay in the construction of the North-Eastern line has several implications both socially and financially for those in the North-Eastern corridor. I believe that the conditions are right for an announcement on the North-Eastern line. The need is there. The Minister has visited the North-Eastern sector and has seen for himself the urgent need for an MRT line. Road congestion is the norm and bus journeys are long and involve multiple trips. The support is also there. My community leaders, residents and I support any move to build the North-East line as soon as possible. Finally, operational viability is within reach with this new financing formula. Whatever there is left that is required to cross the finishing line, my grassroots leaders and I would be happy to work with the Ministry to cross the finishing line. We await with abated breath the good news on the North-Eastern line from the Minister. We hope that we would not be disappointed.”
“What the people living along the North-East corridor want to know is whether the line will come early or not. The Minister himself had said just now that they could not commit. But I want to ask the Minister, since he has stated in public that he sees merit in the line coming early, whether he would personally state publicly that he and his Ministry support the building of the MRT line at the earliest possible moment, ie, as soon as possible.”
“Sir, on a point of clarification. Since the Minister recognises the need for many of our young children to be in child care centres because many families have working parents, I fail to see how this need will disappear the moment the children start attending school. When these children grow up, the families that put the children in the child care centre, because they have to work, and there is no one to look after them, will continue to have this problem even when their children go to school. So I think there is a need for this before-and-after-school-care service. Perhaps the Ministry should look into this need. The need will increase as more of these children reach school-going age.”
“Currently, they are only given a one time grant for the training of social workers. As there may be staff turnover, the Ministry should consider giving a grant to train newly employed social workers. After all, it defeats the purpose of having a FSC if the staff are not adequately trained. Fourthly, it can be a first line defence to potential family breakup. FSCs may be able to play an important role in marital conflict and prevention of divorce. Just as those considering abortion have to watch an educational video and be counselled, the Ministry should consider making it compulsory for all couples intending to proceed with divorce proceedings to attend educational video programmes on resolving marital conflicts and the effects of marital breakup on the children. Such couples should also attend a series of marital counselling sessions conducted by a marital counsellor who is able to communicate effectively with them. The FSC may be an ideal place for such programmes as it will be in the heart of major population centres. Fifthly, and finally, the FSCs should also provide social services that will meet the needs of the present day family - a small family with both parents working. Programmes such as the before-and-after-school-care services and homework centre keep young children occupied in a constructive manner and relieve stress on the family unit.”
“The importance of promoting family cohesiveness is recognised by the Government in its promotion of family values. In addition to national programmes, Family Service Centres (FSCs) have been set up in population centres to address the needs of families. MCD has also recognised that FSCs have several roles to play and hence the growth in the number of FSCs. The Ministry should enhance the effectiveness of Family Service Centres by providing adequate guidelines and support. There are several ingredients to a successful FSC. Firstly, suitable premises in population centres should be made available. Currently, the application for the setting up of a FSC in the housing estates involves several agencies such as the HDB, the NCSS and MCD. As they say, too many cooks spoil the broth. Hence, MCD should provide a single window service to facilitate the processing of the application. After all, if voluntary organisations are willing to offer time, effort and funds to promote family cohesiveness, MCD should do its best to facilitate. Secondly, it should cater to all Singaporeans. One major tenet for the success of a FSC is its ability to cater to the needs of all Singaporeans of all races. FSCs may have to make adjustments to ensure that the minority groups do not feel alienated. For example, Indian Singaporeans may feel uncomfortable approaching a FSC which only has English and Mandarin letterings and brochures. MCD should provide guidelines to ensure that there is a conscious effort by all FSCs to make all Singaporeans comfortable in using the services of FSCs. Thirdly, it must have the infrastructure to provide family services. The FSCs must have trained social workers and counsellors to provide family education programmes and counselling.”
“Places of interest such as the Jurong Bird Park, the Singapore Zoological Gardens, museums, Sentosa and other places of interest should provide free entry to all senior citizens and even have organised activities at these places to suit the needs of senior citizens. All public entertainment areas such as cinemas should provide free tickets to senior citizens during this period. All these places of interest and places of entertainment will benefit as it is likely that the senior citizens will be brought there by their children and even their grandchildren. The bus companies and SMRT should also allow free transport services to all senior citizen pass holders during this period. Hotels and restaurants should give special discount to senior citizens during this period with the aim of making it a memorable week for them and not with the aim of commercial gain. If the Government, the statutory boards and the private sector are sincere in making the Senior Citizens' Week a success, they must be forthcoming and supportive of measures to make this event a memorable and successful one. As they say, charity begins at home and therefore Government, statutory boards and Government-linked companies should take the lead. 1.45 pm In encouraging the senior citizens to be more active, MCD should also consider expanding the facilities and staffing to Senior Citizens Centres under the CCC or CC. These centres should provide a wide range of educational and recreational activities where senior citizens can participate and spend their time constructively. Let us not pay lip service to our senior citizens. Let our actions express our care for the aged. I will move to the next topic on Family Services.”
“They are also likely to earn a lower income. If they have to pay full rates, it may not be financially sound for them to continue with their lowly paid jobs. The bus companies and SMRT should consider extending the concessions throughout the whole day and not limiting it to off peak hours. Many senior citizens feel that this should be so. I have been given to understand from senior SBS officials that SBS is not against this idea. I think TIBS and SMRT should also not oppose this proposal. In an earlier debate, the Minister for Communications said that he would refer the matter to the PTC. I suggest that we take the bull by the horns; if SBS is not against this idea, let them extend the concession hours. If TIBS and MRTC are not willing to extend the concession hours, let them differ in their opinion and explain their position to the public. We do not need to get a consensus from all three organisations to get things moving. I hope that the Minister will look into this issue and take this up with the Ministry of Communications. The Senior Citizens' Week should be an activity that senior citizens should look forward to every year. It should not be a week that activities are organised, and senior citizens are sent in organised bus loads to the site of activities to make the event happen. It should be a week in which senior citizens from all over Singapore should spontaneously come out to the streets to celebrate the event. This can only happen if the Government, statutory boards and the private sector are committed to making this event a success.”
“Sir, the number of aged in Singapore will increase significantly and this can, of course, pose a social problem in the future, as presently most families are small families. Therefore, there must be measures to encourage our senior citizens to keep healthy, live a more active lifestyle and the Ministry must assist Singaporeans in looking after their aged sick. Unfortunately, there are always elderly Singaporeans who do not have dependants and are too elderly to work. These older generation Singaporeans have no CPF and may not have savings. If they were to depend on the meagre public assistance, there is not much to look forward to every day. Surely, having given the best years of their life to the nation, it is not too much for the nation to give them something to look forward to in their twilight years. For those without a home to call their own, the Ministry should work closely with HDB to provide rental flats at special rates. The Ministry should also work with HDB to provide shelter for the elderly widow or widower who may otherwise be deprived of a rental flat when their loved ones depart. The Ministry should also work with voluntary welfare organisations (VWOs) to adopt these families on a long-term basis to add meaning to the lonely years of these elderly Singaporeans. In encouraging our elderly to be more active, there are several concessions for senior citizens and there is also a Senior Citizens' Week to recognise the importance of senior citizens. However, there is much more that can be done to encourage the elderly to be active. The bus services and SMRT give concessions to senior citizens during off peak periods only. If senior citizens are encouraged to work, they will have to use these services during the peak periods.”
“Sir, increasingly, in many families, both parents are working adults. This raises social concerns that need to be addressed. When the children are young, there are child care facilities to enable the children to be looked after. MCD has, to its credit, provided subsidies to enable child care facilities to be made affordable to most. However, there is a need for a school-going child to be looked after so that - (1) the child will not be led astray by bad company before and after school hours; (2) the child will be able to spend his spare time in a constructive manner; and (3) the parents can continue working without having to worry about the safety of their children. As school-going children are at an impressionable age, the Government should invest in programmes, such as before-and-after-school-care (BASC) programmes to ensure that the school-going child's spare time is used wisely and he will learn good values. It is definitely a better alternative than having school children who join bad company and spend their spare time loafing in shopping centres, billiard saloons and video arcades.”
“If they have to travel a long distance to work, the transportation costs alone can easily take up one third to half of the grant. Somehow, with such a big budget surplus, it is difficult to convince such families that enough has been done. If not given sufficient assistance, the gap between these families and the rest of Singapore will widen. Subsidy and welfarism are not dirty words to be shunned. If applied selectively and correctly, we can help these low income families enjoy the fruits of Singapore's success without creating a welfare mentality.”
“Sir, Singaporeans are looking at better homes, bigger cars and a better quality of life. They discuss about their vacations, their clubs and the restaurants they frequent. Unfortunately, there is a small segment of Singaporeans who can never make ends meet, let alone think about these matters. The Public Assistance (PA) scheme is meant to help some of these financially distressed to regain their independence. Under the current PA scheme, the quantum given is really meagre. I think that if MCD is sincere in helping them gain their independence, there is much more that can be done to help these families. Firstly, the PA rates should be revised to a more realistic figure. Before MCD tries to convince us that the PA figures are realistic, why does it not ask some of its officers to try subsisting on PA rates in present day Singapore. Secondly, the benefits given to Singaporeans, in terms of rebates and SOTUS, often do not benefit the low income group. MCD should ensure that these families are not disadvantaged when benefits are given out. MCD must be proactive and devise measures to pass some of these benefits to those on public assistance. Otherwise, the poor will get poorer. Thirdly, MCD should also provide assistance in obtaining skills training for those who are able to work and to give them a salary during this period of skills training. This will make it easier for them to find a job and be independent. Fourthly, MCD should liaise with the bus companies and SMRT, or MRTC, to allow free transportation for these low income families while they are on Public Assistance. For example, under the current scheme, a two-person household of two adults is given a grant of $240 per month.”
“Can the Minister give us a clearer picture of the likely timing for the commencement of construction work on the MRT line? Last but not least, when the decision to start building the MRT line is taken, I hope that the Minister will site the MRT station at a central site that would cater to the large and growing population in the Punggol Division of Cheng San GRC and not at the fringe of the area.”
“Sir, like my parliamentary colleague, Mr Teo, I have also been plugging at the North-East MRT line for years; as far as I can remember, since I entered Parliament. The Government has stated that it would work towards an excellent public transport system. The MRT service is, of course, a major pillar of the public transport system. The North-Eastern sector is a well-populated area and yet an MRT line has not been built. Many residents in my area wonder why the Ministry built an MRT line to Woodlands so quickly in a corridor that is not densely populated and yet it took the Ministry so long to even conduct a feasibility study on the North-East line. Surely, the Ministry cannot be adopting double standards. Is the Woodlands line an attempt to lure residents to live in the Woodlands area? Surely, the Ministry cannot be singing one tune with regard to the Woodlands MRT line and a different tune with regard to the North-East line. It is difficult to convince my residents that the line to Woodlands is viable and that to the North-Eastern corridor is not viable. Maybe the Minister may like to try explaining to my residents with clear facts and figures. The Ministry has announced that it would do feasibility studies. What is the nature of these feasibility studies? Why did it take the Ministry so long to even conduct a feasibility study? Some of my grassroots members have told me that engineers of MRTC have already done soil tests and have made suggestions as to whether the line should be above or below the ground. Perhaps the Minister would like to elaborate on the state of preparation for the North-East MRT line. The question is not one of whether there should be a North-East line, but rather when the line is expected to be completed.”
“One, I owe it to the large number of selfless, dedicated health care professionals who have asked me to raise these issues in the hope that someone in the Ministry will not only be aware of these problems but will be willing to address these problems. And, two, our Minister for Health not only has the strength to face up to these problems but he also has the wisdom and vision to resolve them. 2.00 pm I would like to suggest the following proposals: (1) The setting up of a committee to look into these problems. It should comprise primarily of independent persons with an understanding of the health care situation. (2) The Ministry should monitor the implementation of policy changes so that policies are not applied in a selectively biased manner that will disadvantage the health care professionals. (3) In certain areas, like nursing, the entire concept of nursing may need to be reviewed to make the job more rewarding and attractive. (4) The Ministry may have to provide clear directions for the hospitals. (5) The Ministry must provide clear clinical policy guidelines in the development of medical disciplines both at the inter- and intra-hospital level. These measures may result in clear directions, a formal process for the resolution of conflicting clinical development policies, improve morale, better understanding and resolution of ground problems at a semi-macro level. I was told by a senior civil servant that in the Ministry of Health, the Minister thinks better and speaks better than anyone else in the Ministry. I have every confidence that with this Minister at the helm, the health care providers will see a better tomorrow.”
“If there is a Ministry policy that affects the staff adversely, the hospital can choose to follow it by singing a different tune - it is a public institution and therefore it has to follow Ministry's guidelines. Secondly, although there are some channels for feedback, the disappointments, the frustration, the constructive criticisms often do not find a listening ear. Even if they find one, many feel that nothing gets done. Many eventually give up trying to give feedback because they feel resigned to the situation. Thirdly, the conflict between the medical institutions over the development of medical disciplines in the past few years has also taken its toll on the health care professionals and has affected morale in institutions to a significant degree. Fourthly, many feel that in some of our health care institutions, there is a lack of direction. There is an air of uncertainty about the future. Finally, I feel that the Ministry may not be aware of many things on the ground. Our present health care system is like a majestic tree basking in its full splendour, some of its branches being gradually hollowed out by termites. The buildings and equipment are the best, the macro health policies are faultless and care is affordable. But will there be quality medical staff to ensure a high standard of health care? The restructuring of the hospitals has left the Ministry with little direct involvement in the running of most of the hospitals. Hence it is not unexpected that the Ministry will be less aware of the problems on the ground. It is still not too late to halt the exodus from our health care institutions - don't keep blaming on the pull factors, it is about time to examine the push factors. It is not easy for me to raise these issues, but I have raised it for two reasons.”
“For nurses, they will be penalised in salary increments if they return to public institutions in future. Why then do health care professionals leave? Of course, the Ministry can give the standard reply by saying that the private sector pull is too strong or that in a full employment situation, this turnover is to be expected and there is nothing that can be done. If the Ministry were to take this line of reasoning, then I am afraid it will continue to lose more quality and experienced health care professionals. Today, like me, many believe that push factors are the main reasons for health care professionals leaving public health care institutions. I do believe that the Minister is aware that the morale is low among many health care professionals in many of our health care institutions. What are the problems? Given the limited time, it is impossible for me to give specific examples, but I will try to identify the major problem areas. Firstly, there is a perception among many that the Ministry and the institutions do not care for their staff. In striving to reduce health care cost, a black bottomline becomes the ultimate quest for hospitals - never mind the consequences - never mind if your best doctors quit - never mind if your experienced nurses leave - it helps to reduce the salary burden on the institution. The autonomy given to restructured hospitals is a doubled-edged sword. If there is a Ministry policy that benefits the staff at the expense of affecting the hospital coffers, the hospital can choose not to follow it by saying that it is a restructured hospital.”
“Sir, in the last few years, the main areas of concern in the health care scene were on upgrading and building hospitals, buying the latest in medical technology, containing cost and providing quality care to patients. Every year, we pat ourselves on the back and say that we have a great health care system, but is everything really well? In my opinion, the answer is no. I think that it is time that the Ministry shifted its focus to the most important, but the most neglected, segment of the health care services � the health care providers. We may have the best hospital buildings amd the best hospital equipment, but if we do not have experienced and well-trained medical staff, we will only have a second rate medical service. The medical services have been plagued by a not insignificant number of resignations which not only deplete it numerically but also, more importantly, affect it qualitatively. We lose committed doctors, experienced nurses and para-medical staff. In the worst case scenario, if we do not stem this exodus, some of our public health institutions may become second rate institutions. Perhaps the Ministry would like to believe that the main cause for this flux of professionals is primarily due to pull factors from the private sector. Is it really so rosy in the private sector? Leaving for the private sector is a momentous and extremely difficult decision. For doctors, it is extremely difficult and costly to set up their own clinics with no guarantee of a patient base. It is not a decision to be taken lightly. Furthermore, he will have to relive his days of being a house officer all over again as there are no junior doctors at his beck and call, unlike the public institutions.”
“Are there plans for the Ministry to consider providing an improved facility that has both day-care facilities providing nursing and physiotherapy services for senior citizens and also short stay facilities for these senior citizens, so that health care givers can be given a respite, whenever necessary, or when they are overseas. There are some families who are able to manage the aged sick and disabled at home. However, they will require assistance from organisations such as the Home Nursing Foundation. The Home Nursing Foundation has limited staff catering to increasing demands of an expanding population. If it was to effectively meet these growing needs, it must also evolve; its role may be expanded to provide social support as well. This could be done through coordination with MCD or Family Service Centres. It can then be a one-stop service for those requiring support for home care of the aged sick. Over the years, the problem of the aged will increase. What measures will the Ministry take to meet these growing needs?”
“Sir, I declare my interest as a practising doctor. We recognise that even as the population ages, the family size is also getting smaller. This creates problems as it will be difficult for the working adults to look after the aged sick. Currently, there are nursing homes and some day-care centres. But most of these centres are not near population centres. The current infrastructure does not meet the conflicting needs of small working families who have to look after their aged sick parents and work to earn a living. The facilities provided should allow them to do both and yet maintain close family bonding without undue stress on the family care givers. The Ministry should consider plans to build community facilities in the heart of population centres that will enable families to send their elderly to these community facilities when they go to work in the morning and allow them to fetch them home when they return from work. The alternatives to this, if the aged parents are sick, are for the children to stop working, to hire domestic maids or to send them to a nursing home. I think that a drop-in facility is a better alternative to these three options as it will enable the children to continue working and yet care for their aged sick parents. Facilities such as this should have social, physiotherapy, rehabilitation and nursing services. It should also provide easy access for the sick and disabled. Currently, there are senior citizens' health care centres, day-care centres, and social day centres in certain areas.”