Tan Cheng Bock
Singapore
“As I said, we have not done much. We must not be captured by our old style of managing the old. The new old, as I said before, are better educated and travelled, and are very knowledgeable. So we must quickly explore new ways and methods to meet the expectations of the new old.”
“If we only have such a small pool of talents in Singapore because of our population size, we should spare no effort in seeking every such talent.”
“Thank you. I accepted the Minister's reply on the different pricing in the outpatient polyclinics and the hospitals. My point is that the patient's problem has still not been solved. Whenever a doctor refers a patient from a hospital to an outpatient clinic, he still has to pay more.”
“Six out of the nine items were much more expensive. Sir, I am asking why is there such a difference. Is this a one-off incident or is it going to be a norm? How can doctors in the hospital then refer patients back to the outpatient clinic if the patient is going to pay more?”
“I move this amendment to ask the Minister what is the Ministry's stand on seat belts to be made compulsory for primary and kindergarten buses. I heard over the radio that the Ministry is reviewing the case. There are two issues here, question of cost and question of safety. I think safety has a higher weightage over cost.”
“I also want to commend the NTUC for working with the Government to put this package together. I believe that without the NTUC's representation in putting forward the workers' case, the workers would not be able to benefit so substantially this year from this package.”
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“Every decision they make affects the well-being of the whole nation, and that is why it has always been the PAP Government's policy to pick the most talented and dedicated persons to hold office. It has proven to be the right decision because Singapore has enjoyed continuous stability and prosperity since we gained independence. But it has always been an uphill battle to induce the selected group of talented people to take up office. The reason is obvious. Not only must the office-holders possess the character and ability of the highest calibre, they must also be dedicated and uphold a high standard of integrity. On top of that, they have to make tremendous personal sacrifice. Unfortunately, the people who possess all these attributes are also relentlessly being sought after by the private sector. And in a buoyant economy like Singapore, the offer from the private sector is much more attractive and lucrative. It is said that a political career is a calling and it has to be so, because it takes a special brand of people who possess this quality to come out to serve the nation. However, the reality is that, when confronted with alternative overwhelming attractive options from the private sector, it is difficult for anyone to ignore them when making a career decision. Let us compare our Ministers' earnings with those in the private sector. Perhaps the nearest comparison can be made by comparing them with top bankers, CEOs, professionals, and top earners in the commercial sector. It is obvious that a great number of these people in this group enjoy a much higher earning than a Minister.”
“Mr Speaker, Sir, I rise to support the Statement on salary revision. I have actually two points to raise with regard to this salary revision. I support this revision because we must pay well to get the best. That is very simple and very fundamental. However, Singaporeans will look at the salary revision at the top end of the salary scales and wonder at the sums we will be paying our top civil servants and Ministers. It is therefore important that an explanation be given. What are the criteria that are used to arrive at such figures? What benchmark do we use to come to the figure of $38,799 for the top Staff Grade V, and our top Minister's salary of $33,261? I think an explanation is important. We must let Singaporeans know how we arrive at this salary. The second point is that in the private sector, the top Executives are paid equivalent sums or more. In addition, they are given special perks like cars, drivers, expense accounts, club membership, and even share options. Do our top civil servants get similar perks? Some are wondering, because many of our top civil servants are actually sitting as directors in many of our statutory boards. Are they paid - they want to know - on top of this salary? Are they given other special allowances and also shares during flotation, for example, of Singapore Telecom (ST)? These are also perks. Therefore, I think it is important that the Minister should give us an explanation on these two points that I have raised. Mr Kenneth Chen Koon Lap (Hong Kah GRC): Mr Speaker, Sir, I support the Ministerial Statement. The nation's destiny is in the hands of a handful of selected leaders.”
“To provide the training and expertise which will enhance the graduate's motivation and ability to become a highly trained specialist in the provision of primary health care for patients and families." Sir, NUH has only 14% of the total acute beds in subvented hospitals. This would not be adequate for the training of our undergraduates. Therefore, the other subvented hospitals and polyclinics, as rightly pointed out in the White Paper, must also be involved in the teaching of our students. Some coordination and regulation is definitely essential. I sense the restructuring of our hospitals has affected our medical student training. This White Paper's recommendation that the Ministry of Health provide all subvented hospitals, including NUH, the same rates of subvention to meet the clinical service role is timely, and the Ministry of Education will separately fund the additional resources which the subvented hospitals will need to support undergraduate teaching is most welcome. The call to NUH to regularly review its medical undergraduate curriculum together with the Ministry of Health and the Singapore Medical Council and the setting up of an Advisory Committee on Medical Specialists to advise it on postgraduate training are also good moves. In the past, before restructuring, in every Government hospital the doctors were keen to teach medical students. But with restructuring the situation changed. Because the emphasis was for the doctors to pursue clinical work instead of teaching. I hope this would change with the special grants from the Ministry of Health and the Ministry of Education and, most important, the attitudes of the administrators of the restructured hospitals.”
“The training of our future doctors must be relevant to our needs and our national health policies. The emphasis in the White Paper on family health care would mean that our undergraduate must be exposed to such teaching, as ultimately 60% of each cohort of doctors will practise as family practitioners. To do so effectively would mean a careful reappraisal of undergraduate training. For a long time our doctors have been trained to be institutional doctors. We follow the British Medical School system where training is confined primarily to the wards and hospital surroundings with a token posting with general practitioners or family practitioners for about two weeks. We should perhaps look elsewhere for other models of medical training. One such institution we could look to for guidance is the School of Medicine of the Ben-Gurion University in Beersheba, Israel. I know it is not included in the 28 Medical Schools. But it does not mean that this is not a good school. When I was in Israel, I was pleasantly surprised to find the school training their undergraduates to be, first, community-based doctors before specialising. In this way, the doctor who finally becomes specialist understands a community well because he started out in the community. The school makes use of the many health institutions at all three levels of health care - primary, secondary and tertiary - as training centres. Let me read to you the goal of this University, and I quote: "to turn out the highly competent doctor who will have been given a sound basis for specialised training in all branches of medicine and who would have been exposed to a particular emphasis on the importance of the integration into all specialities of a community medicine orientation.”
“Leave this to the private hospitals. There is no doubt that this move will put a strain on the hospital's resources, including manpower. There are already complaints that doctors, especially specialists, are not paying enough attention to the subsidised patients. The introduction of such class A beds will again lead to such complaints. This White Paper is trying to set right the poor image of subsidised beds, but this move will set it back. The subsidised B2+, B2 and C class beds are already having an image problem, as pointed out by Mr Koo Tsai Kee. Do not add more to this. If the idea behind this is an attempt to retain our specialists, I would suggest that you improve upon the Visiting Consultants Scheme where good specialist consultants are invited to join the hospital doctors in the management of patients. The reason why this scheme has not worked out well in the past is the prejudice of the doctors in the hospitals against the private specialists. But they must know that they will face a similar prejudice if they leave the Government and get invited to go back as Visiting Consultants. I think in the interest of the patients we should overcome this. While we cap at 65% the total beds in our subvented hospitals for B2+, B2 and C class beds, I would request flexibility when applying to the community hospitals because community hospitals are in its early stage of evolvement. It may require more than the 65% for such hospitals because the patients are probably older and chronically ill. I ask for flexibility because this percentage could be related to funding of the hospitals. Do not apply the rules of funding for such community hospitals as you would have for a secondary or tertiary hospital. Undergraduate training.”
“There are many cases of patients who remain in coma for months or years on life support machines. In my years of practice, I find that the people who demand and insist on a particular care or procedure for a relative or friend are those not paying the bills. Those who pay the bills are then made to feel guilty if they do not agree. People must exercise their own judgment carefully in consultation with doctors and care givers so as not to be swayed by emotional guilt feelings. As for myself, if I am brain dead and I depend on the respirator and other life support aids to keep me alive, then I better go. I have told my family members not to allow my medical colleagues to save me by making me undergo active management but just to institute passive treatment. I would not want to live if my quality of life is that of a vegetable. This is my living will. On balance billing, I think I would not talk on this as too many Members have spoken on it. Restructured hospitals have been criticised for the tendency to over provide services and duplication of services, not enough C class beds, more A class beds and more intensive care beds. The White Paper's call for control on the total number of hospital beds and intensive care unit beds is very necessary. Each subsidised hospital cannot have more than 13% class A beds and must have at least 65% class B2 and C beds. However, I disagree with the White Paper's recommendation that subsidised hospitals that want more A class bed wards for new unsubsidised services should develop the services on a commercial basis and as a distinct entity. The provision of such A class beds is a detraction from the role of our subvented hospitals. Do not invite problems. You are only tempting our doctors to do private practice in a public hospital setting.”
“It is a proactive role of delivering health care including health education to the people in the western sector of the island. It is a system that once developed can be duplicated in the north, south and east zones and elsewhere. There is no need to build tertiary hospitals for all the zones. They can share SGH or NUH. A better informed people will help to appreciate the system better, saving cost and time. I agree with the White Paper's emphasis on basic medical care. Basic medical care is open to many interpretations. Many are trying to define basic medical care. Some worry that it may not cover certain modalities of care. We can debate this at length, but finally we must come to some understanding. I think the White Paper's definition by excluding certain care is acceptable. There are two important points in the definition of basic medical care in the White Paper: (i) good up-to-date medical practice; and (ii) essential and cost-effective medical treatment of proven value. I think this is a good start and later, with more experience, we may have to refine the basic health care. The section on basic medical care that has to be treaded carefully is the part on treatment options. This is a sensitive area because hard decisions will have to be made whether we want to institute active or passive management of such cases as incurable diseases with no chance of survival and whether life support should be given to severely damaged patients or intensive care for premature newborns who are unlikely to survive. Or even if they survive, their long-term prospects are uncertain. If the decision to institute active treatment is made, then one cannot expect the Government to back you at all costs because this is beyond the basics.”
“They are the ones who actually diagnose and treat the patients." Now that we have clearly defined three levels of care, namely, primary, secondary and tertiary, we should not allow these institutions to work in isolation but to encourage cooperation and coordination among the many hospitals and primary health care institutions. Restructuring of our hospitals has encouraged competition and independence of operations. While competition is good, too much of it may lead to isolation and non-cooperation. I find most of our health institutions tend to develop in isolation, eg, day care centres, outpatient clinics, the Home Nursing Foundation. Are they working closely together or each doing their own task? How close are our hospitals to the primary health care institutions? There must be a conscious effort on the part of each one of us to get these institutions to work together as part of a single organisation. Maybe for a start we can refine our present health care delivery system. We could divide Singapore into four or five zones, each zone to have primary, secondary and tertiary health care institutions including community hospitals, private and OPD clinics. For example, if we take the western zone, you can have NUH as a tertiary hospital, Alexandra Hospital as a secondary hospital, then you have community hospitals, private clinics, OPD, day care centres, the Home Nursing Foundation and hospice care, all linked to a common system. In other words, we have a system of delivering health care to the people in a systematic manner to the western zone. You could have a department in MOH to collect and process information and data, collate and coordinate the services available of such institutions.”
“Mr Speaker, Sir, I would like to declare my interest. I am a medical practitioner. This White Paper has managed to crystallise the many ideas and issues brought up inside and outside this House. It has addressed many issues like health costs, the role of restructured hospitals, Medisave usage, medical training and education, and financing. I think it is a frank and fair appraisal of the state of health care. The solutions to the issues posed may not be acceptable to all but, on the whole, it is a commendable attempt. I have always lamented the lack of emphasis on the health care delivery system in previous health reports. But this time I notice that it has been given more coverage and emphasis, which is correct. Because you need a good health care delivery system to carry out the policies and to better inform Singaporeans of the choices and accessibility to our many health care institutions. I think we have a more structured and defined health care delivery system with the Government identifying the three levels of health care, namely, primary, secondary and tertiary. The next step will be to educate Singaporeans on the proper utilisation of the many health care provisions at all the three levels. I hope that we can evolve a good health care programme. Some degree of flexibility is needed in its implementation. And this flexibility of implementation was emphasised many a time in the White Paper. For example, on the topic of basic health care, realising that it will not be practical to enumerate all the items in the basic package, it was suggested that, and I quote from page 23, line 3: "A great deal of judgment as to when exactly to carry out a procedure or to prescribe a drug must be left to hospitals and doctors.”
“Mr Deputy Speaker, Sir, may I seek a clarification? Do I get it correct that a C Class patient, having been upgraded to B2, because he cannot get one of the five modalities of care at C Class, he needs to pay only C Class rate? I got a different answer from the Minister the last time.”
“Sir, I accept some of the reasons given by the Minister of State. I would just like to let him know that building new flats in place of old ones is also a form of upgrading. Actually, I am not against upgrading. I just want to make that clear.”
“I am not suggesting that we should not upgrade. I think for many who can afford, upgrading is essential, because it is a different quality of life. It is like Government's call to those who can afford should have more than two children. Those who cannot, should stop at two. People must upgrade in education and skills and improve their earnings before aspiring to higher standards of life. It took me five years of hard work to save up enough to put a downpayment for my first home, and another five years to buy my present home, which is a small single storey bungalow. It took me a long time, but I learn from the Cost Review Committee that more than 50% of engaged couples were opting for 5-room and more expensive flats. Times have changed. But opting for such expensive flats is all right if income is high. But they should not follow the crowd if they can ill-afford. People must learn to live within their means - an old adage, but still valid. Don't blame the Government if you want to live beyond what you can afford.”
“With regard to health, the same principle applies. There should be choices of health services, like the schools. The restructuring of our hospitals has narrowed people's choices of hospitals. The Cost Review Committee's recommendation of one Government hospital not to be restructured, I think, is grossly inadequate. In fact, all future hospitals to be built should remain Government hospitals because there are already sufficient restructured hospitals. Choices must be adequate, not just the provision of one. Moreover, all restructured hospitals, so long as they receive Government grants, must provide adequate "C" class beds, and that includes NUH. All community hospitals should be government-owned or controlled. The very name "community hospital" implies serving the community, that is, having in-patient services, as well as extensive outreach programmes, including some home-support services. Going restructured could change this hospital philosophy. Mr Deputy Speaker, Sir, so far, I have only touched on what the Cost Review Committee and I consider the basic essentials in health, housing, transport and education that Government should provide. Beyond the basics, we are moving into a different world altogether. Upgrading from public transport to private cars, from HDB flats to private homes, from Government hospitals to private hospitals has a price or premium. You must expect a steep rise in cost, because of different needs and services. It is like eating in a coffeeshop and eating in a hotel restaurant. The cost is at least five to six times different. Yesterday, I had a meal in a coffeeshop and it cost me $12 for three persons. We were served five dishes and drinks. I know the same would have cost us at least a minimum of $60. So here is the choice. One has to decide.”
“These are good suggestions. But I think you cannot expect CASE to do the job of a consumer watchdog if the grant is too small. My point is if you want CASE to be effective, lip service is not enough. Government financial support is important. Having said all that, I think we must have an environment of choices so that the different income groups, different age groups, can feel comfortable that their needs are being looked after. And this is where, as a Government, we must provide these choices, these alternatives. Like in education, we started off by establishing independent schools. There were a lot of criticisms on fees and availability of school places. So the Government set up autonomous schools as alternatives. These schools would be good choices too. So now we should upgrade the neighbourhood schools to widen their choices. Singaporeans must feel comfortable when sending their children to neighbourhood schools. Therefore, such schools should be upgraded and improved, with good teachers and facilities, so that the students can do well, academically as well as in extra-curricular activities, and the costs remain affordable. Public transport again must be affordable and good because not all can afford cars. Therefore, careful monitoring of the fares must be a top priority. It must be affordable to the consumer and fair to the operator, or else you will get, what Koo Tsai Kee said yesterday, the consumer pressure in the Philippines to lower electricity costs which caused so heavy strain on the operators that they end up having "brown-outs". Housing is important and HDB's assurance that the HDB flats will always be pegged according to their income is a good practice and should therefore make HDB flats available to Singaporeans without much strain on their pockets.”
“First, they have to adjust to their high hospital increases, then the university and school fees, the rise in housing cost, COE, maid levies, workers' levies and now the GST, and all these within a span of less than 10 years. As these measures primarily hit their pockets, there is created a strain in the individual and the household. It is this difficulty to cope with the fast changes that have stressed many Singaporeans. How do they cope with this? Some work overtime, some take on a second or even a third job, some none of this, and vent their anger and frustration at the ballot box. We must now look for the hows rather than the whys, ie, how do we manage these rising costs in housing? How do we manage health and transport costs? How do we make sure that education is affordable? The Cost Review Committee has provided us with some but not all the answers by way of recommendations in the four important areas of health, housing, education and transport. They recommended that basic necessities, like essential foodstuff, housing, education, transport and health, must remain affordable. That I agree. This is to ensure a sense of security for our people. This sense of security is important because it gives the moral strength to be more effective Singaporeans even after they retire. If he feels a sense of insecurity, like afraid to get admitted to hospital because of the high cost, cannot attend a good school because of high fees, cannot go to the university because of high fees, or transport cost is putting a strain on his travel patterns, then we are in trouble. So it is the responsibility of the Government to monitor these changes. There have been suggestions, like setting up a special committee to do this, and getting organisations, like CASE and NTUC, to help out.”
“Sir, the Cost Review Committee Report did not cause great excitement. But many people talk about it. Most do not quite understand the CPI. Some expect the outcome of the Report to be what has been reported. They think we are trying to justify for the rise in health, education, transport and housing, after we started all these rises through the various measures like COE, independent schools, restructured hospitals and the GST. These rises, to a fair number, are Government departments' attempts to raise money for their coffers. But I think the Cost Review Committee did a good and thorough job. There is no other way to explain cost than using the CPI. We should not be deterred by adverse comments because the Government is sincere to want to find out the truth. And if the conclusion is the same as what we thought the rises were due to when we started the search for answers, then we say exactly what we found. I do not think the panel members doctored or skewed the Report to please us. The panel members came from all walks of life and, as we all know, Mr Low Thia Khiang, the Opposition Member, is there too. They do not belong to the Government. Moreover, reading the Report which contains a wealth of data and information, one gets the impression of an open and frank discussion on the subject. The views of research analyst, Koh Su Haw, and sociologist, Chua Beng Huat, have been challenged and rebutted. However, we should not get too worked up by people who criticised the Report, because this is where democracy is thriving at its best. They criticise, we challenge, and rebut their arguments, we bare the truth, and we let the people decide. To me, I see the changes made in the past few years as too fast for Singaporeans to cope.”
“He is already in B2 class so he is charged B2 rates.”
“I am giving a case where a person really can only afford going to C class. While in the hospital, it was discovered that he has this particular condition that needs B2 treatment. There must be some consideration.”
“But they cannot afford it, in the first instance, and that is why they went into C class.”
“They were admitted into C class first and then they discovered that they need this particular care, so they have to move to B2. Under these circumstances, do you still charge them B2 rates or C class rates?”
“Sir, I believe that in C class there are five modalities of care that are not made available to patients. I would like to ask the Minister whether a patient, for example, a cardio-thoracic patient, would be charged C class rates if he has that particular ailment, and he has to move up to B2 class because he needs that modality of care.”
“Sir, may I ask the Minister whether there is a fixed percentage of C class beds in the various hospitals?”
“His concern for those parents queuing for school places in the cold, rainy night prompted him to ask his nephew to go and buy food and drinks for them is but one of the numerous examples of the extent he would go through to show his care and concern for his people. Further, his love for people shows in the way he presents himself. He disarms you with his natural approach in conversation. He listens and he never talks down. His mild manners and gentle touch leave you at ease and comfortable. It is obvious that his high office never distance him and he remains humble and approachable. He has showed us through his style, example and grace how to be a Singaporean gentleman - confident, gracious, courteous and caring. His actions sum up what we in Government have tried to achieve through the years by way of campaigns for a more caring and gracious society. President Wee will long be remembered for showing us how to be more balanced in life, that materialism, wealth and power can be tempered with humility, care and love. My colleagues in this House and I wish Mr President and Mrs Wee all the best in their retirement.”
“Mr Speaker, Sir, President Wee Kim Wee's term of office ends tomorrow. His eight years as President has left an indelible mark in Singapore's society. Singaporeans have run out of adjectives and superlatives to describe our immensely popular President. From the moment he stepped into the Presidency, President Wee has devoted all his efforts to bring the office into the lives of Singaporeans from all walks of life. He has spared no opportunity to reach out to as many common people as possible and he makes no apologies for this. In fact, from a Straits Times' interview, his instruction to his ADC was that he wants to meet as many people as possible. Many of them who caught his attention, because of his acts of public-spiritedness, were invited to the Istana for tea and coffee and the First Lady's nonya kueh. In doing this, he encourages the best in people. Once, after a game of golf at SICC, he invited me to his table. We talked for a long time. He wanted to know about the concerns of the people. He was also giving me feedback which concurred with what I had been receiving from other sources. I was then the Feedback Chief. I knew at once he was close to the ground. His parting advice to me was, "You must never fear to tell the truth." Indeed, all Singaporeans regard him with respect and deep affection. They consider him the ideal people's President. President Wee has shown us lessons in courage, humility and care. He fought courageously to overcome his illness which was cancer. He never gave up in spite of the operations and the therapies. His drive to give of his best saw him up and about the moment he recovered. You can see he takes his role very seriously. His compassion and care for people was revealed in a Straits Times interview on 22nd August 1993.”
“Instead, Mr Speaker, Sir, I want to move an amendment to Mr Chia Shi Teck's motion. Sir, I beg to move, At the end, to add -- `and deplores the SDP's action in politicising an internal NUS disciplinary matter, and pressuring NUS to rescind its action against a dishonest staff member'.”
“He sent all his findings of Dr Chee's dishonest behaviour to the University, and the University decided that Dr Chee acted dishonestly. Mr Speaker, Sir, many outside this House argue that Dr Chee should be allowed to continue his work till his contract expires. But is this the right thing -- to allow him to perpetuate his wrongdoings in the University? Sir, this matter is strictly between the University and Dr Chee. The University, by way of the Minister for Education, has come out in the open to explain why Dr Chee's service has to be terminated. If Dr Vasoo was not the head, the whole affair probably will not have been so hot. Mr Speaker, Sir, if every time a member of the University staff, under a PAP head, is dismissed and is deemed to be politically motivated, then these heads of department cannot function effectively and fairly because of this political blackmail. And worse still, if such dismissed member has to be reinstated because he threatens suicide by jumping from a tall building or threatens to start starving to death, then how is the University, or for that matter any organisation, going to function? We cannot allow emotions to rule in such circumstances. We cannot give in. Mr Speaker, Sir, even Mr Chiam has been put in a tight spot by Dr Chee's hunger strike. He did not want to debate this in Parliament. There was plenty of time for him to file an adjournment motion. But, I guess, Dr Chee's case was not strong enough for him to make this adjournment motion, but he left it to the Nominated MP, Mr Chia Shi Teck, to bring it up. Therefore, his argument to condemn the Government that Dr Chee's dismissal by the University was politically motivated is weak and cannot be supported.”
“When he started to tread on the fringe of megalomaniac behaviour, he felt important and delusions of greatness, boosted by his so-called popularity response, made him to challenge authority, his immediate superior, his University, his own Party, his family's attempt to stop him, on embarking on his hunger strike, and even has the audacity to urge the SDP to pressure the University. He had his delusions dented after the by-election results when the Prime Minister won by more than 70% of the votes. I am sure he must be wondering how the big rally crowds turned away and rejected his politics of envy. Therefore, this attempt at hunger strike had also a hidden political motive to try and recapture lost political ground and self-importance. Mr Speaker, Sir, Dr Vasoo -- you look at Dr Vasoo -- is he a vindictive man? Can he be vindictive? Listen to his parliamentary speeches. They are always fairly standard. I am sorry. But they are fairly standard. He is always asking for the Government to do more for the poor, for the old, for the disabled. And when he heard I wanted to start a non-profit community hospital, he was the first to volunteer to help me. He is, by all accounts, a reasonable man. Mr Speaker, Sir, Dr Vasoo was in a no-win situation. Under the difficult circumstances, he had to make a decision. He must do the right thing. Here was one of his staff who had committed an offence, but this staff member happened to be an Opposition member. To remove him is to court problems, because he will be accused of being politically motivated in sacking him. Yet, not to do so is to perpetuate a wrong. As for Dr Chee, he wants people to believe that he is being vindicated for political reasons. But Dr Vasoo did the right thing.”
“Sir, after listening to Dr Vasoo and the Minister, Mr Lee Yock Suan, I am much clearer as to the motive of this young man. I am more convinced that his hunger strike is a publicity-seeking, politically-motivated move. This hunger strike is a psychological ploy to play on the emotions of Singaporeans. In doing this, he wants to draw people's attention away from the wrongs he did in the University. Sir, there are hidden agendas in this hunger strike, among which his wrong-doings in the University and a wider political motive he has in mind. I have been studying Dr Chee's behaviour during the by-elections. I see him as a young politician in a hurry. He knew how to win the crowd. He knew how to do this. He must win over their emotions. The topics he selected to speak on must therefore be simple bread-and-butter issues, especially on the needs of the poor and how Government policies have made them poorer while at the same time the Government gets richer and those who support it or are associated with the PAP will also be richer. He saw the big crowd at his rally as a measure of his success. They warmed towards him because he is a fresh face in politics, with a university degree and dare to talk and criticise the PAP. I can imagine he felt great and thus develop a sense of self-importance because the SDP was praising him, even over-shadowing Mr Chiam. The media was quoting him and the rally crowds were cheering him. I sense that because he was so captured by the tremendous response, the sudden thrust to achieving greatness, he lost his sense of judgment and reality. He became a victim of his own psychological training.”
“May I seek a clarification? On this particular letter from the University of Georgia, could I ask Mr Chiam to give us the letter by Dr Chee to this particular Professor?”
“Sir, I want to seek clarification from Mr Chia. He mentioned that we are a semi-smuggled goods centre. Can he please clarify that?”
“Sir, the Member mentioned about timing. He says he objects to GST because of the timing. He has not elaborated on it. I want to know when is a good time.”
“They do not have. So they must provide C class beds.”
“If they have been given a subvention grant, they should also provide C class beds. The subvention grant is given by this House.”
“Sir, with regard to charges, I just want to ask why NUH, having been given a subvention grant by Government, is not displaying C class bed charges.”
“Sir, can I ask some questions regarding ---”
“Can I seek a clarification from the Minister? I am curious. Can I take it from the Minister that those who are in the Intensive Care Unit will still be charged C class rates?”
“In this respect, may I make a suggestion to the Ministry of Health that these community hospitals could follow the PA's cost-sharing, like the way we build the community centres. In other words, the Ministry of Health would be the main partner in this set-up, with a non-profit organisation, like the community centre, as the other. It is not necessary that the community centres be the other partner, it could be any non-profit organisation. But never a private, commercial body because there is always an element of profit and we are talking about non-profit organisations. The basic staffing, like PA, must come from the Ministry of Health. It should provide the community hospitals with the essential key hospital staff, like a few doctors, nurses and a few paramedics. The rest of the doctors, nurses and paramedics will be by the organisation, the other partner of the Ministry of Health. This, I feel, is the community hospital that we should build. It must be a community-based community hospital. We should not build mini-SGH, or mini-NUH.”
“I know the Ministry has set out to do all these. But I get this feeling that because results are slow and not glamorous as compared with the hospital programme, like the push by various restructured hospitals of the kind of services that they can provide, from using laser to remove your gall bladder to ballooning your blocked heart vessels, the Ministry may accuse me of being impatient and that these programmes are coming. But I have been in this House for more than 12 years, and I am still chasing the Ministry to do more for this important sector of our health care delivery system, that is, the primary health care provision of more outreach programmes including home support for the community. We cannot always demand too much on volunteer organisations to take the lead for such programmes. They will suffer from volunteer fatigue. They need more funds, more infrastructure support, like increasing capital grants or start-up funds and a better recurrent grant to maintain so that they can spend more time developing the programmes and improving on the programmes rather than spending time raising funds. What are the primary health care programmes in these community hospitals? My feeling is that if you want to build more community hospitals, you must make sure that the funding is more generous. Do not be so mindset that the funding should be based on hospital beds because in community hospitals, there must not only be inpatient care, there must also be many outpatient programmes. It must also be the medical centre for the community health services. Therefore, your funding must be changed to include programmes for the health needs of the old, the disabled, the mental cases of the community.”
“Sir, if you look at the health expenditure, there is not much increase in spending in primary health care as compared to hospital services. In fact, in the main expenditure, primary health care has only 10.8% while the hospital services, 72%. And in the development expenditure, primary health care is only 5.3%, hospital services, 81%. Even the administrative share of the health expenditure is 11.9% which is twice that of primary health care. While I must give credit to the Health Ministry for expanding many of its outreach programmes, like caring for the old, mental health and various screening programmes, and healthy lifestyle programmes, I maintain that it is still not enough compared to the expansion of hospital services. And judging from the figures I have given, I feel that the priority is still for the hospital services. There is obviously an over-provision of hospital services and an under-provision of primary health care programmes. There will be no end to demand for hospital care because of this over-emphasis. And this has led the average Singaporeans to think that hospital care is the best way out of their ill health. At this point, I must declare my interest. I am a medical practitioner. So if there is more demand for such care, I guess the Ministry will build more hospitals. This, in the long-term, is an unhealthy state of our health care delivery system. There will then be too many hospital beds chasing for patients. I am asking for a more balanced health care system, one that balances hospital needs with extensive outreach programmes mapped out by Dr Aline Wong in Dr Aline Wong's Report, the programme of managing our old age, managing cardio-vascular diseases, like that of the heart, and high blood pressure, diabetes, etc.”
“I still hope that the Minister of State will consider my request. I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, before I withdraw, can I say something?”
“Sir, I think they can carry on the debate outside this House.”
“I am sorry. I apologize. I would like to remind Mr Chia Shi Teck that if he had been an elected Member of Parliament he would not have suggested that the HDB pass over its non-profit making set-up to the Town Councils. I repeat what he said in the debate on Friday: `If parking charges are a losing business, I suggest we give it to the Town Councils.' It shows a lack of grassroots feel because Town Councils are not dumping grounds for HDB's non-profit making set-up. Town Councils are already trying to find money to meet the maintenance cost and the many demands of the residents.”
“I just want to ask the Minister two points. My request for a higher subsidy for the space-adding item, as I said, is based on need, and to make it more affordable to the 3-roomers who need the extra space. I hope the Minister will re-consider my request for a higher subsidy. I do not want to bargain on the level because I am requesting to give the 3-roomers a better chance to meet the objective of upgrading, ie, to bring them closer to the rest of the 4-roomers and 5-roomers, as we have not been building any more bigger HDB 3-room flats since 1986. The other small point is this: We are asking residents to vote for their own upgrading of their blocks. Therefore, the Minister of State's assurance that probably the precinct, as a whole, would vote for a single package upon advice by their advisors is based on an assumption that the owners of all the block types, 2-, 3-, 4-, 5-room and even Executive flats, can all agree. This may be so during the Pilot and Demonstration Phase, as there was no distinct choice. But the picture is different now. They are given three distinct choices. I therefore maintain that it is better to give two choices, one with changes to the external facade and uniformity of the block, and the other with space-adding item as an additional item. I hope the Minister will reconsider my request. Finally, before I withdraw, I will give Mr Chiam a chance.”
“Sir, the recent announcement by the Ministry of National Development with regard to the new form of housing that we have strata title bungalows and cluster housing is most welcomed. However, I would like to know more details on planning guides for this. I hope there will not be too much restraint on design. One question I would like to ask is how do you apply the management corporation on such low-density housing. I ask this because I know we encounter problems putting one building complex under one strata title when you have so many owners of different usages under one roof. And as you need 75% to institute changes, it is very difficult for all tenants to agree because each has different needs and interest. Land for sale to build houses is the other issue that I want to find out from the Ministry. Does the Ministry have restrictions as to how many a person or company can buy? If these are meant for individuals and construction companies, I see that the individual will be edged out. I would like the Minister to clarify on this. Finally, is there a period whereby you must complete building the homes after purchase?”
“Sir, I move this amendment in the light of many accusations by the Opposition that flats are very expensive and being priced out of the average Singaporeans. This has been debated many times. But memories are short and I think answers have to be given again. There are, however, two issues, one of which has been brought up by Dr Vasoo, and that is, the posted prices are HDB's 1984 sale prices and are well below the current market value of resale flats. Thus, buyers of resale flats have to pay a substantial amount in cash upfront. The second issue is that HDB has already stopped building 3-room flats in 1986. Hence, the low income families should be helped to buy 3-room flats. What measures are being taken to help the low income families to own flats?”
“One suggestion would be to have only two packages - Standard package, based on all the items mentioned in the Standard Package, and the Standard-plus Package. Of course, we have to adjust the pricing and subsidy, and the details can be worked out later. Sir, I do not want to see a precinct developing distinct social differences because we do not take into account the social and psychological effects of upgrading. Imagine walking into a precinct with such obvious physical differences. Then there are also other implications, like maintenance and security. A basic block, with no security system, while others have, will pose potential danger to those who have installed security systems. How about maintenance? How do you apportion S&C funds to maintain the different blocks? So I think there should be uniformity if you want to avoid future problems. I therefore ask the Minister to review the packages in the light of what I have said.”
“Because for 3-roomers to upgrade to 4-room, the jump is from $30,400 to $60,500 for a 3-room flat to $125,000 for a 4-room flat. An upgraded 3-room flat will go up in value. So also for the 4-, 5-room and Executive flats. With regard to the Precinct Concept, I wonder if these three packages offered will bring about disharmony and non-uniformity to the physical outlook of the precinct. My impression of a precinct is a grouping of five to seven blocks, well-designed to blend with each other, having many things in common and evolving eventually into a character of its own. However, in the latest upgrading, the offer of three packages is going, I believe, to create physical disharmony and social differences. Imagine, three out of four blocks opt for the Basic Package. Then you are going to have three blocks with no upgrading of the building facade and ancillary works, old HDB number plates, lifts with old interior and no provision for future installation of security system. Of course, you get a repainting job done. The other four blocks, if they opt for the Standard Package, will have a new facade, new block numbers, new lift door jam, new lift interior and provision for future installation of security system. I think the Ministry of National Development should re-think on this. The point is that if the difference between the Standard Package and Basic Package is based only on four items among 13 items listed, and the cost difference is minimal, I believe, and as these four items are, in my opinion, essential to give the precinct a sense of uniformity, colour and character, then the Ministry of National Development should review and perhaps re-package the three packages.”
“Sir, I beg to move, That the total sum to be allocated for Head U of the Main Estimates be reduced by $100. Sir, during one of the debates on upgrading, I did warn the Ministry of National Development that upgrading should be according to need, not according to what is desired. You may desire to have a balcony, but actually do not need it. The Pilot and Demonstration Phase clearly showed that the space-adding item costs $24,800. I therefore can understand why HDB had to re-cost their upgrading. But it is better to let the people know and be frank about this high cost of additional item and their need to pay more, if this item is requested. I agree with this. Even HDB's feedback on the need for this item was not from the 4-, 5-room or Executive flat dwellers, but primarily from the 3-roomers. Therefore, I support that this item be made optional except for the 3-roomers. Sir, we have stopped building 3-room flats. Therefore, to bring the 3-roomers closer to the standard of the 4-roomers, this space-adding item should be given as an item in the package. Here again is a question of need, not desire. Therefore, I am suggesting to the Ministry that the Government subsidy for this item for 3-roomers be up to 90%, leaving the flat owner to pay 10% or $2,480 instead of the $9,900. Sir, another reason why I ask the Minister to consider a 90% subsidy is my concern that some of these 3-roomers may be still paying for their flats through their CPF and I wonder how an additional $13,400, if they opt for the space-adding item, would affect their future payment. In spite of these changes in cost sharing, I still think it is value for money. I would encourage all to opt, if offered, especially 3-roomers.”
“I hope the Opposition's cry that we look after the rich should be critically examined. I have said that we have been fair to all and we will continue to be so. It would be foolish of us not to spread our wealth around because we know that politics of envy can be nasty. That is why from the very beginning we took steps to prevent this. For example, we acquired land, developed it and built subsidised public housing for all. If we had not done that, then the disparity between the haves and have-nots will be very wide. As many of the poor are also saddled with medical problems, C-class beds have been retained in Government and restructured hospitals. I hope NUH will follow suit. Government institutional care for the aged sick must continue to be made available at reasonable cost. It is not possible to make everyone own a flat. Rental flats must be retained because some cannot even afford the first downpayment. Eviction of poor flat owners because of rental arrears has been handled very carefully by Town Councils and HDB. In such cases, many a time such action was not carried out because of the assistance from the CC funds and easier payment terms have been employed. Finally, we have to be realistic. We can never help all, but we can provide and create opportunities for them. If they fail to respond, then we can do nothing. One should not be proud to be poor nor should be ashamed to be poor. Many of us in this House started out poor. We were not proud nor were we ashamed to be poor, but we shared one common objective - the determination to get out of the poor trap, the poverty trap our parents were in. We succeeded and we thank the Government for the bursaries and scholarships that gave us the chance to go to college and university. 2.07 pm”