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.”
The complete record
Every one of 1,095 lines we hold for Tan Cheng Bock, in date order, each linked to its source. Free to read, in full, without an account. Page 2 of 22.
“If HDB can earmark specific plots of land to build multi-storey car parks for vehicles, can HDB also earmark specific plots of land to build heavy vehicle car parks in the HDB estates? We can have built-in features to minimise and buffer the disturbances to the constituents in these housing estates. HDB can charge more for these heavy vehicle car parks because the company who owns these vehicles will pay for the cost.”
“Sir, I listened to Prof. Ivan Png's comments on the in-vehicle unit and the Minister's positive response. I agree with Prof. Ivan Png. It is a good way to solve this problem, and to make it more efficient. But I want to add a word of caution. When you introduce technology of this kind, we will be putting many of our car park attendants out of job. So this is one time I say technology can wait. I think jobs should come first. 5.45 pm Assoc. Prof. Ong Soh Khim (Nominated Member): I actually have three clarifications to put forth. With regard to the Minister's earlier reply before the break on the topic of housing for an ageing population, in view of our growing elderly population, would MND consider giving higher CPF top-up grants to first-time buyers of HDB flats who opt to stay with their parents, so as to encourage more Singaporeans to stay with and provide care-giving to their parents. There are two advantages. First, we actually reduce the need to build studio apartments for the elderly and, second, we also reduce the social cost associated with the various VWOs. My second point is on the topic of affordable public housing. The Minister has said earlier that most Singaporeans can fully service their housing loans from their monthly CPF contributions. Sir, with the progressive reduction of the salary ceiling for CPF contribution and the big reduction in the employer's CPF contribution rate, many households actually can no longer service their housing loans solely from their monthly CPF contributions. How will MND help this working class of Singaporeans affected by these changes in the CPF contribution structure, but who have already been locked in a housing loan long before these changes were announced? My third point is on heavy vehicle parking, mentioned by Mr Wee.”
“Sir, the Minister calls my scheme a "welfare scheme" I call it a "compassion scheme". So I just want to seek clarification from the Minister. The HDB has, in the past, bought back 3-room HDB flats at market price and then sell them to the poorer Singaporeans at a subsidised rate, so that the poorer Singaporeans can have ownership of HDB flats. My scheme is a modification of his scheme. What I am asking is that HDB buys back the flats from these hardship cases and then rent these flats back to them at a subsidised rate. So I do not think my scheme is a welfare scheme. I think my scheme is more to give a life line to these people and a way out - an option - so that they can have some funds to help them to tide over this bad period. And I also had some caveats in my speech. I hope the Minister can respond.”
“I think we should look into this, not forgetting that there are also many people who have suffered very serious medical problems and they need funding. Sir, while I advocate that they should be primarily for the 3-roomers, let us not rule out the possibility that we could also extend this to the 4- and 5-roomers. Sir, I do hope that the Minister will consider my proposal.”
“I think many Members in this House had brought up this rule. This rule must really be looked into by the Minister, because it has to be applied appropriately to the situation. Because some flat owners cannot wait, they are forced to buy smaller HDB flats in the open market. But this eats into whatever little funds they have salvaged from the sale. HDB used to buy back 3-room HDB flats from the open market and rent them to the poorer Singaporeans. This is to encourage home ownership. Now I am asking the HDB to apply this rule but with a widened scope - to buy back the flat at market rate, especially the 3-roomers for those in severe hardship and then rent back the same flat to them at a subsidised rate. Some people have told me that the numbers involved may be very small, because many probably will have negative equity as a result of the sale of their flats. When they sell their flat, they have to pay back the CPF component, and they also have to pay back the outstanding HDB loan. I feel that in spite of that small number, we should not reject the idea. What I am asking for is an option, a way out for people in severe hardship. It is a choice to help those to raise some funds to ease their hardship. I am not asking for welfare. I am asking for compassion. Those who agree to the scheme must also agree to another scheme, to allow their money to be used wisely; in other words, the money has to be used to offset their rentals for at least a minimum of two years or maybe even more. Can we extend this to the 4-roomers and 5-roomers? I think we have to look into this because even if they downgrade to a 3-room HDB flat, they still cannot get sufficient funds to help them out, especially those who have failed in their businesses.”
“Sir, since the Asian financial crisis, SARS and the economic downturn, I have noticed a dramatic change happening at our meet-the-people sessions. No longer do residents queue up to see us for priority of housing or upgrading to bigger flats. But on the contrary, they are asking for the reverse - downgrading to smaller flats, requesting for rental flats, and also restructuring the mortgage loans. I notice that there is a confidence loss in their ability to sustain their lifestyle and home, because of job insecurity due to global and domestic change, in work norms, expectations and performance. Increasingly, more and more are asking for assistance to pay their utility bills, SC&C charges, medical bills and, earlier on as I pointed out, the mortgage payment for the HDB flats. Sir, we have to look and find answers, or it will become a big social problem. The answer lies in the HDB flats, their prized asset. We have to give them a life line by allowing them to monetise their asset, to release funds for their use and to ease their hardships. At present, flat owners can downgrade if they stay in 4- or 5-room flats. But downgrading means having to sell and wait for a 3-month period before they can rent or buy smaller HDB flats. This point has been brought up by my parliamentary colleagues. Of course, this causes a lot of inconvenience, frustration and hardship for these people searching for a place to stay while waiting for this 30-month period to lapse before they can buy or rent again. This ruling, as Members know, was introduced many, many years ago when HDB home owners were upgrading and the property market was very buoyant, and many of them cashed in on the situation and they made money. But situations have changed and we have to look at the rule again.”
“If we continue to stick stubbornly to this administrative requirement, then we would lose some Singaporeans. And, if the attitude is that it is only a few, then we have to be very careful, because we have to ask ourselves whether we are prepared to trade-in these good Singaporeans with the less capable people entering into Singapore via our immigration policy. In other words, you are trading quantity for quality. So I call for a rethink on this. Another category of deferment I am asking MINDEF to consider is somewhat similar to the above, except this time it involves a graduate who wants to do a Masters or a Ph.D. Many of our Singaporean students do well; however, some exceptionally well, and they are usually offered by the university to continue to do their Masters or even their Ph.D. But, again, this is not allowed by MINDEF. Unless these students are very special, MINDEF does not give an exemption. So I would like to ask who are these people who are given exemption, because Singaporeans are always calling for fairness. The number of people that are given the opportunity by the university to do Masters, I do not think is very big. It must be quite small. But these are the very students we want them back. It is very simple. They are very bright students and, therefore, we should try to retain them. Some suggested to me that they should ask MINDEF to up the NS deposit. But I think that is not the right thing to do. I am thinking, if MINDEF softens its stand on this, the trade-off is goodwill and trust. Trust our people, do not prejudge, be less suspicious - and I am sure these students would return to do their NS. So I am asking the Minister to consider my request for deferment for some of these students.”
“Sir, with globalisation, many Singaporeans are travelling more, and some even residing longer in the countries where they do business. So we could see many of our Singaporeans staying in Australia, the States and some even in China. They bring along their families, if their postings are long. And, if the children are doing their secondary or post-secondary education, they very likely would enter the overseas universities as well. Now, this is where the question of NS would affect their choice - whether to return home, or to stay there and continue their tertiary education. Now, if these overseas children enter the university, before the age of 17 1/2 years, then it is not a problem. But, sometimes, some students exceed the 17 1/2 years and are asked to come back to do NS. These students are prepared to do their NS after their university. Yet, their request for deferment cannot be acceded by MINDEF. So parents forgo their NS deposit to let their children continue to study. When the young graduate returns, he has to face MINDEF for not enlisting. Now, some choose not to come back for fear of going to jail and, thus, we lose a few good Singaporeans. In the light of so many Singaporeans going overseas for work, and staying for some, I ask MINDEF to be more flexible in allowing deferment for some of these students. MINDEF insists that the students must be already studying at the university when he turns 17 1/2 years. An acceptance letter from the university is not sufficient for him to get deferment. If he is accepted to enter a university, he must be physically present in the university. Now, if the term starts, for example, when he is over 17 1/2 years, he would not get a deferment.”
“As I have said, there is uncertainty of job and income security has changed all that. Lastly, the pace of change is too fast for some Singaporeans who seem resigned to this. But we must help them to pull them along, if we want to be a strong nation. I support the motion.”
“It is a desperate move to get these people out of the poverty trap using the last asset they have, the HDB flat. Of course, HDB can have rules and regulations to ensure there is no abuse. There is a possibility of abuse for such a scheme. Everybody who cannot make it would want to sell the flat back to HDB. But I am not proposing that everybody in that type of situation would have to sell back the flat to HDB. We must be very careful. We have to isolate this group and then we can see whether we can make this move and let them have, as I said, some fresh start. While the economy has improved and layoffs have declined, now workers remain concerned about job and income security. Let me illustrate this by a simple example. A patient of mine in the early 30s saw me for insomnia, ie, cannot sleep. After a careful history taking, I found out that she had this nagging fear of not being able to service her future housing loans and other commitments. For a young girl, 30 years old, worrying about this, I am also worried. Her job, she said, is not certain and so is her income. She works in an accounting firm. Her future husband shares similar concerns. I advised her to set her sight lower and not to buy a big flat. She said, "No, I am not looking for a big flat, just a small flat." I am not sure how many more couples are in such a similar state. In the past, I remember young couples were very confident. Just before they got married, they went to HDB and registered to buy a flat, and they seemed not to worry about not being able to pay for those flats. Somehow or rather, there is this confidence that the job and income security is there which, I fear, is not present now in this current job market. I think, today, the situation has changed.”
“We will give them any assistance if they want it. In spite of these attempts to attract Singaporeans to these foreign workers' jobs, I think jobs for this group are hard to come by because of age and poor education, lack of motivation for some and, of course, lack of training. What did the Government do? The Government has instituted some interim measures to help these people like, for example, Rent and Utilities Assistance Scheme and Interim Financial Scheme to help this group. But these schemes would be replaced later at end 31st this month by a better scheme. This is called the Self-Reliance Programme Scheme and this would provide needy families, who are unable to work or support themselves, assistance to cover rent, utilities, conservancy charges, medical coverage for selected family members, children's education or cash allowance for three to five months. But a more practical solution must be found. Let me suggest one. Most of these people own flats. But they are trapped because they have to make repayment for their property and, yet, they are out of job and cannot pay. So to help them get out of this trap, I am asking HDB to consider buying back their flats. Yes, HDB should buy back their flats at the market price and let these people rent back the flat. So HDB buys back and rents the flats to them at subsidised rate. The money from the sale of the flat must be monitored carefully and allow it only to be used to offset outstanding bills - utility bills, medical, school fees and, of course, the rental of the flats. This is to give them a breather and a fresh start while waiting for a proper job. I know this may sound crazy to HDB, and I am sure they are going to come after me for this. But what else can these people do? I leave this for HDB to consider.”
“Mr Speaker, Sir, I am sorry I digress from SP to HDB, but it was to bring home a worry of corporatisation and its impact on the ground. Coming back to the problem of structural unemployment facing this group of Singaporeans, I find the answer to this is so basic - find them jobs with a reasonable income to meet their daily family needs. Mr Lim Boon Heng, Secretary-General of NTUC, has told us that he needs to job match 10,000 out-of-work Singaporeans this year. Last year, it was 16,000 and it was not an improvement. But still, there are 10,000 out-of-work Singaporeans for NTUC to job match. This foreign direct investment that we bring in would not be of much help to this group of people. It is beyond them. I see the jobs they need are taken up by foreign workers. So we must do something to get these jobs back. I am not against foreign workers coming here. I think some of you know my stand on foreign workers and foreign talents. But we need to get these jobs back for Singaporeans. I notice NTUC has come out with an agenda to attract Singaporeans take up these jobs. Mr Lim Boon Heng suggested redesigning jobs, to make lower paying jobs more attractive, and some of the examples he gave are horticulture, construction, hospitality - to improve productivity, pay and better image, improve service standards by being more customer-centric to emphasising service excellence, to help business grow and improve job security and, lastly, job matching. But I find that job matching must go with training. Because some of the residents who have got jobs find it difficult to do these new jobs. So somehow or rather, the programmes must be integrated, you cannot divorce them. So I hope Mr Lim Boon Heng and NTUC unionists would look into this.”
“On the other hand, Malays must take full advantage of our education system or they will not have access to better jobs. Coming to the unpaid bills, what is the solution? In the beginning of last year, water and electricity were completely cut off for those who could not pay. After much protests, the taps were allowed to drip. But the power was cut off if the demand payment is not met. Even a payment of less than the demand payment is not sufficient for them to have their water and power cut off. And this was also despite the appeals by Members of Parliament. So what has happened to such families? They moved on to stay with friends and some of them would have even approached me to see whether they could use the water at the void deck for their washing. And I had to make a decision. Of course, I cannot allow it because this would set a lot of precedence. I asked myself, "Is this the result of corporatisation of our utilities? Or are there some deep-seated problems of structural unemployment?" And I want to believe it is due to both. Somehow, I sense a distance between the Government agencies, statutory boards and those working at the ground. Because these agencies are corporatised, they have become more profit-oriented and forgot they have a corporate social responsibility. And the Government does not look like it is asserting on them to do so. Recently, Mr Speaker, Sir, we must have read in December 2004 about Temasek buying HDB Corp. We, at the ground, are worried that with change of ownership, would we continue to enjoy the close association which we have with HDB in the past? HDB Corp is assigned HDB's design and development projects. Will this affect our future upgrading programmes? Or even HDB name will not be retained?”
“Some are in the drug rehabilitation centres, some lost their jobs, some in between jobs, and they have a stack of bills (including Singapore Power bills, conservancy bills, medical and school bills) to pay. What will happen to them? Singapore Power or the Town Council will haul them to court. They go to jail because they cannot pay. They come out again, and they face the same problem. What will happen to their family is even more worrying. Like Mr Heng Chee How said, and I quote him: "The financial situation affects the mood at home and demoralises the children in their studies." I personally know of one child who was so embarrassed to go to school because she had no money to pay for some fees. Also, I had to help some of the students who came to me because they could not afford to pay their 'O' level examination fees. I could highlight more, but we must find answers. At our MPS, I am sure MPs here must have helped to pay some of the Singapore Power bills or some of the school fees. We gave them NTUC food vouchers and we sought CDC's assistance for job placement and many a time, however, they move on one full cycle, coming back to our MPS because they really cannot pay as they cannot find a job. This is one challenge that this Government must face: how to improve the lot of Singaporeans, especially our Malay community? Education, no doubt, is the best answer. And the PSLE results testify that the Malays are doing better each year. This is a good sign, but improving their education must mean better opportunities at the workplace. Job discrimination, whether we like it or not, is present among some Singaporean employers. And those employers who discriminate against our Malays are not wise because they jeopardise our nation building.”
“In this day and age of Singapore, being in the first world league, I feel embarrassed that some Singaporean families are living in darkness and with a dripping tap for their water supply. I notice this happened only quite recently, about four years ago. Before that, at the meet-the-people session, I hardly remember Singaporeans living in darkness. How did this happen, I asked myself. The progress we have made has resulted in the cost of living going up not in tandem with the earned income, which I must admit has also gone up marginally. Disposable income of these breadwinners cannot meet the demands of daily living, and with little increases here and there - transport, school expenses, food, medical cost, licence fees, conservancy charges - all have added up to the family's budget cost and left many of these breadwinners with practically nothing left at the end of the month. Many MPs have highlighted these people's woes - Amy Khor, Wee Siew Kim, Ang Mong Seng, Heng Chee How, to name a few. Who are these people? They are generally retrenched workers with little prospect of other jobs. They lost their jobs during the past turbulent years of the Asian financial crisis, the SARS attack and the changed economic structure in the job market. Most of them belong to our Malay community, although the Chinese and Indians are not spared. The large number of Malays coming to my MPS in such dire straits is indeed very worrying. Their problem is our problem. It is not a Malay problem. If you look at their profile, these people have low education, low salaries, have more than three children, and they come from dysfunctional family background.”
“Mr Speaker, Sir, I rise to thank the President for addressing the Government's policies and priorities for the nation. Mr Speaker, Sir, many issues have been addressed by my fellow MPs. They include the economy and measures to deal with structural unemployment and less skilled older workers. The plight of small and medium enterprises and problems encountered by budding entrepreneurs were eloquently articulated by Mr Inderjit Singh. Then there was the question of security and how the tsunamis have brought home the importance of emergency preparedness and the ability to respond to disaster at national and regional levels. Also, choices in education and career, the need to balance the needs of the young and old, assurance to the old that they are not forgotten, assistance to low income families, and encouraging self-reliance and independence were some of the issues touched on. Today, I want to highlight a group of Singaporeans whose lifestyle is far from the first world's lifestyle enjoyed by many Singaporeans. My colleague, Mr Wee Siew Kim, told this House about a mother who had no money to register the birth of her child and a man who had no money to buy spectacles to help him pass his driving test. Mr Speaker, Sir, 30 years ago we had stand-pipes for water supply. Then, Singaporeans rejoiced when they moved to HDB flats because they had water flowing from their taps. Yet it is ironical today that some HDB families have taps that only drip water. As far as lighting and reading are concerned, Singaporeans had kerosene lamps and pressure lamps some 30 years ago. But today in this modern age, some Singapore HDB families have to live in darkness. Why? Their power supply and water supply have been cut off all because of non-payment of their Singapore Power bills.”
“And we know that many of the young men who come into National Service today really want to do their best. Many of them strive very hard to become commanders and officers. This is a very good sign. So, this is really not a response at all to any public pressure on National Service. In fact, what it does is that it draws on the very strong public support for National Service, the very strong motivation of our young men to do well in National Service, to give them more challenging and demanding things to do so that they can give us a better defence.”
“Sir, the Minister has given two reasons for the reduction of the training period. One is the surge in NS intake over 10 years and the 3G SAF. May I ask the Minister whether this NS training period would revert to 2 1/2 years after this NS surge is over? Can the 3G SAF cope with this change when this surge in intake is over? In other words, is this a temporary measure? How much has public pressure contributed to this shortening of NS period? This is important, because if we just give in to public pressure, then it is not a very good reason to shorten the NS period. Is this a reflection of the confidence of the SAF's ability to defend our country even with this lesser intake of NS men? RAdm Teo Chee Hean: Mr Speaker, Sir, the Ministry of Defence has done a careful study and came to the conclusion that the two years of National Service duration will be able to be sustained over the long term even after this 10-year surge. What this 10-year surge provides us with is the ability to do this transformation and maintain our operational readiness at the same time. If I can refer Members to the chart that I distributed on total National Service full-time resource, the average level of National Service resource for the past 15 years, from 1990 to the year 2005, was 19,100 annually. Over the next 10 years, we expect it to be 24,300, and in the 10-15 years after that, we expect it to come down but not to as low a level as it is today. We expect it to come down to about 20,600, based on current estimates and even current estimates of our total fertility rate. Sir, I am happy to inform Dr Tan that public support for National Service is high. More than 90% of the people that we surveyed feel that National Service is worth while and is necessary for our defence.”
“Sir, I think the Minister missed my three simple questions.”
“So I have three questions for the Minister: Can foreign workers join our unions? If they can, are they allowed to hold office? Are there any OB markers? Companies Restructuring”
“Sir, I agree with Mr Heng Chee How that trade unions play an integral part in the tripartite relations between workers, employers and the Government. This has ensured industrial peace, thus encouraging more investors to come to Singapore and set up shops and, of course, create jobs and wealth. This reflects also well on our unions. It shows an understanding of the importance of industrial peace on the part of the union officials. This philosophy of quiet negotiation, as pointed out by Mr Heng Chee How, between the parties concerned to avoid confrontations has seen Singapore through many good years, and I am sure, many more good years to come. I want to believe that one main reason why our workers and unionists adopt this stand together with the employers is because of our past history of industrial and union conflicts. They do not want to see it happen again. They saw what happened to our lives, our properties and the investors when strikes paralysed this country, not only our transport system (the Hock Lee bus strike), but also our school system where union conflicts brought students pitting against the authorities (the Chinese Middle School strike). Now, we want to avoid all such happenings again. Today, I notice that our workforce has a big foreign element of at least half a million people. They have no such history of our past, and no roots here. They are no stakeholders. But they are coming in bigger numbers and they come from different parts of the world. They bring along their own value systems and some of them with historical baggage of their labour-management relations. Most settle down well and go along with the general sentiment of our local workforce. But a minority of them may be different. They may have separate agendas which we may not be aware of.”
“For example, exempt the first year university course for the better polytechnic graduates or grant credits to subjects they did in the polytechnic. Some university courses would have to be shortened. Polytechnic education can be refined or restructured to have more choices, more options, more discipline. They must not only have technical disciplines but academic ones too, so that the students would have more choices to choose when they opt for university education. For those who do not make it to the university, at least a polytechnic diploma graduate is better equipped for the workforce.”
“Sir, I have spoken on this subject at the Budget debate. So I do not intend to repeat all those points. Very briefly, I would like to recap the main points. I am calling for a review of 'A" level examination. Do we need 'A' level examination? Why not 'O' level students go straight to the polytechnics? 'A' level examination is to prepare students for university education. Most of them must achieve that goal. However, I have checked with the school offering 3-year 'A' level course. In 2002, 20% got into the university, 40% passed but could not get into the university, 40% failed to pass 'A' level. So if 'A' level is for the university education, then the 3-year 'A' level has failed miserably. Worse still, those 'A' level students who failed to enter the university find the job market not favourable to them. In a jobless survey, from a Straits Time report, 'A' level jobless rate was 1.5, polytechnic was 1.1, university was 1.2. Obviously, employers prefer polytechnic students. Thus, I would like to know how many 'A' level students do not make it to the university. My single example should not make me want to call for this change. But putting that aside, I feel that this change should be considered for two reasons: (1) While we want to educate 'A' level students to enter university, we must also help those who cannot enter university to be better equipped with skills that the workplace wants. This will cut down education wastage. (2) A polytechnic education will prepare our students better for the new global economy as their approach to teaching by way of hands-on experience and industry exposure appeals to the employers of the job market. With this proposed change, the universities will have to make certain admission changes.”
“Can I just clarify then? I think it is important because the Minister mentioned about the electronic medical records. The question of confidentiality of the patient is very important, and I think it is important for the Minister to clarify this point.”
“Sir, can I ask the Minister two questions on this?”
“I am not making a speech. I am just saying that the Minister should have put more money, at least, in this year's Budget, on the primary healthcare funding, if he advocates so strongly on primary healthcare.”
“Because I do not see much primary healthcare funding in this year's Budget, and the Minister has talked so much about it. I just cannot understand. If the Minister advocates this ---”
“Can I ask the Minister? I cannot reconcile the fact ---”
“Yes. I am asking the Minister to elevate primary healthcare to a level suchthat we can have a better way to prevent diseases from spreading. For that, I would encourage the Minister to take back the two clusters, all the polyclinics, so that the Ministry, together with these polyclinics, can make a better presentation and understanding to Singaporeans on how the spread of diseases can be controlled.”
“But a truncated speech is no speech. So, would you allow me to ---”
“This requires strong political will and adequate resources and commitment directed towards this development. We have had experience with SARS. We know how the virus created havoc for all. We must learn from it. It cost us a bomb to contain SARS. One reason why I feel developed countries, including Singapore, panic when hit by SARS is complacency. Complacent because they thought they had eliminated the infectious diseases and let their guard down. Worse still, more attention was paid to hospital care, and demand for specialised treatments was created in hospitals. Health became an industry, and controlling of diseases became a lower priority. During early SARS, we doctors in the private sector had problems finding out who was in charge at the Ministry. Primary healthcare, I learned, has been fragmented into many sub-divisions in the Ministry of Health.”
“Madam, at every healthcare debate, the3Ms keep cropping up. What does this mean? It means we are grappling with a high healthcare cost problem, as one must have enough CPF for Medisave, enough to buy MediShield to protect against catastrophic illnesses, and the Government must provide enough in Medifund to help the poor who cannot pay. How did we end up this way? Have we been looking at health problems from the wrong end of the stick? Did we pay too much attention to the financial aspect and less on how we should manage the health of Singaporeans? I use the word "manage" because that is what we should do, not fire fighting the issue. We will have a difficult task because, first, we must change young Singaporeans' mindset about hospitals. It should be the last placethey want to go. The older Singaporeans fear hospitals for a different reason. I would not tell you the reason! Today, I want to propose a paradigm shift, from curative care, ie, hospital care, to preventive care, ie, disease prevention. Many in the Ministry of Health must have heard my call ad nauseam. I have spoken on this subject for the past 20 years. I outlasted five Ministers for Health, including the Prime Minister, in the process, and I am still talking about it today. I do it because I believe that preventing the spread of diseasesis the right way to control rising healthcare cost, as this area of health management is so much cheaper and effective in the long run. There are two reasons for this shift: (1)To help contain health costs; and (2) To better equip Singaporeans on how to take responsibility for their own health, so as to better prepare them to fight not only communicable diseases like SARS, but also non-communicable diseases like diabetes and high blood pressure.”
“Maybe the Minister did not quite get me. I think it is important because I am trying to save costs and I am trying to make sure that there is less disruption during the construction phase. So, instead of IUP, MUP or LUP, why not we just lump them together, have a single package and do all the upgrading programmes that the residents want? I have mentioned them, but I do not think I have the time to go through them all over again.”
“Madam, can I ask the Minister whether he agrees to my one-package upgrading programme? Mr Mah Bow Tan: Madam, in fact, the MUP programme today already incorporates many of the upgrading repair items that Dr Tan Cheng Bock mentioned, whether it is in the changing or the repair of leaking pipes, or whether it is changing of windows, etc. It also incorporates the lift upgrading. If, for example, Teban Gardens had voted in favour of the MUP, within the flat, the repair works would have been carried out. So, I believe the review of the MUP package that we are undertaking today is along the line of what he suggested. Whether we continue with the MUP package as is currently constituted or whether the scope is narrowed further to just concentrate on those items which Dr Tan mentioned, that is something the HDB will be studying.”
“Because, if you accept my proposal, then there will be a lot of cost saving from the cutting down of the upgrading programmes and this cost saving that I have proposed should go to this lift upgrading. Lift Upgrading Programme”
“Madam, there are three upgrading programmes that I want to look into, and I hope the Minister too: the IUP, MUP and LUP. I will leave out SERS, as I will want to talk only on these three subjects. I am asking for a review of IUP, MUP and LUP. IUP is an interim upgrading and only involves the external features; MUP, the internal and the external features; and, of course, lift upgrading - we all know we have to really improve on the lifts. We should marry all these three and just have only one upgrading package. This is to save cost of recurrent upgrading and to avoid too much disruption to the flat owners and also to the environment. We should ask ourselves: what do the residents really need? They need, I think, the lifts to be upgraded; they need the ceiling and interior cracks to be mended; replace the leaking pipes, the electrical wirings and, of course, the windows and walkways. These are what the residents want. So, what I am proposing is that we have a new upgrading package to deal with only all these items. The town councils can come and do the external upgrading, such as the gardening and all these nice environment features. Of course, there is a caveat here: we do not allow them to just do all these changes freely. The Government should give the Town Councils a little bit more of funding for the maintenance and the very essentials. I am sure the Town Council Chairmen would not ask too much. We just want to make sure that the environment looks pleasant for all. So, this is the point I want to raise. However, with regard to lift upgrading, I think it should be given free. Why?”
“I agree with the Chairman of my Committee on what he has said. I would just want to raise one small point. We have been giving assistance to countries. But Singapore has been noted to be very business-like in our dealings and we always expect returns on what we give. This has actually dented our reputation. I am sure that many of this assistance that we have given to the countries, we do not expect them to pay us back. I just want to know from the Minister whether some of these assistance programmes that we have given to the surrounding countries were without any strings attached. This is important because at least Singaporeans will know that we are not so cold.”
“They have the confidence, they have the ability, and we should support them. Therefore, when Singaporeans are afraid that our younger leaders cannot manage without Lee Kuan Yew and losing their sleep, I tell them, "Don't worry, our younger leaders can do."”
“However, all these issues that they raised need to be aired here because of their implications of how the Government handles dissent and labour relations. One question that had been asked is: why is the Government interfering in this matter? Should this not be thrashed out by the management and the union? Why do we allow foreigners to sit in the union executive committee? What if a similar, or even a more serious, issue involving, say, a pilot strike were to happen in future, and there is no Lee Kuan Yew to crack some heads? I think these are legitimate questions being asked. They have always been told that the present political leadership can handle such matters on their own steam and they showed they did well in the management of the country generally and during the Asian financial crisis, SARS and the current economic downturn. Their concern is that all these issues have been managed well because of our good established institutions, good civil service, good financial institutions and a good healthcare delivery system. In the case of the SIA pilot issue, it is more than just administrative ability. It involved people. It involved people management. It involved EQ as much as IQ. It involved politics. It involved political judgement. Will the current leaders be up to the mark when managing such issues without the presence of Lee Kuan Yew? Many have told me that SM should have let the younger Ministers handle the issue by taking a back seat. They asked me, "Why must SM run to the help so fast?" They want to know. Do I believe that our new leaders can handle these issues? Yes, I am sure they can. You watch how our new leaders have handled SARS. You watch how they have handled the Asian financial crisis. And you watch how they are managing our economic downturn.”
“5%; diploma holders, 1.1%; degree holders, 1.2%. Therefore, we know that the 'A' level students are at a little disadvantage. I spoke to a parent who has a son doing 'A' levels and a daughter at polytechnic, and he told me the remarkable difference between the two. The son went to 'A' levels and he was a very good student, but compared to his daughter who went to a polytechnic, he found that she matured very fast, she could mix very well and she was behaving like an adult already. Whereas the 'A' level student is still a student, still wearing school uniform, and in a school environment, cannot mature that fast. Therefore, I am asking the Ministry to look at my suggestion. I am sure there is no hurry but an examination into the merits of polytechnic education to university, to me, is a better option than 'A' levels. Next, I will come to a subject which could be sensitive but has to be aired in this House. The DPM and Minister for Finance wants to build a strong society marked by a high degree of self-reliance, resilience and social responsibility. He said that we must not weaken our people's resilience by being too protective. I fully agree and I support the actions he outlined in his speech. However, at the feedback session, when I raised this point, a young participant asked me, "Is Lee Kuan Yew too protective in the handling of the SIA pilot affair?" Listening to him and to others, I sensed a disquiet among Singaporeans on this matter. I have therefore chosen to raise a few matters that are on the lips of many Singaporeans and hope DPM can enlighten us later in his reply. They articulated the issues passionately but would not want to speak up publicly for fear of the wrath of the Government. This is a common perception of the people.”
“Therefore, I am suggesting that we review the 'A' level examination and perhaps allow all 'O' level students to continue their studies at the polytechnics, as many are doing now. Of course, for those who do not do so well at the 'O' levels they can opt for ITE. The 'A' levels have served us well in the past. It is a British legacy. We must now move forward and ask ourselves whether the 'A' levels are appropriate. Polytechnic education can be refined or restructured to have more choices, more options and more disciplines. They must not only have technical disciplines, but academic ones too, so that the students have more choices to choose when they opt for a university education. For those who do not make to the university, at least a polytechnic diploma graduate is better trained for the workforce. At the university level, the courses could be shortened for the polytechnic graduates, like what is happening now. Polytechnic students can skip the first year of the course they are studying or they might get credits given to the subjects that they took at the polytechnic level. My proposal is a radical change. My thinking is that we must better prepare our students for the new global economy where changes in science and technology and business operations are moving so fast that we may be ill-equipped for the new changes. I call for a review because the 'A' level and polytechnic courses are very different. Polytechnic students are more hands-on and already enjoying a reputation of better job prospects compared to the 'A' level students. 'A' level students do not command such premium as shown in the survey by the Straits Times, on Saturday, 27th December, last year. In the Straits Times here, it is revealed that the upper secondary school students who were jobless were 1.”
“Mdm Deputy Speaker, I am surprised that no one has acknowledged the grandparents' role in the upbringing of the grandchildren. I think my contribution to this baby debate will be to call all grandparents to continue to support their children who have babies or those who want to have babies. The greatest gift that my daughter gave me were her two lovely sons. My two grandsons have given me joy and happiness. So when I listened to Mr Gan Kim Yong's speech and smiled, I understand how he feels. I can share his joy and I can share his happiness. Keep up looking after your children! I will come straight to the point. I have only two issues to present to this House. Before I come to the two points, I want to say that I support the Budget. The Budget indicates that things are getting better. But my fear is that rentals and Government fees are going to go up, like my good friend, Mr Inderjit Singh, said yesterday. I hope the Government will monitor the Government services and rental costs very carefully. The SMEs and companies about to see a turnaround in business are again thrown out of gear when the rentals and Government fees go up. My first point is on the education system. Our education system has undergone many changes. I want to propose one change for the Ministry of Education to consider. After 'O' levels, students move to either the 'A' levels, or the polytechnics, or ITE. Some do the 'A' levels in two years and some do the 'A' levels in three years. Those who fail their 'A' levels have to repeat, go to do a polytechnic course or go to work. But such students do not fare well in the job market because 'A' level schooling is, in my opinion, too narrow and not so tailored to the workforce.”
“And if there are still platforms and ways for us to do this, we should enhance it. Lastly, I would like to say that the act of donating one's organ is indeed an act of compassion, an act that demonstrates one's reverence for life itself, especially the life of others. Indeed, and I quote, "the true meaning of life is to plant trees under whose shade you do not expect to sit." With this, Sir, I support the amendment Bill. ADJOURNMENT OF DEBATE Resolved, That the debate be now adjourned. - [Mr Wong Kan Seng].”
“You may or may not have a job to sustain you as this new disability takes hold of you. As your vision deteriorates, your independence fades away. Family members may need to take care of your daily needs. If they are unable to do so, hiring help may be required, but not all can afford it. I am sure that we can all agree that blindness is one of the most disabling handicaps. Moreover, the procedure is rapid and subtle. Hence, donating our cornea is one of the most precious gifts we can ever bestow on another human being. Those who have cared enough to become donors have given hundreds of others a new lease of life as their vision is restored, as they are saved from a dark and colourless world. However, many more are waiting as the demand exceeds the supply. Sir, I believe that there are still gaps in information and education on the organ donation scheme. Many are clueless on the medical reasons, religious positions, social impacts, safety measures and procedures. On this, I urge the Ministry of Health and other relevant bodies to enhance and improve the public education and information flow. Together with this law, extensive public education will certainly ameliorate the present situation and allow people to participate and make better informed decisions. Recently, I had a conversation with a Malay/Muslim friend whom I casually asked, "Are you a donor?" I discovered something which was quite sad. She told me that she believed in it and she wants to be a donor but she could not convince her waris to sign the document. There are still people who are not sure of the procedures. They are still confused of what the role of the waris is. So I think there is still room for improvement. We can still do a lot of public education and explain to people about the confusion.”
“Their congested lungs deprive them of sleep and their general weak health may not allow them to work. Heart failure patients may not survive beyond a year. However, by pledging our hearts when we no longer need them can end their suffering and extend their lives, because approximately 70% of patients survive for at least 10 years after receiving a transplant. These patients may be fathers or mothers with dependants to care for or young innocent children who are desperate for extra time to spend with their loved ones. Those with liver failure are deeply jaundiced. Their abdomen swells due to excessive fluid and they often vomit blood and are generally weak, lethargic with little or no stamina at all. In severe cases, those with liver failure suffer from sleep disturbance, mental confusion or even slip into a coma. Donating the liver, even a portion, can do wonders. A case in point is the Andrea De Cruz case. This case, fortunately or unfortunately, has brought limelight to donor Pierre Png. This case has also brought a lot of publicity to organ transplant and donation. And we believe that after the incident, more people are aware of what organ transplant is all about and the importance of being a donor. Some may argue that donating the cornea is not life-saving. To them, I say imagine a day in their lives when they have blurred vision or, worse still, suffer complete darkness. How would their day to day living be then? Impaired vision is extremely disruptive and will certainly change one's lifestyle drastically. Suddenly you are unable to work at your desk the way you have been doing all these years. You are unable to see the smile on your children's faces. You are deprived from simple pleasures like reading, driving or watching the sunset.”
“If the ethics committee's final decision has to be approved by the Ministry's Director, then we might as well have a central ethics committee to do all the assessment. I think this will then give us the assurance that there is uniformity. There is also consistency of decisions. So I am really very concerned that this ethics committee in the hospital, which is playing such an important role, should be reviewed by the Ministry of Health. Maybe to have more control, we could make it into a central ethics committee, which I think is a much better way of managing transplants. On that note, Sir, I want to thank you for letting me speak. Mr Zainudin Nordin (Bishan-Toa Payoh): Mr Deputy Speaker, Sir, I rise in total support of the mission to save lives put forward by the Ministry of Health. The battle to save lives began in 1973 when the NKFS launched its major campaign to persuade our citizens to pledge their kidneys after death. Fourteen years later, in 1987-1988, the Human Organ Transplant Act, also known as HOTA, was passed with unanimous support. Nevertheless, we need to be constantly reminded that when we pledge our organs, we do not reduce in any way the quality of our life at all. Yet, it enables us to create miracles for others, and make a major difference even after we no longer exist. Perhaps we should understand better how organ failure patients suffer and how donation can significantly help lives and families can be preserved. Sir, I am not trying to be morbid to describe some of the sufferings, but I think it is very important for us to understand, so that when we make the decision, it is clearer and we make the decision based on information. Patients with end-stage heart disease experience shortness of breath, swollen legs and abdomen.”
“And this ethics committee has a very heavy responsibility and it has a composition of at least three members, one of them must be a doctor not practising in the hospital, and another is a lay person. This committee that is set up looks good. And they have to satisfy themselves of a whole list of concerns before agreeing to any transplant. I have gone through this legislation. I must say it is quite water-tight. It must be so because Singaporeans must be assured that the transplant is carried out ethically. Like I said, the Transplant Ethics Committee is a very important committee because they have to do all the assessments and they also must have consensus before they agree to any transplant. But I notice that the representation in this Transplant Ethics Committee has got no Ministry of Health's representation. I wonder why. Maybe the Minister can let me know. It is silent on the Ministry of Health's representation. But what puzzles me is that the outcome of the decision of the hospital ethics committee, if I had read the Bill correctly, is that it has to be subjected to the Ministry's Director's final approval. If this is so, why not set up a central ethics committee, as proposed by Mr Iswaran earlier on when he made a very excellent speech on why they should not decentralise the ethics committee at the individual hospitals but should be centralised at the Ministry of Health? I think he did it very well and I do not want to go through all his points. I know that there is a clause in this legislation which provides that the ethics committee could be punished if they have not done their job well. I think we should prevent this.”
“Transplant medicine can be a big money spinner for hospitals, because patients needing such transplants will find ways and means to do it. So, hospitals will want to add this field of medicine to the schedule of practices to give prestige to the hospital and also as another hospital service. When hospitals open their doors for transplant medicine with money as the motive, there lies the danger for abuse. In some parts of the world, patients going into the operation theatre to remove an appendix have found, later on in life, that they have lost one of their kidneys. But it is a bit too late already. Can this happen in Singapore, you may ask? I would be more confident that this would not happen 30 years ago when I took up medicine and went into practice. But today, I am not so confident. Somebody asked me, what is so wrong for somebody to want to sell his organs? It is a buyer's and seller's market, just like buying commodities. I think it is not so simple. The potential donor may be, as many have said, under duress, coercion, inducement or promise. We have a very large foreign worker population in Singapore, many under work permits. They come here because they need money to send to their poor families. They are a very vulnerable group and could be exploited. A foreign worker may be approached and is prepared to sell one of his kidneys under the promise of a large sum of money. He knows his life is less in danger if he does it in a Singapore hospital. So, I ask, where are the safeguards? If we read the Bill, there is an ethics committee that is to be established in every hospital. I think it is a good safeguard.”
“Thank you, Mr Deputy Speaker, Sir, for letting me speak. In 1987, when the Human Organ Transplant Bill was debated in this House, many of the concerns, fears and reservations of the different racial and religious groups were addressed and many were accepted. At that time, the issue was quite focused on kidney transplant. The donors then were mainly brain dead. But today, we are moving to involve more organs - the heart, the liver and also the cornea. And we are also involving living donors. So there is a difference. Of course, this brings into question ethical and also moral issues. I believe these issues were thrashed out by the Ministry at grassroots level and I am sure they must have been addressed. But having heard Dr Amy Khor, I realise that a lot more work has got to be done by the Ministry, because many people are still not very familiar with this term "HOTA". Sir, today, I would just focus on one issue which I thought is very important, and this is my fear, that we need a very careful monitoring of the potential commercialisation of organ transplant. With the advances in medicine, better anti-rejection drugs, better equipment and management, transplant has become less scary and more acceptable. At the same time, the practice of medicine over the years has also changed. Medicine is treated less as a profession and more as an industry. This, to me, is very sad. But, unfortunately, this seems to be the trend. In fact, in our White Paper on Health, medicine was called an industry. Therefore, like any industry, the practice has also become more business-like than medicine, unlike in the past. Thus, hospitals have to be profit-orientated and they open their doors to receive patients.”
“But if proper upgrading is done in this services industry, more Singaporeans will work. How? DPM Lee again has announced the Domestic Sector Productivity Fund last Friday. We have got to use this fund to develop systems, guidelines and workflows, because no one, no matter how good he is, if we have a lousy system, he can never perform. So, productivity is linked with the way we do things, the way the company plans the job work. We have to empower that individual with knowledge to be able to be productive. So, let us get this fund to improve the image of our services sector, so that the jobs now taken by foreign workers will eventually go back to Singaporeans. Of course, this is only one sector I have highlighted. I am sure there are many, many sectors which were also highlighted just now by the Minister of State for Defence, Mr Cedric Foo, and we should all look into them in more detail. Finally, Mr Speaker, Sir, this time round, the expectations of many Singaporeans have been dented. Egos have been hurt, but there is no shame in enjoying a lower cost of living, a lower level job with a less than expected salary, a different lifestyle. But all is not lost. We will bounce back. We must use this rough patch in our economy to consolidate our position, internally and externally, so that we can weather the future with even more confidence. We have done it with SARS. Surely, the team that fought SARS well will also bring us out of this jam. We must have confidence in them. But we must also have confidence in ourselves, so that we can try to put everything into shape and move on. I believe this team can make it. Mr Speaker, Sir, I support the Prime Minister's retuning of the CPF.”