Tan Wu Meng
Singapore
“So, if I may just recall briefly what I said five years ago during the debate on the President's Address. Healthcare is about all our people's lives, your life and mine, the lives of our loved ones, the life of every Singaporean. And with that, let us all hope for healthier and happier lives together.”
“Mr Chairman, I thank all who contributed to this debate. Our MOH leadership and MPs of all persuasions. Also want to express deepest thanks to our entire healthcare family, our front liners, the support team and our public officers. If I may briefly seek the indulgence of Speaker —”
“I thank the Ministry of Transport (MOT) for sharing that there are plans to introduce regulations to address the issue of online shops selling AMDs that are in breach and unsafe.”
“The online Community Justice and Tribunals System brings convenience to those who can go online. What happens to seniors who are less digitally-savvy, less literate or who may not be so familiar with the English language?”
“Mr Speaker, I thank MOE for this move. On the topic of social capital and social network diversity, can I ask the Senior Parliamentary Secretary that for these studies, will MOE look at it much further into the future?”
“Mr Speaker, I thank the Minister of State for her answer. My Clementi residents shared with me that they discovered their child was vaping. Because they did not know what to do, they brought their child to the nearest Police station. The Police referred the case to HSA and the child was issued with a $300 fine for vaping.”
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“I thank the Senior Minister of State for his answer. In Clementi where I serve, we have a number of elderly residents, some of whom have shared about the costs of consumables that they need because they have incontinence, for example, adult diapers and other recurring expenditure items. Would MOH, either on its own or together with the Ministry of Trade and Industry (MTI), be willing to consider studying the costs of such consumables for patients with incontinence and to see whether there are areas where these consumables might be delivered in a less expensive way?”
“They are part of an important shift towards a more progressive, more balanced, more modern criminal justice system. They allow for a greater role for modern medical opinion, and additional judicial safeguards. They reflect a more enlightened attitude towards those with mental conditions, as they recognise that, with proper supervision and the right conditions, some such persons can safely be cared for in the community. Sir, we must continue building a criminal justice system that gives due consideration to the vulnerable: whether victims who are vulnerable, witnesses who are vulnerable, or accused persons who are vulnerable – or accused persons who are innocent until proven guilty − doing this even as we protect the interests of the broader community. I stand in support of these Bills. 2.03 pm”
“Unfitness to plead or unsoundness of mind can span a spectrum of conditions. Each case turns on its facts and it can be helpful to provide the Court with a range of options in dealing with such accused persons. So, we should welcome amendments which explicitly set out provisions that such persons can be released, if appropriate, to places such as a properly-equipped nursing home or other appropriate care facility. This provides more options for dealing with such persons in a way that is humane while still serving the interests of justice, due process and protection of the public. Sir, it is also important that a person's unfitness to plead, in and of itself, should not prejudice that person's interests more than would have been the case for a person who is mentally sound and fit to plead. This is an important part of the proposed enhancements to procedural protections. For example, the existing section 249(2) allows the Minister discretion to confine a person of unsound mind who is unfit to plead, but does not specify an upper limit as to how long this confinement might be. The amendments in this Bill set out a maximum duration for the Minister's order of confinement over such persons and will help ensure that such persons are not confined under the criminal law for longer than a person in a similar position without a mental condition affecting fitness to plead. However, there is a clarification as well to ask the Minister: what happens when the maximum term of confinement under the CPC has been reached and the subject is still found to be unsafe for discharge because he or she remains a danger to themselves or others? Mr Speaker, in conclusion, I support these amendments.”
“To clarify, I am not saying that medical case conferences are exactly the same as a "hot-tubbing" model of expert evidence in Court, but one might suggest that there are useful lessons which can be drawn. So, this review of how the Courts manage expert witnesses, especially medical expert witnesses, is to be welcomed. It can help the Court arrive more swiftly at an understanding of evidence and what the key issues are, especially for medico-legal cases or where the medical evidence pertains to a criminal case. Medical experts would also be able to discuss the evidence and provide opinions in an environment which more closely reflects the actual clinical decision-making and opinion formulating in day-to-day real world, responsible, expert practice. This would also provide educational value for counsel as well as patient advocates. But there are clarifications that we need to ask of the Minister. Firstly, what sort of subsidiary legislation will be enacted to regulate expert evidence? Secondly, will there be consultation on the proposed regulations? Thirdly, in particular, each expert domain – whether engineers, computer security, medical professionals – each will have its own established professional practice for discussion of complex expert cases. So there should be consultation with the relevant professional bodies before the regulations are enacted. Mr Speaker, thirdly, I will also speak about our criminal justice system relating to persons unfit to plead or are of unsound mind. I support the amendments which give the Courts and medical professionals a more prominent role in determining the most appropriate action to take in respect of persons who are found unfit to plead, or acquitted on the basis of unsoundness of mind.”
“In a recent case involving an application under the Mental Capacity Act for a declaration that a woman was unable to make decisions on her property and affairs because of a mental impairment, the Court of Appeal suggested in a postscript that, ideally, medical expert evidence in such cases should be tested through "hot-tubbing" and there can be benefits to extending this procedure to criminal hearings. Mr Speaker, it might be useful to share a medical perspective. Currently, when a patient presents with a complex medical condition, a case conference may be convened. Multiple experts from the same specialty may attend, or even multiple experts across multiple specialties. In oncology, we call these conferences "tumour boards". Other medical specialties will have their own names for such conferences. Such conferences are routinely held at reputable specialist centres around the world: Singapore, US, UK, Australia and so on. It is important to note that such case conferences are not adversarial by design. Experts can ask questions or offer comments on other experts' views. Clinical information is presented and discussed concurrently by a panel of experts. Opinions can be tested or clarified, with the aim of seeking understanding of the scenario faced and what the range of appropriate decisions would be. Sometimes, the discussion generates a range of opinions which the panel assesses to be within the bounds of what is appropriate. Mr Speaker, the case conference approach to medical expert decision-making in the context of clinical practice and patient care seems closer to the inquiry-based inquisitorial approach proposed for "hot-tubbing", as compared to the adversarial approach.”
“We must avoid a situation where unnecessary additional suffering is visited upon the victims. Mr Speaker, my second point is on regulating expert evidence through subsidiary legislation. The proposed amendments will allow subsidiary legislation on the use of expert evidence, including the obligations of evidence and the use of concurrent expert evidence, which have been colloquially described in some jurisdictions as "hot-tubbing", or the use of what they call, joint expert reports. These amendments and, in particular, the clarification of expert witnesses' duty to the Court, are very much welcomed because, as our society and justice system mature, expert evidence is increasingly sought to be introduced in legal proceedings, including criminal hearings. For example, the use of medical evidence in criminal proceedings is becoming more commonplace, whether it is relating to the nature or cause of injuries; the mental state of the accused and its impact on the commission of an offence; or the possible explanations for, or the significance of, a substance that may be found in the blood or urine of an accused person. So, the creation of rules to regulate the giving of expert evidence will ensure that such testimony is held to strict as well as consistent standards and taken in an effective manner that would advance the pursuit of truth. Indeed, the practice of "hot-tubbing" has been adopted in civil proceedings in Singapore for some time. As it involves the concurrent giving of evidence in an inquisitorial manner, "hot-tubbing" can reduce the time taken to take evidence from experts and also fosters a respectful environment where experts can put forward and have their opinions tested.”
“Mr Speaker, I declare that I am a medical doctor and specialist in medical oncology in private practice. In supporting this Bill, I will speak on three points: Vulnerable victims, expert witnesses, as well as vulnerable persons of unsound mind. Mr Speaker, as part of the broader discussion of the criminal justice system, I would like to make some points on the Evidence (Amendment) Bill as well. I concur with many of my colleagues who have spoken earlier, it is high time that we provide for appropriate restrictions on the kinds of questions and evidence that can be asked in criminal proceedings involving sexual offences or child abuse offences. We recognise that our judiciary is impartial and can decide what is an inappropriate question to a witness, but, by then, the question may have already been asked. Our legal profession is held in high regard, with only a very small minority of practitioners censured for inappropriate questioning, but, by then, the question may have been asked. And so, there is still a role for safeguards because by the time an inappropriate question has been asked of a sex offence victim or a child abuse victim, it is too late to undo the psychological trauma caused to the person being cross-examined. And so, we must avoid the risk that victims will be deterred and afraid of coming forward to give evidence because of the fear of being subjected to inappropriate questioning during cross-examination. Mr Speaker, indeed, it is even conceivable that a malicious, calculating defendant may seek to mislead his counsel into asking inappropriate questions on sexual history, so as to deter the other victims from coming forward. Victims of sexual abuse and child abuse have suffered terribly already.”
“I thank the Senior Minister of State for his detailed update. I have three supplementary questions. Firstly, does the contract with the commercial provider provide for liquidated damages or other such responses in the event of a failure to provide adequate service and, if so, are these measures in the current contract adequate? Secondly, is there any stress testing of the system to help detect potential points of failure before they manifest and affect users? Thirdly, would the Senior Minister of State be able to provide some assurance about the on-going analysis that will take place moving forward because I have received feedback from my residents in Clementi that even after the system was restored, they still found that the two-factor authentication text messages could take an inordinate amount of time to be delivered to their phones?”
“I thank the Senior Minister of State for his answer. Some mature HDB estates had the road designs, especially the smaller loop roads, built at a time when vehicle norms were quite different from today. As a result, some residents are concerned when there are additional residential developments coming up, such as in the town of Clementi where I serve. What measures will the Ministry consider to, at least, ensure the vehicle congestion is moderated? Secondly, what measures will the Ministry consider to minimise potential risks to elderly pedestrians arising from increased vehicle numbers?”
“I thank the Minister of State for his answer. I have met Clementi residents who are elderly and who, therefore, are not in a position to shoulder the cost of healthcare for their domestic helper, if the domestic helper has a serious illness exceeding the insurance cover. I have received feedback that some FDW agencies do not provide enough information about insurance plans with enhanced cover at the point of hiring. Would the Ministry consider encouraging FDW agents to provide better information to prospective employers? Secondly, what avenues are there to expedite claims for FDW insurance in the event that the insurer is taking a long time to process the claim?”
“They found that, in Singapore, patients staying in public rental housing had a 30% higher risk of being frequently admitted to hospital, even after adjusting for demographics and clinical conditions. So, there is room for us, as a society, as a community, to learn and improve. We need to look at social care and health care as different aspects of the same goal when looking after seniors, and all the more so, with an ageing population and smaller families. 12.30 pm The family is still core but we should find ways to involve the community more – young Singaporeans with a spirit for volunteering, or seniors who are energetic and want to reach out to their peers and in friendship and fellowship. Can the Minister tell us how we can strengthen community support for seniors, in a sustainable way? Furthermore, social care is also about urban design. As I spoke about in the Budget Debate last year, urban design can contribute to community engagement or to social isolation. In Clementi, some older blocks have flats which cannot accommodate the wheelchair ramp designs with the traditional Housing and Development Board's (HDB's) Enhancement for Active Seniors (EASE) programme. This means seniors with mobility needs find it harder to go out, see their doctor or participate in the community. So, at the whole-of-Government level, we can look at ways to keep seniors in the community more, and to keep them healthy.”
“Sir, health goes beyond any hospital or clinic, especially for seniors and folks with chronic diseases. It is about living healthy and being supported in staying healthy, with homes, families, neighbours, communities all coming together. The social environment makes a big difference to whether a senior citizen falls ill – whether a sick patient can receive treatment at home, near to home or recover at home without being admitted to hospital. So, community and social support are very important, and this is something that we see even in the developed nations. Even in Switzerland, with their Swiss standard of living, they have learned this as well. For example, in recent years, in the past few years and going back further decades, hospitals in Switzerland had discovered that, increasingly, patients are being admitted for social reasons because the patients cannot cope at home. It has been published in the literature even as far back as the late 1980s by researchers in Switzerland and these are lessons we can draw from all around the world. It is also worrying when social deterioration becomes medical deterioration and hospitalisation because a long stay in a hospital bed leads to deconditioning and loss of physical strength. It makes it harder for an elderly patient to get back on their feet with the same energy as before. Ultimately, there is no place like home for health or for healing and we should try to find ways to keep health and maintaining health to be focused on the home and the community, with hospital care needed only when deeply necessary. The Singapore Medical Journal recently published a study by Singapore General Hospital (SGH) doctors who looked back at 16,000 patient histories.”
“In the case of HDB blocks, the costs are passed on to the Town Council and, indirectly, passed on from there to the residents. As part of prudent spending, we must look at the lifetime cost of maintenance and cleaning and upkeep of buildings and infrastructure. And as part of keeping lifetime maintenance costs down for infrastructure, ease of maintenance has to be part of the design criteria early on at the tender stage. We can also require space in public buildings to be adaptable, so that as land needs change, a building can be repurposed without having to demolish or rebuild. We can call it "building in prudence", "prudence by design". Remaining Fiscally Prudent”
“Chairman, value is not just about what we spend today, especially when it comes to fixed assets like construction projects and infrastructure. Value is also about the cost of upkeep over the lifetime of the project. We also have to look at how to keep maintenance costs down and that means making maintenance easy to do. When we construct new Mass Rapid Transit (MRT) tunnels, the tender analysis should look at the designs and ask if it is easy to organise track access for maintenance. Every minute counts when it comes to track access, as we have learnt over the years and recently. Likewise, when we design and build a new HDB block, we should also ask whether it is easy to maintain the exterior facade. This includes little details, like whether horizontal struts are needed because such high-rise horizontal beams can be difficult to clean. This also means understanding human nature when buildings are designed. For example, high-rise littering still happens in many housing estates. In Clementi where I serve, some of the newer HDB blocks were reported to have so-called "award-winning designs". These designs look very nice from afar, but some of these designs also very easily accumulate high-rise litter. The litter lands on horizontal beams, difficult to clear. I asked the National Environment Agency (NEA) if there was something that could be done, NEA has been studying this for some time and they have found that the layout of the columns, the layout of the struts, make it very difficult if not impossible to put closed-circuit television (CCTV) cameras to catch high-rise littering. Chairman, when the building design makes it harder to maintain the exterior, when it becomes harder to keep the building clean, the costs do not go away.”
“For example, some have mentioned land costs and rental overheads. These are issues that I have spoken about during the Budget Debate and I mentioned a few possible alternative models for approaching land rental and land cost allocation. More broadly, what is MTI's strategy to help Singapore and Singapore companies remain competitive to support economic growth sustainably in the years ahead to create opportunities for Singapore and Singaporeans from all walks of life? Managing Industrial Land Costs”
“Mr Chairman, the global consensus on free trade is not quite what it used to be. In some Western economies, FTAs are being viewed negatively. We have seen the recent political mood in the US regarding TPP. Some politicians in the US have even proposed that existing long-standing FTAs like the North American Free Trade Agreement (NAFTA) should be renegotiated. Given this shifting environment, can the Minister share the Government’s perspective on FTAs in this emerging new normal of global politics? What are Singapore's options, and what are Singapore’s trade priorities? For example, what balance of bilateral FTAs and regional FTAs should we be aspiring for? Likewise, what are the prospects for further World Trade Organization (WTO) deals in this new environment? And even as we hope for the best of outcomes around the world, what fallback strategies are we building into our trade links to maximise Singapore's manoeuvring room in the event of an unfortunate trade war between any of the major economies? Keeping Singapore Competitive Mr Chairman, some of my Clementi residents have worked in regional markets in ASEAN, or they have counterparts from other ASEAN countries whom they meet through the course of work. My young residents speak of the growing economic buzz in ASEAN, the energy and dynamism, especially in the major cities. Also, a certain hunger and will to succeed among young people in the youthful populations of our neighbouring countries. This growth and buzz pose opportunities for Singaporeans to forge partnerships, find new business partners and new business opportunities. But some Singaporean friends are also worried about whether our businesses can keep up. They worry about business overheads and the cost structure in our domestic Singapore economy.”
“Chairman, in a fair and just society, justice must be accessible to all, including Singaporeans who have less. Some have less resources. Some are less well-informed or less able to put their case across, or even to realise there is a case that could be put across. Some are less aware of how to seek help. Some are unaware of the difference between civil and criminal proceedings. Some are not aware at all. I have met Clementi residents at my Meet-the-People Sessions (MPS) and on home visits. Some were worried about the means test for legal aid. Some were also worried about finding their way around the system, finding out how to seek help. Does the Ministry have any plans to revise the means test threshold for legal aid, so as to cover a similar proportion of Singaporeans, even though average incomes are rising over time? Separately, can the Ministry help enhance education of the public so that people are more aware of the different ways to find help in different circumstances? Has there been any study by MinLaw on how existing processes can be simplified further so that the complexity of finding help does not become an additional barrier for people who want to navigate their way to assistance? Sir, when the search for help becomes complicated, it has a regressive effect – a regressive on the less literate, on the less mobile, on those less able to Google or search for help online. We have to ensure that justice is always equally accessible, including to fellow Singaporeans with less. Improving Access to Legal Aid”
“Chairman, I have a clarification to ask of the Second Minister who spoke about Home Team transformation. We have a manpower-lean environment and an ageing population which means that the SCDF emergency call numbers are going to continue to rise. So, I was wondering how will MHA and the Home Team work to address this, please.”
“Mr Chairman, I ask whether MHA can help guide the organisers of such courses, so that security skills can be taught in a way that is more accessible to Singaporeans of different educational and language backgrounds. More broadly, I also ask what plans there are to transform the private security industry so that we can continue having better working conditions, career prospects and wages for our workers. Private Security Industry”
“Mr Chairman, the terrorism threat remains at its highest level in recent years. So, it is important that we continue upskilling our private security workforce with better knowledge, better skills. But on my house visits, I have also met some older rank-and-file workers who want to join the security sector but find the courses unnecessarily complicated. They have found that some training materials are very wordy and not written in simple English. 1.30 pm One Clementi resident I met on my house visits was very discouraged. He is still physically fit. He speaks well, communicates easily and has lots of energy. But because he only went to primary school 50 years ago, his reading and writing in English are not so strong. He showed me a page from the training handbook. I saw the page and I ran the text through Microsoft Word which can calculate how hard it is to read the text. Microsoft Word said that the reading difficulty is like an American senior high-school or university level grade. As comparison, one American President's State of the Union speech from the 1980s had an easier reading level than that page from the training handbook! Mr Chairman, my residents and people like him – they are good men and women – they did not choose to be born in a time when primary school education was the best opportunity that they had. Many of my older residents still have much to contribute. They are able-bodied, can communicate with the public without difficulty, keen to learn, but for people like my residents, they are finding it difficult to get into the private security industry, even though an opportunity there can provide much-needed income.”
“Mr Chairman, Smart Nation is more than a buzzword. It can be a movement across Government and the economy, bringing people and businesses from different walks of life on board, for example, across public and private sectors, inspiring and attracting engineers, coders, user interface designers wanting to transform an industry or even dare to change how the world sees technology, starting in Singapore. It also needs to have tangible benefits for the economy and jobs for people from all walks of life beyond just the technology sector. So, we need to look, too, at how Smart Nation can empower businesses to grow faster, work smarter, do better. We see this in a very small way today, even with today's technology. Online delivery platforms have helped local small food and beverage (F&B) businesses serve customers further away, a broader clientele, a broader customer base with less floor space needed. But when it is easier to implement cashless transactions, when it is easier to do identity authentication, either with a touch of a fingerprint or recognition of your face, all these basic services, if opened up, can be application programming interfaces (APIs) for businesses and other service providers to build upon throughout the Singapore ecosystem. Can PMO share more about how Smart Nation can contribute further to Singapore’s economy and jobs? And how can businesses and citizens, people from all walks of life, contribute to the Smart Nation movement in a way that is constructive and empowering? E-payments and National Digital Identity”
“Or alternatively, it might be just me because I fully acknowledge that, like Ms Kuik, I am also not trained as an economist. As an interested lay person, I am trying to understand the argument better. But would Ms Kuik agree that maybe we shall leave it more to the expert folk to educate both of us on this issue?”
“My clarification, Mr Deputy Speaker, is that I am not sure, at least speaking as a lay person, how Ms Kuik's speech in mentioning the IMF and Singapore's Reserves lead to the recommended conclusion that we might not be maintaining the Reserves as much as we should?”
“Mr Deputy Speaker, I happened to have seen this online over the weekend as well and, it being a part of some serious-minded commentaries, I took some time to read it, even though there is no SkillsFuture Credit involved. I noted that on page 6 of the report, it mentioned that foreign assets in the form of reserves can form an important part of a country's savings to ensure intergenerational equity; and secondly, that in a later part of the report, it also mentioned on page 22 that the recommended ratio of 20% of broad money M2 is in relation to capital flight risks. As far as I understand it, not being an economist myself, nowhere in the report does it mention protection against currency speculation and other forms of stress which may subject a country's reserves to.”
“Mr Deputy Speaker, I listened with great interest to Ms Kuik's speech and she mentioned that some economists were citing an IMF recommendation relating to Singapore's Reserves. From what I understand of social media, I was wondering if she is referring to the IMF's June 2016 Guidance Note on the Assessment of Reserve Adequacy, please.”
“Mr Deputy Speaker, I would like to raise a clarification for Ms Kuik Shiao Yin.”
“Mr Speaker, once upon a time, when Independence was thrust upon us, we dared, as a matter of survival. Today, the economy is being transformed, many policies, many transformations. But beyond this Budget, we all must have the audacity to dream big. To dream big and boldly go where we can position ourselves to ride new trends and new journeys over the next 50 years. And so, I stand in support of this Budget. 4.24 pm”
“Mr Speaker, let us look at Razer – world-class gaming hardware company. As disclosure, I should mention that I do use a Razer mouse. Razer, a world-class gaming hardware company bought THX, the audio company founded by George Lucas. Razer's founder, Tan Min-Liang, grew up in Singapore. If he had grown up elsewhere, we would have one fewer star in our constellation of entrepreneurs. Mr Speaker, entrepreneurship is also about equality because when there is innovation and entrepreneurship together, it creates value, wealth and opportunities, not just for the owners, but the employees and the whole ecosystem. But entrepreneurship is a skillset as well. The World Management Survey by John Van Reenen at the London School of Economics studied 12,000 organisations, 34 countries. They found that basic management skills account for large differences in productivity and output per worker. But we also know that children from less well-off families do not get the same access to parental support, to parental experience of having run a business, to other forms of social capital. Fewer chances to learn how to run a business or get an apprenticeship at an SME through networks. Our school system can help bridge that gap. So, I call upon the Government to study how we can nurture entrepreneurship and skills in our schools, how our education system can facilitate the sharing of skills, the sharing of experiences, so that young Singaporeans have a less steep learning curve on that journey to entrepreneurship because such skills should not just be the domain of those with prior experience or pre-existing social networks. This is another way we can reduce inequality, grow entrepreneurship, help young Singaporeans to rise up and do well.”
“As a first step, I propose that we establish an expedited fast-track pathway, so that potential unicorns can quickly negotiate an initial public offering (IPO) in Singapore, especially if the IPO brings strategic value with the company, whether it is the valuation, stimulating the local ecosystem, or growing our national prestige, reputation and position. Financial overheads matter. How easy is it for SMEs and start-ups to access credit and funding, especially during the early years of the so-called "valley of death", when many enterprises do not quite make it before taking flight? Can we reduce land cost and rental overheads for businesses? Land has to be priced appropriately, but we can be innovative as well. I call upon the Government to diversify the approach to industrial-commercial land use and leasing. We can have a market for different kinds of leasing models. There is traditional upfront capital expenditure, but there can also be models with discounted upfront costs in return for profit sharing, or even some extent of equity ownership, and that equity could even be conventional or preferred stock. We can have a market of different models to see what works. Mr Speaker, we also need to keep Singapore open to world-class talent. We must be a home – a home where the brightest talent of tomorrow will want to settle down and raise children in, while creating jobs, wealth and opportunities for Singaporeans. It starts upstream. Because when a bright young spark grows up in Singapore, there is that emotional attachment to the little red dot. Sometimes, it is home ‒ home ties ‒ more than any financial incentive that decides whether a company founder keeps that Singapore footprint, even after the start-up goes regional or global.”
“We should increase investment in digital infrastructure and legislate in advance so that Singapore can sustain its reputation of being a safe and reliable hub, hence, becoming the top choice in the region for data storage. With this, Singapore can continuously increase its prestige and influence. At the same time, Singapore should also take advantage of being a first mover and work with neighbouring countries to establish common standards in ASEAN and to establish an ecosystem of inter-operable systems. You can call it One Dot, One Web: "One shining little red dot, One Web of partnerships and networks". Please allow me to continue in English. (In English): The Government has a dual role: minimise risk, maximise opportunity. Both of these help prevent market failure. When we minimise risk, we prevent a race to the bottom. But, if there is too much bureaucracy, too many administrative barriers, it gets in the way of people and businesses racing to the top. So, today, more than ever, the Government can and must be an enabler of opportunity, innovation and growth. That means the speed of decision-making matters. We need to be fast and we need to be able to act fast, especially when speed matters because, in the private sector, in Industry 4.0, a "slow decision" is often the same as "no decision". And if there is "no decision", after a while, it becomes a "no" decision when people take their business and opportunities elsewhere. Mr Speaker, our civil servants and Statutory Board staff work very hard and try their best. So, we must keep on finding ways to empower that Team Singapore to do even better. Can we be better at nurturing and promoting our own unicorns – start-ups that are valued at $1 billion or more? How can we be more competitive on this?”
“On the flip side, quantum-secured communications are also on the rise – sharing information such that eavesdropping can be detected. So, can the Government tell us if we will continue funding research like what the NRF is doing at the Centre for Quantum Technologies? This may seem like "blue skies research", but I see some of this as what I call "blue ocean research" – practical applications and a big harvest for those who can catch the dividends early enough. Mr Speaker, all these elements of a world-class digital data hub are already within our grasp. Firstly, it does not need much land, compared to traditional industry. Our fiscal position is better than many other developed economies. So, the next step is to invest and converge investments, technology, talent, infrastructure, to create that critical mass of opportunities for Singaporeans and for Singapore. Furthermore, by being a trusted, neutral party, a trusted first mover, we can establish common standards in ASEAN with our ASEAN partners, whether it is e-payments, data protection across jurisdictions and so on. Collaborating, learning from each other, working together. We may be a little red dot, but we can help build an ecosystem of inter-operable systems to benefit all stakeholders in the region. You might even call it: "One dot, one web: One shining little red dot, one web of partnerships and networks". Mr Speaker, I would like to continue in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] Mr Speaker, Sir, today, the digital economy is developing rapidly. We should respond appropriately to the situation and prepare early so that we can become a world-class digital centre.”
“We must ensure that Singapore has a strong position in this new digital economic world order. This means good external connectivity, good pipelines for data. That means when we spend on digital infrastructure, we must see it as an investment and not consumption – the same way we invest in the Tuas Port and growing Changi Airport. Obvious next steps for a data hub include machine learning and artificial intelligence (AI). In 2015, the New York Times reported the US Federal Government spent US$1 billion on AI research. South Korea, a similar amount. China, even more. AI can empower many sectors: drug discovery, factory design, service innovation. I propose that the Government invest in an AI technology hub, in the same way that we invested many years ago in building the Biopolis. Because there is strategic value in Singapore maintaining public-sector ownership in AI research, whether it is intellectual property or the insights. Trust and rule of law still matter. So, we must maintain our reputation as a trusted jurisdiction for intellectual property and data protection. Because in the future, when someone sequences all three billion base pairs of his personal genome, who will they trust, where will they trust that data with? This means legislation that is up to date or even one step ahead. It also means investing in better communication security because communication is being disrupted, too. Traditional public key encryption which your "https" and other forms of online secured socket layers depend on – all that presumes that factorising large numbers into individual prime numbers takes a long time, even with a fast computer. But quantum computing is promising to disrupt this, by doing that factorising faster than was thought possible.”
“Secondly, we can also see that, left to the market alone, the structure of an economy evolves bit by bit, stepwise along adjacencies – which means, to transform, there has to be bold efforts by industry and Government. And Mr Speaker, we do need to transform. Because, today, all around, there is disruption and also opportunity. So, how do we get ready for the next 50 years? Looking back, for two centuries, Singapore benefited from geography. Gateway – East and West. Trading port, trans-shipment hub, air hub. But supply chains are being disrupted. Trade routes, many more point-to-point these days. Bespoke and distributed manufacturing 3-D printing where you can build parts next to where they are going to be assembled. In many Western countries, the mood is not so good about trade. And technology continues to disrupt jobs every day. Furthermore, the very idea of economic geography is also being disrupted. Digital data flow is going to create a parallel world economic order, a world economic order that is digital in parallel to existing geography – whether it is collaboration, competition or opportunity. Not just digitising today's businesses, but creating new business models. For example, if you look at life sciences: data science is what turned DNA sequencing into genomics and is what drives personalised medicine, helping patients around the world. E-commerce and retail are more than just going cashless. It is about knowing your customers even better than they know themselves. Artificial intelligence and the Internet of Things will change factories – assembly lines that adapt, maintenance that predicts what parts are going to fail and better quality control. So, Mr Speaker, how do we ride the wave?”
“Mr Speaker, growth still matters because it creates opportunities for young Singaporeans to rise; the means to maintain our defence and infrastructure; resources for fiscal redistribution – for the poor, the lost, the least – to build a more inclusive society. And growth itself can shape inequality. As I shared two years ago in the Budget debate, "When a society is low on opportunity, it is the rent-seekers and owners of old capital who extract profits." But how we grow also shapes how equal a society we become. For example, economist César Hidalgo at MIT has found that countries with higher economic complexity tend to have lower inequality. Some of this is because complex industries need skilled workers and supporting enterprises – which means the workers and SMEs have more stake in a more equitable economic structure. This also contrasts with less complex economies, simpler economies where the income distribution may follow the controlling interests of resource ownership – who owns an oil well, who owns farmland, who owns production facilities. Another finding from Hidalgo's team is that when you study economic structure, you can see how the pattern of exports evolves over time – usually along what they call adjacencies, which means it diversifies towards products which are similar to the existing exports. But what are the lessons for Singapore? Firstly, good quality growth can reduce income inequality. When you have a diverse economy, more paths for people to rise, more paths for workers and students to do well. Everyone building deep skills, everyone having a stake in the workplace, in industry and in the economy.”
“I thank the Second Minister for his reply. I was wondering if LTA so far has received any complaints regarding surge pricing with the new pricing models for rides. Furthermore, what channels are available for members of the public to feed back about private hire platform operators if they feel that the surge pricing has been unreasonable?”
“I thank the Senior Parliamentary Secretary for his answer. I just wanted to raise one supplementary question. In my home visits in Clementi, I have met mothers with special needs children who sometimes felt unsupported by employers. I was wondering whether MSF has plans to engage more directly with employers, including with the human resource (HR) teams, and employees in some workplaces to further increase awareness and understanding of special needs children and the challenges that parents of special needs children face. Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, I thank the Member for the supplementary question. Yes, indeed, as Members can see from the answer, we have been reaching out to all Singaporeans. As I have said, it takes the support and partnership of the public, private and people sectors to make our society more inclusive. With FWAs, we also want to reach out to more to see how we can build not only about having legislation but it is about the heart and mind of our people, including employers, when we want to see and build a community that cares for one another. I want to thank the Member for that suggestion.”
“Mr Speaker, I thank the Senior of State for his detailed answer. Regarding his exposition on enhancing Singapore's connectivity to the rest of the digital world, is there a philosophy to build ahead of demand so that we can keep on seizing opportunities and remain among the first movers? I say this because we could be a key node in the 21st century data world, just as we have been for petrochemicals in the latter half of the previous century.”
“I thank the Senior Minister of State for his answers. I would like to ask whether these studies and frameworks will be forward-looking and include drawer plans and scenarios for technologies that may not have reached the market yet but which would have a significant disruptive impact. I have three illustrations for the Senior Minister of State's consideration. Firstly, what happens when multiple autonomous algorithms interact? What is the impact for competition law if trading algorithms start to collude? Secondly, for example, what are the implications for the criminal law and the idea of mens rea ‒ the idea of guilty intention ‒ when you have AI? Thirdly, would there be a role for more aspirational principles of AI, such as studying, say, Isaac Asimov's Laws of Robotics?”
“I thank the Senior Minister of State for her answers. I was wondering, in terms of cost efficiency, to what extent is the lifetime maintenance cost of a large infrastructure project considered as part of that efficiency, given that these projects may last many years and the design of the project may impact the ongoing cost required to upkeep and maintain it for future years.”
“I thank the Senior Parliamentary Secretary for her answer. Would the Ministry, at some point, as part of the ongoing review of students' socio-economic circumstances, consider conducting such a study in schools, so as to see if students may inadvertently be discouraged from such activities by perceptions that the activities might not be accessible?”
“I thank the Senior Minister of State for his answers. Can the Senior Minister of State assure the House and residents affected that in this study of the upcoming framework, his Ministry will study expedited requirements to remove a bicycle, especially in areas where access is critical? I raise this because my residents have encountered these shared bikes blocking fire exits, wheelchair ramps and other essential parts of the estate, and they are worried that the companies are socialising the costs while privatising the profits.”
“I thank the Minister for his answer. I would like to ask one supplementary question. Can the Minister reassure us that the agencies will be proactive in minimising noise, especially in built-up estates, mature estates, like Clementi? I ask this because I have had residents' feedback that for some developments, especially where there was concurrent demolition going on, large pieces of debris were being broken down on-site rather than transported elsewhere to be broken down, with ensuing noise disamenities.”
“I thank the Parliamentary Secretary for his answer. I was just wondering to what extent does HPB's advice to parents of young children, include the specific reference to burns prevention at home?”
“I thank the Minister of State for his answer. In my interactions with my residents, I have come across residents who have recovered from a previous history of mental illness. They may have had a bout of depression when they were younger. They are now very well but, at the same time, they are afraid that if they declare this information to an employer, it may prejudice their employment prospects. Likewise, I have also met residents who are on dialysis and worry that if the prospective employer becomes aware at an early stage, it may again prejudice their ability to have the job because of the time that needs to be taken out and the flexible work arrangements. What plans does the Ministry have to continue building awareness of more enlightened human resource (HR) practices in the industry?”
“And insurance companies, being profit maximisers, will act in accordance with their business interests and this means that insurers will cherry pick who they want to cover. In practice, this means private insurance companies limiting or even denying coverage to people with pre-existing conditions, especially rare diseases which are present from birth. Again, Mr Deputy Speaker, we see a role for the Government stepping in where the free market is inadequate, or where no private sector player can find a compelling, commercial case to support such patients. Mr Deputy Speaker, as a people, we decide what kind of society we want. In particular, would we want a child with rare diseases to be supported, if that child were our son or our daughter? Would we want the parents to have peace of mind, if the parents were our friends or family? And especially when doing so is a natural progression and harmonisation of existing policies and existing policy philosophy. Mr Deputy Speaker, I was thinking back to my maiden speech in this House in January 2016. I said back then, “We do not choose our parents or when we will be born. So, we must always be a fair and just society.” Indeed, Mr Deputy Speaker, we do not choose our parents. We do not choose the genes we inherit from our parents. And so, we must continue to be a fair and just society – for healthy children, as well as children born with rare diseases.”
“It is a social policy to help Singaporeans from all walks of life, in case of serious illness with catastrophic medical bills, serious illness. Importantly, MediShield Life helps, regardless of whether one is very old or whether one has a pre-existing condition from birth. There is also the Medication Assistance Fund (MAF) and MAF Plus to help patients access new medications which may be beyond their means but which could still benefit the patients. Deputy Speaker, at the same time, no policy is perfect. And when a condition is very unusual, like a rare disease, it sometimes does not fit easily into existing policies. So, what I propose, Mr Deputy Speaker, is for MOH to look at how the Government can extend more support to children with rare diseases. It is a commonsense move and it is not a radical policy shift either. In fact, it is very much aligned with the deeper philosophy that already underpins our current social and healthcare policies. For example, let us look at risk pooling. MediShield Life and other policies recognised the role of pooling risk, of sharing risk within the cohort or the population. It is part of a broader social policy message that when we share risk, when we pool risk, it means no Singaporean has to walk alone. And just as MOH has, over the years, improved coverage for rare, catastrophic illnesses, we can and should find ways to better support children with rare diseases – diseases which are also rare and catastrophic. Because the condition is genetic, because it is inborn, there is no direct moral hazard from providing that extra coverage and support. Furthermore, Deputy Speaker, the private sector insurance market cannot adequately address this issue. Rare childhood genetic diseases are inborn.”
“Even with parallel imports from other markets, the drug cost was reported as about $5,000 per month. Deputy Speaker, what these rare genetic diseases, and similar diseases, have in common are: (a) the condition is rare; (b) the impact is catastrophic; and (c) the need for treatment is not elective. Indeed, treatment is necessary for the child to continue living a normal life. Or in some cases, to carry on continue living. Another recurring theme is that the drugs are very expensive and can be very hard to get hold of. The market is small. So, there are no economies of scale for the producer. The costs of research and development can be very high. There are administrative overheads with registering such “orphan drugs” in Singapore, as they call it, and there is little commercial interest in developing such drugs or making them widely available at a good price even if development is successful by the drug company. Mr Deputy Speaker, the affected children may be few. The affected families may be small in number. But we must not leave behind any Singaporean child. And over the past decade, since the mid-2000s, it is clear that our Government thinking has shifted towards a more inclusive society. Our social policies today include the Workfare Income Supplement, ComCare, Edusave Bursaries and many, many more. Part of a progressive fiscal system where the fruits of progress are shared, especially with the less well-off and the less fortunate. And we can see that the Ministry of Health (MOH) has shifted, too, over the years, as part of what some have called an evolving New Way Forward. MediFund was set up in 1993 as an endowment fund to help needy Singaporeans with medical bills. MediShield Life was implemented in 2015. It is not just an insurance policy.”
“It is a rare disease; some estimate it affects between one in 40,000 or as few as one in 138,000. It affects the muscles, including the muscles of the heart. So, children with Pompe disease have weak hearts, get heart failure and can have difficulty moving or breathing. Without treatment, the classic severe early-onset type of Pompe disease is devastating. The median age at death for children with the severe form of the disease is nine months. Yet, if patients are given enzyme replacement therapy with alglucosidase alpha, a treatment approved by the Food and Drug Administration (FDA) in the United States (US) since 2006, there is a significant reduction in the risk of death of such children of between 79% and 95% reduction in the risk of death. But this treatment is expensive. It has been reported that it can cost as much as $10,000 a week to treat a young child. Deputy Speaker, Gaucher disease is another rare disease, caused by the lack of an enzyme in the body. In children with Gaucher disease, the liver and spleen will swell and swell. The brain and other organs can be affected, too. In the more serious cases, the children can die before the age of two years. There are treatments for Gaucher disease, which work by replacing the missing enzyme in the body. But again, the treatment can be very expensive, with some estimate at over $20,000 a month. Another rare disease is bile acid synthesis disorder and it is very rare, even among rare diseases. Fewer than 50 reported cases around the world, in the international medical literature. But we also have a little boy in Singapore who, unfortunately, has this rare disease. There is a drug available, called cholic acid. But the cost was estimated at over $25,000 per month.”
“Mr Deputy Speaker, I declare that I am a medical doctor in private practice. In a fair and just society, we recognise that people do not get to choose where or when they will be born; that people do not get to choose their parents; that children do not get to choose their genetic background. And today, I am speaking about the challenges faced by children with rare diseases. Each of us inherits half our genes from our father, one half from our mother. Sometimes, a gene is inherited which does not work the way it is expected to. If there is a copy from the other parent which is working all right, the child may still be fine. But in some cases, a child is doubly unlucky and inherits two copies of a flawed gene. These diseases are rare. Very rare. Not much published literature is available on the Singapore experience, but a 2006 paper in the Annals of the Academy of Medicine (Singapore) reported a 13-year experience at the Singapore General Hospital reference laboratory. From 1992 to 2005, a total of 127 patients were diagnosed, although the tests offered did not encompass all known rare diseases. So, even with better technology, better testing and better awareness, the number would still be small. One estimate by patient advocacy group Rainbow Across Borders reported in The Straits Times suggests there could be 2,000 to 3,000 rare disease patients in Singapore. However, even if rare, they can be devastating for a child and worrying for the parents. And even if the disease is so rare that the odds of getting it are 0.001%, for the child who gets the disease, the impact is 100%. Let me illustrate with a few examples. Pompe disease is caused by the lack of an enzyme called acid alpha-glucosidase.”
“I thank the Minister for his reply. I have got two supplementary questions. Firstly, regarding near-misses, would the Minister feel it is beneficial for residents who have been involved in a near-miss to make it known to LTA and the authorities, so that we can draw lessons from such near-misses which may herald more serious incidents in future? Secondly, would the Ministry continue studying or perhaps reviewing whether we should introduce some form of compulsory insurance for device owners, especially where the potential of harm from an accident from that device is higher than other device types? The reason I raise this is because some of my residents are worried that when an accident occurs, there could be a double financial tragedy. The injured party is injured, has medical bills, the person riding the device may be of limited means and unable to provide compensation even if the Civil Court finds him or her liable.”