Tan Yia Swam
Singapore
“Finally, as a follow-up to my Committee of Supply (COS) cut, asking you to help us to help you, do remember not to be prescriptive in the implementation but to guide healthcare workers with kindness and patience as HCSA rolls out in the coming months. The above notwithstanding, I support the Bill.”
“Chairman, I thank Dr Janil for the detailed replies. I have some clarifications. Regarding wellness and beauty salons claiming to offer treatments for slimming and detox, such as fat loss pills and lymphatic treatments to reduce cancer risk: firstly, are these medical treatments? Secondly, how do we recognise misleading claims?”
“I thank both Ministers for the very detailed updates. And honestly, sometimes knowing too much or too little makes people feel helpless over things they cannot control and trigger a lot of anxiety. I have seen a lot of anxious people in the past three years as a clinical doctor.”
“Thank you for the opportunity. Mr Deputy Speaker and the House, I would like to thank Minister Ong for acknowledging the contributions of healthcare workers, especially in the past two years. Three big points. One is that my own term here as a Nominated Member of Parliament is limited and will come to an end pretty much soon.”
“I am so sorry. About the KPIs, one big thing is that, as MOH and various committees talk about KPIs, please remember to involve doctors in the conversation and not be chasing economics – which is more economically viable. Let doctors advise you on what we think are feasible, medical and clinical KPIs.”
“Establishing a good doctor-patient relationship and having mutual trust in each other gives much better patient outcomes and satisfaction. The rise of badly-written Search Engine Optimisation articles is severely detrimental to the doctor-patient relationship. So many articles share half-truths and myths, even fear mongering.”
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“For my own exit interview some years back, the schedule was changed a few times and eventually, it was a new HR staff who met me to take back the staff pass and sign some papers as a formality. I hope MOH continues to engage all stakeholders on a regular basis and take our considered feedback. The Tripartite Committee looking in the welfare of our junior doctors is a positive step. How about other groups? Why are the foreign nurses, who have worked and trained here for years moving on to work in other countries? Is it purely about matching the salary, or struggles with setting up a family and their childcare needs? What are the subsidies available for foreign staff in the childcare centres? I take note that certain kinds of leave are eligible only if the child is a Singaporean Citizen. How may we help them to find a home and be willing to be here long term? Would it be possible to consider offering permanent resident (PR) status for the healthcare worker after one to two years of working here and maybe even extending PR status to the immediate family after a longer period of work, let us say, five years? I do not know. Specialists have raised concerns about the capitation model in particular, will there be funding for complex cases, such as transplants or if a routine case runs into complications? The feedback from senior specialists in restructured hospitals is that, should there be a decrease in the number of complex cases, it will affect the training of our younger specialists. In the long run, we worry that the quality of care will be affected adversely as well as our standing as a leading medical health hub. Finally, I address the elephant in the room – respect for healthcare workers.”
“May I also suggest that we need legislative support, in the event of unexpected complications in trying to implement the changes, for example, in the cybersecurity of electronic health systems, be it the clinic's own records or the national system? I also propose that there should be education and encouragement for patients to take ownership of their own health records in HealthHub and to actively share relevant information with their attending doctor. Why is this mindset important? I, personally, would like some of my medical information to be private. Just, as an example, if I had a previous miscarriage and abortion, mental health issues, I would not like every healthcare worker to know about them. I will choose to inform my attending doctor on what I feel is relevant, or, if they ask, I will question, is this information going to make a difference to my current condition? I value confidentiality and privacy. In conjunction with Healthier SG, let us remember to educate individuals on the importance of personal care and responsibility. Next, manpower issues may not be solved just by hiring more healthcare workers. It is not just the number of staff but the experience of each staff. Losing one nurse with 10 years of experience and intensive care unit (ICU) training, can she be replaced by five new nurses? Look to the retention of staff – for senior, trained doctors to stay in public sectors; for experienced nurses and allied health to want to stay in Singapore. It is good that there are more training and new hires for Singaporeans and for foreigners, but how do we actually retain them? Exit interviews should be taken seriously to evaluate systemic problems or work culture differences.”
“Having a good family doctor provides that strong anchor – to look after you and your family, and in turn, refer you to the necessary and relevant specialists for additional care. In real life, the difficulties and limitations of logistics, insurance panel restrictions and personal preferences will affect the flow of care. I have spoken on the problems with the Integrated Shield plans previously and I am glad to report that there has been some progress made. What other broad challenges exist now for healthcare workers? Three things: one, IT support; two, manpower; and three, the elephant in the room, respect for healthcare workers. Let me elaborate. The newspapers have reported on the national downtime affecting electronic healthcare systems in restructured clusters and this House has had updates from MOH on investigations. As SMA President, I received feedback on the struggles that healthcare workers face on the ground. Complaints and angry patients aside, what we are more worried about is the potential lapses of care, as back-up manual paperwork is done during downtime, and then healthcare workers have to stay back to load the relevant information back into the electronic system. Duplicate documentation – can you imagine how many man-hours are wasted, rather than focusing on actual patient care? As much as we understand the need to make things electronic, most healthcare workers are wary and cautious of the roll-out of the National Electronic Health Record (NEHR). I thank Minister Ong for acknowledging our concerns and recognising the need for good IT support and adequate monetary reimbursements.”
“Mdm Deputy Speaker, as President of the Singapore Medical Association (SMA), I have been involved in some prior discussions on Healthier SG. MOH has been actively engaging the College of Family Physicians and the SMA; and is aware that doctors broadly support this move. We support the shift in emphasis from treating disease to prevention and to strongly support the individual's health in primacy care via the family doctor and community support. I speak now to raise specific concerns and hope that these will be considered as we embark together on Healthier SG. I would like to remind everyone, that we must consider the whole healthcare ecosystem, and not strictly segregate primary versus specialist care, or restructured versus private sectors when problem solving. First, some context and background. I am a general surgeon who has worked in several restructured hospitals, before stepping out to private practice as a breast surgeon three years ago. And, as Dr Lim pointed out about wellness, I am registered as "Breast Friend Surgery and Wellness" because I advocate strongly for prevention of breast cancer. During an administrative briefing many years ago, I once saw patients described as "clients" and doctors are called "service providers". I was saddened and devastated. That is when I decided – I will do what I can to reclaim back the doctor-patient relationship, for all of us. It is demeaning to think of healthcare purely as a business, or a transaction of payment for services rendered. Those of us who have enjoyed good doctor-patient relationships – and I have been on both sides – understand the world of difference it makes.”
“If one has elderly parents who need medical attention, whether in clinic or admission, the barriers to visit are another source of distress. Because of COVID-19, mask-wearing has become a daily necessity. The young are growing up amongst masked faces. There is some scientific evidence showing that this could lead to delayed social developments in young children. The adverse impact of COVID-19 on our nation’s mental health is well reported. I ask for a simplistic solution: consider allowing familial gatherings. Just like how the COVID-19 protocols get streamlined into three, we can simplify rules for interactions and allow people to make their own risk assessments. Allow families to unite once the COVID-19 situation improves, please.”
“Mr Chairman, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Mr Chairman, the saying goes "it takes a village to raise a child". The importance of the extended family has shown itself more obviously in these past two years. In general, many married couples live with their children and pay regular visits to both sets of grandparents. In the past two years, to prevent the virus from spreading, the Government has imposed various restrictions including the size of family gatherings. I believe the majority of families have been compliant. Less family gatherings, less face-to-face contact; phone calls and video conferences have become the norm of communication. Most of the elderly I know are not comfortable with a video call. Uncles, aunts and cousins all form part of the extended family. With the current restrictions of groups of five, there is hardly any chance for two families to meet in public. In my work as a doctor, I see the fallout from this loss of human connections. Many middle-aged people develop cognitive and physical dysfunction. Many reported being more forgetful, lonelier and sleeping poorly, and expressed they fear going out. They miss their children and grandchildren, but do not want to disturb their work. They lose muscle tone, get hunchbacked, unsteady on their feet and tire more easily. Young working parents face the pressures of job, childcare and elderly care. Some have lost their jobs, some in healthcare have worked non-stop without a break for months; and every time there was a school closure, we have to figure out how to adapt. Now, so many school-going children have received the Health Risk Notice (HRN) and need to do daily ART swabs. Not every child can tolerate the procedure.”
“Thank you. I want to thank Senior Minister of State Dr Koh for the reply that MOH will monitor the situation of TPAs. But I have done the research and I am sure that in 2016, Mr Desmond Choo raised a Parliamentary Question and the reply then by Mr Chee Hong Tat was that MOH will monitor the situation regarding TPAs. So, in these five to six years, what have we understood about the situation? May I ask for a more proactive review, including consultation of the professional bodies, so that we can at least better define the problem.”
“Mr Adrian Tan, current President of the Singapore Law Society, shared in a LinkedIn post in December regarding healthcare worker abuse. That post had a wide discussion and engagement from professionals across different sectors. Some, in service industries, brought up denial of service to abusive customers. This is such a foreign concept to most local healthcare workers. But a few friends who have worked overseas have shared that, yes, their hospitals have provisions in place to turn away such visitors. These rare situations are typically for drunks or known drug addicts who come into the Emergency Department, not for a medical condition, but to demand drugs and were clearly abusive, such as screaming, shouting or even spitting at staff. Maybe COVID-19 has, indeed, made it timely for there to be stronger legislation to protect all healthcare workers against bullying and harassment. Please, help us, to help you. Healthcare Workers and Support Staff”
“For a doctor, an SMC complaint may take months or years to resolve, the media may splash a doctor's name across the main page and his or her reputation is ruined, even if found to be innocent later. So, what can be done? The Protection from Harassment Act (POHA) covers only public healthcare workers. It does not allow for immediate remedies to be taken. There must be zero-tolerance of abuse on many different fronts. At the healthcare workers' level, one should have the professional option to terminate the patient-carer relationship after an encounter of abuse, with transfer of care to another provider. At the institution level, there needs to be clear protocols for reporting and management of abuse cases: such as making a Police report, making CCTV evidence available and with calling of witnesses. As a country, we can all play a part to be courteous and kind to one another, to give basic respect and human decency. My vision for Singapore – and even the world – is for us to be kinder, sensible towards and tolerant of differences. Even as the world becomes divided over race, nationalities, vaccine status and so on, as individuals, let us be kind, embrace the Singapore Kindness Movement and practise it in our daily lives. Everyone is going through their own personal hardships, which we may never fully understand. As Minister Lawrence Wong said, let us build a more caring and inclusive society. I applaud MOH’s written response on 10 January that states a zero-tolerance stance towards the abuse and harassment of healthcare workers. I hope that, on the ground, we will see a greater push and enforcement of measures to ensure a safe environment.”
“Two, as a junior doctor, I once had to call a patient’s son to explain why a surgery had to be postponed for a second time – once, due to salt imbalance and once again due to unexpected fever. The son said, "You are lucky I am not there; otherwise, I will hang you, every single one of you". I am certain that many healthcare workers have their own stories of abuse to share. Our professionalism mostly keeps us in check and stops us from posting on social media. And this is why there is such a skewed representation of cases of lapses in healthcare because healthcare workers would do open disclosures when a medical error has happened. Yet, when the abuser is the patient, who can we talk to? Who will believe us? Part of the problem is under-reporting. Healthcare professionals in public healthcare institutions are categorised as Public Service Workers under the Protection from Harassment Act. Yet, many healthcare workers may refrain from making an official Police report. They feel it is just a one-off event, they feel sorry that the patient is sick and not feeling well, or that the families are worried, thereby excusing such behaviour. Another insight is that the type of emotional or verbal abuse that healthcare workers get can be just as elusive as that in an abusive relationship. We may not always recognise it, we just feel drained and guilty after meeting such patients or their families. We are afraid of speaking up, because patients hold the power here – a complaint to the senior management or their Member of Parliament may bring in undue social pressure to give in to unreasonable demands.”
“Mr Chairman, I declare my interest as a breast surgeon in private practice and my role as the elected President of Singapore Medical Association. In recent months, there have been articles in the news and letters to the Forum page highlighting the abuse of healthcare workers in Singapore. Twenty-five months of COVID-19 have placed immense social pressures on every single one of us. But being stressed should not be an excuse for patients to take on abusive behaviour towards healthcare workers or anyone for that matter. The number of harassment cases reported has been increasing yearly, from 1,080 to 1,300 cases. I am glad that there is increasing awareness of this longstanding problem. Healthcare professionals place patients at the heart of all we do and service before self. But when it comes to abuse, it becomes a really difficult thing to express how one feels abused without feeling guilty of being derelict in our duty. If healthcare workers are given the training to recognise it and the organisational support to be able to call out abusive and manipulative behaviours from patients or their families, it will give us all more protection, peace of mind and the strength to keep on doing what we love best. Before you worry that healthcare workers over-react and claim that every patient complaint is an abuse, let me share two real-life examples. One, after a routine, uneventful surgery, on the day of discharge, a patient’s children demanded that the ward staff arrange for daily food delivery to the patient at home because they are all too busy to do so and said, I quote, "if anything should happen, it'll be your fault".”
“Finally, even though my leadership in SMA has a limited tenure, I believe SMA, together with our sister professional bodies, will continue to help in the integration and support of healthcare workers through stronger representation for doctors. My vision is that SMA continues to be the bridge between doctors and patients, doctors and insurers, doctors and the Government, to achieve an equitable healthcare ecosystem for doctors and for patients. COVID-19-related Manpower Recruitment”
“As president of SMA, I have received feedback on what sounds like grossly unfair reimbursements by TPAs. Several have claimed consultation fees may be as low as $6, but they are bound by NDAs, so I do not have more information. Most TPAs often have limits or caps on medications and some GPs have taken the loss on themselves if they want to provide an adequate course of medications for the patient, for example, the duration of antibiotics. This may result in a compromise of good patient care when doctors are not adequately reimbursed. Payments may be delayed for as long as six months, causing cash flow problems for a small practice. The ongoing Fullerton case reported in The Business Times in January this year left some doctors wondering if they will ever receive their fair pay. GP clinics meet 80% of the primary care demand. They are our first line of care for the community. GP clinics are not just sources of income for doctors, they are also places where nurses and administrative staff are gainfully employed. TPAs may be the main source of income for many private clinics and I fear that the livelihoods of many will end up being held hostage to the unilateral pressures of the larger and financially stronger TPAs. We should not allow the livelihoods of private healthcare workers to be lost in the name of turning a profit. In reply to a supplementary question I asked in August last year, Minister for Manpower Dr Tan See Leng replied favourably that there can be increased education to workers on the use of EB versus IP plans, a relook at how TPAs and EB plans are administered, with a need for multiple stakeholders to be involved. I ask for MOH and MOM to consider this in the year ahead.”
“Some patients would go by friends' or families’ recommendations, some ask their GPs, some would check their Shield Plan panel list, some would google and do their own research – but some, some would use concierge services. This is where things get tricky. I do not have any access to contracts and only a few colleagues have told me in confidence about how these work. Such services may be marketed as free for patients, but doctors have to pay a referral fee, which may be a percentage of their usual professional fees. In addition, it is said that doctors on such contracts are asked to restrict referrals to other doctors on such concierge contracts, thereby restricting patient choice, which is against the concept of patient autonomy. I know that the SMC Ethical Code and Ethical Guidelines (ECEG) has clearly stated that fee-splitting is wrong, but the ECEG applies only to doctors. The onus is on us to be aware of the fees and not to fall foul of our ethical code. But are the contracts transparent? Do we understand market forces? Some say that one simple solution is for doctors to refuse to sign any TPA or concierge agreements. But it may not be possible for a doctor to refuse to sign on any of these, depending on the location and model of their practice. A robust private sector complements the restructured services. The unity of the various healthcare sectors in rising up to the unprecedented challenge of COVID-19 is a matter of public record. The private primary care sector has answered the call of MOH, in the Public Health Preparedness Clinics and Swab and Send Home clinics. As awkward as it is to talk about money, fair reimbursement is necessary for a sustainable business model.”
“Mr Chairman, I declare pecuniary interest as a breast surgeon in private practice and as the elected president of Singapore Medical Association (SMA). Last year, I spoke on the difficulties faced by patients in the fair utilisation of their Integrated Shield Plans. I am glad that the Multilateral Healthcare Insurance Committee (MHIC), of which I am a member, has made some progress in this area over the past year. Today, I would like to share my views on the limitations of Employee Benefit (EB) plans, also commonly known as corporate insurance, or company insurance; the influence of Third Party Administrators (TPAs) and concierge services. These last two arose out of an apparent need to provide a gap in services and, like any other businesses, they charge. But how do they charge, who do they charge and who regulates them? To give the background, healthcare economics is incredibly complex, with seven Shield Plan providers, multiple types of insurance products, numerous insurance companies offering EB plans, private hospitals, day surgery centres, close to 2,000 private specialists, 3,000 GPs, multiple radiology centres and labs and all with different business models. TPAs and concierges are, perhaps, the natural result of market needs and forces. For any company offering health benefits, the administration needed to manage employees’ healthcare claims may be deemed too tedious or not cost-effective to be done in-house by their Human Resources team. Therefore, TPAs are engaged. In the most idealistic form, concierge groups help patients to find doctors suitable for their conditions.”
“And since Primary cohorts are also comparatively larger than Secondary cohorts, it also makes sense to balance out the inflow of students headed to schools in the morning. While delays for upper Primary and Secondary school students will, undeniably, alter traffic patterns, its contribution to the overall morning rush-hour jam is likely to be somewhat limited. The half-hour delay for half the Primary cohort would likely add a limited number of additional vehicles to the road, seeing that many upper Primary school students would already begin travelling to school by public or private buses by then. Moreover, these buses would, in any case, begin their pick-up rounds between 7.00 am and 8.00 am, well before typical work start times. And as more Secondary school students already know how to travel to school independently by public transportation, their even later start time will also likely have a limited impact on traffic patterns. Indeed, with more parents working from home or exercising flexible work schedules in a post-pandemic world, it could easily be the case that any anticipated increase in rush-hour traffic be offset by the reduction in working commuters. The staggered school start times could also carry a tangential logistical benefit. Schools currently often face jams during arrival and dismissal times, with roads surrounding schools ensnarled by traffic. This is an isolated but genuine problem as those of us who have received complaints from residents living near schools would well understand. Staggering school start times could reduce the incoming traffic by as much as a third, which would help alleviate this morning school rush-hour crunch. Through-train and Self-initiated Learning”
“Many credible studies have shown that affording adolescents additional sleep can have yielded payoffs in terms of improved behaviour, health and academic outcomes. This is even so, with a relatively modest delay of just half an hour or so. More importantly, the reality is that students are already experiencing sleep deprivations from the status quo. One study placed this proportion at a staggering 80% of Singaporean teenagers hailing from high-ranked schools. Think of all the marginal steps that parents take – the additional hours of supplemental tuition, the move to a neighbourhood closer to a preferred school, the endless bottles of essence of chicken. And it strikes me as failing to pick the lowest hanging fruit when we look at more expensive and intrusive educational interventions but neglect this relatively simple one. As for the second assertion, I am sure that we will all agree that we should not be compromising as important an outcome as student performance simply in favour of one of logistical convenience. My proposal today is simple. Delay upper Primary school start time by half an hour and Secondary school start time by an hour. For schools currently starting at 7.30 am, the earliest start time at the moment, this would mean a meantime of 8.00 am for the Primary cohort and 8.30 am for the Secondary cohort. While I am not suggesting any strict guidelines for post-Secondary levels, it is reasonable that ITEs, Polytechnics and Junior Colleges start even later, at 9.00 am. The additional half hour for upper-Primary students is consistent with how sleep phase delay may occur as early as the onset of puberty and also, certainly, by the time that they are teenagers.”
“I have met older teenagers holding part-time jobs and doing their part to pay for their schooling. I have also met people in their 40s, who still need to ask their parents for all decisions, because that is how it has been their whole lives – to check with their parents. Personally, I see that my role as a mother is to provide for them and to teach them to be the best they can be. I cannot be around for them forever. So, I need to teach them to be independent. I know it is hard, but we have to let our children make their own decisions and accept the consequences of their actions. This may start from the playground, to allow them to climb and fall- while we stand ready to catch them, rather than forbid them to climb at all. Fellow parents, let us stop pursuing the perfect checklist, and truly enable our children to be ready to face the challenges of the real world. Staggered School Start Times Assoc Prof Jamus Jerome Lim (Sengkang): Sir, this House has previously debated the possibility of later school start times. Those in favour have cited evidence, which was compelling in my view, that phase delays in adolescent Circadian rhythms predisposed them towards sleeping and waking later, typically by about two hours, although some, like my sister, appear to have never grown up and exited this phase. The counter arguments are often two-fold. First, that any delay would simply mean that students go to bed even later and, second, that such delays could give rise to disruptive rush-hour crunches. The first assertion, as it turns out, is one that is weakly supported by evidence. Students who have later start times sleep longer, with bedtimes that either remain unchanged or delayed by a smaller amount than the additional time afforded.”
“Mr Chairman, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Mr Chairman, I have two kids who are in Primary school. Parents all want the best for our children, and we may have different ideas of what is "best", and have different levels of means to provide. Some people send their children for enrichment classes, some assign their kids chores at home. Whatever method is used, there’s generally more awareness now to teach life skills and resilience. There have been many positive changes in our formal education since when I was in primary school. There is more structured learning, and improved communications with parents. There are great resources on the MOE website on social and emotional learning. But theory is just the beginning, the challenge is in the real life implementation. How may we truly teach emotional wellness and resilience: that it is okay to not be liked all the time, that it is okay not to be perfect. How does one teach children to think for themselves, shrug off failure, handle disappointment, and to have the strength and courage to keep on going. I want to register my thanks and appreciation for school teachers and educators of all levels, who have been working doubly hard in these COVID times, to provide face-to-face lessons, and to also standby for home-based learning, in addition to doing safe distancing measurements. I am thankful to them for keeping such a close eye on our children. Parental involvement is essential to a child’s educational journey, but I have to constantly remind myself not to solve every problem for them. In previous speeches, Mr Tharman spoke on how Singapore parents must evolve, and avoid the trend of helicopter parenting.”
“Not just to the different branches in the judiciary, but also across the people. Let them call for accountability and transparency in the organisations they work with. Let organisations regulate amongst themselves who are the right people to seek sponsorships or volunteer work from. Let safeguards be what they are: limited protections for the worst case scenario, not pre-emptive strikes against people who may be just trying to do the right thing. Quoting the MINDEF website, Total Defence involves every Singaporean playing a part, individually and collectively, to build a strong, secure and cohesive nation. The six pillars are military, civil, economic, social, digital and psychological defence. In this digital age, foreign interference is no longer a problem that should only be left to the Government to guard against. Every citizen should be empowered to step up to be vigilant and to hold one another accountable. I believe that public education is essential. An educated population will be able to better discern right from wrong, facts from myths. Before this Bill is passed, I ask the Minister to give us some assurance on the appropriate use of FICA, so that ordinary citizens like myself can serve and work for the betterment of Singapore, without undue fear.”
“This brings me to my first concern that we need to leave some space for people to participate as active citizens in shaping our future. Desiring to influence public opinion or decisions is part and parcel of advocacy. Increasing reporting requirements opens up a small organisation to potentially being targeted and increases the barrier for a citizen who wants to participate and contribute, or just to simply air their views. Ground-up initiatives may think twice. My next concern is about how Singapore relates to the wider world. The Bill empowers the Minister to direct a person to account for all donations, possibly return donations and even stop taking volunteers who are not Singapore Citizens. I feel this is unrealistic. Singapore is an open country with organisations forming many collaborations, especially NGOs that might need the scale to ensure that their services are accessible to others. It seems impossible to expect that people should be deterred from seeking sponsorships beyond Singapore and also that volunteers and manpower should only be limited to Singapore Citizens. Singaporeans may, ourselves, shy away from working for NGOs for fear of being unwittingly implicated, real or imagined. I would like to believe that for every malicious person out there, there are way more well-intentioned people who want to support Singapore in its growth, not hinder it. But this requires a lot more trust and faith in the people to do the right thing. This Bill equally asks for a lot of trust and faith in the Minister to do the right thing. There is great discretion given to the Minister on how to exercise the extensive powers under the Bill. It is a lot of power in one man’s hands. How can we protect it from future abuse? Could it be spread out?”
“Arresting a human agent with proof of radicalisation or obvious threats to the stability of Singapore is easy for us to accept. But in the modern world, it is scary to learn that modern threats can be subtle, through social media, bots, ads, sponsored articles and posts to erode trust in the Government and take advantage of social fault lines and sow discord. This is a real threat, and we, as a nation, have to learn to defend ourselves against these threats. Where my opinion differs is how best to tackle it. The Bill grants extensive powers to the Minister to enforce and regulate anyone or any organisation with an online presence, from the content produced down to the operations. While this may scare off the malicious, I am afraid that it may also scare away people who are genuinely interested in improving our nation. How can we recognise the difference between an activist for human rights from one whose motivations are political in nature? I list three key concerns: one, regulating and restricting the political space further may deter genuine individuals; two, organisations may want, or even need, collaborations and support with other foreign entities to survive and thrive; three, the Minister will be granted extensive discretion, in addition to existing powers under ISA and POFMA. Section 8 provides a very broad definition of what activities "directed towards a political end in Singapore" means. This is of concern as any organisation engaging in such could be designated a Politically Significant Person under Part 4 of the Bill and will be subject to multiple additional requirements, such as the reporting of foreign donations and being subject to declare, and may be directed to stop taking in foreign volunteers.”
“Mr Speaker, Sir, Members of Parliament, preparing to debate on the Foreign Interference (Countermeasures) Bill was a challenge. I am a doctor. I do not know much about espionage other than what I read from newspapers or see in James Bond movies. I had not intended to speak, until a few doctors and the Singapore Medical Association (SMA) staff approached me privately and separately to raise their concerns. So, how could FICA affect those of us in medicine? Firstly, many doctors volunteer or lead various NGOs, mostly on medical and humanitarian missions, but also for social goals. Some doctors have patients who are political officeholders in other countries. SMA is part of the Medical Association of South East Asian Nations (MASEAN), Confederation of Medical Associations in Asia and Oceania (CMAAO) and the World Medical Association. SMA also works closely with MOH on local healthcare decisions. As many of you here would know, Dr Poh Soo Kai was one of the founders of SMA and served as its first Honorary Secretary from 1959 to 1961. He was also arrested and detained without trial during Operation Coldstore in 1963 and under the Internal Security Act in 1976. I was born in 1980 and grew up without much knowledge of such matters. What is past is history and I do not question it here. My being here now, as a Nominated Member of Parliament and being the current President of SMA, has made the wearing of multiple hats complicated. I state for the record that I speak now, as an individual, to seek clarity on the intent, and the extent of FICA. I agree that there should never be foreign interference in a country’s politics. As an ordinary citizen, I have remained blissfully unaware of how threats to Singapore have manifested, except for what is reported in mainstream news.”
“I want to thank PSP for sharing its survey on 700 people and sharing some of the ground sentiments. In healthcare, we actually have problems finding nurses, clinic assistants and radiographers for these trained jobs. So, I am just wondering could there be a mismatch of trained Singaporeans in getting these jobs? And I hear a lot of concern over foreigners and foreign talent. I would like to ask the PSP, what do you think of Singaporeans working overseas? In a global economy, I would think that there will always be flow of people, crossing nations for jobs, so would our Singaporeans working overseas then be discriminated against as foreigners?”
“I thank Dr Tan See Leng for the reply. I would like to ask two supplementary questions. One is, there is some confusion on the ground, among friends, lay people and even some doctors, between insurance plans for Shield plan versus employee-benefit types of plans. Is there a way to better educate our people on what exactly these different insurance covers are? My second question is: as the Multilateral Healthcare Insurance Committee (MHIC) is reviewing problems with the Shield plan providers and doctors, will there also be a way to relook how third-party administrators of employee-benefit plans could be better regulated?”
“That cannot be achieved with fear incited to make sure we are safe, but with a more nurturing approach to ensure that everyone unites to stay safe together. Let us work together to create a healthy and happy Singapore.”
“We need to take control of how we take and manage risks. While the vaccination target is a good one to have, it is not clear if we will shift out of Phase Two (Heightened Alert) once it has been hit. The pandemic is uncertain, but citizens will benefit if milestones have been set and we keep to them. We need the Government to be able to trust us to do the right thing. No one wants to fall sick. No one wants to be the one responsible for the next outbreak. The so-called KTV cluster: what exactly happened at these places? Do the patrons and hostesses understand how COVID-19 is spread? Is there a medical indication to perform urethral, vaginal and anal swabs to look for viral shedding? At the fish port and wet markets, likewise, what is the root cause of the spread? Could it be a simple barrier breach because their masks got wet? By understanding the route of transmission, only then can we educate each other on how to minimise risks. These are some of the basic safe tips I know: wear a dry surgical mask; practise good hand hygiene; do not touch your face; keep a physical distance. Reactive shutting down of all services causes suffering to many while the important lessons are not learnt. Prescribing group numbers without sharing the principles of these decisions will not help people make better decisions about their health. Give us some simple rules, with simple reasons why and let the people make that choice and trust that we can make the right choice. As much as health and safety is of utmost importance, the body is not the only thing we have. We must make sure that the mind, the heart and the body are all healthy together.”
“Not being able to dine in, not being able to meet people face to face, it takes a toll on the mental health of our people. In the past three years, the number of Police reports on physical assaults was the highest in 2020, despite us being supposedly prevented from coming into contact with each other. Acts of racism, violence and self-harm are on the rise. What I see is the hurt from these people. Hurt people hurt themselves and hurt others. We cannot deny that we must stay safe to protect our loved ones. But we also cannot deny the strain that the pandemic has put on us, whether physically, emotionally, financially and our inability to reach out to connect with others. It will soon be reaching two long years in our battle against the pandemic. We need to be able to support one another, especially to destigmatise mental illness and channel more support towards avenues where people can reach out and ask for help for their mental health. Members of Parliament, a recalibration is required. The MTF described a future where Singapore would be in endemic mode on 24 June – but it has been a month and here we are, managing the virus in pandemic mode. With sudden changes, a lot of back and forth in the measures, with no sight of whether things can get better or how decisions are made, sometimes it feels like we are always having to shift and having to suffer. Money is only a stopgap to some of the issues we face. Grants can only do so much to help businesses recoup their losses, or for people to regain their jobs and their dignity. We need to find a new, sustainable balance between preventing risks to our physical health and preserving the delicate fabric that holds our society and our economy together. We cannot keep chasing the wind.”
“This is an invasive, deep nasal swab that has been performed on construction, marine, maritime, manufacturing and migrant workers residing in dormitories on a regular basis since mid-2020, recently, implemented on inpatient healthcare workers. Inpatients and visitors also do a less invasive nose swab – the Antigen Rapid Test (ART) – before they are allowed entry to hospitals. The costs are not only financial, but to the health of these people. MOH has replied that there are few reported adverse effects, but there are adverse effects nonetheless. I encourage the Ministry to do a survey and to provide support for people who have suffered adverse effects from the deep nasal swabs. The professional bodies may be able to assist in such a survey. Deep nasal swabs should perhaps be used as the gold standard diagnostic test for the high-risk in a population, namely, identified potential clusters rather than be used for baseline screening in RRT. With promising developments of less invasive methods being used for testing, notably the saliva-based tests, breathalysers which some of you have tried out before the Parliament Sitting yesterday, I wonder if the implementation of RRT could be revised to include these less invasive but adequately effective testing methods. But ensuring physical health is not enough. While the Ministries have worked hard to ensure that everyone is physically safe, it comes at the cost of mental health. At the national level, I believe this manifest as the fabric of society. We see it last week, as we shifted back into Phase Two (Heightened Alert). As a nation, we just inched out of our shell, only to scoot backwards hurriedly. No man is an island.”
“Mdm Deputy Speaker, it has been a year and a half since the COVID-19 outbreak started in Singapore. In his speech on 5 July, Minister Lawrence Wong addressed how the Government was looking to support the population through the outbreak, namely, addressing the measures to take care of the health of the population and the financial support provided to individuals. I thank the Minister and the rest of the Multi-Ministry Task Force on their hard work in fighting the pandemic and their care of the health of the citizens, especially in light of the two massive clusters. The various Ministerial Statements yesterday have been reassuring in answering some of the concerns I had over recent developments. However, as we consider and debate the health of the economy, as a healthcare professional myself, I want to talk about the health of society. What kinds of health? I am talking about physical health, mental health and emotional health. In this pandemic, I do not deny that the physical health of the people is a priority and we want to ensure that Singapore, to the best that we can, is COVID-19-safe as we push for greater vaccination rates. Yet, there might be better ways we can ensure that the society is safe, without measures being overly taxing on the people. Rostered Routine Testing (RRT) that has been implemented is an extremely resource-intensive task. As we debate on the financial support being spent to help affected individuals and companies, we should also ask: has our spending to ensure that the population is safe been effective? To date, there have been more than 13.6 million PCR swabs performed as part of the RRT, and a large part was for RRT, which has picked up a small handful of positive cases.”
“Mr Speaker, thank you. I want to thank Minister Gan for acknowledging the dutifulness of the staff and all of Tan Tock Seng Hospital (TTSH). I am married to a TTSH staff and many TTSH families are now made to live apart to reduce risk to other hospitals, to better support the needs of Singaporeans. But I am concerned about possible on-going community spread. Would there be a consideration to make it compulsory to swab all patients visiting a hospital, whether inpatient or outpatient?”
“For example, walking 10 minutes to the MRT station and another 10 minutes to the workplace. This makes up a total of 40 minutes' walking time and one may clock 8,000 to 10,000 steps, hopefully. The lack of commute while working from home means a reduction in mobility. Some of us snack more. For those of us who like to chat over coffee or lunch at the office, working from home also results in less social engagement, which may lead to chronic health issues such as obesity, depression and anxiety. What are the Ministry's plans to support Singaporeans to pursue healthy habits in this new norm?”
“For many of the patients with mental illnesses, it is a lifelong disease, and some of the triggers may be related to socio-economic stressors. Young patients with mental health may just be the tip of the iceberg, and further investigation may uncover more members of the family with mental health issues. They will all need to have adequate treatment. Community support has to come in hand in hand with doctors in the hospital to provide integrated care. The network of support is essential to minimise the episodes and severity of relapses. Focus cannot be just on the acute admissions, but in discharge back to the community, gainful employment and meaningful living. Finally, vulnerable groups such as singles, single families and elderly staying alone may be at higher risk due to social isolation and lack of access to resources. Does the Ministry have plans in place to help these groups? In summary, the global COVID-19 pandemic has caused increased stress in multiple areas – retrenchment, change in jobs, lifestyles, education. This has a far-reaching impact on interpersonal relationships, physical and mental health. I urge MOH to further develop programmes on mental wellness and building resilience as a routine part of daily life. Staying Healthy in the New Norm Many people are now working from home due to COVID-19. Other speakers have shared on the challenges that parents with young children face working from home. While some adults have managed to incorporate daily exercise into their new routine, many others are struggling to balance work, daily chores and the demands of family care. 4.45 pm For many busy working parents, the daily commute to work and back home might be the only exercise they get.”
“Exploring one’s sense of identity as a growing teenager has never been easy. Being in a more connected world now, they are perhaps subject to more pressures. As a doctor, I have received ground feedback that there is a mental health crisis in our youths – child psychiatrists observe that youth suicide is at its highest rate in the past couple of years. Contributing factors may be increased parental conflicts and divorces, academic stresses, COVID-19, social media and bullying. How do we recognise and stop bullying of any kind – physical, emotional, verbal? In my Budget speech, I brought up the modern phenomenon of cyberbullying and the amplification effect of social media. A short video clip gets shared, liked and goes viral. Shaming gets weaponised. When I was a child, any once-off silly act gets forgotten, and maybe brought up only at annual family gatherings during Chinese New Year. But now, the Internet never forgets. Suicide is a painful and difficult subject, as there is a taboo around this. But this is exactly why healthcare has to educate and teach about the mental health issues that contribute to this tragedy. Let us guide our people to be more caring, and inclusive. How do we approach those who are different? Mental resilience, sleep hygiene, and the safe use of the Internet should be taught in schools, and to adults as well; to be given as much importance as physical exercise! I thank other Members, as well as MOE for addressing this, and welcome the changes to CCE. However, after we succeed in early detection, are there enough healthcare providers to render help? We will need enough psychiatrists, psychologists, nurses, pharmacists, medical social workers, case managers, family therapists and so on.”
“Yes, Sir. Mr Chairman, Sir, the COVID-19 Mental Wellness Taskforce convened by the MOH and the IMH in October 2020, with representatives from various Ministries has done great work in promoting mental health literacy. Yet, I hear of anecdotal cases of discrimination against people who have mental illnesses. I will speak on three main groups: one, the general population and working adults; two, the young; three, other vulnerable groups. For the general public, how do we react when we see someone behaving “oddly” – such as talking to themselves, removing all their clothing in public, becoming violent for no apparent reason, or wailing inconsolably? Do we take a video and post the incident online? Call the Police? Walk away? Or will we step forward to offer some kind of help? I suspect many people want to, but we do not feel able to. For working adults, I understand when colleagues and bosses see only the underperformance of the affected employee. For example, frequent absenteeism, missing work deadlines, or simply being very unsociable at work. Physical illnesses such as high blood pressure and diabetes, have a measurable scale of normality. Mental illnesses are harder to pick up. Is someone just having a bad day? Is it triggered by something specific and situational which will resolve itself after the event is over? Or could these bad moods be symptoms of a mental illness such as depression, anxiety disorder or even schizophrenia? We need to have more schemes in place for the general population to recognise early signs of mental illnesses and learn how to assist as a first responder. Regarding the youth, the world is changing fast. I am only a few years past the official definition of "youth", but there are times when I feel very distant from them!”
“I raise one specific and very common example in my field: a healthy lady in her 20s with no family history is offered a free health screening when she signs up for an IP, including ultrasound of the breasts. This picks up a 3-mm nodule, too small to categorise. This lady is then informed that she will be excluded from breast cancer coverage. Thereafter, there is a cycle of her agent asking her to see a doctor, the doctor telling her it is likely benign and can observe. The agent may then ask for a memo to state that she does not have cancer. I have met patients where they state that the agent has asked them to pay for the surgery themselves to remove the lump, and then appeal to be covered. As a breast surgeon, I do not know how to help this group of affected women. There are no good medical indications for any of these. In summary, escalating healthcare costs is a complex problem, and the medical professional bodies are ready to be part of the solution through honest, open discussion. I call for increased transparency and accountability of insurance companies and their agents. MOH and the SMC scrutinise doctors. Who is scrutinising the other players in the healthcare costs equation? Raise IVF MediSave Withdrawal Limits”
“At the superficial level, it would appear that there is nothing wrong with this because it is the patient's choice and it is good to be prudent. However, there is an externality cost, when IP holders choose subsidised wards in the restructured hospitals when they fall sick. The consumption of these Government subsidies are indirectly subsidising the insurers' IP businesses and depriving patients-in-need of more subsidies, since MOH's budget is a finite thing. These Government subsidies would not have been consumed had the patients chose what they were entitled to, to be treated in the private hospitals or in A or B1 class wards. Another important corollary of this unusual phenomenon is that it further lengthens the waiting times for subsidised services in restructured hospitals. I think it is important that we study this "voluntary downgrading" phenomenon so that we can ensure that the IP environment today is functioning faithfully to the original policy intent of IPs. Also, what is the desired proportion of Singapore residents who should buy IPs. Is it the current 65% to 70%? Or below or above this range? I do not know the correct figure, but with a private sector market share of only 30% to 35%, including B1 and A class beds in restructured hospitals, the corresponding figure of 70% of the population having IPs sounds rather high. Can the private sector support the needs of this 70% if all of them who fell ill chose the unsubsidised services they are entitled to under their IPs? I have a few patients who themselves are insurance agents, and they realise they do not quite know what they are covered for. Are all insurance agents well trained and up-to-date about the products they are selling? Are the medical underwriters also keeping their medical knowledge up to date?”
“More specialists will want to be empanelled with this IP provider and I will have a wider choice. If my IP insurer does not pay the specialist fairly or adequately, how would the doctor feel? We can use the MOH fee benchmarks as a good guide for this. How does each IP provider pay specialists for procedures? Does a certain IP insurer pay up to the higher limit of the benchmarks, or the lower limit, or up to the mid-point? Or does this IP insurer reimburse at rates that are even lower than the lower limit of MOH fee benchmarks? It should be a warning sign to policyholders when an IP provider pays doctors below or only at the lower limit of the MOH benchmarks. I think the regulators of IPs, which are MAS and MOH, can obtain the answers to these six questions from IP insurers and present them in a tabulated and easily digestible form that members of the public can refer to when they make their decisions on which IP to buy. This will advance the cause of patient education and empowerment. A more difficult but important policy question to ask is what proportion of Singapore Residents should buy IP. The combined market share of private hospitals and A class and B1 class beds in Restructured Hospitals is estimated to be in the range of 30% to 35%. Yet the proportion of Singapore Residents buying an IP is nearing 70%. This is an unusual phenomenon in the running of a health insurance system. In the normal scheme of things, healthy insurance policyholders subsidise policyholders who fall sick and make claims. But in our IP environment, the business of IP is cross-subsidised not just by those who do not fall sick, but by those who fall sick and yet choose to be treated at subsidised B2 and C classes in restructured hospitals when they are entitled to more under their IPs.”
“I must admit I am ill-equipped to answer these questions. I myself am insured with an IP, but I must confess that when I bought it many years ago, I did not make a detailed comparison of the various IP providers' offerings, but trusted my financial advisor's recommendation. Close to 70% of Singapore Residents buy IPs. So, IPs affect the majority of us living here. It is therefore important that Singaporeans are adequately informed upfront by the various IP insurers before they make a decision to buy an IP, or before they make a decision to switch IP providers, since IPs are bought annually. I ask myself, what would I like to know before I made a decision to buy a certain IP or not. These are the most important questions that will make me choose one IP provider over another. One, what are the premiums for me now and when I get older? Two, what are the benefits and claim limits of each plan offered? Three, what percentage of private sector specialists are empanelled by a certain IP provider? Four, does the IP provider allow me to go to any private hospital in Singapore? Five, are all restructured hospital specialists automatically empanelled? Six, how does the IP provider pay specialists; does it follow MOH fee benchmarks? I realised that other than the first two questions, information was difficult or impossible to obtain for me to make an informed decision on which IP to purchase. Questions about empanelling are important because ultimately, it is about choice. The IP provider that offers more choices is more attractive to a potential IP customer. The last question about how IP insurers pay specialists is important in an indirect way. A system that reimburses private sector specialists adequately is more sustainable and better for me as a policyholder, in the long run.”
“Since then, the benchmarks serve as a guide on how doctors charge. Patient health-seeking behaviour also affects costs. When people fall sick, how do they choose their care? Just take a panadol and rest? See a General Practitioner? See a TCM physician? Do they go to a polyclinic, the emergency department or straight to a specialist? Finally, how are insurers involved? Patients factor in financial costs when they need to see a doctor. Some will go only to their company doctors based on their corporate insurances with no need to pay out of pocket. When they need to have hospital admissions, day surgery or major operations, that is when their Integrated Shield Plans will come in useful. In my Budget debate speech, I highlighted the importance of shared decision making in healthcare. We are in the age of patient empowerment. This has been so for quite a few years with an increasingly better educated population. The Judiciary has acknowledged this trend when they introduced the Modified Montgomery Test and the understanding was reinforced by this Government when the Civil Law Act was amended last year. Patients must be adequately informed before they make a choice on the medical care that they want to receive. I am all for this and medical practitioners here have been making adjustments in the way they practise, in order that patients are better informed and empowered. Likewise, insurers need to share more information and allow their clients to make informed decisions. From time to time, I get asked by friends and relatives about health insurance, especially Integrated Shield Plans or IPs in short. These questions include – which IP provider is better, and which IP plan provided by the provider is more suited to my needs?”
“Mr Chairman, Sir, I need to first declare conflict of interest as a general surgeon in private practice, with an interest in breast surgery; and my role as the elected President of Singapore Medical Association. Escalating healthcare costs is a concern for many governments. In Singapore, this has gained much attention recently with questions raised by the public on private insurance agents. In truth, managing healthcare costs is a complex problem. Learned economists have studied it, and there is no simple answer. I see a need for everyone to be part of the solution. I list five key factors: (a) advances in technology leading to better quality of care; (b) healthcare facilities costs, (c) doctors' fees; (d) patient health-seeking behaviour; and (e) insurers. As research and experimental trials become validated, the advances will be accepted in mainstream clinical practice. One simple example in my field – 30 years ago, most breast cancer patients had to accept a mastectomy, and the resulting change in appearance was unacceptable to some. Now, patients can opt for nipple-sparing mastectomy and immediate reconstruction which allow the patient to regain a physical appearance which is similar to her normal. This means a better outcome for some patients, but clearly, increase costs. Who monitors the costs of the private healthcare facilities? As a patient, when I receive the itemised bill, how do I know which of these items are reasonably charged, and which are not? Doctors' fees have often been blamed as the main source of increased costs. How true is this? Historically, SMA had a guideline of fees since 1987, which had to be removed in 2007, as it was deemed anti-competitive. MOH announced in end 2017 that fee benchmarks will be implemented.”
“While I recognise the need for the Budget to focus on jobs and re-building the economy, I hope that we do not neglect to nurture the softer aspects of our society, to unify and build social cohesion – only then, can Singapore "Emerge Stronger Together". [Applause.]”
“We classify people by race, religion, nationality, physical appearance, intellectual ability, mental illness, gender identity, sexual orientation. We tend to identify with those whom we feel are "same", and feel that those who are different are just "not one of us". I do not have a global solution – all I can do is to teach my kids to be kind, to think before they speak, and not to fear those who are different. Charity starts at home. Every parent wants to teach their child the right values. How can we, as a Government, best support this? I am hopeful that Singaporeans and those staying here will continue to care for each other in this COVID-19 recovery period. Last year, in the initial weeks of COVID-19, the healthcare community was very heartened by the generous support from many groups. Our frontline healthcare workers, particularly those in the restructured hospitals received gifts and care packages, such as coffee, chicken rice, chocolates, vouchers and thank you cards. I support the Government's Arts and Cultural Resilience Package: doctors heal the body, religious leaders heal the soul; the arts heal our spirit. The Arts is without boundary and can communicate to all people. The Singapore Medical Association started an Instagram hashtag #sgartforhcw which allowed people to share their support for healthcare workers through artwork. Many heartwarming reports surfaced on social media of neighbours helping each other and even random strangers showing kindness. I hope that we will all continue this spirit of caring and I urge the influencers on social media to use their power to keep this flame going strong. Let us all be decent, be kind, and do the right thing.”
“I am in the generation who grew up before the Internet and came of age when the Internet became widely accessible. I read with horror about cyberbullying and I am dismayed at how vicious online and often anonymous comments can be. Minor incidents sometimes get blown out of proportion by thoughtless, insensitive comments. Cyberbullying, internet trolling is an ugly phenomenon in our modern world, for which many of us have no protection against. My eldest child is starting to explore the world wide web. As parents, we have done our part to restrict settings, and so on, but we cannot protect him forever. We are learning so that we can equip him with knowledge on how to protect himself and not get hurt too badly. A previous written response stated that reported cyberbullying incidents remain low over the past three years. I note that it is "reported incidents" and wonder how many unreported ones could there be? While the Protection from Harrassment Act and the Protection From Online Falsehoods and Manipulation Act (POFMA) exist, the average citizen may just fume, rage and cry helplessly, when reading horrible comments by commenters who are anonymous, and we have no resources to track down the offenders. While it is best to ignore and not read these comments, we do have a younger generation of people who live and interact virtually and we have to think ahead on how to teach them to be responsible users and not weaponise digital shaming while being empowered to protect oneself. I acknowledge and agree with part of what another Member of Parliament said previously, "that civic education is the correct way for a society to recognise falsehoods". Let us teach resilience and learn to accept those who are different. Humans like to categorise and place labels.”
“Otherwise, I am confident that our restructured healthcare system is robust and can provide adequate care for all citizens. Those of us with the financial ability to have bought an Integrated Shield Plan will need to keep up to date with the changes to the terms and conditions. Recently, in a Forum letter to The Straits Times, dated 19 February 2021, the writer asked many pertinent questions. There have been on-going discussions between various stakeholders on some of these issues. I list three main ones for thought, and will further speak on these during the Committee of Supply debates. One, is it fair for insurers to make unilateral changes to existing policies that affect policy holders? Two, is it restrictive to have panels, keeping in mind that some panels have only one or no doctors in an area of speciality? Three, how do the insurers choose their doctors to sit on their panels – is it truly based on quality and merit, or are there financial arrangements which are not disclosed? For those of us who are parents, we also have the duty to teach our young on keeping healthy – both physically and mentally. However, having both parents working full-time means that the contact time with our children is often limited, and this is a challenge faced by many young families. I always thank my kids' teachers for being their other parents, in imparting values and lifelong habits for learning. Thanks to all teachers who have worked very hard in the past year. To switch to online learning during the circuit breaker and then to keep up a curriculum in the classroom, as well as being ready to resume virtual teaching should the need arise. I also thank their efforts in keeping our children safe by reminding and enforcing the importance of masks, face shields and hand hygiene.”
“I saw for myself the differences in healthcare subsidies, and I appreciate that every Singaporean has access to affordable and quality healthcare. I am glad to see an increased Budget for healthcare in 2021, to cater for patient subsidies in primary care, namely the three new polyclinics and another restructured hospital, Woodlands Health Campus. I may be stating the obvious, but healthcare subsidies are finite, and those of us who can afford to pay for private healthcare should consider doing so. Interestingly, I have friends who are not quite sure how to navigate the healthcare system here and think that the process starts with going through polyclinics, or that they need to go to the Accident and Emergency department. I will take a minute to summarise for everyone's benefit. Unless you actually needed to see a doctor, you might not quite realise how the whole system works. Briefly, the restructured hospitals are team based, and patients get referred through a polyclinic, and will be seen by various doctors, nurses and allied health during the course of their treatment. A patient may choose a particular doctor in a restructured hospital, but he/she will need to pay private rates. However, due to the sheer volume of patients, the waiting times for doctors, scans and operations will be subject to variable waiting times. In a private hospital, most private doctors run their own practices and use the hospital facilities as needed. Waiting times are usually much shorter and the patient would typically have their chosen doctor attending to them at all times. There are pros and cons to each system. I have worked in both, and also been a patient under both systems. If you have the means and can afford a private insurance plan, it is good to have more options.”
“This is what I hope to do now, to express my views from my multiple roles and represent the people around me. Education is a strong foundation for personal growth. I am not just talking about formal education, but also education from parents, families and daily living experiences. My children look up to me and emulate my words and behaviours. For example, wearing a mask and returning dishes after a meal at hawker centres are good examples. There are bad examples too, such as using vulgar language. Unfortunately, people learn bad examples very quickly. Now in English. (In English): Education plays a huge role in healthcare as well. We teach medical students and trainee specialists. All doctors undergo compulsory Continuing Medical Education to keep up with the rapid advances in healthcare. In this era of shared decision making, the role of a doctor is as much a teacher as healer. In each consultation, I educate my patients on their conditions, so that they can make informed decisions. Sometimes, it is a challenge when they are misinformed by what they read from the Internet. As Dr Google becomes ever more popular, we need to help people be more discerning. We need to learn how to fact find, how to distinguish myth from facts, and how to identify reliable websites. Good health education is critical in empowering people to take charge of their own health. For those of us who are middle aged now, we have to do our part in keeping healthy. This includes health promotion efforts like eating right, exercising, to help in disease prevention, and screening for early detection of disease. I have immediate family members who need care for serious medical conditions. One is a citizen and the other, a foreigner.”
“Mr Speaker, Sir, may I start my speech in Mandarin? (In Mandarin): [Please refer to Vernacular Speech.] I have been wondering why I want to be a Nominated Member of Parliament. Some friends criticised that Parliament already has so many doctors and does not need another. Some even commented at an online forum, “why choose a neh-neh* doctor?” [*term used is a Singlish vernacular which may be deemed disrespectful] I was feeling angry and amused at the same time. I told my children about this and they kept laughing. My mother is a housewife and my father a retired policeman. I went to Woodsville Primary School and was fortunate to attend Raffles Girls' School later. I have some very special memories. In the first few weeks of Secondary school, the English teacher stayed behind after work to teach me the correct English pronunciation so that I would not sound like I was lagging behind the other students. Another teacher noticed that I did not take part in some elective activities because of the additional fees and told my father how to apply for a bursary. These stories illustrate the importance of equal access to education, resources and opportunities. I am now a private breast surgeon and married with three children. I am the first female President of the Singapore Medical Association. All these are not achieved through my personal efforts alone; instead I am able to do it with the support from my family, friends, colleagues and mentors. I remember when I was a teenager, there was a Xinyao song called "xiao ren wu de xin sheng” (Voice of the Little People). One sentence touched me particularly – “Perhaps I cannot achieve a great accomplishment by myself, but I contribute as much as I can, as best as I can”.”