Toh Chin Chye
Singapore
“--- And meet their friends. I do not know. How do we go about it? Supposing we have an impasse. We cannot find anyone who is willing to take on the job of the President. It is a lonely job, yes. I have no ambitions to be called "His Excellency".”
“28 also provides that if the Government is going to change the Constitution in order to modify the powers of the President, he must go and seek a mandate from the people twice (not once, but twice) - first,in a general election and win a two-thirds majority, come back to this House, change the Constitution, and then take the amendment bac…”
“The Minister has not made it quite clear what is tax avoidance, what are the examples of tax avoidance that he would like to close. The Comptroller of Income Tax no doubt has many cases on his hand. If the public, who are paying taxes, are given to know what is legitimate and what is illegitimate, then I think they would be more at ease.”
“It will be invidious for special legislation to be passed for companies that provide essential services so that Government control over them can be maintained.”
“For a whole family to lose their property just because of the act of one is unjust. It is similar to what happened during the days of the Emergency in Malaya when whole villages were resettled because a few were deemed to have collaborated with the Malayan Communist Party. It is exactly the same principle.”
“And, of course, on the HDB side, its accounts will show a deficit because it has to pay high interest, or vast amounts of money in terms of interest, back to the Government. Yesterday the Member for Rochore pointed out to this House the sum of $8.8 billion which was loaned by the Government to the HDB.”
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Every one of 563 lines we hold for Toh Chin Chye, in date order, each linked to its source. Free to read, in full, without an account. Page 6 of 12.
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Third time." Members of the House would have read the Official Report of the Select Committee and the reasons for the proposed amendments. The President of the Republic of Singapore will now only be the Patron of the Society and the Society will be headed by a Chairman who will be appointed by the President of the Republic of Singapore. However, the Honourary Treasurer will no longer be appointed. Members of the Society felt that it was necessary to enlarge the powers of the Council to enable it to recruit and train volunteers, in addition to full-time staff to carry out the functions of the Society. Accordingly the Committee has made an amendment to section 9 of the Act enlarging the powers of the Council. Under section 9 of the principal Act, the President of the Society approves the rules of the Council. With the abolition of the post of the President of the Society, it is necessary to amend section 9 so that the Director of Medical Services will approve the rules of the Council. The Society has no objections to the amendment to section 5(A) of the principal Act on Objects of the Society. Mr Speaker, I beg to move. Question put, and agreed to. Bill accordingly read a Third time and passed. FACTORIES (AMENDMENT) BILL Order for Second Reading read. 3.10 p.m.”
“For adults where the average attendance fee is $3.51 it will now be $4.50. In spite of the revision, Government subsidy on dental services will be 80% of annual recurrent costs excluding capital expenditure. This heavy subsidy is due to the fact that the majority of those receiving treatment are children and students. SUPPLY BILL Order for Second and Third Readings read. 2.46 p.m.”
“Patients obviously do not believe that honesty is the best policy. By the time the Minister for Finance admitted at this Sitting that there are at least 150,000 persons who are earning incomes that are chargeable for income tax but he has found no way to make them pay, it is naive to expect the Ministry of Health to operate a system of full-paying patients and part-paying patients based on a means test. In truth less than 1% of patients seeking dental treatment have been full-paying patients. A general medical practitioner takes on the average 2-4 minutes to examine a patient but a dentist takes much more time to treat a patient. In some cases more than one visit is necessary. However, the present dental fees are not related to time and labour and are low compared to the costs of medical outpatient treatment. The revised scheme of dental treatment charges replaces the present system of an attendance fee plus additional treatment charges by a single fee related to the treatment required. This reflects no more than what is being practised by dentists in the private sector. However, there will be two scales of charges. Singapore residents, including those who hold work permits or employment passes, will pay lower Scale B fees while non-residents and consultation cases will pay Scale A rates. Under the present system children who go to hospital or an outpatient dental clinic have to pay fees while those who have been given comprehensive dental care at the school dental clinics are not charged. Under the revised scheme, children and students will pay 20% of Scale B rates in order to remove the anomaly. This means that students and children who pay an average fee of 50 cents per attendance will now pay an average fee of 88 cents.”
“Outpatient Dispensary Fees Now let me come to the Outpatient Dispensaries. Patient attendances have increased by 13% from 2.45 million in 1975 to 2.77 million in 1977. At the same time, a 3-day supply of medicine is given to OPD patients. Some industries may have collapsed during the current recession and inflation but the pharmaceutical industry continues to flourish because of continuing demand for medicinal products. What it means is that expenditure on drugs will always be upwards. The Ministry has therefore decided to increase the attendance fee at OPD's by 50 cents during weekdays which is less than the price of two cups of coffee. The increase will be $1 during Sundays and public holidays. The existing attendance fee of 50 cents for children and students on weekdays and $1 for Psychiatric Outpatient Clinics remain unchanged. In spite of this revision the Government will continue to subsidise 60% of the cost per patient attendance. Dental Service Charges Now, let me come to the revision of dental service charges. At the opening of the Institute of Dental Health in September last year, I warned that there should be a review of the present system of dental service charges. The cost per patient attendance was $8.60 while the amount recovered was only 90 cents. The review has been completed and Members have been given a comparative table (Cols. 1473 - 1478) showing the present system and the proposed revised charges. table - PRESENT AND PROPOSED NEW SCHEME OF DENTAL TREATMENT CHARGES, LIST OF ORAL SURGICAL OPERATIONS (Cols. 1473 - 1478) The means test based on monthly family income to distinguish between full-paying and part-paying patients cannot be effectively enforced. Family incomes are invariably understated to avoid paying higher dental charges.”
“But if doctors in A&E departments are faced with large numbers of patients with minor ailments, their mental alertness becomes dulled and mistakes can be made. Patients, who go to A&E departments or visit specialist clinics should now understand why they have long waiting times before being examined or admitted into a ward. I have circulated to Members figures (Cols. 1471 - 1472) showing an increasing trend in A&E attendances for the last four years. Something must be done now if the services at A&E departments are not to break down. Having discussed this problem with Medical Superintendents of hospitals and Heads of A&E departments, we have come to the conclusion that because the existing attendance fee of $4 is too low patients with minor complaints or who have a cough and running nose are crowding into A&E departments. In order to protect the efficiency of A&E departments, the Ministry has therefore decided to raise the A&E attendance fee to $10. If patients deserve admission into hospital for treatment, the $10 will be credited to the minimum deposit of $20 which Class C patients have to pay on admission. figures - ATTENDANCES AT A & E DEPARTMENTS FOR PERIOD 1974 - 1977, COMPARISON OF A & E ATTENDANCES FOR OCTOBER-DECEMBER 1976 and 1977 (Cols. 1471 - 1472) Victims in public disasters such as those who were caught in the stampede at the National Stadium last year will be treated free. Currently, blood donors do not pay fees at OPD's. But I am prepared to extend this concession at A&E departments to regular blood donors, i.e. those who have in the year made two donations. Discretion already exists in A&E departments to waive charges in the case of destitute patients. That discretion remains and patients who are really poor will continue to be treated without payment.”
“Mr Speaker, Sir, during the debate on the budget of the Ministry of Health the Member for Anson mentioned of rumours on my Ministry's intention to increase the attendance fee at Accident & Emergency (A&E) departments in the hospitals. I am using this opportunity to inform the House that the Member for Anson is a good fortune teller and he has made the rumours come true. During a press conference last year I mentioned misutilisation of A&E departments. Of the attendances at A&E departments in a 4-month period, 72.8% were self-referrals, 9.4% by general practitioners, 5.1% by the Ministry's Outpatient Dispensaries (OPD's), 3.8% by the Police and 8.9% by others. Only 17.8% of patients were considered serious for admission into hospital and 16.7% were referred to specialist clinics. On the other hand, as high as 61.9% of patients were discharged after examination and the remaining 3.5% were asked to go back to their OPD's. The Member for Kim Seng told the House last week of his own personal experiences with National Service patients referred to the Singapore General Hospital. Most of the referrals according to him had minor ailments which could and should be treated by Army doctors in their camps but are not. This is confirmatory evidence that the hospitals are being misused. In A&E departments doctors assume that the patients who turn up are serious or emergency cases. To be fair to such genuine patients, doctors require a longer time to examine them. It is important that doctors in A&E departments should know when a stomach ache is due to acute appendicitis which requires surgery and do not dismiss it as gastritis or a stomach upset from eating contaminated food.”
“The statistical data on medical and health servants requested are as follows:- Year 1975 1976 1977 ______________________________________________________________ 1 (a) No. of Medical & Health Servants posts in hospitals as at 31 Dec. 3141 3182 3220 No. of vacancies in hospitals as at 31 Dec. 81 75 95 Vacancies as percentage of established posts 2.58 2.35 2.95 ______________________________________________________________ (b) No. of Male Medical & Health Servants in hospitals as at 31 Dec. 1445 1434 1333 No. of Female Medical & Health Servants in hospitals as at 31 Dec. 1615 1673 1792 ______________________________________________________________ (c) No. of Female Medical & Health Servants in male wards as at 31 Dec. 61 125 162 No. of Male Medical & Health Servants in female wards as at 31 Dec. - - - ______________________________________________________________ 2 Turnover of Medical & Health Servants from April to December (resigned, vacated office, retired or dismissed) 169 161 194 Average monthly turnover rate 19 18 21 NOTE: Figures in (1) relate to hospitals only. Figures in (2) include other non-hospital institutions.”
“Mr Speaker, Sir, there is no legislation in Singapore controlling the practice of acupuncture. My Ministry does not issue certificates of proficiency in acupuncture nor is it our intention in the future to control acupuncture which is empirical and is part of traditional Chinese medical practice. The answer to part (b) is that my Ministry does not subscribe to the West Australian, nor does the Parliament library. I do not see a copy of this paper in the Members' Room. So the answer is: I do not know what the West Australian is alleging. HDB HAWKER AND MARKET STALLS (Particulars) 3. Mr Ivan Baptist asked the Minister for National Development and Communications (a) how many Housing and Development Board hawker and market stalls were allocated monthly for the last six months; (b) how many of those allocated stalls were resettlement cases; (c) how many of those allocated stalls were social welfare cases; and (d) how many more stalls will be available within the next six months. The Senior Minister of State for National Development (Dr Tan Eng Liang) (for the Minister for National Development and Communications): Mr Speaker, Sir, the number of HDB hawker and market stalls allocated is as follows: Month Number September 1977 245 October 1977 345 November 1977 69 December 1977 51 January 1978 63 February 1978 45 ___ 818 Of the total of 818 hawker and market stalls allocated during the last six months, the total number allocated to resettlement cases and social welfare cases was 81 and 54 respectively. 965 new cooked food and market produce stalls will be available within the next six months.”
“Mr Deputy Speaker, Sir, I presume that the Member for Potong Pasir is implying that SATA is not probably reporting all the cases that they have come across. The solution is very simple. I would suggest that the NTUC divert their workers to the Tan Tock Seng Hospital for screening. That will solve the problem.”
“Mr Deputy Speaker, Sir, I do not understand what the Member for Potong Pasir is hinting at. I just do not read him. A private practitioner is compelled to notify tuberculosis cases no less than SATA is. I do not have inspectors to go around to examine the medical certificates issued by SATA and the private practitioners. We do not do that. It is up to the doctors who do the screening to notify any tuberculosis cases. I think that is compulsory. But I do understand what he is trying to aim at. All I am interested in is whether the number of tuberculosis cases notified is coming down or going up. If it is coming down, and even if it is gradual, I am quite satisfied.”
“This is why mass screening has never been advocated in some countries as a means of preventive medicine because the cost is enormous and the result that is produced does not justify the cost. But tuberculosis was at one time rampant in Singapore and it was common at that time for mobile vans to move around Singapore to do mass X-ray screening. The pattern of disease in Singapore is changing and it is high time that we reviewed also our methods of tuberculosis control. I will take up this matter with the authorities concerned.”
“Sir, the Member for Potong Pasir has just pronounced the law of diminishing returns. The more you screen, the less you get. I have already given the statistics to the House yesterday when he asked a Question and I presume Members of the House are aware of the problem that he has raised. SATA is required by law to notify tuberculosis cases that they come across. As the figures show, the number of cases that they have notified has been decreasing, from 470 in 1975 to 325 in 1977. I ought to add that many of these notifiable cases are people who have never had BCG vaccination when they were young. They comprise mainly elderly people and, therefore, it is still necessary to carry on with the tuberculosis surveillance programme. It is important to treat them as early as possible, otherwise they can be an endemic source of infection for the younger children who may even have had BCG vaccination. It does not necessarily mean that every child who has had a BCG vaccination will be immune from tuberculosis. The degree of immunity varies from individual to individual. Therefore, the screening process may still have to be continued. But as far as the Tan Tock Seng Hospital and other Government hospitals are concerned, the number of people we are screening is coming down. The number of TB cases that we have detected has more or less remained static. We cannot set a target for notifiable cases. If a person has got tuberculosis, then he must go to Tan Tock Seng Hospital for treatment. We cannot have a target and say, "Well, we will have just so many tuberculosis patients." But we can have a target for the number of persons to be screened. That will help us to cut down the cost and, therefore, producing a better return.”
“The Member for Toa Payoh can encourage his constituents to be more friendly to these poor patients who have been mentally ill for some reason or another. But they cannot remain in Woodbridge Hospital till the end of their lives. In fact, the conclusion of the doctors is that permanent institutionalisation in a mental hospital is not the right way. I do not know whether any Member has seen the film, One flew over the cuckoo's nest. It is a good picture. It proves the point that institutionalising a mentally ill patient is not the ideal way of treating mental illness.”
“Sir, it is more and more difficult to find ideal surroundings in Singapore and the ideal of the Member for Toa Payoh, I am afraid, is very difficult to be realised. I would like to remind him that we have about 2,500 beds in Woodbridge Hospital and occupancy rate is between 90-100%. We have also got a so-called half-way house. It is at View Road Hospital. I was taken to it. They told me it was a half-way house. I discovered that it was not a half-way house but an extension of Woodbridge Hospital. It has got 250 beds. It is rather hard for the staff working in Woodbridge and View Road to have to handle this large number of patients. Let me give the statistics. In 1977, 4,229 were admitted; 4,225 were discharged. At View Road Hospital, 72 were admitted; 49 were discharged. Outpatients in 1977 numbered 62,214. We have got only about 13 psychiatrists to handle them and are also dependent very largely on psychiatric nurses as well as attendants. I agree that it is not an ideal situation to discharge the mentally ill patients into one-room or two-room flats. But the doctors who have discharged them have done so in good faith, believing that the patients have been stabilised on drugs. No patient who is violent will be discharged from the hospital. To-date I have not received any complaint that acts of violence have been committed by a discharged Woodbridge patient. Of course, neighbours do not like to have discharged patients from Woodbridge Hospital staring at them or looking out into space. But I think this is something that we all have to put up with. Toa Payoh is a high-rise area and it is inevitable, therefore, that patients who are discharged will have to go back home. Relatives and neighbours can help.”
“Sir, I would like to thank the Member for Moulmein for the kind words that he has said about my Ministry. It is not every day that I get a bouquet. We have studied the patients who go to our hospitals. We have studied the distribution of their income from CPF returns and understand that about half of them cannot afford to go beyond the third class. I have announced previously that we intend to create different grades of ward charges so that patients can pay according to their ability. The third class or C-class wards are being renovated not only in Tan Tock Seng Hospital but in other hospitals as well. I did a tour of the third class wards of the Singapore General Hospital and I was astonished that no two wards were exactly the same. Every unit has got its own idea of what a ward should look like and I am really disappointed after the tour to find that the third class wards were really very shabby. We will upgrade the atmosphere of C-class wards in the hospitals and at the same time provide other grades of wards so that those who do not feel like going to sleep in a C-class ward can go to a B-2 Ward, B-1 Ward or an A-ward, depending on his ability to pay.”
“Members of the House will remember that I made a statement in the House last year that, if we are critically short of doctors, I will introduce national service for all doctors, including female doctors. I believe there was an uproar because some of the lady doctors began to calculate their future. If they graduate at 24 or 25 years of age and after 21/2 years or three years stint, they will be 28 or 29 years old. By then they would want to start a home.”
“But I must also add, just to remind the Member for Whampoa, that we now have an integrated ambulance service and it comes under the Ministry of Social Affairs. Correctly, that question should have been put to the Minister for Social Affairs but, nonetheless, I have replied on his behalf.”
“I am not suggesting that we are going to charge $25 if a patient goes at night to the A & E departments. But the fact is that the doctor has got his day-time work and it is fair enough that he has to have time also for his domestic and social engagements. I am afraid that the suggestion put up by the Member for Toa Payoh is not feasible. I will now comment on the Member for Whampoa for his being so stalwart in helping two poor ambulance attendants to lift a patient on a stretcher. I look forward to the future when he enrols in the Singapore Red Cross or the St. John ,s Ambulance. I do not know which nurse he was referring to. But if he had taken down her name and written to me, I would have looked into the matter. Probably he did not understand. The nurse was doing history-taking by asking all those questions. If the patient were dead, she would not be asking all those questions. I think it is not quite fair for the Member for Whampoa to complain about the nurse. She knows what to do with the patient. There is one point that he has mentioned, and I notice it too, that motorists in Singapore are becoming more and more bloody cussed. They refuse to give way not only to ambulances but cut each other across traffic lanes. This is a point which should be taken up with the Minister for Home Affairs who is in charge of the Traffic Police. I will liaise with him and tell my ambulance drivers to take down the licence numbers of all motor vehicles who refuse to give way to ambulances.”
“The level of threshold of pain, as doctors will tell you, differs from individual to individual. A man with a slight knock on his head might think he has a concussion and will rush to the A & E department whereas a person with a headache will believe that all he has to do is to take a couple of Aspirins and he will be all right the next day. I much regret that the position at the A & E departments has not improved in spite of the warnings that I have given. The rumour which the Member for Anson has been disseminating is correct that there is an intention to discourage non-emergency cases from attending A & E departments. We are going to raise the fees for A & E attendances. What it will be, I am not yet in a position to inform the House. But it is a notice that I am now giving to Members of the House that this decision has been made. The outpatient departments have been brought into discussion. They are dead against opening a night service. So that is the end to it. Doctors do not like to work on night shifts. It is as simple as that. That is why we find so many lady doctors in outpatient departments. About 85% of doctors in outpatient departments are ladies. They do not like night shifts because they have their own domestic duties to perform. So asking the outpatient departments to operate at night is a non-starter. Likewise, asking private practitioners to help out in the work of the outpatient departments or in the Accident and Emergency Departments is a non-starter. If they could they would already have opened their own clinics at night and charge higher fees. Members who read the newspapers would have already seen the charges which the Society of Private Practi- tioners has recommended for night consultancy. I believe it is about $25 per consultancy at night.”
“Mr Deputy Speaker, Sir, Members of the House will recollect that I gave warning signals about the position of patients at the Accident and Emergency Departments. The attendances have been increasing steadily from 207,211 in 1974 to 252,853 in 1977. This is an increase of 36.4% over a period of four years, although the population of Singapore has not increased by that percentage. Obviously, the A & E departments are being abused. We did a survey and found that there were two peak periods when the A & E departments receive patients who come in the largest numbers. The peak hours are at 10 a.m. in the morning and 8 p.m. at night. Because they all come together and do not distribute themselves throughout the duty hours of the staff at the A & E departments, a heavy strain is imposed upon both the doctors and the nurses. Assuming that these cases who attend A & E departments are genuine emergency and accident cases, then on this premise or probability, we will not have two peak hours at 10 a.m. and 8 p.m. everyday. So we came to the conclusion that there are persons who attend at the A & E departments for their own convenience and are treating A & E departments as outpatient departments. To confirm what I stated in the press interview, I did another three-month survey in October, November and December 1977. I found that there were 75,882 attendances as against 60,421 attendances for the same months in 1976. This is a 26% increase. The number of non-emergency cases was 46%. This obviously is patently absurd and discussing with the heads of the A & E departments and the staff who work there, we came to the conclusion that some of these cases could easily wait for treatment the next day in outpatient departments or go to the outpatient departments themselves.”
“Now, the paediatricians are in favour of mothers staying with their children at the paediatric wards. The Mistri Wing was built in the 1950s and it was not designed to provide sleeping facilities for the mothers of sick children. So benches were provided outside the wards for the mothers to rest there after seeing their children. If the Member for Anson were to visit the paediatric ward in the Tan Tock Seng Hospital which has 40 beds, he will find that the ward has been renovated. It has been done so well that I am very pleased to note that it is one of the bright features in the hospital. I see the mother sitting beside the child. Both mother and child are contented. In fact, mothers are a great help because they look after their own children. Otherwise we would have to employ more nurses. From the therapeutic point of view, of course, the child feels more confident when the mother is close by and therefore recovery is faster. In the first class ward we have provision for a bed for the mother. If there are mothers who wish to sleep with their children, then they should send their children to the first class ward. However, I hope to go through the Mistri Wing and see whether we can reorganise the Mistri Wing and provide similar facilities for the mothers of children in the Mistri Wing. In fact, I believe it can be done because the Mistri Wing has only 50% occupancy rate. We can move out some of the empty beds and the space can be taken up by the mothers. I really see no problem from that point of view. However, I would like to thank the Member for Anson for his deep interest in the facilities that we provide in the hospitals. I will look into some of the points he has raised.”
“In fact, it is not necessary because many of the drugs prescribed by private practitioners are pre-packed in standard doses. I am surprised to hear about rats in the Tan Tock Seng Hospital and cats in the Kandang Kerbau Hospital. I will ask the Ministry of Finance for a vote to buy some traps to trap the rats. But it is very likely that the reply I will get from the Ministry of Finance is that we should transfer the cats from the Kandang Kerbau Hospital to the Tan Tock Seng Hospital to catch the rats there. However, I will seriously look into the points made by the Member for Anson and we will have the rats and cats caught. Now, admission to wards is a general complaint which we get. I agree that the Singapore General Hospital complex is very complicated indeed, particularly when the new hospital is only half-way up. But I appeal to members of the public to be patient. The procedure, of course, is that those who are critically ill are immediately directed to the wards for treatment and the patients' relatives are asked to go to the Admission room to complete the admission formalities. This is one relationship between the public and the hospitals which I myself would like to see improved. If it is true that admission formalities are complicated and take too long a time then we shall make an inspection to see how we can improve the system. There is really no shortage of nurses, as the Member for Anson has stated. In fact, we have trained too many nurses. We have a surplus of nurses who cannot find jobs when they graduate. We have at present 270 nurses employed against training posts. But we hope that as the year progresses vacancies will arise and these nurses will be duly employed as staff nurses.”
“Mr Deputy Speaker, Sir, the Member for Anson has raised several points. First, with regard to the question about the staffing establishment of pharmacists. May I enlighten him that we do not require pharmacists all the time to dispense medicine. At present we have 45 pharmacists in the Ministry of Health and we expect to recruit another three later this year. Of these 45 pharmacists, 42 are Singapore citizens, one a Malaysian and two are British subjects. Just as we have nurses assisting doctors, so we also have dispensing assistants assisting the pharmacists. There are now 188 dispensing assistants of different grades in the Ministry of Health. Twenty of these dispensing assistants are in the senior grade. This means that one out of every nine dispensing assistants has been promoted to a higher grade. Promotion is no longer dependent on the number of posts but according to merit, as long as the PSC deems that they are suitable for promotion. In the hospitals that do not have dispensing assistants to work after office hours, we have an emergency drug box which the doctors can use. The doctor himself is qualified to dispense a drug. I do not want to resurrect a movement started several years ago when the Department of Pharmacy in the University of Singapore suggested. that doctors should prescribe and pharmacists should dispense, thereby creating two types of professional people to do two different types of jobs. I would rather prefer the present system in which doctors are allowed to prescribe as well as to dispense medicine. For the information of the Member for Anson, if he were to visit private practitioners, he will find that many of them do not at all hire pharmacists or dispensing assistants.”
“Sir, the Ministry of Health cannot build a general hospital for every constituency. So I regret to inform the Member for Sembawang that there will be no general hospital for Sembawang. After 2 1/2 years we have at last come to grips with the problem of the required number of beds for future years. We have made projections and we have found that another hospital to be located in Sembawang is unnecessary. With regard to his appeal not to raise charges in future, may I remind the Member for Sembawang that he is in the coffeeshop business. If he can guarantee that the cost of a cup of coffee or tea will come down, then he will not have to pay his shop assistants more wages. Eighty percent of the cost of health care is due to salaries and wages. So given the normal annual increase in expenditure on manpower, I just do not see how hospital charges can remain stable. But do not use this as an excuse to up the price of a cup of coffee. Mr Teong Eng Siong( In Mandarin): Sir, I do not see the connection between the price of a cup of coffee and medical charges. I think he is confused. However, I would like to withdraw my amendment. Amendment by leave, withdrawn.”
“Sir, I would like to remind the Member for Kim Seng that it is only doctors and dentists within the civil service who are given an allowance for a post-graduate qualification. The engineer may get a Ph.D or a Master's Degree but he will not get any extra allowance. Therefore, it cannot be said that doctors and dentists have not been given special consideration by the Government. I am indeed surprised to hear from him that non-citizens who are now living in the PSA flats are being evicted by the Housing Board. I shall certainly go back and investigate this point. With regard to the cooperation which he has offered on behalf of the University doctors to the Ministry of Health, I welcome that cooperation and I certainly hope that members of the University will not object to being posted to some obscure peripheral hospitals.”
“However, I will take note of the article which the Member for Potong Pasir has cited from The Lancet and I will discuss with the Chief Pharmacist on what can be done as far as these six products are concerned.”
“If the Member for Kim Seng believes that the Singapore General Hospital has or will have better teaching materials than Kent Ridge Hospital, he is quite entitled to join the Ministry of Health and work at the Singapore General Hospital. But if he wishes to remain in the University, then I presume he will go to Kent Ridge Hospital. However, the choice is his. Kent Ridge Hospital will have to serve a growing population in Jurong and Clementi New Town, which is expected to grow to about a quarter million by 1990. In answer to the Member for Potong Pasir, I do not know why he quotes The Lancet and asks me about aspirin, paracetamol, ferrous sulphate, aluminium hydroxide, senna and a multivitamin preparation. I am not a pharmacy student. He is always testing my knowledge of consumer drugs because he is very familiar with them. Under section 7 of the Medicines (Advertisement and Sales) Act, it is required that all medicines sold over the counter must have the formula printed on the label. Information as to purpose, dosage, administration, is normally given on the label. In some instances, those who do the marketing will also include pamphlets together with the drugs sold. Part V of the Medicines Act deals with containers, packages and identification of medicinal products. I would like to do whatever is practical. I can tell the House that there are 20,000 drugs on the market, and if we try to oversee that every drug is labelled in great detail, we are going to create a great inspectorate and a bureaucracy within the Ministry of Health, which will not at all help to promote the health of the population.”
“It will be preferable if we could ask those who wish to do medicine to perform not the type of national service that the others are doing, but to get them to perform a service which will test them for their aptitude and their understanding of what medicine is all about. In this way, I believe we can have a better generation of doctors who will be more dedicated to the profession. The Member for Kim Seng is a great proponent for the working conditions of doctors. I do not blame him because he has to speak out for his peers in this House. On the question of providing housing for doctors, I have already stated that the problem does not arise. Doctors who serve within the Ministry of Health are treated like other civil servants and they are entitled to buy executive flats at Marine Parade or flats built by the Housing and Urban Development Company. There is no problem among doctors who are Singapore citizens. In fact, many of them have taken up this opportunity. It is a false excuse given by those who have resigned or have left the country to say that they have not been given housing. That is not fair indeed. It is not true. It is not because the conditions for housing are not met that they have resigned. Non-citizen doctors are looked after by the Ministry, which has made arrangements with the Housing and Development Board and the Port of Singapore Authority to rent flats to them at subsidised rentals. In fact, up to-date we have 45 such doctors who are being accommodated in Housing Board and PSA flats. Kent Ridge Hospital will be an acute general hospital. I said previously that it will not be a premier hospital. It will not be the only teaching hospital. There will be other hospitals in which students will be posted.”
“To be truthful, I believe that it is fair and equitable that those who aspire to be doctors or dentists should perform national service before they enter the university, like the students who do engineering, architecture, law or other professional subjects. I would suggest that those who opt to study medicine or dentistry in the University should do a different kind of national service. It is pointless asking those who choose to study medicine to serve in the Tank Corps or in the Artillery or to learn how to shoot. It would be better if they will first learn how the sick are treated at a lower level. I had previously suggested in this Parliament that if I were to start a new medical school in another country, the entry qualifications would be that those who wish to study medicine must first do two years, nursing service. They will then understand how hospitals are run at the lower level before they themselves become medical officers and give orders to those who are going to be their subordinates in the future. I think that will also be a test of not only their aptitude but also of whether they will understand that medicine is a vocation to which they will have to sacrifice their whole career. Some study medicine because of the status. I am very worried indeed that 50% of the intake into the medical school this year are women. According to the British experience, 15-20% of lady doctors are lost after graduation. They get married and are no longer attracted to medicine. But they have the status. They are called "doctors" and they also have got doctor husbands. It is a tremendous waste in manpower and in investment.”
“Doctor shortage is not hopeless in the long run. Neither would I say it is critical. But I would say it is not satisfactory. The reason why our hospitals can manage to carry on, I specifically mention hospitals, is the low occupancy rates in the hospitals. The allocation of staff to hospitals is in accordance with the number of bed complement in the hospitals. The occupancy rates in some of the hospitals or units are 50-60%. We find, therefore, that we are employing staff to look after beds, not patients. Because of this, the Ministry has managed to survive, keep its head above water, and provide a service for patients. But it is the intention of the Ministry that the occupancy rate of the hospitals should be increased and we are aiming at a target of 80-85%, which I think will be the ideal. It will take a few years before we can achieve that target and during the period of time I suspect more graduates will be coming out and we will be able to train them either as general practitioners or as specialists to man the hospitals and the outpatient departments. It is not always that the Member for Kim Seng see eye to eye with me on the question of doctors. I am pleased indeed to hear his remarks about national service doctors. I agree with what the Member has said, but unfortunately the Minister of Defence does not agree with me. So I presume the Minister of Defence will not agree with what the Member for Kim Seng has said. Unfortunately, I am in no position to press the Ministry of Defence to change its rules for recruiting medical students into national service.”
“She has to have a one day break in service so that she can be paid a gratuity and be re-employed again. This is one of the rules put up by the Establishment and we are just carrying that out. As regards contribution to the provident fund by housemen, it is a matter for which I am not responsible and about which I am not in the least in the clear. Apparently, it started sometime in 1972. At that time, it was decided that non pensionable Government officers would be put on the provident fund, and since housemen were drawing an allowance they were also asked to contribute 5 1/2% with the Government contributing a similar quantum. 5.45 p.m. On the question of A & E unit of the hospital, I will come to that later because I believe one other Member in the House wishes to speak in greater detail and I will answer that point. I am really alarmed indeed to hear the Member for Anson saying that he has heard rumours that I am going to raise the fee in the A & E unit. I would like to know his source of the rumour. The Member for Kim Seng raised a number of points. It is true that there is a decrease of $6.78 million for Expenditure on Manpower for FY 78. This is because in the past years there has been an over-estimate of money to be spent on manpower. In the financial year 1975, the surplus was 12.9%; in 1976, 20.3% and 1977 it was 18.39%. We know very well the number of doctors that we will be able to employ this year. There will be two intakes, one in April and the other in October. It is obvious that if we are taking in the group which will be graduating in October, we will require only six months' financial provision. Likewise, the 50 super-numerary posts for medical officers on study leave do not require full financial provision.”
“Mr Speaker, Sir, may I first answer the points raised by the Member for Anson? It is not quite true that doctors are worse off than dentists, although dentists do not do housemanship. If we are to calculate the salaries earned by dental officers and medical officers, we find that after seven years, they all reach the same point at $1,100. The dental officers spend four years in training and are then appointed dental officers at $1,000. Three years later, they are at $1,100. In the case of the medical officer, he spends five years studying, one year paid as a houseman and then he is appointed a medical officer at $1,100. So at the end of seven years, the dental officer and his contemporary medical officer would be at the same point. However, I would like to add that this policy of not having dental officers doing housemanship was not started by me. In fact, it came as a surprise to me when I was Vice-Chancellor of the University of Singapore. I think it is probably a decision made in haste because at that time Malaysia was directly appointing dental graduates as dental officers without requiring them to do housemanship. The Ministry of Health in Singapore panicked and followed likewise. However, this is not a recantation of what had happened in the past, but the fact is that over a period of time both the dentists and the medical officers are at the same point of salary scale. The other question raised by the Member for Anson over a one day break in service before they are appointed as medical officers is entirely a legal affair. According to what I am told, housemen are apprentices under training and in order to be appointed as medical officers, they have to break service for at least one day. It is very much like a lady civil servant who wishes to get married.”
“It is non sequitur. I have just explained my programme. He does not understand English! NOTIFIABLE INDUSTRIAL DISEASES (Number of, and compensation paid) 2. Mr Ivan Baptist asked the Minister for Labour (i) the monthly breakdown figures for each of the notifiable industrial diseases confirmed in 1977 and the first two months of 1978; and (ii) the monthly breakdown figures of the quantum of compensation paid out for each of those industrial diseases.”
“If he is a vegetarian, then probably he will not have to worry about cholesterol and ischaemic heart disease. As far as cancer is concerned, there are many factors involved in producing cancer, but nobody really knows the reason why cancer is induced. There is no cure for cancer. All that we can do is to take preventive measures. For example, there is a correlation between smoking and lung cancer. So obviously if Members of the House do not wish to catch cancer, they should not smoke. The other alternative is to urge the Minister for Finance to raise the tax on cigarettes. This is one of the measures that we hope to take, either fiscal or legislative measures which will bring about a social change in the style of living of individuals and the society, and thereby cut down the morbidity rates. But sad to say, some time or other, all of us must make an exit. We either make a quick exit or a slow one. So I am afraid I cannot promise magic pills or magic measures that will prevent people from catching cancer, heart attacks or strokes.”
“Sir, I do not know whether the Member for Potong Pasir is a vegetarian. An hon. Member: He is not!”
“Mr Speaker, Sir, I will give the total number of deaths to be followed by the rate per 100,000 population as is the customary practice. Rate per 100,000 Cause of Death Number population 1. Malignant Neoplasm (including neoplasms of lymphatic and haemopoitic tissue) (Cancer) 2,265 98.1 2. Ischaemic Heart Disease (Cardiac infarct) 1,592 69.0 3. Cerebrovascular Disease (Strokes) 1,326 67.4 4. Pneumonia 1,174 50.9 5. Accidents and Violence (all forms) 457 19.8 6. Other forms of Heart Disease 387 16.8 7. Diabetes Mellitus 377 16.3 8. Tuberculosis of Respiratory System 289 12.5 9. Hypertensive Disease 257 11.1 10. Nephritis and Nephrosis (Kidney diseases) 247 10.7 Deaths - all causes 11,952 5.2 Members are aware that my Ministry is placing great emphasis on health education. We had a very successful year in 1976 when we conducted a mass campaign against six diseases. We are planning to conduct another campaign next year against those diseases which are associated with lifestyles and with environment. It is our intention to make the population conscious of the nature of some of these diseases, but I cannot promise that my Ministry will guarantee immortality to everybody. All that we hope is that this health campaign will be able to educate the laymen and therefore they will be in a better position to avoid some of these diseases and thereby prolong their lifespan.”
“As a matter of interest, this is less than the noise produced by a rock-n-roll band (105 PNdb). Sir, I am tabling in the Library a detailed plan showing the anticipated noise level around Changi Airport for Members to study. Presently, the noisier aircraft are the Boeing 707 and the DC 8. The wide-bodied aircraft like the Boeing 747, the DC 10, the Lockheed 1011, and the Airbus are much quieter. Most airlines are now using more and more quieter aircraft. Furthermore, all new aircraft manufactured on or after 1st January 1976 are required by international standards to be just as quiet, if not more so, than the wide-bodied aircraft. The older and noisier Boeing 707s and DC 8s are being gradually phased out. Presently, 30% of the aircraft passing through Singapore are in the "noisy" category. By 1982, this is expected to drop to only about 20%. Depending on the amount and pattern of traffic, the Department of Civil Aviation may be able to confine all aircraft movements after midnight to the second runway, thus further reducing the noise level.”
“1 and 2 with a combined frequency of 27 buses per hour. Residents of Tanah Merah Besar/Jalan Darat Nanas and Lloyd Leas Estate need to walk about a quarter of a mile or less than half of a kilometer to catch a bus at Upper Changi Road. This is an acceptable walking distance. Moreover, the number of commuters in this area is small. For this reason, SBS cannot justify the re-routing required. CHANGI AIRPORT (Noise generated by aircraft) 12. Mr Teo Chong Tee asked the Minister for National Development and Communications what will be the area around the new Changi International Airport which will have adverse noise effect on the residents. Mr Ong Teng Cheong (for the Minister for National Development and Communications): Mr Speaker, Sir, tolerance to noise is very subjective in nature. It varies from person to person and from community to community. Nevertheless the planners had given serious consideration to noise generated by aircraft during landings and take-offs when drawing up the Master Plan for Changi Airport. The second runway for Changi Airport will be constructed on reclaimed land so that all landings and take-offs from this runway will be over water. This means less noise to residents living near the Airport. Landings and take-offs from the first runway will generate some noise for residents living near the Airport. A study of the noise that is generated by the noisier aircraft such as the Boeing 707 or DC 8 during landings and take-offs from the first runway, indicates that only those areas close to Somapah Road, Wing Loong Road and that stretch of Upper Changi Road from Wing Loong Road to the northern coastline would have Perceived Noise Levels about 100 PNdb. This is approximately the noise level produced by a nearby power lawnmower.”
“Plans for redevelopment are under study and will be released when finalised. TIONG BAHRU PRE-WAR FLATS (Leaking roofs) 10. Mr Ch'ng Jit Koon asked the Minister for National Development and Communications whether he is aware that the roofs in the 20 blocks of flats in the Tiong Bahru Pre-War Estate are leaking very badly, and if he will ascertain from the Housing and Development Board whether there are plans to solve the problem of those leaking roofs permanently. Dr Tan Eng Liang (for the Minister for National Development and Communications): Mr Speaker, Sir, the Housing and Development Board has, on several occasions, from time to time repaired leaking roofs of the 20 blocks of flats in the Tiong Bahru Pre-War Estate. The Board's officers are now studying plans for an economic and more permanent solution to the recurrent problem of leaks. TANAH MERAH BESAR (Re-routing of Bus Service Nos. 210, 213, 218) 11. Mr Teo Chong Tee asked the Minister for National Development and Communications whether he will request the Singapore Bus Service Limited to re-route Service Nos. 210, 213 and 218 to include Tanah Merah Besar and Jalan Darat Nanas as this will not only benefit approximately 500 residents living in and around those areas, which include Lloyd Leas Estate, but also provide convenience for workers going daily through Tanah Merah Besar to the new Changi Airport worksite. The Acting Minister for Culture and Senior Minister of State for Communications (Mr Ong Teng Cheong) (for the Minister for National Development and Communications): Mr Speaker, Sir, the SBS bus service Nos. 210, 213 and 218 are planned as feeder services to serve specific areas within short distances from the Changi Point Terminal. At present, Upper Changi Road is served by Service Nos.”
“Mr Ivan Baptist asked the Minister for National Development and Communications (a) how many lift breakdowns were recorded in Housing and Development Board estates each month for the last six months; (b) what were the main causes for these lift breakdowns; (c) how long on average does it take to remedy a lift breakdown; and (d) what measures are being taken to limit the number of lift breakdowns. Dr Tan Eng Liang (for the Minister for National Development and Communications): Mr Speaker, Sir, in answer to (a), the number of lift breakdowns in HDB estates for the months of July to December 1977 was as follows: July 3,385 August 3,662 September 3,539 October 3,648 November 3,602 December 3,720 (b) The main causes of breakdowns are vandalism, heavy usage and wear and tear. (c) Minor repair time is one to two days, and major repair time is five to seven days. (d) Active steps are taken to reduce the number of lift breakdowns. The mechanical parts and the quality of the electrical contact and control parts of the lifts are being improved. Courses are conducted to train more lift mechanics. The cooperation of residents is continually sought to eliminate vandalism. CLEARANCE SITES ALONG CANTONMENT ROAD AND NEIL ROAD (Redevelopment) 9. Mr Ch'ng Jit Koon asked the Minister for National Development and Communications whether he will ascertain from the Housing and Development Board what plans there are for the redevelopment of the clearance sites along Cantonment Road and Neil Road in the Tiong Bahru Constituency. Dr Tan Eng Liang (for the Minister for National Development and Communications): Mr Speaker, Sir, the site concerned has been acquired for urban redevelopment. The old houses have just been demolished.”
“The following measures have been taken to ease the congestion:- (a) an additional lane has been provided to allow traffic from Braddell Road to turn right into Upper Thomson Road. (b) an additional lane has also been provided along the Upper Thomson Road approach to the Upper Thomson Road/Lornie Road intersection to, cater for traffic from Upper Thomson Road to Lornie Road. (c) the bus stop has been shifted from its original position in front of the Mount Alvernia Hospital to a lay-by nearer the traffic junction. This will reduce interference to traffic as the buses will be stopping off the main kerb. (d) the North-South Arterial Road from Avenue 1 /Avenue 6 Ang Mo Kio to Thomson Road is being constructed. Much of the traffic from Ang Mo Kio using Upper Thomson Road at present is expected to be diverted to this new road when it is completed in October 1979. There are no plans for the westward extension of Avenue 1 Ang Mo Kio through the Peirce Reservoir Reserve to link up with Upper Bukit Timah Road. The extension would disturb the quiet environment of the reservoir. The existing links between Upper Thomson Road/Sembawang Road and Bukit Timah Road/Upper Bukit Timah Road via Adam Road/Lornie Road and Mandai Road are considered adequate. ANG MO KIO NEW TOWN, NEIGHBOURHOOD I (Construction of hawker centre) 7. Mr Yeo Toon Chia asked the Minister for National Development and Communications whether there are plans to construct a hawker centre for the residents of Neighbourhood I in Ang Mo Kio New Town. Dr Tan Eng Liang (for the Minister for National Development and Communications): Mr Speaker, Sir, a hawker centre will be constructed for Ang Mo Kio Neighbourhood 1. It is expected to be completed in 1979. LIFT BREAKDOWNS IN HDB ESTATES (Particulars) 8.”
“Mr Yeo Toon Chia asked the Minister for National Development and Communications, in view of the heavy volume of traffic along Upper Thomson Road and Lorong Chuan, whether there are plans to provide better lighting along (i) Upper Thomson Road from Kampong San Teng to Sembawang Hill Circus; and (ii) Lorong Chuan from Braddell Road to Ang Mo Kio Avenue 1, and, if so, when they will be implemented. Dr Tan Eng Liang (for the Minister for National Development and Communications): Mr Speaker, Sir, the street lights along Upper Thomson Road between Sembawang Hill Circus and Kampong San Teng have been proposed for upgrading in FY 78/79 as part of PWD's programme to improVe street lighting along all major arterial roads. Lorong Chuan is not classified as a major arterial road and is therefore not included in the present programme. UPPER THOMSON CORRIDOR (Measures to relieve traffic congestion) 6. Mr Yeo Toon Chia asked the Minister for National Development and Communications what action is being taken to ease the traffic congestion at the junctions in front of Mount Alvernia Hospital, and whether it is feasible to construct a new road from Ang Mo Kio Avenue 1 passing through Peirce Reservoir Reserve and joining Upper Bukit Timah Road, to alleviate the traffic congestion. Dr Tan Eng Liang (for the Minister for National Development and Communications): Mr Speaker, Sir, the peak period congestion at the two intersections in front of Mount Alvernia Hospital is caused primarily by heavy peak hour traffic approaching from the various major roads, namely, Upper Thomson Road, Braddell Road, Thomson Road and Lornie Road.”
“Sir, the Ministry was aware as early as 1976 that there was overcrowding at the Tiong Bahru Outpatient Department. Now we are in the Year of our Lord 1978. It has taken us two years of correspondence to-ing and fro-ing between the officials of my Ministry and the Housing and Development Board, so that they can allocate us two suitable units of flats to be rented to us. Then we have got to correspond with the Senior Architect (Works and Buildings) and the Senior Architect's plan has got to be handed to the Housing and Development Board's architects for their approval. We also have to approach the Government Building Committee for approval to rent the two units of Housing and Development Board flats. Then we have to approach Budget Division to seek the release of funds so that renovation work can be put up. All I can say is that, after two long last years, I can assure the Member for Tiong Bahru that the Outpatient Dispensary in his constituency will see some improvement in the year 1978. MASTER PLAN (Revision of Green Belt Zones) 4. Mr Ang Nam Piau asked the Minister for National Development and Communications if he will consider revising certain Green Belt Zones of the Master Plan for industrial use. The Senior Minister of State for National Development (Dr Tan Eng Liang) (for the Minister for National Development and Communications): Mr Speaker, Sir, there is adequate land for future industrial use and it is unlikely that Green Belt Zones in the Master Plan will be considered for industrial use. Existing Green Belts will be retained to serve as "lungs" to relieve intensive urban developments. UPPER THOMSON ROAD AND LORONG CHUAN (Request for better street lighting) 5.”
“Sir, I would suggest that the Member for Potong Pasir make that appeal to the Minister for Social Affairs. I would not like to be accused of being an unkind person. TIONG BAHRU OUTPATIENT DISPENSARY (Expansion of) 3. Mr Ch'ng Jit Koon asked the Minister for Health, in view of the inadequate space at the existing Tiong Bahru Outpatient Dispensary at Jalan Membina, whether he has any plans for the expansion of that Dispensary in order to ease the overcrowding.”
“I am very sorry the Ministry of Social Affairs gives them that grant. The Member for Potong Pasir would like to know further that SATA is not solely involved in screening tuberculosis cases. It is also involved in "clinics" which look after lungs and hearts as well. Mr Ivan Baptist: Could the Minister then recommend to the Ministry of Social Affairs that this $25,000 grant be used instead to solve the drug problem in Singapore?”
“The Member for Potong Pasir should understand that I am not responsible for SATA. SATA is an independent body.”
“Mr Speaker, Sir, the number of persons X-rayed from 1974 to 1977 was 365,971; 381,642; 402,593 and 295,712 respectively. The number of tuberculosis cases notified for the years 1975 to 1977 by Tan Tock Seng Hospital, Other Government Hospitals and Outpatient Dispensaries, SATA, private medical practitioners and through the Registry of Births and Deaths was 3,097, 2,813 and 2,747 respectively. I have given to the Clerk a breakdown of the statistical details (Cols. 721 - 722), and he will make them available to Members if they so desire. NUMBER OF PERSONS X-RAYED FROM 1974-1977, SOURCE OF TUBERCULOSIS CASE NOTIFICATION 1975-1977”
“Woodbridge Hospital 1975 1976 1977 Total Admissions 2,798 3,412 4,229 New Admissions 1,102 1,160 948 (% of total admissions) (39.4%) (34.0%) (22.4%) Total Discharges 3,827 3,983 4,225 Psychiatric Outpatient 51,825 59,139 62,214 Attendances GOVERNMENT HOSPITALS AND DISPENSARIES (Patients, 1975-77) 3. Mr Hwang Soo Jin asked the Minister for Health (a) how many in-patients were treated at the various general hospitals in 1977; and (b) how many out-patients were treated at the various Government hospitals and dispensaries in the same year; and if he will give the comparative figures for 1975 and 1976. Dr Toh Chin Chye: (a) Admissions 1975 1976 1977 Total Admissions 164,205 184,146* 191,059** Admissions into General Hospitals 110,139 119,392 125,489 Admissions into Specialised Hospitals 54,066 64,754 65,570** * Includes 11,692 neonatal admissions ** Includes 13,306 neonatal admissions (b) 1975 1976 1977 Total Attendances at Outpatient Dispensaries and Hospital Outpatient Clinics 3,584,939 3,675,391 4,030,459 Attendances at Outpatient Dispensaries 2,473,891 2,489,596 2,782,858 Attendances at Hospital Outpatient Clinics 1,111,048 1,185,795 1,247,601 LABOUR FORCE, UNEMPLOYMENT FIGURES AND AVERAGE WAGE, 1975-1977 4. Mr Hwang Soo Jin asked the Minister for Labour if he will state, as at 31st December, 1977, (a) what was the labour force in Singapore; (b) what was the number of unemployed persons; and (c) what was the average wage paid, giving the figures for (a) and (b) by sex; and if he will give the comparative figures as at 31st December, 1976, and 31st December, 1975.”
“So we will have to take some time to work out a re-arrangement of the night duty roster, and if we can have more manpower pitching in, I think the burden will be less both for the medical officers and housemen. DIPLOMATIC RELATIONS WITH VIETNAM (Development since hijacking incident) 2. Mr Hwang Soo Jin asked the Minister for Foreign Affairs whether there has been any further development in our relations with the Vietnamese Government since the hijacking incident in October 1977.”
“We therefore find that most doctors posted to the Department of Obstetrics and Gynaecology, including the Registrars and Senior Registrars, have a higher mean rate of weekly hours. They range from 68 hours for Registrars and Senior Registrars, 55 hours for Consultants, 78 and 79 hours for medical officers and housemen respectively. The problem, of course, really depends upon manpower. If there are more doctors available who can be rostered for night duty, then the number of hours per week worked by each doctor can be reduced. However, I must point out the distinction between hours of work and productivity. During the night, patients do not require much attention as most of them have been treated and attended to during the day. So during the night it is necessary to have only a small number of doctors for emergency calls. That is why they are asked to be within the hospital precincts. In the case of housemen, it has been a tradition that to be on night duty is part of their training. While we can permutate the roster, I am afraid that as of this moment it is not possible to reduce the number of night duties which are already allocated because of the existing staff position. If doctors are unable to perform night duty on a particular day, arrangements can be made for them to have substitutes. I think that is not a problem at all. However, I do hope to make an in-depth study into this problem, and I do admit that it is an unsatisfactory position. In New Zealand medical doctors of all grades are on call and this means that they must be within the precincts of the hospital. It is only the Consultants who are allowed to stay away from the hospital. That would be an excellent pattern for us to follow.”