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.”
The complete record
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 7 of 12.
“Mr Speaker, Sir, I have distributed to Members of the House figures (Cols. 299 - 300) to Question 1(a) and 1(b). I will therefore not repeat them here. figures - APPENDIX TO ORAL ANSWER TO QUESTION NO. 1(Cols. 203-205) In answer to Question 1(c), I would like to explain that the hours of work of doctors vary according to the posting. Normally doctors who are working in Outpatient Departments, for example, work office hours and they have a normal week of 42 hours. Those in the hospitals, besides their normal week of 42 hours, are required to perform night duties. If they have a night duty once a week, it will add 15 1/2 hours to the normal 42 hours quota, and if they do have two night-duty performances in a week, it will work out to about 72 hours in a normal week. In the Accidents and Emergency Department the doctors work on shifts and, therefore, they have a 42-hour week but they are given time off for night duties. The problem is a very vexing one because night duties are not necessarily applicable to all doctors working in hospitals. In our system we find that housemen and medical officers are asked to perform night duties. This means that they must be within the hospital precincts. Senior doctors, however, are on call which means that they can go home, attend to their family life or attend to their social life, but they have a bleeper and, if necessary, they can be called to the hospital. Sir, I am in sympathy with those who have to perform as many as two night duties in a week, especially those who are in the Department of Obstetrics and Gynaecology. As Members of the House are aware, babies do not tell doctors what time they are supposed to come out into the world.”
“Mr Speaker, Sir, the Bukit Merah Town Centre's Regional Polyclinic is scheduled to be completed by September 1978. It will provide the following services: Outpatient services, Maternal and Child Health care, Dental services, X-ray services and minor Theatre operations. HIJACKING OF VIETNAMESE AIRCRAFT (Effect on relations with Vietnam) 3. Dr Ong Leong Boon asked the Minister for Foreign Affairs, in the light of the hijacking of the Vietnamese aircraft that landed at Seletar Aerodrome on 29th October, 1977, (a) what Singapore intends to do with the four hijackers and the passenger who refused to return to Vietnam; (b) how this will affect relations between Singapore and Vietnam; and (c) what is Singapore's stand in regard to international hijacking taking into account the Tokyo Convention Act of 1971.”
“Question put, and agreed to. Bill accordingly read a Second time. Resolved, "That the Singapore Red Cross Society (incorporation) (Amendment) Bill be committed to a Select Committee consisting of Mr Speaker as Chairman and seven Members to be nominated by the Committee of Selection." - [Dr Toh Chin Chye]. SINGAPORE LABOUR FOUNDATION BILL Order for Second Reading read. 3.26 p.m.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Red Cross Society (Incorporation) Act, 1973, provides that the President of Singapore shall be the Patron as well as the President of the Red Cross Society. The President has indicated that he wishes to relinquish his appointment as President of the Society. I am accordingly proposing an amendment to Section 6 of the Act to enable the President to appoint another person to be the Society's President. This Bill also seeks to amend sections 7 and 9 of the Act to empower the Society's Council to make rules to regulate the management of the affairs of the Society. Section 5(a) of the principal Act defines the objects of the Society as follows: "5(a) the improvement of health, the prevention of disease and the mitigation of suffering throughout the world without any distinction on the grounds of race, nationality, religion or political opinions." It is felt that this clause is too embracing as it is unlikely that a Singapore Society can mitigate diseases and suffering throughout the world. Moreover, it impinges on the functions of certain Government Ministries. For example, "the improvement of health" and "the prevention of disease" are the responsibilities of the Ministries of Health and the Environment. It is therefore proposed to amend section 5(a) of the Act as set out in the Notice of Amendments which has been circulated. The Red Cross Society is performing a commendable public service in running a Home for Crippled Children. The amendment will permit the Society to continue this excellent work. As the Council of the Singapore Red Cross Society has expressed its desire to make certain amendments, I shall be committing this Bill to a Select Committee where they can present their views.”
“Bill considered in Committee: reported without amendment: read a Third time and passed. INCOME TAX (AMENDMENT) BILL Order for Second Reading read. 3.25 p.m.”
“In other words, some pawnshops are functioning as finance companies but do not offer security to depositors. There are two alternatives to solving the problem relating to deposits. (a) Pawnshops that wish to take on the functions of finance companies by accepting deposits can do so by registration under the Finance Companies Act. (b) Pawnshops will be allowed a grace period of 2 1/2 years to wind up that part of their business involving acceptance of deposits from the public. This can be done by reducing their fixed deposits by 10% every three months during the 2 1/2 year period. No new deposits will be allowed during this period but renewal of existing deposits during the grace period can be permitted provided the total amount of fixed deposits does not exceed the level as required by the phased run-down. The Government has no intention to stop pawnshops servicing those members of the public who are in need of small loans. This aspect of the business can be carried out with lesser capital as the loans given are only 50%-60% of the value of articles pledged. Pawnshops with a history and good standing will not disappear. In fact, their business will increase as the pawnbroking business is brought under control. The other amendments to the Bill are minor and deal with the administration of the Pawnbrokers Rules such as substituting an office of a Registrar for the Pawnbrokers Licensing Board. They are clearly spelt out in the explanatory statement at the end of the Bill. Sir, I beg to move. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Dr Toh Chin Chye].”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." I ought to inform the House that the Bill has nothing to do with health but I am taking this Bill as acting Minister for Social Affairs who is on leave prior to leaving for Jakarta as Ambassador. There were misgivings when the Bill was first published. However, as a prelude, let me mention that between 1952 and 1966 seven pawnshops went bankrupt. Their total declared assets at bankruptcy were only $1,678,498 while $5,914,294 were owing to 1,551 depositors. The causes of bankruptcy ranged from using funds in the interests of the principals of the pawnshop companies, poor management, paying of high interest rates or using depositors' money in uncertain business ventures other than the pawnbroking business. There are now 55 pawnshops with about 16,000 depositors. At the end of March 1977 their combined fixed deposits amounted to $79 million. It is hard to believe that with rising GNP per capita Singapore citizens are becoming more and more insolvent. The liquidity position of pawnshops can be seen from statistics collected for the years 1974-76. The average amount of loans issued in pledges varied from $15 million to $18 million per month or an average of $16.6 million per month. On the other hand, income received from pawners including payment of interest, public auction and sale of unredeemed pledged articles varied from $13 million to $22 million per month or an average of $16.73 million per month. This is the alarming part of the pawnbroking business. The fixed deposit is obviously too large and more than adequate for the purely pawnbroking business. It must be assumed that a substantial sum is being diverted to other types of financial activities.”
“Mr Ang Nam Piau asked the Minister for National Development and Communications if he is aware that zebra crossings without traffic control lights are dangerous to both pedestrians and motorists and if he will consider installing traffic control lights at all zebra crossings. The Senior Minister of State for National Development (Dr Tan Eng Liang) (for the Minister for National Development and Communications): Mr Speaker, Sir, zebra crossings are used at locations where vehicular traffic flow is relatively light such as minor roads in housing estates, factory roads and slip roads at junctions. Usually beacons, flood lights and traffic signals are installed at these crossings to attract the attention of motorists. Pedestrian signals, on the other hand, are normally used at locations where vehicular traffic flow is heavy and fast moving. The Public Works Department will convert zebra crossings to signalised crossings at locations where vehicular traffic has since increased appreciably. LORONG CHUAN/LORONG KINCHIR (Overhead pedestrian crossing) 5. Dr Lau Teik Soon asked the Minister for National Development and Communications whether an overhead pedestrian crossing will be constructed across Lorong Chuan near its junction with Lorong Kinchir.”
“Mr Speaker, Sir, the Changi Hospital has an Accident and Emergency Department to attend to traumatic and emergency cases. Its Specialist Outpatient Department caters for follow-up treatment of discharged patients and those referred by OPD doctors or by private practitioners for specialised consultation. As in other hospitals, it is not the policy for these two departments to attend to non-traumatic/non-emergency cases or those not requiring specialist consultation. For this reason, patients with common or minor ailments reporting at Changi Hospital are advised to go to the Somapah Outpatient Dispensary. This is necessary to ensure that costly specialised services at hospitals are properly utilised to treat the acutely ill, especially when treatment for minor illnesses can be obtained from outpatient dispensaries. During a four-month survey carried out recently in six hospitals a total of 79,951 cases were seen at the Accident and Emergency Department. Among the self-referrals more than 40% were non-emergency and non-traumatic cases. This is misuse of the Accident and Emergency Department which is already congested. I would therefore like to advise the public to go to the outpatient dispensaries if they are suffering from minor ailments. In this way, they will not overload the staff at the Accident and Emergency Department and will be helping the Government to hold down the rising costs of running hospitals. However, if there are genuine emergency cases the Accident and Emergency units will attend to them since the outpatient dispensaries are closed at night. ZEBRA CROSSINGS (Installation of traffic control lights) 4.”
“Mr Speaker, Sir, at present, a trained Nurse Practitioner visits Pulau Tekong daily, except Tuesdays when she goes to Pulau Ubin, to provide outpatient services. She attends to about 20 patients daily at Pulau Tekong and 10 at Pulau Ubin. The majority of cases are common ailments, like cough, cold and sore throat, poor appetite, diarrhoea, sores, boils, sore-eyes, insect bites and so on. If in the Nurse's assessment a patient requires a doctor's opinion, she will refer him to the Somapah Outpatient Dispensary. When hospitalisation is required, the patient is referred to Changi Hospital. However, such referred cases form only about 10% of total cases seen by the Nurse Practitioner. In addition, a Maternal and Child Health team consisting of Staff Nurses and Midwives visits the two islands once a week. A Maternal and Child Health doctor visits Pulau Tekong once a month. As the bulk of the cases at the two islands involves minor ailments and in view of their small population, the present medical facilities provided are considered adequate. CHANGI HOSPITAL (Outpatient services for Changi Village residents) 3. Mr Teo Chong Tee asked the Minister for Health whether the Changi Hospital will also provide outpatient treatment for residents from the nearby Changi Village, as most of the time residents from this village who call at the Hospital for medical attention are re-directed to the Somapah Outpatient Dispensary in Somapah Road which is about 6 1/2 kilometres away.”
“Mr Speaker, Sir, I have mentioned that the licensing of these sanatronic clinics should have gone through the Building Control Division, and I am told that the Building Control Division will look into the matter. The Public Utilities Board likewise has asked for specifications of the installations in these clinics and I am sure that the problem will be solved quite early in the next week or so. ASEAN TRAINING AWARDS (Particulars) 2. Dr Lau Teik Soon asked the Minister for Foreign Affairs the number of ASEAN training awards offered and the number actually taken up by each of the other ASEAN members for the year 1976/77, and how these awards have promoted ASEAN cooperation.”
“Since we are concerned about the sale of unsafe electrical domestic appliances, I ought to inform the House that preliminary inquiries reveal that persons who patronize these so-called sanatronic clinics sit in an electrical field of several thousand volts in order to attract the negative ions that are generated to their bodies. They accumulate an electrostatic charge so that when they touch a person or object outside the treatment area which is earthed they experience a slight electric shock accompanied by a spark discharge. In layman's language the patient is acting like a lightning conductor except that the current passing through him is too small to electrocute him. On the other hand a real danger exists if by any mischance the insulation system between patient and earth breaks down. Under these circumstances the patient will be sitting in an electric chair. It is in the public interest that the operators of these sanatronic clinics should submit the technical specifications of their installation to the PUB for scrutiny. As far as the Ministry of Health is concerned, the whole business is nothing more than a fraud being perpetrated on a section of the public that is always gullible to fantastic claims.”
“Mr Speaker, Sir, ion generators are used to purify or sterilize the atmosphere. Microscopic particles such as bacteria, fungal spores, dust and smoke particles can acquire an electrostatic charge and remain suspended in the air. Particles which are positively charged are neutralized by negative ions and negatively charged particles by positive ions. When fine particles are neutralized they aggregate or collect together to form larger particles that are too heavy to remain suspended in the atmosphere and are deposited or settle down on the ground by gravity. The claim that positive or negative ions are effective in treating rheumatism, migraine, insomnia, mental fatigue, asthma, indigestion, skin diseases, constipation as well as diarrhoea and impotence is not substantiated in scientific or medical literature. If it were true that a wonderful instrument exists that can cure or treat such a variety of physical ailments, then hospitals all over the world would have installed such ion generators today. The danger of untruthful advertising is that gullible patients who should really be receiving treatment from their medical doctors are led astray and, by avoiding medical treatment, they are exposing themselves to unnecessary risks and complications arising from their ill health. However, I ought to add that the Ministry of Health is not involved in the licensing of clinics operating ion generators. I understand that there are six such establishments in Singapore. What is surprising is that they were allowed to open for business without the knowledge of Building Control Division and the PUB.”
“Mr Speaker, Sir, it is possible to introduce outpatient services in the Maternal and Child Health Clinic at Toa Payoh by using two rooms in this Clinic; one for the doctor's examination room and the other for the treatment room. I understand from the Member for Toa Payoh that at present the Maternal and Child Health Clinic in his constituency is underutilised because of a very successful family planning campaign. His suggestion that it should be converted into an outpatient services department is a good idea. The service will be introduced as soon as a medical officer is available and a few items of equipment are obtained. This can only be a temporary measure as the long term solution requires a much bigger facility for the population at Toa Payoh which is over 200,000. For this a three-doctor clinic is required. At the moment, residents in Toa Payoh have a choice of consulting private practitioners within the housing estate or, alternatively, they may attend the nearby Government Outpatient Dispensaries, namely:- Pegu Road Outpatient Dispensary; Bright Hill Drive Outpatient Dispensary; Upper Serangoon Road Outpatient Dispensary. WORK PERMITS (Policy and Number issued as at 28.2.77) 2. Mr Ang Nam Piau asked the Minister for Labour what was the total number of Work Permits issued as at 28th February, 1977, and whether he is satisfied with the policy of issuing Work Permits to foreigners when there is still a large number of Singapore Citizens who are unemployed.”
“I am rather amazed or stunned by the Member for Jalan Kayu when he suggested that it is pointless to appeal to the doctor's loyalty and that he would rather pay them. This is suggesting that all doctors are mercenary and that they have got no other instincts. I do not believe that all doctors are the same and there can be no institutional loyalty. My fear is that the young doctors are leaving too early for their own good. 5.50 p.m.”
“65% 1974 ... 69% 1975 ... 74% 1976 ... 73% So there is a clear-cut trend, and not to understand this trend means that we will forever be chasing our tails and listening to complaints made by the doctors' union on inadequate salaries, unsatisfactory conditions of service, and so on. I have indicated earlier that the eagerness to enjoy the good things in life exists among our younger generation. In the case of private practice, market forces of supply and demand apply. We all like to believe that our doctors are serving only the population of Singapore of 2.3 million permanent inhabitants. This is not really so. There were 1.5 million transient visitors last year, plus another 120,000 estimated floating population of expatriates. In other words, I put it that the doctor-population ratio in Singapore is less than what it is. Therefore, as long as there is a demand and as long as members of the public or even visitors are prepared to pay the prices which the private practitioners call for, the exodus from the Ministry of Health will continue. Hence. I have suggested earlier that there is a clear-cut distinction between migration and leaving the Ministry of Health for private practice. As far as migration is concerned, it is very difficult to control the doctors, short of withholding their passports. I do not think that can be done. But there is no reason at all, as I have said earlier, why the Ministry of Health or the Medical Council should ever give an applicant a Certificate of Good Standing when there is nothing under the law to say that this should be done. On the other hand, I have appealed for institutional loyalty.”
“Sir, the Member for Marine Parade has raised a very important question. Firstly, I would like to congratulate him on his sharp eye in detecting the enormous difference in the subhead under Singapore General Hospital for the financial year 1977-78. I must confess it was a ghastly error. An investigation has shown that in reality $0.368 million is intended for annual increments, the balance of $1.797 million was to cover 606 new posts proposed by the Ministry. The explanation given to me was that most of the new posts proposed were not approved by the Ministry of Finance when the Estimates were submitted under subhead BAA 1101, and because of clerical oversight it was too late to adjust the provision since the Estimates had already been finalised and printed. The error would be rectified administratively by freezing the excess provision. 5.45 p.m. Now, on the second point with regard to the question of the resignation of doctors - I think it is a continuation of what the Member for Kim Seng, the Member for Anson and the Member for Punggol have said a little while ago, and so may I continue with what I said a little while ago before? While I do not want to appear to be harsh in my judgment of the attitudes of the younger generation, I think it is fair enough that we should try to be as objective as possible in our estimation of trends. I made a speech at a dinner two weeks ago in which I stated that about 60% of doctors had resigned with less than three years of service. I am afraid it was a very conservative estimate. I should have qualified that statement by saying that at least 60% had resigned. I have examined the trend and I would like to inform the House of what I have discovered. The percentage of doctors resigning within three years was: 1972 ... 44% 1973 ...”
“Sir, may I just take up the point immediately since you indicated to me that there is a guillotine. I ought to explain that under the present scheme of medical charges all those who are in possession of a work permit or Employment Pass are considered as residents and are charged residential fees, obstetric cases excepting. Unfortunately, this interpretation has been applied even to those who hold Singapore blue identity cards. It does not make sense indeed that permanent residents who hold Singapore blue identity cards but do not work are charged residential rates whereas those who are willing to work and hold work permits are charged nonresidential rates. I have reviewed the matter and decided that henceforth a permanent resident holding a blue Singapore identity card regardless of whether he holds a work permit or an Employment Pass and who is the wife of a Singapore citizen will be charged the same hospital rates as for residents in all obstetric cases. To answer the second point on breast feeding, I cannot remember whether all of us were brought up on mother's milk. But at least I assume some of us are well aware of the campaign conducted by the Member for Potong Pasir, He is a great enthusiast for breast feeding, excepting that I have to remind him "that is meant for kids only". I am not aware that any of the obstetric departments in our hospitals are hostile to the practice of breast feeding. In fact, the Member for Potong Pasir is very pleased indeed with the milk bank that we have helped him to establish. But if it is true, as the Member for Telok Blangah has alleged, that there is a campaign at marketing cow's milk in hospitals, I would like to know the full particulars so that action can be taken.”
“I would just like to say that there is a trend among the younger generation, and the trend is to achieve the good things in life as early as possible. It is an indictment, of course, that our social values that we wish to impart are not there. All that you have to do is to watch the commercial advertisements over television. They are all directed at urging the consumer instinct in the young. You see the case of a 24-year-old entertaining ambitions of becoming a millionairess at her age, going to work in a chauffer-driven Mercedes Benz. By the time she has that ambition, what about the younger doctors? Mr Speaker reminds me that there are four more amendments to go; perhaps I will reserve what I have got to say when the other four amendments are moved.”
“I will cover everything as fast as I can, Sir.”
“To be truthful, I believe there is a trend among the younger generation. This is a new trend which we did not see 20 years' ago. In the 50s I remember some colleagues of mine who retired from the University Service as doctors did not collect enough from their pension or the Provident Fund to buy a house. These days the young doctor who graduates immediately asks for a house. The Member for Kim Seng mentioned in a speech at a Rotary Club which was reported recently -”
“If a doctor cannot find satisfaction in his job, then obviously he has chosen the wrong profession. If I were given the responsibility of having to build a completely new medical school in a completely new country, I would insist that all those who aspire to enter medical school should do a spell of nursing for two years. As it is, entering medical school is like first passing your GCE "O" Level, then the "A" level, then the first MBBS and then the second MBBS: a series of passing examinations. Medical students have little concept that their profession is a vocation and even among nurses there is a 20% dropout during the training period. I am quite sure that if we ask those who wish to be trained as doctors to do a spell in nursing, some of them will change their minds after they have gone through a period of nursing. I am more particularly concerned because last year 50% of medical students in the first year are girls. So this is going to pose a genuine problem, not only for my Ministry but for the Ministry of Defence. The Ministry of Defence requires male doctors for national service. So if there are less male doctors. there are going to be less doctors for national service. Since the lady doctors have prospects of getting married and bringing up a family, in the end we might not be having the effective number of material whom we can recruit as doctors, particularly when the experience of Britain shows that at least 15% to 20% of female doctors are lost to the profession. This is a point which I ought to bring to the attention of the House because it is food for thought and I am just thinking what I ought to do with regard to future intake of students into the Medical School and how I ought to correspond with the University of Singapore.”
“And you can only do that if there are good gurus. So long as we search for good gurus and as long as there is hope that we can find good gurus, I think they ought to be duly rewarded. But I am afraid doctors are difficult persons to deal with, like lawyers. You know, lawyers never agree with each other. So also, doctors rarely agree with their diagnoses or even their treatments. That is why both lawyers and doctors have one thing in common - plenty of words. The other reason why they leave is that the job is not challenging and that they are unable to get a requested posting. I have discovered that doctors have been posted by computers. I believe this is not a clever idea. For one thing, the man who did the programming had left the Ministry. Circumstances have changed and there is nobody to change the programme. So the computer is operating on old yardsticks for a new generation of doctors. So wrong people are being posted to the wrong places. For instance, when I visited Woodbridge Hospital I was greeted by a young medical officer. Far from smiling at me, he grimly told me "I want another posting." Looking into the complaints made on the inability to get the right posting, I have suggested to my officers that henceforth the posting of doctors will be made according to where vacancies occur, so that when a person applies for a job he knows what he is in for. I would rather have happy doctors working in the right places than reluctant doctors in the service, because they will demoralise the whole service. These are the gripers and grumblers who will collect around them dissidents and who keep on pressing home the point that there is no job satisfaction. A doctor is a doctor.”
“However, this does not mean that we are discouraging doctors who wish to improve their knowledge and learning by taking higher examinations. On the contrary, the present practice of awarding doctors with allowances, if they hold a higher qualification, should be continued. On the question of poor staff relationship, this is a point which I am afraid the Minister is in no position to handle. Staff relationship has got to do with doctors and doctors. Some doctors are soloists. You will notice that some doctors who go into private practice do not practise as a group but practise solo. So also, I feel that such people will not fit into a team in a hospital because in a hospital doctors are required to work as a team. Once they are in a team there is a hierarchy. The junior doctor or medical officer has to take orders from the Registrar, who takes orders from the Senior Registrar, and who in turn takes orders from the Consultant, and so on. There is a "hen pecking" order. It is very much like what you get in the Singapore Armed Forces. I am concerned indeed that the man at the top should be sound headed and competent so that he can hold his team together. I would be very worried indeed if we do not try to bring up a generation of gurus or teachers who can collect around them disciples. because it is through their leadership that a tradition can be built in the hospitals. If each doctor looks after his own interest, I am afraid all medical traditions will disappear. It is not the private sector or the private medical practitioner who is setting tradition in Singapore, or standards if I may add. It is those who work in the hospitals, in the University units, who have a very large responsibility for collecting disciples around them, for building a medical school.”
“But bearing in mind that expenditure for the health services has increased by 300% in five years, and now our health expenditure is as high as 1.15% of the GNP, I think it is very difficult indeed to satisfy doctors or to match doctors' salaries with what they can earn as private practitioners. By the time a Chinese newspaper editor comes to the conclusion that the private practitioner can earn two to 10 times that of a Government doctor, I do not see how it is possible for the Minister for Finance to agree that the immediate solution to the shortage of doctors in the Ministry of Health is to proportionately increase their salaries. It will lead to a demand for similar increases among other professional staff - the lawyers, the architects, the engineers, the accountants and so on. 4.45 p.m. On this score, therefore, I can say that little can be done but on promotion something can be done. I am in sympathy with those doctors who have worked for many years in the Ministry of Health. I think they deserve consideration for promotion although they may not have a post-graduate qualification. I am convinced that medicine is still an art acquired through experience and medicine relies on clinical judgement, which again is based on experience. Therefore, by virtue of this experience, I believe that those with eight years' service deserve consideration for promotion regardless of the fact they do not have a higher qualification. After all many civil service administrators have been promoted not because they have a Ph.D or any other higher university degree but because of their experience and their personal capability. I think, likewise, the same criterion should be applied to doctors.”
“A Certificate of Good Standing as I see it, is like a testimonial, very much like one given on behalf of a person by his referee to a prospective employer. I can say from experience that not all referees write good testimonials. Any doctor who wishes to register overseas can produce his own Certificate of Registration in Singapore. But we are going beyond our obligations to issue so-called Certificates of Good Standing to every applicant. Let me now come to this problem of doctors who move out of the Ministry of Health into private practice, because it does hurt the Ministry. I think I ought to expound a little. There are many reasons why doctors move out. Some of the major reasons which have been listed by private practitioners who once upon a time worked in the public sector are:- Job is not challenging. No opportunity for promotion. Poor physical working environment. Poor salary Poor staff relationship. Inability to get requested postings. These are the major reasons. The other reasons are that they have got more freedom and that they are able to do other business. Obviously, we cannot satisfy anyone or everyone because of the numerous reasons that have been given. However, let me deal with some of these reasons. In the case of salaries and promotions, I would like to say this for the information of Members of the House. In the Soviet Union doctors are paid less than the ordinary industrial worker. Doctors are paid 120 roubles per month. The industrial worker is paid 162 roubles per month because he is the person who produces the goods. And the rate of inflation of retail prices has been kept at 2% in the USSR. I am not suggesting that Singapore can operate like the USSR because we are an open economy. There is a free market here and we operate on free market rules.”
“I would like to make it quite clear that we should make a distinction between doctors who migrate and leave Singapore and doctors who leave the Ministry of Health to enter private practice. Members may be aware or recollect that the Ministry of Defence last month advertised that two of their doctors holding the rank of Captain deserted national service by absconding overseas. Both of them were doctors trained in foreign universities and, therefore, were registrable abroad, one in Canada and one in the UK. They did not therefore require certificates of good standing from the Ministry of Defence or the Singapore Medical Council in order to register abroad. This made their flight from Singapore easier. The Member for Delta will recollect that in July last year he questioned me on the number of Singapore doctors who were registered in foreign countries. (Hansard, dated 23.7.76, cols. 983-5). I could not then give him an accurate answer but provided the House with information on the number of certificates issued from 1973 to 1976. I have since examined the problem and discovered that it is not obligatory under the written law for such certificates of good standing to be issued at all. Furthermore, such certificates have been issued freely without the applicant providing evidence that he is of good standing during his period of practice. In fact, every doctor who has just finished his housemanship if he asks, will be automatically given a Certificate of Good Standing. This, of course, is an extraordinary position. I feel that in future applicants will have to prove that they are of good standing, and I do not see how good standing can be proved unless the applicant has at least three years of practice, either in the private or public sector, to show his competency.”
“It has announced the need to recruit women into non-combatant national service and maybe in 10 or 15 years' time we may not even find the people who want to work in convalescent homes or in nursing homes for the chronic sick. This is a nagging problem. I am already finding it difficult to recruit people who will want to work, let us say, in Woodbridge Hospital. Woodbridge Hospital is intended to house those who are mentally ill. But those who are mentally ill have become geriatric cases. From a state of mental illness they have advanced to a state of mental senility. So Woodbridge Hospital is really a combination of a home for the aged as well as a home for the mentally ill. Doctors in particular are very reluctant to work in Woodbridge Hospital, and that is why my sympathies and my encouragement go to those who are prepared to take on a job which is unpopular and not at all very attractive, because working in a home like that does not provide an outlet and encourage a doctor to leave the Ministry to enter into private practice. We have therefore decided to concentrate on home nursing as explained in the Addendum to the President's Address. The Home Nursing Foundation will deal with patients referred to by hospital doctors in the first instance, and it is part of primary care service. This is one sector which we hope to expand and on which money will be spent. More nurses will be recruited for this particular aspect of home nursing service. Lastly, let me come to the vexing problem raised by the Member for Anson and the Member for Punggol on the shortage of doctors. I am afraid that there are many factors relating to the exodus of doctors from the Ministry of Health, and it is a problem which requires some degree of analysis.”
“But bearing in mind that there is increasing affluence, and there has been a rise in wages or income among the population, we have decided to introduce a second A class ward and a second B class ward so that a patient can pay according to a progressive scale of charges. This. I think, is fairer than the present system where there is an enormous quantum jump from $30 B class to $60 A class and from $4 C class to $30 B class. The C class ward will be intended primarily for those who really cannot afford to pay, and I think it is fair that the people of Singapore should be conscious that medical costs have gone up by 300% in the last five years, or about 1.15% of the GNP in 1975, and therefore part of the cost will have to be paid for. On the Member's suggestion that we should open a nursing or convalescent home for stroke and other chronic patients. I regret that our studies indicate that it is going to be very difficult to do so because we have discovered from the experience of the United Kingdom that nursing homes or even homes for the aged are very expensive to run as compared to treating them as outpatients. In 1970, the expenditure spent by the British Government on in-patients was �293 million. On outpatients �24 million. On home nursing only �12 million. But the cost of running homes for the aged shot up to �53 million. And presumably the same economic rules will apply to us if we try to run homes for the chronic sick. Worse than that, I am afraid that in future years we are going to face a labour shortage. Mindef is already facing that problem.”
“In response to the Member for Kim Seng as to whether there will be any increase in medical charges. I must say that this is being looked into. In the first instance, we are studying the rationale for an increase in dental charges. As of this moment, Members are aware that the Ministry is charging only $4 per patient per treatment. This, of course, leads to pressure in the demand for treatment in the Ministry's Dental Department. For a charge of $4, the dental surgeon has to spend probably half an hour on a patient. This is patently absurd. So we are looking into the matter to vary the charges, according to the type of treatment that is to be provided as well as according to the time that has to be spent on a particular patient. When there is any increase in dental or medical charges, we will announce them in this House. The newspapers have got hold of a story that we are contemplating on introducing five classes of wards. It is a true story. As of this moment, there are only three classes - A class for which we charge $60 per day. B class $30 per day and C class $4. There is an enormous gap between $4 and $30 and $30 and $60. With successful family planning and greater acceptance that two children are enough, more parents are anxious that they and their children receive the best medical care. Doctors and the nurses at the Kandang Kerbau Hospital have been plagued with requests from C class patients, even B class patients, to be lodged in A class wards. The number of requests amounts to about eight to 1 2 per day. I believe that $60 per day may be too high for some middle income groups, and likewise $30 may be too high for some working class people.”
“The reason why we are still seeing a significantly large number of tuberculosis cases is that tuberculosis is prevalent among that generation which has never received BCG vaccination. BCG vaccination was introduced in Singapore only in the late 195Os and it is to be expected that the older generation will be carrying tuberculosis and spreading it to those who are at risk. So it will be many more years before tuberculosis disappears entirely from Singapore. SATA is a separate organisation. It has no connections with the Ministry of Health. It receives a subsidy of $35,000 from the Ministry of Social Affairs. I am told that operations of SATA have now expanded to cover heart and chest diseases. However, SATA is bound to notify the Ministry of Health of tuberculosis cases that it comes across, SATA, like any other private practitioner, is entitled to treat tuberculosis cases. With regard to his question on swine-flu vaccine, the Ministry has ordered several thousand doses of vaccines, but they have not yet arrived. Off the cuff, I think that the total cost would come to about $600,000. The number of doses ordered has been calculated to provide, first, for those who are working in essential services. If there is a demand by members of the public, then more doses will be ordered but they will have to pay at about $5 per dose. The vaccine that we have ordered will offer protection against swine-flu, Hongkong flu and Victoria `A' flu. It is a tri-valent vaccine. When the vaccine arrives, we will first vaccinate national servicemen because they live together in camps and are very likely to spread influenza among themselves and to their families when they return home from camp. 4.30 p.m.”
“It is true that in the past the Maternal and Child Health Clinics were run separately from the Outpatient departments and from the school services. Because of this set-up, the utilisation of manpower was not optimum, and last year we integrated the Maternal and Child Health Clinics and the school services together with the Outpatient departments so that we can make full use of the staff. In this way we hope to be able at least for the next three years to overcome the problem of shortage of doctors. The ambulance services will be integrated by April or May of this year after a discussion between my Ministry and the Ministry of Social Affairs. In future the public need ring only one number and they will be able to get a public ambulance provided by the Fire Brigade. There will be a distinct improvement in the ambulance services, Moreover. these ambulances will be controlled by radio so that there will be constant contact between the ambulances and the Accident and Emergency Departments in the hospitals. However, with regard to ambulances carrying patients from one hospital to another hospital, I would say that after the integration the load on hospital ambulances will be eased and therefore patients need not have to wait that long if they have to be transported from one hospital to another for specialist treatment. The Member for Potong Pasir has mentioned about the prevalence of tuberculosis cases. For his information, there were 4,711 cases in 1965 and 2,815 cases in 1976. If we were to calculate the rate per thousand population, they work out to 250 in 1965 and 124 in 1976. This means that the rate has gone down by 50.6% in 12 years. So there has really been no increase in the number of tuberculosis cases.”
“Mr Speaker, Sir, may I just take up the specific points raised by Members of the House before I enter into a general statement, particularly with regard to staffing the hospitals with doctors. The Member for Anson has stated that we are spending money to improve hospitals and he has enquired whether we have adequate doctors to man these hospitals. I would like to explain that improvements which we are going to make to the hospitals will amount to only $9 million, and they are intended for old hospitals, such as the Tan Tock Seng Hospital, Alexandra Hospital, Kandang Kerbau Hospital and Woodbridge Hospital. All these hospitals were built before the war. I have visited all the hospitals but I must confess that I have not made an exploration into public toilets. If the Member for Anson reports that the toilets are in a disgraceful state, then I must say that it might be a good idea if he carries out an education campaign among the users of public toilets so that they do the right thing in the right place. However. I shall bring this matter to the attention of the Medical Superintendents and the secretaries in the hospitals so that public toilets will be used for what they are intended to be. The Member for Anson also mentioned that the Maternal and Child Health clinics are understaffed. Strangely enough. I hear from the Member for Toa Payoh that his Maternal and Child Health Clinic is irrelevant because, as a result of a very successful family planning campaign, there are very few mothers taking their children to the Maternal and Child Health Clinic at Toa Payoh. And he is requesting that this clinic be converted into an outpatient department.”
“as at present; and (iii) special provision to allow cars of residents in Novena Estate to turn right from Jalan Novena into Thomson Road and to turn right from Thomson Road into Jalan Novena more easily and safely than at present.”
“As to when these polyclinics will be commissioned it will depend very much on the speed with which these plans are processed. The Bedok Regional Polyclinic would be built by the Housing and Development Board within the housing estate itself. Equipment for the polyclinic is estimated at $371,000. Running costs would amount to about $1.4 million per annum (about $1 million of which will go to pay for salaries of staff.) RECREATIONAL FACILITIES FOR BEDOK NEW TOWN (NEIGHBOURHOOD I) 2. Haji Sha'ari Bin Tadin asked the Minister for National Development and Communications what recreational facilities are planned for the residents of Bedok New Town (Neighbourhood I) and when they are expected to be ready. The Senior Minister of State for National Development (Dr Tan Eng Liang) (for the Minister for National Development and Communications): Mr Speaker, Sir, the recreational facilities for Bedok New Town Neighbourhood I consist of multi-purpose courts, a roller-skating rink, children's playground as well as footpaths and landscaping. These facilities are expected to be ready by early 1978. WIDENING OF THOMSON ROAD 3. Mr Sia Khoon Seong asked the Minister for National Development and Communications when the stretch of Thomson Road between its junctions with Balestier Road and Moulmein Road will be widened and whether the plans to widen the road include (i) provision of a pedestrian crossing with controlled lighting; (ii) provision of a special lane at the Thomson Road/Balestier Road junction to allow cars to turn right from Thomson Road into Balestier Road at all times and not just between 7 p.m. and 7 a.m.”
“Mr Speaker, Sir, polyclinics will provide the following services: Section Service (a) Outpatient General curative services including psychiatric services (b) Maternal & Child Health Centre Preventive (mothers and preschool children) including family planning (c) Dental health services Remedial/conservative extractions, fillings, oral surgery, etc. (d) X-ray Services(e)Minor day surgical theatre Radiological services (e) Minor day surgical theatre Minor surgical procedures The Bedok Polyclinic is one of four being planned. It is scheduled to be completed in 1978/79. The plans for the next five years in developing the Primary Health Care Services are as follows: Regional Scheduled Polyclinic Completion by HDB (a) Ang Mo Kio 1977/78 (b) Telok Blangah 1977/78 (c) Bedok 1978/79 (d) Woodlands after 1980 In addition, five polyclinics would be established to serve Housing Board estates with population concentration of 150,000 to 200,000. They will be located at: Polyclinic Scheduled for Remarks Completion By (a) Kampong Kapor 1977/78 Replacemetn clinic for Prinsep street Maternal & Child Health Clinic and Kee Seng Street OPD which would be affected by urban redevelopment. (b) Kreta Ayer 1977/78 Replacement clinic for Maxwell OPD and Kreta Ayer Maternal & Child which would be affected by urban redevelopment. (c ) Clementi 1978/79 To serve Clementi and Ayer Rajah New Towns. (d) Upper Serangoon 1978/79 Existing Outpatient Dispensary to be upgraded to polyclinic to replace Paya Lebar OPD which would be affected by road widening. (e) Geylang East 1979/80 Replacement of Kallang OPD which would be affected by road widening. The plans are currently under consideration by the Budget Section of the Ministry of Finance.”
“Mr Speaker, Sir, now that I am here I will be very happy to listen to the Member for Kampong Chai Chee on his remarks on family planning. I can enlighten him. I can also send him to my Family Planning Population Board for advice, if necessary.”
“Mr Speaker, Sir, on a point of clarification. I just wish to question the Member for Kampong Chai Chee. He was the Parliamentary Secretary to the Minister for Culture. We would like to know which side he is speaking for and whether he was cancelling out the Ministry of Education,”
“Mr Speaker, Sir, I have nothing particularly to add to what the Member for Katong has said except to thank him for the historical references that he has made. It sounds amusing in these modern times. I am glad I am receiving his support. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill.-[Dr Toh Chin Chye]. Bill considered in Committee; reported without amendment; read a Third time and passed. ESTATE DUTY (AMENDMENT) BILL Order for Second Reading read, 4.25 p.m.”
“The control of infectious diseases within Singapore will be administered by the Director of Medical Services, whilst the prevention and introduction of such diseases, in particular cholera, typhoid, malaria and dengue haemorrhagic fever, into Singapore will be administered by the Commissioner of Public Health in the Ministry of the Environment. Clause 20 of the Bill empowers the Director of Medical Services to prohibit any person from carrying on any occupation, trade or business if in doing so he will cause the spread of the disease. Members of the House are aware of the "Combat Infectious Diseases Campaign" carried out in September this year, during which the public attention was focussed on tuberculosis, food-borne diseases, malaria, dengue haemorrhagic fever, leprosy and venereal diseases. The campaign has been successful in educating the public into the causes and effects posed by these diseases. Apart from legislative measures, I believe that an educated and well-informed public is a more important factor in controlling the outbreak of epidemics and assure a high standard of health in Singapore. Question proposed.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The control and prevention of infectious diseases into Singapore have been regulated by the Quarantine and Prevention of Diseases Act of 1915, the Leprosy Act of 1949 and the Diphtheria Immunization Act of 1962. The purpose of this Bill is to bring the provisions of the old Acts under one cover and at the same time to provide more effective measures against the spread of infectious diseases. The need for this Bill is substantiated by the outbreak of two epidemics in 1975 - a malaria epidemic and a typhoid epidemic. Investigations showed that the outbreak of malaria in the Whampoa area was due to a single patient who had been infected by the disease when he was outside Singapore. As facilities for travel become easier and immigration controls are more relaxed, it becomes essential for Singapore to be vigilant against the importation and spread of infectious diseases in the Republic. At present, diseases which must be notified by medical practitioners include cholera and typhoid, plague, smallpox, yellow fever, chicken pox, diphtheria, leprosy, malaria, poliomyelitis, tuberculosis and typhus. Under the provisions of this Bill, the schedule of notifiable diseases has been widened to include infectious hepatitis, encephalitis and venereal diseases, Although private doctors are required to notify cases of venereal diseases, they do not have to reveal the names and particulars of their patients. The reason for such a step is to encourage infected persons to seek treatment by their own doctors as early as possible. In this way, it is hoped that the spread of sexually transmitted diseases can be voluntarily kept under control without patients being fearful that they will be publicly embarrassed.”
“Sir, may I ask, who is going to subsidise? Will the Member for Bras Basah pay more tax? If so, then I think the subsidy will come from taxes. PAN ISLAND EXPRESSWAY (Completion date) 6. Mr Ng Kah Ting asked the Minister for National Development and Communications when the Pan Island Expressway which is being built in parts and stages will be completed and at what cost.”
“Mr Speaker, Sir, the capital expenditure for the new Singapore General Hospital is estimated at $200 million, and if that capital sum were to be amortised I believe the interest will be considerable. I am afraid I cannot give a clear-cut answer to the question asked by the Member for Bras Basah. If there are any changes at all, I think due consideration will be given to the changes in charges for the health services as a whole.”
“Sir, I do not think it is possible at this juncture to calculate what it is going to cost us to maintain a bed a day in the new Singapore General Hospital until the building is completed and taken over. As of this moment, for the whole Singapore General Hospital it works out to about $17,000 per bed per year.”
“Does that question refer to the new Singapore General Hospital or the existing General Hospital?”
“(3) An Obstetric and Gynaecology Unit and a Neonatal Unit will be located in the new Singapore General Hospital. (4) A Paediatric Surgery Unit, for all children under the age of 12 who require surgery. (5) A Department which will provide facilities for medical investigations using radioisotopes. (6) A Clinical Measurement and Health Evaluation Unit to evaluate the function of the heart, lungs, brains, using an electrocardiography (ECG) machine and treadmill stress-testing machine, respiratory functions, electro-encephalography (EEG) and electronyography (EMG). The Unit will also have a multi-phasic health testing laboratory. (7) An Experimental Surgery Department which will provide facilities for doctors to undertake experimental surgery on animals.”
“Mr Speaker, Sir, the new Singapore General Hospital is scheduled for completion by June/July 1980. When completed, the Hospital will have a total bed complement of 1612, scheduled for commissioning as follows:- August 1978 466 beds December 1978 471 beds September 1979 150 beds July 1980 525 beds ------------ 1612 beds ------------ On new medical equipment, there is need to economise and therefore existing equipment which are still serviceable will be transferred to the new Hospital. Some of the more modern and sophisticated equipment to provide new services and to upgrade existing services will be bought. Among the new equipment that will be bought are:- (1) linear accelerators for the treatment of cancer; (2) modern diagnostic equipment using radioisotopes for the diagnosis of various medical and surgical conditions; (3) modern diagnostic x-ray equipment, including the EMI Scanner for diagnostic procedures; (4) operating theatre equipment, including monitoring facilities, medical gas supply systems. etc, which are normally used in surgical work; (5) x-ray equipment, resuscitation and diagnostic equipment for the Accident & Emergency Department. Under new medical treatment and specialities, there will be the following:- (1) A 32-bed Day Surgery Department for patients requiring minor surgical procedures and investigations such as endoscopy which do not require full-day hospitalisation. As of this moment, such patients have to be admitted into the hospital and thus they form a substantial number of in-patients in the hospital. (2) A Cardiothoracic Surgery and Cardiology Unit will be transferred from Tan Tock Seng Hospital to the new Singapore General Hospital.”
“The real objective is to provide them with some training for those who can be trained and thus enable them to take up employment and return to independent living in the society. Unfortunately, the number who can be helped in this way is hopelessly small. I should also point out that a number of beggars or apparently destitute persons do have families who, for one reason or another, do not wish to assume the responsibility for their care. The biggest problem that the Social Welfare Department faces is in motivating their families to take care of them. The policy has been that, wherever it is possible, such destitute persons will be discharged to the care of their families. CIGARETTE SMOKING BY YOUTHS (Prohibition) 3. Mr Yeo Choo Kok asked the Minister for Law and the Environment, as cigarette smoking is considered dangerous to health and anti-social, if he will consider introducing legislation to prohibit the smoking of cigarette by youths below a certain age.”
“Singapore citizens constituted 78% of persons to whom these certificates were issued. Appendix - REQUEST FOR CERTIFICATE OF GOOD STANDING FOR MEDICAL PRACTITIONERS/FROM DENTAL SURGEONS (Cols 1001-1002) I would like to assure the Member for Delta that my Ministry is processing registers which we have obtained from overseas, and we are now in the process of counting heads. I think it is useful information that the Ministry should acquire, just in case. BEGGARS (Accommodation in welfare homes) 2. Mr Ang Nam Piau asked the Minister for Social Affairs whether he is aware that there has been an increasing number of beggars in the crowded streets and eating places recently and if he will take steps to accommodate those unfortunate people in welfare homes. The Parliamentary Secretary to the Minister for Social Affairs (Mr Chan Chee Seng) (for the Minister for Social Affairs): Mr Speaker, Sir, the Social Welfare Department of the Ministry of Social Affairs regularly checks public places for the presence of beggars. Patrols are carried out twice a day by Social Welfare officers. This has been done since 1965. For the 10-year period from 1965 to 1974, an average of about 300 beggars per year were contacted by the Social Welfare Department. However, in 1975 the number of beggars contacted dropped to 202. In the first quarter of 1976 there were only 43. These figures indicate that far from there being an increase in the number of beggars in public places, there has been a drop in number. Beggars who are found to be destitutes are admitted into the Department's Homes for the Destitutes if they need shelter and care. The aim of admitting beggars into such homes is not just to accommodate them.”
“Mr Speaker, Sir, the only way of ascertaining the number of Singapore doctors registered in foreign countries is to obtain the registers of such countries and to check them against the local register. This is a formidable task; nevertheless, my Ministry is obtaining the information. However, this information will not indicate whether those who have registered themselves in a foreign country have already migrated or would be migrating to that country. An indication of how many Singapore doctors have sought registration overseas is the number of applications for Certificates of Good Standing which are required for registration in a foreign country. Similar certificates are required for doctors wishing to do postgraduate studies abroad. The total number of Certificates of Good Standing which have been issued from 1973 to date is 496, of which 211 are for those in Government Service, 31 for those in the University of Singapore and 254 for private practitioners. Singapore citizens constitute 80.4% of those issued with such Certificates of Good Standing. I have given the Clerk of the House a list of tables which set down the analysis of the number of doctors who have obtained these Certificates of Standing, and they will be made available to Members of the House. However, I would like to comment that in 1973 the total number of doctors to whom Certificates of Good Standing were issued was 45; in 1974 it more than doubled to 114; in 1975 it was 151 and in the first five months of 1976 it was 186. For additional information (See Appendices A and B, cols 1001-2) with regard to dentists,in 1 973 the number of Certificates of Good Standing issued to dental surgeons was zero; 11 in 1974; 11 in 1975 and 14 for the first five months of 1976.”