Xie Yao Quan
Singapore
“Thank you, Sir. Sir, the Minister mentioned the incidence rate of bullying behaviour in our schools and I would like to stress that this is based on reported incidences.”
“Thank you, Chairman. I thank MSF for responding to our cuts and I seek leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $5,822,529,800 for Head I ordered to stand part of the Main Estimates.”
“What would be a fair valuation of fairness to current, affected homeowners? The Government will need to use sound and consistent principles for such an exercise, to justify the higher public spending that this implies.”
“My idea of balance that I prompted you on was not so much about keeping versus sharing at the individual level, but about spending and saving at the societal level.”
“Thank you, Mr Speaker. I will just reiterate two points that I have made in my speech. First, I think it is more meaningful to look at how a term of government balances its collection against spending over its entire term in government.”
“Sir, I thank the Member for both clarifications. My basic response to both clarifications is yes. I accept that surpluses can be transferred into Past Reserves at the end of a term of government.”
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Every one of 336 lines we hold for Xie Yao Quan, in date order, each linked to its source. Free to read, in full, without an account. Page 7 of 7.
“" A complete exemption of TraceTogether data from Criminal Procedure Code provisions, in line with the Government's original communications on this matter would, in my view, be the surest way to achieve this. Some have pointed out that other technological applications that are so prevalent in our lives today have far broader terms of use regarding our personal data. But that is really not the point, and in any case, the trust between Government and its people is a completely different matter. It is sacrosanct. It is strategic. I was, therefore, very concerned about how Singaporeans would take to the Government's clarifications on this matter last month, and to the proposed amendments before us today. In this respect, I was relieved to observe that, in general, in fact, the level of participation and the desire to participate in TraceTogether had actually remained high. In fact, many of my residents have been anxious to collect their tokens and were asking me when stock at the Community Club would be replenished – happy to know that stock has arrived. Other residents pointed out to me that the amendments actually limit Police access to a much narrower scope than what the Criminal Procedure Code provides for. So, they understand the Government’s thinking on this matter and recognise the Government’s practical and calibrated approach on this matter. And I note that TraceTogether data, as it was originally designed, will ultimately continue to be automatically purged after 25 days and cease to exist altogether once this pandemic is behind us, the proposed legislation notwithstanding. So, ultimately, it was really a dilemma for me. On the one hand, the need to jealously safeguard trust in the interest of public health.”
“Mr Speaker, Sir, Singapore may be doing well now, but COVID-19 could be with us for quite a while more. Indeed, many countries around the world are currently dealing with major outbreaks. In Singapore, we have a multi-layered strategy to keep ourselves safe, for as long as possible. But, crucially, every single layer in this strategy rests on trust between the Government and its people. Safe distancing, wearing of masks, complying with group size limits, keeping at all the Safe Management Measures and resisting fatigue and complacency – we can only do this if there is trust between the Government and its people. Getting as much of our population vaccinated as possible, allaying concerns, countering misinformation. These too require trust between the Government and its people. And participating voluntarily in a national contact tracing scheme like TraceTogether certainly requires that same trust. In short, trust is the lynchpin in every layer of our multi-layered strategy to stay safe in a COVID-19 world. And therefore, the Government must do all it can to continue keeping trust with our people in this fight. This is why personally, I would much prefer – much prefer – that the Government maintains what it had communicated at the start, at the outset, and completely exempts TraceTogether data from Criminal Procedure Code provisions. In my view, this is the surest way – not the only way but the surest way – to maintain the trust between Government and people that is so crucial in this fight, and the surest way to help Singaporeans understand what Minister Balakrishnan himself had referred to in his clarifications in this House last month, and I quote "not only the measures that we are implementing, but why we are implementing it, the spirit behind it.”
“Thank you, Mr Speaker. I thank the Minister for his reply. I have one supplementary question. The Minister has mentioned that the Community Care Apartment is a novel housing scheme and I think the key differentiator is that this scheme integrates – it is not just about housing but it integrates care, health and social services. And the Minister, in his reply, has also emphasised the importance of evaluating this new housing scheme. So, my question is apart from public response and market demand, what other factors and outcome measures might the Ministry take into consideration as it reviews its plans for the roll-out and evaluate the pilot scheme.”
“The more sensational a case is, the more we can see the conduct of some officers, and the more we should remain objective, and cheer for the integrity of our officers. Mr Speaker, Sir, in conclusion, our judicial system is sound. Otherwise, we will not be one of the safest countries in the world. However, there is always room for improvement. We can agree with that. Even the famous Justice Bao made some mistakes, as in the Bodyguard Liu Xiaoyuan case. Whether it is a prince or an ordinary citizen, all are treated alike. It was under this spirit that Justice Bao upheld justice for the people. Similarly, our legal system also safeguards the safety and rights of all Singaporeans regardless of their status and wealth. According to legends, when people wanted to seek redress from Justice Bao, they could stop him on the road, or drum up their grievances. But in our country, we have proper channels such as legal aid for civil cases and criminal cases, and the Yellow Ribbon Project to help former convicts to reintegrate into society. After this case, I am sure the authorities will learn from this painful experience and draw lessons from it. With a solid foundation in the judicial system, the authorities will strive for excellence to serve the country and the people better, and allow justice to prevail. 7.05 pm”
“They are the foundation of our country, and are our original intentions of nation building. In other words, the boat, at the highest level, represents the systems in our country and society. It can also be said that justice and equality, as mentioned in the Motion, go above the political divide. They cannot be discussed along political lines, because they are core concepts that must be acknowledged by the whole Parliament. Mr Speaker, after talking about the boat, let me talk about the people. There are many heroes and men of outstanding in the system. They perform their jobs dutifully and serve us, navigating the ship. So I hope to see more public recognition and support for our law enforcement and judicial officers regarding this case. As pointed out by the Minister in his statement, there were lapses on the police when handling the evidence this time. In fact, it has to do with manpower and workload. In other words, this is not a question of professional conduct. It is a matter of manpower and workload. To improve the system, we must first identify the root of the problem, beware of the daily challenges faced by law enforcement and judicial officers, and assist them in their tasks as far as possible. Mr Speaker, Sir, Justice Bao was famous for his impartiality and selflessness. In his famous Kaifeng Court, he also had four important officers to help him execute his work: Wang Chao, Ma Han, Zhang Long, Zhao Hu, and the resourceful Gongsun Ce and a capable guard Zhan Zhao. Take a look at our own “Kaifeng Court”. In our system, we also have many people like Gongsun Ce, Zhan Zhao, Wang Chao and Ma Han. They are our policemen, prosecutors, law enforcement and judicial officers.”
“1% of all domestic workers in Singapore. Of the 245 foreign domestic workers arrested by the police, 188, or nearly 80 per cent, were not charged. In 2016, there was even an employer who was sentenced to 7 weeks in prison for making false report by wrongly accusing his maid of stealing. Therefore, I feel the claim that the vulnerable group is disadvantaged in the overall judicial system because of their limited resources, or that the system treats people differently based on their social status, does not hold water. Volunteers in Jurong told me a case that happened a few years ago. I was quite impressed. The resident involved was a former drug offender. He was caught by the police one day for possessing sleeping pills and was charged with possession of prohibited drugs. The fact is, however, he was depressed because his mother just passed away, and he went to see a doctor for his depression and got a legitimate prescription from the doctor. But the doctor happened to have retired and migrated overseas. He could not find the doctor to prove his innocence and was about to plead guilty. When the volunteers and Members of Parliament in Jurong learned about it, they assisted him to engage a lawyer, and called the doctor back as a witness. He was found innocent and justice prevailed. Therefore, our judicial system as a whole is fair, just and equal. But this is a never-ending journey. In some ways, there is certainly room for improvement, but we should not overlook the overall fairness and equality of the system. One bamboo pole should not knock off everyone in the boat. Justice and equality are the key words in our National Pledge, and also the basic principles of our judicial system.”
“Third, as for Carl Liew, we learnt from the Ministerial Statement that the authorities have also started further investigations on him. At the same time, after further reflection on the case, I begin to understand that precisely because the case has drawn much public attention, we must be more vigilant, and avoid falling into the trap of "knocking off everyone in the boat with one pole". When "one bamboo pole knocks off everyone in the boat", It is not only the boat that is overturned, but also the people on board the boat. So, let me first talk about the boat, then talk about the people in the boat. The so-called "boat" is our country's current legal system. The Liyani case reflected several core issues in the system. The first question is: does the system work in favour of the rich and powerful? Let us look at a few examples. In 2019, Tay May Li, daughter of the Hour Glass founder, was sentenced to 22 months in jail, for careless driving, drug abuse and possession of drugs. In 2017, Howard Shaw, grandson of movie mogul Shaw Runme, was sentenced to 8 weeks in prison, revocation of all classes of driving licence for 8 years for drink driving. Earlier in 2012, He was sentenced to 12 weeks' imprisonment for child prostitution. Huang Guang Tian, the son of a shipping tycoon, was charged with 19 counts of drug abuse, fraud and theft and was sentenced to 3 years and 9 months' imprisonment. These cases show that our legal system, from the police investigation, prosecution, to sentencing, does not favour the rich and famous. The second core issue reflected in the case is: is the judicial system fair to the disadvantaged? According to figures in the Ministerial Statement, in 2016, 245 foreign domestic workers were arrested for theft, about 0.”
“Mr Speaker, Sir, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Mr Speaker, Sir, the High Court ruled that the Liew family may have ulterior motives, and wrongly accused their former maid Liyani of stealing. This case lasted for 4 years, going through all sorts of twists and turns which include the police's handling of the stolen items, the DVD player presented by the prosecutors as evidence in court, and the State Court judge choosing to believe in Carl Liew and convict Ms Liyani. All these have aroused a strong sense of justice among many Singaporeans. In their eyes, this is a clash between the rich and the poor. The rich and famous use their power and the judicial system to take advantage of a vulnerable maid, and the judicial system did not seem to have treated her fairly. To be honest, I felt the same way when I learned of the High Court's ruling. I am not a lawyer myself. So, from the perspective of the general public, I can totally imagine that the ordinary citizens would cheer silently for Liyani’s acquittal and getting her freedom back. On the other hand, people also started to have suspicions, frustrations, and even resistance towards celebrities and our legal system. Therefore, I welcome the statement just made by the Minister for Home Affairs and Law. The Minister made several important clarifications. First, as for the police, the Minister was of the view that the police did commit a lapse in handling the exhibits. Second, in response to the handling of the DVD player by the prosecutors, AGC has also initiated relevant legal and disciplinary proceedings. It is not appropriate for the Minister to make further comments. But the point is that due process is being carried out progressively.”
“I thank the Minister, for the Statement. I have two points of clarification for the Minister. First, the Minister has spoken about the evidence in this case in detail and also touched on the findings of further investigations. I would like to clarify with the Minister, is Ms Liyani, in fact, guilty. The second question is, the case was originally seen as one involving a wealthy complainant, fixing their foreign domestic worker, but it seems now that the case is really about wealthy people who are cavalier in dealing with a foreign domestic worker who had, on her part, not exactly acted well as well. So, I would like to ask the Minister what is his view on this issue.”
“The immediate challenge will be to help businesses recover slowly under the new normal. Under this new normal, project arrangements will be more complex, operating costs will rise and the supply of foreign workers may be interrupted from time to time. Hence, I support the Government's proposed amendment to the COVID-19 (Temporary Measures) (Amendment) Bill to provide more certainty and fairer protection for contractors, developers and the individual businesses along the entire value chain. At the same time, I would like to urge the Government to continue to improve the testing regime and safety measures such as quarantining and complement with legal measures. By adopting this two-pronged approach, the Government will help businesses tide over this difficult time and emerge stronger. (In English): Mdm Deputy Speaker, the above notwithstanding, I support the Bill.”
“Indeed, there may yet be further disruption, the extent to which remains highly uncertain as rostered routine testing for construction workers continues and the possibility remains that groups of workers would continue to be quarantined from time to time. But a four-month universal extension of time strikes a practical balance and gives contractors a legal option besides negotiating for relief, a legal option that offers more certainty. I hope the Ministry has consulted the industry widely for this proposed amendment and has achieved broad buy-in. It would also help the industry if potentially disruptive safe management measures like the quarantining of workers could be applied more consistently. There has been feedback about apparent inconsistencies on the ground whereby some workers get quarantined but others in similar circumstances do not. These inconsistencies add to the frustration. That said, I know our officers implementing these measures have been working very hard and trying their level best. In this respect, I hope the BluePass tokens for targeted contact tracing amongst the construction worker community will be a game-changer. Ultimately, these measures, while potentially disruptive, reflect a new normal that the industry must adapt to in order to resume construction activities safely. The additional pain will persist but our construction industry is rising to the occasion. As long as everyone continues to play its part and share the burden, we will get through this together. Mdm Deputy Speaker, in Chinese, please. (In Mandarin): [Please refer to Vernacular Speech.] COVID-19 has dealt a severe blow to the construction and the property sectors. The numerous measures introduced by the Government have prevented a total collapse of these sectors.”
“Mdm Deputy Speaker, I have led medical operations in purpose-built dormitories to support migrant workers during the height of infections in the dormitories. I have also had the privilege to speak to contractors and sub-contractors and visit construction sites that are in the midst of restarting construction activities. So, I have had a first-hand glimpse into the extent of disruption that the COVID-19 pandemic has caused to the construction and property sectors. With regard to MND's proposed amendments to the COVID-19 (Temporary Measures) Act to provide further relief to the built environment sector, I would like to raise three points. Firstly, on the co-sharing of non-manpower-related additional costs. While I welcome the move, anecdotally, it has not been easy in the first place for contractors and other players to fully account for the additional costs caused by the pandemic. For example, movement restrictions mean their supervisors who are on S Pass and with lodging outside the dormitories now have to take private transport. These incremental costs are hard to capture fully but these things add up. Secondly, on the universal extension of time, I would like to suggest that the proposed amendment be extended beyond contracts between developer and main contractor to cover contracts between contractor and sub-contractor. This would provide further support for a larger portion of the value chain – support sub-contractors who would otherwise have to negotiate with main contractors under current provisions of the COVID-19 (Temporary Measures) Act. Thirdly, also on the universal extension of time, I would like to recognise that for most industry players, the disruption caused by COVID-19 has gone well beyond four months.”
“Mr Speaker, I thank the Senior Minister of State for his reply. I have one supplementary question. I recently saw an estimated bill for a procedure in the highest surgical table, table 7, and assuming a C class ward stay, the out-of-pocket expense, meaning the cash outlay after MediSave and MediShield Life claim was estimated to be $9,000. My question is: were outlier surgical bills in the scope of the Council's review? And, if so, what were the conclusions of this review regarding the adequacy of MediShield Life coverage for such outlier bills?”
“So, we would have very hard and very important choices to make. Sir, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] To combat COVID-19, the Government has announced four Budgets decisively and introduced additional assistance measures in August. The Government has allocated tens of billions of dollars to tackle the immediate challenges. The scale and decisiveness of these efforts are evident to all. But the economic impact of the pandemic on Singaporeans will not abate soon. I urge the Government to continue to address the immediate needs and concerns of Singaporeans while looking into the future planning and implementing the Emerging Stronger strategy. First, one of the current conditions for the COVID-19 Support Grant is a reduction of at least 30% in income for three consecutive months. I suggest that the Government provide wage subsidies based on the degree of income loss of the applicants so that more Singaporeans can receive appropriate assistance to avoid the current cliff effect. I would also like to urge the Government to put in more resources to improve the success rate of the SGUnited Jobs and Skills Programme to give more hope to the many workers who are still looking for jobs. (In English): Sir, in conclusion, I ask that the Government provide more calibrated support for the broad middle, more effective job matching for workers across all age groups and age groups, and more clarity on our long-term investment strategy in key capabilities that will shape our survival and success. I am confident that we will remain a hopeful and united people, determined to build a better future for ourselves and future generations. Sir, I support the Motion.”
“Deputy Prime Minister and the Finance Minister has said that the latest set of support measures would not draw further on past reserves but be funded by the reallocation of reduced spending, as well as deferred development expenditure. The total amount of deferred development expenditure is almost $7 billion. This includes more than $3.5 billion for transport infrastructure, more than $0.5 billion for healthcare infrastructure, more than $0.5 billion for waterworks and land preparation for the AgroTech zone at Neo Tiew and more than $150 million for MCCY. Given the Government's weak revenue outlook for the next few years, I share hon Member Mr Liang Eng Hwa's concerns about how we might be able to fund these deferred projects in future. I appreciate the Government's commitment to minimise its draw on past reserves, but I wonder if current revenues originally budgeted for strategic development should be set aside in a fund for deferred spending while additional, exceptional COVID support measures continue to be funded exceptionally with a further but prudent draw on past reserves, instead of reallocation of deferred development spending. At the same time, I hope the Government could clarify our overall outlook for these key investments. Certainly, we should not expect a catch-up in deferred capital expenditure in the next few years. And so, I echo the hon Member Mr Murali Pillai's question and ask: are we looking to push out the investment timeline, or are we expecting to cut back on our overall level of investment? These investments concern our long-term connectivity with the world and within Singapore. They concern our water and food self-sufficiency. They concern our healthcare capacity, and our capacity to stay healthy through community sports.”
“And there is this resident, who switched from being a bar executive in one of the top bars in Singapore, to being a lift technician with one of the top OEMs in Singapore in the market. I told him I hope he would consider joining our Town Councils some day. Sir, the anxiety and struggle of Singaporeans and Singaporean jobseekers is palpable. We have to match these jobseekers with available opportunities much more quickly. And we need to do this because we must maintain hope amongst our people and maintain hope in our society. To this end, I propose that we resource e2i and WSG decisively beyond today's levels to enable decisive outcomes for Singaporeans. Anecdotally, a big part of the challenge in job matching has been about expectations, concerns and mindsets, on the part of both jobseekers and employers. Therefore, we need an intensive relationship-management approach, focus on building the relationship with each employer and jobseeker, really understand and work the accounts, broker a match with persistence and finesse, and ultimately, convert and secure a placement. I think we are know where we want to go. We are aligned in terms of our objectives. We have the schemes in place. But I am asking that we resource much more decisively because we need the outcomes for Singaporeans a lot more quickly. Sir, I have spoken about keeping our eyes firmly on helping Singaporeans through their immediate struggles. At the same time, I would like to look ahead and seek clarifications on the Government's strategy to invest in our long-term capabilities and priorities.”
“She ended up with nothing – she could not go back to the company she had resigned from and there was no other opening in the company she was slated to join. It has been seven months since. She has sent out more than 80 applications. In her words, "anything to get me started, I applied." And in her words, from "using various platforms, cold-emailing, career fairs, I have tried them all." She is 25 years old. Another resident of mine was manufacturing vaccines with a major pharmaceutical company here, but was let go after her contract expired. Her applications for similar positions had been without success, despite relevant experience. In her words, "it doesn’t make sense." She had also applied for other positions in MedTech and healthcare. It has been again months. She tells me she simply hopes to support her ageing parents, who probably cannot for work much longer. She says her "mind is dropping to almost negative now". She asks me to put myself in her, quote, "dusty shoes". She is 34 years old. Then there is this other resident, 44 years old, holds a Master's in Chemical Engineering, retrenched three months go – still searching and still interviewing. Yet another resident, this one, in his 50s, with more than 25 years of managerial experience. He has been searching for 10 months. In his words, "when recruiters see my age, they just pass me over." He told me he does not mind at all a lower pay or position and he told me he wished his career coach would have more time for him, because in his view, time is of the essence in certain openings. Of course, there are happier stories too. There is the resident who was an air stewardess and is now signing up for a training course with monthly allowance under the SGUnited Skills Programme to become a healthcare assistant.”
“Pro-rating the COVID-19 Support Grant would provide calibrated relief for more middle income households and better cushion the lingering economic pains of the pandemic for Singaporeans. Sir, my second suggestion to address the immediate struggles of Singaporeans is with regard to job matching. As of end August, almost 120,000 openings have been curated under the SGUnited Jobs and Skills Package and more than 33,000 jobseekers have been placed into these openings. While this has been encouraging progress, it remains that around 84,000 openings are as yet unfilled. More importantly, if we cut through the statistics and think about the thousands of Singaporean jobseekers as individuals, with lives to build and families to feed, grappling with the uncertainties of a search that has been going on for months, trying to stay strong amidst the deflating radio silence after that application that was sent out weeks ago, or after that interview last week that seemed to have gone went quite well – then it becomes abundantly clear to us that we not only need to walk alongside each Singaporean each step of the way, but also deliver outcomes for these jobseekers. In other words, I urge the Government to double down on job matching and get many more openings filled much more quickly. One of my residents was holding a full-time job. She successfully applied for another role, in a different sector and was told that her first day will be in April. So, she resigned and started serving her notice period. Then, the global economy worsened, the department she was slated to join got shut down and the offer that she had accepted got withdrawn.”
“Sir, I understand where the agency is coming from, but if my resident's income had fallen by just one more percentage point, he would have qualified for the grant and all of these considerations about household income and circumstances would have been moot. And while the responsible policymaker would make sure that the next $1 in income support is given to the household that needs it the most, I urge that we also consider what the next 1% point drop in income would mean for a household in the middle income segment. The median income in Singapore is about $4,000 a month. Take a 25% drop, that represents $1,000 less each month. A resident in this situation would not qualify for the COVID-19 Support Grant at all. And we can point to the $3,000 that the resident still draws each month and say this is sufficient. But I urge that we consider from the resident's perspective, his or her lived reality, his or her expectations, burdens and commitments, and what that $1,000 loss might feel for him or her. I therefore suggest that we pro-rate the COVID-19 Support Grant, based on the extent of income loss up to 30% and avoid the all or none cliff effect of the current criterion. In making this suggestion, I am well aware that wherever we draw the line in a policy, there will always be those on one side of the line who feel like they have missed out. And yet, in many of our policies, we have drawn not one, but multiple lines, such that it is a gradient rather than a cliff. This is the case with housing grants and this is the case with healthcare subsidies in the Pioneer and Merdeka Generation Packages and CHAS.”
“I thought these bear mentioning, because it is so easy to underestimate the scale of the Government's response to the crisis, so easy to overlook the Government's fundamental commitment to think long-term and so easy to take for granted the resources that we now have to sustain our response to the crisis while building a better future together. I hope that by highlighting these, we would have a better sense of perspective as we debate the Government's strategy to emerge stronger from the pandemic. Sir, with this sense of perspective, I would like to highlight the immediate struggles that Singaporeans continue to face, and what more the Government can and should, do. I have two suggestions. First, on the COVID-19 Support Grant. The COVID-19 Support Grant aims to help Singaporeans cushion the impact of the pandemic on their livelihoods. It is meant to work alongside ComCare assistance, which remains available, and indeed has been enhanced for the lowest income households in Singapore. So, ComCare is designed for one particular segment. The COVID-19 Support Grant, for another segment. One of the criteria for the COVID-19 Support Grant is income loss of at least 30% for three months. Sir, I have residents who narrowly miss this criterion. One resident in particular lost 30% income for two of three months and 29% in the remaining month. He did not get the grant, despite my appeal for him. I was told there were no extenuating circumstances in his household to justify an exception, as his other family members are working and so the gross household income should continue to be sufficient for their needs.”
“Six billion dollars that it is setting aside, amidst a crisis, for future GST Voucher payouts, because the Government knows that the GST Voucher scheme is a permanent commitment. And so, I completely disagree with the hon Member Mr Leong Mun Wai, who suggested yesterday that, because the Government is putting $6 billion into the GST Voucher fund, he has raised apprehension about an impending GST hike and in fact, the $6 billion should be spent elsewhere. On the contrary, the Government is doing the responsible thing, by recognising the GST Voucher scheme for what it is, a permanent commitment by the Government to help Singaporeans and keep GST progressive for all Singaporeans. Therefore, we must stay the course. And staying the course we are, in other areas as well, the Government has maintained its initial commitment in the Unity Budget for all other sums, for various endowment and trust funds: $5 billion to the Coastal and Flood Protection Fund, for our 100-year defence plan against rising sea levels; $2 billion to the National Research Fund, $2 billion to the Skills Development Fund and almost $1 billion to the ElderCare Fund, to save up for our future healthcare needs. More than $10 billion in total that the Government has set aside again during the crisis for our strategic, long-term needs. More than $10 billion that the Government has remained committed to, despite all the fiscal exigencies of the crisis. By any count, these are extraordinary measures.”
“Mr Speaker, Sir, I would like to speak on three key areas today. First, to offer some perspective on the truly extraordinary measures that the Government has taken in its Budgets to deal with this crisis, such that we are even in a position today to debate about the way ahead. Second, to highlight the struggles that Singaporeans continue to face in the immediate term and what more we can do to support Singaporeans. And third, to look ahead and seek clarifications on the Government's strategy to invest in our long-term capabilities and priorities. First, on what has been truly extraordinary in the Government's four Budgets this year and the latest set of support measures. Sir, the Government now estimates that in this fiscal year, it would spend $27 billion for the Jobs Support Scheme, $1 billion for the Self-Employed Person Income Relief Scheme or SIRS, and more than $1.5 billion each on Workfare Special Bonuses for low-wage workers and rental rebates for businesses. More than $31 billion in total, or almost 7% of GDP, directly injected by the Government into our economy to save jobs, keep viable businesses afloat and put a floor beneath an unprecedented economic contraction. By any count, this is extraordinary. The Government also estimates that it would spend more than $4 billion in Care and Support cash payouts, GST vouchers, service and conservancy charges rebates, utilities credits and Passion Card top-ups. More than $4 billion, directly into the hands of households, to boost the Government's support for households in these difficult times. More extraordinarily, the Government has maintained its initial commitment of $6 billion in the Unity Budget for the GST Voucher Fund.”
“In such a situation, our structures and processes must become a back-stop, to serve justice efficiently and consistently. In turn, this prevents the loss of trust in one relationship from spilling over into and eroding the larger system. All stakeholders – doctors, patients, the professional self-regulatory system, healthcare institutions – all of us need to work hard to maintain and grow this trust, because it is our surest way to guard against a regression into defensive medicine. Trust is our ballast for a sustainable and effective system to secure our healthcare future and meet the many complex challenges ahead. Sir, I support these Bills. 5.31 pm”
“Indeed, at the University of Texas at Austin, their Medical School and the College of Fine Arts have joined forces to form a Design Institute for Health. It is their way to deliberately bring design sensibilities into healthcare, because design is ultimately about addressing human needs, and they have recognised that healthcare is first and foremost about the human relationship. It goes well beyond a transaction, or a delivery of service. And if we think about it, our healthcare system is essentially the sum of millions of these relationships, exchanging value on a daily basis and at a micro-level. And so, the system can only work effectively and sustainably when these relationships are thriving, on the basis of a high level of trust. So, when all is said and done, it is time to double down on trust. It is time to double down on both the human relationships and the professional quality in our system. Amongst hospital management teams here, there is a common saying: we aspire to provide "care that is good enough for my mother". And then someone said, perhaps it should be care that is good enough for my mother-in-law. Well, I shall leave it to Members to mull over the material differences. But it is a case of differences but same same. The essential point is this. Beyond legislation and policy, institutions on the ground are working relentlessly at high quality and quality relationships, creating care that is good enough for our own loved ones. Mr Speaker, Sir, let me conclude. The ultimate paradox for the enhancements in the Bills before us is that one hopes to never have to use these, for when these are invoked, it means a care relationship between doctor and patient has broken down.”
“So, for instance, while I welcome the proposal for an Inquiry Committee to act as a first and efficient level of triage for the merits of a complaint, prima facie, complete facts will become crucial for the Committee to effectively perform its intended function. I therefore urge the Ministry to look into providing resources to guide lay complainants through the filing process, especially in providing supporting documents and other evidence. This is a key detail in implementation that would safeguard patient welfare. But while we strike that fine balance at a system that works for both doctor and patient, ultimately, the panacea against defensive medicine cannot be about enhancing a system of recourse and justice for times when something goes wrong. Rather, our surest inoculation against defensive medicine must be that broad public confidence that in our system, things would by and large, and almost always, go right. More to the point, when I am the patient, I must feel that things would go right, for me. Objectively, this must mean that our system has high standards of quality and safety. Dr Tan Wu Meng has spoken about the roles of both the individual and the system to achieve these. But more viscerally, this is also about the deep human-to-human relationship between patient and doctor. This is why we talk in terms of care, instead of just treating an illness. This is why we talk in terms of the experience, instead of just a consultation or a procedure. And this is why there is a whole emerging field on empathy in medical education – systematically teaching doctors about kindness and compassion. This is why a doctor's "bedside manners" matter so much to us.”
“Now, the study observes that the harm to patients caused by overuse can be physical, in the form of side effects and complications, financial and psychological. The paper concludes that, and I quote, "The provision of medical services that are more likely to cause harm than good is a global problem that afflicts rich and poor countries alike." Sir, the amendments in these Bills have been made amidst a significant level of disquiet in the medical profession. The high-profile decisions last year, around specific issues of informed consent and patient confidentiality, had brought this disquiet to the fore, but I think it stemmed from a broader uncertainty about standards of care and a general gap in confidence in the professional disciplinary process and its outcomes. Members before me have spoken on the merits of specific amendments and I will not belabour these. I think the amendments, as well as the non-legislative measures, as a whole, are decisive and better grounded in practice realities. I hope this would help restore trust between doctors and the regulatory system and arrest the risk of us sliding further towards defensive medicine, to the detriment of both patients and professionals. As the hon Member Dr Tan Wu Meng puts it, we must help doctors to help patients, because this is the way to help both doctors and patients. That said, we must avoid swinging to the other extreme, where patients without medical training or deep resources are left to feel like their access to justice in this system has been compromised. When something goes wrong, we must have a system that works for both patient and doctor.”
“Now, as an example of defensive medicine and this is anecdotal, in one hospital in Singapore, there is a large number of a certain scan that is ordered each year to look for a particular condition of the lungs. From my understanding, the pick-up rate from these scans at the hospital has been less than 10% compared to around 25% in the best centres worldwide. In other words, doctors at the hospital are frequently ordering the scan and a rather expensive one at that, but rarely, finding anything adverse. This is a specific type of behaviour in defensive medicine known as assurance behaviour. The Minister, in his Second Reading speech just now spoke about a study showing avoidance behaviour, that is when doctors do not order a test when it is appropriate to do so. Assurance behaviour is the opposite, when doctors order tests when it is not entirely appropriate. And yes, it seems to be happening here in Singapore. In 2017, a major paper published in the Lancet presents compelling evidence on the overuse of medical services around the world. First, there is overuse of medication, the best-documented example being the inappropriate use of antibiotics. Second, there is overuse of screening tests, even for cervical and breast cancers, and screening colonoscopy. In one country, it is estimated that up to 99.9% of thyroid cancers detected there by way of the aggressive use of ultrasound screening represented over-diagnosis. Third, there is overuse of treatment procedures. For certain cardiovascular procedures, up to 20% of the procedures ordered have been found to be inappropriate across various countries, despite clear and broadly accepted criteria for what is appropriate.”
“Mr Speaker, Sir, I declare my interest as an administrator in a public healthcare institution. Sir, as our population ages, the number of healthcare encounters in our system will only go up. And as more patients face not one, but multiple conditions interacting with each other in complex ways on the one hand and as therapies become more advanced on the other, the healthcare decisions that doctors have to make will only become more complex. In other words, this debate about regulating the professional and ethical practice of medicine in our society is not taking place in a static context, but in an operating environment that will become more demanding and more complex going forward. It is therefore a timely debate and one that we must get right, because the stakes are high and will only get higher. Against this backdrop, we must guard zealously against defensive medicine, because it is bad for everyone. The US Congress' Office of Technology Assessment defines defensive medicine as occurring when, and I quote, "doctors order tests, procedures or visits, or avoid high-risk patients or procedures, primarily to reduce their exposure to malpractice liability." This was published in 1994. And so, the problem of defensive medicine is a longstanding one. And as Minister Gan Kim Yong noted in this House last year, defensive medicine "will not only affect doctors, but ultimately compromise the quality of medical care, raising medical costs and harming patient welfare." In short, defensive medicine is bad – it is bad for the patient; it is bad for the healthcare professional and it is bad for the system.”
“And certainly, our society would need more passionate individuals, both local and foreign, to step forward to provide the best care possible for our seniors. And finally, as a society, we must also care better for our caregivers. We must be a society that commits to dignified care for our seniors, because it is the right thing to do. And we must be a society that commits to stepping in and stepping up to help each other with the burdens of care, especially where the individual or the family is unable to manage, because this is who we must be as a people. Sir, I support the Motion. [Applause.]”
“Here I have three suggestions: first, the Government should focus on developing and building nursing homes, inject more resources, improve the quality of care beyond basic care, and at the same time increase subsidies for Singaporeans; second, explore more comprehensive home care services because hospital wards can never be as comfortable as a bedroom at home; and third, provide more financial assistance to full-time caregivers and establish a suitable parent care leave regime through the Tripartite partners. Of course, as Deputy Prime Minister has pointed out, our national pocket is not bottomless. Every policy comes with a price. As a society, how we help to share the burden will be a core issue in our future social compact. Let us face it squarely, make decisions based on care, protect the dignity of our seniors, and uphold the core value of respecting the elderly. (In English): Sir, let me conclude. Keeping our seniors healthy will always be key. At the same time, becoming sick and losing functionality is part of being mortal, but it does not have to be morbid. We, as a society, must resolve that it will not be morbid for our seniors and the caregivers in our midst. Families, community and Government must work together to provide dignified care for our seniors and preserve their quality of life as much as possible. This means even better standards in our nursing homes and allowing as much optionality as possible for care within the home, where our seniors truly want to be. At the same time, we need to make hard choices on treatments and therapies and involve our tertiary care model to keep a lid on overall costs. Yet, overall costs would go up and these would have to be funded.”
“Introducing parent-care leave entitlements send an important signal to workers, employers and the whole of society on our collective compact to care for seniors. At the same time, we have to recognise the impact on businesses. Therefore, flexible work arrangements must remain as our most sustainable strategy. COVID-19 has changed the way we think about workplace and collaboration, and we must use this opportunity to further cement flexibility of work as part of our new normal. Thirdly, we should work with caregivers to raise the uptake of Lasting Power of Attorney and Advance Care Planning among seniors. These may be difficult conversations, but necessary ones as they significantly reduce caregiver stress down the road. We should support our caregivers to plan ahead and plan well with our seniors. Sir, in Chinese, before I conclude. (In Mandarin): [Please refer to Vernacular Speech.] We all know that Singapore is ageing rapidly. When I make house visits, I have met many senior residents. The good thing is that many of our Pioneer Generation seniors were mistaken by me as the Merdeka Generation and many of those who are from the Merdeka Generation were mistaken by me as being middle-aged. In other words, our seniors look young and live a good life in their old age. However, degeneration and ageing are inevitable. As the sandwich class, the children not only have to take care of their parents, but also their own children. Work and life have brought double amount of stress on them. Under these circumstances, the society and Government must better support Singaporeans and families, and ensure that seniors are properly taken care of, both physically and mentally, when they get old or fall sick.”
“On 16 March, it was announced that the flow of people across the Causeway would all but cease within two days. Yet so many of our non-Singaporean nurses decided to stay with us in Singapore. Some rushed home to pack before crossing the Causeway just in time, even on foot. These nurses have not seen their families for months. Some have postponed weddings or missed funerals of loved ones. So, if there is anything that COVID-19 has taught the healthcare sector, it is that everyone, Singaporean or Work Pass holder, has made sacrifices and everyone has worked as one team to care for Singaporeans and keep Singaporeans in the community safe. COVID-19 has taught us that we need resilience. We need a buffer in our system to anticipate disruptions. And so, I hope Singaporeans can recognise that going forward, we need more locals and more foreign nurses to continue working together as one team to ensure the best care possible for our seniors. To this end, I would also suggest a comprehensive review of the Dependency Ratio Ceiling and manpower strategies for the healthcare sector, especially for intermediate and long-term care. At the same time, we have to care better for our caregivers. I have three suggestions. Firstly, we should enhance financial support for full-time caregivers. We need to define full-time caregiving carefully and guard against abuse in implementation. But fundamentally, we must recognise that full-time caregivers have sacrificed much in terms of career and income. Secondly, we should reconsider parent-care leave. Both childcare and parent care are key burdens for Singaporeans in the “sandwich generation”. So, our policy principles for childcare and parent care should be consistent.”
“And this would require our healthcare professionals to also refresh both mindsets and skillsets, starting with a training framework that must emphasise broad skills on top of deep skills. Sir, in both hospitals and nursing homes, the Government has been adding beds. But ultimately, no bed matters quite as much to our seniors as the bed at home. I have attended a number of wakes in my constituency and almost all of these residents who passed on have either passed on at home or wanted to do so. Indeed, we need to grow our home-based care capabilities in a major way, including the protocols, technology, financing and regulations. We should strive to provide what has traditionally been hospital-level care outside the hospital and in the home. Providers around the world are exploring this in earnest and we will need to evolve our own way. This may be a moonshot for our healthcare system, but one that I believe is worthy for us to apply our minds and energies to. Sir, let me now talk about people. Firstly, we need more healthcare professionals, in particular, more nurses. We continue to improve productivity through technology and job redesign, but fundamentally, care remains a high-touch, highly human endeavour, especially if we want care to be dignified. We need more nurses going forward and it is key that we maintain a strong Singaporean Core. So, to this end, we have intensified recruitment and reviewed salaries, training and career pathways for Singaporeans. But we also need to complement our workforce with foreign nurses. There had been several debates on this topic in this House, around qualifications, culture and language. Allow me to share my views with a simple story.”
“Therefore, while we keep at flattening the epidemic and unemployment curves in the COVID-19 new normal, we must also urgently flatten our healthcare cost inflation curve. How do we do so? I believe we need to start with our hospitals, our tertiary care setting. At this point, I would like to declare my interest as an employee in a public healthcare institution. In our hospitals and tertiary care setting, we must continue to make difficult decisions on standard treatments and therapies. Even as the range of treatments and therapies available to patients continue to grow, our society would need to constantly review and refresh our consensus on this. As importantly, we must continue guarding against fragmentation in tertiary care. An encik once told me, "Jantung (heart) got problem, better see jantung doctor lah". That is very understandable, but I wondered, "Hati (liver) also got problem, how? Paru-paru (lungs), tulang (bone) also got problem, how?" The point is more seniors will be affected by multiple conditions. And while we would expect to see a specialist for each organ, it may neither be sustainable nor lead to the best overall outcomes. So, increasingly, we should move towards having a single doctor to coordinate care around a patient's whole range of conditions. For our healthcare system, this reduces duplication of resources and reduces costs. But, as importantly, for the patient, it means less visits and more convenience. Indeed, when illness is stressful and becomes more complex, care should become simpler – one patient, one principal doctor. This would require patients to shift their expectations about care fundamentally.”
“Firstly, on our nursing homes and the intermediate and long-term care (ILTC) sector. The Government has steadily grown nursing home capacity and continues to do so. While we must avoid the moral hazard of institutionalising care as a society, we must also recognise that more families would require the support of long-term full-time institutional care for our seniors. In the last decade, the sector has improved its quality of care significantly, but I believe it is time to go beyond basic care to dignified care. We can do more, in terms of integration with the community, rehabilitation and thoughtful design to improve residents' quality of life. For instance, could residents continue to enjoy their favourite hawker food in a nursing home? Could residents mix with children regularly and bond? Could our nursing homes be more home than nursing? To achieve even better standards, cost of care in the sector would have to go up. To raise and sustain an ecosystem of capability building, innovation and human capital development, cost of care in the sector would have to go up. I believe there is scope for the Government to bear the bulk of incremental costs for these higher standards of care. At the same time, while most nursing home residents are already getting some level of Government subsidies, I would urge a review of the current subsidy framework to see if we can do more and be even more progressive. Ultimately, we must keep long-term care dignified and affordable for those who need it the most. And yet, we must guard against runaway healthcare costs in general. Indeed, in the COVID-19 "new normal", we face serious fiscal challenges. At the same time, demands for healthcare spending will only grow as our population ages.”
“Sir, I am heartened to hear the President reaffirm our commitment to take good care of our seniors to enable them to age well and with dignity. While our seniors strive to stay healthy for as long as possible, it is quite inevitable that at some point in time, disease sets in or an injury occurs. So, today, I would like to speak on how we, as a society, can also care well for our seniors and their dignity, in sickness and in infirmity, when they are at their most vulnerable. Sir, fundamentally, the structure of our family unit has changed. Our seniors may have multiple siblings, but few children. Their siblings may offer some degree of support to each other, but all are ageing at the same time. Their children, on the other hand, have to balance the demands of supporting parents while building their own homes, raising kids and fulfilling career aspirations. In my house visits, I have met many seniors. They would tell me about their family portraits, their children and grandchildren. So often, their children would have moved out and built their own families. Against this backdrop, we have to recognise the practical limits of the family unit in caring for our seniors if and when their healthcare needs become the highest. While the individual and family must continue to be cardinal and first line of support, we also need stronger interventions – by Government, local communities and society at large – to support families in providing dignified care for our seniors. Any intervention would have fiscal or social implications or both. So, as a society, we would need frank and thorough discourse and seek to refresh our compact on personal and shared responsibilities. Allow me to touch on some specific areas that we need to look it collectively.”