Yeo Cheow Tong
Singapore
“Mdm Ho Geok Choo asked the Minister for Health in light of the recent report on fungal corneal infections (a) whether those who contracted the contact lens related fungal corneal infections will suffer permanent damage to their eyes; and (b) how long will his Ministry take to conclude its investigations into the causes of these contact le…”
“My Ministry performs a regulatory role and what we do is that we try to ensure that we have a conducive regulatory environment for the growth of this industry in Singapore. Let me tell him what we are doing in some areas.”
“Sir, on her two questions, whether we are satisfied that the school buses are collecting fares during the school holidays, as I mentioned just now, the school bus service is a contractual service between the parents and the service provider. It is therefore up to them to work out the terms and to abide by the terms.”
“Sir, on the first question, whether there is any abuse by owners of buses while using the 50% rebate, the answer is no, because LTA monitors very closely.”
“Sir, I have to repeat my answer. We are not responsible for regulating school buses and therefore will not be involved. SCHOOL BUSES (Installation of seat belts) 5. Assoc. Prof.”
“Ong Soh Khim asked the Minister for Community Development, Youth and Sports (a) if his Ministry will increase the cap of $10,000 per disabled person over their lifetime for the Assistive Technology Fund scheme; and (b) if not, whether there will be a flexibility to adjust the funding cap for this scheme based on the applicant's need, as j…”
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“It will be invested in very safe, very guaranteed type of investments so that there will always be a continuing income to Medifund. And investing in Government bonds, I think, should get us, even with just the $200 million, about $5 million or $6 million quite easily every year. As Medifund capital increases in the coming years, the amount of income available to Medifund should increase and I think it should be more than adequate. Even though the income should be more than adequate, there must be the proviso that the Hospital Medifund committees act responsibly. Because in a hospital like Singapore General Hospital, the expenditure each year comes to the region of between $200 million and $300 million. So if the Hospital Medifund committees are not responsible, the few million dollars that we give to them would be quickly dispensed with. We must therefore make sure that they live within the budget given to them and they prioritise, identify and give out the available funds only to those people who genuinely need the assistance. This process is very important. To identify who are the people who genuinely need the assistance, we must get them to fill in a form and give some basic data about the family - family income, how many are there in the family, how many dependants, etc. These are very basic details which most patients have no problems filling them. Patients who are deterred because they need to fill the form and who can find other ways of paying for their treatment are clearly not amongst that group who really need help to pay for their hospital bills. We must have some basic criteria. We must ensure that people apply and provide the necessary financial data.”
“Sir, first, I would like to thank all my colleagues in this House for their very active participation in the debate on this Medical Endowment Scheme Bill. I am glad that many of the colleagues have spoken out strongly in support of the Bill although they have some questions on some specific clauses in the Bill. Sir, I would like to go through the concerns of the Members, one by one. Mr Loh Meng See has asked about waivers in 1992. I quoted the 1991 waivers and that we waived about $1.7 million in 1991. He has asked whether that figure is in the same ballpark for 1992 as well. In 1992, for the first nine months, we waived about $700,000. If you pro rate it for the full 12 months, you will expect the 1992 waivers to be close to about a million dollars. So the $5 million that we have allocated for 1993, I think, should be more than adequate in the light of our previous years' experience. He has also expressed some concern about the need to tie Medifund to our ability to generate a budget surplus. Sir, I think that is very important because the Government has a limited pool of money. There are a lot of competing demands - education, defence, on-going programmes. We must make sure that our budgetary process allows us to generate a surplus so that we can contribute to Medifund. But whether or not we have the surplus, the endowment is safeguarded. We are already starting off by putting $200 million in the endowment and for the next few years, we hope to be able to contribute another additional hundred million dollars a year into Medifund. The $200 million that we are talking about for this year will be invested in Government bonds which are guaranteed, because it is the job of Medifund to safeguard the capital of the fund and not to invest in speculative investments.”
“The Advisory Council and the Hospital Medifund committees will largely comprise members who are actively involved in community and social work. They would be familiar with the needs and problems of lower-income Singaporeans, and would be able to adopt a flexible and helpful attitude towards applicants. Sir, Medifund will grow over time, provided our economy continues to improve and grow, and we achieve budgetary surpluses. It will be a valuable safety net. With Medifund, no Singaporean need ever fear that he or she will be unable to receive good basic health care, no matter how much financial difficulties he or she is facing. However, we must not let Medifund lull us into a false sense of security. It is important for every Singaporean to maintain a healthy lifestyle in order to reduce the risk of falling ill. Singaporeans must use their Medisave wisely, by using the class of ward that best suits their income level. This way, we will have enough finances to look after our health care needs in our old age. Sir, I beg to move. Question proposed.”
“However, as there will be no income for the first year, the Government will provide Medifund with a more than adequate sum of $5 million to fund its first year operations. This sum will not be regarded as part of the capital money of the Medifund. Sir, Medifund will act as a safety net for those needing medical treatment. Initially, it will provide grants to approved hospitals and medical institutions for them to help Singapore citizens who, either by themselves, or with the help of their families, cannot afford to pay their hospital bills. Additional schemes to help Singaporeans meet their health care expenses will be considered later when Medifund has more resources. Singaporeans eligible for Medifund support will include, first, the destitute and indigent, who presently apply for hospital fee waivers; second, elderly Singaporeans with no Medisave, or who did not accumulate enough Medisave before retiring because the scheme was implemented too late for them; and third, younger Singaporeans who have not worked long enough to accumulate sufficient Medisave, but who are unexpectedly faced with high medical expenses. Medifund will give greater support to those who have contributed regularly to their Medisave accounts, and who are covered by MediShield. The Bill provides for the establishment of an Advisory Council to advise the Minister on the use of the income of Medifund. We will be decentralising the processing of Medifund applications to the individual hospitals. Each hospital will have its own Hospital Medifund committee to consider and to approve applications, and to decide on the quantum of remission according to the guidelines recommended by the Advisory Council.”
“For those who do fall ill, the Government is committed to ensuring that every Singaporean is able to obtain good basic health care. For lower income Singaporeans, this has been achieved through our nation-wide network of polyclinics, and the provision of heavily subsidised Class B2 and C beds in our acute hospitals. In the Class C wards, the Government pays $4 for each dollar paid by the patients, and in the B2 wards $2 for every dollar paid by the patients. Medisave helps Singaporeans meet their hospitalisation costs. And our catastrophic medical insurance scheme, MediShield, provides relief to those who are seriously ill and who require long hospitalisation and therefore face bigger hospital bills. However, we recognise that there would be some who, for various reasons, cannot even afford to pay the heavily-subsidised Class B2 or C bills. At the moment, they can apply to have their bills fully or partially waived. In 1991, about 6,000 patients out of a total of over 160,000 Class B2 and C patients in the Government and restructured hospitals applied for waivers. About 98% of the applicants were granted waivers, amounting to a total of $1.7 million. When this Bill is passed, Singaporeans using the heavily subsidised health services who face problems paying their hospital bills can apply for waivers from Medifund. The scheme will have more flexibility when considering appeals for fee waiver. The Medifund privilege will be extended to only Singaporean citizens, and not to non-Singaporeans. The Government will establish Medifund with an initial capital of $200 million, and thereafter increase the capital by $100 million per year, provided that there is continued economic growth and a budget surplus. Only the income from Medifund will be used.”
“Sir, I beg to move, "That the Bill be now read a Second time." The Prime Minister announced during his National Day Rally in August 1991 that the Government will be setting up an endowment fund, called Medifund, to help poor and indigent Singaporeans pay for their medical care. During last year's debate in the Committee of Supply on my Ministry's budget, I also gave Members some details of Medifund. This Bill is to enable the Government to establish Medifund. Sir, we have today one of the best health care systems in the world. To achieve a similar level of health care, most developed countries have to spend over 7% of their GNP, with the USA topping the list at over 13% in 1992. In Singapore, we spend about 3% of our GDP on health care. This shows that overall, our health care system is a very efficient and cost-effective one. Health care costs are very much influenced by the nation's wage levels. Health care is very labour-intensive, requiring highly trained personnel such as doctors, nurses and other professional staff. As a result, labour costs make up over 70% of health care costs. Hospitals must pay their staff fairly and competitively. Otherwise, they will not be able to retain their staff or recruit new ones. It is therefore inevitable that the healthy pay increases enjoyed by Singaporeans over the last 10 years have had a significant impact on health care costs. Expensive modern drugs and advanced medical equipment, and high-tech medical tests and procedures have also helped to push up costs. The best way for individuals to keep their health care expenses low is to adopt a healthy lifestyle, and to reduce their chances of falling ill.”
“Sir, Medisave is allowed to be used for hepatitis-B immunisation, and this is because hepatitis-B is fairly widespread in Singapore. And the only way to cut off the transmission to future generations is to ensure that every new born child is immunised against hepatitis-B. But we do not allow Medisave to be used for routine screening for hepatitis-B. AMOUNT COLLECTED FROM CERTIFICATES OF ENTITLEMENT (Expenditure) 9. Mr Chiam See Tong asked the Minister for Communications how does he intend to spend the sum of $693 million which was paid by successful Certificate of Entitlement tenderers in 1991.”
“The answer is "no" because such tests are still fairly inexpensive and very affordable.”
“Sir, as I indicated just now, screening for cancer should only be done when there are indications. For example, pap smear. Pap smear is something which we recommend to all women. That is one of the very few screening tests that we recommend routinely and it costs only $15. So women should have no problem going for pap smear tests. For the other cancers, it should be done on an indicative basis. For example, people with nasopharyngeal cancer, ie, cancer of the nose. We would not recommed that all Singaporeans go for that test regularly because it is not cost-effective. Very few Singaporeans do have cancer of the nose. But for those whose immediate families have cancer of the nose, then we recommend that they go for a blood test costing only $25. It is more cost-effective for those patients who have definite indications to do cancer screening rather than for the whole population.”
“Sir, in fact, it is not recommended that Singaporeans go for regular screening for cancer and that is because the screening test should be carried out only when it is indicated rather than on a population-wide basis.”
“Sir, the Medisave Scheme is primarily to meet the hospitalisation expenses of account holders, especially in their old age, and those of their immediate family. It has also been extended to cover certain costly outpatient treatments, such as radiotherapy and kidney dialysis. Currently, there are only a few effective cancer screening tests recommeded for the general public. Screening tests which are effective such as screening of women for breast and cervical cancers are inexpensive and generally affordable. Therefore, the use of Medisave for cancer screening is not necessary.”
“Sir, we are still in the midst of the review. So I would not be able to tell the Member how much we are considering. I will ask the officials to bear in mind the request about including the fourth child. SAFETY IN CONSTRUCTION INDUSTRY (Measures to enhance awareness) 5. Dr Toh Keng Kiat asked the Minister for Labour whether, in anticipation of the increase in foreign construction workers, appropriate measures have been taken to enhance the awareness of safety in the construction industry and to reduce the possibility of social, health and security problems.”
“Sir, the current subsidy for childcare centre fee was fixed in 1987, six years ago. My Ministry is now reviewing the childcare subsidy scheme. I expect the review to be completed soon.”
“Sir, there is no need to set up a special crisis centre for the aged to help those who are abandoned by their children or who find it difficult to live with their children. Besides my Ministry, there are a number of Voluntary Welfare Organisations (VWOs) which provide advice, assistance and counselling for the family and the elderly. Individuals and families who face problems and social difficulties can contact my Ministry. We have an Information and Referral Service which provides direct assistance or referral to specialised agencies which can provide help. In addition, the VWOs manage four hotlines and 18 social service and counselling centres. They act as focal points for those in crisis or in need of immediate assistance. Two of the four hotlines are specifically designed for the elderly. These are the hotlines managed by the Singapore Action Group of Elders (SAGE) and the Bukit Ho Swee Social Service Centre. The overwhelming majority of Singaporeans still value and do take care of their elderly parents and grandparents. There have not been many cases of ill-treatment, abandonment of or conflict with elderly members within the family. Over the last three years, my Ministry received about 45 reports per year of elderly persons having difficulties with their families. The Government has always emphasised the important role of the family in caring for the elderly. We have held public education and awareness programmes over the years. These programmes, among other things, help to foster respect and care for the elderly. My Ministry, together with the National Council of Social Service, community and civic organisations, will continue its efforts to strengthen and sustain its public education and awareness programmes. 1.30 pm”
“Sir, under the Singapore Sports Council's third Five-Year Cyclical Maintenance/Upgrading Plan which stretches from 1989 to 1993, $15.2 million has been budgeted for the maintenance and upgrading of sports facilities. This programme includes the upgrading of running tracks in seven stadia from bitumen to synthetic material, upgrading of 10 swimming complexes and the replacement of flooring of three sports halls. We have upgraded the grandstand pavilion of two stadia, and improvement works will begin on the Jalan Besar Stadium early next year. On top of this regular maintenance and upgrading programme, the Singapore Sports Council will also be upgrading the National Stadium and six existing sports facilities in preparation for the SEA Games in June 1993. CRISIS CENTRE FOR THE AGED 18. Mr Low Thia Khiang asked the Minister for Community Development if he will consider setting up a crisis centre for the aged to help those who are abandoned by their children or who find it difficult to live with their children.”
“Yes, correct. He is also free to take part in the Cost Review Committee and ask for further information.”
“Mr Speaker, Sir, if the Member likes to ask for more detailed information on the subsidy policy, he is free to file another question. The Minister of State has already clearly told him that the subsidies include things like the capital cost incurred in the building of hospitals and manpower costs, ie, the recurrent costs incurred in the operation of hospitals. If he wants to have more specific details, please file a question and we would -- An hon. Member: He can take part in the Cost Review Committee.”
“There are no changes to the plans to build a general hospital at Simei. The development of the General Hospital will proceed as planned. Piling works are scheduled to begin in November 1992 and building works in August 1993. The new General Hospital is scheduled to be completed in February 1996 and operational by the middle of the year. LIBRARY IN OR NEAR THE NEE SOON CENTRAL CONSTITUENCY 19. Mr Cheo Chai Chen asked the Minister for Information and the Arts whether there are plans to build a library in or near to the Nee Soon Central Constituency and if so, when the library will be ready and where will it be located. BG George Yong-Boon Yeo: The Government has set up a Library 2000 Review Committee to conduct a major review of our public library system. The review is now underway. It will determine, among other things, the number, size and location of libraries that will be needed over the next ten years. The Review Committee will take about a year to complete its work. Whether a library will be built in or near the Nee Soon Central Constituency would depend on the recommendation of the Committee. ROAD TAX, FEES AND FINES COLLECTED BY THE REGISTRY OF VEHICLES 20. Mr Ling How Doong asked the Minister for Communications what was the amount collected for road tax, Additional Registration Fees/Preferential Additional Registration Fees, fines and composition fines by the Registry of Vehicles in 1990, 1991 and up to the latest convenient month in 1992.”
“The total annual hospital fees and charges collected by Government and restructured hospitals were $224m in 1990, $266m in 1991 and $132m for the first half of 1992. FOREIGN WORKERS AND MAIDS LEVY 19. Mr Ling How Doong asked the Minister for Labour what was the total amount of levy collected from the employers in respect of foreign workers and maids for the year 1991 and what is the estimated amount for 1992.”
“Sir, in 1991, my Ministry disbursed $4.55 million as public assistance allowance. In addition, my Ministry also gave out $730,000 from six charitable funds administered by my Ministry to needy families, including those on public assistance allowance. There were 2,332 households on public assistance allowance as at 31st December 1991. Of these households, 2,030 had aged destitute persons; 184 had either disabled persons or others who were mentally ill or chronically ill which rendered them unfit for work; 113 had heads of households who were widows, deserted or distressed wives with young or schooling children; and 5 had children who were orphans and were living with relatives. HOUSING AND DEVELOPMENT BOARD ESTATES (Management of common property by Town Councils) 15. Mr Chiam See Tong asked the Minister for National Development whether he will consider introducing legislation to amend the Town Councils Act to give Town Councils a completely free hand to manage, control and improve the common property of Housing and Development Board estates.”
“Sir, we will bear in mind the points raised by Mr Loh when we consider the legislation. CENTRAL PROVIDENT FUND (Withdrawal age) 8. Mr Cheo Chai Chen asked the Minister for Labour if he will give his assurance that the withdrawal age for the Central Provident Fund will not be altered as a result of the proposed raising of the retirement age. The Minister for Labour (Dr Lee Boon Yang): Mr Speaker, Sir, my Ministry has no intention to change the present CPF withdrawal age in conjunction with the raising of the retirement age. CENTRAL PROVIDENT FUND (Withdrawal to help relatives) 9. Mr Cheo Chai Chen asked the Minister for Labour whether he will relax on the use of the Central Provident Fund so that members with large savings in their CPF accounts will be allowed to withdraw a certain amount of money, within a specified scope, to help their relatives in the payment of housing loans, conservancy charges and even living and medical expenses during unusually hard times.”
“Sir, that option is also under consideration. We are now looking at the legislation enacted by Canada earlier this year which includes the ban on smoking in public places by youths. We are following up to see how they have coped with the issues posed by such a ban and we would, if feasible, introduce that in Singapore as well.”
“Mr Speaker, Sir, my Ministry's Smoking Control Programme has a two-pronged strategy - education and legislation. As education is the key to the prevention of smoking, my Ministry plans to step up the education of youths against smoking. Smoking education is included in the health education curriculum of primary schools, and the science curriculum and the new physical education syllabus of secondary schools. My Ministry will also conduct more exhibitions and talks and expand the smoking education component in the healthy lifestyle programmes in schools, Institutes of Technical Education (ITE) and other educational institutions. We will also work with youth organisations to reach out to youths in the community. In addition, my Ministry will work with the Singapore Cancer Society and the Youngberg Hospital to increase the reach of their smoking cessation programmes for young people in schools and workplaces. My Ministry will continue to provide smoking education in the workplaces. We will assist companies interested in becoming smoke-free and help them conduct smoking cessation programmes. We will also continue to use the mass media to educate the public and youths on the harmful effects of tobacco and to deglamourise smoking. As part of the plan to prevent the young from taking up smoking, my Ministry will be introducing legislation to prohibit the sale, giving or furnishing of any tobacco product to any person below the age of 18 years. We are also studying legislation enacted by other countries and their effectiveness in controlling smoking amongst youths.”
“Sir, building works will commence in mid-1993 and we expect to complete them by mid-1994. LAND BETWEEN BISHAN STREET 22/24 AND CATHOLIC HIGH SCHOOL (Development into Garden Park) 12. Encik Ibrahim bin Othman asked the Minister for National Development whether his Ministry will consider developing the land between Bishan Street 22/24 and Catholic High School into a Garden Park.”
“I do not have the details about the number, Sir. GEYLANG POLYCLINIC (Development progress) 11. Encik Othman bin Haron Eusofe asked the Minister for Health what is the progress of the development of the Geylang Polyclinic in the Marine Parade Constituency and what medical services and facilities will be provided in the polyclinic. Mr Yeo Cheow Tong: Sir, Geylang Polyclinic will be located at Geylang East Central. We are in the process of finalising the architectural drawings. Building works are expected to commence in mid-l993 and will be completed in one year. Geylang Polyclinic will be a one-stop health centre with promotive, preventive, curative and rehabilitative services. Like the other modern polyclinics, Geylang Polyclinic will provide outpatient medical care, maternal and child health care, family planning, health screening, rehabilitation and day care of the elderly, dental care and outpatient psychiatric care. Its facilities will include a laboratory, an X-ray clinic, a pharmacy, a minor surgical procedure room and a health education resource room.”
“Of course, there will still be Class C beds and there will be enough to cater for the needs of patients.”
“Sir, there are no plans at present to restructure Alexandra Hospital.”
“Sir, for the subsidised patients, the costs of renovations are not included in the costing of services.”
“Mr Speaker, Sir, my Ministry is currently undertaking a $18.2 million project to upgrade the facilities of Alexandra Hospital. The project includes: (a) The creation of a 13-bedded Day Surgery Suite; (b) The establishment of a clinical Department of Geriatric Medicine; (c) Improvements to the major opera-ting theatres with better pre- and post- operative facilities; (d) Creation of a 10-bedded Coronary Care Unit; (e) Renovation of the X-ray Department with upgrading of equipment; (f) We are also renovating and refurbishing all the wards. The B1 wards will be airconditioned. We will also add new Class B wards which are quite lacking in Alexandra Hospital; (g) The total number of beds will be increased from 397 to 488 after the ward renovations. The development of the Day Surgery Suite will be completed by the end of June 1992, ie, the end of next month. The other renovation works are being carried out in phases and are expected to be completed by early 1994. With regard to staffing, the staffing ratio in Alexandra Hospital is comparable to the other Government and restructured hospitals. The number of professional staff has increased over the years. In the last two years, the number of doctors has increased from 80 to 85; the number of nurses from 356 to 386; and paramedical staff from 52 to 61. To further upgrade their skills and professional knowledge, the medical and nursing staff attend continuing education courses. For the period 1989 to 1991, 9 doctors, 5 nurses and another 5 paramedical staff from Alexandra Hospital were sponsored for courses overseas and for overseas attachment to medical centres under my Ministry's Health Manpower Development Programme. All these efforts have helped to better equip them to provide a higher standard of care to the patients.”
“If we manage to find another Dr Ee who is able to commit all his energy and to devote all his time to the Council, and he is prepared to do it for 10, 15 years, I think we should be very grateful that such a person exists. 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. - [Mr Yeo Cheow Tong]. Bill considered in Committee; reported without amendment; read a Third time and passed. ACKNOWLEDGEMENT TO THE CHAIR”
“Sir, let me take this opportunity to inform Members that Dr Ee's successor as the President of the new Council will be Dr Robert Loh who is an eye surgeon. In fact, it was Dr Ee himself who recommended that Dr Loh succeeds him. Dr Loh has worked alongside Dr Ee for many years as the Vice-President of the Singapore Council of Social Service. He has served on many of the SCSS and Community Chest committees and he has been active in many other committees and welfare organisations. I have no doubt that Dr Loh, like Dr Ee before him, has the trust and the confidence of the voluntary welfare organisations. He will be able to build on the strong foundations laid by Dr Ee and he will be able to lead the NCSS in anticipating and providing for the future welfare needs of Singapore. Sir, I would like to assure Members that the appointment of the President and the Chairman will not change the independent and voluntary status of the NCSS to be able to continue functioning independently as the present SCSS has done. Sir, Mr Zulkifli has asked whether there should be a time bar for the appointment of the President of the new Council and the Chairman of Community Chest, just as there are similar time bars on the others. These two positions are key positions and as key positions, the pool of Singaporeans who would be suitable for performing these two roles would be very limited. It is important for us to let them do the job as long as they can continue doing the job well and if they wish to step down, then we will, of course, have no choice but to look for another member.”
“Indeed, we can say that the achievements of the Council and the Community Chest are a credit to Dr Ee's foresight and to his leadership. Sir, Dr Ee was elected as the President of the Council when it was first established as a legal entity by Parliament. I think many Members know that. But what Members may not know is that the Council was first registered as a Society in 1958. One of the pioneers responsible for the formation of the Society at that time was the late Mr Lee Kong Chian. He realised at that time that there was a great need to have capable and dedicated persons to lead the Council. In 1964, he personally identified Dr Ee and persuaded him to come in and take over the leadership role in the Council. Sir, having served for almost 28 years, Dr Ee has decided that it is time that he stepped down and handed over the reins to someone else. He has served the nation and Singaporeans well, and we are truly grateful and, in fact, indebted to him. The NCSS and the CCS will need to continue to have people like Dr Ee to head it in the coming years. Such a person is likely to be already well established in the business or professional world and would preferably also be involved already in voluntary work. The question is, can we be sure that such persons would readily come forward to participate in the election process? I think chances are that such persons will not. As the Council and the Community Chest are such vital national organisations, we cannot leave it to chance. The Government has a duty to ensure that the Council and the Community Chest are well managed and well led. We have to ensure that only eminent persons who have the trust and the confidence of the public as well as of the many voluntary welfare organisations are appointed to these two high positions.”
“Sir, I would like to thank my two colleagues for their strong support for this Bill. Sir, Mr Tarmugi has asked two questions. Firstly, what is the fate of the present employees who are working in CCS and SCSS. Sir, the new Council and the new Community Chest will absorb all the staff who are presently employed. Secondly, the perception that Government is intervening by appointing the two key members. Sir, out of the 22 members on the Council's Board of Management, the Government will only be appointing the two key members - the President of the Council and the Chairman of the Community Chest. Sir, there are important reasons for this. This is because the Council would have greatly expanded roles and functions in the future, compared to when the SCSS Act was first enacted in 1968. It is now an umbrella organisation responsible for planning and helping to provide welfare services on the national level. Sir, the Community Chest also raises a tremendous amount of money each year and it will have to raise even more money in the future. Let me give an example. Last year, it raised $20 million and disbursed $18 million to 42 charities. This year, the target is $27 million. It is a lot of money, all donated by members of the public. Understandably, the public would expect the money to be properly accounted for, properly invested, and used prudently. The President of the Council and the Chairman of the Community Chest are the key figures in assuring the public that their donations and money are being handled carefully and properly. Sir, we have been fortunate that the SCSS and the Community Chest have been led by a man of great integrity, commitment, dedication and ability in the person of Dr Ee Peng Liang.”
“Government's financial assistance will be reviewed after the initial three years, by which time NCSS will be in a better position to determine its longer term needs. Sir, the new NCSS to be set up under the Bill will provide the critical link between Government and VWOs and will help energise VWOs to fulfil the current and future welfare needs of Singapore. Sir, I beg to move. Question proposed.”
“Two Board members will be ex-officio, representing the Director of Social Welfare and the Director of Medical Services. The President of the Council will appoint the Secretary and the Treasurer, and the remaining five appointed members will be drawn from the Chairmen of the various service and fund allocation committees in the NCSS. Clauses 10 and 11 set out the objects and powers of the Council. The Bill provides for greater emphasis on the Council's leadership role. It will enhance service provision by NCSS to its member organisations and strengthen its role in fund-raising. It provides for the establishment of minimum acceptable standards of social service and guidelines on good practice. This will enhance the services and facilities provided by VWOs to their clients. Clause 12 establishes an Endowment Fund which shall vest in the Council. This will help provide the Council and Community Chest with a steady stream of income. It will facilitate better planning and help to even out the fluctuating results of annual fund-raising efforts. Clause 13 establishes the Community Chest and deals with the appointment of its Chairman and members. The existing Community Chest of Singapore was established in 1983 as a Committee of the Singapore Council of Social Service. It is now a household word, with public donations amounting to millions of dollars each year. The Bill provides for the establishment of the Community Chest as a clear legal entity within the National Council of Social Service. The expanded NCSS will require an increased budget to fulfil its enhanced roles. My Ministry will help the NCSS by funding up to 50% of its operating expenditure for the next three years.”
“Dr Ee and members of the SCSS Board of Management recognised in 1990 the need to re-examine the role and functions of the Council to ensure that the Council would be well-positioned to serve society through the end of this decade, and into the next decade. In collaboration with my Ministry, the Council commissioned a consultant firm in 1990 to carry out this review. The consultants completed their study, and submitted their recommendations to the Council and my Ministry in 1991. The recommendations were accepted by my Ministry, the Council and the Community Chest. Voluntary welfare organisations were also briefed and have accepted the conclusions of the study. The proposed legislation is to put into effect these changes recommended by the consultants. Sir, this Bill, when approved by Parliament, will enable the National Council of Social Service (NCSS) to take a strategic and more pro-active role in welfare planning and provision to meet the more complex and diverse welfare needs of our society. I will now explain the major new provisions in this Bill. Clause 3 establishes the National Council of Social Service as a corporate body. The new name is to reflect its enhanced and more pro-active role. Clause 5 vests the management of the affairs of the Council in a Board, and deals with the appointment and election of members of the Board. The Bill provides for an equal number of appointed and elected members on the Board of Management. This will help to ensure that the VWOs' interests are adequately represented, while at the same time, allow NCSS to tap the resources and expertise of capable persons from other sectors. The Minister will appoint only two members, namely, the President and the Chairman of the Community Chest.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." Sir, the Bill seeks to repeal and re-enact the Singapore Council of Social Service Act, Cap. 321. The Singapore Council of Social Service Act was enacted 24 years ago, in 1968. At that time, we had high unemployment, and many Singaporeans lived in cramped quarters that lacked proper sanitation. The situation has changed dramatically in the last two decades. With strong economic growth, we now enjoy full employment. Any able-bodied person can get a job without any problems at all. With greater affluence and full employment, the nature and scope of our welfare problems have also changed. We had more than 16,500 public assistance recipients in 1968. Today, the number has dropped to about 2,300. The social problems we face today are those of a modern, urbanised and industrialised society. Our families have become smaller. The dual-income nuclear family with both parents working is becoming more common. This is to be expected, since women today are as well-educated as the men. The aged population will also increase dramatically. Sir, these changes in our economy and the family structure will pose new challenges to us in the future. Instead of the homeless, the destitute and the aged single who migrated to Singapore from China, India and Malaya many years ago, new social problems are emerging. The Singapore Council of Social Service (SCSS) and the Community Chest of Singapore (CCS) have performed an excellent and invaluable job in supporting and providing welfare services in Singapore. The President of the SCSS, Dr Ee Peng Liang, and his team of volunteers have done much over the years to provide relief for those in need.”
“My Ministry, endorsed by the Review Committee, would be responsible for approving the major purchases of equipment in Government and Government-owned hospitals to ensure that there is no what you call "arms race", which was observed in the US, where every hospital tried to outdo the other in the purchase of expensive equipment. Medical centres - because we are small, it is important that we do not duplicate specialties in all hospitals, especially in cases where the number of specialists in the country is limited, for example, in skin. It is actually more cost-effective for us to group them into one centre, so that the required equipment can be based in one location and not duplicated in all the other locations. Sir, we would definitely give consideration to all the relevant factors before deciding whether or not a medical centre is required.”
“Sir, I totally agree with Dr Michael Lim that we have to be very prudent and careful when planning new hospitals or new centres, and we have to learn from existing hospitals. Sir, all the things that he has talked about are generally acceptable, and we definitely are already paying attention to those details. He has not been involved in hospital planning. So I will explain to him that in planning all the new hospitals, we rely on existing specialists and doctors to be in the planning team as well as bring in consultants from abroad to ensure that our plans are correct, and they are not excessive. In terms of beds per cubicle, in our subsidised wards we do have a different number of beds in each cubicle. As to whether it is mandatory that there should be only one nurse per cubicle, the answer is no. If the cubicle has only two beds, I would have expected the hospitals to ensure that the nurse looks after three cubicles, and not just say that each nurse is only in charge of one cubicle, and therefore it is a fixed ratio. It cannot be. Expensive equipment - yes, we need to avoid unnecessary duplication. In fact, like in the case of the MRI machine, in 1986 we were under strong pressures from NUH and SGH to purchase MRIs for them. We refused because we were not convinced that the time was right and that the demand and the requirement for MRI was justified. So we sat on the requests until 1991 before NUH was allowed to buy one. Sir, I can assure the Member that we are concerned about unnecessary duplication.”
“Sir, Dr Michael Lim has raised a few points. Firstly, ambulatory care. I agree with him that we have to strongly promote ambulatory care, because it is a very cost-effective way to reduce hospital costs. And because of that, many of our hospitals now have a significant percentage of their operations done on an ambulatory basis. For example, Singapore General Hospital, in 1987, only 17% of the operations were done on an ambulatory basis. In 1990, the percentage had gone up to 33%. Toa Payoh Hospital, before restructuring, in 1987, only 6% ambulatory surgery. In 1990, after restructuring, that number went up to 24%. So we will look for all ways to do operations on a day surgery basis rather than hospitalise them. 2.30 pm He also asked whether Medisave would be allowed. Sir, Medisave is allowed for most of the day surgeries and most of the day procedures. We will be prepared to consider any new procedures which have been found to be able to be carried out on a day basis. If those are valid, we will be prepared to allow Medisave to be used. Optimise ICU, yes, I agree with him. ICUs are very, very expensive. We need to ensure that strict guidelines which exist are being complied with. Because we have good guidelines, the number of ICU beds in our hospitals has been maintained at only 3% of total hospital beds. In comparison, in the developed countries, most hospitals have between 5-10% of their beds as ICU beds. So we are keeping a tight control on those beds. Cost centre accountability, I agree with him again, it is a good idea. Restructuring has allowed the hospitals to introduce cost centre accounting and we would definitely try to stretch the advantages and benefits under this system to the maximum.”
“Sir, obviously, he has not been listening to what we have been saying the whole day, ie, for Class C patients, we will subsidise 80%. And for those who cannot even afford to pay the remaining 20%, we have Medifund to help them. Medifund would either help these patients to pay for the remaining part in full or partially. So the safety net is there. I have been stressing that many times just now. Sir, on his statement that Singaporeans cannot afford to get sick but can afford to die, I can assure him that if that is the case, our life span in Singapore would not be 75 years today. Singaporeans today are living to a ripe old age because, firstly, the environmental health conditions are very good. So they stay healthy. But we can help them stay healthier by adopting healthy lifestyles. Secondly, when they fall sick, we have a very effective health care system that helps them to recover and at a cost that they can afford. So everybody who is sick can get a cure and that is why they all live to a ripe old age. That is why today we have a good chance of living to the age of 75 which puts us amongst the developed countries.”
“Sir, in that case, let me answer Mr Low Thia Khiang. Sir, I would advise Mr Low to please go to the Library and refer to the Hansard. We have debated many, many times here on why we restructured the hospitals. But for his benefit, I will just give him a very quick summary. We have restructured the hospitals, not privatised them. We have restructured them to enable the hospitals to operate more cost effectively, more efficiently. For example, as Government hospitals, all their procedures, all changes, have to be approved by the Government. As restructured hospitals, they can innovate, they can improve, they can, for example, recruit different categories of people. Instead of using nurses, they can recruit clerks and reduce costs. So restructuring has helped the hospitals become more efficient, more productive.”
“The charges for Class C service that they receive will start from the day they go back to Class C.”
“Upon admission, all patients are clerked, that means their details are recorded by either a medical officer or a houseman and, subsequently, he is then reviewed by a Registrar or a Senior Registrar; these are doctors with higher degrees and they are specialists. After that, the senior specialist in charge of the team will then review each case within 24 hours. For a subsidised patient, he actually goes through three levels of consultation and examination by the doctors. The only difference between the subsidised patient and the private patient, as I mentioned just now, is that the private patient can choose the particular specialist. Sir, in reply to what Mr Yeo has said about subsidised patients being encouraged to go to the A and B1 wards, we have been doing surveys for the past few years and our surveys show that for the first few months of this year, only 3.3% of the patients who went to A and B1 wards told us that they were influenced by doctors and nurses. In comparison with last year, our surveys show that 7.5% of A and B1 patients were being influenced. When we asked them what they meant by "influenced", the answer was that they asked the nurse or the doctor what was the difference and the doctor explained to them that the ward was better, airconditioned and so on. Based on what they were told, they then opted to go to the higher class wards, and not because the doctors told them, "If you don't go to the A or B1, I won't look after you." That is the result of our survey. Sir, I would like to assure the House that subsidised patients do get very good medical treatment in our hospitals.”
“And our surveys show that the waiting time in the Specialist Outpatient Clinics is actually shorter for subsidised patients. The median waiting time for subsidised patients is 29 minutes, shorter than even if you go to a GP clinic. The median time for the private patients in A and B1 is 40 minutes. You may ask, why is that so? The reason is that for the private patients, they specify a particular doctor. Quite often, when the doctor is away because of some emergency case in the ward, the patients then have to wait until he comes back. Whereas for the subsidised patients, because they are seen by a team of doctors, if any particular member of the team is away, another member takes over, so, therefore, there is no delay in his appointment. In terms of elective surgery, ie, patients who have some problems and require to be operated on but is not an emergency case, he can, therefore, choose his time. For such elective surgery cases, the waiting time for a subsidised patient is eight days and the waiting time for a private patient in A and B1 wards is seven days. There is not much difference. Of course, whether you are a subsidised patient or a private patient, if it is an emergency case, all patients are operated on immediately, there is no waiting time at all. Sir, the fear of the subsidised patients that they are only seen by non-specialists is not true. This is because all patients are managed by a team of doctors, comprising specialists as well as non-specialists, and in charge of the team is a senior specialist.”
“Sir, many of the MPs have asked about the consultancy fee scheme, so I will answer that now. Sir, let me clarify that when the scheme was implemented, there were safeguards because the specialists were only allowed to spend four sessions or four half-days out of the five-and-a-half days that they have on looking after private patients, ie, patients in A or B1 class wards. We have been monitoring and in actual fact the vast majority of the doctors do comply with this guideline. But it is understandable that from the point of view of the public, the risk is high, that some doctors may be motivated by the ability to earn more money and therefore be discouraged against looking after them. Sir, the Ministry has been looking into this problem and we will be implementing a scheme within the next three to six months, whereby the specialists will earn the same amount for a particular service, whether he provides a service to a private patient or to a subsidised patient. So this way, there should be no incentive or disincentive for the specialists to look after one patient or the other. It is all neutral. We will be implementing that in the next three to six months. Sir, Mr Yeo Toon Chia has asked whether it is true that because of all these operational systems, the subsidised patients are actually getting poor services. He has mentioned about waiting time. Let me assure him that in terms of medical quality, there really is not any difference. There is difference, yes, but in the level of comfort in the wards. Class A and B1 wards are more comfortable because they are air-conditioned. B2 and C wards are not air-conditioned. You would have to depend on the fans and natural ventilation. 2.00 pm Sir, in terms of waiting time, we have done surveys. We do surveys regularly.”
“Sir, I have just said that we have no means of registering them, since we are not involved in their training.”
“The two local TCM schools should have the expertise to assess TCM practitioners and to assess whether the herbs are genuine and of the correct quality. Unfortunately, my Ministry does not have such expertise. It is therefore better for such programmes to be carried out by the private sector rather than for them to wait for my Ministry to develop such expertise which is very difficult to develop. Yesterday, Dr Ow also suggested that we explore the possibility of carrying out some research on TCM with Taiwan or China. I am happy to inform him that we are actually doing that. We are exploring the possibility of working with the Chinese on using TCM to complement western treatment for diseases, for example, cancer. Dr Tan Cheng Bock rose --”
“Sir, Mr Peh has brought up the same issue last year too. My reply then was that currently there are no requirements for Chinese physicians to be registered. Since the Government is not involved in the training in any way, my Ministry will continue this practice of not registering them. Nothing has changed in the one year to warrant a shift in our position. But I understand his concern. The question is, how do we help Singaporeans to differentiate between Chinese physicians who have undergone some formal training versus those who have not, but who have obtained their skills either through apprenticeship or knowledge which has been transferred from one generation to another. The Chinese Physicians' Association has started to issue certificates to their members. I think that is to be encouraged and they should find more ways to publicise this so that when Singaporeans visit a Chinese physician, they can look for that certificate. Also, there are two main schools of traditional Chinese medicine (TCM) in Singapore. For a start, they may wish to consider amalgamating so that there is no question on the standards and the curriculum that they are using. By speaking with one voice, I think the public will be less confused. Sir, Mr Peh suggested that we get Chinese physicians from China and Taiwan to establish an examination council and to conduct examinations. I think that is a good idea. We should encourage the two TCM schools, after they have amalgamated, to explore this. My Ministry can help them to get in touch with the relevant reputable TCM schools in China or Taiwan and we can also help to clear immigration and work permit requirements.”
“Because all that he has described are precisely things that we are already doing. It is just that he has managed to call them under a different name. He has quoted a Finnish model, saying that we are underspending, without realising from the data that actually we are spending more than what Finland is spending on primary health care. Sir, Mr Loh is correct. I think for primary health care we are very well established. But, nonetheless, I appreciate his concern and I can assure him that in our future studies and planning for primary health care, I will definitely call on him to volunteer his time in helping us to further improve the primary health care service. Sir, with regard to hospital services, I can assure him that we also share his concern that we do not over provide medical services in the hospital area. That is why we have been freezing the number of beds for many, many years. In fact, we had a freeze for the last seven years on hospital beds. We will continue to gauge the demand very carefully, and ensure that only those who require hospitalisation are being hospitalised. More importantly, to ensure that only those who require investigations are being provided investigations. Otherwise, if everybody comes in for all those tests unnecessarily, we must invest more in equipment, and that will be very adverse. Sir, on the point about the Consultancy Fee Scheme, I understand, looking at the amendments, that some other MPs may also be talking about it. So I would reply to it later. Do I have the time to reply to Mr Peh?”