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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“Sir, he has taken a lot of time yesterday, more time than he could have.”
“They prefer to wait only 10 minutes. It can be done by putting in more people. To do that, it increases the cost. When they call for a nurse in the ward, they want the nurse to respond immediately when they press the button. It can be done. You put in more nurses. That again raises the cost. So we will have to re-examine our service levels and see whether we can actually afford those service levels. Secondly, technology related. Mr Loh has also mentioned that. We will have to control tightly the purchase of high-tech expensive equipment. Some scarcity may be useful, and I agree with Mr Loh on that. We also have to tighten on the use of drugs, especially the more expensive non-standard drugs. We will have to audit our operations properly, both in the public and the private sector, to ensure that there is no unnecessary admission and investigation. So all these, we feel, will help us to address the issue of rising health care costs and how to control them. Sir, I will now ask my Minister of State to reply to some of the other questions.”
“If they choose to go to Class B2 in the Singapore General Hospital, 75% of the patients will pay less than $635 as a total bill. If we assume that patients going to Class B2 are at the 40th percentile income, then their salary is about $1,000. This is equivalent to about 10 months of their Medisave contributions. The Class B2 and Class C bills in the Singapore General Hospital, being a tertiary hospital, a more expensive hospital, are actually quite affordable. If patients choose to go to the other hospitals, like Toa Payoh Hospital, Tan Tock Seng Hospital or Alexandra Hospital, being secondary hospitals, the costs are much lower and the bill sizes will be even lower. It will also require fewer months of Medisave contributions to pay for the bills. The bill sizes are affordable and they are not crippling. And we must also remember that for those who cannot afford even these subsidised bills, we have a safety net of waivers. Now that safety net will be provided by Medifund. 1.15 pm Mr Othman Haron Eusofe appealed to the Ministry to keep health costs down, especially hospital costs, and asked what are we doing with regard to that. Various MPs have also asked about this. I will go through it quickly. Sir, labour cost is the primary cost factor. So we must address the labour cost. The hospitals will try to improve the systems and procedures so that they can use less people. We will use less expensive staff, where possible. For example, instead of using nurses to do clerical work, we recruit clerks, who are less expensive, to do clerical work. A very important area and one which Dr Wan also asked is: are we giving Singaporeans a level of service that is too high for them to afford? Singaporeans want better service. They do not want to wait half an hour.”
“These equipment, drug cost, maintenance cost, make up the remaining 30% of the hospital costs. To give Members an idea of what is really involved in running a hospital, I will give you the example of the Singapore General Hospital. The hospital requires over 4,000 staff to operate it round the clock. It requires a budget of $270 million a year, that is, about three quarters of a million dollar a day to run. I believe this is more than what it costs the whole of the MRT to run. So the costs are high and because of that, Government has made available very generous subsidies, depending on the class of wards that the patients choose. The patients are allowed to choose based on what they can afford. In fact, some may choose to go to wards which they cannot really afford. We would like to encourage all patients to choose the class of ward wisely. Sir, Encik Haron Eusofe has asked how affordable those fees are, and Dr Wan Soon Bee has also stated that even if patients pay 20% to 25% of Class C costs, the charges can be crippling. We have to focus our mind on what really are the actual charges faced by our patients. I will quote what the patients have to pay in the Singapore General Hospital. 75% of Class C patients in the Singapore General Hospital pay less than $400 each time they are hospitalised. That means from the day they go in to the day they come out, including the cost of the ward, medication, doctor's fees, operation fees, if they have an operation, 75% of the patients pay less than $400. Let us convert that to Medisave contributions. Using the 1990 census, the 20th percentile income of individuals is $730. Based on the 1990 figures, it would take a person, if he is paying for himself or his family, nine months of Medisave contributions if he goes to a Class C ward.”
“We cannot assume that economic growth will continue to outpace health care spending as the economy matures. Expenditure on health care, currently at 3.1% of GDP, is likely to rise steadily over the next two decades. Every Singaporean has the duty to stay fit and healthy. A healthy lifestyle will reduce his chances of falling sick. He should save up for future medical needs by contributing regularly to Medisave. And he should use his Medisave prudently, by choosing the class of ward which he cancomfortably afford. The Government will implement the measures contained in the Review Committee's Report to restrain the rise in health care costs. The subsidy policy for the different classes of wards, the changes to Medisave contribution rates, the introduction of Medisave for the self-employed, and the creation of Medifund will help to keep our basic medical care affordable and accessible to all. Sir, I now move on to some of the other points raised by Members. Various Members have expressed the fear of the public, as well as their own fear, as to whether our hospital charges are affordable despite the high subsidy rates. Sir, it is very understandable. But the fact is that the hospitals are expensive operations to run. The hospitals are highly labour-intensive and, not only that, the labour that is required in hospitals is all highly skilled. Nurses, doctors, therapists, radiographers, all of them require long periods of training and, therefore, they command high salaries. As a result, labour costs make up about 70% of hospital costs. Added on to that, hospitals also require medical equipment, many of which are high tech, very expensive, as well as a full range of drugs, some of which are again very expensive.”
“The administration of the scheme will be decentralised to hospitals. It will take some time for the Government to draft and pass legislation to set up Medifund. This should be done by 1993. Meanwhile, the Ministry of Health will continue its existing fee waiver scheme, but it will apply the new Medifund rules in approving requests for fee waivers. Other Providers of Health Care Today, the Government provides 80% of hospital beds in Singapore. However, the trend is for the private sector to play a bigger role and to compete against Government hospitals as in obstetrics. While the Government will always retain a major role in health care, it also encourages more competitive providers to enter the sector, to give Singaporeans more options to choose from. There is room for the unions and other civic organisations to run hospitals on a not-for-profit basis. Such hospitals will be given the same subsidies as Government and restructured hospitals, and their patients will be eligible for Medifund on the same basis. They should provide a full range of wards, from unsubsidised Class A wards to the heavily subsidised C Class wards. The Government has been discussing with the NTUC on the possibility of the unions taking over and running a major hospital. The NTUC has expressed interest in taking over the Tan Tock Seng Hospital. The Government intends to redevelop Tan Tock Seng Hospital with modern facilities, and hopes that the NTUC will operate it as an integral part of our national health care system. Sir, let me conclude by saying that as a percentage of GDP, our health spending has not risen as sharply as in other countries because our population has been young and our economic growth has been high. But the population is aging.”
“Subsequently, it will contribute up to $100 million each year to Medifund, provided the economy does well and there is a budget surplus, until a sufficient amount is built up in Medifund. Only the income from the endowment fund will be used. Medifund will act as a safety net. It will assist citizens who cannot afford to pay their hospital bills, either by themselves or with the help of their families. It will cover patients in C and B2 Class wards in Government and restructured hospitals. Patients in both classes of wards will receive the same dollar amount of support from Medifund. Depending on the need in individual cases, Medifund will pay all or part of their bills. In cases where the patient or his family members are still working, Medifund may instead give loans which they can repay out of future contributions to Medisave. Singaporeans eligible for Medifund support will include, firstly, the destitute and the indigent, who presently apply for hospital fee waivers; secondly, younger Singaporeans who have not worked long enough to accumulate sufficient Medisave, but who are unexpectedly faced with high medical bills; and thirdly, older Singaporeans with no Medisave, or who did not accumulate enough Medisave before retiring because the scheme was implemented too late for them. Medifund will give greater support to those who have contributed regularly to their Medisave accounts, and who are covered by MediShield, but, despite this, have run into difficulties. This will be an added incentive for the self-employed to contribute regularly to Medisave, and for all Medisave account holders not to opt out of MediShield. Medifund will be supervised by an Advisory Committee which will include com- munity leaders.”
“If the rates of 6%, 7% and 8% still prove insufficient, further adjustments may be necessary. Medisave for the Self-Employed So far, Medisave has not been extended to the self-employed. The self-employed can contribute voluntarily to Medisave, but only very few, about 200, have done so. The Government will extend Medisave to self-employed Singaporeans earning more than $200 per month from 1st July 1992. The contribution rates will be phased in gradually, so that the self-employed do not suffer a sharp drop in their take home pay. The initial rate will be 3% for self-employed of all age groups. The rates will be raised gradually by 1% point per year, until they are level with those for other employees, that is, 6%, 7% and 8% depending on the age of the contributor. Sir, I will now ask the Clerk to hand out the table (Cols. 1271 - 1272). [Copies of table distributed to hon. Members.] table - New Medisave Contribution Rates (Cols. 1271 - 1272) Sir, the Government will verify Medisave contributions through personal income tax returns. When the self-employed file their tax returns, IRD will assess their Medisave contributions for the year based on their declared income. In addition, from 1st January 1994, the Government will also require those who apply for licences, for example, taxi drivers, hawkers, or shop proprietors, to show proof that they have contributed to Medisave before it issues licences to them. Medifund Medisave and MediShield should cover the medical expenses of nearly all Singaporeans. But in the minority of cases where they are insufficient, Medifund will supplement them. Government will give Medifund an initial endowment grant of $200 million.”
“Many rely on their children, but their children may have just started working, and may not have sufficient Medisave to support aged parents. The Government will tackle these issues by raising contribution rates for older Singaporeans, extending Medisave coverage to the self-employed, and through Medifund. Medisave contribution rate The experience gained since the introduction of Medisave shows that the 6% Medisave contribution rate was conservative. The Review Committee has confirmed this. To enable Singaporeans to save enough for their hospitalisation needs after retirement, the Government will raise the Medisave contribution rate for older Singaporeans in two stages. From 1st July 1992, the rate for those above 35 years of age will increase from 6% to 7%. From 1st July 1993, the rate for those above the age of 45 years will be further raised to 8%. These increases will be achieved by correspondingly reducing contributions to the CPF Ordinary Account. The overall CPF rate will remain unchanged, at 40%. The approach of increasing Medisave contribution rates for older Singaporeans means that workers will channel more of their savings to their HDB flat while they are young, and more towards Medisave as they grow older, when their flats are largely paid for, and their own and their families' medical needs increase. 1.00 pm Some Singaporeans aged above 35 will still have mortgages outstanding. HDB estimates that the reduction in contributions to the Ordinary Account will have minimal impact on their HDB mortgages. However, HDB has agreed that in cases where there are difficulties, it will extend their loan repayment period. The Government will review the trend of medical expenses and Medisave contribution rates over the next few years.”
“Each person contributes to his Medisave account to meet future medical expenses of himself and his immediate family. This arrangement has helped most Singaporeans to meet their hospital expenses. The Medisave is not meant to cover the entire cost of a person's medical needs. It only covers that part which the individual has to bear - 20% if he goes to C Class wards, and 35% if he opts for B2 Class. The rest of the cost is covered by the Government subsidy. The Medisave contribution rate of 6% of income was set to enable the average middle income family to save enough to cover treatment in B2 Class wards, and the average lower-middle income class family to pay for the C Class charges. The savings should be enough not only to meet ongoing expenses, but also to accumulate a sum for medical needs after retirement. In the long term, Medisave should assure all Singaporeans of access to good basic medical care. However, the Medisave scheme was introduced only eight years ago. The scheme has not yet reached steady state. Meanwhile, three transitional problems have arisen, which have contributed to the worries of Singaporeans that they will not be able to meet rising health care expenses. The three transitional problems are: (1) The 6% contribution rate was an initial estimate of the amount necessary. It has to be adjusted as we gain actual experience of usage and cost trends. (2) Most self-employed Singaporeans have not yet been brought under Medisave. The hospitals all report that this group has greater difficulty in meeting their hospital bills. (3) Older Singaporeans have not accumulated enough Medisave in their earlier working years to meet their post-retirement needs.”
“In addition, the Government intends to provide a new 5-bedded ward, intermediate between B1 and B2 wards. It will be subsidised 50%. Sir, this scheme enables the Government to focus health subsidies on those who need them most. The Government does not intend to phase out medical subsidies, except for A Class wards. The C Class subsidy will not be reduced below 80%. That is an assurance. An 80% subsidy means that for each dollar that the patient pays, the Government in effect pays $4 on his behalf. In the B2 Class wards, the Government pays twice the amount paid by the patient. Fee increases Sir, despite these large subsidies, Government and restructured hospitals will still have to raise fees regularly in order to attain the target subsidy rates and maintain medical standards. They have been doing this for the last few years. Further fee revisions can be expected this year. Our policy is to revise fees regularly by smaller amounts, rather than infrequently in big jumps. Whatever the fee increases, the percentage level of subsidies which I have just mentioned will be maintained. Some of the restructured hospitals, for example, Singapore General Hospital, are already close to the target subsidy rates. Their fee revisions can be smaller, sufficient to cover the annual increases in wages and other costs. Other hospitals are still below the target subsidy rates. They will gradually raise the recovery rates until the targets are reached. They therefore must make larger fee revisions for the next few years. Medisave Sir, let me move on to Medisave. To help Singaporeans save enough to pay for their part of the medical bills, the Government instituted Medisave in 1984.”
“The Government has accepted all the Committee's recommendations. The six key ones are: (1) Priority Health Care Programmes to improve the health of the elderly, strengthen the management of cancer, heart diseases and strokes, enhance child health, and improve medical services and health education; (2) Measures to contain health care costs - These would include public education; avoiding over-supply of doctors, duplication of expensive medical technology and excessive sub-specialties; encouraging development of more economic alternative facilities; and carrying out medical audit programmes; (3) Government's role to be reviewed to allow part of its market share as a provider of hospital services to be taken over by competitive providers and other organisations running not-for-profit hospitals; (4) Restructuring of hospitals to continue, to produce maximum cost efficiency. The level of service to be pitched at what the public can afford; (5) Health care financing - To review the various mechanisms to curb excessive demand and restrain increases in health care costs; and (6) Health subsidy policy - I will elaborate on this. Subsidy rates The Committee proposed that the Government should continue to subsidise 80% of C Class costs, and to raise co-payment levels for Class B2 patients gradually together with improvement of service. The Government agrees. Dr John Chen has also raised that just now. The Government has decided to set the following target subsidy rates for the ward classes in our hospitals: A Class ward, there will be no subsidy. Patients will pay the full cost for delivering such services. B1, the subsidy rate will be 20%; B2, the subsidy rate will be 65%; and C, the subsidy rate will be 80%.”
“Where countries have provided "free" medical services funded out of general taxation, eventually the services deteriorate in quality, and the financial burden on the state becomes unbearable. When the individual enjoys health benefits unrelated to his own contribution, he feels no responsibility to stay healthy and use medical resources only when he needs them. Such services appear to be free to the user, and demand inevitably becomes insatiable. Subsidies, no matter how large, will always be insufficient. Sweden, after 70 years of state welfare, plans to reform its system of government-funded free health care. Canada and Britain also face problems. Even Communist China intends to start charging state employees for medical care. Singapore must learn from the lessons of these countries. Our medical system is based on individual responsibility, coupled with state subsidies to keep basic health care affordable to all. No Singaporean expects to enjoy health services for free. When he is hospitalised, he pays part of the bill, more if he is in B2 and B1 class wards, and less if he is in a Class C ward. His Medisave is his own money. This gives him the incentive to be healthy, minimise his need for medical treatment, and save on medical expenses. Recommendations of Health Review Committee Sir, I will move on to the recommendations of the Health Review Committee which Mr Loh has also asked about and which Members have commented on. Sir, the Review Committee has published its findings. In its first Report, it emphasised preventive medicine and healthy living. The final Report reviewed the current health care policies, in order to contain health care expenditure and Government subsidies, and to keep basic health care accessible and affordable to all Singaporeans.”
“Sir, first, I would like to thank my many colleagues who have spoken on the health budget. Many views have been expressed, comments made, and also many suggestions. Sir, Members have covered a very wide range of topics. I will respond to the key issues raised before going on to answer the other questions raised by individual MPs. Sir, let me first explain the Government's philosophy on health care. Government's philosophy Sir, health spending is rising in many countries. In developed nations, health spending has exceeded economic growth, and absorbed an increasing share of the nation's resources. As societies grow more affluent, they tend to place more emphasis on the quality and the value of human life. Aging populations, rising manpower costs and the greater use of expensive medical equipment and drugs all exacerbate the problem. Whichever way we choose to finance the cost of health care, we must recognise that the burden ultimately falls on the people. This is true regardless of whether patients pay directly for their own medical treatment, buy medical insurance to cover the risk, get employers to provide them with medical benefits, or pay taxes to fund medical subsidies from the state. Insurance premiums have to be paid by the insured, employee benefits form part of the wage costs, and taxes have to be paid by everybody, ie, the taxpayers. The question is therefore not how Singaporeans can enjoy good health care without paying more. It is how best to structure the health care system, and the means of financing it, in order to make it efficient, economical, accessible to all citizens, and at fees that they can afford.”
“Mr Deputy Speaker, Sir, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 1992/93, and ask leave to sit again tomorrow.”
“In this way, members at the grassroots level are also able to discuss policies and to come to a conclusion as to whether these policies are right or wrong. I think all this will help to forge national consensus. On racial harmony, we have created many opportunities for the various grassroots organisations, the National Community Organisations Council, to enable all the ethnic groups to work together in playing their part on preserving racial and religious harmony. We have to encourage our ethnic organisations to get together regularly and to work closely with our grassroots organisations, like the RCs, the CCCs and the CCMCs, on community projects and activities, such as Community Day and the various festive programmes, Hari Raya, Chinese New Year, Christmas, so that all the ethnic groups could work together and celebrate the festivals together, and not to celebrate them as a Malay festival or as a Chinese festival, but for the Malays, Chinese and Indians to celebrate all these together, even though it does not really involve them directly. Sir, in order to enable the various ethnic groups to understand each other better, we are also producing documentary dramas and information booklets on the various ethnic customs and festivals. In this way, it will not help just people within the same ethnic group, for example, Chinese, to better understand the Chinese customs and practices, but it will also help Malays and Indians to understand what the Chinese festivals and practices mean. Similarly, for the other documentary dramas that we are producing on Indian and Malay cultures. Sir, I believe that all our programmes will help to forge a stronger national consensus and they will help to preserve our racial and religious harmony.”
“Sir, Mr Abdullah Tarmugi wants to know what we are doing to forge racial harmony and consensus whilst preserving our cultural heritage and roots. Sir, we all know that we are a multi-racial and multi-cultural society, and that our different ethnic groups come from societies which have very rich cultures and values which have survived the test of time. Sir, we live in an era of rapid changes. As an open economy, we are exposed to all the different influences, in terms of modern lifestyles, values and norms of behaviour. The challenge is how do we preserve our values. How do we ensure that we are not swept along by such undesirable values and forms of behaviour to the extent that we weaken the very fabric of our society? Sir, to do this, we must have a strong cultural ballast. This is provided by our deep cultural roots and heritage. So we must preserve it. On the question of what the Government is doing to preserve racial harmony and to ensure that we have consensus, we have adopted a pro-active approach by introducing measures and programmes to preserve and to strengthen harmony, and to provide the various mechanisms for feedback on discussions of national issues so that we can arrive at a national consensus. Sir, we have various measures, such as the Feedback Unit, where issues are collated and where members of the public can participate, express their views, and also listen to explanations on policies, and hopefully, through all these discussions, a consensus can be reached. Similarly, at the grassroots level, the various community organisations, RCs, CCCs, CCMCs, the various grassroots sub-groups, all have regular meetings. One of the items on the agenda is the discussion of Government policies.”
“Sir, I am not familiar with the case of the 29-year old widow. If the Member feels that the widow has got good grounds, he should, as an MP, write in to reappeal, and I am sure my officials will reconsider. As regards his suggestion that we channel the PA grants through the CCCs, I am glad, in the first place, that his CCC was able to provide some help. I think that is the right way to go. The payment of the PA allowance through the POSB is a very convenient one. It imposes no inconvenience on the recipients.”
“All right, Sir. What I want to stress is that the PA scheme is adequate. We do review the rates. We do ensure that the PA allowances are adequate to ensure that the PA recipients are able to survive. And, more importantly, on top of the PA scheme, they are able to draw on other resources to help the recipients.”
“They have gone ahead to apply and they have been interviewed. Then why have they withdrawn the application? Sir, the key point is that we want to be sure that only those who are genuinely in need and who are unable to find other forms of assistance apply for PA. That must be the basis. For those who have applied, we must subject them to some interview to ensure that these are the genuine cases. I think there is no other way, Sir, for us to sort out the genuine from the non-genuine. But I can assure Members that the interviews are done very professionally. They are non-threatening and they are in no way meant to embarrass the applicants. Also, the data and information gathered are treated very confidentially. Sir, when I went to MCD, I made sure that all rejections were seen by me to ensure that they were valid. I am glad to say that in all rejection cases, when I went to MCD and before that, the rejections were valid. Because the applicants really upon investigations were found to have either adequate savings of their own or they were actually being supported by their families, children and relatives. All the cases were rejected on good grounds.”
“But our scheme has to be stringent in order to encourage the able bodied to rely on themselves and not to rely on the dole. If we do not do that, then I think we are heading down the slippery road to disaster. No one in Singapore is denied the opportunity to apply for PA. Whilst we open the door for all to apply, I think we must be careful to ensure that whilst we have a soft heart, we do not have a soft head. Dr Lim mentioned that some people in his constituency feel shy about applying for PA. They feel that it is a shameful thing to do. I think it is not at all a bad emotion, because if they feel that it is degrading to apply and therefore are able to rely on their own mechanisms, as well as to rely on other organisations to help them, I think it is a very good thing.”
“Yes, Sir. As regards helping them to live within the community, we have a lot of programmes. On institutional care, there are already adequate nursing homes and other facilities. We will be helping the VWOs increase the number of places in the homes to meet the requirements for the coming years by funding 80% of the cost of these new facilities. On recurrent expenses, we will also be helping them. We will therefore be making sure that we have enough institutional facilities to help look after those who require institutional care. Sir, let me move on to the issue of public assistance. The public assistance scheme is meant to help the financially distressed to regain their independence. It is not meant as an unemployment, retirement or disability allowance. We grant allowances to the aged destitute, the disabled and the chronically sick, the orphans and the widows. Sir, the scheme has to be stringent. I know that some Members are not very comfortable with that. An hon. Member: All Members!”
“We also provide screening and medical counselling in such centres. Sir, the Singapore Action Group of Elders has also established a hotline and counselling service for the aged, and they are able to provide advice, counselling and referral services for the elderly who require such services.”
“Whilst we have very few working people to help look after the elderly in the future, we must not forget we will have a large number of very fit and healthy older persons who should then participate in helping to look after themselves. Sir, the success of our programmes to look after the aged depends on how the public perceive the aged and the process of aging and how they accept the aged. I think there is a tendency to perceive the aged as being sickly, dependent and decrepit. We must change such an attitude if we are going to be able to encourage more members of the public to come forward to participate in providing assistance to the elderly. So what the Government is doing is that we are having an annual public awareness and public education programme on the aged in order to enhance the level of awareness of the population. The highlight of this programme is our Senior Citizens' Day and I am glad to say that the programme has been quite successful, because the level of participation in our Senior Citizens' Day's programmes at both the national and constituency level has been increasing. Sir, on the question of the aged who live alone, my Ministry runs a Befriender Service Scheme which helps to recruit volunteers and matches them to the senior citizens. The volunteers befriend, advise and assist the aged to cope with their daily demands of living within the community. Because it is important for us to encourage and to assist the elderly to live within the community, and to obtain institutional care as a matter of last resort. In line with that, we also have the Home Nursing Foundation assisted by the Ministry of Health which provides a home nursing service and trains family members in the care of their aged dependants.”
“There will be 1 aged to 2 persons in the working age group of 15 to 60. I think this is a problem which will have great significance and many implications for our society in Singapore. What is heartening and important to note is that, fortunately, most of our elderly are actually healthy. Our studies show that about 93% of our elderly are fit, active and healthy. Only 5% are frail and about 2% are bedridden. Sir, because of the large number of elderly that we will be having in the future, the responsibility for caring for the aged falls on all of us - everyone, the family, the community, the Government and the aged themselves. In looking after the aged, we must preserve the family as the best social insurance for its members. Because by the year 2020-2030, even if we want to, we would not be able to find enough economically active people to look after the aged, because the number of the aged will be so great. The family setting allows the aged to grow old graciously in familiar surroundings and therefore helps them to maintain their self worth and dignity. Our programmes are therefore directed towards helping them to live within the community. As regards caring for the aged sick and poor, Mr Tarmugi asked what are we doing in terms of providing health facilities. On the needs of the elderly, he asked what are we doing in terms of providing institutional care and in helping them to live within the community. Sir, our programmes which are aimed at helping the aged to live within the families and the community are aimed at promoting self-help or mutual help, because for every frail elderly, there will be at least 20 fit and healthy elderly.”
“Members will have noticed that some of the decisions and programmes have been implemented as a result of this policy. You have seen the public walkways in the city, for example, being modified so that ramps are provided to allow our handicapped to get on to the walkways without having to move up the steps. He has also mentioned about HDB flats. Sir, HDB has also been very supportive. The HDB has already formulated guidelines on incorporating barrier-free features in its estates. The new HDB blocks in the future will have provision, wherever possible, for improved linkages with adjoining blocks. There will also be more blocks where you have lift opening on every floor. The lift lobby will have ramps to facilitate movement of wheelchairs and the lift size will be wide enough for the wheelchairs. This will help the disabled who are moving around in wheelchairs. Sir, HDB has also made provision which meets what the Member has asked for, that is, an applicant or a family member who is medically or physically handicapped will be considered for priority allocation for a flat on a lower floor or a flat on the lift-landing floor. This has already been implemented. I think in due course the disabled will find that moving around will be a lot easier than compared to, say, five years ago when more ramps are available and more barriers are removed. I think I have replied to most of the points on the disabled. 3.30 pm Sir, I move on to the aged population. Both Mr Tarmugi and Dr Michael Lim have spoken on the aged. The aged is an issue which should concern all of us. This is because our aged population will increase very significantly. Today, only 9% of our population are aged above 60. By the year 2030, about 1 in 4 of our population will be above the age of 60.”
“The point specifically brought up by Mr Tarmugi is that what the disabled are looking for are opportunities, not just sympathy. There are various programmes that are available to help in the employment of disabled people. The Bizlink Centre, as I mentioned, has a job placement centre. The centre has already placed out 227 disabled people in various companies. There are also other schemes, for example, there is a scheme whereby employers who take in disabled people are helped through a subsidy that is provided by the Singapore Chinese Chamber of Commerce and Industry. Under this scheme, employers who employ the disabled can have the first 1 1/2 months' salary of the disabled paid through a fund which is provided by the Chamber. In this way, it allows the employers who never have the experience of employing the disabled to take in the disabled for a trial period and they are assured that for the first 1 1/2 months their salaries are borne by this fund. We also provide tax incentives to employers who make worksite modifications in order to accommodate the disabled. In terms of direct help to the employers, providing training for the disabled and providing a job placement service, all these are already there, and I am sure the VWOs will be looking into more ways of enhancing such programmes in the future. On the question of physical barriers, Sir, the Government does advocate a barrier-free environment within the community for the disabled and the aged. This led to the Government incorporating the accessibility code into the building control regulations in February 1990 in order to promote a barrier-free environment. The Government has also formed a coordinating committee to provide a comprehensive barrier-free environment under the Ministry of National Development.”
“They will have a committee which will focus strictly on the disabled and this group will then be able to study into what are the best ways to reach out to the disabled and what sort of help to provide to such people. With the setting up of this unit in the Council in the near future, we will be able to have a more effective method for compiling such data. Sir, as regards training programmes, there are training programmes available for the disabled already. For example, VITB already conducts training programmes and 103 disabled people have been able to take part in the regular VITB programmes. For those who are unable to take part in the VITB programmes, the VWOs do have training programmes of their own, for example, the Vocational School for the Handicapped offers training programmes. There are also sheltered workshops offering skills training as well as pre-employment training. The Singapore Council of Social Services has also set up a centre called the Bizlink Centre which has a centralised vocational assessment service as well as a job placement centre. The Bizlink Centre also operates a production workshop employing disabled people who have potential but who face some difficulties in getting jobs for the time being. So there are enough training places available, in terms of the number of workshops, and more will be set up. Sir, he has talked about barriers to the disabled, physical as well as emotional barriers. The Government, together with the VWOs, has been conducting educational programmes and public awareness programmes to raise the awareness of both the public and, more importantly, the employers, in terms of being more sympathetic to the disabled and to offer them employment.”
“We will also support these VWOs in their recurrent expenditures and such funding would amount to $47 million over the next three years. We would be helping the VWOs to establish two more residential homes for the disabled, one production workshop, one sheltered workshop, two day activity centres, one hostel and two multi-service centres. Some of these are already in the process of development. Sir, in terms of special education, for example, there are already currently 13 special education schools with an enrolment of about 2,500 children and the Government provides a grant of $4,600 per student which is twice the cost of the regular primary school education programme. Dr Michael Lim has also asked some other specific questions. He has said that in having a referral service for the disabled we need to set up a centralised referral system and a registry, and that such a centre can then be a coordinating centre for the disabled. At the present moment, there is a very loose arrangement for referring disabled people for help. For example, in the hospitals, their system is to refer the disabled either through the VWOs that are involved in helping the disabled or they are referred to the various centres for the aged sick. For example, the Home Nursing Foundation has a Senior Citizens' Day Care Centre that also helps the disabled to recover from strokes. We also have community-based day care centres which provide help to such disabled. The Singapore Council of Social Services will be undergoing some changes in the future and they would have specific committees to focus attention on the different groups of people that require help.”
“Sir, both Mr Abdullah Tarmugi and Dr Michael Lim have raised questions on the disabled. Sir, the Government's policy towards the disabled is to enable them to live independently as far as it is compatible with their capabilities. This would enable them to look after themselves, as well as to lessen the burden on the family. Sir, the House will recall that in 1988, an Advisory Council on the Disabled was formed to recommend ways to help the disabled and to help them to integrate into society. The Council's recommendations covered a wide spectrum of issues affecting the disabled, such as prevention of disability, special education, accessibility and transportation, social services and institutional care. Sir, 26 of the recommendations were adopted by the Government for implementation, and these are now in the various stages of implementation and would be of great help to the disabled. Sir, historically, the voluntary sector has been in the forefront of provision of services for the disabled. They have done extremely well and should be encouraged to continue to do so. We will assist them as far as possible to provide improved and expanded programmes. Through the concerted efforts of both the Government and the VWOs, a wide range of services and facilities have already been implemented. These include special education, vocational training and rehabilitation, vocational assessment and job placement, production and sheltered workshops, day care, hostels and residential care. Mr Tarmugi has asked what we are providing to the disabled. Sir, we have set aside about $22 million as capital grants for the further development and upgrading of facilities for the disabled for the period 1990 to 1994.”
“But in the meantime, we must recognise that about 20% of women over the age of 35 who have at least secondary school education are still single today. They hold good jobs and are able to support a family. Fortunately, most would be resigned to their singlehood. They recognise that our society does not encourage single motherhood out of wedlock. Not only do they realise that, but most of them do believe in such a value. However, a small minority may decide that their maternal instincts are too overwhelming. They may resort to adoption or to have their own baby. Of these two alternatives, adoption would be the preferred approach. The Adoption of Children Act allows single women to adopt children. Over the last three years, 105 single women have petitioned successfully for the adoption of children. As for the other alternative, Mr Peh has referred to the newspaper article about single women resorting to artificial insemination or to have a child out of wedlock. I would like to clarify that at the moment the Ministry of Health's guideline to the six registered IVF centres and to the National Sperm Bank is that artificial insemination is only for married couples and not to be performed on single women. This again reflects our emphasis on the family unit and on the importance of family life. Sir, the best solution is still for those who wish to have children to find a suitable life-long partner and to get married. The Government will continue to encourage this. For those who are unable to meet members of the opposite sex for various reasons, we will continue to organise functions that will facilitate social interaction. I hope all Singaporeans will also join in in our efforts by quietly helping their single friends to meet others who are eligible.”
“Sir, I agree with Mr Peh Chin Hua that we should not encourage single women to have children out of wedlock or to have children without getting married. Sir, societal values emphasise the sanctity of marriage and the wholesomeness of the family, the family as a basic social unit and building block of society. This is reflected in one of our five Shared Values, namely, Family as a Basic Unit of Society. Sir, every child deserves the love of both the mother and the father. A child growing up without the benefit of a father and without the benefit of a father figure and not knowing who his father is will feel emotionally deprived. It could well affect his development. The Government noticed since the early 1980s that more women than men were staying single. Most of the single women were well educated with at least a secondary school education. Studies show that most women would like to eventually marry and raise a family. For various reasons, some of them are unable to find a suitable or compatible life-long partner. The Government has various programmes to encourage Singaporeans to remember that while a career is important, they still need a family and loved ones to make their lives complete. We also have several organisations to help provide opportunities for singles to socially interact with members of the opposite sex, organisations like the SDU, SDS and SPS. But the Government alone will not be able to solve the problem of singles. Society as a whole, parents, friends and colleagues can also help to create the social opportunities for young adults to get to know each other. Hopefully, more of our younger adults will be able to find a suitable partner and get married.”
“Sir, I believe our network of support programmes for sports is very adequate.”
“So the key thing is that besides excelling in sports, they should try to excel academically and if they are unable to, they should also try to pick up some skills which should help them in later life.”
“In addition, many others were given awards administered by the Singapore Sports Council and the Singapore National Olympic Council. Sportsmen can also vie for the Sportsman and Sportswoman of the Year awards and there are similar awards to recognise the contributions of teams, coaches and sports officials. In addition, gold medallists in the SEA Games, Commonwealth and Asian Games are also presented with awards. In addition, the teams receive double the amount. 2.15 pm We also have scholarships to help young sportsmen who pursue competitive sports alongside academic studies. These sports scholarships are tenable at local as well as foreign institutions. In addition, the Sports Council helps sportsmen to gain admission to polytechnics through the joint polytechnic/SSC admission scheme for sports persons. With regard to Mr Davinder Singh's appeal that we help sportsmen and sportswomen to find employment, the SSC has a scheme to help such people find employment. It has a scheme called the Sports Employment Assistance Scheme which has helped various sportsmen to find employment. While these support programmes are useful, we should encourage our sportsmen and sportswomen to be pragmatic, and not expect to devote their whole lifetime to sports alone. Because it is the very unique minority who are able to make it to that level where they can achieve at least regional fame and therefore be able to earn a living. Fandi, of course, is one such person. We have other footballers who have done the same. In squash, we have Zainal Abidin who not only was good in squash but managed to develop his own business expertise and set up his own business.”
“While we can provide our athletes with good equipment and facilities, our chance of producing international champions would definitely be less than that of countries which have larger populations than ours. I think that is one good reason why we only have one Mr Ang Peng Siong in the last 10 years, because other countries have put in similar efforts, and from their large population base, they have managed to find many natural sportsmen and, therefore, people who are able to do much better than our sportsmen. Sir, for the forthcoming 17th SEA Games which will be held in Singapore, the Sports Council has allocated a sum of $3 million to help the athletes from 31 National Sports Associations prepare for the games. This is twice the amount spent by the Singapore Sports Council for the last SEA Games which was held in Manila last year and this $3 million is in addition to the half million dollars given by the Government as annual subsidies to assist the National Sports Associations to promote their sports. The fund would then enable the NSAs to devote more resources to the training of the sportsmen and to help them to be better prepared for the SEA Games next year. Sir, on the question of recognition for sportsmen, I would like to assure Mr Chandra Das that the Government has been giving recognition to our sportsmen. We do recognise their significant contributions. For example, in the last 10 years, no fewer than five outstanding sportsmen and 10 sports officials were awarded the prestigious Public Service Awards in recognition of their contributions to sports excellence. Five others were accorded similar recognition for their contributions to the promotion of grassroots sports.”
“The SSC has a Sports Aid Fund, and the Government also contributes a million dollars every year for sports excellence and the Singapore Pools also matches with another million dollars. The SSC also gets donations from other sources and all these go towards funding the National Sports Associations to help them to get coaches, to help athletes and sportsmen to go for training locally and overseas, and it also helps to provide scholarships and the needed equipment. We will continue to work closely with the National Sports Associations to ensure that our sportsmen are well taken care of. The National Sports Associations can also help themselves by raising additional funds from the corporate donors as well as from their many very keen supporters - people like Mr Davinder Singh. While the Government and the private sector can provide the necessary backing, in terms of financial support, at the end of the day, the efforts must be put in not just by our sportsmen but also by the National Sports Associations themselves. They have to work together, they have to work hard, work cohesively so that the sportsmen can train with one mind and not have their energies diverted to other areas. And also we have to be realistic. We must realise that we only have a population of less than three million people, one of the smallest in the world. In terms of facilities, yes, we have good facilities now. But we must not also forget that, over the last 10 years, many other countries have also invested in similar sporting facilities. Therefore, our edge, in terms of the advantage in facilities which we have in the earlier years, has been diminished, if not totally reduced to zero.”
“Sir, Mr Chandra Das and Mr Davinder Singh have asked what we are doing to help achieve sports excellence and what we are doing in preparation for the next SEA Games, as well as how do we help our sportsmen. Sir, the Government does recognise the importance of sports, as stated by Mr Davinder Singh. Firstly, it benefits the individual by building a healthy body and, hopefully, a healthy mind as well. Sir, as Singaporeans become more affluent and adopt a more sedentary lifestyle, it is important that we encourage Singaporeans to exercise regularly in order to ward off the lifestyle diseases, such as coronary heart disease, stroke, diabetes. Secondly, competitive and spectator sports promote social interaction and, as Mr Davinder Singh said, serve as rallying points for the community and the country. We recognise that. Therefore, we do place a high priority on sports. We encourage Singaporeans to be active in at least one sport or one form of exercise in order to keep them fit for life. In the last 10 years, the Singapore Sports Council (SCC) has spent over $400 million for the building and maintenance of new and better sports facilities as well as on programmes to promote sports. Sir, this is in addition to the facilities provided by the Ministry of Education in over 400 schools in Singapore as well as the facilities provided by PA in our community centres. This extensive building programme has ensured that there are ample sports facilities for the use of both the general public and sportsmen. Sir, the Sports Council provides subsidies and grants under the Sports Excellence Programme to enable our athletes and sportsmen to train and to compete locally and abroad.”
“This is because community organisations have the flexibility to provide the individualised attention which is very necessary when helping a very wide spectrum of people who are involved. Government Departments cannot do that. In this way, with the help of voluntary organisations, we have a better chance to help the needy to level up because we can tap on a much wider spectrum of resources. Sir, we, therefore, appeal to more civic, community and religious groups, as well as corporate citizens and individuals, to come forward to volunteer their time, effort and resources. Their different and broader outreach would enable us to provide a more comprehensive scheme and range of assistance to those who are in need of help. On the part of the Government, we will support and enhance these community bonds and the network of social services. What we can do is that we will fund the welfare organisations by providing 80% of the funds required for their capital investments and we would also provide 50% of the recurrent costs incurred by them. For this purpose, we have set aside $75 million over the next three years to finance 80% of the construction costs of new welfare facilities and the support for the recurrent expenditure would cost us $63 million over the next three years. In the planning pipeline, we have children's homes, sheltered workshops, day activity centres for the disabled, family service centres and homes for the aged. Sir, our social welfare efforts go beyond providing the financial support to the needy. It must go beyond that to enhance and expand the network of welfare and community volunteers. In this way, we can then effectively assist the needy to break out of their unfortunate situation.”
“Our experience shows that giving money, for example, through our Rent and Utilities Assistance Scheme (RUAS), alone is not adequate. Let me quote a case. We had a case of a 38-year old divorced lady with two schooling children, who were temporarily on the Rent and Utilities Assistance Scheme for six months. She was first working as a night shift worker because she thought that in that way she could help look after her children in the day time. But she was not earning enough money and also because after working late at night, she was really too tired during the day time to look after the children. So she left and got a part-time job as a cleaner. It paid even less. As a result, she was in arrears in her PUB bills and HDB rental payments. HDB referred her case to the Singapore Council of Social Services which administers the RUAS scheme. Vouchers were then given to her to help her tide over her financial difficulties but, over and above that, a social worker from the Asian Women Welfare Association helped her to look for another job which paid her more and, at the same time, helped her to spend more time with her children. She was given counselling on how to budget, how to manage her time, and the Association also arranged tuition for her son. As a result, she could manage her funds better and she requested to be taken off the RUAS scheme after six months. The aim of our programme is to help them cope with the demands of everyday living, which means how to earn, how to find a job, how to manage the funds, how to save for a rainy day and, very important, how to help their children. Sir, helping the needy is most effective when it is done at the local and the community level.”
“Sir, first of all, I would like to thank my three colleagues who have spoken up on the first cut. Mr Tarmugi has asked about the Government's approach to those in need. He has stated very clearly that the GPC does not subscribe to a welfare state and that the members do not subscribe to just throwing money at a situation. Sir, the Government's approach to social welfare is the "many helping hands" approach, involving a partnership between Government and the various civic, community and welfare organisations. Social welfare issues are difficult issues to deal with in any society. Long-term vision and perseverance are necessary, and they require painstaking efforts and the results only show up many years later. Similarly, welfare assistance programmes which go wrong are very difficult to unravel. We have seen many countries in which this has happened. They started off with very good intentions but end up only aggravating the problems, instead of solving them. For example, many countries have unemployment benefits - very generous ones - to help those who are temporarily unemployed. What happens is that all these programmes instead ended up encouraging people to stay unemployed. In America, the welfare programmes started off also with very good intentions and with manageable budgets. Today, social security and welfare is the largest single item in the USA Federal budget, taking up more than 1/3 of its budget. We, therefore, are on good grounds in being very careful. Sir, our focus in our social welfare programmes is to help the needy get back on their own two feet. Taxpayers' money go only to programmes which are designed to motivate and help them to become independent, rather than to dampen their drive to be independent.”
“Sir, he is talking of free market forces. We learn from others whether those theories work. It is in our interest to learn from them. And if it does not work, not just in the US but elsewhere in the developed countries, we better learn quickly before we fall into the same problems that they find themselves in. EMPLOYMENT OF FOREIGN MAIDS TO LOOK AFTER AGED PARENTS (Lower levy) 5. Mrs Yu-Foo Yee Shoon asked the Minister for Labour whether his Ministry will consider allowing those who employ foreign maids to look after their aged parents to pay a lower levy. EMPLOYMENT OF FOREIGN MAIDS TO LOOK AFTER YOUNG CHILDREN (Tax relief for working widowers and male divorcees) 6. Mr Teo Chong Tee asked the Minister for Labour whether he will consider granting tax relief to working widowers and male divorcees who have to engage foreign maids to look after their young children, in view of the proposed increased levy on foreign maids.”
“Sir, I quoted noted authorities who say that the principles of free market cannot be fully applied in the health care sector. It does not mean that the principles do not apply totally. Of course, principles of free market will apply in certain sectors. For example, in the supply of manpower, if the service providers do not pay according to the free market forces, they will not get enough nurses and administrators. Similarly, if they do not pay the prices of drugs as determined by free market forces, they will not get the required drugs. For the Government's restructuring of the hospitals, we are allowing free market forces to prevail in terms of setting salaries, but I can assure you that the free market forces are not allowed to apply in the setting of fees. If that is the case, then I can assure you that the hospitals would be charging a lot more, because that is what the market would be prepared to pay when people are in need of health care. So in the interest of the public, we have had to influence the cost of health care.”
“Sir, doctors who obtained their qualifications from foreign universities will be vetted by the Singapore Medical Council and only those with qualifications that meet the specified standards will be allowed to practise in Singapore.”
“Sir, contrary to conventional wisdom, this does not apply to medicine. Let me quote from some well known authorities in this area. Prof. Brian Abel-Smith from the London School of Economics and Political Science has done much research in this. In 1989 he published a paper, and I quote him: 'An excess of doctors is likely to lead to excessive prescribing and use of medical procedures and diagnostic tests in addition to the cost of paying them.' He goes on to say that: 'In 11 of the 12 countries of the European Community, doctor supply is limited by planning the number of medical students or, in countries where this is not acceptable, raising the standard of the examination at the end of the first year of the course.' So they have their own mechanism for ensuring that the number of doctors is appropriate to meet the needs of society. From the United States, Prof. U E Reinhardt, professor of political economy at the Princeton University, also stated that: 'The bulk of health care is received by rather sick patients who typically may not be able to act as a well-informed rational consumer depicted in textbooks of economics. They are easily exploited financially in a so-called free market for health care.' He therefore concluded that: 'The conventional, completely free market of the sort extolled in textbooks of economics is not applicable for health care in a civilised society.' So contrary to conventional wisdom, it is not possible to apply the free market principles to the provision of health care.”
“Mr Speaker, Sir, the number of doctors in Singapore has increased significantly in the past 20 years. We had about 3,600 doctors in 1990, compared to only about 1,400 in 1970. This is an increase of 2,200, or about 160%, compared to the increase in our population of 45% over this period. The doctor to population ratio improved from one doctor to 1,500 population in 1970 to one doctor to 830 population in 1990. The total number of doctors in Singapore will continue to increase significantly, even at the present intake into NUS of 150 medical students a year. This is because, in addition to the medical graduates from NUS, there are also Singaporeans returning from abroad with medical degrees as well as non-Singaporean doctors working in Singapore. My Ministry projects that we will have about 5,200 doctors in the year 2000. The number of doctors will therefore increase by 1,600 in this decade, compared to an increase of only 2,200 in the past two decades. Our doctor to population ratio by the year 2000 will be 1:650. This will be comparable to the current ratios of Switzerland and the United Kingdom. Members should note that these are countries with more dispersed and older populations than ours. Their need for doctors would consequently be higher than Singapore's. We therefore have enough doctors now, and will have even more in the future, to ensure that Singaporeans have at least good basic health care.”
“Those who are going abroad can also come and seek assistance from the Ministry in terms of getting information about the places they are going to, and what sort of safeguards they should look into. Mr Peh Chin Hua has also warned Singaporeans who are travelling abroad to be very careful. I agree with him. He has also asked that we must be very stringent on HIV-infected persons who are rapists. Sir, I would pass his suggestion on to my colleague, the Minister for Home Affairs, for consideration. 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. TRADE UNIONS (AMENDMENT) BILL Order for Second Reading read.”
“Mr Speaker, Sir, I would like thank my two colleagues who have spoken out in support of the amendments. They have very correctly warned Singaporeans to be extremely careful so that they do not get infected with AIDS, especially when they travel abroad and indulge in sexual activities. Sir, Mr Loh Meng See has asked whether we would be prepared to let patients with HIV infection to use Medisave for AZT treatment. The Ministry has been considering that and I am happy to inform him that we will allow HIV-positive persons to use their own Medisave to the extent of $12 per month to help pay for AZT treatment. He has also asked whether we would be prepared to have two different questionnaires, one for new donors, and one for repeat blood donors. Sir, much as we would like to help repeat blood donors, unfortunately, the safety of our blood should be the main consideration. For repeat blood donors, the frequency of donation is normally about twice a year, and certain things can still happen in the six months between the donations. I am happy to say that since we introduced the questionnaire, we have had no drop in the number of repeat blood donors. They have been quite happy to answer the questionnaire because they already know what the questionnaire is all about. I also think they fully understand what is the purpose of this questionnaire, so most of them have been happy to answer all the questions. As to his suggestion that we discuss with travel agents and get them to distribute AIDS pamphlets, I will get my officials to look into this. It is a good suggestion and we will explore it. As to whether we can provide counselling for Singaporeans who are going abroad for surgery, if we are aware of these cases, we would definitely counsel them.”
“The proposed new section 20B makes it an offence for any person who knows that he has been infected with the HIV, to have sexual intercourse with another person unless before the sexual intercourse takes place, the partner has been informed of the risk of contracting the HIV infection from him, and has voluntarily agreed to accept the risk. The proposed new section 20C makes it an offence for any person who knows that he is infected with the HIV to donate blood at any blood bank in Singapore, and to commit any act which is likely to transmit AIDS to another person. Any person who commits an offence under these three new sections will be liable to a fine of up to $10,000 or imprisonment for a term not exceeding two years, or both. The Bill also protects the identity of any person who has been diagnosed to be infected with the HIV except in certain circumstances specified by the Bill. The Bill provides for an increase in the penalties for certain offences under the Act from $2,000 and $5,000 for the first and subsequent convictions, to $5,000 and $10,000 respectively. Sir, the proposed amendments to the Infectious Diseases Act will enable my Ministry to have a better control over AIDS and other infectious diseases in Singapore. It will help to deter HIV-infected persons from activities that are likely to spread the disease. It will further enhance the safety of Singapore's blood supply. Sir, I beg to move. Question proposed.”
“All blood donations are also screened for HIV to ensure that only uninfected blood is used. With greater awareness of AIDS, I hope Singaporeans will avoid high-risk activities that put not just themselves, but also their family and loved ones, in grave danger. But the Government alone cannot contain the further spread of AIDS amongst Singaporeans. We can only succeed if everybody joins in this fight against AIDS. Singaporeans can greatly help by advising and persuading their friends not to indulge in high-risk activities, in Singapore as well as when they travel abroad. My Ministry will closely monitor the disease and we will undertake all the necessary measures to prevent the spread of AIDS. However, there is the risk that some of those who are already HIV-infected will continue to be irresponsible in their behaviour. We need to strengthen the existing legislation to deter such irresponsible and dangerous behaviour. We need to give the legal backing to our AIDS counselling and educational efforts. We need to protect the safety of our blood supply. The proposed amendments will help us to achieve these important objectives. Sir, I will now deal with the six major provisions of the Bill. Clause 3 empowers the Ministry to undertake epidemiological investigations of other infectious diseases which have not been made notifiable under the law. Examples of these are Legionellosis and Hand, Foot and Mouth Disease. The proposed new section 20A empowers the Director of Medical Services to require any person who has been diagnosed as having AIDS or as having been infected with the HIV to undergo counselling and to comply with all the safety measures which may be specified by the Director.”