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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“Over time as Singaporeans become more familiar and comfortable with the concept of kidney donation and when the need arises for the other organs, I am sure the level of objection will have reduced. The Ministry will also be strengthening the crisis counselling capability of our staff. We will be training a team of counsellors whose job will be to counsel and assist the relatives in their moment of grief. This will help them overcome the intense emotions that they will be feeling and that will be the main role of the crisis counsellors. The Member for Telok Blangah has also asked for assurances that the Ministry and the National Kidney Foundation will not persuade objectors to withdraw their objections. As I stated in my address earlier on, the Ministry will not be counselling individual objectors and the list of objectors will be kept confidential. That means nobody else will have access to information as to which person has objected. So the NKF will be in no position to counsel individuals who have objected. I would like to reassure the Member that this list is totally confidential.”
“Regarding the easy availability of forms and to ensure that the administrative mechanism for acknowledging and processing the forms is efficiently implemented, I would like to assure the Member that forms will be available in all parts of Singapore through our Ministry of Health's facilities - the OPDs, the polyclinics, hospitals - and that we have worked out a system where all the objector forms will be processed within 24 hours and that an acknowledgment form will be sent out. There will be intricate safeguards built in to ensure that there is cross-checking that the forms that are sent in have been processed. In cases where the forms may be misplaced in the mail or have gone astray in the mail, the forms will carry an advice to objectors that if they do not receive an acknowledgment form within three weeks they should telephone the Ministry so that we can look into the reasons why. Regarding the fear that the Human Organ Transplant Bill will be broadened to include other organs, that point was brought up also in the Second Reading of the Bill. In fact, there were two schools of thought. One school of thought, as expressed by, I think, two Members, was that because of the improving medical technology regarding transplant of organs, the Ministry should also look into broadening the ambit of the Bill. The other school of thought was that we should be very cautious. I would like to remind the Member that my answer was that yes, in due course, there may be a need for other organs. But the Ministry would prefer to persuade Singaporeans on the desirability of donating those organs on their own rather than through the use of legislation.”
“Mr Deputy Speaker, Sir, I would like to thank the three Members for their comments and the various suggestions that they have made. The Members for Changkat and Telok Blangah have suggested that the publicity drive for the Bill be kept up. I would like to assure the Members of the House that there will be an intense publicity campaign for the six months that the grace period is in force. Subsequently, every year, all Singaporeans upon reaching the age of 20 years will receive a reminder and we will also, on an annual basis, be carrying out mass-media campaigns to ensure that Singaporeans are aware of the implications. In terms of having dialysis facilities made available, the Ministry is working with the National Kidney Foundation to assist the NKF in making dialysis facilities available in various parts of Singapore. We will also assist the NKF to purchase the consummables in bulk so that the cost of dialysis can be further reduced. In terms of using Medisave for payment for dialysis, at the present moment the dialysis facilities that are available in the private sector are rather expensive. It costs between $2,000 and $3,000 a month. Most Medisave account holders will therefore have inadequate Medisave balances to enable them to undertake the dialysis for long. What we are looking into is having a catastrophic illness insurance system which would help bear the bulk of the dialysis cost. When this catastrophic illness insurance system comes into force, then the Medisave requirements will not be a problem.”
“In 1980 the subsidy figure, if we just consider recurrent expenditure, that means if we do not consider the expenditure on facilities, which in most cases we really should be considering, if we just consider the subsidy on recurrent expenditure, the subsidy for the Ministry of Health came to $165 million. In 1986, this was $271 million. For this year, 1987, the subsidy after providing for the minor fee revisions that would be implemented next month, will still increase to $325 million. Sir, this is an increase of $54 million over last year, taking into consideration the fee increase. So I would not like to just look in terms of percentage and say, "Yes, it has gone up by 1%." But what is more important is the absolute quantum because if the subsidy level is increased just to take into consideration inflation, it means that the fee increases for 1987 would have to increase by not just the minor revisions, but by a significant enough sum to recover another maybe $50 million. So the subsidies for our hospitals, for all our medical care system, are very very significant. It has been going up at a very rapid pace. Over the last three years alone, in spite of the lack of inflation, or the lower inflation in Singapore, our subsidy in dollar quantum has been going up by 8% a year versus an inflation rate of 1% to 2%. So I dispute the Member's interpretation of what the subsidy is.”
“The couples who were married under this scheme had offered to undergo sterilization in order to get married. So I will refer this issue to the Ministry of Labour. The Member for Buona Vista asked about whether we could provide nurses in our schools, since we are already providing dental nurses. Sir, the provision of medical care for students, especially students who get sick in school, is best left to trained doctors. The schools normally adopt the practice of contacting the parents if the child is very ill so that the parent can come and bring the child home and bring the child to the doctor. Where there are accidents, the teacher then normally brings them directly to the polyclinic closest to the school or to the hospital's Accident and Emergency unit. So I feel that for such cases it is best to leave it to the trained professionals and having a nurse there in the school would not really help at all. Sir, in terms of labelling of medicines, under the regulations relating to labelling of medicines, doctors have to label the actual generic name of the medicine or use the trade name. They are not allowed to use code names or whatever other indications. So under the regulations they have to use the proper names. So if they are using the proper medicines and they are using the proper names, there is no need in that case for them to be subjected to drug registration. The Member for Telok Blangah asked about the subsidies for our hospitals. With your leave, Mr Chairman, statistics can be very misleading, especially in the hands of people who quote them out of context. I would like to inform Members that while the subsidy levels may have declined, the subsidy quantum has been increasing at a very, very rapid pace. Let me give a few figures.”
“What we have to recognize is that incentives are to encourage new births. It is therefore appropriate for such incentives to apply to only new births that were delivered in 1987 and subsequent years. Sir, to back-date the special rebate to the past few years would, in fact, set a very dangerous precedent. It could be applied to many other measures, much to the detriment of Singaporeans. So I would like to caution against it. For example, there is another population issue that we all know about because this is widely discussed. And that is the car population. The Minister for Communications and Information has always been warning about unrestrained growth in our car population. Should we, if the Minister should decide it and decide that it is necessary to increase the various taxes in the future, also use this same argument to say that "all cars in Singapore that are already existing should also pay the incremental tax because the issue has been widely discussed before?" I think that is a dangerous precedent and I would be the first to disagree with it, if it applies to the car population. Just as all our Members here would also disagree. Sir, I believe that all those parents who proceeded to have their third child in the last two, three years, did so because they wanted another child, and that is, in spite of our "Stop-at-Two" policy prevailing at that time. They have enjoyed the pleasure of watching the baby grow up, toddling around and I think they should not let this joy be spoilt by dwelling on what they have missed. Sir, the Member for Yuhua also asked about non-citizens who are married to citizens and who have agreed to undergo sterilization. She asked whether that could be reviewed. Sir, this scheme is administered by the Ministry of Labour.”
“So I hope that we can all focus on the importance of the new policy and give the package of measures which should be seen in its totality a chance to work. Sir, a few points were brought up in the previous debates and the Minister for Finance has asked me to reply to them since they form part of the population measures. Some Members have suggested that the special tax rebate for the third child is not socially equitable. I would like to stress that the special tax rebate for the third child does not discriminate against any person. In essence, it grants the vast majority of Singaporeans a tax-free period of five years. In fact, it can be deemed as being discriminatory against the higher-income groups as these people in the higher income group will be limited to a maximum of $20,000. So, in actual fact, people in the higher income group may only be enjoying a one, two, maybe three-year tax-free period. So they can deem it as being discriminating against them. So what in effect happens is that each couple gets back what they are actually paying. And we should not begrudge them their own money. The Members for Thomson and Bukit Timah have also suggested that the special tax rebate should be backdated so that parents who had their third child two, maybe three years ago, will also be able to enjoy the benefit, if not in full, at least partially. Sir, I agree with them when they say that the setting of the deadline is arbitrary. Yes, there is a certain degree of arbitrariness in setting any deadline. We could have fixed it on 1st March 1987, the date on which our First Deputy Prime Minister announced the new three-child policy. So the date of 1st January 1987 was therefore chosen more for administrative convenience, a difference of two months.”
“I hope that Singaporeans will not get so engrossed in the fine details that they lose sight of the grave dangers that lie ahead of us if the population growth rate decline is not arrested. Sir, the policy of three-child norm is a fundamental change and so are the measures. Demography is not a perfect science. Mankind has not learnt to be able to predict accurately the behaviour of his fellow men. And I do not think we ever will. But that does not mean that we should do nothing. Can we predict to any degree of accuracy whether the new policy will succeed? I think the answer must be no. We can only hope that Singaporeans will look carefully at the statistics that we have compiled and presented to them and think about the statistics and I hope they will say, "Ah, yes, there is a problem ahead if I as a person do not do anything now and if I do not play my part, and worse, the problem is going to affect the ones that we love most, our children." So I hope that that is going to be the response because I believe that people will have children only because they want to have them. They want to have children for the joy that the children bring, for that little sparkle that they add to our lives. I do not believe that many, or if any, Singaporeans will have a third child simply because we have provided some incentives. Our surveys have shown that many Singaporeans, in fact, would prefer to have a third child but for our previous stop-at-two policy and the number of disincentives we had against the third child. I hope such people will now proceed to have their third child, now that all the disincentives have been removed. And then they will look at the incentives as being a small bonus.”
“Sir, the Member for Yuhua talked about the population issue and I would like to address that on a broader basiss. Members are aware of the drastic drop in our birth rate over the past decade. As a nation, we are not producing enough babies to replace ourselves. If this trend is not corrected, our children will face very grave consequences in the years ahead. I think we owe it to our children and the future generations to reverse this trend of declining birth rate. And this is the crux of the whole population issue. It is not the fine details of what incentives are available. Nor is it how convenient or how easy we can make it for parents and mothers to care for their young children. It is much more than that. It is a kind of legacy that we, as Singaporeans and as parents, wish to leave behind for our children. It has to do with the type of future we wish to leave behind for them and for them to have. Sir, I do not believe that any of us as parents wish to leave behind for our children a heavy burden to shoulder when they grow up. The new population policy aims to reverse the dangerous decline in our birth rate. We do not expect to reverse the decline overnight. And as the First Deputy Prime Minister said, he would be very happy if this goal can be attained by the mid-1990s. But we have to make a start now towards reversing that decline. And much would depend on the attitudes of Singaporeans towards marriage and family formation, as the Member for Yuhua has stated. Whilst encouraging singles to get married and for those married couples to have more children, we will also need to strengthen the concept of responsible parenthood. I hope Members of the House and Singaporeans outside the House will keep the broader objectives and the issues in mind.”
“Sir, the role of the private sector is very important. And over time, I am confident that the role of the private sector in terms of providing primary health care will increase. As part of our efforts to increase their role, the hospitals are now giving discharged notes to our patients that will summarize the case and the treatment so that when the patient is discharged, he can then go back to his GP and allow the GP to carry on with the treatment. In this way, the role of the private sector can be improved. As to his other suggestions, I will definitely ask my Ministry to look into them. However, there is one very stark impact in terms of his home service, ie, asking doctors to visit homes is not really the most efficient way of utilizing skills, although it may be saving on the hospitalization costs. I think there could be other intermediate forms of treatment and we will definitely look into them.”
“Sir, I was replying to the Member for Ayer Rajah when my time ran out just now. So I would like to continue from there.”
“But we will consider them very carefully as well. Sir, the area of primary health care that the Member has spoken on, that is an area that the Ministry is also strongly focussing upon. But the role of the Government in terms of provision of primary health care needs to be seen in the context of present day Singapore. If we cast our minds back, 20 to 25 years ago, to the old Singapore when there were plenty of kampongs, very few GP clinics around and those that were around were also perhaps beyond the reach of many of the Singaporeans - in those days the role of Government in provision of primary health was a very very key one. Government was the primary provider of primary health care. Today, the situation has changed quite significantly. Today, 70% of all primary health care is delivered by doctors in the private sector, like the hon. Member for Ayer Rajah, and they are doing a very very good job. They are well located, strategically located mainly in the HDB estates, easily accessible, reasonable costs, personalized service which the Government, I think, would find very difficult to try to match.”
“Even one abortion, right. That is why we counsel her on the attendant risks of abortion. Sir, the tape has been withdrawn temporarily while a new copy is being produced and they will be used as soon as they are ready. As the private sector is responsible for about two-thirds of all abortions in Singapore, they will also be brought into the abortion counselling programme. As the Member for Yuhua had mentioned, doctors will not have time to do the counselling properly. We have trained many of the nurses of the private practitioners to do the counselling instead. Sir, we feel that with this abortion counselling, some of those women who come for abortion can be counselled to think again and to retain the pregnancy. The reason is simple. We should not force any woman to try to retain an unwanted pregnancy. I think Members have read in the papers over the past few weeks about abandoned babies. We do not want more of this. All births must be births that have been planned and wanted so that the child can have a strong future. Sir, the Member for Ayer Rajah has given quite a few suggestions which I have listened to very very carefully because being an experienced practitioner, he has a lot of good ideas to give to the Ministry which we would definitely consider.”
“During the counselling, with the aid of the video-tapes, the risks of abortion are explained so that the woman can then make a critical decision after examining all the options open to her. If she still chooses to have an abortion, she is counselled after the abortion, again through the use of video-tapes and personalized counselling, and she is told about the range of contraceptives that are available. The objective is to avoid a situation where the woman would require abortion again in the future because repeated abortions also have adverse effects on the woman's health. An hon. Member: Even one abortion.”
“And only one in 20 of the patients have to wait more than an hour. Sir, I can assure the Singaporeans that we will always be very cost conscious in all our programmes. On the administrative and managerial aspects, we have taken a number of measures to improve productivity and the efficient use of resources. For example, we have computerized and mechanized many of our administrative and operational procedures. We have also improved management systems and management capabilities to ensure that they are utilizing our resources properly through better training of the staff. We are also contracting out work which could be provided more efficiently by the private sector but which in the past was required to be provided by the hospital. Another area that we are looking into is the re-development of the old sprawling hospitals where they cover large pieces of ground requiring a long distance to be travelled by patients, by doctors. We will re-develop them into compact units so that the services can be centralized and made more efficient. So all these measures would help to curtail the rising cost of health care. The Member has also asked about abortion, whether we can do something about abortion as it would help to perhaps increase the birth rate. Sir, the Ministry introduced a counselling programme for all women seeking abortion in Government hospitals in the middle of 1986. The programme was a two-stage one - pre-abortion counselling and post-abortion counselling. It involves personalized counselling as well as the use of video-tapes and printed materials. The aim of the programme is to ensure that the woman fully understands the implications of abortion.”
“In the A&E, the average waiting time in the past was about 45 minutes per patient and 30% of all patients had to wait in excess of one hour, in most cases up to 2(r) hours. With the improvement in the doctor to patient ratio, we have now managed to reduce the average waiting time to only 12 minutes. 4.30 pm”
“In terms of doctor to population ratio also, the US doctor to population ratio today is 1:500. Singapore is 1:930. Since our one doctor can cater for 930 Singaporeans, can we say that our doctor is actually almost doubly efficient as the American doctor? It is difficult, and I would like to say that it is not possible for us to use simple indices because health care is highly personalized. The complexity of the case is also not standard. You do not have patients coming in through the door and you can quantify the complexity and say, "With that complexity, the doctor should take 20 minutes to diagnose and treat him. And if he takes more than 20 minutes he is not doing his job. If he takes less than 20 minutes he is very efficient." It is just not possible, but I think it is possible to show that we are trying to improve the level of care for Singaporeans. With the greater demand for services and the need for sub- specialization to deal with the greater complexity of diseases, we have been consciously recruiting and training more doctors in order to ensure that the workload on the existing doctors is lessened so that they can devote more time looking after the patients. Some examples. In the hospitals, the daily doctor to patient load in 1980 was 1:36. Today, it is 1:30. Another area where we have tried to give better service, devote more time for patient care, is the Accident and Emergency Unit where the ratio was one doctor to 24 patients in 1980 compared to one doctor to 17 patients in 1986. In the A&E it is more self-contained. It is easier to find out what really has been the impact. Have we over-provided thereby resulting in waste or are we just making the requirements by ensuring that the service factor is being catered for?”
“Sir, there is an Accreditation Board that comprises representatives from Government and representatives from the private sector as well and they are all highly recognized specialists in Singapore. I am sure they will be in touch with the Academy and other members of the profession in Singapore in terms of knowing what is needed. Whilst they may not consult the Academy formally, I am sure they are aware of the situation as to what is needed in Singapore. The Member for Whampoa talked about fee increases and asked whether the Ministry has been looking into productivity and the cost factor. He said that when we upgrade hospitals, costs go up, maintenance costs also go up and in trying to upgrade health care consequently the cost of delivering the health care is too high, thereby pricing it above what the lower income group can afford. I wonder whether the Member for Whampoa was here when the Member for Ayer Rajah was proposing that we should provide a home-based doctor service. Productivity in health care is a very complex issue, and it is very difficult to relate it to factory productivity. In factory productivity, if a worker produces 10 items in an hour, you can check the quality, measure it, check against its functionality and say that is his or her productivity. If another worker can produce 15 items an hour with the same quality, you can say the second worker is 50% more efficient, more productive than the first worker. It is easier to relate, but in the medical field, productivity, unfortunately, is a more complex issue. For example, whilst it is possible for a doctor to see and treat, say, 150 patients a day, can we say that he is actually more efficient than another doctor who is treating only 100 a day versus another doctor who may be treating only 70 a day?”
“It is estimated to cost about $5.5 million. SQUATTERS ALONG PASIR PANJANG/SOUTH BUONA VISTA ROADS 10. Encik Abbas Abu Amin asked the Minister for National Development what steps are being taken to clear the pockets of villages that are still scattered along Pasir Panjang Road and South Buona Vista Road in order to meet the target set by the Government to clear all squatterland by 1988.”
“The answer is yes. There is a scheme of benefits which is available for all regular blood donors. PLAYING FIELD IN TELOK BLANGAH 11. Dr Koh Lam Son asked the Minister for National Development whether the open space between Fairway Condominium and Block 45 Telok Blangah Drive will be converted into a playing field as there is no such facility in the Telok Blangah Constituency.”
“Mr Speaker, Sir, that point did not escape me. That is why I said that if he would give me the name of the person, I can check into the background and perhaps provide him with the person's medical condition, if he is entitled to that information.”
“Mr Speaker, Sir, I think the virility of a person is not taken into consideration when we consider a person's blood. We look into the medical factors. In fact, we should not bring up rumours in this House. If the Member has such a case, perhaps he can give me the name. We will look into it and advise him of the person's medical condition.”
“Sir, I do not have the information on the percentage of the total that are first- time blood donors. On his second question as to whether the majority of the donors were turned away because their blood was not good enough, I am not too sure what he means by "not good enough". But the breakdown of the rejections are as follows. Out of the total of 6,054 who were rejected, the vast majority, 84% of them, were rejected on a temporary basis. That means, for example, they were on medication or they were suffering from anaemia. They were therefore given iron pills and told to come back in the future. We will welcome them back when they have recovered.”
“We will have to first see what is their level of skills and education and then try to find them employment in keeping with their level of skills. And, where necessary, we will refer them to the Ministry of Labour for assistance. JALAN KAYU INDUSTRIAL PARKS (Free evening parking on weekends) 9. Mr Heng Chiang Meng asked the Minister for National Development if he will consider allowing free parking in industrial parks in Jalan Kayu Constituency after 5 p.m. or 6 p.m. on weekdays.”
“The cost of the (Elisa) test previously was about $6.50 per test. Each year we have about 60,000 donations. So I suppose if you do a simple multiplication, it is about $400,000.”
“Mr Speaker, Sir, the plan for the Ministry with regard to members of the world's oldest profession, as the Member has called it, who have contracted AIDS is to counsel them and try to find them alternative employment.”
“Mr Speaker, Sir, all blood donations are tested for the AIDS virus and antibodies before they are allowed to be used.”
“Whilst the situation warrants close monitoring by the Ministry, however, we do not feel that it warrants a national campaign other than a general education campaign to ensure that members of the population understand how AIDS is contracted.”
“Mr Speaker, Sir, there are nine AIDS carriers and one confirmed AIDS case in Singapore to date. Since 1985 medical personnel of both Government and private sectors have been educated on the management of AIDS patients. Several specialists have been sent to key AIDS centres in the USA and Europe to study the experience of their specialists in the prevention and treatment of AIDS. Precautionary guidelines have been issued to all Government and private hospitals and laboratories for their reference on such matters as handling and disposal of potentially contaminated laboratory specimens. The Ministry of Health has an action plan covering all aspects of management of AIDS patients and carriers in Singapore. One ward in the Communicable Disease Centre at Tan Tock Seng Hospital has been redeveloped to provide in-patient and intensive hospital care for seriously ill AIDS patients. Outpatient follow-up of AIDS carriers and patients between episodes of illnesses will be carried out in the Middle Road Hospital as well as the Communicable Disease Centre. Since 1985 a systematic health education programme on AIDS has been established for the population. Information brochures, talks and counselling have been provided by my Ministry for high-risk groups, such as prostitutes and homosexuals. In addition, general education, talks, lectures and seminars on AIDS have been conducted for community groups, blood donors, schools and SAF personnel.”
“In terms of the fees, the last time the A & E fees were increased was in 1978, a full nine years ago. I think Members and Singaporeans would recognize that in the last nine years costs have gone up very significantly, even if the resources made available to the A & E had not increased. I think Singaporeans in situations where they need emergency treatment very urgently would appreciate that improving the services would definitely result in an increase in costs. I am sure they would not mind paying a little bit more to ensure that their lives are well taken care of in an emergency. AIDS (Education and state of preparedness) 8. Mr Teo Chong Tee asked the Acting Minister for Health (a) how many cases of confirmed Aids and Aids-carriers have been detected in Singapore to date; (b) whether our hospital facilities are adequate and medical professionals prepared to tackle this deadly disease; and (c) what measures are being taken to educate our population on Aids.”
“Mr Speaker, Sir, emergency treatment is a very important treatment for Singaporeans. And it is the priority and the objective of the Ministry to ensure that such cases are treated correctly. Over the years, we have been making strenuous efforts to try to improve the level of service. For example, if we just look at the number of doctors provided to the A & E departments, in 1981, just five years ago, only 44 doctors were posted to all the A & E departments in our hospitals. In 1986, this number has increased to 60, which represents about an increase of 36%. In the meantime between 1981 and 1986, the patient load has dropped by about 10%, which means that in actual effect the number of doctors serving the patients has increased by about 50%. What has that resulted in? It has resulted in a tremendous reduction in the waiting time for patients. Previously, the waiting time for the patients would average about 45 minutes. Today, the average waiting time has gone down to 12 minutes. In the past, during the peak period, over 30-35% of the patients would have to wait in excess of one hour before treatment. And it was not unusual for patients to wait between 1 1/2 - 2 hours. Today, only one out of 20 has to wait for more than an hour and normally it is just slightly over an hour. In terms of the quality of the doctors who have been posted to the A & E departments, this has also increased very significantly. Previously, there was only one consultant in all the A & E departments in Singapore. Now we have five consultant doctors posted to the A & E departments. All this represents a tremendous allocation of resources to the A & E Department to ensure that the patients there are well looked after.”
“The information given to me so far is no.”
“Mr Speaker, Sir, where the case is highly complicated, the nurses would then, for the sake of safety, err on the side of safety and refer the case to the doctor. The guidelines are fairly straightforward. Perhaps it will be useful for Members to know what are considered emergency cases and what are not considered emergency cases. Emergency cases would include cases where the illness or injury could end in death or serious complications would arise if it is not treated immediately. And generally this would involve acute or sudden onset, for example, of bleeding, severe or increasing pain, or a change in the vital signs of life, like loss of consciousness or difficulty in breathing. A condition that a patient has been suffering for a long time or is currently under treatment which suddenly takes a turn for the worse would also constitute an emergency. Examples of emergencies would be trauma emergencies which are quite straightforward, eg, fractures and dislocations, head injuries, deep cuts or large wounds on the body, severe bleeding and severe burns or scalds. It would also include minor injuries such as bee and insect stings and non-trauma emergencies such as heart attack, acute appendicitis, vomiting of blood, passing blood in the stool or urine, high fever, severe allergy and poisoning. So it is very broadly encompassing and it is very unlikely that any serious case or true emergency case would not be caught under such guidelines.”
“Mr Speaker, Sir, part of the problem with the peak load is that many of the patients tend to arrive at the Polyclinic in the early hours of the morning between 8 and 9.30 am. What happens is that patients on their way to the market will drop in at the Polyclinic or bring along with them their children who are sick. This adds up to a tremendous peak load, which is very hard to overcome. What the Polyclinic staff do is to explain to the patients that they should try to come at all times of the day rather than to come all at the same time. However, recognizing that there is a problem with the queuing time, my Ministry is planning to send another doctor to the Ang Mo Kio Polyclinic later this year. NOISE POLLUTION IN HDB ESTATES 9. Dr Koh Lam Son asked the Minister for National Development whether noise pollution is a serious problem in Housing and Development Board Estates and whether stricter rules will be introduced to control noise pollution.”
“Mr Speaker, Sir, as long as Singaporeans expect standards of medical care and service to improve and for the latest developments in medical technology to be made available in Singapore, such expectations must necessarily result in higher costs to the Government. And such greater expenditures must also inevitably result in higher subsidies. The public must therefore expect to pay for a certain portion of these cost increases in order to be able to take advantage of all the latest developments in health care and medical care.”
“The Ministry undertakes a continual process of vetting the expenditure programmes. This is to ensure that every dollar that has been allocated to the Ministry is spent wisely and efficiently. By aiming to give the hospitals more autonomy, we also hope to achieve greater efficiency, thereby making sure that we continue to get better value for the money spent.”
“It will be borne by the Housing and Development Board as part of the expenditure in connection with the development of Pasir Ris New Town. Since the construction of the bund necessitates reclamation of about 18 hectares of the foreshore and seabed, approval of this House under section 4(2) of the Foreshores Act (Chapter 270) is necessary. Sir, I beg to move. Question put, and agreed to. Resolved, That this Parliament, in accordance with section 4 of the Foreshores Act (Chapter 270), approves the reclamation by the Government of that portion of foreshore/seabed at Changi East containing an area of 18 hectares as shown coloured pink on the plan marked "Land Office Reclamation Plan No. 3/86" which is deposited in the Land Office, Singapore. ADJOURNMENT Resolved, "That Parliament do now adjourn to a date to be fixed." - [Prof. S. Jayakumar]. Adjourned accordingly at Twelve Minutes to Four o'clock pm to a date to be fixed. WRITTEN ANSWERS TO QUESTIONS LAND ACQUISITION 1. Mr Chiam See Tong asked the Minister for Law what are the reasons for adopting the policy of compulsorily acquiring land, without stating the specific purpose or purposes for doing so in many instances.”
“RECLAMATION (CHANGI EAST) 3.45 pm The Second Minister for Law (Prof. S. Jayakumar): Mr Speaker, Sir, I beg to move the Motion* standing in the name of the Minister for Law as it appears on the Order Paper. *The Motion reads as follows: That this Parliament, in accordance with section 4 of the Foreshores Act (Chapter 270), approves the reclamation by the Government of that portion of foreshore/seabed at Changi East containing an area of 18 hectares as shown coloured pink on the plan marked "Land Office Reclamation Plan No. 3/86" which is deposited in the Land Office, Singapore. Sir, over the past two or three decades, sand quarrying has been carried out in the Pasir Ris area. This has resulted in numerous deep pits in the ground filled with silt slurry and debris. In order to pave the way for development of Pasir Ris New Town, it is necessary to remove the silt slurry and debris in the sand pits and restore the quarry areas before such development takes place. The Housing and Development Board proposes to discharge the silt slurry into a depression in the area off the coast of Changi, as shown edged pink in the plan marked "Land Office Reclamation Plan No. 3/86", a copy of which is displayed in the Library of this House for the information of hon. Members. However, in order to contain the silt slurry to minimize siltation to the ports' navigation channels, it is also necessary to construct a sand bund for the discharge of the slurry. The area of the proposed sand bund above highwater level is about 18 hectares, as shown coloured pink in the plan. The cost of constructing the bund which will take about six months to complete is estimated at $30 million.”
“Under section 19 of the Residential Property Act, 1976, a person acquiring any interest in the land under an instrument lodged for registration in the Registry of Titles and the Registry of Deeds needs to state his citizenship and particulars of documents of proof such as identity card, passport or birth certificate. As for companies, there is a need to state only their place of incorporation or registered address, whichever is applicable. The provisions relating to the registration of dealings in land are actually more appropriate if they are provided in the rules governing registration of land. New rule 26A which is similar to new rule 46A of the Land Titles (Amendment) rules, 1986 also provides that additional particulars are required. These particulars are the residential status, such as permanent residence and employment pass holder and other types of pass holders. For companies incorporated under the Companies Act, the new rule requires that the registration number of the company assigned to it by the Registrar of Companies be stated. Forms 4 and 5 of the Second Schedule to the Rules concerning memorial of probate and memorial of letters of administration have also been revised for purposes of clarity. Sir, these amendments are not controversial and Parliament's approval of these amendments is required under the enabling provisions of the Act. Sir, I beg to move. Question put, and agreed to. Resolved, That this Parliament pursuant to subsection (2) of section 29 of the Registration of Deeds Act (Chapter 281), resolves that the Registration of Deeds (Amendment) Rules 1986, published as Notification No. S. 267 in the Government Gazette Subsidiary Legislation Supplement No. 45 of 24th October 1986, as contained in Paper S.L. 46 of 1986, be approved.”
“Examples are: (a) the new rule 3 providing for changes to search and registration hours; (b) the amendment to rule 7 requiring that size of forms shall be A4 size; and (c) the new rule 11A providing for forfeiture of the lodgement of fee when there has been unreasonable delay by solicitors in complying with any requisition made by the Registrar. If I may turn to some of the amendments, Sir. Rule 13. Under section 14(1)(c) of the Registration of Deeds Act, only instruments of finally surveyed lands can be finally registered by the Registrar of Deeds. Where the Chief Surveyor has not yet approved the survey of part of a lot vested in Government, notwithstanding that all those parts constitute a whole Government survey lot, the Registrar of Deeds nevertheless is not empowered to finalize the registration of the instrument vesting these parts of the lot in Government. The amendment of Rule 13 will now allow the Registrar to finalize the registration of outstanding instruments of those parts of the lot, subject to conclusiveness of their boundaries and areas, so long as they constitute the whole of a Government survey lot. The new Rule 25 empowering the Registrar to accept instruments only when correct fees are paid will give legal force to the Registry's practice as agreed to by the Law Society of Singapore since November 1985. Prior to the implementation of that practice, the Registry had to deal with a high volume of refund of fees which a number of law firms habitually over-paid in small amounts for their instruments lodged.”
“And I am sure members of the family and their friends who are there would, when asked by the hospital staff, definitely be able to confirm whether or not the victim is or is not a Muslim. I think I have covered most of the major points brought up by Members of the House. Once again, I would like to thank everybody for their very useful comments. Question put, and agreed to. Bill accordingly read a Second time. Resolved, That the Human Organ Transplant Bill be committed to a Select Committee consisting of Mr Speaker as Chairman and seven Members to be nominated by the Committee of Selection. - [Mr Yeo Cheow Tong]. REGISTRATION OF DEEDS (AMENDMENT) RULES 1986 3.40 pm The Second Minister for Law (Prof. S. Jayakumar): Mr Speaker, Sir, I beg to move the Motion* standing in the name of the Minister for Law as it appears in item (4) on the Order Paper. *The Motion reads as follows: That this Parliament pursuant to subsection (2) of section 29 of the Registration of Deeds Act (Chapter 281), resolves that the Registration of Deeds (Amendment) Rules 1986, published as Notification No. S 267 in the Government Gazette Subsidiary Legislation Supplement No. 45 of 24th October 1986, as contained in Paper S. L. 46 of 1986, be approved. Sir, as part of its computerization plan the Registry of Deeds needs to revise its practices, procedures and forms of instruments. In order to provide for consistency in practice in both the Registry of Deeds and the Registry of Titles, new rules have been introduced or old rules amended.”
“This issue of dialysis upon demand has been brought up in this House before and I have given the reasons why, ie, dialysis is a very very expensive process and it is not really a suitable method for treating kidney failure. The best method for treating kidney failure is to obtain a replacement kidney for him, and that is a permanent remedy rather than a temporary remedy which will just totally destroy a person's quality of life as well as that of his family. I would like to thank the Member for Ulu Pandan also for her comments on the medical and surgical aspects of transplants. I am sure Members of the House would have appreciated her explanation. There have also been calls for trained counsellors to counsel families of those accident victims who have died and who have donated their kidneys. Yes, we have a team of what we call "kidney persuaders" at the moment stationed in each hospital. Their job goes further than just persuading families of accident victims to allow the kidneys to be donated. It goes further than that in terms that they also counsel the family on their present grief. But the programme will be reviewed to see how we can expand that further. The Member for Kampong Ubi has also asked how do we recognize Muslims. After all people from other races have also become Muslims. Well, there are a few methods that we use. One is, of course, to look at the identity card to see whether that name is a Muslim name, whether there is an alias there. But that is not always available. What we will have to depend upon will be the feedback from the immediate family members who are there at the hospital, at the bedside of the victim. We will have to depend upon them to advise us because there is no other way for us to seek the information otherwise.”
“I gave three examples, plus Belgium, which is the latest country to adopt this system. The European position is quite interesting because most of the countries in Europe that have adopted this system of presumed consent are countries that have a strong belief in personal rights, strong belief in the democratic processes, strong belief in protecting the individual as far as intervention by the State is concerned. Yet these very conservative countries in terms of personal rights have been the pace setters in terms of enacting laws that allow presumed consent. In that respect they have been very progressive. So I would like to correct the Member for Potong Pasir. There are not three but fourteen countries that have adopted this system to date. The Member for Potong Pasir has given a very simplistic example of one person who has agreed to donate and another person who has not agreed to donate. I think it is a very simplistic example. The key thing is that we have got to persuade and convince as many people as possible to be potential donors. Then the pool of potential donors can expand. The reverse will be back to where we are today - 27,000 people who have agreed to donate will result very very certainly in over 200 kidney failure patients every year dying with this disease. So I think we have to be sure as to what is its objective. And the system of priority is in no way unfair to those people who have chosen not to be members of the pool. So we must get our thoughts very clear on that. The Member has also requested for dialysis on demand before passing this Bill, although he said that he is in support of this Bill.”
“So we will make sure that every person who dies in an accident and whose kidneys may be considered suitable, that all those names would be checked carefully against our Register of Objectors to make sure that they have not objected in their life-time. The Member has also asked another question: what happens if the computer fails? That is not an unlikely scenario. It could be due to power failure. It could be due to anything. I would like to assure Members that if the computer system does fail, during the period that the computer is down we will err on the side of safety, in the sense that we will not in that case carry out any removal of kidneys under this Act. This is to ensure that during such unforeseen circumstances things are under control and that we do not make any mistake. Various Members have also talked about the impact of superstitions in Singapore; the impact on members of the public would be a reluctance to donate their kidneys. Yes, we realize that there is a group of people who may be strongly influenced by superstitions. That is why we are working hard to better inform the public. We would also be encouraging the various religious leaders to be more open in their support. And taking up on the Member for Jalan Kayu, I hope also that they will come out and adopt a high profile in terms of explaining the stands of the various religions on this issue. The Member for Potong Pasir has been having problems all along with his figures. Today he is no different. He said that I had in my opening address stated that there were only three countries that have to date adopted this system of presumed consent. This is where he is mistaken, unfortunately. I stated that there were 14 countries in Europe. And I gave four examples, not three.”
“He brought up the point that we should try and educate the public on healthy living to try to prevent kidney failure. We know what causes kidney failure. But medical science has still not really ascertained what leads to those causes. For example, we know that there is a connection between high blood pressure and kidney failure, between diabetes and kidney failure. We also know that certain infections of the body will result in the release of toxins which when they pass through the kidneys would end up in gradually damaging the kidneys. So this is the direct impact on the kidney functions which we know about. And our health fairs have been concentrating very heavily on getting members of the public to take care of their health, to watch their blood pressure, try to cut down their intake of salt and all the other substances which lead to hypertension and high blood pressure, and also to encourage them to go for a check for diabetes. So all these are on-going programmes which we will continue to emphasise, and they would definitely help in the long term to reduce or at least check the spread of kidney diseases. In terms of the pledge cards being lost and the suggestion that we should indicate it on the NRIC, ie, the identity card, we have discussed this with the various Government departments. We feel that that card is only an acknowledgment card. The important thing is that all the names are being captured on the computer, and we are not depending on whether or not a person has that card on him when he dies. We are actually relying more on the computer and that is a more guaranteed way.”
“25 pm [Mr Deputy Speaker in the Chair] The Members for Nee Soon and Kaki Bukit have brought up the question of whether the Bill could be perhaps expanded to cover other organs. At the same time the Member for Ayer Rajah and another Member just now have also cautioned the Ministry against expanding coverage too rapidly. The Ministry will be adopting a very cautious approach towards legislation. First and foremost, we have to convince Singaporeans that the donation of organs to save other people is a good act, it is a humanitarian act, and it is an act which they should all support. So I think the process of persuasion and convincing must first be put in place. And over a period of time when more people become familiarized with the fact that, yes, organ donation is taking place, then perhaps they will also be very willing to donate other organs as well. At the present moment, there is no need for the donations of other organs, for example, the heart, liver, and all that. There is no need for that yet because no such are being have been carried out. With the progress of medical science, in the future we may go into those areas if there is a need for such transplants. But we would try the persuasion approach before we resort to legislation. The Member for Pasir Panjang has also raised the point about what happens to those Muslims who reach the age of 21 during the grace period. How will they stand in terms of priority? Well, if they reach 21 during this grace period, they will still be covered by the grace period. Therefore, they need not fear losing out on priority should they opt in after the age of 21 during this grace period. The Member for Kaki Bukit came out with a long list of questions. I will try to answer them wherever I can.”
“We will use the various media, newspaper advertisements, the TV, to keep our population continuously informed, so that those teenagers, when they get to the age of 21, will then be fully aware of the implications of the Bill. Hopefully, through the publicity programme, by the time they get to the age of 21 they will be sufficiently informed about the higher objectives of the Bill so that they would agree to donate their kidneys and therefore not have to register their objection. Various Members have also talked about the need to better inform members of the public. The Member for Ayer Rajah has mentioned about the questionnaire which we had sent to the Feedback Unit and which has been distributed to the various grassroots organizations. Yes, the Ministry will continue with the publicity programme. In fact, only yesterday we took up a full-page advertisement in the newspapers to explain certain aspects of the Bill. This publicity programme will continue for the next six to eight months to ensure that members of the public will know over a period of time the major aspects of the Bill, what are the objectives, what are the problems facing the kidney failure patients, so that they will be totally knowledgeable of what we are talking about. The Ministry will also be sending out flyers through the mail to every family. PUB has agreed to support us in in that respect. We will be sending out together with the PUB bills in the future flyers that will contain questions and answers to the major aspects of the Bill. So in this way every family will have such information delivered to their home. Therefore, this will enable us to reach every home in Singapore directly with the information. And, again, this will be continued periodically to ensure that Singaporeans know about this. 3.”
“Mr Speaker, Sir, I would like to thank the many Members who have spoken in support of the Bill. As I intend to refer this Bill to the Select Committee, I will therefore only reply to the broad points and not go into the detailed drafting of the Bill as this would be the job of the Select Committee to look into. Several of our Muslim MPs have spoken on various aspects relating to the Muslim community. My officers and I myself have been in discussion with the MUIS leaders on the various aspects of this Bill. I am very happy that MUIS has come out in support of the Bill. They have come out in support of the concept of organ donation, except that for Muslims it must be an active consent system which is covered under our present Medical (Therapy, Education and Research) Act. Arising from our discussions, we have agreed that the pledge form for kidney donation under this Medical (Therapy, Education and Research) Act will be redesigned to take into consideration the points brought up by MUIS and which have also been covered by the Member for Tanah Merah, that is, that the donation will be only for kidneys, that it will be for immediate transplant, and that the next-of-kin must give his or her permission at the same time when the individual signs his consent form. This will be done. The forms will be ready very shortly and we hope MUIS and the various religious leaders of the Islamic faith will help us to bring them to the ground and explain to their congregation, the Muslim congregation, about the various aspects of kidney donation and how to go about it. In terms of those people who reach 21 years of age, how do we keep them informed every year? What the Ministry will do is to continue with its publicity programme on an annual basis.”
“The Ministry has announced plans to set up community hospitals. The community hospitals will provide beds for the chronic sick who require hospitalization. The community hospitals will also cater for those who are sick but who do not require the intensive care that is provided in the acute hospitals. CPF MINIMUM SUM SCHEME FOR RETIREMENT NEEDS AFTER AGE 60 (Statement by the Acting Minister for Labour) 11.20 am”
“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. ADJOURNMENT TO A DATE TO BE FIXED (Motion) Resolved, "That at its rising today, Parliament do stand adjourned to a date to be fixed." - [Prof. S. Jayakumar]. ADJOURNMENT MOTION”