MAIN AND DEVELOPMENT ESTIMATES OF SINGAPORE FOR THE FINANCIAL YEAR 1ST APRIL, 1974 TO 31ST MARCH, 1975

Order read for resumed consideration in Committee of Supply [6th Allotted Day].

[Mr Speaker in the Chair]

Head LK --

Mr Teong Eng Siong (Sembawang): (In Mandarin): Mr Speaker, Sir, I beg to move,

That the sum to be allocated for Head LK be reduced by $10 in respect of subhead AA 1107*. (* The same amendment also stood in the name of Mr P. Govindaswamy.)

Sir, it cannot be denied that in the past few years the Primary Production Department has made useful contributions towards the promotion of agriculture. For instance, the Department has introduced the immunisation of poultry, the introduction of fine breeds and also the teaching of modern and scientific methods of agriculture and poultry-keeping so as to benefit the farmers. However, we are faced with the basic problem, namely, the shortage of land for agriculture development. Therefore, we have to depend on import of vegetables, fish, and other foods for which we have to pay foreign exchange. Because of this, the yearly foreign exchange that we spend amounts to several hundreds of millions of dollars.

Sir, in view of world-wide inflation and high prices I feel that the Primary Production Department should take up more responsibility in the provision of daily necessities so as to enable our people to buy goods at reasonable prices. In what fields can the Primary Production Department be of any service? I feel there are three aspects of work which it can do: (1) the extensive planting of certain vegetables, including potatoes and mushrooms, in some villages or in certain islands so as to lower the cost of agricultural products; (2) to develop fresh water fish breeding and deep-sea fishing so as to save some tens of million dollars on foreign exchange: and, (3) to develop a tropical fish market on a large scale in order to get a substantial amount of foreign exchange for our country. At this time of inflation I feel that these schemes would contribute towards national savings and the development of new sources of income.

We all know that orchid growing is a new industry which will also bring in a substantial income. In recent years we know that orchid cultivation is making great progress in rural areas. In our country, the history of orchid growing goes back to some 40 years. First, we must give credit to the authorities of the Botanic Gardens for their efforts on orchid growing and cultivation. Today many people have taken the cue and have since been growing orchids. Today we have many hybrids and varieties of quality orchids and we are well known for orchid cultivation. Even Hawaiian orchids are not comparable to ours now. Here the Primary Production Department has made great contributions. There is another aspect which we can be proud of. The Currency Board has chosen our orchids as the design for our currency notes.

We also have a substantial amount of foreign exchange through the sale of orchids. If we can pay more attention to the development of orchid growing and a wider market, we will achieve even more. Therefore, I would like to suggest to the Minister concerned to set up an organisation to help the farmers in the marketing of orchids. According to a survey, Europeans and Americans are fond of orchids. For example, West Germany alone exports various kinds of flowers to various countries amounting to S$850 million per year. According to calculation, our total export of orchids is about US$6 to US$7 million, which is about 3 per cent of that of West Germany, which is our major market. In addition to this, there are other markets in West Europe. So we must intensively develop our export markets. I would suggest to the Minister to set up a special unit in the Primary Production Department and vest it with special duties to develop foreign markets for orchids and other kinds of flowers. We may then give more attention to our small farmers who plant flowers, so that they may be cared for and not be exploited by the middlemen. Next, we must extensively develop the methods of orchid planting. Though we are short of agricultural land, we still have a certain number of farms available for the planting of orchids. This aspect of agriculture has many good points. (1) It does not lead to pollution of the air. (2) It has a beneficial contribution towards water. (3) We can earn much foreign exchange through the use of small capital investment on non-productive land and also utilising manpower to our benefit.

So I hope the Minister will urge the Primary Production Department to develop this type of agriculture in order to get more foreign exchange for our country.

2.45 p.m.

Mr P. Govindaswamy (Anson): Mr Speaker, Sir, because of the present inflation in Singapore, what steps are being taken to produce and to grow more crops locally? We cannot be self-sufficient in all types of food products; but we can be on some of them. What effort is being made to ensure that we are self-sufficient in poultry, pigs, eggs, fish, etc.? With proper farming, we can be self-sufficient in vegetables too. If those who live in houses with a garden are encouraged to grow vegetables, the inflated price of vegetables in the markets can be lowered considerably. Just to quote an instance, today at the Kandang Kerbau Market, the cost of two red chillies is 10 cents. Normally, you can get about 15 chillies for that price. Imagine the difference in real value.

It would appear that our vegetable gardens are gradually being pushed out. What is the possibility of putting up vegetable gardens in flatted farms? Has the Minister thought about that? The roof-top of every housing block can be rented out to farmers to plant vegetables.

Mr Ivan Baptist (Potong Pasir): Mr Speaker, Sir, some of my farmers in Potong Pasir are affected by urban renewal. It is strange that those farming some 0.5 hectare of land, or less, were not considered bona fide farmers by the Primary Production Department. Because of this, they did not receive compensation normally paid to bona fide farmers, either in the form of cash, a free HDB flat, or alternative land to cultivate. I cannot fathom the rationale governing the Primary Production Department's determination of bona fide farmers and the necessity to differentiate farmers. Is one of the reasons that of avoiding paying compensation? I would be most pleased if the Hon. Minister could enlighten me.

To my mind, a farmer is bona fide, whether he tills 0.5 or 1.0 hectare of land. He should not be discriminated against for being poorer. He sweats and toils, just tilling the land, perhaps harder, to provide Singaporeans with fresh, green vegetables. He has no other means of earning a living. The Primary Production Department merely confuses the poor hardworking farmer by telling him that he is not a bona fide farmer. How can he figure this out when, in actual fact, his occupation is farming? Imagine the farmer willing to assist the Government by moving out of the land, which provides him with his livelihood, to spend the rest of his days in the confines of a HDB flat, and yet he is denied the right of compensation as a farmer. Why is the Government denying him this right to live and enjoy the just rewards of his hard work by refusing to compensate him as a bona fide farmer?

Mr Ho Kah Leong (Jurong): Sir, I have an amendment* under this Head and since everybody is talking about agriculture, can I join in?

• The amendment reads as follows:

(2) That the sum to be allocated for Head LK be reduced by $10 in respect of subhead CA 1111.

The Chairman: Yes.

Mr Ho Kah Leong: (In Mandarin): Mr Speaker, Sir, since I am the Member of Parliament of a constituency, half of which is rural, I feel that it is necessary for me to reflect in this House the poor plight of our farmers. I believe the Member for Chua Chu Kang will also have the same feeling, although he is not in the House yet.

Sir, most of our farmers are rustic folks of great forbearance. They are law-abiding, hardworking, and their only aspiration in life is to earn three comfortable meals a day. They neither play with power, nor do they manipulate our market. So when there is a manipulation of prices of farm products in Singapore, the greatest victims of such manipulation are the farmers.

Sir, when prices of farm produce fall, who extends a helping hand to the farmers? But when there is a slight rise in prices, everybody tries to keep it down. For example, a scheme was introduced to stop slaughtering pigs for two days a week, and there was even the lifting of import duty on frozen chicken and the lifting of the import ban of pigs from other countries. As a result of such measures, our farmers have been very hard hit.

Mr Speaker, Sir, the world seems to be unduly harsh and unfair to farmers in Singapore. We are very hard hit by imported inflation and we cannot do anything about it. The 20,000 farmers in Singapore are also affected because they have to pay more for their daily necessities. In the case of employed workers, they have the 9 per cent and $25 recommended by the National Wages Council. But who is there to look after the poor farmers and help them fight inflation? So it is fair that when there is a little rise in the prices of farm produce, attempts are made to suppress it.

Sir, it is becoming increasingly difficult to engage in farming activities in Singapore because of the diminishing returns of farm land. Although a lot of land has been acquired from the farmers, they are resettled in a much smaller plot of land. Furthermore, the rate of compensation still remains the same, despite the increase in the cost of building construction and materials in recent years. This has also made it difficult for farmers affected by resettlement to build their own farms and farm-houses.

Mr Speaker, Sir, our labour shortage has also affected farmers because it is difficult for them to engage help on the farm. So they will have to pay higher wages to engage farm help. This is another item that adds to their burden.

Sir, furthermore there is the question of the rise in the price of animal feed. Animal feed dealers have not only increased the prices of their products but they have also asked for cash from the farmers instead of allowing them credit. Because of this difficulty, the cost of production has definitely gone up, and if no help is rendered to the poor farmers, I am afraid they will suffer in the end. Sir, if what is left of our agriculture cannot be developed or even continue to exist, it will be a great tragedy for Singapore because it will mean that all the consumers in Singapore will have to pay more for imported farm products. The situation will then be much worse.

Sir, it is quite right that because of geographical limitation, we do not depend on farming and agriculture for a living. But it cannot be denied that farming activities are also an asset to our national wealth because they help to solve our unemployment problem on the one hand, and they help to balance the prices of farm products imported from overseas on the other hand. Without agricultural activities in our farms, we will have to pay at least 30 cents for an egg imported from abroad. Therefore, every assistance must be given to our farmers to enable them to increase their production, so that higher productivity will help to bring down prices and the cost of living in Singapore thereby helping our consumers.

Mr Speaker, Sir, our agriculture is now in great difficulties. It is only the Government that is in a position to revive agriculture which is declining in Singapore. I would like to take this opportunity to ask the Government to extend a helping hand to the development of our agriculture. It should not be allowed to swim or to sink by itself.

Mr Hwang Soo Jin (Jalan Kayu): (In Mandarin): Mr Speaker, Sir, I rise in support of the Member for Jurong in regard to his views on agriculture in Singapore.

Sir, over the past one or two years, many countries in the world have suffered from food shortages. Worldwide inflation has affected all of us in Singapore, particularly those who depend on imported goods. The cost of living in Singapore has also risen because of this. In respect of food supply, the Primary Production Department has over the years encouraged farmers in Singapore to work hard and to help them with all kinds of farming aids. As a result we have been able to achieve self-sufficiency in the supply of pigs, chicken, and eggs. But because of the fantastic rise in the price of animal feed, the prices of farm products have also been affected. So if we had neglected our agricultural sector, our cost of living would have risen still higher, because we will then have to depend entirely on the importation of farm produce and other consumer goods as well. That would add further to what is already a heavy burden on our people. Sir, if this had happened we would have lost at least by way of foreign exchange. So the contribution made by our farmers cannot be denied.

The next problem I would like to bring to the attention of the Minister is the question of change of employment of our farmers. We all know that most of our farmers in Singapore are in the age group of 40 to 50. Because of a change of circumstances, such as measures taken by the Government to protect our water resources which make it difficult for farmers to carry on their farming activities, then these farmers will have no choice but to change their employment. But with their limited qualification and experience, and age, it will be difficult for these old farmers to change their jobs. As a result, their livelihood will become problematic and, from the point of view of our national economy, that will also constitute a great loss of our manpower. Sir, it is my belief that our enlightened Government will not allow our small and medium-size farmers to sink or to swim by themselves, and every help will be given them.

Mr Seah Mui Kok (Bukit Ho Swee): Mr Speaker, Sir, Singapore has to import a good number of agricultural products from neighbouring countries, and the prices of these agricultural products are rising higher and higher. In view of this fact, I am enquiring from the Hon. Minister whether he would care to make a feasibility study of using a few of our small neighbouring islands for agricultural farming. If it is feasible, the farmers will be interested. Could the Minister please give consideration?

3.00 p.m.

Mr Cheong Yuen Chee (Toa Payoh): Mr Speaker, Sir, since the banning of the importation of livestock from neighbouring countries on account of the outbreak of foot-and-mouth disease, there is little or no fresh beef for sale in many of our markets. We have to import most of our frozen meat from countries like New Zealand, Australia and the USA. The prices of frozen meat have increased considerably over the past year, thus contributing to the high cost of living. We are aware that there is a joint project between Singapore and Indonesia on Batam island where cattle is raised for eventual importation into Singapore. May I know from the Minister what is the total investment contributed by Singapore, and whether the cattle raised in this joint project will be sufficient to meet the needs of beef consumption in Singapore?

The Minister for Law and National Development (Mr E. W. Barker): Mr Speaker, Sir, as Members have rested well over the week-end, they have come back afresh. Perhaps we should have carried on until 8 o'clock on Friday, but it is not my wish to silence them.

In my reply, I shall go backwards and start with the Member for Toa Payoh, who has complained about the lack of fresh beef in the markets. This is obvious because there was an outbreak of foot-and-mouth disease sometime back and, as a result, we had to slaughter about 400 head of cattle. There have also been complaints why we have stopped the import of cattle. The answer is obvious: it is because of the foot-and-mouth disease. Otherwise it will spread throughout Singapore.

As for the project on Batam island, we have invested nothing. It is completely an Indonesian project with Australian assistance - Australian cattle. The cattle is already there. If it is imported into Singapore, Batam island will be used as a quarantine station. In other words, if the cattle there is free of the foot-and-mouth disease it can then come straight into Singapore and not necessarily into our quarantine station in Jurong. At the moment they are still breeding the cattle on Batam island. I do not think they have enough head of cattle for export to Singapore.

As for the Member for Bukit Ho Swee, he wants to know why we do not farm on the islands. There are already some farmers in Pulau Ubin and Pulau Tekong. But it is not easy to get the farmers from the main island to farm on the other islands around Singapore because it means transporting the products across the sea. This takes time and money.

The Member for Jurong made his usual speech on the Budget. Can I deal with one point that was raised by him, and that is, the question of the lifting of quota on chickens? This was done in order to bring the price down. But this was not done by my Ministry because we are not in charge of the quota. However, we have warned the Ministry of Finance of the dangers of leaving that quota too long. Our prime concern, like the Member for Jurong, is the protection of our farmers. Having seen the poultry industry grow to such a strong position that we export chickens and eggs - this was not easily done, but done over many years - we are naturally conscious to see that this industry is not affected by foreign competition. We have already warned the Ministry of Finance of these dangers and we are keeping a finger on it.

The Member for Potong Pasir talked about bona fide farmers. If someone keeps a few chickens and a pig in his backyard for the Chinese New Year or Christmas, that does not make him a bona fide farmer, especially if he works in Jurong or drives a taxi. By a "bona fide farmer", we mean a farmer who genuinely does farming. There are, of course, genuine or bona fide farmers. But there are also people who do farming part-time just to have eggs for breakfast or chicken for the week-end. They do not depend on farming completely as a means of subsistence, and that is why we say they are not bona fide farmers.

The Member for Anson wants the Primary Production Department to grow vegetables on the roof-tops of Housing Board flats. It is an ingenious idea, but it has practical difficulties. The Member for Sembawang wants the Primary Production Department to find a market for orchids. There are already several orchid exporters in Singapore who have their contacts overseas, and hence the export of orchids brings in considerable foreign exchange. But it is not for the Primary Production Department to compete with these firms. No one is prevented from exporting orchids if he can find the right contacts overseas. As for fishing, there is a Fisheries Research Station at Changi and I would be happy to show the Member around. If he goes there he will see that fish are reared. There are also the giant fresh water prawns. The young fish and prawns are sold to the farmers or fishermen for breeding.

Every year the Primary Production Department is asked to help farmers. Well, it does help them. But there is a shortage of land in Singapore, and there are priorities. The town itself is expanding and with the creation of new towns like Toa Payoh, Queenstown and Woodlands, there is less land for farming. But the Department is not asleep. It has the Veterinary Diagnostic Laboratory at Kampung Java which provides routine diagnosis of pigs and poultry which have died. It finds out what is wrong and tells the farmers. Specific disease control schemes are conducted by the Primary Production Department. There is also the control of pullorum disease in poultry, and swine brucellosis in pigs, a disease which causes abortions in fertility, resulting in loss of production. We have a scheme which enables farms to get rid of this disease. We have also a free swine fever vaccination service, a poultry vaccination service, a plant protection service, and there are 10 treatment centres strategically located throughout the island providing treatment services to pig and poultry farmers on the island. We even have training facilities and both ad hoc training and organised training are conducted by the Department to enable farmers to learn more recent techniques on farming, breeding and disease control. The Farm School at Sembawang is one example of organised training conducted by the Department, it runs a one-year residential course and trainees can choose one of three subjects, animal husbandry, horticulture or fish culture for specialisation. The school has turned out 173 graduates who are now either managing their own farms or gainfully employed in the primary production sector.

Members may be interested to know that the Department has successfully experimented with the cultivation of straw mushroom, and yields of up to 15 per cent of the weight of the growing medium have been obtained. The Department has also run a number of courses for the public, and there are now a few commercial farms producing straw mushrooms. A limiting factor to this development is the lack of padi-straws, the medium used for cultivating the mushroom. But the Department is now experimenting with substitutes, such as sawdust, cotton waste, coconut fibre and paper waste. The results are inconclusive.

As for hydroponics, the Department has successfully experimented with the cultivation of high value crops, such as capsicum, under this system. Yields of up to one pound per plant per crop may be obtained, and with three crops in a year. The Department is now extending its experiments to leafy vegetables, and these have shown encouraging results. Yields are much higher than those produced from the conventional methods of cultivation. The Department is now intensifying its efforts to transmit its findings to the private sector.

As for the fishing port at Jurong, Members will remember the opposition we met when the port was first opened and the fishmongers had to shift to Jurong. But I am happy to say that, since its opening in 1969, an increasing number of fishing vessels have made use of the port facilities. The number of fishing vessels visiting the port in 1973 was only 387, and last year numbered 659. The fishing port has attracted fishing vessels not only from our own Republic but also those from Japan, Taiwan, Korea and Russia. About 2,000 local fishermen and 4,000 fish merchants and retailers make use of the market facilities. Members will be interested to know too that seven factories are now in production, producing filleted fish meat and fish meal for animal feed.

3.15 p.m.

Mr Baptist: Sir, I was not talking about one pig, two chickens and three ducks. I was actually not talking about animal farming at all. I was talking about vegetable farming, not on just one square metre of land but about 0.5 hectare of land tilled by the farmers in Potong Pasir. They are not considered bona fide farmers although vegetable farming is their only means of livelihood, and in addition licences were issued to them by the Primary Production Department. I was wondering whether the Minister could enlighten me as to why they are not receiving any compensation as farmers.

Mr Barker: Sir, anyone who is paid compensation must be a bona fide farmer. If he grows vegetables and just depends on that for his living, then I would say he is a bona fide farmer. If there are cases of that nature in Potong Pasir, perhaps the Member could give me specific instances and I will look into the matter.

I referred to pigs and poultry because that is the practice in Singapore. The farmers do not only grow vegetables; they have chickens and pigs, and sometimes even a taxi too.

Mr Cheong Yuen Chee: Sir, on the Batam island project, in view of the likelihood of a continuing ban on the importation of cattle from neighbouring countries, which consequently leads to a shortage of beef, does the Minister consider that it would be of mutual advantage to both Indonesia and Singapore if we were to enter into a similar project in the form of regional aid in veterinary science and animal husbandry, possibly under the auspices of ASEAN?

Mr Barker: Sir, the answer is yes.

Mr Teong Eng Siong: (In Mandarin): Sir, I thank the Minister for answering my questions. The officials in the Primary Production Department are working very hard. They are not sleeping.

But before I withdraw my amendment, I would like the Minister to answer one more question with regard to the Fisheries Research Station in Changi. Is the Station still in the research stage? When will it be able to embark on production?

The Chairman: Mr Teong, the Minister has invited you to visit this place.

Mr Barker: Yes, Sir, if the Member can come along to Changi, he will see what is going on there. It is not in the research stage. Research goes on all the time. But assistance to farmers and fishermen has gone on for a considerable time, in fact, for many years.

Mr Teong Eng Siong: (In Mandarin): Sir, I thank the Minister for his reply, and I hope that the results achieved would be excellent.

I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The following amendments stood in the name of Mr Ho Kah Leong -

(2) That the sum to be allocated for Head LK be reduced by $10 in respect of subhead CA 1111.

(3) That the sum to be allocated for Head LK be reduced by $10 in respect of subhead EA 3001.

The Chairman: Mr Ho, the Minister has already answered your amendments (2) and (3).

Mr Ho Kah Leong: I am aware of that, Sir,I am not moving them.

The sum of $10,328,970 for Head LK ordered to stand part of the Main Estimates.

The sum of $2,167,000 for Head LK ordered to stand part of the Development Estimates.

Head MA --

Mr N. Govindasamy (Telok Blangah): Sir, I beg to move,

That the sum to be allocated for Head MA be reduced by $10 in respect of subhead AA 1004*. (* The same amendment also stood in the name of Mr P. Govindaswamy.)

Sir, within the past three years, I was admitted into hospital twice and I have first-hand knowledge of what I am going to say about the yeoman's service that is being given by our nursing staff. In any large establishment there are bound to be some black sheep. But amongst our nursing corps, I found that the number of unsatisfactory staff is negligible. Having said that, I would like to point Out a number of grievances of the hardworking nursing staff which can be rectified without much cost to the Ministry.

One very common grouse is that the quality of uniforms and shoes provided is generally very poor. They are badly tailored, shoddily made, ill-fitting, and on top of it several trips have to be made to the suppliers or contractors to obtain the required uniforms or shoes. All this in spite of the fact that, I am sure, we pay these contractors and suppliers.

The Chairman: Mr N. Govindasamy, the Minister for Health is not a fashion designer of uniforms for nursing staff!

Mr N. Govindasamy: He is not, Sir, but he is responsible for the payment for what the nurses are supplied with. If we pay for shoes, we expect to get fitting shoes. If we pay for uniforms, we expect to get uniforms that can be worn.

The Chairman: Is this part of the Ministry's policy?

Mr N. Govindasamy: It is at least part of the Ministry's policy, Sir. The Minister and his mandarins at Palmer Road do not seem to be aware of this poor and unreliable service given by the Ministry's suppliers. Nor are they aware that sometimes some nurses have to stump up from their own pockets to supplement their inadequate supply of uniforms and shoes. For instance, district nurses and midwives have to make rounds to private homes in the rural areas, and they should therefore be supplied with additional shoes and uniforms.

Sir, it appears that there are far too many Assistant Nurses with practically no promotion prospects at all in our Government health service. In fact, I am told there are only eight posts of Senior Assistant Nurses for the 1,800 Assistant Nurses in service now. A number of Assistant Nurses can and should be given the opportunity to undergo training to be Staff Nurses. Although these Assistant Nurses have the necessary educational qualifications, they have not been given the opportunity. One begins to wonder, Sir, if this is not deliberately intended to ensure a constant supply of Assistant Nurses to provide the necessary nursing service at a cut-rate salary.

An hon. Member: Cut-throat!

Mr N. Govindasamy: Cut-rate, so that their throats can be cut! Sir, because of the limited number of post graduate vacancies and to avoid delay in getting their post basic training in the preferred specialty, some Staff Nurses choose to go abroad on no-pay leave for such training. On rejoining the service after completion of the post graduate course, they are neither accorded incremental credits for the additional qualifications obtained nor is their no-pay leave period considered in the pension calculations. The additional qualifications they have obtained, Sir, benefit the service and yet they lose out financially.

Sir, I have noticed that in the hospital wards, in many instances, there is only one Staff Nurse in each shift duty, the rest are Assistant Nurses or Student Nurses. If more than one patient is taken seriously ill, or if two or three patients are critical, then pandemonium prevails. If there is a shortage of nursing staff, why is it that in some hospitals nurses are required to copy out in their own laborious handwritting Gazette notifications or departmental circulars concerning them? Surely a lot of nursing time could be saved if such notices or circulars are cyclostyled by the administrative staff.

Sir, the nurses prefer a three-night shift which is less strenuous than the old seven-night shift system. Although this system has been implemented in some hospitals there are other hospitals which still follow the old seven-night shift system. I do not know why this is so.

Mr P. Govindaswamy: Sir, since the increase in charges for out-patient treatment, members of the public find that visits to out-patient clinics are extremely costly and a great financial strain at times. I agree with the Government that whoever makes use of the medical services must pay a token share towards the cost, to check abuse in the unnecessary use of these services. A patient visiting the out-patient clinic pays $2 (the fee is $3 at the General Hospital) on his first visit, and quite often the doctor asks the patient to come back for further check-ups or treatment. All these subsequent visits cost $2 each. Such second visits, where the doctor sees whether the prescribed treatment is correct or effective, can last only 5 or 10 seconds. The patient still pays the usual charges. There are also occasions when a doctor refers his patient to another unit on the same day, and yet the patient has to pay at two places, though it is for treatment of the same sickness. Is it possible to waive the charges for these second visits, or at least reduce them in order to reduce the strain on the pockets of the poor?

3.30 p.m.

The Medical Service in Singapore must be one of the most unpopular professions for any aspiring young man of Singapore. Despite promotions and other incentives, doctors still continue to resign at an alarming rate. Can it be that this is not so much a problem of finance but rather a problem associated with working conditions? We still hear of doctors on duty for 24 hours. I wonder if any Members of the House have experienced 24-hour duty shifts. How can a doctor perform his best during the second 12-hour shift, when he would have been tired physically and mentally? As a result I believe that some of them do not diagnose the sickness thoroughly, and thereby patients become worse. Can something be done about these abnormal working conditions, before there is more brain drain towards the private sector or even to other countries? Sometimes offers of money alone will not work. The conditions must be right. Can the Minister give us the rate of resignations per month?

Sir, our Medical Service has a restriction on the recruitment of doctors who are trained in certain countries, unless they have passed an examination locally. Can the Minister enlighten the House with facts and figures? Since the introduction of this restriction, how many recruits in this category have applied, and how many have passed the examinations so far? Is it possible to revise these restrictions on some foreign university degrees which have attained worldwide recognition?

Dr Tan Eng Liang (River Valley): Mr Speaker, Sir, the Misuse of Drugs Bill was passed in this House on 16th February, 1973.

The Minister for Health and Home Affairs (Mr Chua Sian Chin): Sir, I object to the Member for River Valley raising the issue now when he has his own amendment under Head MA subhead AA 1105.

The Chairman: Is the Member for River Valley speaking on the Ministry's policy or is he going to speak on the next amendment?

Dr Tan Eng Liang: No, Sir. Actually what I am going to speak on is related to a decision by the Minister. It is a policy decision. And on the next subhead, I will be speaking on matters which also involve policy. But if the Minister wants me to take them together, I can do so.

Mr Chua Sian Chin: Sir, I think the matter can be dealt with in the next subhead.

The Chairman: All right. Dr Tan, you may speak later, then.

Dr Ong Leong Boon (Kim Seng): Sir, the main topic that I would like to bring up has been touched on by the Member for Anson. If the Minister agrees, may I raise it now, or would he rather prefer I raise it later?

The Chairman: Are you going to speak on the Ministry's policy?

Dr Ong Leong Boon: I would be touching on the subject of resignation of doctors.

The Chairman: Then it would be better if you speak on amendment (4)* when it comes up.

• Amendment (4), standing in hte name of Dr Ong Leong Boon, reads as follows:

That the total sum to be allocated for Head MA in respect of the Main Estimates be reduced by $100.

Mr Chua Sian Chin: Sir, may I refer to the Member for Telok Blangah first? He has raised this matter of uniforms of nurses. As a matter of policy, I would like to assure him, first of all, that it is not my policy to issue ill-fitting uniforms and ill-fitting shoes to our dedicated nurses.

May I just move on to the other matters which have been raised? The first point he has raised is that there are too many Assistant Nurses around, and he thinks that we are taking in too many Assistant Nurses in order to exploit them. That is certainly not true. In fact, it is not true that there are more Assistant Nurses than qualified Staff Nurses.

The other point which the Member has brought up is that Assistant Nurses have very little prospects for promotion or transfer to become student Staff Nurses. In fact, there is no lack of promotional prospects for them. Promotion from Assistant Nurse to Senior Assistant Nurse is based on merit and not necessarily based on the number of vacant posts. There are also opportunities for Assistant Nurses who do well in examinations to join as student Staff Nurses in the second year of the three-year Staff Nurse course. This is again based on examination results. Those who score 70 per cent and above are allowed to join these courses. Another opportunity also is given to serving Assistant Nurses who have failed to score 70 per cent but on the basis of good work are allowed to join the student Staff Nurse course. They are paid full salary while on this course.

The other point raised is the three-night shift system for nurses in our hospitals. As a matter of fact, the Ministry of Health agreed to reduce the seven-night duty cycle to a three-night duty cycle for nurses. This was agreed to in principle with the union concerned, with the qualification that a pilot scheme should, in the first instance, be introduced at the Outram Road General Hospital. To-date, some hospitals have been able to implement completely this three-night duty cycle They are the Outram Road General Hospital, Middle-ton Hospital, and the Trafalgar Home. Some other hospitals, however, like the Woodbridge Hospital, Kandang Kerbau Hospital, and Thomson Road General Hospital have partially introduced the three-night duty shifts. The point is that it is not the Ministry of Health that does not want to introduce the three-night shift in all the hospitals. The reason why some hospitals have not introduced it completely is due to the shortage of staff. The Member can be assured that in due course the three-night shift duty will be introduced in all hospitals.

With regard to granting of no-pay leave to nurses who wish to go overseas for their post-basic courses, the selection for granting this leave is based on the following criteria:

(1) The training course must be directly related to the development and expansion of the medical services.

(2) The course can be recognised for both post-basic increment, and

(3) The course is not available locally. For the information of the Member, for the years 1972 and 1973, only two applications for no-pay leave to go on a post-basic course have been turned down. In 1972, 31 applications were received, of which only one was turned down. This applicant wanted to apply to go on a course at a time when many of her contemporaries were already abroad completing a course in plastic surgery. For the 1973 case, the applicant was advised to proceed on other types of courses which would meet the needs of the medical services. But as she was adamant on her choice, her application was rejected.

With regard to the promotion of those who have obtained this post-basic qualification, may I say that it is not possible to promote everyone who has this post-basic qualification. In a promotion exercise other considerations have to be met with. Moreover, not every post-basic qualification can be recognised. As far as nurses going abroad are concerned, they are always advised as to which post-basic qualifications are recognised.

With regard to ill-fitting uniforms and shoes, may I say that uniforms and shoes are being supplied by a contractor. May I stress the fact that uniforms are made to measure. They are not ready-made uniforms. If, after measurement, the tailor does not give a fitting uniform then he will have to re-cut it at the expense of the contractor. Similarly with shoes. Therefore, it is not true to say that we are not aware of the fact. But such errors do occur sometimes, and when they do the contractor has to make good.

With regard to fixed allowance for midwives, may I say that midwives serving in the City districts are paid $60 per month and those in the outlying districts are paid $70 per month. Those serving in the rural areas are paid $55 a month. This, of course, as you can see, is an anomaly inherited from the former City Council and the Rural Board, which paid different rates. The question of fixed allowances is now under review. Fortunately, no decision has been arrived at, at the moment, and because of the rise in fuel prices and taxi-fares it has been necessary to restudy the matter.

With regard to the point brought up by the Member for Anson, may I just enlighten him on the $3 and $2 charges. A $2 fee is charged for each treatment in an ordinary outpatient dispensary, but a $3 fee is charged if one attends a specialist clinic attached to our hospitals. There is no such directive as the Finance Minister saying, "You charge $2 in this hospital and $3 in that hospital."

With regard to the increase in hospital fees. I am glad the Member for Anson agrees with the Government policy that whoever uses the medical services should pay a token sum towards costs. This helps to check the abuse of these facilities, and perhaps instilling in our people an awareness that nothing is for free. However, it is not true to say that doctors often request patients to come back for check-ups after treatment. Requests for patients to come for second visits are only made when necessary.

3.45 p.m.

With regard to the point about doctors being on call for 24 hours, may 1 enlighten the Member for Anson that this 24-hour on call duty is also true of doctors the world over, and certainly not peculiar to Singapore. However, I would like to say that it does not necessarily follow that the doctors do not sleep during such 24-hour duty. Perhaps the Member for Kim Seng can enlighten the Member for Anson on this matter. Nevertheless, doctors who are on call duty are given the day off the following day.

With regard to the resignation of doctors, I may have something more to say when the Member for Kim Seng raises the matter under a different subhead. So I do not think I will deal with it in detail now. But may I just say that there are many reasons for a doctor to resign from Government service. It may not necessarily be associated only with working conditions. Some go out to be in private practice because they believe that they can earn more money. In fact, those who are in private practice may have to work even harder, particularly when they are starting to establish their practice. On the analysis of resignation, Sir, among the doctors who have resigned there are those who do not go on 24-hour call duty at all, particularly those who work in outpatient dispensaries and school health clinics.

The other point is the amendment to the Medical Registration Act which the Member for Anson has raised. The major change in the amendment to the Act is that we now have a local list of recognised medical qualifications. In other words, persons with qualifications which are not on this list, however, may be registered by the order of the Minister after they have satisfied the Singapore Medical Council that they have reached a standard of competence to practise independently. Normally the Medical Council makes its recommendations to the Minister, under the provisions of the new Act. The person would have to go through an examination set by the Medical Council to test his competency. This is quite important because we are letting him free to practise independently, and if he is not competent he will endanger the health and life and limb of members of the public. In 1972, two persons who did not have the recognised qualification were so examined. One passed and was recommended for registration. In 1973, there were six persons who applied for registration and were examined. One was successful and has been registered. This year one applicant will be examined in March/April, and six others have asked to be examined in September 1974.

Mr N. Govindasamy: Sir, although the Minister said that it is not his policy to supply ill-fitting uniforms and so on, the point made is that public funds are being utilised to supply these uniforms. We expect public funds to be properly utilised. If the contractor supplies ill-fitting uniforms, though they are made to measure, I suppose something has to be done to see that we get a contractor who does not supply ill-fitting uniforms in spite of the fact that made-to-measure uniforms are called for.

Sir, I also raised the problem of nurses in the rural areas. They ought to be provided with more uniforms because they are out on the field. Nurses in hospital work within the confines of the hospital and perhaps they do not need as many uniforms as those who work in the outlying areas.

Sir, it is good to hear that promotions from Assistant Nurses to student Staff Nurses and Staff Nurses are based on merit. The word "merit" can be interpreted in many ways. Perhaps it would be better if the number of promotional posts available is made known as that would at least give the nurses an opportunity of knowing what to expect when applying for these promotional posts. As was pointed out, there are 1,800 Assistant Nurses with only eight promotional posts.

Sir, the Minister agreed with me that there is a shortage of nurses and that is why the Ministry is not able to implement the three-night shift system although they accept that it is a better system.

Mr Chua Sian Chin: In all hospitals?

Mr N. Govindasamy: Yes, in all hospitals. It has been done in some hospitals. But for the other hospitals, they are not able to do it because they are short of nurses. That is the point I am also trying to make - shortage of nurses. What is the Minister going to do about it? I thought I even pointed out that there was an occasion that I know of when there was only one Staff Nurse and the rest were either Assistant Nurses or student nurses. This is not a satisfactory state of affairs.

I should congratulate the Minister when he said that about 30 nurses were given leave to do post-basic courses. This bears out the point that these post-basic courses are necessary, and the fact that he gave the nurses leave to do this post-basic course on their own shows that this post-basic training is necessary. And as the Minister has said, when they come back there are no promotional posts available. My quarrel is not about promotional posts not being available. But after they have utilised their own time and their own money to go through an approved course -if it is not approved, he would not have given them no-pay leave - when they come back, they should at least be given the annual increment. No, they do not get it. I hope the Minister will give some consideration to this matter, and perhaps let me know why this is not being done.

Mr Chua Sian Chin: Mr Speaker, Sir, I have already explained the position. As far as post-basic qualifications for nurses are concerned, not all of them, in particular Staff Nurses, are entitled to an increment. But most of the courses do entitle the nurses to an increment. If they are entitled to it, they would have got it.

The other point made by the Member for Telok Blangah is that too many Assistant Nurses and Student Nurses are around, and not many Staff Nurses. Let me just give him the figures. The student nurse population as at 1st March, 1974, is 763, as compared to 2,182 qualified nurses. In fact, each ward has a team of an average of 19 to 20 nurses, made up of Sisters or Nursing Officers, Staff Nurses, Assistant Nurses and Student Nurses at various levels of training.

As far as shortage of nurses is concerned, every attempt has been made to expand the training school of nurses, and we have been getting larger intakes in the last year or two, in view of the expansion of our medical services. But, as you know, whatever calculations we make with regard to intake and projection, if we expand too fast, as we do at the moment, there is bound to be a shortage of manpower, including nurses. But the Member for Telok Blangah can be assured that we are training as many nurses as we can at the moment. In fact, when our calculations were made, they were based on a seven-night shift duty. But now because of the union's representation, we thought it reasonable and have changed it to a three-night shift. But surely the Member for Telok Blangah cannot expect us to do wonders and increase the population of nurses overnight. We do what we can.

The Deputy Prime Minister and Minister of Defence (Dr Goh Keng Swee): The union must co-operate.

Mr Chua Sian Chin: And as my colleague says, the union must also co-operate.

Mr N. Govindasamy: We always co-operate.

Mr Chua Sian Chin: Not just words, but in practice. The other point is about ill-fitting uniforms. I think there may have been some cases. But one swallow does not make a summer. In fact, even if the Member for Telok Blangah goes to a tailor, he does not expect a right fit on the first fitting.

Mr N. Govindasamy: Then I will change tailors.

Mr Chua Sian Chin: Yes, it is very easy for one person to change his tailor, but changing a contractor takes time. In any case, the contractor who gives the ill-fitting uniforms will be asked to change again and again, and that will incur more expense on his part. So that is his punishment. Of course, if he has been producing too many ill-fitting uniforms, he can be rest assured that he will not get the contract when the next tender comes up.

Mr P. Govindaswamy: Mr Speaker, Sir, regarding the Minister's reply about uniforms, if a contract is given to a contractor who has quoted the lowest tender, he does not sew properly and the uniforms will be useless. Moreover, the measurements are not taken properly. They just sew the uniforms and supply them to the nurses.

I would also like to ask the Minister about the charges of $2 and $3. Why is there this difference in charges between outpatient clinics and hospitals? I do not know the reason. If a person goes to a hospital, he is charged $3, but charged $2 if he goes to a clinic. The Minister has also promised that a person will be charged only once if he goes to an outside clinic and pays $2 and then subsequently he is required to go to the general hospital again on the same day. The Minister has promised that a person will not be charged twice in the same day for the same treatment.

Mr Chua Sian Chin: Sir, the Member for Anson has not understood me. I have never made any promises as far as charges are concerned because they are levied according to the manual which is not put up by me. But if patients are to be charged, they will be charged.

With regard to the difference between $3 and $2, I think I might have to take half an hour to explain to the Member for Anson for his enlightenment. This is in regard to specialist treatment for injuries and treatment of coughs and colds. Perhaps the Member for Kim Seng could help me explain to the Member for Anson outside Parliament the difference between specialist treatment and a simple outpatient service.

Dr Ong Leong Boon: Mr Speaker, Sir, in reply to the invitation of the Hon. Minister, I certainly shall explain it to the Member for Anson.

I would just like to put on record the point made by the Hon. Minister regarding the working hours of doctors in hospitals. I should hate to have it thought that, in actual fact, doctors sleep when they are on night calls. As a matter of fact, I think the Minister could bear me out when I say that doctors in hospitals work seven days a week, Sundays and public holidays included. And many of them go on night calls, at least twice, if not three times and sometimes four times a week. This means that they start work at 8.00 in the morning, work the whole night through till 8.00 the next morning, and continue till 2.00 p.m, the following day, which means putting in at least 30 hours at a stretch, depending on the exigency of the service when they may not be released until 5.00 p.m, the next day.

4.00 p.m.

Mr Chua Sian Chin: Sir, may I clarify the point about sleeping on duty? What I said was this. If they are on call duty, it does not mean that they cannot sleep. When they are on call duty, they can sleep but have to wake up when somebody calls the bleep. It is very foolish while on 24-hour call duty to keep waiting for the bleep. I think the Member for Kim Seng understands what I have been trying to put across.

With regard to the point that they work long hours, the situation was worse before, but not now. Because of the protests and so on, we have introduced a system whereby if a doctor is on night duty he gets an afternoon off on the following day. I cannot say that this system has been followed in every case, but it has been followed in the vast majority of cases. But, of course, being doctors they have to respond to the exigencies of the service. In fact, I know that in a few specialities, like surgery, obstetrics and gynaecology, they have to work longer hours than in the other specialities, maybe orthopaedic surgery.

Mr N. Govindasamy: Sir, I beg leave to withdraw.

Amendment, by leave, withdrawn.

Dr Tan Eng Liang: Mr Speaker, Sir, I beg to move,

That the sum to be allocated for Head MA be reduced by $10 in respect of subhead AA 1105*. (*The same amendment also stood in the name of Mr P. Govindaswamy.)

Mr Speaker, Sir, the present control of poisons, including caustic soda, is cumbersome and confusing as the Poisons Inspectorate section of the Ministry of Health, in enforcing the Poisons Ordinance (Chapter 146) uses under the Eighth Schedule a series of seven types of forms stretching from Form A to Form G. However, it is admitted that strict control on the purchase, storage and sale of sodium hydroxide (more commonly known as caustic soda) by the Poisons Inspectorate is indeed necessary as caustic soda is still one of the favourite suicidal poisons.

Rule (3) of the Poisons (Sodium Hydroxide) Rules, 1958, states that "it shall not be lawful to sell sodium hydroxide unless the purchaser holds a permit (i.e. Form E) to purchase same". Under the Poisons Ordinance a holder of Form A is licensed to import and store poisons, and presumably is allowed for his own use but he cannot sell. To sell, he requires to possess Form C. It is further complicated that while a holder of Form A can purchase caustic soda from anywhere outside Singapore, he is not allowed to purchase within Singapore unless he simultaneously possesses Form E.

During an emergency, such as shipping delay or out-of-stock situation, an industrial firm using caustic soda cannot temporarily buy caustic soda locally unless he possesses Form E as explained above. In this acute situation where a seller, in helping out an emergency, contravenes the law, he is prosecuted in court. A few "good-intention" sellers have landed in court and their rice bowls broken in performing a samaritan act. To avoid this situation and perhaps the only solution for the industrial firm using caustic soda is to stop production and await the approval of his application for Form E which normally takes three or four weeks.

Recently, the Director of Medical Services appears to have taken a retrogressive step in that licensees cannot simultaneously hold both Form A and Form E. This makes matters worse and the industrial sector is badly inconvenienced and simply cannot understand this illogical decision. Could the Minister for Health and Home Affairs explain the rationale behind this confusing state of affairs?

To solve this confusing situation in the control of caustic soda, may I suggest that the relevant Rules be amended and the procedure streamlined. Like many countries elsewhere, it appears obvious that the holder of Form A should be allowed to purchase caustic soda from both outside and inside Singapore, subject to any reasonable control procedure the Ministry of Health think fit.

The second point I would like to raise concerns the strict enforcement of labelling requirements for all scheduled poisons controlled under the Poisons Act and Poisons Rules. Here again, the Poisons Inspectorate is too rigid and do not allow any degree of flexibility within the scope of people who are suitably qualified or authorised to handle the use and sale of poisons.

In most instances, imported poisons are already labelled with the word "Poison" in the English language. In these cases, exemptions should be granted to sales made to trading and manufacturing firms with knowledgeable, qualified and authorised personnel, in the case of poisons sold to the public (e.g, at retail pharmacies), it is understandable that the word "Poison" should be written in the four languages.

Currently, importers have to label these preparations when they sell them to the trade. However, the moment these goods arrive at the retailers they in turn paste their own label on it. Usually, the first label is either removed or superimposed by the second label. This is because the name and address of the seller has to be included in the label at each stage. The label put by the importer, therefore, serves no useful purpose between the importer and the retailer. This wastage of labour and labelling material will again lead to higher expenditure which will finally be passed on to the end-users.

Many importers of new drugs and poisons have found the approval procedure very arbitrary, especially in border-line cases. There appears to be no co-ordination between relevant departments and frequently importers are pushed from one department to another. Although the Poisons authority insists on the requirement of a qualified pharmacist to present the case, far too often the authority is simply represented by a clerical officer, who finally makes his recommendation to his qualified superior. Occasionally, there appears to be a "bargain or negotiation" taking place during this discussion. This unhealthy situation also needs streamlining. I would like to suggest that a permanent assessment committee be set up consisting of knowledgeable and qualified representatives and given proper terms of reference and guidelines to work with.

I understand that there exists a Poisons Advisory Committee (PAC) which seldom sit and only meet when necessary. Perhaps the PAC should be given a "shot" to wake them up. It should be completely re-organised and re-vitalised with proper terms of operations and guidelines. One of its more important functions must be the continuous review of Poisons regulations and to keep up-to-date with recent information on the availability and danger of existing and/or new poisons. At the moment, the decision to ban an existing poison or to add a new poison to the Poisons Schedule is based on an ad hoc basis. Frequently, incomplete or partial information is used in the assessment.

Available published literature shows that for the period 1960 to 1969, 114 deaths were due to caustic soda poisoning consisting of 90 per cent suicides and 10 per cent domestic accidents. For the same period the number of deaths due to salicyclates poisoning was 21 cases consisting of 50 per cent suicides and 50 per cent domestic accidents. This 50 per cent of domestic accidents mostly involved young children. The majority of these cases were due to methyl salicyclates, as it is the common ingredient used in the popular medicated oils used extensively in external application by the Chinese. Most Chinese families stock a few bottles of these medicated oils at home and they are sometimes used as a sort of panacea. On certain occasions, such as in the revival of unconscious persons, a small amount is even taken orally.

More recent available figures for the four years 1970-73 revealed 10 deaths due to caustic soda poisoning, whereas the number of deaths due to methyl salicyclates poisoning was about 3� times more (36 cases). This clearly shows that deaths either suicides or domestic accidents due to methyl salicyclates poisoning have now come to the forefront.

The Department of Chemistry Annual Report for 1972 gave a figure of 140 tests for salicyclates detected in biological samples. In addition, tests for salicyclates were also conducted at other public testing institutions such as the Department of Pathology. For 1973, the Department of Pathology reported 91 tests for salicyclates submitted by the Hospital Authorities. From the above figures (both deaths and tests), it is obvious that poisoning due to salicyclates has achieved wide proportion. Yet the Poison Advisory Committee is still sleeping and doing nothing about it. As mentioned earlier, the Ministry of Health has stringent and complicated procedures for the control of caustic soda but salicyclates is not even placed in the Poisons Schedule. I would therefore like to suggest that, in the first instance, salicyclates should be placed in the Poisons Schedule. This will help to effectively control and prevent domestic accidents and deaths in some cases of small children and young adults.

I would like to suggest the setting up of a Poisons Information Centre. The list of available poisons is expanding rapidly and a store-house of the latest information on existing and new poisons is most essential. Many professionals such as the medical practitioners, pharmacists, chemists, etc. are sometimes caught in a situation where they are in no position to recommend a treatment for a particular new poison. The availability of the Poisons Information Centre for consultation under such a situation will be most helpful. It is not suggested that the Centre should be established on the scale as those in Japan, Edinburgh or London. For a start, a small Information Centre is suggested.

Lastly, I would like to comment on the Misuse of Drugs Act, 1973. The Act became operative in July 1973 and contains extensive provisions for the regulation and control of dangerous and harmful drugs - referred to as "controlled drugs". Nobody will dispute the need for such stringent control, especially with the increasing problems of drug peddling and drug addiction facing our society now.

Sir, I support generally the wide provisions in the Act, but it is my opinion that the implementation part requires streamlining. I regret to suggest that the enforcing officers are extremely bureaucratic and do not exhibit any sense of discretion or flexibility.

Section 34 (1) (d) of the Act empowers the Minister to make regulations "requiring medical practitioners, dentists, pharmacists, veterinary surgeons and other persons who deal in controlled drugs as may be authorized by regulations made under this Act to keep records and make returns". Arising from this provision the enforcing authority makes rules insisting that all purchase, storage and usage of controlled drugs must be registered in a specially bound book and that entries must be made daily. To comply with this regulation, clinics and surgeries have to employ a clerk just to do the monotonous task of posting the controlled drugs.

The Chairman: Your time is up. Dr Tan.

Dr Tan Eng Liang: Let me summarise it then.

The Chairman: Your time is up.

4.15 p.m.

Mr P. Govindaswamy: Mr Speaker, Sir, what measures are being taken to introduce an emergency unit at the Alexandra and the Sembawang Hospitals? The Alexandra Hospital should be expanded to serve the urban population of Alexandra, Queenstown and Telok Blangah. An emergency unit at this hospital would help to relieve strain at the Outram Road General Hospital. At present any emergency treatment in the Sembawang area i5 referred to the Thomson Road Hospital unit. Travelling that distance from Sembawang to the Thomson Road Hospital may quite often be a waste of time, for the narrow roads are reputed to be crawling with traffic.

Sir, I understand our hospital wards are crowded, and there is usually a long waiting list. Why not introduce a `Home Care' service in hospitals as introduced in some countries? Patients who have the necessary people to look after them in the home can be discharged from the hospitals early so that their beds can be occupied by those who are really serious. A nursing service that can keep an eye on these discharged patients can be introduced to help those who are looking after their patients at home. Valuable time and money can be saved in this way. Further, patients have a better chance of quick recovery when they are being attended to by their loved ones.

Sir, recently there was an outbreak of typhoid fever in isolated areas. May I know what remedial action has been taken to stop the fever from spreading?

Mr Chua Sian Chin: Sir, may I answer the Member for Anson first? For the Member's information, there is already an emergency unit at the Alexandra Hospital. It was opened in November 1971. However, at the beginning it was providing a limited service, i.e, only during office hours. In the middle of last year the hours were extended to 9 p.m, on weekdays and 5 p.m, on Sundays. But from the 1st of October last year, it operates a 24-hour service. At the same time, a new emergency complex, complete with operating theatres, X-ray department and intensive care area, was being developed in the Alexandra Hospital. This complex is expected to be comp1eted in May this year. This will certainly help to relieve the load on the Outram Road General Hospital.

With regard to Sembawang Hospital, an emergency unit is also being constructed there, and this will be completed in the middle of this year.

With regard to `Home Care' service as suggested by the Member, this is being looked into by the district nursing service which cares for patients who are discharged from hospitals. Similar care for mothers and new born babies after delivery are also provided by midwives. T.B., leprosy and V.D. patients are visited by investigators. However, all these services are in the process of being reorganised. It must, however, be pointed out that such services are not economical since considerable manpower has to be expended on the field. Whereas only four to six cases can be attended to per day by such visits, three or more times the number can be attended to at our Maternal and Child Health Clinics as well as the school clinics if the patients go to these centres.

With regard to overcrowding of hospital wards, I have to inform the Member that now there is no overcrowding particularly after we took over the Alexandra and Sembawang Hospitals. Together, these two hospitals have an additional 469 beds. The Alexandra Hospital has at the moment 405 beds. This number will be increased to 430 beds. Furthermore a small hospital will be built in Changi to be called the Changi Chalet Hospital. This hospital will be equipped for the treatment of emergency, outpatient, and X-ray services and minor laboratory investigation. It will have about 36 beds. It is expected to be completed by the middle of this year.

That is all I have to say with regard to the queries raised by the Member for Anson.

Regarding the points raised by the Member for River Valley, I am glad, Mr Speaker, Sir, you ruled that this matter should have been brought up under a separate subhead. The whole tenor of the speech of the Member suggests that he was confused with regard to the rules pertaining to our Poisons Act. First, let me refer to the sodium hydroxide rules under the Poisons Act, 1958. May I inform the Member for River Valley that it is a simple piece of legislation with six paragraphs. Its purpose is to regulate the sale of sodium hydroxide, commonly known as caustic soda, so that it is available only to persons who require it for trade, business or industrial purposes. This has been made necessary to reduce the incidence of poisoning, intentional or otherwise, by this chemical which has caused death and injury prior to the introduction of this control. The rules require that licensed sellers may sell sodium hydroxide only to persons holding valid permits issued by the Ministry. Permits are issued free of charge to persons who have satisfied the Ministry that sodium hydroxide is necessary for their industries. In order not to inconvenience industrialists, permits are issued for quantities estimated for six months' requirements. Further, persons who wish to buy sodium hydroxide for resale, export or for scientific and educational purposes are exempted from applying for these permits. The rest of the rules consist of instructions to sellers when handling these permits and are well understood by all licensed sellers.

With regard to the flexibility in labelling control which was referred to by the Member, may I say that poisons are controlled because of their toxicity and potentially harmful properties and in order to prevent accidents arising from their use. For the safety of workers handling these poisons, one basic requirement is that containers for poisons should be labelled with the name of the poison contained therein and with the cautionary words "POISON - NOT TO BE TAKEN" in red ink and any other specific cautions relevant to the form and danger of the chemical concerned. For example, sodium hydroxide is to be labelled "Poison - This substance is caustic." And the Poisons rule provides that they be printed in English, Chinese, Malay and Tamil.

The requirements of labelling provided in the Poisons rules and enforced by the Ministry of Health are minimal for the protection of all persons handling dangerous chemicals in factories, laboratories, etc. These requirements are basic and universal. Any relaxation of these requirements would increase industrial hazards which I believe my NTUC colleagues would not support because it would be creating hazards for the workers.

There are certain relaxations in labelling provided. For instance, all drugs including patent medicine classified as poisons if dispensed on a prescription need not be so labelled. Certain groups of medicine, e.g, insulin and antihistamine preparations, may be labelled with only the word "POISON" and in black letters.

With regard to the Poisons Advisory Committee, this committee advises me on matters with regard to poisons and drugs. In fact, it is an ad hoc committee and not a standing committee. I do not think it is fair to say that this committee has gone to sleep. In fact, it is an ad hoc committee and a meeting of this committee is called when there is any matter to be discussed on and for their advice. In fact, this committee met on several occasions and made certain recommendations.

With regard to further control to regulate the use of drugs, this is covered by two other Acts apart from the Poisons Act, namely, the Medicines (Advertisement and Sale) Act passed in 1968 and the Misuse of Drugs Act passed in 1973. However, may I say that additional controls are also being considered and my Ministry is now looking into measures for the registration of all medicinal products recommended for treatment of human ailments. The quality of control of all finished medicinal preparations are also being looked into. In fact, this is an all-embracing control and very much has to be done, and a thorough Medicines Bill is now in the process of being drafted. There may be some loopholes here and there with regard to medicines sold in Chinese medicine shops, and they will be taken care of when the new Medicines Bill is passed. At the moment, this very comprehensive Bill is being drafted.

Dr Tan Eng Liang: Sir, the Minister has completely missed all the points that I have raised. I am not quarrelling about the rules in the Poisons Act. I am fully aware of the six paragraphs in the Act. What I am suggesting is fairly straightforward. Why is it that a person, who holds Form A which allows him to buy caustic soda from anywhere outside Singapore, cannot be allowed to buy sodium hydroxide within Singapore? In other words, the law requires that if he holds Form A under the Poisons Act, he must simultaneously hold Form E under the sodium hydroxide rule 1958. Without this Form E, he cannot buy caustic soda locally. My question is straightforward. Why is it that a person, who is authorised by law by holding Form A to purchase caustic soda from anywhere outside Singapore, is not allowed to buy caustic soda within Singapore unless he holds Form E? That is the gist of the first point that I want to make.

The second point is on the question of labelling. I am not suggesting any leniency or relaxation of the Poisons Act or the Poisons rule. From the practical point of view, I am saying that the enforcement section, in particular the Poisons Inspectorate, does not exercise any common sense at all and no sense of discretion. I went through the trouble to quote the examples. For example, an importer already imports a certain poison with the label "POISON" in English, and what he does is to sell this labelled poison to a trading firm or to a manufacturing firm which intends to repack and sell it to the pharmacist. Therefore. I am saying that there is no necessity for the importer, having bought this carton of poison, to put the word "POISON" on the carton in four languages and send it to the retailer, because the retailer will tear the whole label out and put another label "POISON" in four languages inside the carton. I do not see the logic. I am trying to explain that this requirement is unnecessary, and in terms of labour and labelling material the end-user finally has to pay a higher price for it. I am saying that some discretion be exercised in the interpretation of this simple rule. I am not suggesting any relaxation.

4.30 p.m.

The third point, as far as the Poisons Advisory Committee is concerned, is precisely what I am trying to get at -that decisions are made on an ad hoc basis. To ban or to include a poison is a decision made on an ad hoc basis. So I have suggested very clearly that there should be a permanent committee. So on these three points, the Minister has completely misunderstood me.

The next point that the Minister has not answered is my suggestion on the procedure for approval. I mentioned that there is no co-ordination between relevant departments. I have also mentioned that on the one hand the Poisons authority requires the retailer or the importer to have a pharmacist to present his case and yet, on the other hand at Government end it is only a clerk who tries to negotiate. I am suggesting that a more permanent committee be set up, which the Minister has not even touched on.

The next point which I wanted to say was that I went through a lot of trouble collecting statistics to show why - and I am sorry to say the Minister did not quite understand what I was trying to get at with all the confusion of the control of sodium hydroxide -there is a need to put methyl salicyclate under the Poisons Ordinance. I illustrated that for the whole period 1970-73, there were only 10 deaths from caustic soda poisoning whereas there were 36 cases of salicyclate poisoning. I would have thought it obvious that the Minister would give a reasonable reply and say, "O.K., we will put it in the Poisons Schedule", or "We will consider it." Instead he completely dismisses all the efforts I have put in. He did not say anything about it.

Finally, in connection with this lack of co-ordination and also this non-flexibility or complete lack of discretion on the part of the enforcement section, I am suggesting that although laws are passed by Parliament with good intentions, sometimes the spirit and intention are completely misinterpreted by those responsible for its implementation. This is serious because it can lead to misunderstanding between the Government and the public. This sometimes leads to resentment against the Government.

Let me sum up the last point on the non-flexible bureaucratic approach. Under the Misuse of Drugs Act every medical practitioner or practising surgeon must put an entry into a specially bound record book whatever he buys, uses and stores. And he must employ a clerk to do all this monotonous work. Because of section 34 (1) (d) of the Act, the enforcement section in the Ministry of Health insists that it must also be a specially bound book approved by the Ministry of Health officials and that entries must be made in the book every day. I do not see the logic of it. Consequently some doctors have been summoned to court on a technicality, which defeats the usefulness of this Misuse of Drugs Act. Perhaps the Minister could please comment on these few points.

Mr Hwang Soo Jin: Sir, in all fairness, let me say that the Member for River Valley is a highly qualified chemist, whereas the Minister is not. It does seem to me that the Minister has been fed with all sorts of wrong information, and it is about time we changed the Chief Chemist in the Ministry!

Mr Chua Sian Chin: Sir, if the Member for River Valley is less excited about the whole matter, I think he would have understood some of my answers. The trouble is he gets so excited that he does not understand me.

With regard to the point he raised about Form A and Form E, may I say that if anyone buys from outside, that means he is importing. That is quite different from buying within Singapore. He may be an importer, a small time consumer or a big time consumer, but if he buys in Singapore, that is not importing. So different rules apply.

With regard to the Poisons Advisory Committee which advises me as Minister, I am not saying that we will not consider his recommendation of a permanent committee. I am just pointing out to him that it is not fair to ask an ad hoc committee to meet regularly. He says this committee has gone to sleep. In fairness I must stand up to defend this committee. It is an ad hoc committee and it only meets when it is called to meet. So it is unfair to say that it has gone to sleep. The suggestion of the Member for River Valley was that we must form a permanent committee. Well and good, we will consider his suggestion. Perhaps I might even nominate him to be Chairman of this committee, since he is so well versed with the small details. If I do, then the suggestion made by the Member for Jalan Kayu will be met and I will be fed by a well-qualified chemist on matters of poisons.

The other point complained of by the Member for River Valley is that these rules and regulations have not been implemented in the right spirit, but carried out to the letter of the law. There are always two sides to a question. That was his point of view, whereas the enforcement officer has his point of view. The trouble is that while he has made this allegation, I do not have the enforcement officer here to confront his charges. But since I represent them I will do as best as I can. Sir, I do not know of the actual instances where he says that they are unimaginative in their action. But to be fair, I always listen to both sides of the story and come to my own conclusion, not just one side of it.

Mr Hwang Soo Jin: Sir, just a point of clarification. I did not say the Minister has been fed with the wrong poison!

Dr Tan Eng Liang: Sir, I do not think it is my job to go into small details, as the Minister has implied. He has a whole army of qualified people from the Director of Medical Services downwards. I am suggesting what I think the public are thinking, and I am reflecting their views. Perhaps to satisfy the Minister, what he has to do is simply to ask the public. Go round to some clinics, surgeries or manufacturing firms and see what they think of the enforcement officers, in particular the Poisons Inspectorate.

I think it is unfair for the Minister to suggest that since I have brought the matter up, then I had better do it. This is a wrong attitude.

I am still not happy with the reply because either I am misunderstood or I do not understand him - put it that way. I think this point of logic is very important because it means either an industrial firm has to stop production or not. I grant that if one is allowed to buy anything from outside Singapore, that means importing. Whereas if one buys anything locally -

Mr Chua Sian Chin: It is not import?

Dr Tan Eng Liang: Yes, but it does not make sense. For example, a person imports sodium hydroxide all the way from Germany and if he tries to help me as my shipment is delayed, he gets prosecuted in doing this good act. I am trying to tell the Minister that it does not make sense. Maybe that 1958 rule requires amendment. Therefore, it is time the Inspectorate woke up to what other people in the world are doing. If the Minister cannot accept that, then I am sorry that I still maintain my views.

Mr Ho See Beng (Bras Basah): Sir, I think the Member for River Valley has a point. Poisons may mean life or death. That is why he gets so excited. I think the Minister is too light-hearted. He does not concern himself with this problem as an important one. The Member for River Valley has mentioned that the oil of methyl salicyclates (the common name is Winter Green) has caused a number of deaths. The Ministry of Health allows this oil to be sold very freely. I do not understand why this oil, which, is classified as a deleterious drug, is sold so freely in the market.

Mr Chua Sian Chin: Sir, I think the Member for Bras Basah is a bit confused when he says that the Ministry of Health or myself has not taken this point very seriously. I do not think the Member for Bras Basah has even understood the Member for River Valley because his complaint is that they have been too strict about it. As far as sodium hydroxide is concerned ---

Dr Tan Eng Liang: I think he is right.

Mr Chua Sian Chin: No. They are erring on the side of safety as far as sodium hydroxide is concerned, because there have been deaths caused by caustic soda or sodium hydroxide, whether intentionally or unintentionally.

With regard to methyl salicyclates, I have already said in my answer that we are now going to alter the classification of medicinal products and we will have that embodied in it in a comprehensive Medicines Bill. Perhaps the Member for Bras Basah will understand now that this matter was not taken in a light-hearted manner, though in a debate we do not want any fisticuffs. We take it with a sense of give-and-take, not in a fighting manner as otherwise we might end up with fists flying and so on. I am glad to see smiles on the faces of Members!

Dr Tan Eng Liang: Sir, I think in future queries on more technical matters, the DMS or the Permanent Secretary should be present to help the Minister concerned.

However, although the reply was unsatisfactory, I withdraw my amendment.

Amendment, by leave, withdrawn.

The following amendment stood in the name of Mr Hwang Soo Jin -

(3) That the sum to be allocated for Head MA be reduced by $10 in respect of subhead HA 1109.

Mr Hwang Soo Jin: I am not moving, Sir.

The Chairman: In that case, I think it will be a good idea to have a break at this stage.

Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House.

Mr Speaker: I suspend the Sitting and shall take the Chair again at 5.15 p.m.

Sitting accordingly suspended at 4.43 p.m. until 5.15 p.m. Sitting resumed at 5.15 p.m.

[Mr Speaker in the Chair]

Debate in Committee of Supply resumed.

[Mr Speaker in the Chair]

Head MA (contd.)--

Dr Ong Leong Boon: Mr Speaker, Sir, I beg to move,

That the total sum to be allocated for Head MA in respect of the Main Estimates be reduced by $100.

Mr Speaker, Sir, last year during the Budget debate, I raised several matters regarding the future of the health service in Singapore and expressed grave concern about the decreasing number of Singapore students who chose medicine, dentistry or pharmacy for a life-time profession. At the same time I pleaded with the Health Minister to review salary and service conditions so as to provide better incentives for doctors and dental surgeons to stay in the public service and simultaneously to attract more students to study for these professions.

Sir, it is a year since, and sad to say, no definitive action has been taken to solve these problems. I am alarmed by the degree of discontent and low morale among hospital staff. This has been compounded by the world-wide inflation in 1973 that served only to further aggravate the situation. To illustrate this, may I quote figures of the number of doctors resigning from the Health Ministry from 1970 to 1974? Resignations 1970 35 1971 44 1972 69 1973 67 1974 (January to March only) 53 These figures eloquently speak for themselves. For the first three months alone this year, 53 doctors have resigned. It is conceivable that by the end of this year many more will leave - multiply 53 by 4, and we will have more than 200 resignations. Sir, are we to wait any longer to see more resignations before remedial action is taken by the Health Ministry to keep doctors in service?

Perhaps what is more disturbing today is not the exodus of doctors from the public to the private sector, but the growing number of doctors and dental surgeons who have left or are leaving Singapore to work or emigrate to Australia, New Zealand, the United Kingdom, U.S.A, and Canada! I hope the Hon. Minister can produce figures to highlight this very sad and very regrettable state of affairs.

The last comprehensive salary review for doctors was more than 10 years ago. Unless an immediate review of salary and service conditions is made, the future of the health service and health care for our people will hang precariously in jeopardy.

As it is today, the hospitals are grossly understaffed. Work-load continues to increase. New hospitals and new departments are set up and with fewer doctors the work-load per doctor naturally increases. Some departments, I am sure the Hon. Minister is aware, are now running with just a skeleton staff. I am sure the Hon. Minister is also aware that departments are running with one senior registrar when there should be four, and two medical officers when there should be seven, and five housemen when there should be eight or nine. What incentive is there to keep the remaining doctors from leaving?

Sir, private practice is attractive with every good prospect of earning multiples of the salary that institutional service offers. Most certainly it is preposterous to expect Government to substantially increase salaries to match the private sector. What can be done is to raise salaries to a more realistic and reasonable level and at the same time to offer fringe benefits such as housing. Housing for the middle income group in Singapore is without doubt its biggest problem. This problem has been raised in Parliament during this Budget debate and the Government has shown full cognisance of it. The cost of private housing has soared way beyond the reach of doctors and other middle income wage earners. I am confident, Sir, that doctors will stay in service if housing benefit is extended amongst other incentives.

The Health Ministry has made desperate attempts to solve the doctor crisis by recruiting foreign doctors into Singapore. More and more doctors are being recruited from India and Ceylon. Recently, doctors from the Philippines, Taiwan, Korea and even Indo-China are recruited to prop up our hospitals. I wonder if this move of the Health Ministry is a temporary measure to meet the doctor shortage, or is this going to be a permanent feature. Paradoxically, we in this country have enough doctors of our own to staff our establishments. Sir, I do not propose to discuss the merits or demerits of recruiting foreign doctors. What I hope will not happen is a situation in this country like that in Britain today where its hospitals and allied institutions are run by foreigners.

Besides the need for a review of salary and service conditions, there is an urgent need to attract and to encourage more students to study medicine. This is all the more necessary with the projected plans to build new hospitals. Has the Health Ministry made any projection of its staff requirement say, in five years' time? Sir, this month, out of 26 dental surgeons who graduated from the University of Singapore, not one is a citizen of this country. With more than 100 houseman-posts available, not more than 60 Singaporeans are expected to graduate as doctors from our medical school which proudly boasts to be one of the top medical institutions in the Commonwealth.

Sir, with regard to part-time doctors, some 20-30 per cent of doctors are females. It is a well-known fact that many female doctors are not practising their professional expertise as they are also at the same time expected to be good housewives and mothers. In view of the current staff shortage, would the Hon. Minister reconsider the Ministry's stand not to accept these lady doctors for part-time service? Requests for part-time employment in the Health Ministry by lady doctors have up till today been rejected. The medical establishments can well do with these additional hands. The public spends almost $10,000 a year to train medical students to become doctors. Can the Ministry justify this huge expenditure if the expertise obtained is to waste behind kitchen doors?

Mr P. Govindaswamy: Mr Speaker, Sir, according to the Member for Kim Seng a lot of doctors have resigned since 1970. Could it be that there is discrimination in their promotions? There are also some specialists who have resigned. How is it that foreign doctors are promoted whereas our local doctors are not promoted? If they are not promoted they will resign. The Minister must find out why Singapore is short of doctors. Foreign doctors from Australia, U.K., Brunei, and Malaysia, including India, can be accepted. The Minister must reconsider this matter and try to recruit foreign doctors who are able. It is unfair not to accept foreign doctors. Otherwise next year there will be a bigger shortage of doctors. But if the Minister does not care about the shortage, who will suffer? The people will suffer, and therefore he must take into consideration what I have said.

Some Members: Hear, hear!

Mr Chua Sian Chin: Mr Speaker, Sir, listening to the Member for Anson makes one think that only he is concerned about the shortage of doctors, not the Minister or the Ministry. I think he has made a very far-fetched statement.

May I just deal with the Member for Kim Seng now? He spoke about the shortage of doctors last year and also about why they should have their salaries revised and so on, and that nothing has been done to date. That is not strictly true because, as far as our specialist doctors are concerned, their pay has been increased by the recent increase in specialist allowances. Further, they can now be promoted on merit and their promotion will not be dependent upon vacancy in the posts available. In fact, there is no limit to the superscale level to which they can be promoted. For example, a head of a unit has been promoted to Superscale Grade D, whereas in the past heads of units were limited to Superscale Grade E. That is just for a start. There have been promotion exercises, and it is not true to say nothing has happened.

But as far as medical officers are concerned, hon. Members may be aware that the National Wages Council has been given the responsibility of reviewing salaries not only of doctors but also others in the context of the nation as a whole. In fact, to be fair, doctors are not the only professionals working in the Government. There are architects, engineers, and so on. So any increase or revision in salaries must also include the doctors. Of course, as the Health Minister, I would very much urge that their terms and conditions of service are improved. But, before the National Wages Council deliberates over these matters, the medical officer, in the meantime, has benefited from the 13th month payment - there were two 13th month payments in one particular year - and also the 9 per cent wage supplement as recommended by the National Wages Council. So it is not true to say that nothing has been done with regard to their salaries. Something has been done although perhaps not as much as we wish it to be. But it is rather odd - and I am not saying anything in objection - that salaries of doctors have been raised again and again in this august Assembly, but so far I have not heard in this Chamber of any raise in salaries of accountants, engineers and architects employed by the Government.

5.30 p.m.

The other point is the resignation of doctors. Let me hasten to assure the public that they should not be alarmed. Although the rate of resignation has increased, I do not think the way in which the Member for Kim Seng has presented the case is correct, that is, just because there has been a large number of resignations in the first few months of this year, resignations will come up to a very high figure by the end of the year. I do not think that will happen. I would like to assure members of the public that although we are understaffed at the moment we are not badly off. In fact, some years ago doctors had to work longer hours. At the moment, although not in all hospitals but in quite a number of hospitals, doctors have been given a day off following night duty.

With regard to the figures about the resignation of doctors in 1970, which the Member for Kim Seng quoted, they are more or less correct. They tally with my figures although there may be a difference of one or two. Then he did ask me how many of these doctors had emigrated to Canada, Australia and so on. I do not have the actual figures, but the figures which I have on migration are obtained from various sources, that is, the Singapore Medical Association, medical colleagues, the Medical Register and so on. I can say that in 1973, out of the 67 resignations, four went to Australia, one to Brunei, one to Canada, one to India, one to New Zealand, one to Sibu, two to the U.K, and 10 joined the University of Singapore. And 41 of them actually resigned for personal reasons, which means that they are probably in private practice earning, as the Member for Kim Seng has said, three or four times more. If they want to earn much more money in private practice, we cannot help it. But we try our best to retain them. In fact, as far as the movement of doctors from Government service to private practice is concerned, as Members would know, we have introduced two schemes to get them back to work for at least a few sessions in our hospitals. First, there is the part-time consultant scheme whereby those in private practice who volunteer to work in the hospital will be paid a certain sum per session. This scheme is particularly helpful to those departments which need the specialists concerned. The other scheme, of course, is the appointment of honorary consultants so that their expertise will not be lost in the private sector. In fact, they will see more searching cases in the hospitals and their talents will be more usefully employed there than in the private sector.

Now, on the point about foreign doctors having been recruited into the Singapore health service, may I say this? As far as Government policy is concerned, we do not go out of our way, for example, to advertise in the press to recruit doctors from other countries. Any applicant who writes in and is found suitable for recruitment is offered employment. Recruitment of foreign doctors into the service is in the main confined to those with higher qualifications. With regard to the breakdown of figures of foreign doctors which we have employed, may I say that the largest group consists of Malaysians. We have in service today 43 Malaysian doctors, 16 of whom are with higher qualifications and 27 without higher qualifications. The second group consists of 13 Ceylonese, 11 of whom have got higher qualifications, in other words, they are specialists. Only two of them are without higher qualifications. We have also six Indian doctors, two with higher qualifications and four without higher qualifications. And there are 14 others, five with higher qualifications and nine without higher qualifications. Altogether the number of foreign doctors is 76. As far as our policy is concerned, as I have said, we do not go out of our way to recruit foreign doctors. If they apply and if they are found suitable, we employ them if there are vacancies. We cannot be too choosey in our recruitment. If we have vacancies we fill them up. Of course, we are very concerned about their competence and standards. In fact, as I have said, most of them have higher qualifications. For the information of Members, the vast majority of the Indian and Ceylonese doctors we have recruited have recognised higher medical qualifications from the U.K. Their qualifications include the M.R.C.P. London, or Edinburgh, or F.R.C.S,. London, or Edinburgh. Most of them had hitherto held specialist positions in the U.K, hospitals. On recruitment into our service they were appointed directly to consultant positions, as for example, Senior Registrars. Thus with regard to the policy of appointing doctors from overseas which I have enumerated, the possibility of recruiting incompetent doctors is very much reduced.

The majority of them have performed satisfactorily. However, in any group there would be a few who might not perform as satisfactorily as we would have wished. In this respect there has been only one case in which it has been necessary to terminate the contract of a foreign doctor. This was not for lack of competence but because he did not fit well into the service. However, if any one of them is found to be incompetent. We can easily terminate his contract.

With regard to the intake of medical and dental students into our medical schools, I agree entirely that we should do our very best to get our citizens to take up medicine and dentistry. But, unfortunately, it appears that with rapid industrialisation going on in Singapore and the shortage of engineers, architects and accountants, many of our young men now tend to opt for such courses and overlook medicine and dentistry. This is the situation we are now facing. But, in any case, we will give them every encouragement to take up medicine, not only for an under-graduate course but also a post-graduate course for those who have already qualified. In fact, we have devised a very attractive training scheme for young doctors to take up a higher qualification. I do not think there is much complaint as far as that scheme is concerned. Many doctors have taken advantage of that scheme and, as a result, we produce quite a large number of Masters of Medicine in the various specialities each year.

With regard to projections for staff requirements, may I say that there are not only new projections but also new services as well. This is based on the criteria determined by actual observation in the ward. For example, in the medical unit, for every 70 beds there should be a staff complement comprising one consultant, two senior registrars, three medical officers and three to four housemen. The figures are higher, for instance, in the surgical, obstetrics and gynaecology wards. Of course, this is the ideal number. We try to project the Ideal, but if we do not have the ideal number we try to make do with what we have.

With regard to incentives to retain doctors in the service, particularly young doctors, apart from the scheme for Government officers to be eligible for housing, we are also considering building some blocks of flats for medical officers as part of the development of the new hospital that is coming up in Outram Road. I am personally very sympathetic to the need of doctors for houses, especially the young doctors, who have not established their own homes. My Ministry has recently appointed a committee to study this question and to make recommendations. I believe that if our young doctors are given houses they will not only be tied down to their service but they will also have something to lose if they think of emigrating.

Before I go on to the Member for Anson, I might as well enlighten the Member for Kim Seng about employing lady doctors part-time. I would like to say straightaway that we have a scheme at the moment to employ lady doctors part-time. It is not that we have no such scheme. In fact, there are two schemes whereby doctors in private practice can be appointed to the medical service. The first Scheme A is based on sessional appointment where we pay $30 for a two-hour session up to a maximum of $400 a month. The second Scheme B is a part-time appointment paid in proportion to the hours of work given each week to a 42 hourly times the last drawn salary. Such appointments would be for those who were previously in Government service. At the moment, in respect of Scheme A we have four appointments. For the information of the Member for Kim Seng, three of them are married women and I think one is a male doctor. With regard to Scheme B, two lady doctors have also been appointed. In other words, they are being utilised for the benefit of the medical service. It is not true to say that their applications are not considered at all. We will be happy to take in a larger number under this scheme. Perhaps the Member for Kim Seng can encourage some of his colleagues to apply for these appointments.

5.45 p.m.

Unless I have left out anything else that the Member for Kim Seng has raised, may I just go on to the Member for Anson. The Member for Anson has again brought up the question of the recent amendment to the Medical Registration Act whereby we have in our local List excluded medical schools in India. This does not mean that those who graduated from medical schools in India are not able to practise in Singapore. Under a certain provision of the Act, they can apply to practise. The Singapore Medical Council will judge their competence by invariably setting an examination, and on passing the examination, they will be registered. I have already answered this question when the Member for Anson raised it at the last Budget debate. Of course, the Member may have his own views. But that is the position. It is very important that we guard our standards of medical practice very jealously. Other countries may have other standards, but that is their privilege. As far as Singapore is concerned, human life and health is important and we want to ensure that only competent doctors are allowed to practise independently.

Mr N. Govindasamy: Sir, the Government has again brought out the bogey of the National Wages Council. It is not true that the doctors have not got wage increments, wage adjustments and so on. They do receive the 9 per cent and the 13th month pay and so on. Sir, everybody receives the NWC award, not just the doctors and architects. NWC recommendations are the result of a number of factors - to make adjustments for the wage restraints and for the cost of living that has increased tremendously. Perhaps this may not be a permanent feature. But to say that doctors did get wage increases is not correct. It is something that 1 find hard to accept. The Minister said that doctors are not the only people who did not receive the wage increase, but others too, architects, accountants, lawyers. But the brain drain in the medical services has been greater than in any other service.

Mr Chua Sian Chin: Does the Member have the facts and figures?

Mr N. Govindasamy: I want the Minister to tell me. I do not have the figures. I hope the Minister would be able to tell me that the brain drain in the medical services is not greater than the brain drain in all the other services and, therefore, why should there be wage adjustments for doctors. It is not for me to produce facts and figures. However, Sir, we have examples. Where we are afraid that there will be further resignations, wage adjustments have been made in the Government service, e.g, the Police and the Fire Brigade in spite of the National Wages Council awards. Therefore, we should look into the question of resignation of doctors much more carefully than just writing it off as "What to do? We cannot do anything about it."

Sir, the question of housing for doctors brought up by the Member for Kim Seng is worth looking into. I am glad the Minister has mentioned that the Government is looking into the possibility of providing doctors with houses. This is a move in the right direction. I know of a doctor who asked his wife to resign so that they could qualify to apply a Housing Board flat, as he was bonded to serve the Government. I think he had a scholarship and, therefore, he had to serve for five years. If he did not have such a bond with the Ministry, he would have resigned from the service instead of asking his wife to resign. This is a matter that we have to look into.

Sir, the very fact that less people want to take up medicine is a sure sign that there is no money in medicine.

Mr Chua Sian Chin: It is not true.

Mr N. Govindasamy: No money in medicine in Government service - if the Minister wants me to be specific. I think I heard - I hope I am wrong -the Minister saying that private doctors who come to serve the Government are being paid $30 for two hours. Sir, we get what we deserve. If we pay for quacks, we get quacks. Look at the newspapers. Even unqualified private tutors for secondary school students command much more than $15 per hour, Sir!

An hon. Member: Hear, hear!

The Chairman: May I remind Members that the guillotine time for this particular Head is 5.55 p.m.

Mr Tay Boon Too (Paya Lebar): (In Mandarin): Sir, on the question of medical services, the Minister said just now that there is a shortage of doctors in Singapore. I would like to ask the Minister whether he is prepared to consider allowing Chinese physicians to serve our people in the hospitals.

Dr Ong Leong Boon: Sir, I brought this subject up because he happened to be the Minister for Health. If he were the Minister in charge of architects, engineers or lawyers, I would have brought up the same topic under the pertinent Head. I raised this point because I feel that there is a real case for us to give careful and thoughtful consideration. And I thought that it would be helpful to him as the Minister for Health. It was not my intention to be an alarmist. I have quoted figures. The Minister has very cleverly reduced these figures and felt somehow that one should not be alarmed. I hope he is proven right. He has raised a number of points and it is a pity that I do not have time to reply to them. I thank the Minister for mentioning the Ministry's care and concern about housing and his assurance that he will look into this problem further. The second point is that he would proceed to encourage more students, and in the coming year I shall be watching it very carefully.

As for incentive programmes and traineeship programmes to keep doctors in service, I beg to disagree with him. In actual fact, a number of doctors who have elected for higher training have resigned and have refunded to the Health Ministry whatever amount they were given initially for further training.

Mr Chua Sian Chin: How many?

Dr Ong Leong Boon: Sir, I do not wish to quote cases. But if the Minister wants, I can give him cases. There was one classic case of a trainee who went on leave for one week. On Monday, the Head of Department received a letter of resignation but two days before that he had already left for Australia.

As for part-time lady doctors, I am thankful to the Minister for mentioning that there are cases. But it is surprising that this is somewhat unknown or mysteriously hidden. There are in actual fact a good number of doctors who have applied but have been rejected. With the Minister's assurance, I am sure more doctors will apply for this scheme because in all sincerity I hope we attract back into the service more people, whether they be ladies or men, because we need them just as the Minister has said quite clearly earlier on. We cannot afford to be choosey.

The Chairman: Half a minute for you, Mr Chua.

Mr Chua Sian Chin: Sir, I just want to assure Members that we are concerned about this question of resignation of doctors and we are looking seriously into it. That is why I said that the Ministry has appointed a committee to look into the question of housing for our doctors. I think one of the attractions of retaining them in the service is the provision for housing.

With regard to the National Wages Council, I do not know why the Member for Telok Blangah is very averse to the NWC. Of course, I quite understand him. He is a trade unionist. The point is: I did not say that medical officers should not have wage revisions. I said that it should be revised in the national context, not only for medical officers but also the other officers. That is the point which I want to put clearly.

Dr Ong Leong Boon: Sir, although I hate to end this debate, I am grateful to the Minister for his reply and I beg leave to withdraw.

Amendment, by leave, withdrawn.

The sum of $27,152,150 for Head MA ordered to stand part of the Main Estimates.

The sum of $1,600,000 for Head MA ordered to stand part of the Development Estimates.

Head MB --

Mr P. Govindaswamy: Sir, I beg to move,

That the sum to be allocated for Head MB be reduced by $10 in respect of subhead BA 1107.

Sir, the Emergency Unit at the Outram Road General Hospital does a good job most of the time. But there are times when this Emergency Unit does not live up to its name. I have received complaints that there are times when some of the doctors and nurses attending to cases brought in to this Unit have been found to be rude and snobbish.

The doctors attached to this Unit must do their work only at this Unit but instead they are made to go on ward duty as well. As such, when the doctor goes round checking the patients, sometimes with housemen following him around for lessons, there is no other doctor available at this Unit. The Emergency Unit is meant for emergency cases. Those who are suffering in pain or requiring urgent treatment cannot wait for hours.

There was the case of a person who was brought in because of a heart attack. He was attended to only two hours later. By that time he was only good enough to be pronounced dead. A life was lost and it could have been saved only if proper attention was given at the right time. I also understand that often when patients are referred to the X-ray unit by the Emergency Unit, they are not attended to as quickly as possible. This has resulted in an ordinary X-ray taking about two to three hours. Sometimes the doctors are overworked and some of the cases are not thoroughly checked. To quote an example, there was a case of a statutory board employee who fractured his leg in an accident at his place of work. He was referred to the Outram Road General Hospital, and was granted three months' leave, but he is still not fully cured. Though the nature of his illness does not permit him to do normal duties, the doctor nevertheless sent him to work without recommending that he be given light duties because of his limping leg.

6.00 p.m.

In the meantime, since the doctor at the General Hospital had taken such a decision, the Board's doctor did not want to overrule the decision of the hospital doctor. I think they have an agreement between them. The patient then got a note from his union leader to appeal. But the letter was ignored. Furthermore, I understand he was advised by his superior to take vacation leave instead. I do not blame the doctor for this decision; probably he could have made a wrong decision due to pressure of work. We take pride in our hospitals and their facilities, yet there are many services left wanting. Some buttons in the medical service have to be pushed.

The Paediatric Unit too at the hospital is often overworked. It is believed that there are only a few paediatricians with many children to look after. If more paediatricians are appointed, then our children in the ward and those requiring specialist attention will not be neglected. Sometimes patients are turned away just because the doctors in the section had gone to the University to give lectures to the students. Why is this section understaffed?

Sir, I also note that in this unit there is no skin specialist available. The children are also not referred to the skin clinic for treatment.

Furthermore, improvements are needed in the non-paying wards. There is often congestion in these wards. Beds are placed all over the corridors and they are so close to each other that there is hardly any space for free movement. This is aggravated when student nurses and housemen are moving around during their lessons.

Sir, something is definitely wrong with the billing system in the General Hospital. When patients leave the hospital after treatment, part of the Bill is sent to the employer and part of it to the ex-patient. This brings confusion to the employer and the ex-patient. I am sure the accounting system in the General Hospital is no better either. Why not eliminate all this unnecessary paper work by sending the full bill directly to the employer or the ex-patient? A division of a single bill will thus be avoided.

I bring this subject up because there n a case of an employee of a statutory board who was admitted to the hospital some time back and he was faced with this problem.

Mr Chua Sian Chin: Sir, in reply to the Member for Anson, I would like to enlighten him by saying that it is not true that doctors in the Emergency Unit do ward duties. For his information, there are 18 doctors attached to the Emergency Unit of the Outram Road General Hospital on full-time, and they do not do ward duties at all. Up to March, 1972, there were only 12 doctors attached to the Emergency Unit. This number was increased to 18 in April, 1972. The Head of the Unit is a surgeon, and these doctors are also not on 24-hour call-duty but on a shift duty of eight hours each. The Head of the Unit is a surgeon and he operates on cold cases as well.

May I assure the Member for Anson that emergency cases are always promptly attended to by doctors. However, the problem here is that non-emergency cases come in to crowd the Emergency Unit, which is meant for emergency cases. As a result, there could be occasions when a genuine emergency case escaped notice and was not given proper attention. The Member has quoted some particular cases. If he wants me to look into them, he should write to me and give me the details. We will certainly give him satisfaction. He is in the habit of writing to my Ministry and myself, and I hope he continues with that habit.

With regard to paediatricians, I would like to assure him that there is no shortage of specialist paediatricians. In fact, there are 12 trained paediatricians with higher qualifications working in the children's ward in the Outram Road General Hospital. In the past year more doctors have acquired a higher qualification in paediatrics. However, no skin specialists are available in such wards. Skin specialists are available in units specialising in this field, and references are made to such specialists, if necessary. It is not possible to have all sorts of specialists in one ward. In so far as congestion in the ward is concerned, it is hoped to alleviate this situation when the new Outram Road General Hospital is completed, when we will then have more beds in the Paediatric Unit. Of course, the problem is that we will have more and more children, and that is why family planning has to be stressed.

The Member for Anson also referred to non-paying wards in the Paediatric Unit in the Outram Road General Hospital. By this, I suppose he refers to C class wards, and his implication is that there is no crowding in the A and B class wards. In fact, in the Outram Road General Hospital there are no A and B class wards for children.

With regard to patients being turned away because doctors have gone to the University to give lectures to medical students, may I say that patients, whether they are attended to by the University doctors or Government doctors, are usually requested to come on the appointed day.

With regard to bills, they are never sent partially to the patient and the employer. As far as the Ministry of Health is concerned, bills are sent to either the patient or the employer. A bill is sent to the employer if the employer is willing to furnish a letter of guarantee. However, if an employer is not willing to furnish a letter of guarantee, the bill is always sent to the patient. In industrial cases where it is possible to identify the employer, the bill is always sent to him. However, in a manually operated system which has to cater for anything up to 180 bills per day, minor errors are bound to occur. However, Members may wish to know that the feasibility of computerising the billing system is under active study, and we hope to implement it before long.

Mr Hwang Soo Jin: Sir, in view of the somewhat high rate of turnover of medical staff at the hospitals, I presume we have to depend quite heavily on newly qualified doctors and housemen. I am just wondering whether the Minister can off-hand tell the House what is the average length of medical experience of doctors in the hospitals. He has many times emphasised on the competence of the medical staff, and I am just wondering what sort of arrangements are in force to supervise the work of these young doctors or housemen.

Mr Chua Sian Chin: Sir, young doctors are always supervised by the consultants and, therefore, supervision is adequate. So I do not think the Member for Jalan Kayu should worry very much over this point. In fact, with the recent increment in specialist allowances, there have been less resignations from among our Government specialists than from among our medical officers.

Mr Ho See Beng: Sir, I was a bit disturbed when the Member for Anson alleged that a patient was not attended to in time. There was some delay. I just want to know whether or not the Minister for Health has received any such complaint. Was he aware of this case or did he come to know of it only just now when the Member for Anson brought it up?

Mr Chua Sian Chin: I myself was very disturbed when I heard that. In fact, the Member for Anson should have written to me, but he thought it fit to bring it up only now. He should have brought it up to me in a letter, which lie normally does. The point is this, and I have said just now, we try to give prompt attention to emergency cases, but the trouble is that the non-emergency cases crowd into the Emergency Unit. As a result, genuine emergency cases may have inadvertently escaped attention. In fact, the doctors and nurses now and then pick cases which need urgent attention and they do give prompt attention straightaway. The non-emergency cases, of course, have to wait.

Mr P. Govindaswamy: Sir, with regard to this matter of delay, the patient is already dead and gone! How is he going to complain against that? Anyway, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The following amendments stood in the name of Mr N. Govindasamy -

(2) That the sum to be allocated for Head MB be reduced by $10 in respect of subhead BA 3002.

(3) That the sum to be allocated for Head MB be reduced by $10 in respect of subhead BA 3003.

Mr N. Govindasamy: Sir, in answer to the previous question, the Minister for Health has replied that at last Outram Road General Hospital is going to be modernised and that the ancient buildings are going to be pulled down. I am therefore not moving my two amendments.

The sum of $101,244,320 for Head MB ordered to stand part of the Main Estimates.

The sum of $12,633,000 for Head MB ordered to stand part of the Development Estimates.

The Chairman: There is a business motion, as indicated by the Minister.

Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House.