COMMITTEE OF SUPPLY (Disposal of Amendments)

[Mr Speaker in the Chair]

Announcement by Mr Speaker 11.54 am

The Chairman: I have indicated that in view of the time constraint I would welcome speeches that are brief and sweet. Yet I see that some Members have been making full use of the 10 minutes allowed per amendment. Let us play the game and allow every Member who has filed an amendment to have his or her say and also to allow the Minister concerned to answer fully.

Head P (cont) -

Resumption of Debate on Question [24th March, 1986],

"That the sum to be allocated for Head P be reduced by $10 in respect of Subhead PA-01 Object Group 1100 of the Main Estimates." - [Dr Aline K. Wong].

Question again proposed.

Dr Dixie Tan (Ulu Pandan): Sir, I shall continue with the remarks on organ transplantation. In 1985, 141 patients with chronic renal failure were presented for treatment at the Renal Unit of the Singapore General Hospital. This represents the demand for kidney transplant operations. On the supply side, in the same year, only eight kidney transplant operations were done. In 1984, 1,109 people died as a result of accidents. Of these, 45 of them were suitable potential organ donors. However, because they had not previously indicated their wish to be organ donors, 90 other people lost the chance for a new kidney and a new life, and if we include heart transplantation for which surgical expertise is also available in Singapore more people could have had a new life.

Sir, I wish to urge the Minister to redress this situation by introducing some legislation. Legislation does not need to be compulsory. People who do not wish to donate their organs should they die in an accident can opt out of being organ donors and a register of such persons should be kept and be available at all times before organs are removed.

Secondly, certification of brain death should be done by a panel of doctors who are not in any way connected with the transplantation programme. And finally, a lot of time and opportunity should be given to all sectors of the public to express their disapproval or their support or to bring up additional safeguards so that fair provisions be made for everybody's protection but at the same time allow our big problem of organ shortage to be met.

Dr Koh Lam Son (Telok Blangah): Sir, I have an amendment under the Medisave scheme and I will confine myself to the subject. Sir, as I am paid by Medisave, I think it is in order that I declare my pecuniary interest in the subject.

The Medisave Scheme has been implemented in Government hospitals for two years now and in the private hospitals only recently. There have not been many teething problems, as I understand it, and I think this is mainly attributed to the well laid-out groundwork which was carried out before implementation by the First Deputy Prime Minister who was then the Minister for Health. The users of Medisave seem happy with the scheme and I think the main reasons are that they do not have to cough up money from their own pockets to pay the hospital bills and also that they now have both the choice and the means to opt for a better class ward in a Government hospital or even in a private hospital.

The saving on their own spending money can be quite substantial. As an example, in the case of childbirth, it will cost about $2,000 to have a baby delivered in a private hospital but the user of Medisave Scheme needs to pay the difference of about $500. So there is a substantial saving of $1,500 from his own pocket. This unrestrained use of the Medisave fund is not what is intended by the Government. One of the basic reasons for not opting for the insurance health scheme is that the Medisave fund, being the user's own savings, will impose upon the user some responsibility on how the fund is to be disposed and will encourage him to put a premium on good health. This has not happened and I do not think it will happen. Singaporeans place a premium on health only when they are sick. They are prepared to spend what they can afford and that includes all the money in their Medisave to restore themselves to good health. This is not really an abuse of the Medisave fund. It is more a misuse and due to a lack of foresight for the need to have a standby fund for future use.

I therefore think that it is prudent and I would like to recommend for the Minister's consideration that a maximum limit be set for each hospital admission. I suggest two-thirds of the user's existing fund so that there will always be some fund left in his Medisave Account for future use. And the user is to be made personally responsible if he exceeds the maximum limit. Thus if he wants a better class ward, he must be prepared to pay the extra out of his own pocket.

Sir, the subject of abuses of the Medisave scheme is of great public interest. Unlike the insurance health scheme, the Medisave scheme is not as vulnerable and exposed to exploitation and abuse. In fact, I believe there are already safeguards built into the Medisave scheme, for example, the Government has already set a maximum limit for claims for both hospital fees and doctor's fees. I understand that the maximum claims will cover the whole bill in the Government hospital but will probably cover about 70% or less in a private hospital.

Contrary to what the Member for Jalan Kayu implied yesterday that people tend to look at Medisave fund as if it was not their money, I do not think this is true. It is true that users are ever ready to make use of their Medisave fund when the need arises but this does not mean that they do not realize that this fund is part of their CPF; after all 3% is deducted from their wage bill. What is more important is that the other parties concerned, ie, the hospital and the doctors, realize that this is not insurance, but that this is the user's savings.

The other safeguard is the letter of certification which every doctor has to sign, and this forms a record and a monitoring system on the individual doctor's charges. This will discourage overcharging. As we know, the implementation of the Medisave scheme in the private hospital has brought about a boom in business and up to now, I am glad to provide the feedback to the Minister that there has been no increase in hospital charges for patients in private hospitals.

On the whole, Sir, from my own observation, there have been very few abuses or misuses of the Medisave scheme, and if there had been any, they would have been limited. However, this does not mean that the Ministry should be less vigilant over possible abuses. I can think of six possible ways which the Medisave can be abused. First, a patient may connive with a doctor to be hospitalized on a false diagnosis in order to use the Medisave fund, such as for an annual health test and investigation. Secondly, patients who are in hospital may request for a longer stay in hospital although there is no medical indication for it. Thirdly, a doctor may claim for additional operation procedures which were not actually carried out. Fourthly, because of the availability of Medisave fund, there may be a temptation to carry out unnecessary operations or to admit patients to hospitals without a medical reason. Fifthly, in-patients may also request for more tests and more investigations which are not related to the diagnosis and treatment during the hospital admission. Lastly, because of Medisave there is always the possibility that charges of doctors and private hospitals will go up, and the Minister should keep a close monitor on this.

I would like to ask the Minister to comment on these possible abuses and to inform us how these can be checked, and what further safeguards he intends to establish.

Mr Jeyaretnam: Mr Speaker, Sir, I will try and be very brief. I have a feeling your remarks were particularly directed to me.

May I make another plea for the Ministry of Health, particularly in Hospital Services, not to be too rigid in its efforts to collect charges. I say this because only last week somebody came to see me in my MP's office. He has been out of employment for about nine months, and he has been told that he has got to have an operation. He has got to go into hospital and, on top of this operation that is facing him, he has got his family problems. He was very worried about the hospital charges and the operation charges and all the other investigation charges. I told him, "Look, I think you had better go and have a word with the hospital almoner or medical social worker about your problems. And if you do not get any help there, then perhaps you can come back and see me." This is really the problem that I want to try and place before the Minister for Health and the Hospital Services - that, in this time of recession, there must be hundreds of people who are unable to pay even the basic daily ward fees. They may or may not have enough in their Medisave Account but even if they do have it, perhaps they may not be very anxious to use it all up in the hope that they might be able to rely on it later for their own living expenses.

So could I make another plea? I did that the other day and I was told there are other avenues - they can go and use somebody else's Medisave Account or go and ask for assistance somewhere else. May I ask that a more enlightened policy be taken by the hospitals when it comes to, particularly, workers who have been out of employment for six months, nine months, and less anxiety be shown about collection of fees and greater attention given to the needs of the man?

Finally, may I ask, why is it not possible for a patient who has to attend at the hospital every day for treatment to pay these charges out of a relative's Medisave Account? I know a man who was not warded in the hospital. Apparently it is his mother, he says, who has to attend at the hospital every day for treatment and he has to pay $10 a day, which amounts to $300 a month. And he wants to use his Medisave Account but he is told he cannot. I do not know why he cannot be allowed to use his Medisave Account because it is almost as though his mother was warded in the hospital getting treatment daily. So could we have a bit of relaxation of rules governing the use of Medisave and the collection of fees to suit the needs of individuals in their circumstances?

Encik Abbas Abu Amin (Pasir Panjang): Mr Speaker, Sir, though the National University Hospital has been in operation for quite some time, there are still some members of the public, especially those from the neighbouring housing estates, who are not fully aware of the facilities and services available at NUH. Some even think that it is just a teaching University. Could the Ministry or NUH authority consider providing information to the residents in the neighbouring constituencies on the following:

(a) Are there A&E services?

(b) How many and what classes of hospital beds are available?

(c) Are the charges similar to that of other Government hospitals? Perhaps it would be a good idea if grassroots leaders be invited to NUH to have first-hand information about this hospital.

Finally, Sir, I would like to know from the Minister whether there are plans to further develop NUH as one of the best in the region, perhaps as a place for research and development in the medical field.

Mr S. Vasoo: Sir, I would like to raise a few points, fairly quickly. I am concerned about the condition of Toa Payoh General Hospital and its medical and physical facilities. The hospital appears to be congested. It is old. It has served its time. It is now overcrowded, and it is not providing an efficient service for a growing population in the neighbourhood. The residents living in Ang Mo Kio, Toa Payoh and Bishan estates want to know what plans are being taken to develop the Hospital to meet the growing health needs of this population.

Sir, on the second area, I am concerned about the increasing admissions of psychiatric patients to Woodbridge Hospital and also the increasing number of discharges of psychiatric patients from the Hospital, as well as the increasing attendances of psychiatric patients at outpatient services. Sir, many of the families are concerned about the quality and the follow-up services provided to such families who are mainly living in housing estates. Most of them are seen for a very short time and they ultimately do not get the required attention. Consequently, many of them get re-admitted again. This revolving door admissions and discharges creates a problem for the family. I am wondering what plans are to be taken to strengthen the outpatient services in the treatment of psychiatric patients.

Finally, Sir, on the question of abortion, I share the sentiments of the Member for Whampoa but I am more concerned about the increasing number of teenage abortions. What has been done to help teenagers who seek abortion? What are the types of services available? More importantly, Sir, I feel that family life education programme for young people would be relevant in order that we can prevent such an increase in abortion. I think abortion should be made specifically available to those who seek abortion for a medical condition.

The Minister of State for Health (Mr Yeo Cheow Tong): Mr Speaker, Sir, I will respond on behalf of my Minister.

Sir, before I proceed to answer the points and questions raised by Members, I would like to give an overview of the broad direction my Ministry will take over the next three to four years. The thrust of my Ministry's programmes will be to lay the foundation for Singapore to develop into a Centre of Medical Excellence. Some people have asked what this involves and how this will benefit Singaporeans. Medical excellence involves the upgrading of standards of health care at all levels, whether it is at primary, secondary or tertiary level. While emphasising the upgrading of standards, my Ministry is committed to the philosophy that prevention of disease is as important as its cure. We will expand our efforts to educate the public on the need for healthy lifestyles and on the responsibility of the individual for his own health.

Sir, today two-thirds of primary health care and one-fifth of hospital care are provided by the private sector. The private sector must therefore actively and constructively participate in our endeavour to further improve our nation's health standards. My Ministry will work closely with the academic and professional bodies to achieve this. My Ministry's Health Advi- sory Council has been expanded to include representatives from professional organizations, the University, the private sector, as well as non-doctors. The Council would provide feedback on future directions and developments of the health services in Singapore.

Let me now outline some of the major programmes that the Ministry is or will be implementing. To improve the Ministry's primary health care services, 10 new polyclinics will be built over the next five years in the larger new towns. This will allow the phasing out of old outpatient dispensaries and maternal and child health clinics which are small, inefficient and poorly equipped. These new polyclinics will also provide facilities for the care and rehabilitation of the aged. Such health care centres will be run by the Home Nursing Foundation. In fact, two such centres will be opened this coming financial year at Kampong Ubi and at Kuo Chuan.

My Ministry will be studying measures to provide a more efficient, effective and higher level of care in the new polyclinics. We will continue with our responsibility of providing primary health services to children, the elderly and the indigent. For those who are in the working age group, my Ministry will take steps to encourage them to use the private sector.

I now come to the question of medical excellence at the secondary and tertiary levels. Here, we have to ask ourselves just how much we can hope to achieve. For the small population, we have to provide a limited patient base. With our limited manpower and financial resources, we have to be realistic and set attainable targets. Sir, we cannot hope to achieve excellence in everything but we can be good in some things. We have to set our priorities and decide what to invest in and which areas to specialize in. My Ministry has therefore decided that it will continue to emphasize on the specialities first identified by the Government in 1970 for further development. These are the specialities of cardiothoracic surgery, neurosurgery, plastic surgery, paediatric surgery and renal medicine. We have made significant advances in these areas. I believe that we can do more.

My Ministry will concentrate, in particular, on dealing with the two major killers affecting Singaporeans today, namely, heart diseases and cancer. Special multi-disciplinary task forces have been set up to look into all aspects of these two disease conditions. They will shortly make recommendations to the Ministry on the strategies to be adopted and the developments needed to contain the rapidly increasing incidence of these two diseases.

Members of this House will therefore note that to achieve medical excellence, we will need to upgrade the general standard of medical practice in Singapore and in the areas which affect Singaporeans most. It will benefit all Singaporeans. In the process, some foreigners will come to train or to work in Singapore. Others will come for treatment and all these will benefit the economy as well.

Before we can hope to achieve any of the above, we must restructure our hospitals to give them autonomy and flexibility. They must be given management flexibility to allow them to innovate, motivate their staff and achieve greater efficiencies while providing good personalized services.

The National University Hospital (NUH) was the first hospital to undergo this pilot project of restructuring. We are monitoring the performance closely and we hope to learn some valuable lessons from it. We are now studying the possibility of restructuring the Singapore General Hospital. The exact form it would take and the timeframe have not been decided. But it will probably take at least two or three years before it can be brought about.

As for the other acute hospitals, the Ministry recognizes the need to upgrade the physical facilities first before they can be restructured. The Ministry is planning to redevelop in phases Toa Payoh Hospital, Tan Tock Seng Hospital and Kandang Kerbau Hospital over the next 5-10 years. Facilities or services like the accidents and emergency departments, specialist outpatient clinics, operating theatres and intensive care units will be upgraded if they are presently inadequate or substandard. Adequate numbers of the subsidized B2 and C class wards will be retained to meet the needs of the lower-income group.

Mr Speaker, Sir, the redevelopment and building of new hospitals and polyclinics will cost large sums of money. Modern diseases are more complex and difficult to diagnose and treat. They often require sophisticated equipment which can be very expensive. For example, a computer tomography scanner can cost up to $2.7 million each. Higher level support staff are also needed to operate and maintain such machines and systems. Our health costs have gone up significantly, increasing seven-fold from $57.4 million in 1970 to $506.8 million 1985. Last year, the subsidy level for health services was 73% which works out to $144 per person for the whole year. The bulk of the subsidy goes to patients in B2 and C class wards and to the polyclinics.

Sir, in line with the Government's aim to contain the growth in Government expenditure, it is necessary that the high subsidy level continues to be reduced. Singaporeans must therefore be prepared to pay their fair share of the cost of high technology medicine. However, as I have stated many times before, the indigent and the lower income groups need not fear as they can apply for remission or waiver of fees.

Sir, I will now move on to the Medisave scheme. Since its inception on lst April 1984 in the Government hospitals, we have rapidly extended its usage. About 136,000 representing 8.6% of total Medisave account holders have used their Medisave by the end of last year to pay their hospital charges. The feedback, as the Member for Telok Blangah has mentioned, is that the scheme is helpful.

Sir, we recognize that the Medisave scheme in itself is not enough. There will always be the unfortunate who will fall sick with some major illness that may completely deplete his Medisave account. For such persons, my Ministry plans to introduce a form of major medical catastrophic health insurance scheme. The Ministry is currently working with the representatives of the insurance firms in Singapore and with the Council of Health insurers. We hope to be able to finalize details of the scheme by the end of the year.

Sir, for the catastrophic health insurance scheme to succeed and to incur low premiums, it must cover all persons within the effective age group. Premiums will be paid using Medisave contributions. This should not pose any problems to wage earners with Medisave accounts. However, the self- employed are presently not required to contribute to Medisave although it was announced on 22nd June 1984 that the Ministry of Labour will amend the CPF Act to require the self-employed to contribute to Medisave. My Ministry together with the Ministry of Labour will be studying how best to extend the Medisave Scheme to the self employed may be implemented. We expect to complete the study within the next 12-18 months.

Sir, further liberalization of the use of Medisave will be considered. My Ministry will also carefully study the usage pattern and changes in the profile of the balances over the next 12-24 months. We will then make whatever changes are necessary or feasible to the prevailing ceiling on the Medisave balance.

Let me move on now to the specific questions and points raised by various Members yesterday and this morning. The Member for Changkat has asked several questions relating to the Home Nursing Foundation and the care of the aged. The Ministry plans to build two community hospitals during the next 6-7 years. The community hospital is not meant for the use of the aged exclusively. It provides inpatient care to all those who do not need complicated or sophisticated medical care irrespective of whether they are young or old. The first community hospital will be built in Ang Mo Kio New Town where there is a large concentration of population and the large number of elderly as well. A second community hospital is meant to be built in the early 1990s. The exact location has not been decided yet.

The Home Nursing Foundation (HNF) does not intend nor is its objective to take over the entire care of the elderly at home. One of its main tasks is to teach and train family members to nurse the elderly in the home environment. In addition, the semi-ambulant will be encouraged to make use of the rehabilitation and day-care facilities at the health care centres which will be opened. The target is to cover all who require home nursing care in five years' time. The Ministry currently provides 23 nurses to assist the HNF in its activities. This will be increased to 42 with the expansion of the Foundation's activities and the opening of the two senior citizens' health care centres later this year. The Ministry also provides the HNF with medical and surgical supplies at Government rates. The Ministry will be prepared to provide the Foundation with more assistance and subsidies should the need arise.

Sir, with the ageing of the population, the HNF has plans to expand its scope or function and activities. Being a voluntary organization, it will be mobilizing greater community participation in its activities and in fund raising. HNF will consider being part of the Community Chest when its functions and activities are consolidated.

The services to be provided in the senior citizens' health care centres will include day-care, rehabilitation, health screening, health education and counselling. The senior citizens' health care centres will be located in the new polyclinics to be built. They will be sited in relation to the number of the aged and the absence of other day-care centres for the aged. The setting up of health care centres required a considerable amount of organizational and infrastructural support in terms of professional manpower and volunteers. It is not necessary nor is it possible to provide every constituency or community centre with one health centre. The HNF has therefore decided to build ten centres in the next five years. This should be adequate to cover the needs of the aged in the community. We would like to discourage the proliferation of health care centres all over the island. However, if any private organization, residents' committee, or community centre, management committee, wished to set up such centres, they should be consolidated into a few areas where the need exists. The Ministry will assist private and voluntary organizations in the setting up of such centres together with the Ministry of Community Development and in training their staff and volunteers. With the ageing of the population, there is more in gerontology amongst the medical profession and sociologists and economists. The Ministry is participating in a study on the socio-economic consequences of the ageing of the population. Research emphasis is also being given to the medico-socio- and psycho-geriatric problems of the aged. A teaching Fellow in geriatric medicine is presently attached to the Department of Socio-Medicine and Public Health at the National University of Singapore. The Ministry has also sent two doctors for training in geriatrics over the past two years. We plan to send at least one doctor and, if possible, two, a year for training in geriatrics for the next five years.

Let me now move on to the points raised by the Members for Toa Payoh and Ulu Pandan. Sir, many Members of this House must have read the various articles appearing in the press on the plight and suffering of kidney patients. They have publicized the predicament of these patients in the hope that more Singaporeans will step forward to join a scheme that amounts to the only long-term solution to their problem. Sir, as mentioned by both Members, dialysis can only be a temporary measure. It is prohibitively expensive. As mentioned by the Member for Toa Payoh, it costs a patient $1,000 per month to undergo dialysis. Not only is it expensive, but the quality of life for both the patient and his immediate family is also lowered. The patient is tied literally to the dialysis machine for about five hours each session three times per week. Usually while undergoing dialysis, a family member needs to stay with him to assist him. There are also long-term side effects, such as brittle bones. Sir, not only does the patient suffer, but the family members suffer along with him. They suffer emotionally in terms of worrying about the possible infections, they agonize with him in his treatment and financially it is a burden as well. The patient's work or career is normally affected because of the need to undergo regular dialysis. Sometimes the spouse's own career may be affected.

The correct solution is to ensure that there is a supply of kidneys for transplantation. Where can this come from? There are two sources. One is from a living sibling, from a parent, or in the case of a parent from the child. The other, which is preferred, would be cadaveric organs. Sir, for the cadaveric organ programme to succeed, we need to have at least 800,000 kidney pledges. Over the last 15 years the Ministry together with the National Kidney Foundation have been publicizing widely the need for Singaporeans to sign up as a kidney pledger. However, despite all the wide publicity, only 24,000 have signed up to date. What are the reasons for this reluctance? Well, it is partly due to the lack of public awareness, awareness that only when there is an accidental death will a person's organs be required or be appropriate for transplant. Secondly, some Singaporeans show they are prepared to sign up, by obtaining the necessary forms. But after taking the forms, because of apathy or other reasons, they fail to send in the form.

The Ministry has been studying this problem and one measure that is actively being considered now is the possibility of legislating for automatic organ donation when there is accidental death. This has been mentioned by both the Members for Toa Payoh and Ulu Pandan. Sir, this is not a new legislation because many other countries already have it. We are now studying the experience of such countries but the initial reports are quite encouraging.

The Members for Toa Payoh and Ulu Pandan have also pointed out that, in considering the implementation of such a legislation, Government must be aware of and be sensitive to the views of Singaporeans who, for various reasons, either religious, cultural or personal, may not be in favour of joining such a scheme. Sir, their objections must be respected. The Ministry must therefore make sure that when such a legislation is being considered, we must make available convenient means for such people to opt out of the scheme. However, whilst respecting the wishes of those who do not wish to join and who wish to opt out, we must also be fair and safeguard the interest of those who are participating in the scheme. We must ensure that they are given first priority if they happen to need an organ and if such organs are available.

The Member for Toa Payoh has also made some very relevant comments on catastrophic health insurance. He voiced concerns about the impact of the high cost of dialysis on this insurance scheme. He has estimated that over the period of ten years the annual cost of dialysis may increase to about $24 million a year and that this huge sum will overload the insurance system. It may end up depriving other patients who are suffering from other serious illnesses from benefitting from the insurance scheme adequately. Sir, we will definitely need to consider certain safeguards and I wish to thank the Member for Toa Payoh for his suggestions.

Let me move on now to the question of Medisave as raised by the Members for Jalan Kayu and Telok Blangah. The Member for Jalan Kayu has expressed fear that Medisave account holders may misuse their medisave funds by getting hospitalized when their medical condition does not warrant it. He is also afraid that, with the extension to the private hospitals, the doctors in the private sector may not practise restraint and liberally hospitalize their patients. Sir, I sounded a similar reminder some three weeks ago to Medisave account holders that they should not overlook the fact that the money in their Medisave account belongs to them and that, if they conserve their funds carefully, they will over a period of time reach the ceiling that has been imposed. The contribution in excess of the ceiling will then be transferred to the Ordinary account which can then be used for paying their housing loan or for investment, as the case may be. More importantly, nobody can predict when they or their family members may fall ill. It may be from an accident or from contracting various diseases. It could be from normal wear and tear of the body because, after all, one's body does wear out. Whatever is the cause, when it does happen and one is hospitalized, the Medisave funds will be a great relief. At least the account holder and his family need only worry about recovery from the illness and not about availability of funds.

However, while there is a need to periodically sound a note of caution on the use of Medisave, there is presently no cause for alarm. The usage over the past two years since Medisave started shows a very cautious usage pattern. For the six months to the end of December 1985, 90% of all withdrawals were for less than $1,000. I am confident that Singaporeans are by and large very careful with their money and they will spend it wisely, provided they realize it is their own.

The Member for Jalan Kayu has also suggested the possibility of using Medisave for payment towards a general medical insurance. Sir, we must learn from the experience of others who have gone through the route of general medical insurance for the whole population. These countries are now facing difficult problems in relation to funding the system. Let us learn from their mistakes. It has been shown that a general medical insurance scheme when extended to the whole population inevitably end up creating the "buffet lunch syndrome". What is this? This is a situation where the insured, after having paid for his insurance, decides that he should use the benefit. Yes, of course. Initially there will be caution and reluctance to use the scheme unnecessarily. But after a few years when he starts toting up how much he has paid up, he will be wondering, "what am I paying for? I have not used any of it, I'd better use it up when I have the next opportunity." What does that do to the insurance companies? Very easy. They just increase the premiums and the careful and sensible account holders end up paying unnecessarily for those who abuse it. So eventually even the cautious get into the act. This ends up in a big usage spiral.

The Member for Jalan Kayu also stated that with a general medical insurance system Singaporeans will end up taxing the taxpayers less because they will be using their own insurance system. They will not be using subsidies. I think he is totally wrong on that point. In fact, we will end up paying more subsidies to the hospitals. The reason is that at the moment 80% of all hospital services are provided for by the Government. Out of these services 75% of all beds are in the heavily subsidized B2 and C wards. Sir, the Ministry is definitely not in favour of using Medisave as payment towards a general medical insurance system.

The Member for Whampoa has also asked that the Medisave ceiling of $15,000 be lowered to enable more people to use it for house-ownership. The Government has already announced a wide range of measures to overcome problems faced by house owners because of the CPF cut. They can also use the amount in their Special Account if need be. The Medisave scheme has just been extended to private hospitals. We have also liberalized recently and more liberalization will be considered. I think it is prudent for us to study and analyse the usage pattern for the next 12 to 24 months, as I have just mentioned, and then make appropriate modifications when necessary.

Let me move on now to the question on the A&E problem. Let me first give an overview of the problems facing the A&E departments. Up to the end of 1985, the A&E departments have been overly utilized. The fundamental problem is that the large number of patients which stood at 211,000 in 1975 increased to a total of 470,000 in 1984. This represents an increase of 122% over a 10-year period. Analysis of the patients revealed that only 43% of the patients had an emergency condition, the remaining 57% were actually non-emergency patients. The misuse of the A&E facilities has created huge problems. Firstly, you have the problem of long queues with long waiting times. Yes, certain patients during the peak periods have had to wait up to three hours. The doctors, the nurses and the supporting staff also face tremendous pressure from the large crowds who are all clamouring for early treatment. The sad part is that because of this pressure, genuine cases sometimes are not able to obtain immediate treatment as they fall into the queue. The doctors are also unable to give adequate treatment time. Because of the rush, the doctors run the risk of missing vital symptoms. The result has been frayed nerves and tempers and unhappiness all around.

The Ministry reviewed the situation and late last year decided on a two-prong approach. We launched a publicity blitz in the mass media. We used posters. We distributed plenty of pamphlets and the whole programme took off on 1st November 1985. At the same time, we started a pilot project at Tan Tock Seng Hospital whereby non-emergency cases were identified using triaging nurses and during the evening peak hours they were re-directed to the evening clinics that have been established within the hospital for this purpose. The pilot project has been found to be very satisfactory and by the beginning of this year all the four A&E departments, namely at SGH, Toa Payoh, Tan Tock Seng and Alexandra Hospitals, have started re-directing non-emergency cases. During the daytime they are re-directed to the OPDs that are close by and to the GPs. In the evening, they are re-directed to our evening clinics.

The results have been good. We have seen a drop in attendances from about 8,100 per week before the scheme started to about 6,500 in February this year, representing a decline of 20%. The proportion of non-emergencies has also reduced from 57% to only 22% in February. Waiting time has also been reduced and now 85% of all patients only wait for less than half an hour. The remaining are seen to within an hour. We will continue to educate the public and we will continue to triage and turn away the non-emergency cases to ensure that genuine emergency cases will be given their proper treatment.

Let me move on now to the remarks made by the Member for Whampoa. Sir, yesterday the Member for Whampoa, true to form, made an impassioned and emotional speech on abortion. Unfortunately, because of shortage of time, he was unable to complete his arguments but I am aware of his stand. One needs only to refer to the Hansard to note his firm and unwavering position on this issue. I understand and appreciate the Member's strong religious convictions. While I do not intend to repeat all the past arguments which are still valid today, two points bear repeating.

The Government's prime concern must be for the safety and health of the expectant mothers. Depriving them of legalized abortion will not eliminate the existence of the operation. It merely erases the official data on the number of abortions that have been carried out. A woman who is determined not to complete her pregnancy will only be forced to go to the back-street abortionist. It will be very unwise to return to the 1960s when septic abortions by back-street abortionists were the order of the day.

Secondly, it will be totally erroneous to blame the availability of abortion on demand for permissiveness. Singapore is an open society. We are completely exposed to western influence and lifestyles. It is inevitable that a number of our impressionable youths and others will adopt some of these lifestyles, including undesirable ones. It will be folly to try to turn the clock back and isolate ourselves from the rest of the world. Since we cannot, we must find other alternatives. My Ministry has all along been counselling patients seeking abortion in Government institutions. This has made our hospitals unpopular despite the fact that it costs only $5 for an abortion.

Today, two-thirds of all abortions, as pointed out by the Member, are carried out by the private sector. It is therefore important for private practitioners to also participate in counselling abortion patients. The Ministry is finalizing plans to make abortion counselling mandatory for all seeking abortion at Government and private hospitals and clinics. This abortion counselling programme will involve the following:

1. Advising patients that abortion is not without risks and should not be resorted to unless absolutely necessary;

2. Emphasizing that abortion should not be used as a method of family planning and that there are other safer and simpler methods of family planning;

3. Encouraging women to continue with the pregnancy if she is psychologically, socially and economically in a position to do so; and

4. Motivating the women to use a reliable contraceptive method after the abortion if she insists on continuing.

The abortion counselling programme will be closely monitored in all Government and private institutions.

Sir, abortion is a social, more than a medical, issue. Any reduction in the number of abortions will require a change in society's attitude towards not only abortion but also marriage, responsible parenthood, illegitimate children and unwanted children. The Ministry will work closely with the Ministry of Education in this respect. Sir, I am not hopeful that we can erase the need for abortion. What we can do is to try to restrain and eventually reduce such demands.

Let me move on to the Member for Anson. He has made a plea that the Ministry be less rigid in collecting charges. He has mentioned a case of a man who is now jobless who has approached him for advice. I am very happy that for once he has given him good advice, and that is, "Please go to the hospital, inform them of your plight and the hospital will help you." That is the correct advice to give and I hope he will abide by this practice in the future.

Mr Jeyaretnam: Will I see results?

Mr Yeo Cheow Tong: Anyone who approaches our hospitals and informs us that he is unable to pay for various reasons, will have his case investigated. We will review his employment circumstances, his family circumstances, and if it is a genuine case we will give him full assistance. Sir, he also said that some members may not be prepared to use their Medisave because they would like to leave some balance for future living purposes. My advice to them is that they should use the Medisave in relation to the balance that they have. If they have a low, Medisave balance, they should go to the C class and the bills will be low, and if the balance is still not enough they are allowed to overdraw. If they are jobless and they cannot afford to pay, we will then investigate and, if necessary, give them a waiver.

Mr Jeyaretnam: Why can't we have a rule that those who are unemployed can avail themselves of free treatment?

Mr Yeo Cheow Tong: Let me move on now to the points brought up by the Member for Bo Wen. He has asked about the redevelopment programme for Toa Payoh Hospital which serves Ang Mo Kio, Bo Wen and Bishan. There are plans now to upgrade Toa Payoh Hospital. The timing has not been fixed. But it is likely that when the redevelopment programme proceeds, Toa Payoh Hospital will be redeveloped with an increase of 150 beds, making a total of 560 beds. The renovations of the existing building will be carried out to upgrade and provide more B2 class beds, for which there is a tremendous demand and which unfortunately is not available at the moment. The facilities and services which are presently inadequate would be upgraded and this would be included as part of the redevelopment programme. With the completion of the redevelopment, Toa Payoh Hospital will then definitely be in a good position to service the new towns around the area, namely, Toa Payoh, Ang Mo Kio and Bishan.

As regards the enquiry by the Member for Pasir Panjang, he has asked a few questions. Firstly, is there an A&E service available at NUH? The Emergency Department of NUH will be opened in May this year, ie, in two months' time. What are the number and class of beds available? At the moment, we have 47 private rooms, ie, single-bedded rooms. We have 92 beds in 4-bedded rooms and we have 145 beds in 6-bedded rooms. The 6-bedded rooms are equivalent to the B2 beds in Government hospitals. The charges are similar and they are very heavily subsidized. When fully commissioned, we will have 81 beds in the single-bedded rooms, 156 beds in the 4-bedded rooms and 403 beds in the 6-bedded rooms, making a total of 640 beds.

The Chairman: Mr Yeo, it is guillotine time. It is 1.00 pm.

Dr Aline K. Wong: Sir, in view of the Minister of State's full replies, in spite of the shortage of time, I beg to withdraw my amendment.

Amemdment, by leave, withdrawn.

The sum of $455,781,740 for Head P ordered to stand part of the Main Estimates.

The sum of $58,667,600 for Head P ordered to stand part of the Development Estimates.

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

Mr Speaker: I suspend this Sitting and will take the Chair again at 2.30 pm.

Sitting accordingly suspended at 1.00 pm until 2.30 pm. Sitting resumed at 2.30 pm

[Mr Speaker in the Chair]

Debate in Committee of Supply resumed.

[Mr Speaker in the Chair]

Head R -

Mr Lim Boon Heng (Kebun Baru): Mr Speaker, Sir, I beg to move,

That the sum to be allocated for Head R be reduced by $10 in respect of Subhead RA-01 Object Group 1100 of the Main Estimates.

Sir, a few days ago the Straits Times reported in its Forum page a reply by the CPF Board to a request by an employer for greater flexibility in terms of payment of CPF. The CPF contributions, whether they are from the employer or employee, are workers' wages. Employers are made responsible for the payment of CPF contributions to their employees' CPF accounts. Last year the NTUC drew the attention of the CPF Board to the fact that some employers had failed to pay their contributions into employees' CPF accounts, resulting in some workers losing CPF contributions when employers defaulted and went into liquidation. As a result, the CPF Board took measures to tighten up the procedures.

Although this has been done, more workers have lost their CPF contributions when companies wind up and go bankrupt. This comes about because of the time lapse between default of payment to actual enforcement action by the CPF Board. Employers are normally given two weeks to pay CPF contributions. The CPF Board lists out those companies who fail to pay three weeks from the end of the grace period, and sends out notices. Employers are given another two weeks to pay the arrears. It is only after the expiry of 14 days that the CPF proceeds to initiate legal action to recover the money due to the employees by first obtaining permission from the AG's Office. By the time legal action actually commences, as much as three months would have elapsed because one must remember that a date for a court hearing has to be obtained. The employees come to know about the position a little earlier, roughly about two months after the employers' default of payment. So there is a real risk on the part of employees to lose their CPF contributions if eventually the employer is unable to pay. This situation is unsatisfactory. While one may sympathize with employers who face temporary cash flow problems, it is the employer's duty to inform employees that he is using the employees' money for business operations, in other words using part of the employees' wages for his business operations. And making use of employees' money without informing them must be morally wrong.

I am aware that the CPF Board has come under pressure from employers to be more flexible. While we do not want to take hasty action to cause the unnecessary collapse of firms with liquidity problems, on the other hand we must protect the interests of workers. I would urge the CPF Board to require all employers to inform their employees immediately when they are unable to pay their CPF contributions. I think it is only fair that the employee knows that his CPF contributions have not gone into his account. I think it would be unwise of the CPF Board to continue to give the employers the latitude which they have hitherto had with workers' money without the workers knowing about it promptly. I would like to urge the Minister to request the CPF Board to further tighten the measures in the manner in which I have outlined.

Sir, I have another amendment No. 5 which I propose to speak on now. In this period of economic recession, much has been asked of workers to make sacrifices. It is always unpleasant to face the prospect of no wage increases. But workers are prepared to go along if it is justified. The success of our wage restraint policy will depend very critically on the labour-management relations that exist within companies. So in this critical stage of our economy, I think it is only wise on the part of managements to exercise understanding and to keep the trust of their employees. So I think this is a time where they have to exert even more to win the hearts and minds of the workers who work for them. We should not allow unconsidered action by employers to disrupt the labour-management relations which hitherto have been cordial. Now I would like to express in this House an appeal to all employers to act carefully and wisely in this difficult period of time so as not to create unrest, unhappiness among workers. It is only when there is industrial peace, harmony, a willingness on the part of both employers and employees to pull together that we will succeed. So we must not have unscrupulous employers taking advantage of the situation. We should have caution all round, good sense and good will.

Mr Chng Hee Kok (Radin Mas): Mr Speaker, Sir, an item of keen interest during this recession is, of course, the CPF. In fact, during good times or bad times, CPF is a hot topic. This is inevitable as there are more than $20 billion standing in the fund. At this level it is easy for one and all to suggest how this money may be made use of. The latest scheme, of course, is the investment of CPF savings in shares, loan stocks, unit trusts and gold. Personally, I am not in favour of CPF savings being used for such investments as it goes against the philosophy and objective of the CPF. Before we liberalize further on the use of CPF, I think it is important that we go back to fundamentals. The objective of the CPF is well known and I do not intend to discuss it here.

However, I shall limit, my discussion to three areas which have a bearing on the utilization of the CPF. The first is the changing rate of savings. Sir, in asking that CPF savings be used for different purposes, there is this general expectation that CPF savings will continue to rise or at least be maintained at a high rate. The recent reduction in the CPF should bring home the point that this is not so and that the CPF savings rate is actually an economic tool. In the years of high inflation, the CPF rate should increase to reduce the liquidity in the market, to cut costs of doing business. We have just modified the employer's rate of contribution and I cannot see, or be absolutely certain, when will its original 25% rate return. The CPF may also have to be modified at some point in time to take into account the structure of the workforce. A young worker will need a higher rate of CPF to enable him to pay up for his home and an older worker may be paid a lower rate to make him more attractive in the workforce. Such flexibility will ensure that we shall always be able to react to changing circumstances. This flexibility also means that we must be prudent in the way in which we use our CPF savings because our savings may not always remain high.

The second point, relating to CPF is the rate of return. In the years when market interest rates were high, there were recurring complaints that CPF savings were not attracting a good interest rate, even though it is for payment on HDB mortgages. HDB mortgages command a special interest rate. Even these people felt that the Government was unfair as the CPF balances were getting a poor rate, never mind what is their mortgage interest rate.

Sir, today the situation is quiet for various reasons. Therefore, I fully support the move of the Government to peg the CPF rate to market rate. The linkage between return on savings and the cost of mortgage is now properly established. You pay for what you get. With the pegging of the CPF interest rate to the market, an important by-product is that there is no rationale for allowing CPF to be invested in shares and gold. In the days when there were complaints that the CPF interest rates were low, contributors said they could get a better return in the market. Butwith the rate pegged to the market, people must understand that this interest rate is a risk-free, tax-free rate. That is about the best rate you can get in the market without any risk. Therefore, I think the Government should not open up Pandora's box and allow more uses to be made of the CPF.

The third point is investment in property. This I support wholeheartedly. Investment in Singapore property or whether it is an HDB flat, a private residential property, commercial and industrial property or even vacant land, with CPF funds is a correct move in line with the basic aim of the CPF. With ownership of a property, when you retire you can always convert your property into cash and rent a home. In my opinion, it is also the right philosophical bent. Nothing evokes a more emotional response than to be able to say, "I own a piece of Singapore." This is a stake in the country which we must all nurture. Hence, instead of opening the door to other forms of investment, the Government must restrict the use of CPF savings to property investments only. However, the rules may have to be liberalized further. In fact, I see no reason why HDB flat dwellers or flat owners should not be allowed to invest their surplus CPF savings in a second residential property, better this than in shares and gold.

Finally, Sir, let me refer to the Economic Committee which has called on the Government to, "review the CPF scheme from a longer-term perspective, to decide on the appropriate long-term rate and structure of CPF contributions that would meet the basic needs of retirement income, home ownership and medical care." I endorse this call for a comprehensive review. However, if we accept the fact that the CPF rate of contribution is an economic tool, a long-term rate must also have built-in flexibility. The question of home ownership must also be enlarged to property ownership and, most important, the objectives of the CPF must be clearly restated and argued. The Government must not be afraid to do what is right and it is better, as far as I am concerned, to err on the side of prudence. 2.45 pm

Mr Heng Chiang Meng: Sir, during the past year, we have seen many changes made to the utilization of CPF funds. We have seen the CPF allowing members to purchase non-residential properties. Although the rules are not out yet, I understand that the Minister will soon come out with the rules regarding this. We have also seen an allowance of 10% to be made for investment in stocks and shares, gold, trustee bonds and the lot. For these, Sir, I understand that the CPF would allow what they call a substitution of stocks and shares or gold for money, which means that when the new rules come out, members already with stocks and shares in their names can submit them to the CPF and in return, the CPF would release the funds. So it is not a new purchase.

Sir, I would like to ask the Minister whether he considers these new avenues of so-called investments speculative and consumptive. We do know that the prices of these so-called assets can vary very drastically, especially during these times. Hence, it is beyond understanding why the Minister has steadily refused the most important investment of all, that of investment in our children's future. Sir, here I am referring to the perennial question of asking the Minister to allow the use of CPF funds for children's tertiary education.

Sir, we all know that the entry into our University is on a competitive basis. Last year, I understand that there were many qualifiers who could not secure a place in our University because standards were high and places were limited. These persons have no place to go for their tertiary education except overseas. Their results are not good enough for scholarships. But the same results are good enough to gain acceptance into recognized universities abroad.

Sir, their parents would like to send them overseas but for the lack of money. On the other hand, they do have large balances in their CPF accounts and they are prepared to use these monies to further the education of their children. However, the Ministry has always said no to such pleas. May I therefore suggest that in the current review of the CPF Act, the Board should set aside a percentage, maybe 10%, of the balance to be permitted for withdrawal for the use of educating members' children.

Mr Chairman, Sir, this is not the first time this matter has come up. Last year, I mentioned and I hoped that the Minister would finally allow this to be permitted. But he has refused. Last year, although I added one more "P" to the politics of perseverance, persistence and patience which did not pay off, this year, Sir, if I may, may I add one extra "P" and say "please" to the Minister.

The other point that I would like to bring up is in regard to the foreign maid levy. I am aware that the Acting Minister, in his reply to an oral question on foreign worker's levy several days ago, has stated that there would be no change in the quantum of the foreign maid levy. In his reply, he said that Singaporeans should employ locals and provide employment to Singaporeans, especially during this recession.

Sir, a number of my constituents have called me to express their agreement with the Acting Minister's comments. However, they have also asked me a few questions and because I am unable to reply, I am redirecting them to the Acting Minister. They asked, (1) where can they get Singaporeans to be full-time domestic help? (2) are there any Singaporeans registered with the Employment Service Department in the domestic help category so that they can go to the Department to employ them? If so, how many are there? (3) Are there Singaporeans who are prepared to work as full-time domestic servants for roughly about $400 per month, which together with CPF contributions would come to about $440 per month? The reason for this figure is that they are currently spending roughly about $500 per month on their foreign maids. And with the recession and the CPF cut of 15% on their own salaries, they find it difficult to make ends meet.

Sir, they have also ended their request with the comment that if it is difficult to get Singaporeans to be maids, would the Ministry reduce the foreign maid levy by 60% which is the same percentage as the reduction in the employer's CPF contribution? After all, they are also employers and need to cut costs in these times.

Mr Chairman, Sir, I happen to agree with these views. Sad to say, as I said earlier, I cannot answer these questions and I would really appreciate if the Acting Minister could provide the answers. More importantly, the Acting Minister should also realize that the quantum of $120 per month was imposed at a time when the economy was booming and when incomes were high. However, we are now in a recession and incomes are low. Further, I think I would not be too far amiss if I say that there are not many Singaporeans who are prepared to work as full-time maids although I do not know the figure. Sir, based on this, I do think that there is a case for a reduction of the levy.

Mr Jeyaretnam rose -

The Chairman: I am trying to follow the order of the names appearing on the Order Paper Supplement. If you want to be Dr Wong, by all means, Mr Jeyaretnam.

Mr Jeyaretnam: I am sorry, Sir.

Dr Aline K. Wong (Changkat): Thank you, Mr Speaker, Sir. I would also like to join the debate on the CPF and also on foreign maids. By pure coincidence, the previous speakers and also the last Member have touched on these two issues which I wanted to talk about.

First, on the CPF. I would like to approach it from the problems of the aged. Since the Ministry is currently reviewing the entire CPF structure, I would like the Minister to pay attention to the question of the age of retirement which is necessarily tied with the age of CPF withdrawal. It is well-nigh impossible to separate the two issues. In the Howe Yoon Chong Report, it was recommended that the customary retirement age should be deferred as far as possible, from 55 to 60 and eventually to 65 years. It also recommended that the Government should set the pace by liberally re-employing its employees beyond the current retirement age. It would seem that the present effort of the Government to trim the size of the civil service is a temporary setback to this long-term strategy. But in my opinion, we should not lose sight of our long-term objective and therefore the question of retirement age should really be considered at the same time as the age of the CPF withdrawal when the entire CPF scheme is being reviewed.

Unfortunately, this became a very emotional issue during the last general elections. The dust has now settled. I think it is time for us to look at this rationally again.

The second point I want to make about the CPF and its relationship to old age and our old age problem is that, as the Member for Radin Mas has pointed out, with a declining rate of CPF contribution, ie, declining with age, the older workers will face some problems with paying their housing loans. So if this scheme of progressively reducing the CPF contribution rate is adopted, then the Government would have to pay special attention to the ability of the older workers to repay their housing loans. And I would like to reiterate my previous point when I spoke on my amendment on the Ministry of National Development, that it is perhaps time for us to encourage our population to start thinking about buying smaller flats.

The HDB should also think of allowing the older residents to exchange their flats for an annuity. This is not just a matter for the HDB to consider. But I am sure the Acting Minister for Labour would consult closely with the Minister for National Development on these matters.

Coming to foreign maids, I am of the opinion that foreign maids are not a good solution to our long-term problem of encouraging more women to go into the labour force. It is not and cannot be a long-term solution. In other countries, women have tried to cope by working part-time, by using more labour-saving devices, by paying very expensively for part-time domestic help, by enlisting their husband's help in housework and also by sending their children to child care centres.

In Singapore, part-time employment for women is not so readily available and it is a fact that there is still not enough child care services. With the $120 foreign maid levy that our people are paying for each foreign maid, and assuming that there are 30,000 foreign maids now, the Government is collecting a total of $43 million a year. I feel that this sum should be directed towards building more child care centres, which to me is a much better long-term solution to helping women to enter the labour force.

Right now, each child care centre receives about $40,000 subsidy from the Ministry of Community Development in terms of the capital cost. Of course, these centres have to raise their own running costs as well as to find the suitable staff. Also, parents' attitude towards sending children to child care centres has to be changed. My point, I believe, Sir, is that more efforts in fact should be directed towards building child care centres. And since we are collecting this levy on foreign maids, it is a logical way of using this money for the building of child care centres.

The second perspective that we have to adopt when considering the foreign maid question is the social and cultural implications of having a large number of foreign maids living with our families. I need not belabour this point. There are all kinds of problems of cultural adjustment on both parties involved, problems of children learning a different set of cultural values from people coming from different kinds of backgrounds, problems between husband and wife that may arise because of misunderstanding over the maids. In the long-term, it is no good for our society to have so many foreign workers living right in our homes.

The third angle I want to talk about is the humanitarian side. Sir, foreign maids are also people who come here to work because of economic hardship or other reasons back home. They deserve our every sympathy and also our understanding. Occasionally, you hear about employers ill-treating the maids. I am sure this may be just a small minority of cases. But it does not do any good to our national reputation, nor any good to bringing up children to respect people. Sir, would the Minister not think it possible to devise some minimum legal or legislative protection of some kind for these foreign maids, in case they are seriously ill-treated by their employers? Is it purely a matter of the numbers involved, the small minority of cases that are being reported? Is it purely a matter of the difficulty of implementing this kind of law? Or should we not think in terms of the benefits to be derived from a legal protection, a legislation, which would teach our people what it means to be living in a really caring and cultivated society where people respect people as people.

Mr Goh Chee Wee (Boon Lay): Mr Speaker, Sir, under this amendment I would like to talk about the CPF rate of contribution, in particular the employee's contribution.

Sir, presently, employees who earn less than $200 a month need not contribute to CPF. A person starts to contribute to CPF when his salary exceeds $200 a month. He has to contribute the full 25% CPF only if his salary reaches or exceeds $363 a month. Sir, it is pertinent to note that while the CPF contribution rate has been raised over these years, the salary level above which CPF is payable has remained unchanged. As a matter of fact, this floor salary of $200 a month above which CPF is payable was first introduced in 1968, some 18 years ago. Even at that time the full CPF payable for those who earned morethan $363 a month was 6(r)%, and today we are insisting that all those who earn $363 a month must save 25% of their salary for old age or for buying properties.

Sir, the take-home pay of a person earning $363 after deducting CPF is only $272. I think it is unrealistic to insist that a person who earns $363 a month today must save 25% of his income. The full salary is not even enough to meet the expenses of the family. Sir, I am not against savings for old age or for helping our citizens to own their homes. But we must be realistic enough to acknowledge the fact that the immediate concern of a person who earns $363 a month is to make ends meet. I believe it is just wishful thinking that we can effectively sustain a high compulsory savings rate for a person earning $300-400 a month, especially if he has to support a family. He will have to resort to ways and means to beat the system. Either he will look for jobs which can evade CPF contributions, or the law-abiding employers will have no choice but to raise their salaries in order to attract the workers. Given a choice between a low-paying job which attracts full CPF contribution and another job, say, an odd job which can avoid CPF contributions, a person will tend to take up the latter job which offers a higher take-home pay. If today we are serious in wanting to convince our workers, especially the retrenched workers, to accept and adjust to a lower salary under the present difficult economic conditions, then a lower employee's CPF contribution rate for the lower wage level is a proposal which merits consideration. This will help to ease the pressure on both employer and the employee in offering or requesting for high salary.

I would therefore like to suggest to the Minister for Labour that a complete review of the employee's CPF contribution rate be made. To start with, the floor salary above which CPF is payable should be raised. I suggest that the limit should be raised from $200 a month to $300 a month, that is, an employee starts to contribute to CPF only if he earns $300 a month. Even then the employee's CPF savings rate should only be 10%. But the rate of contribution can be increased gradually to the full 25% when his income reaches, say, $800 a month. This 25% contribution rate can be maintained throughout the working life of the employee until he reaches the age of, say, 50 years old when the rate can be gradually reduced. By that time, he will have sufficient savings or would have already owned a home. Hence a reduction in the savings rate could possibly be justified. A corresponding reduction in the employer's CPF contribution rate for the older workers would have a positive and desirable effect of encouraging the employers to engage these older workers. Sir, I would like to suggest to the Minister to consider these proposals very seriously.

Mrs Yu-Foo Yee Shoon (Yuhua): ( In Mandarin): Mr Speaker, Sir, I would like to express my opinion on certain matters under the Ministry of Labour. I support the Member for Kebun Baru for what he has said about CPF, that it is part of the salary of the workers. What we should pay attention to now is that many employers are in arrears as regards their CPF contributions. Not only has the employer's part of the CPF not been paid up, but also the employee's part. That is to say, part of the employee's salary deducted from the employee's pay for CPF contribution is not paid to CPF. This has not only caused a loss to the employees but also when they submit income tax returns because their figures do not tally. Therefore, this has affected the truthfulness of the income tax returns. Therefore, I hope the Minister would review the CPF regulations and if necessary, amend them in order to protect the interest of the employees.

The second point is about secret ballotting for recognition of a union. I would urge the Ministry of Labour to review this provision because employer-employee relationship has reached maturity nowadays. We have very responsible unions and workers. When workers want to form a union and before they could request their employer to recognize the union, they have take a decision by way of a secret ballot. I feel that this regulation should be amended because this regulation usually causes a worsening of the relationship between the employer and the employees. The reason is that when a secret balloting is being carried out, the procedure itself gives rise to a worsening of the relations between the two parties from the very start. In many countries, including Japan, when the employees want to form their union, they need not go through secret balloting. I wish to point out that in Singapore the relationship between the employer and the employee is quite mature. Therefore, when the employees want to form a union, it would not be necessary to ask them to take a secret ballot.

The other point I would like to raise is that the Ministry of Labour should strengthen the staffing of the Industrial Relations section. I believe in the next five years its staffing position should not be reduced in spite of the Government's policy to reduce manpower by 10%. On the contrary it should be increased. The reason is that the Industrial Relations section will play a continually important role in the future employer-employee relationship towards an era of free collective negotiation and wage reformation. In future, industrial relationship and negotiations will be more complex and will not be dependent only on the profit and loss situation of the company but also on the various systems and the various investments of the company, its capital yield analysis, and so on. Also, in wage reform, there would be the evaluation of each job and the individual assessment of the employee's qualification, background experience, etc. All these will be taken into view. At the same time, in going about wage reform there will be the gradual doing away with annual wage increment in keeping with the company's business condition and its prospect and even a comparison will have to be resorted to with capital yields in other developing countries. It is no longer like haggling and bargaining in the market place as in the past. There is going to be a more scientifically enlightened and sophisticated systematic type of analysis of the company and negotiations. In view of this, I believe the proper staffing both in terms of quantity and quality in the industrial relations section of the Labour Ministry in this respect is very important. Therefore, I hope the Acting Minister for Labour would give the Labour conciliation officers more power and proper guidelines in order to carry out their role more effectively. I would also call upon the Ministry of Labour to organize more study courses and seminars through the National Productivity Board in order to train the Labour relations officers of the unions and the management personnel on the employer side in order to maintain the existing good relationship between the parties concerned in future.

Mr Jeyaretnam: Mr Speaker, Sir, before I speak on the amendment, perhaps I should say I have no direct personal pecuniary interest in whatever I say. Of course, I do act for workmen in claims against their employers and in accident claims.

Sir, I would like to commend to the Minister whether he should not consider changing his designation from that of "Minister for Labour" to "Minister for Employers". I am not saying this out of sarcasm or with my tongue in my cheek. I am quite serious about this. I am saying to the Minister that for all the work that he and his Ministry is doing to protect the workers in Singapore, it is a waste of public funds. The workers will be no worse off if the Ministry fails to exist in Singapore. Are these harsh words, Sir? They might seem to be harsh words. But I will try in the time limited to me to show that they are not harsh words.

First of all, there is, as we know, this growing unemployment, but the Ministry apparently is still not able to collect accurate information on the number of unemployed and about the numbers who have been found jobs. Sometime ago the Minister said in 1984 there were no jobs lost in reply to the Member for Rochore. I checked this up in the 1984 Research and Statistics Department in his Ministry Report on the Labour Force Survey, and I find that in 1984 more than 6,000 jobs were lost, not taking into account those who resigned and those who retired. So it would appear that even the Minister does not take the trouble to get his facts correct.

The other thing is that the Minister appears to show no appreciation or empathy for the workers and their feelings. May I again refer him to his answer given in this House to a question that I asked him whether his Ministry would take any action to stop needless retrenchments by companies. His answer shows exactly where his interest lies. He says, "I do not think the employers would just retrench workers out of spite or for no good reason." We have heard from several Members here, not just me, that employers are taking advantage of the recession and they are throwing their workers out of employment, and the Minister says, "No, I don't think they do that, do they? And I don't think my Ministry should interfere." So I ask: is it a Ministry to protect our workers, or is it a Ministry for the employers?

Our workers who have come to see me tell me that when the Ministry speaks, they hear the voice of the employer. They do not hear their own voice whenever the Ministry speaks. I think the Minister should know this. There were the Jurong Shipyard workers who were being "persuaded" by the company to accept early retirement. Then because they had come to me, the company thought better of it and said they would take them back. But they wanted to see the Minister on the terms on which the company would take them back and I spent a whole Saturday morning trying to get the Minister to see these workers. I got no reply. The following Monday I was told that the Minister would not see the workers but one of his officials would see them. Why cannot the Minister see the workers if they wish to see him? Is he too busy seeing the management that he cannot find time to see the workers whose welfare is his responsibility?

There is the urgent need, desperate need, I tell the Minister, for legislation to protect our workers. I can tell him about all the countries in which there is this legislation. Is he going to consider introducing legislation to give security to our workers in their employment, to protect them against employers, or is he going to say, "Oh, no, we have got good employers in Singapore. I cannot see any bad employers." There is this section 14 of the Employment Act. I have mentioned this several times in this House that it was intended to protect the workers from unfair retrenchment.

Last year I brought up the case of a man who had appealed to the Minister some months before I brought up the matter, and the Minister's reply was, "We are still considering this." I am now told, several months later, that the man was informed, but in a curt reply, that the Minister has decided not to intervene. That is the sort of attitude that our workers get from the Ministry. It is appalling that the Ministry of Labour, set up primarily to look after the welfare of our workers, should so neglect its responsibilities and duties.

Sir, I would urge the Minister to take immediate steps to see that, particularly at this time, our workers are protected and I would urge him quite seriously to lend his efforts to persuade the Cabinet and the Government to giving unemployment relief to those out of employment.

There is another amendment I have and, that is, under the workmen's compensation. Here again, it is a sorry tale, Sir. I see that the Auditor-General in his Report for the financial year 1984/85 reports at paragraph 104 that the Ministry had:

'no procedures to ensure prompt clearing of long outstanding compensation moneys. As at 30 September 1984, compensation moneys totalling $156,399.79 received [mind you, Mr Chairman, this is what he says] during the 1960s and 1970s remained in the Workmen's Compensation Deposit Account.' That is, between 24 and 14 years, they have been remaining in the Workmen's Compensation Deposit Account. Why? May I know from the Minister what has happened to these moneys now? And he goes on to say:

'A further sum of $349,600.23 in another trust account, as at 31 December 1984, had also not been distributed to beneficiaries as required by law.' The Prime Minister last week said, "Do we need to flout the law?" "We who have 77 Members in this House," he said. But there you have it from the Auditor-General saying that the Ministry of Labour flouts the law. A sum of $349,000 undistributed when the law requires that it should be distributed.

May I also, whilst we are on the question of funds, ask the Minister what has become of the Spyros fund that was set up for the victims of the Spyros disaster. I have been questioned on this by people who have asked me to raise in Parliament as to whether any account has been published of this Spyros fund. Will the Minister be able to tell us, if not today, sometime later at another sitting, what has become of this fund, and how much of it has been undistributed?

Whilst on the workmen's compensation, may I also bring to the attention of the Minister a case where a worker, who was injured in an accident and which was reported to the Ministry of Labour, had to wait for more than three years before the Assistant Commissioner for Labour assessed the compensation. And when he received it, more than three years later, he found it was completely inadequate for the injuries he had sustained. Of course, the Assistant Commissioner for Labour was not to blame. That was the assessment under the Workmen's Compensation Act. But this unfortunate man who should have got a lot more than what was assessed under the Workmen's Compensation Act was debarred from bringing any action in court because under our Limitation Act any action for negligence had to be brought within three years. So may we have an assurance from the Minister that the Workmen's Compensation Section of his Ministry will speed up things a bit and try and protect workmen who have been injured?

I have one other instance where a company sent a worker outside Singapore to work and he was injured in an accident and the Ministry refused to do anything about it because the employer said, "This was not in the course of any of his work that he sustained this accident." That is the sort of attitude that the Ministry takes, ready to listen to everything that the employers have to say but not ready to lend a willing ear to the workers. I do hope that we will see a complete change of attitude from the Minister and his staff after this, especially, as I said a little while ago, in this time of recession when our workers are being made to bear the cost of the recession. It is they who are suffering and it is time the Ministry awoke to its responsibilities to them and discharges those responsibilities.

Mr Chiam See Tong (Potong Pasir): Sir, the Government has announced that it will defer payment out of CPF and give a decision in two years' time. But the Government has also thrown out some ideas in that regard. In December 1984, the Prime Minister agreed on a proposal that $25,000 be kept at 55 years and the balance given out. However, if the contributor has purchased an HDB flat and paid for it in full, then he can take out all his balance CPF at age 55. However, this sum of $25,000, when the worker reaches 55 years old, will have to be paid out in instalments until he reaches the age of 60 and then 65 years. Does the Acting Minister agree to that proposal? I should say that that proposal originated from his pre- decessor, Prof. Jayakumar. Will the sum of $25,000 eventually be held back? The public has a right to know because it is their money.

CPF savings are the workers' money, it is often said. All CPF money belongs to the contributors. Therefore, I say to the Government, it has no business to hold back any money belonging to the people. The Government should now, in clear terms, state whether or not it intends to return all CPF money to contributors when they reach 55 years. I have asked this question many times but I have not got a straight answer yet. I hope this time I will be more successful because a very vast sum of money is involved, about $24 billion.

My Party has stated that due to the aging population and the vast amounts accumulated in the CPF by workers, the Government eventually will not be able to pay back the money to the contributors. We were ridiculed by the Government for that statement. Now we are not alone in saying that. The economist of Philip and Drew, one of London's largest stockbroking houses, in their studies also, came to the same conclusion last year. Their report stated that the Central Provident Fund faces the danger of severe financing problems in the next 25 years with payments exceeding contributions as a result of a gradually aging population.

Sir, I make no apology for taking up this issue again. All our workers' CPF savings are involved. So we in the Opposition have that responsibility at least to our workers. The Finance Minister and the Acting Minister's explanations in respect of that report are not convincing. The Prime Minister himself admitted that there was a problem, in the interview published in the Straits Times, 21st December 1984, when asked whether there was concern among people nearing the age of 50. He said:

'No, no. They don't have to worry about that. We are not worried about the people over 50. We are not even worried about the people over 45 because their numbers are small and it is not going to be a serious problem.

The problem will be enormous when the people in their early 40s, middle 40s when they get old at 65 because from then onwards larger and larger numbers will be involved.'

The time-frame of 25 years predicted by Philip and Drew was borne out by the Prime Minister. 25 years will be within the lifetime of the majority of our workers. If you look at the demographic pattern, the bulk is around the 30 age group. There is no doubt about it. The Government will have problems of paying out in time to come. I say to the Government, "Be honest. Own up and let us have your solutions to the problems." This Government has created the problem and it has the duty to the public to tell how it intends to solve those problems. The Acting Labour Minister told this House last year that Government has $33.5 billion assets, and most of those assets are in bonds and property. When needed, can the Government liquidate those bonds and property, in particular, property? Property prices are now almost at their rock bottom levels. And we all know a bad investment is consumption. How do we know that the Government's investments are not being eaten up? We need answers from the Acting Minister.

No other issue has put the credibility of the Government in question more clearly than the CPF issue. Within a period of six months, we have seen how the Government made a complete turnaround. Just let me quote from the horses' mouth, so to say, from their own Ministers' mouth. Let me first quote the Prime Minister, right from the top:

'The question is: Should we do so? Should we cut future workers' savings for the benefit of employers? No, unless it is an economic crisis.

I ask MTI [Ministry of Trade and Industry] economists this question: If one year ago there had been a saving of wage cost by 10% on the CPF and wages, would we have avoided a downturn? Their answer is: No. I asked MTI economists if the downturn could have been avoided if the wage cost, including CPF, were 20% less.... Their reply was that it would have made no difference.' This was in August 1985.

Let us see what the Prime Minister said in January 1986:

'One of their [that is the PAP leaders] options is to reduce or suspend a portion of the employer's contribution to the CPF...'.

What about his son, the Acting Minister for Trade and Industry? He, BG Lee Hsien Loong, (this is a quote from the Straits Times, 1st August 85) said:

'It was an illusion to think that the CPF rate could be cut without reducing the worker's total wage package. You cannot manipulate CPF in such a way that the employer pays less, and the worker takes back the same.'

Now, of course, I have quoted him, and not about six months later, he said:

'I think this 15% CPF cut is a reasonable cut.'

What about the First Deputy Prime Minister? On 1st September, 1985, he was quoted in the Straits Times:

'As I have just explained, we do not recommend a wage cut for everybody. CPF contributions are part of the workers' wages. Many workers use them to pay for their HDB instalments. Here, I would like to make it clear that the CPF is not the cause of our high wage costs.'

Then, let us see the turnabout on 1st November, 1985. Before I quote that, I will quote another of what he said:

'Wages, we think, is not the main cause of our downturn.'

On the same note:

'Even reducing CPF now would not help the economy because the cause is not high wages. If wage costs for the higher technological industries are 50% as we reduce CPF by 10%, I think the actual impact on costs of production will be only 1%.' This again was on 1st November, 1985 in the Straits Times.

Now here is the turnaround. On 28th January, 1986, this is what the First Deputy Prime Minister said:

'Employer's CPF rate needs to be reduced by greater than 10%.'

Then the changed tune:

'The CPF cut would not adversely affect the present standard of living.'

Then again in the same changed tune, on 30th January, 1986, he said:

'I think we can settle for a CPF cut of 15 percentage points.'

What about the Acting Labour Minister? Well, this was quoted in the Straits Times on 12th August, 1985 in banner headlines:

'4 reasons not to cut CPF. (1) CPF is a pillar of the Singapore economy. (2) It is part of our workers' wages. (3) Contributors will find it difficult to service their housing loans. (4) CPF savings can be used as a form of hard cash in the event of a world banking crisis.' There you are! Solid bedrock of the Acting Minister for Labour. We should ask for his reasons, clear-cut reasons why there is a big change now. He was laughing at me then. I wonder whether he is laughing now. Now in December 1985, four months later:

'The CPF should not be a sacred cow.' The same person saying that, and again the same person on 11th January, 1986 said this. This was quoted in the Straits Times:

'But Mr Lee made it clear that the employer's CPF rate would be cut.'

I do not think he is going to deny all these; what he had said. I do not think I would labour you on all this turnaround but surprisingly the only consistent person is the Member for Rochore.

The Chairman: You have spent 10 minutes purely on quotations.

Mr Chiam See Tong: I believe I have got four amendments.

The Chairman: Four?

Mr Chiam See Tong: I will just check and see.

The Chairman: So you are going to spend another 30 minutes on quotations?

Mr Chiam See Tong: No, I will just round it off.

The Chairman: All right. I will give you two more minutes.

Mr Chiam See Tong: Now, it is the cost of production that must be reduced. Far from decreasing shopkeepers' overheads, the Government has increased them. It is escalating like a snowball, that is, gathering more snow. This was in March 1985:

'If all these years increasing CPF rates of contributions have been implemented as purely political ... -

The Acting Minister for Labour (Mr Lee Yock Suan): On a point of clarification, Sir. The point is that the Member for Potong Pasir has two amendments in his name, according to the Order Paper Supplement. So I do not know, on what basis, he claims he has four.

Mr Chiam See Tong: Are you afraid?

Mr Lee Yock Suan: No, I am not. I would just like to say that there are other Members who want to speak.

Mr Chiam See Tong: Well, I think I have made my point. It is obvious that the credibility of the Government is definitely in question. Thank you, Sir.