MEDICAL AND ELDERLY CARE ENDOWMENT SCHEMES BILL

Order for Second Reading read. 3.58 pm

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

Sir, the Government has decided to introduce a new endowment fund to finance operating subsidies to nursing homes run by Voluntary Welfare Organisations, or VWOs. This Bill is to repeal the Medical Endowment Scheme Act and re-enact it as the Medical and Elderly Care Endowment Schemes Act, to set up this new endowment fund.

Need for step-down care increases as population ages

Our population is rapidly ageing. Today, we have about 220,000 people aged 65 years and above, making up about 7% of our population. By 2010, we will have about 312,000 elderly persons, comprising 8% of our population.

Most elderly persons will remain healthy and independent. However, it is estimated that about 3% of those aged 65 and above do acquire severe disabilities and are unable to go about their daily lives without considerable nursing care, medical attention or assistance. Yet, at the same time, their conditions are not severe enough for them to be warded in acute hospitals. These elderly persons should be looked after in their own homes, or if residential care is required, in "step-down" facilities such as nursing homes. As our population ages, the demand for nursing home care will rise.

Currently, some two-thirds of our nursing home beds are in VWO-run facilities. VWO nursing homes receive assistance from the community, in the form of volunteers and cash donations. Community assistance thus supplements the patients' payment for their share of the cost of care. At the same time, the Government also provides financial assistance to keep nursing home care affordable to those from lower income households. Nursing homes that are funded by Government now receive capital funding of up to 90% of the cost of building and equipping the homes. In addition, Government also provides full subsidy for land rental and input GST. At the same time, Government also funds 50% of the recurrent cost of providing care to patients with immediate family incomes of less than $2,000. Patients on public assistance receive 75% subsidy.

Higher proportion of Singaporeans will be eligible for subsidy

The Inter-Ministerial Committee on the Ageing Population, in its report released late last year, had recommended that the Government consider expanding its operating subsidies to VWO-run nursing homes.

The Government has considered this recommendation and decided to implement a three-tier subsidy of 75%, 50% and 25% for VWO nursing homes this year. The highest quantum of subsidy will be given to those with the least ability to pay.

To ensure that subsidy goes to those who most deserve them, the introduction of the new subsidy structure will be accompanied by refining the means test conducted in VWO nursing homes. In addition to the financial means of the immediate family, it will also take into account the size of the immediate family. This is fairer because larger families would necessarily require a larger income to live on. VWOs will also continue to take into account the patient's assets in evaluating his financial circumstances.

The three-tier subsidy will result in higher funding support by the Government to the VWO nursing homes. In addition to patients on public assistance, those with immediate family per capita incomes below $300 will receive 75% subsidy. Those with per capita incomes between $300 and $500 will receive 50% subsidy. Further, those with per capita incomes between $500 and $700 will receive 25% subsidy, where they now receive none.

Under this three-tier subsidy framework, therefore, a higher proportion of Singaporeans will be eligible for subsidy. The financial burden on low- and lower-middle income households supporting disabled elderly family members who require nursing home care will be considerably lightened.

Need to safeguard affordability of care in future, against shrinking tax base

Having decided on this subsidy framework, we need to consider how best to finance it. Sir, our population today is still relatively young. Many of us are able to contribute actively to the economy and help generate tax revenue to finance Government programmes, including health care subsidies. However, this will change. Not only will a rapidly ageing population require more step-down health care services such as nursing home care, it will also result in a shrinking tax base where a smaller working population will find it harder and harder to pay for health care subsidies consumed by a larger ageing population.

Without these subsidies, health care for the future elderly may not remain affordable to individuals from low and lower-middle income households and their families. Yet, at the same time, we need to preserve our economic competitiveness in an increasingly globalised economy, where countries maintain competitive tax rates to attract investments. Hence, it would not be realistic for us to continually count on taxpayers to pay for the subsidies to our nursing homes.

We need to ensure the affordability of nursing home care in future years. Instead of continuing with today's practice of paying subsidies to the VWO nursing homes directly out of the Government's budget, the Government will establish the alternative mechanism of an endowment fund.

Purpose of ElderCare Fund

The proposed endowment fund will be called ElderCare Fund. We will gradually build up a large enough capital sum in the ElderCare Fund, so that the interest income can be used to fully finance the subsidies for patients who are cared for in VWO nursing homes.

By setting aside funds now while we can afford it, we will ensure that funding of subsidies for step-down care facilities for the elderly of the future can be sustained in the long term.

Top-ups of capital sum during budget surpluses

The ElderCare Fund will start off with an initial capital injection of $200 million. During years of strong economic growth, the capital sum can be topped up with budget surpluses, so as to generate more interest income. Only the interest income can be used to finance the nursing homes.

In the initial years, subsidies to VWO nursing homes will be partially funded from the interest income of the Fund, and partially funded direct from the Government's budget. The goal is for the Fund to reach a capital sum of $1 billion by the year 2010. By then, the capital sum should be large enough for subsidies to VWO nursing homes to be completely financed from its interest income.

For a start, ElderCare Fund will provide subsidies only to VWO nursing homes. Other kinds of step-down care provided by VWOs and supported by the Government, such as community hospitals, will continue to be funded from the Government budget. However, when ElderCare Fund has more resources, extension of its coverage to other kinds of step-down care services can be considered.

Endowment fund will not replace community support

Sir, I have mentioned that VWOs fund their operating expenditure through community donations, patient fees and Government subsidies. The introduction of ElderCare Fund will not displace the role of community donations in helping the poor to pay for VWO nursing home care, as this is part and parcel of the community support structure. This spirit of community help must be preserved and encouraged. Hence, VWOs should continue to raise funds from the community and do their part in helping the needy and indigent patients foot their share of the charges using the donations raised.

No change to administration of Medifund

Sir, this Bill also proposes some amendments to the existing provisions on Medifund. Today, each approved hospital sets up a Hospital Medifund committee, comprising persons of standing with grassroots or social work experience, to consider and approve applications from needy patients. Funds are then paid out from the hospital's Medifund Account to defray the charges incurred by the applicant.

Although this system has worked well, we need to build in greater flexibility for the administration of the scheme to adapt to changing circumstances, so that patients' needs will continue to be well served. For instance, instead of setting up one Medifund committee for every approved hospital, it might be more desirable in future for community organisations to be responsible for disbursing Medifund to needy residents living in the community. The proposed amendments to the existing provisions on Medifund will allow for such alternative arrangements to be made, if necessary.

At present, however, no changes will be made to the administration of Medifund. Singaporean patients in B2 and C class wards of public hospitals and subsidised outpatients who face financial difficulty, and are unable to pay their charges, can continue to apply for Medifund assistance at the hospitals. Their applications will continue to be considered by the hospital Medifund committees.

Sir, I beg to move.

Question proposed.

Dr Lily Neo (Kreta Ayer-Tanglin): Mr Speaker, Sir, I would like to support the Medical and Elderly Care Endowment Schemes Bill. In fact, I am very glad that the Government has come up with yet another provision to cope with our fast-increasing population of elderly and an ever-increasing ratio of non-working to working individuals in the near future. It is good that there is now a scheme that gives Singaporeans further peace of mind in their golden years. I would, however, like to add that this Government must continue to promote and encourage some of the very basic values that have served us well all these years. Sir, the need for self-sufficiency and looking after one's own kin and families in our Asian values should be emphasised. Otherwise, the two endowment funds which are to serve only as safety nets for those really in dire need, will be found lacking through callous and overwhelming demand.

The ElderCare Fund, like the Medifund, will be for the nursing care of our needy elderly in future. As announced by the Minister for Health in his introductory speech, the Government will build up the ElderCare Fund with an initial capital injection of $200 million. Further capital injections will be made when budget surpluses are available. Only the interest income of the ElderCare Fund will be used to fund the operating subsidies to VWO nursing homes and extension to other kinds of step-down care services will be considered when the ElderCare Fund has more resources. Sir, in order to build up the ElderCare Fund faster so as to extend the other services sooner, would the Government consider accepting donations from private organisations, philanthropists or even grassroots organisations? Would the Government also encourage donations with an incentive of three-to-one matching grant, similar to that given to the CDCs?

I would like to suggest that the Ministry of Health devise a plan for the approval and disbursement of the Medifund and ElderCare Fund via "local councils". Such "local councils" could be the CDCs. The authority to assess eligibility and to approve the use of these Funds can then be devolved. The Ministry will, hence, need less administrative manpower. Each CDC could be made to raise some of the money so that it will have more authority to disburse the funds. It is likely that the CDC, through its closer rapport with the constituents and with the liberty to decide whom to help in its ward, will allow for more effective disbursement of the funds. The CDC will also become more relevant to the people. Sir, as Members of Parliament have closer contact with their residents and also have the help of the grassroots workers, they would know the needs of the residents better. They could be advisers to these "local councils".

Mr Speaker, Sir, I would like now to comment on the following clauses of the Medical and Elderly Care Endowment Schemes Bill.

Clause 6

The Act to be repealed specifies that the Advisory Council should contain not less than five and not more than nine members. The Bill does not provide for any minimum or maximum number and is left to the discretion of the Minister. Is there any reason for this?

Clause 25(6)

Where there is any suspension, the approved provider shall not be regarded as one. What happens to its patients in the interim?

I hope the Minister for Health could enlighten me on these points. Mr Speaker, Sir, I support the Bill although I would like to propose an amendment to one clause of the Bill at the Committee stage.

Mr Seng Han Thong: Mr Speaker, Sir, the Inter-Ministerial Committee on the Ageing Population headed by Minister Mah Bow Tan presented its report to the Government in November last year. One of its key recommendations is that community based step-down care services need to be strengthened to support the family in its role of caring for elderly members.

Thus, the Elderly Care Endowment Scheme to be introduced and the ElderCare Fund to be established under this Bill can be seen as Government's response to the recommendations. It is in line with the principle of promoting individual responsibility.

The Singapore 21 Committee, launched by Prime Minister Goh in 1997, was tasked to look into the challenges faced by Singapore in the 21st century. One of the dilemmas the Committee dealt with is that of taking care of the needs of senior citizens versus the aspirations of the young. The idea is that we need to promote strong family ties so that the needs of the elderly can be taken care of by the family. But the community and the Government will help if the family is unable to handle the problem. The ElderCare Fund is in line with this idea.

Sir, while I support the setting up of the ElderCare Fund, may I seek clarification from the Minister as to the interpretation of the step-down care. Clause 2 of the Bill defines step-down care as "accommodation, personal care and health care for persons suffering or recovering from any sickness, disability or injury." Could the Minister clarify whether the elderly who are "frail" and need some form of supervision but not sick, disabled or injured, fall under the category and can qualify for step-down care? We know the figure of Liang Po Po. Just imagine that one day Liang Po Po gets older, cannot even "ho, ho, ho", and becomes frail but she is not sick, disabled or injured. As our population ages, there will be more of such groups who are able to carry out their daily needs or daily routine but are frail. In fact, the majority of the NTUC Day Care patients are frail but not sick, disabled or injured.

Sir, the Minister may also clarify whether the provision of elderly services at the space designated for such communal services at the HDB apartments qualifies for approved provider premises status under clause 22 of the Bill. I raise this because it is foreseen that there will be a need to provide such services at the void decks of HDB flats in future as our population is ageing.

Sir, clause 26(4) refers to "relevant patient" to be a person who, in the opinion of the Minister, requires step-down care and is assessed by the Minister to be "financially disadvantaged". May I propose that in arriving at the definition, the Minister will consider the predicament of the elderly who belong to the "sandwiched" group, that is, the middle income group who cannot afford the fees charged by the private organisations and, at the same time, not eligible for any subvention.

Sir, I support the Bill.

Mr Gerard Ee (Nominated Member): Mr Speaker, Sir, I rise in support of the Bill.

Firstly, I would like to declare my interest as the Chairman of the Medifund Council since it was set up. Over the years, the Medifund has helped many thousands of people to meet their hospital and medical expenses. It worked well because of the flexibility built into the rules for the Medical Endowment Fund. With a basic set of rules supported by guidelines, Medifund committees were able to exercise judgement, especially in border line cases, to balance between the resource available and the help that can be provided. And I am happy to see that even more flexibility is being considered under the reconstitution. The same spirit of flexibility is being suggested for the ElderCare Fund. It is certainly timely to establish such a fund to provide subventions to approved providers of step-down care. It will be a great help to existing providers of step-down care who qualify as well as encourage the establishment of newer facilities.

I have two areas that I would like to seek clarification. One in particular relates to the ElderCare Fund. The definition of "step-down care" suggested means "accommodation, personal care and health care for persons suffering or recovering from any sickness, disability or injury; personal care and health care during the day for any such persons; or such other forms of health care or care arrangements". If I look at the definition of "step-down care", I do not see it as something that is strictly restricted to the elderly. It could well be something beneficial to someone that is young. So I am not sure why we are restricting ourselves to the elderly. It could be just to start it off and as the Fund builds up, maybe it will be expanded. In which case then, by calling it the ElderCare Fund, are we placing a mental ceiling and whereby even if the Fund builds up, we will continue to restrict step-down care only for the elderly? Perhaps, the Minister could let us know the rationale for this.

My next concern is the sweeping exclusion from the definition of "step-down care" of medical or health care provided in any maternity homes or premises used or intended to be used for the accommodation of pregnant women or of women immediately after child birth. I can accept that post-natal care is excluded from the definition of "step-down care". However, I am sure there is a range of health complications arising from pregnancy which can be adequately dealt with by the professionals at a maternity home or similar premises.

My concern arises from the first-hand knowledge of a lady who suffered from a stroke whilst pregnant. The health insurance policy taken out for her covered medical care for strokes, but because her stroke was deemed to have arisen from her pregnancy, she found that her medical costs were not covered. A less sweeping exclusion directed at medical and health care for normal pregnancy, including Caesarian births, would be preferable. This would ensure that only premises set aside to deal with special pregnancy cases would qualify. Larger families are being encouraged in the light of a rapidly ageing and shrinking population. No one would wish for a complicated pregnancy. The medical cost for a normal pregnancy is sufficient financial burden to many. Some help is well deserved by those playing their part in replenishing and expanding our major resource, our citizens.

Dr Jennifer Lee (Nominated Member): Thank you, Mr Speaker, Sir, for the opportunity to speak on the Bill. My comments are directed largely to Part III of the Bill on the ElderCare Scheme. The Bill seeks to establish a Government fund to subvent the recurrent cost of step-down care providers.

Firstly, I would like to commend the Ministry of Health for moving so expeditiously on the recommendation of the Inter-Ministerial Committee (IMC) on the Ageing Population to make provisions for the funding of step-down care. The IMC had observed that while the provision and financing of acute health care services for the elderly in Singapore are pretty much adequately taken care of, the step-down care and, primarily, the community-based services still need much strengthening. The Ministry has in fact started to address those areas under its purview. The recent announcements relating to allocation of land for private nursing homes and changes in eligibility for subsidy of new residents in Government-funded VWO-run nursing homes and, now, this Bill to set up the ElderCare Fund, are all directed towards facilitating the provision of step-down care, encouraging appropriate usage and assisting in the financing of these services. This is certainly moving us in the right direction in preparing for our growing population of older Singaporeans.

I do have a concern, however, that our attention continues to be much more heavily directed towards the very visible problem related to institutional care and not enough towards the not so visible, but equally, if not, more important, educational, preventive and rehabilitative aspects of the whole picture. The Bill has defined step-down care very broadly to cover both accommodation and day care, and to cover both health and personal care as well as other forms of care arrangements. This is good and necessary as it is not only more places for institutional care and nursing homes and in day care centres that are needed, but even more so the provision of home care services, medical and nursing services and simple home-help services in which a large gap currently exists. But step-down care, as its very name indicates, addresses the situation after the damage has been done and seeks the solution from the acute care institution's point of view of how to get the senior citizen who has needed to be hospitalized back in various stages to the community.

We have defined in our vision of successful ageing for Singapore that, at the individual level, we aspire to have healthy and active older Singaporeans who lead independent and fulfilling lives. To achieve this, there is a chasm we have yet to bridge in mindsets and attitudes, both in the value that we currently place on the advanced years of an older person's lifetime as well as in the importance of paying attention to the simple daily routines in preventive health care to ensure that our senior citizens continue to stay fit.

Sadly, it is not infrequently that I have heard stories of older persons who have not had treatment for correctable conditions simply because the family had not thought that, at their age, the expense would be worth it. Just recently, a colleague who does voluntary work in the community shared an account of an elderly woman who was house-bound because of failing eyesight due to cataracts. The family felt that it would not be justified to dig into the family reserves for the thousand dollars that they took for the operation to correct the problem, and that was because she was 70 years old. But for this lady, she has five more years, 10 more years, maybe even more, house-bound and unable to see. It is the attitude, I think, of after a certain age, it does not matter so much. But our life expectancy is now pretty high and I think we need to put more value on the quality of life for the older Singaporeans.

The National Health Survey conducted by the Ministry in 1995 discovered a high occurrence of high blood pressure and diabetes in our population. These medical conditions will increase in incidence with age. High blood pressure that is not managed well will predispose to strokes and diabetes that is not well treated may very well lead to amputations. Poor eyesight and frailty result in falls. All three result in drastically reduced mobility for the older persons. The quantum leap in care needed when an older person suffers loss of mobility and the impact on her or his quality of life is horrendous. Very often, people will scrimp on or ignore what they feel to be small things - good, effective control of low grade chronic illnesses or exercise and rehabilitation to maintain fitness, not paying attention until what could have very easily been managed on an outpatient basis in the community becomes a hospitalisation for a major health event.

So while the provisions in the Bill for financing and subsidy of step-down care are most welcome, I urge the Minister to put aside enough resources towards encouraging and facilitating the development of strong programmes in the community for health educational and preventive services, to re-orient our perspective so that what drives the system is how to prevent the strokes, the amputations and the fractures that give rise to the need for the step-down care in the first place.

Services to meet the needs of the frail, ill and disabled elderly are currently provided by a range of agencies under the umbrellas of the Ministry of Health, the Ministry of Community Development and the National Council of Social Services. As the Health Ministry proceeds to refine its existing criteria for susbsidy of nursing home residents to ensure the appropriate use of facilities and services and to enact and implement regulations to ensure that the ElderCare Fund to be established is drawn upon prudently and appropriately, there will be a shift in the mix of residents that are presently being looked after by the nursing homes.

The Ministry has recently announced that it will no longer subsidise new incoming residents who need only varying levels of assistance in their routine activities of daily living - I think these are referred to as Category 1 and 2 patients - as these persons should not be cared for in the nursing home, but rather in their own homes, in the community, or perhaps in the homes for the aged. Unfortunately, at the moment, the homes for the aged, which come under MCD, are not geared up to deliver this care as they are actually meant for the well elderly. And there are insufficient VWOs providing community services and support that would be available to help families and elderly individuals to cope at home. So, as the nursing homes resist taking in the Category 1 and 2 patients because they no longer receive subsidy for them, where will these people go to? In this interim, there will be tremendous pressure on families to cope. Is there some way perhaps the Minister could look at some resources towards helping bridge this interim gap, until such time as MCD and VWOs are able to provide the services that will enable these categories of residents to be taken care of at home.

As the various agencies will move at different speeds in undertaking their part of the work that needs to be done in moving towards our desired destination of successful ageing in Singapore, much coordination is required to ensure that, for all our good intentions, we do not in fact exacerbate the problem in the meantime. I trust that the Minister will take the points raised into consideration as he moves to put together the policies, initiatives and legislation to provide for and finance appropriate health and personal care for our growing senior citizenry.

Sir, I support the Bill.

Mr Thomas Thomas: Mr Speaker, Sir, I support the Bill.

How we treat the sick and old is a strong signal on how we recognise their contributions to the success of this nation. It is part of strengthening the software to look after the old and the sick. Today's old was yesterday's young who contributed to the success of Singapore. And today's young who is presently contributing to our success will be tomorrow's old. I do not wish to go through all the many things in the Bill because it has been covered by previous speakers. However, I have two concerns regarding elderly care. First, in promoting step-down care, the private sector would be playing a role. The private sector is primarily profit-motivated, and there is nothing wrong with that. But, Sir, the question we ask is: should the question of elderly care be subjected to too much of market forces? And as a follow up, is it not better to serve the needs of the elderly through the VWOs and cooperatives? The setting up of cooperatives would have social objectives and they could give the elderly care and those who need it better value for money. Moreover, the surpluses of cooperatives, which are run on commercial line, belong to members and will go back to the people who need it.

The other point I want to make is about home care. While we promote institutional care, I think we should not neglect home care. The report of the Inter-Ministerial Committee on the Ageing Population had a whole chapter on enabling families to care for the elderly. It primarily says that the care of the elderly by the family is the best avenue as they also need to talk about physical need as well as the emotional and social needs. And it is also in keeping with our value of filial piety.

While I support step-down care and institutional care for the elderly, I ask that we do not neglect home care. Home care is also the desire of most of the elderly. They like to be near their children and grandchildren, and we should say that it is part of the value for the family to take care of them. Towards this end, I would like to ask the Minister what steps are going to be taken to promote home care so that more and more people will look after their elderly at home.

Mr Lim Hng Kiang: Sir, I would first like to thank the Members for their contributions to this debate. This whole issue of looking after the aged sick is a very big challenge for us. This is not the first nor the last time that we are going to discuss on how we are going to approach this challenge.

At the outset, I would like to say that I agree entirely with Dr Lily Neo and Mr Seng Han Thong that our entire approach must emphasise the personal responsibility for looking after one's health and also counting on family members to look after you when you grow old or when you fall sick. I think these are two pillars that would not change - personal responsibility and family support. But at the same time, there would be this small percentage of the elderly who would fall sick. This elderly sick is quite well-defined in medical terms. This is defined through some criteria of how a person can go about his daily living with different levels of assistance. For those categories that require a very high level of nursing care, what we designate as Categories III and IV, the medical conditions of such people would affect approximately 2% to 3% of the elderly above 65 years old. So, what we are discussing today is a fairly well-defined group of about 2% to 3% of the elderly above 65 years old. Of course, this is part of the whole issue of how you address the challenge of the ageing population and many issues have been raised by Members. But I just want to concentrate Members' minds that the ElderCare Fund is set up to target at this 2% to 3% of the 65 years and above who fall sick, categorised as Categories III and IV under these medical conditions, and who require care in an institution or in a home setting.

Sir, the first definition is the medical condition of the person that requires such care. As Mr Seng Han Thong has asked, this is addressed in the definition in the Bill and it does not cover the elderly frail. Elderly frail, who are out of this 3%, would not be covered by this ElderCare Fund. Having defined this group whose medical condition requires us to look after them, then it really does not matter whether we look after them in an institution setting or in a home setting. But for purposes of implementing the financial support, we are saying that we start off first with supporting the nursing homes run by VWOs. This would be extended in due course in future to nursing homes run by the private sector when we are familiar with running such financial support. The subsidies are meant for people meeting the medical condition, and passing the means test. In future, we can also extend to other institutional care settings, whether it is a community hospital, chronic sick hospital or such facilities set up in the void decks. When we are able to develop home care facilities and services in a better way, such financial support would also be extended to home care services for this 3% of elderly sick.

I think we start off with this category that requires the medical attention and financial support. As a start, to implement this programme, my Ministry suggests we do it first with the nursing homes run by VWOs, develop some expertise, and then we can systematically extend it to widen the coverage.

Mr Gerard Ee asked does the ElderCare Fund only cater for the elderly? The answer is no. It is mainly the elderly who would require such nursing home care, but there would be others who would also require such rehabilitative and nursing home care, for example, the case that he cited of a pregnant lady who suffered a stroke. In the first phase of the sickness, she would be cared for in an acute hospital setting. Then later, when she is more stable, when her recovery is better, we would probably transfer her to a nursing home. And when she is in a nursing home, and if she belongs to the low and lower-middle income, then the financial assistance would kick in. We call it ElderCare because the vast majority of the people who would enjoy this funding would be the elderly. But it is not restricted to just the elderly. People whose medical conditions satisfy or require us to provide medical and nursing care, ie, those in Categories III and IV, would be eligible for the financial assistance.

Having defined the medical condition and the premises, we can now define the relevant patient, that is, the different categories of people who deserve the different levels of financial support. Mr Seng Han Thong made a plea for the sandwiched group, the middle-income group whose income is too low to afford private nursing home and too high to enjoy the subsidies. We try to take care of this by having a three-tier framework. Previously, it was only either above or below $2,000 household income. Now we have three tiers, so it is no longer a sandwich. It is now a three layered nonya cake. But of course, there would still be people who fall outside the criteria. I do not think we need to go into a kueh lapis, with so many layers, but we can obviously extend the layers and provide more assistance when we build up the fund and when we build up the experience.

Now, I would turn to the specific suggestions and points raised. Dr Lily Neo asked whether we accept private donations. The answer is yes. All donations and bequests can be paid as capital monies into both the Medifund and ElderCare Fund. She asked whether the Government would give a matching grant of 3 to 1. At this moment, I do not see the need because the Government is pledging to build up the ElderCare Fund to the tune of $1 billion. That is a lot of money, so there is really no need to have further incentives to ask the private sector or the individuals to donate. In fact, I would urge the private sector and individuals, if they want to make donations, not necessarily to make donations to the ElderCare Fund because the Government is going to build it up to $1 billion, but to make donations directly to the VWOs, because they need the donations to help pay for the patients' portion of their bills.

Dr Lily Neo also asked whether we can work through local councils like the CDCs. This is something that we are thinking about and this is one of the reasons why we are making some of the amendments, in particular, the amendment to section 6 where we did not stipulate the number of advisory councils. This is to give us the flexibility to appoint enough people to match the CDCs, depending on the number of members in the CDCs. So, the intention is to involve the community in the form of the CDCs. They are the people who know the residents on the ground and can understand their needs and make sensible decisions on who qualifies for Medifund assistance.

Dr Lily Neo asked what happens to the patients if we have to suspend a nursing home. That really depends on the reasons for suspending the nursing home. We may suspend nursing homes for several reasons. The most drastic reason is when we have to remove the licence from the nursing home because it does not meet the medical criteria of continuing to run the nursing home. Under such circumstances, the patients will have to be taken care of in other homes. But if the nursing home continues to meet the medical criteria of running a nursing home, but gets suspended for other reasons, for example, for not keeping good accounts or for whatever reasons, then of course, it would not affect the patients.

Mr Gerard Ee asked why we exclude facilities meant for pregnancy, etc. As I explained, complications arising from pregnancy will be dealt with either in the acute hospital setting or if it is something that requires nursing home care, then it will be dealt with in a step-down nursing home care facility. Under the latter circumstances, the patient will qualify for ElderCare funding.

Dr Jennifer Lee made several very good points. I just want to say that all these are very important. We do recognise the full range of the challenge facing us. As I said, the Bill tackles 3% of the elderly who require nursing home care. My Ministry, working together with MCD, would also look at the other very important areas. I agree with her entirely that we first have to set up the framework for preventive care so that as few as possible of our elderly actually fall into acute or chronic problems. So preventive healthcare and public education are very important, and we are also working on programmes that will address this.

Both Dr Jennifer Lee and Mr Thomas also talked about the very important role played in home care facilities. This is a tremendous challenge. It requires a lot of resources. I can assure both of them that both MCD and my Ministry are working to improve the home care facilities and services that we have in Singapore but Members have to give us some time to work on it.

The particular problems of Categories I and II, I think, require a joint effort between MCD and MOH to deal with. I do not want to give the impression that because we come to this House on our plans for setting up nursing homes and our financial arrangements for the ElderCare Fund that we are giving focus or attention to institutional care, and not to the other aspects of the problems confronting our aged. As I said, this would not be the first or the last time that we would be talking about the issue. I am sure we will be addressing it. Members can have my assurance that my Ministry and MCD will tackle this problem systematically, and we will come back to the House for support for the other components of looking after the elderly.

Dr Lily Neo: Sir, the Minister said earlier that the ElderCare Fund will also go towards the recipients of home care. I want to ask him how would this work and who will be eligible for this ElderCare Fund. Will the recipient be the beneficiary or the carer of the recipient?

Mr Lim Hng Kiang: Dr Lily Neo is always moving at the speed of a train. I said that we start off first with nursing homes run by VWOs. We build up the experience and, in future, we can extend the scope to the next step, which is nursing homes run by the private sector. Then we can extend it to another step, which is other types of homes, not just nursing homes, but community hospitals, chronic sick, and also facilities in the void decks. We can also extend it to home care. I know the real challenge and the difficulties of providing subsidies or financial assistance to home care, the very issues that the Member raised, whether it is the provider or the recipient; who gets, who approves. It is a huge problem. I prefer to go about it systematically. Let us start with the easy part first, which is nursing homes run by VWOs. Then we extend it systematically, but I can assure Members that we will reach home care in due course.

An hon. Member: When will that be?

Mr Lim Hng Kiang: Before you grow old!

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Mr Lim Hng Kiang].

Bill considered in Committee.

[Mr Speaker in the Chair]

Clauses 1 to 22 inclusive ordered to stand part of the Bill.

Clause 23 -

The Chairman: The hon. Member for Kreta Ayer-Tanglin, Dr Lily Neo, has given notice of an amendment to this clause. A notice of the amendment has been circulated to hon. Members. As inadequate notice has been given of this amendment, it is subject to the consent of the Chair and the general assent of Members present. I give my consent. Is it the pleasure of hon. Members that the amendment be moved?

Hon. Members indicated assent.

The Chairman: All right. Dr Lily Neo, could you move your amendment?

Dr Lily Neo: Sir, I beg to move,

In page 12, line 32, to delete the words "without assigning any reason,".

Sir, my reason for proposing the deletion is that it sounds too harsh, as it gives an absolute discretion to the Minister to reject any application without assigning any reason. Secondly, the deletion will, in a way, leave a room for the Minister to give reason if any applicant attempts to appeal or ask for a reason for the rejection. Without the deletion, the Minister may conveniently refuse to entertain any such request.

Mr Lim Hng Kiang: Sir, when the Member pointed this out to me, I accepted her reasons for wanting to make the amendment. It is not our intention not to give any reasons. It is just one of the standard clauses. I think it is a very jarring phrase. So I have no problems at all with the deletion. I concur with the Member's amendment.

Amendment agreed to.

Clause 23, as amended, ordered to stand part of the Bill.

Clauses 24 to 47 inclusive ordered to stand part of the Bill.

The Schedule ordered to stand part of the Bill.

Bill reported with an amendment; read a Third time and passed.