ESTIMATES OF EXPENDITURE FOR THE FINANCIAL YEAR 1ST APRIL, 2001 TO 31ST MARCH, 2002 (Paper Cmd. 3 of 2001)

Order read for consideration in Committee of Supply [3rd Allotted Day].

[Mr Speaker in the Chair]

Head Q -

The Chairman: Head Q - Ministry of Home Affairs. Amendment No. (1), Prof. Chin.

Assoc. Prof. Chin Tet Yung (Sembawang): Sir, I beg to move,

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

Sir, the GPC for Home Affairs will focus primarily on the Home Team and its relationship with the community in this Committee of Supply. We believe that the Home Team should continue to work hard at integrating the community in its efforts to fight crime in Singapore. Because of the increase of public awareness in crime prevention, we have seen positive results in combating crime in Singapore. We would like to see more done in this regard.

Sir, the Home Team released its major crime report recently, indicating a drop of over 17% in major offences cases. This is heartening news indeed and the Home Team deserves recognition for a job well done in year 2000. However, there are a couple of disturbing statistics and trends and I would like to ask the Minister to clarify some of these for us. First, for sexual offences, namely, outraging modesty and rape, the decrease has been marginal - 1.6% for rape and 3.3% for outraging modesty. In other words, these offences are still committed with regularity. I am particularly concerned that the two rape/murder cases, one in Woodlands and the other in Bukit Gombak, remain unsolved to this day. Even more disturbing perhaps is that we now have sexual offenders who are using the Internet and chat lines to establish contact with their victims. Even though the figures may still be low, eight rapes and two cases of outraging modesty, they are on the increase, and may increase further if no action is taken. How will the Home Team respond to this worrying problem? May I suggest that the Home Team embark on a publicity campaign, especially in secondary schools and the like, to warn young people of the potential dangers of becoming too friendly with Internet contacts. Simple measures such as getting them to make sure that their chaperone comes along perhaps should be told to them.

Second, while I note that house-breaking has registered a 30%-plus drop in the year 2000, the number of break-ins into private properties has actually increased somewhat - 134 cases in year 2000 as compared with 97 in 1999. In percentage terms, the increase is in the region of about 38%. Could the Minister let us know how the Home Team is responding to this worrying trend? Has the Home Team, for example, taken any steps, similar to the ones that have been taken in HDB estates where police officers have actually visited the residential units to provide residents with information and advice about crime prevention? Perhaps similar steps should be taken by the police with respect to private homes and estates.

Third, I note that foreigners account for roughly 10% of those arrested for crimes in Singapore. While this might seem as a small percentage, it nonetheless comes to a figure of nearly 1,500 foreigners - the majority of them work permit holders or on social visit passes. I should like to know whether we have sufficiently tight controls at our border checkpoints to prevent such criminals from entering Singapore. Do we have good relations with the police forces of other ASEAN countries, South Asian countries and China to improve the screening of foreigners coming to Singapore?

Sir, I am sure that the Home Team has made Singapore a much safer home for almost everyone. I hope that this year it will be an even safer one for Singaporeans.

Mr Goh Choon Kang (Marine Parade): (In Mandarin): Sir, last year, the crime rate was reduced by 14.7% as compared to 1999, and this is very encouraging. Many people are saying that our Home Team has been doing a very good job.

Maintaining law and order in our society is just as important as our national defence, and we need a very effective force to take care of this matter. Our declining crime rate did not come by chance. It is the result of the efficiency of our Home Team. Last Saturday, I attended the annual meeting of the review committee on the Home Team, which includes the Police, Immigration and CNB officers. Every unit presented its workplans and these are very comprehensive and farsighted plans. That is why I say that the decline in our crime rate did not come by chance.

Although, generally, the crime rate has reduced, recently we read from the media that there were many cases of juvenile delinquencies, especially young girls involving in fighting and robbery, and there were also a lot of cases of outraging of modesty and rape. This gives the people the impression that there seems to be an increase in the number of juvenile delinquency cases. It is particularly noteworthy that an army officer and a teacher were involved in a series of outraging of modesty cases. There was also one 15-year old girl who made friend with someone on the Internet and subsequently had sexual intercourse with a number of strangers.

Notwithstanding the statistics released by the police that there were only two outraging of modesty cases arising from Internet acquaintances, there were eight cases of rape. This was significantly more than last year's figure. But these were only reported cases. We do not know how many cases went unnoticed, because no police report was lodged.

We all know that our young people and students like to go on ICQ and chat room on the Internet. And because of their curiosity, they become easy prey for the criminals. I think the parents and the teachers should take special notice of this. Although such cases are not many, it seems to be on an upward trend. I think the police should pay more attention to this problem and take some effective measures to counter them.

Assoc. Prof. Chin Tet Yung: Sir, earlier, I spoke about the need for the Home Team to establish a strong bond with the community. There are several innovative programmes in place to encourage this sort of bonding. In particular, the two-year old Community Safety and Security Programme (CSSP) has taken root in many grassroots organisations. Even school children and stallholders in markets are now involved in CSSP. At last count, over 500 RCs are involved in such a programme. This, again, is a major achievement for the Home Team.

Where there are grassroots organisations formed, the bonds between the Home Team and the community have been strengthened through the CSSP. However, in the case of new towns, there is frequently a perception among residents that the Home Team has not been visible enough, and that they fear that there is insufficient protection, especially when the policy is now not to build any more Neighbourhood Police Posts (NPPs), but to concentrate on the larger type of Neighbourhood Police Centres (NPCs) and mobile policing rather than static NPP type of policing. Nonetheless, it appears that the traditional concept of the policemen on the beat still strikes a chord of security in many residents.

Sir, I would like to ask the Minister whether the Home Team could look into how police presence can be improved in new estates, where residents have a natural tendency to feel insecure in their new environment. Would the Minister consider the following:

(i) reinstate foot patrols or bicycle patrols in new areas where there are many new residents and where the RCs have not yet been formed;

(ii) purchase more mobile NPPs and station them on a regular basis around the new neighbourhoods; and

(iii) start house visits early to new residents; in fact, as soon as they move in and, in any case, not later than 6-8 months.

Sir, such visits and patrols increase police presence significantly and add to the sense of security and well-being among the residents.

Mr S. Iswaran (West Coast): Sir, the Community Safety and Security Programme (CSSP) was started in 1998, and it brings together the grassroots organisations, the CDCs and residents with the help of the Home Team to address specific areas of concern pertaining to security. I think there are sound principles that underlie this approach. It fundamentally emphasises that safety and security is everyone's responsibility, and it nurtures the spirit of self-help and mutual support within the community. So on all those counts, it is very consistent with Singapore 21 and the idea of active citizenship.

Sir, the question I have for the Minister is, given that the programme has been in place for over two years now, how well received is it on the ground, particularly amongst the RCs. Also, last year, there was the suggestion that it was going to be extended to schools, and I would like to know how the schools have responded to this initiative, especially as there were some concerns that schools might be somewhat reluctant because they may be stigmatised as having particular problems and that is why they are participating.

Sir, I am also interested to know how the Ministry assesses the effectiveness of the CSSP. Is it purely by input measures, such as the numbers participating, or are there other ways that we can measure the efficacy? For example, the latest crime statistics show that the elderly have been particular targets for cheating offences. Has there been a response through the CSSP to this particular form of problem?

Sir, the related issue is police presence which the GPC Chairman, Prof. Chin, has also spoken on. Even as residents come forward to do their bit, they do look to the police to continue to maintain vigilance and protection on the ground. In this regard, police presence and visibility is crucial. The feedback is that residents see less of the men in blue on the ground. They attribute this to closure of NPPs and also perhaps to a greater emphasis on police patrols by cars, rather than by foot or bicycle. Sir, I do not think that this is confined to just the newer estates. In general, I have received this feedback from various quarters. The visibility of the police has an important deterrence value to would-be criminals but perhaps, more importantly, it has an important assurance value for residents, assurance of security and general safety.

Sir, I would like to ask the Minister what measures are in place to ensure that the police continue to maintain a certain level of visibility on the ground, particularly in those areas of high human traffic where visibility through foot patrols or bicycle patrols will be much more effective.

Mr Goh Choon Kang: (In Mandarin): Sir, just now, our GPC Chairman, Prof. Chin, talked about a scheme whereby Neighbourhood Police Posts (NPPs) are closed down with the opening of Neighbourhood Police Centres (NPCs). My constituency is one of those affected by this scheme, and I would like to reflect some of the feedback I have got from my residents.

Since the 1980s when we first started this concept of Neighbourhood Police Post, the NPP has become a familiar feature in our neighbourhood, and it has given the people the impression that the Police is very friendly and pro-residents. Very good relationship has been built up between the Police and the residents, and it has given the residents a sense of security living there.

However, with this new concept of Neighbourhood Police Centre being implemented, many of these NPPs will be closed down and many people are feeling a sense of loss, as though with the closure of these NPPs, they would lose this sense of security. They do not understand why the Police must make these changes. Some people are concerned that by so doing, it would affect the law and order in the area and would go back to the situation before these Neighbourhood Police Posts were set up. The good relationship previously built up by the policemen in the NPPs and the residents would then be dampened.

I hope the Minister would answer these queries. 10.15 am

The Minister for Home Affairs (Mr Wong Kan Seng): Sir, I thank the Members for their comments on the good work done by the Home Team, and in particular the Police which they talked about - their presence and their relationship with the community, that there is now a very wide level of acceptance of the Police friendliness and the way they have been helping the public, and serving their security and safety needs on the ground.

As Prof. Chin has mentioned, crime rate has indeed dropped very significantly last year. Last year was in fact a very good year for the Police in that the crime situation was under control, although we still have something like 30,000 cases of seizable offences reported last year. But as a percentage, this is a significant drop of something like 15% from that of 1999. On a per hundred thousand basis, the drop is even more significant, from 924 to 764 cases per 100,000.

In the year 2000, eight of the nine index crimes fell, compared to 1999. Index crimes are those offences which are used for international comparison purposes on the situation of crimes in other parts of the world. These are selected for their reliability and higher reporting rates. In our context, the nine offences in the index crimes are murder, rape, outraging of modesty, robbery, housebreaking, motor vehicle thefts, snatch thefts, cheating-related offences and rioting.

Property offences such as housebreaking, robbery, motor vehicle thefts and snatch thefts also fell very significantly, between 14% and 36%. The offences of murder, cheating-related offences, outraging of modesty and rape also declined. But the offence of rioting recorded a slight increase of 4%, after having dropped by close to 33% in 1999, compared to 1998.

Mr Goh Choon Kang was concerned about youth crime and the situation of young people not knowing about the dangers of Internet chats, and so on, the same concern as expressed by Prof. Chin - that young girls are caught unawares when they engage themselves in IRC chats and eventually get taken advantage of. There has been a slight increase in the number of such cases reported, but the number is still very small. But the main part really is in not just Police having public education campaign on the young people but the parents themselves must play a very important part in ensuring that their children, when they get involved in Internet chats, know what they are doing and educate them of the dangers of meeting strangers in strange places and unaccompanied. There is a Parents Advisory Group on the Internet led by private citizens and the Police will work closely with them, together with the Education Ministry, on educating our young people on the dangers of such Internet chats, which may eventually lead them to trouble.

But, on the whole, talking about crimes committed by youths, such as shoplifting, theft, rioting, causing serious hurt, these have decreased very significantly. The number of youths arrested for shoplifting, which is a major component of the number of crimes committed by the youth, has decreased by 16%, from 1,300 cases to 1,100 cases in the year 2000. The number of youths arrested for theft, which also includes shoplifting, has also fallen from 2,400 youths to 1,900 youths, and that is a decrease of about 23%.

So we have seen a significant decrease in the number of youths arrested for shoplifting or theft which includes shoplifting. While that is still quite a large number, I think that with enough of publicity effort on this on the part of the Police to educate the young people, particularly working very closely with the schools to ensure that the students know the rights and wrongs when they go to the shops, and not just be too quick with their fingers and pinch things that do not belong to them and not paying for them, the crimes involving youths and young people have actually not increased. But I think the perception that we have a problem among the young people that there is an increase in youth crime probably is due to the publicity given by the media whenever a case happens, and when it is reported, people get excited about it. When these cases are highlighted, then, of course people will be concerned. But from the number of young people arrested for crimes, we have not seen an increase but we have seen a significant decrease. Nevertheless, we pay very close attention to making sure that young people do not go wayward and we try to do as much as possible to educate them about the dangers of committing crimes. In my Ministry, we have formed an Inter-Ministerial Committee on Youth Crimes, chaired by Prof. Ho Peng Kee, working together with the Education Ministry, the Ministry of Community Development and Sports, and the other voluntary organisations. The whole idea is to engage the community, plus all those Government agencies that are involved in educating young people or making sure that they do not get into trouble, like MCDS.

This multi-agency approach actually has worked quite well in that they have come up with many new ideas to cope or deal with this problem of young people committing crimes. They have also worked with this Parents Advisory Group on the Internet. So we should leave it to such initiatives and not get the Police thoroughly involved in every activity or every crime that may impact the public. Really, in the case of young people, the parents themselves should play an important part in educating their own children and not leaving it to others alone.

There is also a concern expressed by Members that the Police seem to withdraw themselves from the community by setting up Police Centres and closing down police posts, as Mr Goh Choon Kang said. Actually, this idea of a Police Centre increases the presence of Police on the ground. It does not reduce the presence of Police on the ground. The NPPs in the past, we still have them - and by the middle of this year, we would have concluded the phasing over of the Neighbourhood Police Centres taking over a large part of the NPC system - we still have these NPPs until July, and thereafter we will have the NPCs being the key nodes of the Police presence on the ground, supplemented by some other NPPs that are still in operation. But the difference between the NPP and NPC is that in the past, the NPPs were very static operations. NPP just involved a few officers sitting in the post and from time to time, they went on house visits, they went on their feet or patrolled on their bicycles. And even when they were requested to attend to a crime scene, they just went there and watched and waited for their divisional officers to come. So we thought that was not a very good use of Police resources. For every trained Police Officer should really be right there on the ground the moment something happens and do something about it, and not just waiting for an investigator or somebody else to come from the Division to start the investigation work.

So this NPC system has allowed us to pool more of our Police officers together in 32 NPCs, so that with the number, they can then do their job more thoroughly when they respond to a particular event or incident. Let me assure Members that with the phasing over to the Neighbourhood Police Centre system, there is no reduction in Police presence on the ground. In fact, the level of Police presence has increased with the NPC. And the Police will make their presence felt in the form of foot patrols, bicycle patrols, vehicle patrols, as there are now more vehicles on the road than when we had the NPP system. These vehicle patrols also allow our Police officers to reach a wider area, instead of just walking on foot and reaching a small part of the estate. With the communication equipment available in the Police vehicles, the patrol vehicles are also deployed to respond to `999' calls whenever there is an incident reported. In addition, the Police Task Force operations and the dog patrols also complement this regular Police force.

Under the NPC system, we have four officers from each NPC conducting patrols compared to practically no one doing foot patrols under the NPP system. By July this year, we will have more than 124 officers from the NPC performing such foot patrols island-wide. So the public should see an increase in the number of officers on the ground.

Prof. Chin asked about the temporary police post that we have deployed, or actually we call them mobile police post. We have deployed these temporary or mobile police posts since 1997. They are basically vehicles and they make stops at selected locations at different times of the day. They are deployed to meet some very transient or very seasonal demands for Police presence, such as when there is a crime-prone area, we will set up a temporary or mobile police post in the particular area. We have now three such temporary police posts, and by the end of this year, we will have another three more. So we will increase the number of temporary police posts by the end of the year.

Prof. Chin mentioned that the residents of new housing estates are concerned about the sense of safety and security. Let me assure him that the Police is very mindful of this and that is why we will try to build the Police Centres in the new towns such as Sembawang and Chua Chu Kang as soon as possible. By the year 2003, Police Centres will also be built in Sengkang, which is another new housing estate. Even before the Police Centres are set up, the Police will make sure that their presence is felt through the deployment of these temporary police posts. I have also asked our Police Officers to try to work together with HDB to find out who are the new residents who move into the new estates and visit them as soon as possible, to assure them that the Police knows that they have moved in and that they are around and if they need help, there is a particular number which they can call to seek assistance. So that is well in hand. Let me assure Prof. Chin and his constituents that the Police is well aware of their concerns and they will do what they can within the resources to cope with their demand.

We know that the sense of public safety in Singapore is quite high. At least in the last survey that the Police conducted - the Police commissioned a private survey firm to conduct a survey in late 1999 - almost 96% of the respondents, including those from the new housing estates, feel that the general security of Singapore is good or, if not, better. 10.30 am

Mr Goh Choon Kang is worried about the closure of the police posts when we set up police centres. We have to look at the overall deployment of the force, including the siting of the police centres and the police posts. In a few instances, I have noticed that the police post is just about 200 metres away from the new police centre. In fact, there is one instance where the police post is just 20 metres away from the police centre. It does not make sense to have a police centre and the police post almost within one minute of walking distance. So these posts would have to be closed. For example, the one in Braddell Heights will be closed when we set up a new police centre there. But the residents there need not be too worried because the police presence will still be felt on the ground.

The experience of residents in areas where we have the police centres seems to suggest that they now feel quite comfortable with the new police centre system. And indeed, in those areas where we have the police centres, crime has fallen and more residents are also getting involved in ensuring the safety and security of their own neighbourhood. Two surveys conducted in 1999 and 2000 showed that almost 90% of the residents and grassroots leaders who live in these areas where we have the police centres supported the introduction of the police centres. They also appreciated the fact that police centres deliver more services and have more police presence on the ground than before when we have the police post system. This means that this system is now gaining acceptance and it is only in the old areas where we do not have police centres yet, and people are very used to the police posts where they can just go and chat up with the friendly policeman, that they feel a bit uncomfortable when they see a bigger station with more officers and they do not know who to keep in touch with, and so on. Let me assure the Member that when we have a police centre, we will also delegate officers to work closely with the grassroots leaders so that the grassroots leaders will know who to contact when they have any request to make.

Questions were also asked about the Community Safety and Security Programme and how much more involved are residents now in the safety and security of their own neighbourhood. As Prof. Chin has cited the numbers, there are now more than 500 such Community Safety and Security Programmes. This is a programme to directly involve the residents concerned in dealing with the problems of their own areas because each neighbourhood faces different problems. And it is better for the residents themselves to find out how to deal with those problems by working closely with the authorities, whether it is the police or whether it is some other Government agency. And the police will, together with the other Home Team partners, give them whatever resources they need to do their job. But the primary initiative must come from the residents themselves.

Mr Iswaran's area in West Coast, for example, has a few Community Safety and Security Programmes. But they can be much more active than what they are now. With Mr Iswaran's support and involvement in encouraging them to be more active in looking out for issues and problems that concern them, they will be more effective in increasing the sense of security among the residents. It is important for the advisors on the ground also to play their role, and not just leave it to the RCs and the community organisations, to take their own initiative. If they take an interest, I am sure their residents will take an interest.

In the case of schools, a year-plus ago, I have asked the Education Ministry to see whether we should not introduce a scheme like that to the schools so that, at least, within the school community, they can help to improve the sense of safety and security among the students and teachers. And the Home Team took this to the schools, to the Education Ministry, spoke to the principals and many principals were very supportive. Now, we have 42 schools directly involved in the school safety and security programme, and they have come up with many initiatives. Quite a number of them have been publicised, including the safe drive zone within the school's neighbourhood to ensure that when the children come to school, or when they go home, and when there are too many vehicles in the school compound and in the vicinity of the school, how they can ensure the safety of the children who leave or come to the school.

But numbers alone are not enough, of course. We need to have quality programmes. With these new initiatives and when they come from the residents, they feel that they have identified the problems and found the solution, they feel quite proud when they have achieved something.

Let me just quote an example here. In March last year, Blks 55 and 56 of Telok Blangah Drive in West Coast GRC, which is also Mr Iswaran's GRC, were hit by a series of deliberate fires that caused substantial damage to the common areas. More seriously, the fires were potential threats to the elderly residents living there. So the West Coast GRC leaders and the town council, together with the Bukit Merah West Neighbourhood Police Centre, implemented this Community Safety and Security Programme to deal with this threat. They found that there were many discarded mattresses, newspapers, furniture which had given the arsonists a lot of materials to burn. So they realised that these materials had been discarded by the residents at the staircase landings and lift lobbies, partly because the elderly residents cannot carry these materials, like mattresses and newspapers, down to discard them in the proper places. So once the principal source of the problem was identified, all the residents came to help and they quickly cleared the staircase landings and lift lobbies of all these flammable rubbish. Since then, no fire has occurred in these two blocks, Blks 55 and 56, and the elderly people there now feel much safer. So this is a simple example and yet very effective way of how residents can be involved in their own safety and security without too much of the police presence on the ground, or too much of the civil defence involvement in this.

Prof. Chin expressed concern about foreigners committing crimes. Let me assure him that the great majority of the foreigners, who come and work here legitimately with work permits, come here to earn a living. They do not come to commit crimes. It is only those who try to smuggle themselves in illegally and they eventually cannot find food, lodging and employment that they may resort to crime. I will talk about the illegal immigrant situation afterwards. But even then, taking into account that group of illegal immigrants, immigration offenders plus the legal workers, the number of foreigners who were arrested for crimes actually went down from 1,700 to 1,450, a drop of almost 16%, and they accounted for about 9% of the total seizable offences, excluding immigration offences. And this has been about the same over the last five years. So there has been no increase in the number of foreigners arrested for crimes committed in Singapore.

As to how we can tighten border control, like improving security screening, for example, we have a very porous border and people can come in easily by hiding themselves in car boots and we have tens of thousands of vehicles coming in every day, it is not an easy task. But we will acquire X-ray machines by the end of the year at our Woodlands Checkpoint to help us combat this problem. But even with the installation of the X-ray machines, we cannot screen every vehicle. Because to do so, we will definitely have a very long traffic jam stretching all the way to Johor Baru.

I think I have dealt with all the points raised by the Members.

Assoc. Prof. Chin Tet Yung: Sir, one of the other areas that the GPC has mentioned as a subject that should be brought up is the use of technology by the Home Team.

Technology is an instrument for both good and evil. In today's world of supercomputers and broadband communications, both law enforcement agencies and criminals are locked in battle using the latest and most sophisticated equipment - one, of course, to prevent detection, and the other to improve detection. Technology these days allows fingerprints to be lifted off fabrics, DNA profiles to be determined through saliva or a sliver of hair, faces to be reconstructed with sophisticated software and computers. At the same time, technology allows criminals to hide their tracks using encryption, and to coordinate their activities to use clone phones, to jam communications or radar equipment or to create counterfeit currency or false documents.

I should like to ask the Minister how technology has been utilised to assist the Home Team, particularly in criminal investigations. For example, the Minister mentioned on a previous occasion the possibility of starting a DNA database for those with criminal records. Could he update us on how far this project has gone? And how this type of database would render perhaps other types of criminal records unnecessary? Could he also let us know how the Home Team has been reorganised to fight the techno-crooks? How has the Home Team leveraged on technology to make them more efficient and more effective in the investigation of crime?

The Chairman: Mr Iswaran.

Mr Iswaran: I am not speaking.

Mr Wong Kan Seng: Prof. Chin asked how technology can be used for crime investigation and crime detection. Certainly, as criminals become more sophisticated in their methods, the Singapore Police Force must also do likewise by making use of technology. And indeed, the Police will have to stay ahead of the criminals in order to do its job well.

One recent initiative which the Police has undertaken to improve a crime investigation method, which is the old method of photo-fit, manual photo-fit, is to come up with a computerised photo-fit system. In the past, Police took many hours to ask the victim or the witness to reconstruct the possible facial features of a suspect and, painstakingly, Police has to search out for the many pieces before it can come to a composite photo-fit. But now, with the computerised system, it has reduced the amount of time taken to arrive at this photo-fit in a much faster time. 10.45 am

Police is also updating and upgrading the automated fingerprint identification system, and this new system will have features that add greater value to the investigation process. For example, again, like the computerised photo-fit system, it will take a much shorter time to match fingerprints than the previous method of checking on the fingerprints.

I mentioned some time ago that the police will set up a DNA database to complement the use of fingerprints and photo-fits as forensic investigation tools against crime. By having a DNA system, it does not obviate the need for the other traditional systems because we may not have DNA samples available all the time for analysis. So we may still depend on other crime investigation techniques like fingerprint search and photo-fit. The police is working to set up this DNA database by the latter half of this year. DNA, as a blueprint of living things, is a very powerful aid to criminal investigation, provided of course we get a sample. With the setting up of this database, DNA profiles will analyse from evidence lifted from the scenes of crime and be matched against those stored in the DNA database. DNA evidence is helpful not only towards solving major and serious crimes, but also routine crimes as well. DNA samples will be taken from persons arrested for registrable offences, suspects in relation to registrable offences who were placed under arrest, and also people, eg, the police officers who have access to the crime scene, so that they do not rule out any particular group of people, and they can have a comprehensive set of DNA prints for matching.

The police is now working with the Attorney-General's Chambers, the Institute of Science and Forensic Medicine, and other relevant agencies to sort out the operational, technical, as well as the legal issues involved in setting up this DNA database. The database will be ready this year and will greatly enhance the police's investigative capabilities, especially in solving criminal cases that have few physical leads and few eye-witnesses to rely on.

Technology will not only be used for crime investigation and crime detection but also for many other aspects of the Home Team's work. In our departments like Civil Defence, Central Narcotics Bureau, the Prisons or Singapore Immigration and Registration, there are quite a number of these examples where technology has been deployed to good use. One is the new Light Fire Attack Vehicle or what we call the "Red Rhino", the small compact fire-fighting vehicle. It is the result of the use of technology where we now do not store the water in the water tank to be carried to the scene of fire, but rather to make use of fire hydrants at the scene itself, and then have the pumps and motors to get the water from the hydrant to the fire scene.

The Police Coast Guard also, for example, has made use of surveillance and radar equipment, electro-optic cameras, and thermal imaging equipment to detect intruders at sea, and imaging x-ray equipment to be purchased by SIR. Similarly, for the Prisons, the electronic tag is one example, and we are now looking at the new version of the electronic tag which may not be so large as the one that is being used now.

The Chairman: Members may want to note that we are falling behind schedule on this amendment. Prof Chin.

Assoc. Prof. Chin Tet Yung: Sir, according to the statistics, there is still a substantial problem in Singapore in illegal immigration. The Home Team has arrested more than 16,000 immigration offenders and overstayers in the year 2000. I understand that the Home Team has stepped up enforcement action against such offenders. However, it is quite clear that these numbers will grow, unless we can also take firm action against those who bring them in, ie, the traffickers or smugglers; those who provide them with food and shelter, ie, the harbourers; and those who provide them with an incentive to come, ie, the employers.

I should like to ask the Minister whether the situation concerning the harbourers and the traffickers is under control. I am particularly interested to know whether the number of harbourers has gone up, despite the immense publicity that was given to the issue when this House debated the problem last year and the year before. Sir, we have to live on a different planet to avoid knowing about the harsh penalties not just for immigration offenders, but also for those who help them. Yet, the perception is that the problem has become worse.

At the same time, the media has reported on deacons, academics and old ladies who are arrested and convicted for harbouring. Very often, the defence is that they were either duped by forged documents, or that they relied on the housing agent. Sir, these reports tugged at the heartstrings of readers who see only the personal trauma of the deacon, the old lady and the academic. Perhaps, what is needed is a new procedure on vetting the bona fides of foreigners seeking accommodation. Can a one-stop agency, either at MOM or SIR, or preferably both, be set up where, for a fee, say, about $50, a validation of a prospective foreign tenant can be determined? If a certificate is produced by the authorities that such a person is a bona fide visitor or worker in Singapore, then it can be presumed that the person has entered and stayed in Singapore legally. In this way, for a fee, the worries of would-be landlords can be assuaged, and the prosecuting authorities also would have a much better idea of whom to prosecute and whom not to.

Secondly, I hope that we can look into the legislation to see whether there is a case for making housing agents, who are charged with the duty of verifying the status of potential tenants, primarily liable for the offence of harbouring, rather than charging them as aiders and abettors. Sir, may I suggest that the legislation be amended, for example, to shift the burden of proof on to the landlord to exculpate himself or herself, by simply showing that he or she has asked a housing agent to check on the status. If he satisfies this on a balance of probabilities, then the housing agent, and not the landlord, should be charged with the primary offence. In this way, justice would be done, and the primary wrongdoer would be convicted instead.

Finally, Sir, I commend the Home Team for their efforts in controlling the immigration offender problem, but I hope that the Minister would take further steps, as suggested, to buttress the law even further.

Mr Kenneth Chen Koon Lap (Hong Kah): Sir, as Prof. Chin mentioned, last year 16,000 illegal immigrants were caught. Although the figure cannot be deemed to be very alarming, it remains to be a very worrying problem for a small country like ours. With some of our neighbours having serious economic and political problems, the situation can only get worse. Apart from security problems, illegal immigrants have also become a peace and safety problem for our citizens. Whether this fear is real or perceived, somehow it has always been in the back of our mind that they pose a threat to us in terms of our personal safety, as well as to our properties. It is also clear that apart from the problem of tracking them, if they happen to engage in criminal activities, it is also known that the crimes they commit are more violent and serious in nature.

Yesterday, we heard a lively exchange between my colleague, Mr Shanmugam, and the Minister of State on the subject of mandatory jailing of harbourers of illegal immigrants. While I agree that stringent laws to punish offenders who knowingly and persistently harbour illegal immigrants are necessary, I would like to know whether the Home Team has put in their best efforts to ensure that every means is being explored to prevent these illegal immigrants from entering Singapore. I fully appreciate that Singapore, being an island-state, has many possible entry points to be guarded, and it would be an extremely difficult task to ensure that these entry points are made impermeable. And I must commend the Home Team for a job well done so far.

Nevertheless, we have to make sure that this problem is brought under control and not let it escalate. Therefore, I would like the Minister to inform us what new initiatives have been introduced, apart from increasing the stringent checks on the checkpoint at the Causeway, constant patrolling of our shores, and the tough laws against illegal immigrants as well as those who harbour them.

Mr Ang Mong Seng (Bukit Gombak): (In Mandarin): Sir, our control over the foreign workers has been fairly stringent all the while. Therefore, employers who employ foreign workers have to apply for work permits from MOM and to ensure that when the permits expire, they have to take all the necessary action to repatriate the foreign workers. However, there are some foreign workers who are overstaying in Singapore and there are some Singaporeans who unwittingly rent their premises to these overstaying foreign workers and are arrested and sent to prison.

Recently, I have a resident in my constituency who encountered this problem. He advertised to rent out one of his rooms, and a foreign worker came with a photocopy of his passport and asked to rent this room. My resident took this copy of the passport and checked with the relevant authority. He was informed that the passport was in order. But not long after, the police came and arrested him for harbouring this foreign worker who had overstayed in Singapore, and he was charged in court. . He came to see me. I requested the police to further investigate the matter. Finally, the police found out that this foreign worker who had overstayed had actually used a photocopy of his friend's passport and put his photograph on it. As a result, he committed this crime. I was very glad that the police, after further investigation, had withdrawn the charge against my resident. I would like to know whether the Immigration Department has looked into this matter and see how their system of checking could be improved.

I remember that when we joined National Service, we would surrender our identity card to MINDEF, and MINDEF would issue a military IC to us, the NSmen. Perhaps we should use the same system for the foreign workers. The Immigration Department could consider using this system. Any foreigner who wishes to work in Singapore must present his passport to SIR. The SIR would then issue a special permit with his particulars and photograph on it for him to carry it as his personal identity card throughout his stay in Singapore. The work permit holder would have to present this special permit to the landlord when he applies to rent a room. When his work permit expires, and when his stay in Singapore is not extended, this foreign worker would have to surrender this special permit to SIR to recover his passport so that he could proceed to go home.

Sir, we could also use new technology to examine whether these foreign workers have overstayed in Singapore, and to track them down for serious charges to be taken against them. I feel that with such a control system we would be able to reduce the unnecessary social problems to our citizens.

Mr Wong Kan Seng: Sir, Mr Chen said that the illegal immigrant situation is not alarming but it remains a matter of concern. Certainly it is a deep matter of concern for the Home Affairs Ministry. I am sure it is also a great matter of concern for many Singaporeans, particularly if they have a neighbour who has rented out such properties to a foreign worker and they are not sure whether the foreign worker has proper work papers to work in Singapore or if he is just simply an illegal immigrant, and they are always very worried that something would happen in their neighbourhood. So this problem of the immigration offender situation is still with us although I would say that it is in a way under control. The numbers are still quite large. The number of immigration offenders arrested was about 16,500 last year. This is only marginally less than the 17,000 that we arrested in 1999. So, there is still a big problem with us and, in particular, if you look at the number of illegal immigrants who are arrested - they are not overstayers, overstayers are the ones who come in with proper papers, passport and so on, but they just overstayed - the number actually has not changed very much compared to 1999. It has increased very slightly from 11,500 to 11,650. Here, we are only talking about those who were arrested. There could be others who were not arrested. 11.00 am

On overstayers, we have seen a decline by about 10%, from 5,400 in 1999 to about 4,850. Mr Chen asked whether the Home Team has done enough to stop these illegal immigrants from coming in. I think we have done quite a lot. We will continue to do more. But Singapore is a very porous place in that there are so many checkpoints and we also have a coastline that is not easy to keep watch on, particularly the stretch of water between Johor and Singapore, is barely three minutes away by speedboat. Despite that, we will do our best in making sure that the problem does not get worse.

So long as Singapore's economy continues to grow and so long as there are employers and landlords willing to give jobs to or harbour these illegal immigrants, we will have illegal immigrants coming to Singapore, especially when it is so lucrative for the traffickers to bring them in. When these people come in, they do not know what they are in for until they are arrested.

What have we done with regard to enforcement? We have got daily police operations to conduct spot checks on the ground against the suspected immigration offenders in public places or wherever these foreign workers or illegal immigrants are likely to congregate. We check them because legitimate and illegal foreign workers do mix around. These daily checks by the police resulted in the arrest of 15,000 immigration offenders last year. And altogether, the Home Team mounted 228 immigration offender operations throughout the whole of last year. Last year, the Home Team also crippled two syndicates that smuggled illegal immigrants into Singapore. These illegal immigrant syndicates provided the illegal immigrants with forged documents to find jobs. 17 syndicate members and 215 immigration offenders were arrested in these two operations.

At sea, the Police Coast Guard has kept up its enforcement, both in the southern, as well as the northern part of Singapore. We have got high-speed interception boats, together with the latest surveillance equipment. We deploy the latest radar surveillance systems and electro-optic cameras at strategic locations to detect illegal landings at night. Last year, we detected 71 such landings and sea interceptions, compared to 52 in 1999.

At the Woodlands Checkpoint, there are more checks now on suspected vehicles which bring in illegal immigrants. That resulted in the arrest of 87 illegal immigrant traffickers. Of course, many of the leaders of traffickers are not the ones who bring these illegal immigrants in. These syndicates operate in the northern part of Singapore, Malaysia.

But no action is complete if we, say, just target illegal immigrants. We have to also target those who give jobs to the immigration offenders, as well as those who harbour them. Last year, 590 people were arrested for harbouring immigration offenders, compared to 306. So there is an increase. That is in answer to Prof. Chin's question. 572 were arrested for employing immigration offenders, compared to 388 in 1999. This increase in arrests can be attributed to the information provided by members of the public, the neighbours and others who know or who suspect that the employer or the landlord has given jobs to or harboured the immigration offender. Here, I cannot over-emphasise the critical role that the public plays in helping themselves and the Home Team to deal with this problem of immigration offenders.

There are many avenues already available for homeowners and employers to check the immigration status of their prospective tenants. Prof. Chin suggested a one-stop centre. While the law requires due diligence requirements to be exercised by checking the passport, the original documents and also checking with the employer, last year, I announced that the Manpower Ministry and the Singapore Immigration and Registration Department would also provide information through the Internet for employers or landlords to check the status of these foreign talents. Since April last year, both MOM and SIR have received about 5,300 and 3,200 phone enquiries respectively. And since April last year also, 2,500 of them have gone to SIR personally to check on the immigration status of the tenants and 4,500 have gone to MOM to verify the authenticity of the work permit cards and other employment passes of the tenants. People are now becoming more aware, and that is good. If they do not want to go personally and they cannot make a phone call, they can also directly access the Internet. Since the launch in August last year, 15,000 users have already accessed the Internet system. SIR has also directly, or through the Inland Revenue Authority, distributed pamphlets to all homeowners to advise them on what to check when they let out their properties to foreign tenants. We have done as much as we could, but I am sure that there could be other ways of solving this problem or helping us to reduce this problem and I welcome any suggestions that Members may have.

Prof. Chin suggested that we shift the burden to the housing agent whenever a landlord employs a housing agent. We are going to amend the Immigration Act to also enable the prosecution to prosecute the housing agent if he plays a major role in helping to secure that tenant, and that tenant happens to be an immigration offender. But that does not obviate the need for the landlord to check the document himself because when the case goes to court, it is sometimes very difficult for one side to believe the other when one side's story is just as plausible that "He never asked me to check, etc." We would require both parties to be responsible. We are also now looking into amending the Act.

Mr Ang Mong Seng has a few suggestions. One of his suggestions is that we retain the passports of these foreigners who come to Singapore to work. Firstly, no Government authority can retain the passport of a foreigner unless it is through a court order, because that passport is the property of a foreign government. Even if the law allows us to retain the passport of a foreigner, there is no guarantee that the person would not overstay. He can still run away. He can still disappear. And what it would mean is that we are landed up with passports which we do not know where to find the persons. The best thing is to ensure that we have a different method of making sure that the foreigners who come to Singapore go home. For a foreign worker, the employer has to provide a bond to the Manpower Ministry. He can only take the bond back when the foreign worker is repatriated. So, he has got to prove. The moment the work permit is cancelled, the foreign worker would be given a special pass of seven days, and then the employer has got to bring him to the airport and send him home. At the airport, immigration would check and take back the embarkation card and special pass from the foreign worker. Then that clears the record that that person has left. Those who have not left would then be the number of overstayers who were once foreign workers.

When we look at 4,800 overstayers arrested by the police, we found that more than three quarters of them (77%) were those who came in with a social visit pass. That means, they came in as visitors and were given 2-4 weeks, and they overstayed. The number of foreign workers who overstayed, including some who were given special passes, is only 23%. So the problem does not lie with the foreign workers. The problem lies with the social visitors. We have more than 7 million social visitors in Singapore. How do we decide who to go after? If he comes in, which is really for pleasure, etc, how do we ensure that he provides a bond or that he keeps his passport with us? I do not think Mr Ang's suggestion is a very practical idea. We have to find other ways. If Mr Ang has better suggestions to help us solve this problem on overstayers, I will be very happy to hear it.

The Chairman: I would like to inform Members that I will end discussion on this amendment at 11.35 am.

Mr Lew Syn Pau (Kreta Ayer-Tanglin): Sir, we are planning for a population of 5.5 million people. We have a population of 4 million today, out of which only 3 million are Singapore citizens. I suppose we could take about another half a million to one million more Singapore citizens.

Singapore citizenship is a much sought after commodity. We only need to talk to people from China and India to realise this. Given the limited numbers available, it is understandable that we should be selective in whom we give citizenship to. I would like to ask the Minister if he can tell us what are the key criteria for Singapore citizenship. The process has never been very transparent. At my meet-the-people sessions, I have frequently come across cases that I thought worthy and deserving, but were rejected time after time. Many of these cases involved relationships with Singaporeans, spouses and children born overseas of Singaporeans living in Singapore who have often been rejected for citizenship without reasons being given. Some of these involved Singaporeans who have done their national service and they become bitter over these rejections for their loved ones. In some cases, we lose them all, as they decide to move overseas.

I would like the Minister to be more sympathetic in cases involving relatives and loved ones of Singaporeans. Singapore can only be our home if our loved ones are with us. Otherwise, it is as good as telling them all to emigrate. We have given PR and Singapore citizenships to families who have not contributed to Singapore yet. We took them in on their potential. We should review our policies involving Singapore citizens with roots here and have already contributed to the country's progress and prosperity.

The Chairman: Mr Sin is not speaking. Mr Wong.

Mr Wong Kan Seng: I would like to assure Mr Lew and his constituents that SIR is always very compassionate in granting citizenship to Singaporeans who marry a foreigner and who happens to have children who are born overseas and requests for citizenship for their children are normally very favourably considered. Just looking at the data over the last three years, it shows that about 90% of such applications have been approved, whether it is a Singaporean woman or a Singaporean man married to a foreign woman or a foreign man. Only in certain instance when there are irregularities in the marriage or where they cannot prove that they were married that SIR takes a closer look to see whether indeed the child belongs to that Singaporean or not. There was one case referred to by Mr Lew and, unfortunately, I am not at liberty to disclose all the details here, but I think that particular resident did not fully disclose his relationship with his so-called wife, who bore him a child. Unfortunately, in that case, SIR could not grant citizenship to that child. But, in general, SIR always looks favourably in such cases and grants them citizenship, unless there is some doubt as to the legitimacy of the marriage. 11.15 am

But SIR will take it one step further, and they have done so in a number of cases by asking the Singaporean applicant whether he or she is prepared to undergo a DNA test to prove his or her relationship with the child or not. And if the person agrees to do so, and if the test shows that indeed he or she is the natural parent, then SIR will be very sympathetic.

Mr Kenneth Chen Koon Lap: Sir, in February 2001, the CNB had successfully mounted an operation which resulted in the arrest of eight drug traffickers and 113 drug abusers and seized heroin, cannabis and Ecstasy tablets. Altogether, they have carried out three such operations. I am sure this is the major factor leading to the drop in drug abuse cases reported last year.

Although drug abuse cases cannot be a zero sum game, no decrease in such cases can be considered sufficient. As long as there are crimes involving drug trafficking, there will be a drug problem. In many nightspots, drug abuse still prevails. These places are mainly patronised by mostly young people and, if not checked, can create a very serious social problem.

Another disturbing development is the increase in cases involving catamine or Ice. As this is a very potent type of drug, I would like the Minister to inform us the reason why this particular type of drug offenders is on the increase, and also give us an update on the profile situation of drug addicts in Singapore. Is the situation under control? And, in the case of drug rehabilitation, can we achieve a better recovery rate?

Recently, there was also news that many Singaporeans were arrested overseas for drug trafficking. The reason given was that foreign syndicates recruit Singaporeans for drug trafficking because Singapore is deemed to be very stringent in the law against drug trafficking, and its citizens are subject to less stringent search when they travel abroad. Is the CNB monitoring the situation, or has any follow-up action been taken to trace their connections in Singapore? Has any syndicate, engaging in recruiting these traffickers, ever been apprehended?

Mr Wong Kan Seng: Sir, the drug situation has indeed improved quite significantly over the last few years, but that does not mean that we have no more drug problem. It just means that it is well under control, and CNB will continue to work very hard to crack the syndicates that bring in the various types of drugs. The majority of the drugs brought in are actually heroin, although we now see some increase in the trafficking of Ice and Yaba. But the percentage of Ice traffickers is actually not very large. Last year, only 9% of traffickers arrested trafficked in Ice. But the increase of Ice traffickers arrested last year is 74%. Ice is primarily brought in by the Filipinos who come to Singapore. So far, it seems that this drug is very much confined to the foreign community, just like Yaba for Thais, although some Singaporeans are also involved in it. Singaporeans are mainly involved in heroin, cannabis and Ecstasy.

As far as rehabilitation goes, CNB, together with the other agencies in the Home Team working with the community, the voluntary organisations and the half-way houses, have seen a significant improvement in the rehabilitation rate of our drug addicts. For example, the relapse rate has gone down, from 80% or thereabouts many years ago to just about 44% last year. But, definitely, more can be done by working very closely with the community.

Mr Chen is concerned about drug trafficking in the nightspots, nightclubs and so on. The National Council Against Drug Abuse (NCADA) is fully aware of that problem. But let me say a word of caution here; it is not a significant problem. NCADA has launched an anti-drug abuse initiative this year in collaboration with the nightclubs, discos, KTV lounges, bars and pubs to promote this anti-drug abuse message among these nightspot goers. Ever since CNB took a very strict approach with the nightclub operators, they have been very cooperative in reporting any sign of drug trafficking among their clients.

As regards Singaporeans trafficking overseas, yes, indeed, there was an increase of Singaporeans who were arrested overseas for drug related offences. Between 1998 and 1999, there was a significant increase from 65 to 132 last year. Last year, 98 were arrested overseas for drug related offences, of whom 53 were arrested for drug trafficking. Because of the lucrativeness of drug trafficking - very good for making money - many Singaporeans do get tempted to be involved as couriers for trafficking drugs for other people. But we will work very closely with the drug enforcement agencies of other countries, like Australia, America, Thailand and so on, to help in minimising this problem.

The Chairman: Can I ask the remaining Members who want to speak to confine themselves to asking their specific questions, so that we can try to cover as many cuts as possible?

Mr Ong Kian Min (Pasir Ris): Sir, in an effort to help individuals who have been on the wrong side of the law and to turn over a new leaf and, as a society, to become more forgiving, transparent, yet fair, I think we should fine-tune our criminal registration process. Currently, a person carries a criminal record if he is convicted of any of the scheduled offences listed in the Registration of Criminals Act. He may have been punished for his crime, gone to jail, served his sentence and even rehabilitated. But certain jobs are still closed to him, because of his criminal record. For example, if he applies for a vocational driving licence to be a taxi or bus driver, the licensing authority will conduct a screening with the Police Criminal Registration Office, and his application will not be approved if the applicant has a criminal record, even records of minor offences committed many, many years ago. He may apply to be employed as a security guard, and that will be turned down.

Sir, I understand the rationale for this stance taken by the licensing authorities. Clearly, a person who has committed robbery should not be allowed to be a security guard, bus or taxi driver. However, for certain more minor offences and especially if he has not committed any other offences for, say, a period of 10 years, he should be given the benefit of doubt that he has indeed turned over a new leaf and committed to embark afresh on a new life. To deprive him of this opportunity would be to condemn the petty criminal for life, forcing him to go back to a life of crime, as he would not be able to secure a good job to start building a good life. In a sense, he would be paying for his crimes forever.

Sir, on the other hand, for certain serious criminal offences, such as sexual offences, molest and rape, robbery, drug-related offences, I believe the public has the right to know the person's background. Presently, we have to rely on newspapers, reports or gossip to find out whether the person we are dealing with, or intending to deal with, has been convicted of an offence in the past. The screening process of checking a person's criminal records is not open to the public, even on a need-to-know basis. It is only available to Government authorities. Why should that be so, especially in this age of transparency and full disclosure? There may be situations where a person has the need to find out another's background. If you are considering whether to do business with someone or to rent a room to someone, or even when you are thinking whether to let someone take your daughter out for a date, surely you would want to be able to find out whether that person was a trickster or molester.

There is nothing private or confidential about a person's criminal record or background. For his crime, the accused is charged in open court, and evidence is produced in open court. It is not something that he should be able to hide. I would like to suggest that these criminal records be available, not just to the police, but to any person who has a need to know through a process similar to the bankruptcy searches that one can do with the Supreme Court registry to find out whether a person has been declared a bankrupt or not.

Mr Chng Hee Kok (East Coast): Sir, the Government has announced that it will encourage recruitment of persons with criminal convictions in the service. With this first step, I think the Government can go further than just making such a directive. It should introduce legislation to expunge the criminal records of persons after a certain number of years have elapsed for some kind of offences.

It is not uncommon to come across people who did foolish things when they were young, such as shoplifting, joining in a fight after a staring incident, illegal betting, littering or even being caught for selling illegal pirated VCDs. These are minor offences, done at a moment's folly or weakness. If a person has repented by not repeating the same offence, I think his criminal record should be expunged after a number of years.

I have a constituent who has been trying very hard to expunge her shoplifting record, because she believes that this will help her heal psychologically. She was accused of stealing from a supermarket a compact powder costing less than $15 sometime in the mid-1980s when she was just fresh out of school. She had pleaded guilty under tremendous pressure from her accusers who were security guards. Although she later pushed this incident into the recesses of her mind and went abroad to study, this unfortunate incident came back to haunt her and she abandoned her studies and returned to Singapore. She was emotionally scarred.

She has tried many avenues, including making an appeal to the Ministry of Home Affairs, to expunge her record but to no avail because, currently, there is no law to authorise this. Legally speaking, her case had closed upon her conviction, as the time to appeal had long lapsed.

Furthermore, it appears that the records kept at the CRO are made available to all and sundry, and all Government departments. I wonder if this is correct. I have, from experience, applied for my constituents who failed to get passes just to enter the airport and the seaport, even though they have got employment with transport companies. They need the passes to get into such places. As a result of some minor offences in their records, several people have also failed to get taxi driver's licences and there seems to be an internal checking process in Government. Hence, the seriousness of such a record for no matter how small an offence cannot be overstated - it will bar a person from gainful employment for the rest of his life. I wonder if this is the right approach, Sir.

The Minister of State for Home Affairs (Assoc. Prof. Ho Peng Kee): Sir, Mr Ong and Mr Chng are concerned that disclosure of criminal records would make it difficult for ex-prisoners to get jobs.

Sir, criminal records are kept by the police to facilitate police investigations. They are also referred to by the courts when sentencing repeat offenders. They are not for public information. Therefore, as a general policy, police has not released them to prospective employers. This approach assists ex-prisoners in their rehabilitation efforts, and this answers also Mr Ong Kian Min's point. I think we should keep the present practice where criminal records are made available to Government departments, not to all employers. The current practice is for employers to ask for a declaration from job applicants whether they have got court convictions. I think that is the right approach.

Otherwise, I think there will be curiosity seekers. He gave an example of a father who wants to screen prospective suitors. But I think once you go that way, the boundaries will expand and other people will also make all kinds of enquiry. So for the purposes of helping ex-prisoners to rehabilitate, we should keep our present practice. 11.30 am

Police provides screening information to employers only for jobs that have public safety or security implications. Let me assure Members that this is not to put obstacles in the integration of ex-prisoners but to protect public interest and safety. Mr Chng cites some of these jobs, so has Mr Ong - jobs relating to the taxi trade, jobs where people have access to the airports and ports, which are sensitive places where theft can take place and this can mar Singapore's reputation. So these people who are working in these areas will be screened, not just directly in the airport and port, but also employees working in companies with access to these places. Because the principle is the same - they have access to these places where further crime can be committed.

But let me assure Mr Ong and Mr Chng that people who are barred from doing these jobs are not barred forever. There are guidelines where after a certain period of time, the debarment is lifted. Let me also assure Mr Chng and Mr Ong that my Ministry is constantly reviewing the categories of people and the periods of debarment so that if need be, over time, we can make it easier for people to get back into the workforce in these areas.

The other point Mr Ong and Mr Chng made was whether or not records could be expunged after a certain period of time. Sir, in fact, currently the Commissioner of Police already has the discretion to expunge criminal records for minor offences. This is under section 7 of the Registration of Criminals Act. Indeed, he has expunged some of these records in the past. But the point is whether more can be done. Let me also inform Mr Chng and Mr Ong that we are reviewing the Act to see how the discretion given to the Commissioner can be widened. And when we do this, we will take their suggestions into consideration.

Mr Yeo Guat Kwang (Cheng San): Sir, in Singapore, we believe strongly in ensuring and maintaining religious harmony and that religion is not misused to fulfil vested interests. I would like to ask whether the Government has a screening mechanism for preventing non-religious groups or political groups to register as a religious society. Recently, we have seen cases where companies and restaurants use religious names, causing discomfort among religious groups.

Sir, may I suggest that the Government consider making it mandatory for all religious groups to be registered to be cleared with the Presidential Council for Religious Harmony? This will help to ensure that all societies registered under the name of religion are truly religious in nature.

Assoc. Prof. Ho Peng Kee: Let me assure Mr Yeo that the Societies Act ensures that we do not allow any group to carry out undesirable or objectionable activities that are detrimental to society's interest.

Sir, there are basically two levels of checks. First, pre-registration; and second, post-registration. While any group of 10 or more persons can apply to register a society, before registering the group the Registrar will check to ensure that the proposed society's objects and activities would not be contrary to public peace, welfare or good order in Singapore or national interest. He also consults relevant agencies, such as MCDS, if it is a religious society.

Post-registration, the society's activities would still be subject to our laws. If the society is found to have been used for unlawful purposes or purposes prejudicial to public peace, welfare and good order in Singapore, the Minister may order the dissolution of the society under the Societies Act. Hence, we do not generally have a problem with registered societies in these areas.

Mr Yeo, however, is concerned that some companies and restaurants registered with religious names may have caused discomfort among religious groups. Before registering the name of a company, business or society, the respective Registrar will consult the relevant authority, such as Police and MCDS. For example, if the name contains Islamic words, the Registrar will consult MUIS. If a complaint concerning the registered name is received, the Registrar will evaluate, in consultation with the relevant authorities, and if the complaint is a valid one, the Registrar would ask the organisation to change its name. In fact, just recently the Straits Times carried a report on the Singapore Buddhist Federation's concerns that some organisations are using names associated with Buddhism. It was also reported that the Singapore Buddhist Federation planned to write to the Registrar of Societies on the matter. While indeed if a society is using a name that is objectionable or misleading, the Registrar of Societies will, after consulting with the relevant authorities, if necessary, direct the society to change its name.

The last suggestion of Mr Yeo was to refer all such applications to the Presidential Council for Religious Harmony. I think the Act designates different purposes for this Council and as I have assured Mr Yeo already, there are enough mechanisms and checks in place. So I do not think we should load the Council with more work.

The Chairman: We have run out of time on this amendment. Prof. Chin.

Assoc. Prof. Chin Tet Yung: Sir, I thank the Minister and the Minister of State for their answers and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Chairman: Amendment No. (2), Mr Yeo.

Mr Yeo Guat Kwang: Sir, I beg to move,

That the sum to be allocated for Head Q of the Main Estimates be reduced by $10 in respect of Code QC 1500.

Sir, there have been cases recently where some individuals who have borrowed money from loan sharks sold their flats to new owners. However, they did not bother to change the addresses in their identity cards and continued to borrow money from the loan sharks. So when they are unable to pay up the money, the new owners unwittingly have to bear the brunt of the harassment caused by the loan sharks.

I would like to urge the Ministry of Home Affairs to double their enforcement and come out with a more effective way to arrest these loan sharks. I also would like to ask the Ministry to consider revising the law to punish this group of irresponsible people who intentionally did not report the change of the addresses in their identity cards so that they will be spared from the harassment caused by the loan sharks. In doing so, this would render justice to the innocent and the victimised new owners of the flats.

The Chairman: Mr Ong is not speaking. Mr Ang.

Mr Ang Mong Seng (Bukit Gombak): (In Mandarin): Sir, the Seventh Month Festival is celebrated very extensively in Singapore every year. The highlight of the Festival is the auction of auspicious articles. In most cases, proceeds from such auctions are donated to charity.

In previous years, the amount collected from such auctions could be as much as $8 million. However, last year, the Ministry restricted the auction bids to not later than 10.30 pm each night. This has affected the proceeds of the auctions. Some festival organisers have approached me to ask the Minister to allow them to extend the auction time by another quarter of an hour, till 10.45 pm. We could perhaps designate the extra 15 minutes as "charity time" when all auction proceeds collected would be donated to charity.

Assoc. Prof. Ho Peng Kee: Sir, the option of prosecuting borrowers was considered but not taken up when the Moneylenders Act was reviewed in 1993 and again recently. We felt that it would be counter-productive because illegal moneylending would not be eliminated but would merely be driven underground. Currently, Police already faces difficulties from borrowers who are reluctant to cooperate in the investigations and in any subsequent prosecution of lenders. If borrowing is made an offence, no borrowers will come forward to give evidence against lenders. Police will in fact not have an accurate picture of the ground situation.

But Mr Yeo highlights a type of borrower - a person who has borrowed and changed his address, but then did not report the change of address, so that the buyer of the premises gets harassed by the loan sharks. In such a situation, first and foremost, the borrower would have committed the offence of not changing his address under the National Registration Act and is liable to a fine not exceeding $5,000 or imprisonment for a term not exceeding five years. The question really is to find him. I think this is one situation where we may need suggestions from Members. Indeed maybe some press publicity will be good, so that if you can find him, then you can deal with the situation and stop him from borrowing further and using his former address.

Mr Ang Mong Seng wants to raise the time limit for Seventh Month dinners from 10.30 pm to 10.45 pm, so that more money can be raised for charities. Currently, the time is 10.30 pm, which is also the time in place for all other events on the ground, such as wayangs and other events. This is a matter of balance. There are people who want a longer time, particularly the Seventh Month organisers and participants. There are also residents who live nearby who will say 10.30 pm is a good time. So I think it is a matter of maintaining this balance. This time limit has been there for a long time, and we have enforced it, although with some flexibility. I think it should stay at 10.30 pm.

As to the question that less money is raised for charities, I would suggest that Seventh Month organisers, and many of them already have done this, use other means to raise funds, both in the Seventh Month setting and out of the Seventh Month setting. Indeed, one good way for Seventh Month organisers to ensure that more funds are raised is to start the event early. Over time, this is happening on the ground. So let us keep it at 10.30 pm.

Mr Yeo Guat Kwang: Sir, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The Chairman: Amendment No. (3), Mr Chng Hee Kok.

Mr Chng Hee Kok: Sir, I beg to move,

That the sum to be allocated for Head Q of the Main Estimates be reduced by $10 in respect of Code QH 1000.

Sir, the number of immigration offenders apprehended last year was 16,500. The number of apprehensions has been going down since 1998 of 23,000. The number of illegal immigrants has shown a similar trend, from 1998 of 14,700 to 11,650 last year. So also for overstayers, declining from 8,300 in 1998 to 4,800 last year.

This seems like great news. Perhaps we are beginning to have the problem licked. However, with the ongoing economic and political problems of our neighbours, and the continuing economic growth of Singapore, it is hard to imagine that we do not continue to attract an increasing number of such offenders who are prepared to sacrifice their lives to be here. The question which comes to mind naturally is: Are we becoming less effective in enforcement action and the offenders are becoming cleverer, as the statistics suggest? In other words, if the number is going down, does it mean that we are doing a better job at controlling this problem? Or is it because we are not able to really apprehend these people?

Hence, I shall like the Minister to elaborate why he thinks the control measures are sufficiently effective at the source, meaning the points of entry and not, as the statistics suggest, which is that we are less effective in apprehending such offenders. The question to be raised is the amount of effort we had done in 1998 versus last year, ie, did we have more raids in 1998 than, let us say, last year?

Mr Wong Kan Seng: Sir, the Police conducts raids from time to time and I have mentioned earlier on, they conducted about 280 or 290 operations last year, specifically to target at these areas. But in their normal patrols, they also look at the places where foreigners tend to congregate and, from time to time, check on those to see whether they are here lawfully or not. So the Police has done as much as they could. But the Police cannot spend all its resources just to look for illegal immigrants and overstayers because, as I have mentioned, a lot of people come through the Causeway every day, and even if we check everyone who travels with his papers, we also have others who hide in vehicles and specially-constructed compartments in trucks and containers, and so on. Unless we stop all vehicles and check every vehicle, it is simply not possible to screen out all who attempt to come in one way or another.

Let me assure the Member here that we will do everything possible but within the constraints of our resources to deal with this problem. Ultimately, it must depend also on the public to help - 11.45 am

The Chairman: Order. "Guillotine" time. Mr Chng, could you withdraw your amendment?

Mr Chng Hee Kok: Sir, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The sum of $1,582,372,770 for Head Q ordered to stand part of the Main Estimates.

The sum of $581,691,300 for Head Q ordered to stand part of the Development Estimates.

Head F -

The Chairman: Head F - Parliament. Amendment No. (1), Mr Tay.

Mr Simon S. C. Tay (Nominated Member): Sir, I beg to move,

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

Sir, having suffered the guillotine yesterday, let me speak in "CNN style" and give three brief points on the Nominated Members of Parliament. The criteria for NMPs are settled by the Constitution, and interpreted by the Special Select Committee of the House that sits to decide who should be NMPs. I believe, Sir, there is one important criterion which is not set out in the Constitution that should be. This important criterion is that NMPs should be non-partisan, that is, not a member of any political party, whether of the PAP or of an opposition party. In contrast, this criterion is especially set out for the Elected President.

Sir, my second point is that, I believe, this criterion is actually a very important one. This is the best way to ensure that NMPs do indeed represent a wide diversity of views as the scheme intends. It is also a safeguard against the NMP scheme becoming a backdoor to Parliament, as expressed by some concerned MPs when the scheme was first set up.

My third point, Sir, is that I would urge Parliament, and especially the committee, to require that all candidates for NMPship declare whether they are members of political parties. They should weigh very heavily against anyone who is. More when a candidate has been a member of a political party but has since resigned, they should favour those who have resigned some time ago, rather than those who resign on the eve of nomination. There should, in a sense, be a cooling-off period. Those who belong to a political party, Sir, should seek elected office. NMPs should not be a training ground for MPs. They should be non-partisan and seek to represent independent views from diverse sectors.

Mr Wong Kan Seng: Sir, the question of whether an NMP should be non-partisan or not, and whether this should be clearly stated in the Act, was fully debated in this House when the Bill was first read in 1989. The Bill was subsequently submitted to a Select Committee. We deliberated the matter quite extensively and, finally, we came back to the House for the Third Reading, and the matter was debated again in March 1990. And as the Prime Minister said, we want the Nominated MPs to be non-partisan and that we would prefer that to be written in the Constitution. But after deliberation in the Select Committee, the Select Committee felt that it was not necessary to have it written into law, but we should evolve this through practice and convention to make sure that the candidate or the person being nominated to be an NMP should not belong to a political party.

We know from the nomination form whether a person belongs to any political party or not, because I remember there is a particular column that requires him to state whether he is a member of a political party. There had been, in the past, some candidates or nominees who were members of a political party and they had, by practice, resigned from the political party before they became an NMP. But to be so purist to say that we should not have anyone who has belonged to a political party to be even considered for an NMP unless he has resigned from the party for a certain period of time, I think we are just minimising the pool of people that we may have available who may represent a certain segment of our population from being present in this House to speak up on their behalf, or to state their views about certain issues. So while we want to evolve this, we should at the same time guard against limiting ourselves not finding the suitable candidate just because the person happens to be a member of a political party for some time and has only recently resigned.

The Chairman: Mr Tay, can you withdraw your amendment?

Mr Simon Tay: Sir, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The Chairman: Amendment No. (2), Mr Lew.

Mr Lew Syn Pau: Sir, I beg to move,

That the sum to be allocated for Head F of the Main Estimates be reduced by $10 in respect of Code FA 1500.

Sir, most backbenchers, like myself, are working people. We have to juggle between work in the office, parliamentary work, grassroots work and family. We need support for research and other secretarial duties so that we can discharge our political responsibilities and duties more fully. I am sure you like us to be more active in debating Bills in this House.

Ten years ago, allowances for legislative and secretarial assistants were introduced to help backbenchers to employ help. We started with $500 for a legislative assistant and $250 for a secretarial assistant. Since then, the amounts have gone up to $550 and $275 respectively, which is 10% increase in 10 years. This works out to about 1% increase per year. This amount includes the employer's share of CPF which means that the net amount they take home is substantially lower after deduction of CPF. It is difficult to employ anybody with relevant experience with these small sums nowadays.

In many Parliaments overseas, I know that MPs get allowances for the full-time employment of two to three aides and assistants. I am not asking for that right now. But I think we can afford a little more so that we can employ some part-time assistants with more experience and quality. It would certainly uplift the quality of our work which seems to be increasing all the time. The volume of our work has increased with the formation of town councils, the GRCs, the Community Development Councils, and so on. We are now even doing charity work as well, that is, fund-raising for charity. I do not know what would be next. But I know that it will not get any lighter. I hope the Minister will review this sympathetically.

Mr Wong Kan Seng: Sir, we recognise that the last revision of the legislative and secretarial assistants' allowance was way back in 1993. And when we first started this scheme in 1989, or thereabout, it was only $250 for secretarial assistants and $500 for legislative assistants. Even in those days, the $750 would not enable the Member to employ somebody who is fully qualified to do the job for him in researching materials for his speeches, etc. So that allowance is actually a small sum of money to help him to defray part of the wages that he pays his legislative and secretarial assistants. It is not meant to be the full salary for a staff assistant for him. Of course, after eight years, I should say that we will look into that again and find an opportunity to increase the sum of money. But I hope that Members do not expect that we will revise the sum to such an extent that will enable them to pay for the full salary of the assistants. Members have an MP's allowance as well. Please make use of that as well to help in whatever constituency work that they need to do.

Mr Lew Syn Pau: Sir, I thank the Minister for his reply. We look forward to increases to come. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The sum of $29,360,000 for Head F ordered to stand part of the Main Estimates.

The sum of $3,716,700 for Head F ordered to stand part of the Development Estimates.

Head P -

The Chairman: Head P - Ministry of Health. Amendment No. (1), Mr Bernard Chen.

Mr Bernard Chen (West Coast): Sir, I beg to move,

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

Sir, the budget of the Ministry of Health for financial year 2001 shows an increase of 30% over the previous year. The amount of $1,600 million is probably the highest that the Ministry has received so far, indicating the priority that the Government has placed on healthcare for Singaporeans. Whatever the various indicators may say, whether as percentage of GDP or per capita medical expenditure, the fact remains that the Government is devoting considerable funds and resources to meet the health needs of the people.

The issue however is not one of how much we spend on healthcare, but do we spend the funds allocated, whether we are getting the desired impact or we are just wasting the resources. I note that of the amount allocated to the Ministry, $1,200 million is in the form of operating subventions to the restructured institutions of the National Health Group and the Singapore Health Services. Between them, they are responsible for all the public sector hospitals, national centres and polyclinics. They are autonomous bodies responsible for their own bottom lines. What may not be evident to the public is that they are very substantially subsidised by the Government, especially patients from a lower income category. It would be useful if the Minister can elaborate on the main components of these subventions to the two restructured institutions and, if possible, highlight the extent of the subsidies to the lower income groups.

Mr Bernard Chen: Sir, can I move to the next item?

The Chairman: I will propose the question first. [Question accordingly proposed.] Mr Chen, please continue.

Mr Bernard Chen: The increase in health expenditure is as inevitable as the sun rises. The major part of this expenditure is on manpower. Doctors and nurses and other operational staff have to be paid at market level wages. They have to compete with other demands for the scarce labour resources. With our extremely tight labour market in Singapore, we are not talking about single digit increases. The days of regular small increases are over. We have to consider not only salary increases but bonuses as well. We can try reducing labour usage through higher productivity and mechanisation. In healthcare, there is a limit to mechanisation, as healthcare is a very personalised affair.

Increases in manpower expenditure will continue to drive health costs higher over the years. Increases in fees and charges will not be able to cope with these increasing costs which would lead to more subsidies. I would be grateful if the Minister can give us an idea how the increases in manpower expenditure have impacted the budget, especially in terms of the increases in subsidies, to meet the rising costs.

Dr Lily Neo (Kreta Ayer-Tanglin): In the ensuing years, Sir, we can expect increased demands on our healthcare system as a result of higher needs of a fast ageing population, higher expectations of an increasing affluent population and higher usage of new medical advances. The cost of healthcare will be a cause for concern as we face the challenge to ensure the affordable quality healthcare that Singaporeans have grown accustomed to. Sir, planning and spending now to address the issue will save us millions of dollars in the future.

The Finance Minister has increased the FY2001 budget allocation for the Ministry of Health by 31%. This is heartening and I would like to urge the Minister for Health to spend not only on immediate healthcare needs but also on the foundations that will take care of our future healthcare concerns. In this respect, I have several observations to make as follows: 12.00 noon

Our National Healthcare Expenditure, which formed about 3.1% of GDP in 1999, amounted to $4.4 billion or $1,370 per capita. The public healthcare expenditure is 1.1% of GDP and the private healthcare expenditure is 2% of GDP or twice the amount spent by the Government. This contrasts significantly with that in England where the private share is only 1/6, in Australia where the private share is only half, and in Hong Kong and Malaysia where the ratio is roughly one to one. Sir, the healthcare burden on the people is high in Singapore and we should try to lessen this burden. The Minister may like to consider having more healthcare benefits for children. Such a reduction of healthcare burden on the people may induce more couples to have more children.

Whilst we cannot arrest the rising medical demands and the increasing costs of healthcare, our challenge is to find all avenues available to lessen the need for expensive medical care. It would appear that the basic tenets for a good and affordable healthcare system seem to rest upon a system that enables us to:

1. maintain our population as healthily and for as long as possible;

2. ensure the elderly population remains as independently as possible;

3. ensure the appropriate use of our medical care without wastage; and

4. emphasise on self-help and that people are responsible for their own health.

Sir, we must go beyond rendering remedy only when sickness strikes. We need preventive care. It is crucial to promote preventive care with more resources provided for it. The Community Health Screening programme, embarked by MOH for citizens above 50 years of age, is on the right track. The challenge now is to facilitate those diagnosed with any of the chronic diseases to go for long-term follow up and treatment. Failure here would make the whole programme a waste of time, effort and money. Perhaps, we should consider subsidy, either through MOH or CDC, to defray some of the costs for those who really cannot afford long-term treatment.

I had previously asked in this House that more help be given to voluntary welfare organisations (VWOs) so that they have less fund-raising burdens. Fund-raising can be a very tedious task indeed. It gets harder each year, with increasing numbers of fund-raising events. It detracts the VWOs from their good work in caring for their charges. I sincerely hope the Minister for Health will accede to my request to give them more help.

Dr Wang Kai Yuen (Bukit Timah): Sir, Dr Lily Neo has already touched on our public expenditure on healthcare being 1.1% of GDP and that the private expenditure was 2%, giving a total of 3.2% in 1999. This is indeed lower than what other countries had spent during the same stage of economic development as we are. Yet the Minister has pointed out in the House, during the debate on the constitutional amendment on NII, that if we measure the outcome of healthcare delivery system, in fact, our healthcare delivery system ranks very high against the various international benchmarks. It strikes me that Singaporeans must be very efficient to achieve such a high standard when we spend comparatively quite a little amount in this area.

So my question is: what are we doing right that others might not be doing? One possibility is that ours is a city-state with limited geographic areas, and thus the infrastructural costs of the public health delivery system must be low compared to other countries with large rural areas. Another possibility is that perhaps our environmental health is very good, thereby minimising the expenditure on actual health delivery. But, maybe, another third possibility could be that we might be underpaying our healthcare workers, such as nurses and doctors in the public health delivery system, thereby leading to low morale and high attrition. There were reports indeed in the newspapers several months back that some of our doctors are regretting their career choice, for having chosen to become doctors.

Sir, I notice that in the FY2001 Budget, the operating expenditure allocated for the Ministry of Health is going to $1.46 billion, a whopping 34.5% increase over last year. This is, in fact, the highest increase in percentage terms of all Government ministries, and I hope that part of this increase would go towards salary adjustment in the public health sector so that doctors and nurses could look forward to some recognition of their contribution. The question I would like to pose to the Minister is a simple one. How did we spend so little and yet achieve so much?

Dr Tan Cheng Bock (Ayer Rajah): Sir, I want to bring a practical approach to this issue. We have given the people the assurance that healthcare is affordable to all. We have Medisave, MediShield and other insurance coverage to pay for health bills. Yet we get the common refrain that Singaporeans cannot afford to fall ill.

I have looked at some of the hospital bills and I am convinced that, as a Government, we have actually done our best for those patients in C and B2, where the subsidy is substantial. Let me give you an example. A two-day stay at NUH for the investigation of a chest pain in a 6-bedded ward costs $1,272. However, after the Government subsidy of $1,026, this patient paid only $244, which was paid by her husband's Medisave. So in the end she did not have to pay any cash top-up. Similarly, when she was admitted for a day surgery to do a coronary angiogram, she only paid $5 cash. Her husband's Medisave deduction was $519 although the actual cost to Government was $1,890, a subsidy of $1,365. In other words, there is a substantial subsidy for C class patients.

Yet we hear Singaporeans complaining of having to pay huge hospital bills, including outpatient hospital bills. It could be that such patients do not have enough Medisave savings, or they do not know the system well enough to maximise its full benefits. And this is where I will try to give some advice to some of these patients, and I will explain this later. The above patient is my taxi driver's wife and he knows the healthcare delivery system well and, thus, avoided the many pitfalls that many unknowing Singaporeans get into.

Sir, there are two categories of patients seeking hospital treatment. One, the acute, ie, the very sick patients, and the less acute, or the cold cases. In the acute cases, the patient goes to the A&E Unit. His frame of mind is one of anxiety and fear. He cannot think straight and he is eager to get hospitalised. His relatives are equally worried and stressed, and this is where his choice of ward, which should be C or B2, is upgraded to B1 or even A class. Children of the patient are prepared to use their Medisave to help out and so, at that moment, all caution is thrown to the wind.

Admission to B1 or A, without any subsidy, would be very expensive. Thus, instead of having to pay only $244 for a 2-day stay, like my taxi-driver friend's wife, this patient would have to pay $1,272 for a similar 2-day stay. In an acute case, it is quite understandable for someone to make a wrong choice of hospital wards, because the circumstances are one of urgency. Nevertheless, it could be avoided if they are aware of the implications. However, in a cold case, going to get admitted to A or B1, when you cannot afford, is wrong and, in fact, stupid. Ill advice by relatives, who are not paying the bills, is quite common. Some children put their parents in A or B1 because they think they have Medisave, and they want to give the best care to their parents. This is very laudable. Some do not want to lose face if they stay in C or B2, or relatives might pass comments. The ones I dislike most are those giving the most expensive advice and they are not paying the bills. Choosing the wrong wards can be very costly.

Sir, having opted for the expensive wards is not the end of the story. Many are not aware that this is not a one-time cost. A subsequent follow-up at the specialist clinics, after they get discharged, is also not subsidised, and they cannot use Medisave and this is where those on long-term follow-up, like those with hypertension, diabetes and heart cases will continue to pay high specialist consultation fees and high cost of surgical and medical procedures done at the outpatient level. This policy of no downgrading once you have opted for the expensive wards, like A or B1, is closely adhered to by most hospitals. This is where I appeal to the Minister to consider downgrading those who are retrenched, lost a job through stroke or accident.

And I know that this has been given, but of course more can be done. For example, many workers who opted for A or B1 class while working, because of insurance coverage by their companies, lose this privilege when they retire. This is one group of workers who should be allowed to downgrade upon retirement. My advice is: Singaporeans must ask about costs. Know the healthcare system well. And, as doctors, it is our responsibility to explain to patients the cost options of a direct referral to hospital specialists, or indirect referral through the outpatient clinics to hospitals. A direct referral by a general practitioner to any restructured hospital is a very expensive way. An indirect referral through the polyclinic is the least expensive route. At the hospital end, counter staff at A&E must pay special attention to explain to patients the difference in pricing of the various hospital wards before admission. At Government level, Singaporeans must be assured that C class wards are given equally good medical care but without frills.

There is one area which I would like to talk about - that is over-prescribing of drugs. Many a time, a patient will bring a plastic bag full of medicine from the hospital. They are not cheap drugs, most having to purchase at the hospital pharmacy, and the supply is usually a month to 3 months. It costs hundreds of dollars at times, especially if the patient is multi-diseased, ie, they receive drugs from the cardiologist, from the diabetic specialist, from the kidney specialist. The poor patient is usually so groggy after the drugs he has to take and, sometimes, when I ask a patient whether he informed the various specialists about the different kinds of drugs he has to take, invariably the answer by the respective specialists is, "You just take my drugs." If there is a drug interaction, that can be very serious. Usually such patients, unfortunately, are not educated, and they have no ways and means to argue with the doctor or to seek better advice from the doctor.

Most specialists or some specialists guard their turf too closely and, at times, I am sure, inter-relationships between physicians break down, at the expense of the patient. My suggestion is that the clinical pharmacists should alert the physicians if they come across such cases, so that a more rational approach to management can be achieved. Moreover, it is not wise to give them one to two or three months' supply. I think we should start off by just giving them two weeks of medicine to find out whether they do agree to the medicine.

The situation, however, is sometimes complicated with the patient seeing doctors from two different hospitals. And, now, with the two clusters, from two different hospitals in two different clusters, this is where we will have to quickly rationalise how we are going to manage such patients. My suggestion is that there must be a transparent medical record system to help overcome such problems so that medical records of those in one hospital can be passed on to another doctor of a different hospital in a different cluster for better patient care.

One last point, Sir, is that doctors are now practising defensive medicine because of the fear of being sued ---

The Chairman: Order. Dr Tan, you have used up your time. Mr Shanmugam is not here. Mrs Lim. 12.15 pm

Mrs Lim Hwee Hua (Marine Parade): Sir, as my colleague, Dr Neo has mentioned, the Singapore population has grown increasingly affluent and their medical needs have risen in tandem. Given our small size, and unlike elsewhere, medical attention is always within easy reach and there may be a tendency to over-consume. Yet, there is an expectation that medical services must remain affordable. I would like to raise some common concerns and perceptions and ask the Minister to clarify the philosophy behind each of these issues.

Firstly, the role of restructured hospitals. Many Singaporeans feel that restructured hospital services must remain affordable as they are, after all, owned by the Government as they always have been. Many are not clear about the positioning of the restructured hospitals, vis-a-vis private hospitals. In fact, some, especially the older persons, continue to view the difference as that between the polyclinic and the general practitioners or specialists. The confusion could have stemmed from the co-existence of subsidised services at restructured hospitals. I would like to ask the Minister whether there is any merit to creating separate identities to help differentiate the services although operationally, there is the same degree of integration.

As an aside, the financial model of a restructured hospital can be a challenging one, in that there is the risk of presenting a moral dilemma for doctors. Restructured hospitals presumably require all employees, including doctors, to be conscious of the bottom line. Unless the subvention for subsidised patients were accounted for in a way as to make the difference between the revenues from subsidised and private patients less marked, there would always be financial pressure to achieve a higher mix of private patients. Could the Minister please clarify the philosophy behind the role of restructured hospitals?

Secondly, the choice of wards and services. Sir, like Dr Tan, I have encountered numerous cases where residents checked their parents into a higher class ward only to have to appeal to the hospitals to have them downgraded as the costs turned out to be beyond their ability to bear. Most requests for downgrading, as I understand, would typically fail. On the flip side, there are also cases where admission to a higher class is sought in order to jump the queue, with a subsequent request made to be downgraded.

This downgrading phenomenon raises several issues. Firstly, many Singaporeans are guided by emotions when they are confronted with an urgent decision on ward class, as Dr Tan has elaborated on, for a loved one. Not to opt for the best class for an elderly parent when there are several children with Medisave funds appears to be a less-than-filial act.

Secondly, as many do not use hospital services on a regular basis, as to what a ward class entails can be somewhat mysterious. Many have equated a lower ward class to poor or inferior care. It would be good if the Minister can clarify what the suite of services are for each ward class and what the differences are, as well as what minimum standards would be maintained regardless of class. Furthermore, like Dr Tan, I would like to ask that some counselling be given to guide family members in making the most appropriate and rational financial decisions.

Finally, on the degree of subsidy. Currently, the needy are being helped via the Medifund administration. The lower income groups have of late raised concerns about their ability to afford healthcare service. This chorus is likely to intensify with the ageing of the population. In this context, I would like to ask the Minister whether there is merit to determining by way of, say, a means or income test, the degree of subsidy at restructured hospitals. Admittedly, this would be difficult to administer but it would hopefully extend subsidised care equitably.

Mr Yeo Guat Kwang: Sir, in Singapore, we have established a good healthcare financing system based on the philosophy of individual responsibility, coupled with the Government's subsidies to keep basic healthcare affordable for all people. Through the years, we have developed Medisave, MediShield and Medifund that will ensure that every Singaporean will have access to basic medical care.

However, these systems still need to be fine-tuned and reviewed from time to time. I would like to inquire whether the Ministry of Health will be reviewing its policy on MediShield. I have seen cases where people find it difficult to claim for MediShield due to the stringent criteria set for the claim.

Sir, we should also review the deductibles. The present policy states that MediShield will start paying when the total claimable medical expenses exceed the

deductibles. Deductibles are currently set at $500 and $1,000 for patients in C and B wards respectively.

With economic restructuring and the recent development in medical science, it is timely for the Ministry to consider reviewing the policy to make MediShield more responsive to the needs of our people.

Mr Low Thia Khiang (Hougang): (In Mandarin): Sir, the patients who wish to go to the specialist clinics at the Government hospitals must be referred by polyclinics to qualify as subsidised patients. But referrals by private doctors do not qualify the patients for subsidy. So, if they have to be admitted to the hospital, they would be sent to "B1" or "A" class wards where the medical costs are higher.

The Ministry of Health must have some reasons for doing this. But, what are these reasons? Does it mean that private doctors are not as good as Government doctors in judging whether the patients need to consult specialist doctors? If the principle for patient subsidy is based on the patient's financial needs, then how do you determine that all those who go to polyclinics need the subsidy financially? Furthermore, at the polyclinic, the waiting time is normally very long. Do the patients need to suffer the inconvenience just to qualify for Government's subsidy? Can MOH consider allowing patients referred by private doctors to qualify for admission to the subsidised wards as well?

Dr Wang Kai Yuen: Sir, the Medical Endowment Fund set up by the Government would help older Singaporeans to defray the cost of medical treatment after the Government hospitals were restructured. Yet, when we talk to the retirees, many of them are fearful of their ability to pay for their treatment and this has been reflected by previous speakers before me.

As Dr Tan pointed out, this could be an irrational fear. It is possible that many of these retirees are unaware of the existing Medifund or whether they are eligible for such a subsidy. In this year's Budget, FY2001, another $100 million is added to the Medical Endowment Fund, bringing the total to $800 million. This is a laudable move by the Government and demonstrates this Government's care for the elderly. Yet, Sir, at 4% interest, the Fund yielded $28 million last year and would yield another $32 million this year, a mere $4 million increase this year over last year. To meet the needs of the elderly in Singapore, $4 million increase per year seems a pretty meagre sum to me.

I have several questions for the Minister. Firstly, for the years since the Medical Endowment Fund has been established, what has been the utilisation rate of Medifund? Secondly, whether MOH has a programme to publicise Medifund and help people understand how they could qualify for such a fund.

Dr Michael Lim Chun Leng (Cheng San): Sir, casemix was born out of a desire to increase hospital efficiency through appropriate funding and also as a tool for cost containment which was the Government's major concern in the context of a rapidly aging society.

Casemix is here to stay. However, we must be aware of the weaknesses and be cautious of extending it to Medisave based claims. I have spoken to many in the profession and these are some of the expressed concerns on casemix.

Firstly, in increasing the efficiency of hospitals, we must be mindful that, given our standard and quality of healthcare, our GDP spending must be one of the lowest, if not the lowest in the world, for comparable healthcare services. Even though casemix is overall subvention neutral, it will increase the impetus for doctors to discharge patients earlier as hospitals will be penalised if patients stay longer than the so-called "appropriate length of stay". I remember that in all my years of service in a restructured hospital, we often had to do an extra discharge round on top of the routine ward to discharge even more patients so that we can create more bed space. If we push the limits further by putting pressure to further limit the hospital stay, the losers are the patients.

Casemix puts pressure on hospitals to reduce high outliers, that is, those patients who have exceeded the perceived cut-off point for an appropriate length of stay. The reality of medicine is that you are dealing with human beings who are not only biologically different, but also socially different. In the National Heart Centre, the percentage of cases with high outliers was as high as 20% and the second and third commonest DRG had 12% and 13% of outliers respectively.

Casemix has also created new concerns by itself. It has created a new clinical coding profession and this itself has produced new problems by increasing cost through an additional layer of administration and by a shortfall of well-trained and experienced coders. A shortfall of experience and trained coders can affect data collection and hence interpretation of the casemix data.

A central tenet used in our casemix model is flawed. The definition of principal diagnosis (PD) currently being used is that of the Australian definition where the principal diagnosis is a diagnosis of condition established after study to be chiefly responsible for the patient's admission to hospital. Feedback received from hospitals suggest that the present definition of PD may not be fair and equitable. The Casemix Project Office (CPO) has rejected the definition of PD as a diagnosis that requires the most resources, although they stated that it was logical as actual costing would be required to determine each individual condition to compare them with. They considered it too costly and too time-consuming. This would involve getting real cost data and not just historical data. It will be time-consuming to get true cost data and this will require more years than a short period we are taking to implement this. The Australian took years to implement the system but yet we want to do it in such a short time. Are we ready or are we using historical data rather than true cost data because there are implementation timelines to meet? How then can equity of subventions be addressed with a flawed definition? The CPO tries to justify this by saying that the level of resources for patients is not kept to each individual patient, that is, no specific cap at the individual level. No patient should be denied care because they cost more than the average patient. What really matters is that hospitals are adequately subvented. In theory, this sounds statistically acceptable. In reality, there will be pressure on everyone to reduce outliers as this is the purpose of casemix, which brings me to the next question.

If we are saying that the level of resources is not capped to each individual patient, how then can one justify a Medisave based system, since Medisave is personal to each and every patient? The CPO has visited private hospitals and has made no bones that they would implement a balanced billing Medisave based casemix system. There are real concerns about a balanced billing system in the private sector. How does balanced billing cater for new treatments as there will be significant time lag for administrative changes? Would there be sufficient flexibility in the proposed system to allow rapid adaptation to increasing costs due to new effective treatments which are necessary to maintain a world-class medical support system? How do we solve the problems of outliers in a balanced billing system for patients in the private sector when the percentage of outliers is even as high as 20% in the restructured hospitals? Casemix may work to some extent in the public sector because it is possible to average out the cost of large numbers of patients. Outliers are, therefore, compensated on a statistical basis. This does not work out in the private sector where each individual specialist has a few patients of a particular DRG and the number is not anywhere large enough for statistical averaging to be meaningful.

Casemix does not recognise the difference between public and private medical treatment. The quality of personalised care with time taken, conducted exclusively by consultants, is also not acknowledged. In the private sector, where hospitals' and doctors' bills are separate, how would casemix be able to apportion the fees in a fair and equitable manner? Many issues remain unresolved.

I would end by sharing with the Minister the sentiments expressed by a prominent doctor after a recent meeting with the CPO team. He said, "The dialogue was a farce. The team took the view that casemix in private is a fact of life already and they are only looking to see how to tweak it a little bit based on feedback. This is a mockery of the S21 process and openness of Government. In this case, even if very fundamental flaws cannot be solved, casemix will be rammed through regardless of consequences." Unlike him, I have better faith in the Government and the Ministry. The Minister has always been extremely thorough and has a good grasp of issues. I am not looking for answers today as these are complex issues, but rather to place these real concerns across. Casemix is here to stay but let us resolve these issues so that we can have a good system and not a flawed system.

The Chairman: We should be getting hungry now and it is a good time to take the lunch break.

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

Mr Speaker: Order. I suspend the Sitting and will take the Chair again at 1.20 pm.

Sitting accordingly suspended at 12.30 pm until 1.20 pm. Sitting resumed at 1.20 pm

[Mr Speaker in the Chair]

Debate in Committee of Supply resumed.

[Mr Speaker in the Chair]

Head P (cont.) -

The Minister for Health (Mr Lim Hng Kiang): Sir, I want to thank the Members for raising the issue of healthcare costs and the affordability for Singaporeans. This gives me the opportunity to reassure Members that the Government is indeed committed to providing good and affordable basic medical services to all Singaporeans. This commitment is clearly set out in the 1993 White Paper on Affordable Health Care and we intend to meet this commitment.

First, I must say that I am very happy with my Ministry's budget this year. It has been increased by 30%. Mr Bernard Chen has asked how we intend to use the additional funds. We will put the additional money to good use. We will increase the budget of our two healthcare clusters. Specifically, we will increase the budget of the primary care sector by 28%, the acute medical sector by 14% and the psychiatric medical sector by 26%. The additional budget will be used to offset increases in manpower cost. I think several Members raised the importance of paying our medical staff appropriately according to market rates. The money will also be used to strengthen quality assurance programmes and to also implement new initiatives.

My Ministry will also increase the budget for health promotion activities by a very significant 68%. The funds will be used to strengthen preventive healthcare, health promotion and public education, to prevent the onset of chronic diseases. This is what Dr Lily Neo said, "setting the foundation to keep future healthcare cost down."

In addition, we will also set aside $75 million for specific national programmes, such as the health services development programme, setting up the various disease registries and so on. Funds will also be set aside specifically to train our medical undergraduates and specialists.

Let me now turn to healthcare expenditure. Dr Lily Neo and Dr Wang Kai Yuen have commented about our low level of national healthcare expenditure (NHE), which is about 3%-odd of our GDP compared to other major developed countries which can range from about 7% in UK to 14% in the US. Dr Wang asked specifically how we can spend so little and yet achieve so much. I must first say that we cannot claim full credit for this performance. There are several factors in our favour, some of which have been pointed out by Dr Wang. We are an urbanised society, compared to many big countries which have a rural sector, which will cost quite a lot more to service. We have, right from the onset, laid a very good foundation in very stringent and good environmental health, and that has, of course, given us a good starting point, and public healthcare is therefore lower.

At the same time, another key factor is that we have a relatively young population, compared to many of these developed countries. Our aged population, those aged 65 and above, constitutes about 7%. In many of the developed countries, it is closer to 10-12%. We have a much younger population. So we can expect that when our population ages, the national health expenditure will increase correspondingly.

Another reason is our strong economic growth in the last 20 years, which averaged about 8% per annum, compared to our population growth of less than 2% per annum. In this way, we could enjoy significant improvements in our healthcare every year without the percentage share of GDP going up by very much. But as we move forward, as our economy matures and growth slows down, we can therefore expect the NHE, as a percentage of GDP, to correspondingly increase.

Another very important reason is our prudent policies in the provision and financing of healthcare. This has played a significant role in containing healthcare cost increases. If we lose this discipline, we can expect healthcare cost to soar.

Sir, all in all, I can say that our national healthcare cost is low and indeed we should be happy that our national healthcare cost is low, because this correspondingly means that the average Singaporean household needs to pay only about 3% of their household expenditure, or about $93 per month, on healthcare services. Based on an average household size of 4.2, each household member therefore spends about $22 per month on healthcare. To put this in perspective, this amount is less than the average amount that the average Singaporean spends on recreation and entertainment. So, because our national healthcare cost is low, the burden on individual household is also low. Of course, this is looking at the macro level. When we look at the individual level, we have to make sure that our medical financing framework caters for the family who has to pay a high bill because of a particular episode.

I think Members agree that we should not look at how much we spend to evaluate our healthcare system. When we evaluate whether a national healthcare system serves its citizens well, we should not look at the inputs but we should look at what we achieve. I think there are many parameters, which I will not go through in detail. I would just say that these parameters are adopted by the World Health Organisation. They did an assessment of all the countries in the world. Among 191 countries, they came to a conclusion that our healthcare system is ranked 6th in overall cost effectiveness. That means they looked at our output, the clinical outcomes of service, our waiting times, sense of equity, sense of accessibility. They looked at all these factors and looked at our inputs, and they ranked us 6th. So I think we have done well.

The other key macro parameter which Dr Lily Neo and Dr Wang pointed out is the public share of the national healthcare expenditure. They observed that the public share is about a third, compared to other countries which will range from probably half for the average to maybe 70-80% for countries which adopt a national health system kind of approach.

Sir, if we look at the healthcare systems around the world, we probably can put them in a spectrum. On the one hand, we have a very equitable, open to all, everybody enjoying the same type of service, epitomised by the National Health Service of the UK. On the other end of the spectrum, you probably look at the voluntary health insurance system, as practised in the US, and somewhere in between, most of the other systems will fall in. Most of the developed European countries will be closer to the British end of the spectrum. Because of that approach, the share of the public sector will be higher.

In Singapore, the public sector share is one third. This is because of the way we organise the healthcare financing. We ask every Singaporean to pay into their Medisave and then they pay the bills from their Medisave. If you can imagine that instead of contributing 6% into the Medisave account we ask them to pay 3% of their salaries into a national insurance system, as a medical payroll tax, and that is then used to fund the system, you will see the share of the public sector going up. So I do not think we should read too much into this sharing of the national healthcare expenditure between the public sector and the private sector. It is how you organise the medical financing framework. It is more important to look at the output.

Notwithstanding what I said about our low national healthcare expenditure, I do not think we are complacent. We know that the pressure on healthcare cost is relentless, and many Members have spoken about this. The increase in healthcare cost is a world-wide phenomenon. Singapore cannot be insulated from the trends and developments around the world. Medical technology continues to advance and we expect new developments in diagnostics, biomedical devices and drug development. In the US, for example, drug prices have risen by as much as 15% a year. Also, as our standard of living improves, Singaporeans will have higher expectations. Demand for healthcare services will correspondingly increase. In particular, we are undergoing a major structural change in our demography. So we are under tremendous pressure on healthcare cost. The challenge for us is how do we keep abreast of this challenge so that to the average Singaporean, healthcare continues to remain affordable. Mr Bernard Chen's comments on health cost is spot-on, 60% of our cost is in manpower, 15% of our cost is in medical supplies, the majority of which is imported and therefore out of our control. So the cost pressure is there. 1.30 pm

But so far, we have done reasonably well. We have been able to contain the increase in healthcare cost to within the range of 6% to 8% per year. Looking forward, we cannot keep still. We have to adjust and refine our financing framework so that we can continue to enjoy sensible improvements in our healthcare service, while still keeping it affordable to all Singaporeans.

Let me now turn to the whole framework of financing - we call this the 3M framework (Medisave, MediShield and Medifund) - and how the 3M framework has allowed Singaporeans to be able to pay for their medical bills.

First, Medisave. I agree with Members that there is a general perception that the use of Medisave is rather restrictive. There are many suggestions to extend Medisave to outpatient treatments. While the original intent of Medisave is to help Singaporeans cope with hospitalisation expenses, we all agree that the trend is towards ambulatory care. Medisave is already allowed for day surgery and over time, we will extend Medisave to more outpatient treatments where appropriate. However, I must say that we must proceed cautiously because an overly liberal use of Medisave would necessitate higher monthly contribution rates. So we need to strike a balance.

My Ministry will be making adjustments to the Medisave withdrawal limits so that most Class B2 and C patients would be able to pay their hospitalisation bills through Medisave. We will also increase the Medisave withdrawal limits for certain expensive outpatient treatment, such as chemotherapy and renal dialysis, to help alleviate the financial burden on Singaporeans. Details of these adjustments will be announced soon. But I would just want to dampen expectations. We know we need to make the change, but we will have to move cautiously.

Second, MediShield. My Ministry is also looking at relying more on medical insurance to complement medical savings to improve the efficiency of the entire patient finance structure. Mr Yeo Guat Kwang has pointed out the problem of low payouts of MediShield. My Ministry is currently reviewing MediShield with a view towards enhancing its features, in particular the claimable amounts. We are also looking at the deductibles. This is to ensure that MediShield is able to provide adequate protection to the elderly and other Singaporeans who incur high medical bill sizes. Again, we need to strike a balance between enhancing the features of MediShield whilst at the same time keeping MediShield premiums affordable to all Singaporeans, especially the elderly.

The third "M" in our 3M structure is Medifund. Dr Wang Kai Yuen asked about the utilisation of Medifund interest income. The average utilisation is about 77%, and this is despite the approval rate for Medifund which is consistently being above 97%. 97% of applications that come to us are routinely approved, and even then we only use 77% of the funds available. So I want to assure Members here that Medifund is more than adequate to meet the needs of the low-income Singaporeans. In fact, it is a very effective safety net. As we all know, Dr Richard Hu announced that the Government will inject a further $100 million into the capital sum of Medifund, bringing it to a total of $800 million. I agree that we should publicise the use of Medifund more deliberately so that people who face financial difficulties will seek recourse to Medifund.

Let me assure Members that we have medical social workers in all our hospitals. Whenever they come across cases of patients facing financial problems, they will take up the cases and apply for Medifund on behalf of the patients. I do not think we will find very many people falling through the Medifund safety net. As I have said many times here in this House, if any Member comes across genuine deserving cases that require Medifund assistance, feel free to write to either my Parliamentary Secretary or myself, and we will take up the cases. But from my experience in the last years, the Ministry has shown that the Medifund safety net is a very effective safety net.

By and large, the 3M framework has served us well. I think what we need are refinements and adjustments. What is our target? Our target is that all Singaporeans who make regular contributions to their Medisave and who are covered by MediShield would not need to pay out of pocket, if they stay in a B2 or C ward. If their Medisave accounts run out, they can apply to Medifund to help pay for their bills. So that is our target, and by and large we have achieved that.

But I must caution that Singaporeans who choose to go for higher ward classes or who wish to go to private hospitals would have to pay out of their pocket. It is therefore important that Singaporeans who require hospitalisation choose their ward class prudently. This is why financial counselling is a mandatory requirement in all hospitals, both in the public and private hospitals. This is a requirement before they are allowed to use Medisave for their patients.

I agree with Mrs Lim Hwee Hua when she spoke about the importance of financial counselling which would enable patients to have a better estimate of the expected hospitalisation charges so that they can choose the type of ward class according to their means. I think Dr Tan Cheng Bock also made several very timely and wise remarks about the role that doctors play in helping to keep health cost down. I think it is worth reiteration, and these remarks would have to be more widely transmitted to the professional community.

Let me at this juncture try and respond to some of the other points raised by Dr Tan Cheng Bock. We have some rules in the way the subsidies are given. If a patient opts for a B1 or A class ward, he or she can ask for a downgrade, and most times this would be acceded. The only exception is if you go to a private hospital and then later you want to transfer to a public hospital, we will insist that you transfer to a B1, that means, a non-subsidised ward. But if you are within the public hospital system, if you ask for a downgrade, this would be considered with one condition - we will ask that you go for means testing. So if you enter the health system and at the point of entry you choose B2 or C, no questions are asked, we would let you have the subsidies. But if you opt to be non-subsidised and later on you ask to be subsidised, then we insist that you go for a means test so that we know that the subsidy is correctly targeted at the low income families. So that is the only rule. If you cannot afford to pay the fees, you can ask the medical social workers in the hospitals and they will undertake to review your case. And the hospitals have some means to waive the fees, if the case is genuine, or to seek Medifund assistance.

Dr Tan also asked that we prescribe shorter duration for drugs rather than giving out one to two months' supply. I think we would have to depend on the doctors to exercise the judgement. In some cases, it is more sensible to give one to two months' supply so as to make it more convenient, and the patients do not have to come back so often. At other times, it may be sensible, as he suggests, to just give one or two weeks' supply.

Sir, on this whole issue of Government subsidies, again, let me stress that the Government basically assures all Singaporeans that they will have access to affordable basic healthcare. The same package of basic medical service is available to all classes of wards. The key differences are that in the unsubsidised wards, you enjoy the ambience of fewer patients to a room and you can name your own consultants. But other than that, between a B2 and a A ward, the Government will extend the same basic level of service.

Several Members also remarked about the high level of subventions to the hospitals. As you well know, the highest share of medical expenses occurs in our hospitals and therefore this results in a higher proportion of subvention. Government subvention to the restructured polyclinics and hospitals has therefore increased significantly every year. In FY1999, it was $580 million. In FY2000, it was revised to $700 million and this year, we will increase it to just about $1 billion.

While the Government is prepared to increase the subventions, we must make sure that we target the subventions appropriately. I agree with both Mr Low Thia Khiang and Mrs Lim Hwee Hua that subsidies should be directed at those who are most deserving. The most direct way to channel the subsidies to the lower-income group, which may eventually be necessary, would be through some form of means testing. However, as pointed out in the 1993 White Paper on Affordable Healthcare, means testing is an administratively clumsy procedure which the public will take some time to get used to.

The current rules allow you to enjoy subsidies if you go through the polyclinic system and then you go to the public hospitals. We keep these rules. But if you enter the hospital through the private GP, at the point of entry into the hospital, whether or not you are in the A&E ward, you can choose the ward that you want to go to, whether it is B2 or C. If you choose B2 or C, then obviously you will enjoy the 65% subsidy and 80% subsidy accordingly. The choice is available at the point when you are admitted. If you are referred to the Specialists' Outpatient Clinic by the private sector GP, then as a starting point, we will treat you as a private patient. If you are referred to the Specialists' Outpatient Clinic by the polyclinic, we will treat you as a subsidised patient. But if you cannot afford to pay the fees in the Specialists' Outpatient Clinic, you can ask to be reclassified and we will require you to be means tested. So it is a win-win situation for Singaporeans.

Anybody who wants to enjoy subsidised healthcare can go to a polyclinic and then go to the SOC, and no questions are asked, we would not require you to be means tested, and you can enjoy subsidised fees. But if you enter the public healthcare system through the private GP and you think that you deserve subsidised healthcare because you are from a low-income family, then you ask to be means tested. And if you do qualify, then you will enjoy the subsidy. So that is a fair system. It may not be completely effective, because as Mr Low Thia Khiang suggested, you will allow rich people to enjoy subsidies by going through the polyclinic system. So I hope Mr Low Thia Khiang will continue to plug the line and when the population is ready to accept means testing, we will use means testing in a wider way.

Dr Michael Lim raised some concerns about casemix. I do not want to go through the details because this is a very specific issue. All I want to say is that we would take his comments and review them. I want to assure the House that casemix is intended to be a more effective and efficient way to allocate resources. It is not intended to cause doctors to discharge patients earlier. The casemix provides for outlier cases, as Dr Michael Lim raised, that means people who need to stay longer than what is provided for in casemix subvention. We allow the outliers to continue to stay in the hospitals if the doctors deem it necessary and we will then subsidise those outlier patients on a per day basis. So there is no change in the way we continue to subvent these patients. 1.45 pm

I want to assure Members that casemix will not result in doctors coming under pressure to discharge their patients prematurely. Casemix is still in its initial phase. We need to build up confidence and I am sure people would have more confidence in the system as we implement it. As we get the costing data sorted out, people will feel that the costing is more reflective of the real cost, and the system is more equitable. So we are not rushing the system. We are making sure that the system is well implemented, the cost data is well researched. So far, of course, we have seen that our local cost data, when we compare it with the Australian cost data, is very close. So there is no reason to believe that we are costing our system wrongly.

We also have an ongoing process where we review the costing methodology with the hospitals. We will look at the subvention rates every year to take into account the changing pattern of resource utilisation. So I just want to assure Members here that, before casemix is fully enforced, we have the safeguards in place and we will make sure that it will be implemented properly.

Mrs Lim Hwee Hua raised some very fundamental questions about the role and philosophy of our restructured hospitals. Let me just say that we cannot just deal with the increasing healthcare costs by simply increasing the Government subventions every year. If we have to, I am confident the Minister for Finance would provide the additional budget, as he has done this year with his 30% increase. But, at the same time, for all of us in the healthcare sector, we have to continue to be more efficient, more productive and more responsive to the patient's needs.

One key strategy in containing healthcare costs and yet providing quality healthcare has been the restructuring of the private healthcare delivery system. Since the late 1980s, we have been restructuring our public hospitals one at a time, starting with the Singapore General Hospital. By October last year, we have successfully completed the restructuring exercise, with the restructuring of Alexandra Hospital, Woodbridge Hospital and the polyclinics.

I am aware that some Singaporeans are concerned that restructuring of public sector hospitals and polyclinics could lead to higher charges because they are private companies out to make a profit. I would like to reaffirm that making profits has never been the main objective of our restructuring exercise. We restructure so that we can be more efficient, more productive and more responsive. In this way, we bring the costs down and offer a better service to Singaporeans.

I want to make our position on this explicit. SingHealth and NHG would therefore be repositioned as not-for-profit entities. As not-for-profit entities, their main objective is not to maximise profits, neither are they under pressure to pay dividends to their shareholders. To underscore this "not-for-profit status", the Minister for Finance has agreed to exempt the two clusters from paying corporate tax. Instead, the tax savings and any surpluses generated as a result of their efficiency gains will be ploughed back for medical research, training and patient care.

While the concept of not-for-profit is relatively new in Singapore, it is well established in the US. In the US, some of the very well-known medical centres, such as the Mayo Clinic Foundation in Minnesota and Johns Hopkins Medicine in Maryland are operated as not-for-profit organisations. By modelling themselves as not-for-profit organisations, our restructured hospitals will have a different organisational culture from the private hospitals. Our restructured hospitals will continue to preserve their sense of public service. Let me clarify that not-for-profit does not mean that our restructured hospitals do not have to worry about costs. The not-for-profit organisation must still exercise financial prudence, cost their services accurately, control their costs and improve productivity.

So what is the difference, you may ask? For the private patients in Class A wards, they will continue to pay for the full costs for the healthcare services they receive. The difference is that the profit is not taxed and the profit is not meant for disbursement to the shareholders. For subsidised patients, they will continue to enjoy a high quality of medical care that is heavily subsidised by the Government. The difference is that the hospitals will be more efficient and more service-oriented than if it is run as a Government department.

For the staff, they will continue to be part of a dynamic medical institution with high standards and a strong reputation. The difference is that any surplus they make will be channelled back for medical research, training and patient care, ultimately, for the benefit of the patients they serve. This would therefore differentiate our restructured hospitals from the other private hospitals and Singaporeans will continue to enjoy a good affordable healthcare.

Sir, in summary, I would say that the 3M structure has given Singaporeans a good affordable healthcare. We need to continue to make improvements primarily to extend the Medisave withdrawal limits so that Singaporeans do not have to pay out-of-pocket expenses. We need to extend MediShield and medical insurance so that the risk is better pooled among the population. And we need to implement casemix sensibly so that we can achieve better allocation of our resources. And by repositioning our two clusters as not-for-profit organisations, we want to reaffirm the importance of public service in the organisational structure of our restructured hospitals.

Dr S. Vasoo (Tanjong Pagar): Sir, thank you for allowing me to join in the debate. Sir, like the demographic changes to Singapore, some of us here are elderly, including myself. Others are going to be elderly and some, in due course, will become one. So there is no escape from this.

I am glad to hear that the Minister in fact is going to reposition the hospitals to be not-for-profit organisations. This is indeed enlightening. And I hope that the hospitals will be more patient-centred and be able to render more help and more support for the growing elderly population.

Sir, healthcare cost for the elderly is and will be an increasing burden to families. All families with elderly members are likely to be affected, most of all, those with elderly who are chronically ill. Sir, prolonged hospitalisation of these elderly is costly. And as you know, they are likely to remain in hospital for a long time and there will be difficulties to discharge them. It is obviously not a cost effective solution.

Sir, admission to private nursing home is also not affordable, particularly to the lower middle income families because they do not have the funding to be able to do so. Many do not qualify to get into the nursing homes run by voluntary welfare organisations. Care in community hospitals is equally costly.

Sir, there are indeed a few issues for healthcare of the elderly that we need to urgently review. First, the referral system by general medical practitioners. For

medical care of the frail and the elderly, we need to relook at the issue because many frail elderly are unable to get to the polyclinic. As they are quite familiar with their general practitioner, therefore, their first line of defence is to go to see their private medical practitioners. And referrals of these to specialist care and others land them with having to be in B1 class ward or A class ward. This costs quite a lot for many of them, particularly, those with chronic ill health conditions.

The second issue is the adequacy of step-down healthcare provisions. I would like to find out what active plans are going to be implemented to help the chronically ill elderly as quickly as possible. The third area is the more flexible usage of Medisave funds, particularly for those with chronic illness because it is going to be a long-term healthcare cost for them. There is a need to review this as that would in a way reduce the burden for healthcare cost.

Finally, Sir, there is a need to revise the current income criterion of $2,000 and below for subsidy because many families are within this sandwiched group. Therefore, it becomes quite difficult for these families to meet the healthcare cost if any of its members are chronically ill.

Mr Goh Choon Kang: (In Mandarin): Although the Minister has given the assurance that everyone in Singapore can afford the medical charges, I feel that I still need to reflect to him the worries of the elderly.

That medical fees are expensive is a fact. That is because of the high treatment costs. Nowadays, many of the elderly patients prefer to see the specialists, such as the cardiologist, the neurologist, the dental specialist, etc, instead of the general practitioners. Of course, the fees charged by the specialists are higher than those charged by the general practitioners.

I believe there are other reasons why people are worried about the high medical expenses. First, because they are not fully aware of the 3M healthcare framework that incorporates the characteristics of personal saving, medical insurance and Government assistance, as mentioned by the Minister - Medisave, MediShield and Medifund. The majority of people know only Medisave. In fact, until today, many people are not aware of the existence of Medifund. They thought that once they are hospitalised and if they cannot pay the high medical bills, that will be the end of the road for them.

In fact, many people are still not fully aware of the differences between the subsidised wards and the non-subsidised wards. They only know that the higher wards are more expensive. It is only when they receive the bills that they have a shock of their life, "Wow, so expensive!"

Of course, there are real cases where people could not afford the medical bills. But there has not been a case of anyone being driven to the wall. In my constituency, from 1997 to 2000, there was a total of 54 people who could not afford the medical bills, and received assistance. The amount owing totalled about $200,000. Medifund paid for the $200,000 medical bills. There was one patient whose medical bill was more than $10,000 per year. Over four years, his hospital bills from Tan Tock Seng Hospital totalled $52,000. He had no money to pay any of these bills. All these bills were settled by Medifund.

People say, "You can die, but you cannot be sick.". As a Member of the GPC for Health, I would say this is a ridiculous statement. I would not say that our healthcare system is perfect. In fact, I think the greatest challenge for the Ministry of Health is how to eliminate the worry of the elderly people on this problem of escalating medical fees.

I think we should have some system in place to enlighten the elderly people of all the types of assistance available. We should let these people know more about our Government's 3M healthcare framework. For those who do not have Medisave or have no income, particularly the older Singaporeans, I think we should give them more care and more concessions. In fact, most of the older Singaporeans have no Medisave and not much income. We should give them more practical assistance. For those who have no income, I think we should give them better discounts and perhaps we should consider raising the age ceiling for MediShield coverage in line with our aging population.

Thirdly, in the downgrading of the wards, we should be more flexible. Some people who opted for the higher class wards may not know that at the end of their stay, the bill would be an astronomical figure. Therefore, I think, we should have more counselling to the patients upon their admission, so that they know what to expect and how much they would have to pay for their hospitalisation charges.

Secondly, we should also check to see whether there is any way we could help them to settle this problem. At the point of admission, the patient could afford to stay in the ward class of his choice, but something has happened in the meantime, resulting in his inability to pay the bills subsequently. For example, if he suddenly becomes unemployed or his income is substantially reduced. In such circumstances, the hospital should be more flexible in dealing with his application for downgrading.

I know of a case where a patient was a former nurse. About 10 years ago, she had some heart problem. At that time, she had an income and because of special treatment as a hospital staff, she was admitted to class A ward. Some years later, she stopped work and hence had no income. She asked the hospital for downgrading to a lower ward, but it was not approved. So every time when she went back for treatment, she had to pay class A charges.

Just now the Minister said perhaps we could have a means test to see whether this patient could qualify for downgrading. I think we should make known to the public the details of this means test. Perhaps the Minister could give us more details as to how the Government is going to meet the needs of the elderly people in Singapore, whether there is some master plan to help these elderly to pay for their medical expenses. I think this will help to alleviate their worries about the escalating medical expenses. 2.00 pm

Dr Lily Neo: Sir, there is little doubt that one of the biggest challenges for the Ministry of Health now is to ensure that healthcare for the elderly will be efficient and affordable in the years ahead. We should be proactive in planning and we must start laying the foundations for eldercare with urgency to ensure success in this area.

Sir, a favourable outcome in this aspect will make the inevitable escalation of healthcare costs a lesser burden for the people and the Government. It will also make life a happier and healthier one for our elderly population. We must be especially painstaking at putting in place a scheme to cope with the very old, those aged 75 and above. There will be an almost three-fold increase of this group that is most likely to depend heavily on our healthcare and social services.

A one-stop diagnosis and care-plan centre is essential. At this centre, a standardised and holistic assessment can be done according to the patient's needs. Having the correct diagnosis and the choicest management for each illness will not only result in a better outcome but also save us money. Referral to the correct doctor and discipline for treatment are essential for a reduction in hospital admissions. There must be help to promote independence by supporting people to achieve their best potential and strengthen families and communities by supporting family and community responsibility. To do this, we have to start training for more medical personnel. They include geriatricians, physiotherapists, community nurses and home-care nurses and care-givers. New courses need to be conducted to teach the various types of care, especially community healthcare. I feel MOH should not hesitate in organising a team to look into establishing such a centre.

The challenge for MOH on the care of the elderly will be in assisting them to live as independently and for as long as possible in their own homes, with appropriate support. Sir, the aim is to maximise independent living and social functioning, and to minimise avoidable hospital admissions and premature or avoidable dependence on long-term care in institutional settings. There should be appropriate support services to help maintain the frail elderly in the community for as long as possible. Home-care with domiciliary services, and day-care with rehabilitation facilities as well as occupational therapy services with the equipment and adaptations at homes, should be made readily available. It is also necessary to garner ample community help and community volunteers to deliver the services.

Preventive care should remain the hallmark of eldercare. MOH should facilitate further in this area with more campaigns through the doctors and healthcare workers, the grassroots, VWOs and the media, to encourage Singaporeans to go for early health-checks and treatment. MOH must provide early treatment for the sick elderly. An important message for this target group will be "disabilities in old age are often due to disease, and early treatment of the disease can prevent disabilities". Upon this basis, it is necessary for MOH to ensure that those with chronic diseases can get their regular long-term medications.

Sir, if a preventive care scheme is not provided for those elderly who are well, illnesses causing disabilities will occur more frequently. This will, in turn, lead to more hospitalisations and higher costs. If the community-based services are inadequate, more re-admissions to hospitals or institutional-care centres will again lead to higher costs. I hope, therefore, that the Ministry of Health will look into these issues soonest possible.

Mr Ang Mong Seng: (In Mandarin): Sir, I would like to first of all thank the Minister for Health, Mr Lim Hng Kiang, for accepting my proposal of providing health checks for the elderly people. The comprehensive health check for all the elderly above the age of 55 has gained good support from the people and they really appreciate it. In the long-term, this kind of health-check will help to prepare them for preventive health care.

This is a good plan. Unfortunately, there are some snags in the implementation of this health-check exercise. Some of the elderly people who have registered, failed to turn up for the health-check at the appointed time. I have done some house-to-house visits to find out the reason why they failed to turn up for the health-check. Some of them told me that they were afraid that the health check would reveal something wrong with their health and they would have to take drugs for a long time, and taking drugs for a long time is very expensive. So they simply bury their heads in the sand and pretend that there is nothing wrong with them. This is the way they try to run away from reality. We must find some ways to relieve them of this psychological burden.

I would suggest that the Ministry of Health seriously consider that some discount of, say, 30% to 50%, be given to the senior citizens, particularly the retirees, when they purchase their medicine from the Government polyclinics. Secondly, the health checks should be extended to those aged 50 and above, instead of the minimum age of 55. This would enable people who are above 50 years old to start the practice of preventive medical care earlier, and ensure that they would live a longer and healthier life after retirement. I hope the Minister will consider these two points.

[Mr Deputy Speaker in the Chair]

2.08 pm

Mr Ong Ah Heng (Nee Soon Central): (In Mandarin): Sir, I would say that the Government has done well in providing healthcare for the elderly. Recently, we announced the subsidized health screening for the elderly costing the Government $6.6 million and also a provision of $11 million basic MediShield plan for the elderly. All these schemes are intended to ensure that our elderly are well taken care of in the event they have to be hospitalised.

However, I am concerned over the recent increase in charges for specialist treatment in hospitals. Will the increase in charges make it more difficult for the elderly to seek treatment? Even if their children are willing to pay, it would cause undue financial burden to them, especially if they come from lower-income families. This is especially so when the elderly are more prone to illness due to their old age. As a result, they may require more extensive and long-term treatment.

Our polyclinics have done well by providing affordable outpatient treatment and by giving the elderly sick concessionary rates. However, in hospitalisation cases, the MediShield plan should be able to take care of the main bulk of the cost, while, in certain extremely difficult cases, Medifund will chip in to help. My main concern is how we can make sure that in the event the elderly patients need specialist consultation at the hospital after referral from the polyclinic, they will not stop seeking treatment due to the high cost of such treatment. If they do not want to burden their children, they will cite reasons such as high cost or others, and ask for traditional and cheaper types of treatment. Therefore, I would urge the Minister to consider imposing a cap on the amount that could be charged. When they seek specialist treatment, the amount should be a token sum as a gesture of goodwill in recognition of their past contributions to the society during their younger days. In this way, they will know that their charges are capped and they would not have to worry whether they have the financial resources to pay for continual treatment.

Mr Low Thia Khiang: (In Mandarin): We welcome the Minister's announcement that the restructured Government hospitals will not be profit-orientated and that they will serve the people, irrespective of their affordability. We all know that we are facing the problem of an aging population. With an aging population, the number of elderly admitted into nursing homes will also increase. At present, most of the nursing homes are run by VWOs, with subsidies from the Government.

Last year, the Government provided a piece of land for building a nursing home with a lease of 30 years only. This was open for the private sector to tender and the tender price was close to $7 million. With 30 years' lease, plus construction costs, investment in infrastructure, I am not sure how much the nursing home will charge the patients in order to recoup its capital and make some profit. Given the high costs of setting up nursing homes and the need for the operators to make some profits on top of the recovery of their cost, it is inevitable that the burden on the patients will increase if they are admitted into nursing homes. According to reports, the Government will, in stages, continue to allot 13 to 17 pieces of land for tender. The plots of land will be conveniently located in HDB housing estates.

Does the change in policy mean that there will be a change in the Government's attitude towards the care of the elderly? The report of the Inter-Ministerial Committee on the Aeging Population states that every Singaporean must be responsible for his health when he gets old, including financial planning for his old age needs. I have some questions. What would be the Government's attitude towards the elderly who need medical care but who do not have their own resources to pay for such care? Secondly, will MOH continue to allocate land to encourage VWOs to build nursing homes and, at the same time, provide them with subsidies? Thirdly, what is MOH's long-term plan for the establishment of nursing homes? What will be the ratio between nursing homes run by VWOs and those run commercially by the private sector? 2.15 pm

Dr Jennifer Lee (Nominated Member): Sir, it has been a little over a year since the Ministry of Health introduced revised funding principles for nursing homes, in which the homes are required to utilise at least 80% of their bed capacity for category 3 and 4 patients who need a higher level of nursing care and the new category 1 and 2 residents, that is, those needing a lesser level of care and assistance would not qualify for MOH's subsidy. While the principle behind this move to ensure the appropriate utilisation of nursing home resources is certainly correct, there is cause for concern for the care delivery system for these frail senior citizens is currently not yet well-developed to provide adequate support and assistance to these elderly persons and their families. In other words, are there currently any other affordable residential institutions that are able to accept the new category 1 and 2 patients, or is it the intention that they should be looked after at home? If they should be looked after at home, are there enough agencies, I would expect essentially VWOs, currently providing home healthcare services, available to assist families to cope with this responsibility? May I ask the Minister if he would give us an update of the situation with regard to whether there have been cases during the past year of category 1 and 2 patients who have had difficulties finding placement.

With regard to home healthcare services, are there other present services we thought would be sufficient, if not, what initiatives have been put in place to encourage more providers to come forward? I believe a new funding framework has been or just about to be put in place which seeks to fund step-down care through approved community hospitals and nursing homes. Are these institutions able, at this point in time, to rise to the challenge of undertaking to provide these new services? Will this move unwittingly result in retarding the speed of growth of step-down care services?

The Minister moves with his usual relentless efficiency. One is just concerned whether the VWO sector is able to keep up with him. The Inter-Ministerial Committee on the Ageing Population has recommended, in its report, that MOH and MCDS review the present division and responsibilities for health and social care services to ensure that planning and development of these services, will facilitate the service providers who want to look at providing community-based services and in the future development of more holistic models of eldercare. May I ask the Minister if there has been any progress in this area?

Mr Lim Hng Kiang: Sir, let me again assure Members here that the healthcare for the elderly is a very key item in my Ministry's agenda. I would just like to say that whatever I said just now about the whole financing structure for the country applies equally well, if not more so, to the elderly, because the elderly consumes a large portion of the healthcare services.

In addition, we have also been making special provisions for the elderly but I must stress that the elderly must play their part and come forward and make full use of the healthcare facilities and services that have been set up for them. What can the elderly do? First of all, they should try and maintain a healthy lifestyle, eat sensibly and exercise regularly. Second, they should take part in the Community Health Screening Programme that we started in July last year. The cost is minimal. The elderly pays only $5 for the screening, which costs us about $20. In many constituencies, in fact, the elderly is only required to pay $3 or $2 and, even in some constituencies, just $1. But only 18% of the eligible residents turned up to be screened. Mr Ang Mong Seng said that one reason for this low turnout is the fear of detecting medical problems which are costly to treat.

Let me assure the Members here and our elderly citizens that most of the problems that the elderly face can be managed at the polyclinic level. And at the polyclinics, the elderly enjoys a subsidy of 75%. So it is very affordable. For those who cannot co-pay the 25% portion, they can apply to the polyclinic for their fees to be waived. I agree with all Members here who made the point that prevention is better than cure that if the elderly were to manage their conditions properly, this would prevent severe complications and disabilities down the road, which would be even more expensive to treat and lower the quality of life of the elderly.

Our polyclinics run the Comprehensive Chronic Care Programme (CCCP) to improve the management of diabetes, high blood pressure and high blood cholesterol. The polyclinics will remind those who are on this programme when the follow-up dates are due. Dr Lily Neo asked for a one-stop diagnosis and care planning centre. In fact, our polyclinics already serve this function. As I said earlier, most of the kind of problems that the elderly face can be managed quite well at the polyclinics.

We have also experimented by co-opting private sector GPs in a pilot scheme to make healthcare more accessible to the elderly. This is working well in the four areas that we have started the pilot scheme, and we will extend this to other areas. The elderly can look forward to seeing their regular private GPs and continue to enjoy the same subsidy as they do in the polyclinics, if they meet the means test.

Let me also assure Members that referrals of these elderly by the participating GPs to specialist outpatient clinics will also be at the subsidised rate. In time to come, the elderly will continue to enjoy subsidised rates at the specialist outpatient clinics, regardless of whether they go through the polyclinic or their private sector GPs, as long as they meet the means test.

The third area is acute care. We all know that hospitalisation bills can be expensive and, therefore, last year, we offered to pay the MediShield premiums for the elderly for two years. Making sure that our elderly is covered by MediShield will ensure that they will be in a position to pay for their hospitalisation bills. As I said earlier, the safety net provided by Medifund is also working. The elderly takes up between 25% - 30% of our restructured hospitals' Medifund disbursement. I think the elderly is well looked after in the primary care sector, as well as in the acute care sector.

Let me now turn to the step-down care sector. Today, the VWOs provide about 60% of the market share in the nursing homes. The Government funds 90% of the development cost and last year, we introduced a new 3-tier subsidy level for the nursing homes. We recognise that there is a shortage of nursing home places and, therefore, we have taken steps to build more nursing homes. My Ministry is currently working with VWOs to build another seven nursing homes. They will be ready in the next one to two years. The Government funds 90% of the development of these seven nursing homes, which is about $75 million. At the same time, we have put up plots of land for private nursing home development. Our long-term intention is to allow the private sector to take up 40% of the market share by the year 2010. Today it is 70:30, and by the year 2010, we hope to achieve 60:40 the share between VWOs and the private sector. We believe that this 60:40 share will better serve the different socio-economic segments of our population.

Both Dr Jennifer Lee and Mr Low Thia Khiang asked about the other provisions for nursing care and step-down care. Let me just say that for the other forms of step-down care, essentially home medical and home nursing, we have several VWOs providing this service. Today, there are six VWOs providing home nursing to more than 4,000 patients. Last year, we worked with the various VWOs to integrate the services provided by the VWOs. In July, we announced the framework for integrated health services for the elderly. This is a long-term plan to guide the developments of the various VWOs in providing step-down care. I am not sure about my relentless efficiency, but I would like to assure Dr Jennifer Lee that since we are at the initial stages of the development of the plan, we will review this each year. So far, the feedback has been very good and the VWOs are confident that they can step up their provision of home medical and home nursing services.

Basically, the whole idea is to divide Singapore into three regions, each supported by the geriatric and other departments of each regional general hospital. Then, the VWOs will run the community hospitals and the nursing homes and the other forms of step-down care - home medical and home nursing services. The Government will provide the funds, the training and the other resources for them to do so. We are working towards this. We will proceed at a pace that the VWOs can deliver the services.

Sir, I am confident that in the next 10 years, with this framework, we will be able to build up all the necessary facilities to look after the elderly. The other element of this is, of course, the financing framework. Having built up all the facilities and services, we must also make sure that the elderly can afford to pay for it. Again, in addition to what I said earlier about the financing framework that applies to the elderly, there are four things which we have done to make sure that the elderly can afford all these services.

One, we established the Eldercare Fund last year. This is an endowment fund built up by the Government's budget surpluses. The Government will inject another $250 million into the Eldercare Fund, bringing it up to $750 million. We are progressively building up the Eldercare Fund and this will provide subventions to the various step-down care facilities.

Second, we implemented means testing and the 3-tier funding for the nursing home residents since July last year. I am happy to say that this 3-tier subsidy scheme has given more support to the nursing homes. The funding of nursing homes receiving Government funding under this new 3-tier system has increased by over 20%, as more residents now qualify for funding and at higher funding rates than before. The Government's recurrent subsidy to step-down facilities is $31 million last year and we estimate that this will increase to $100 million by the year 2010 and that is why we are building up our Eldercare Fund quite aggressively.

In the third area, I am pleased to announce that we will extend Medifund to the residential step-down facilities with effect from this year. This measure will supplement the fund-raising efforts of VWOs. For this fiscal year, we will set aside $1.7 million from the Medifund interest income for this scheme. Let me clarify that the extension of Medifund to VWOs is not meant to displace the role of the community in raising funds for the VWOs, but it should be seen as complementing their efforts. This is part of our "Many Helping Hands" approach.

The final component to make sure that healthcare is affordable to our elderly will be to establish a Severe Disability Insurance Scheme to help defray out-of-pocket expenses in the event of severe disability. This payout is not only for those in institutional care, but also for disabled elderly who are cared for at home, using community-based services or home care services. Our intention is that Medisave can be used to pay the premiums of this insurance scheme. We are actively working out the key parameters of this policy and we hope to be able to introduce this scheme in the fourth quarter of this year.

Sir, I hope I have assured Members here that my Ministry has put in place a comprehensive package for looking after our elderly. We have a framework to set up all the facilities. We can assure you that these facilities will be adequate in number and of an adequate standard, and that the services will be seamlessly integrated. At the same time, we have also put in place the financing framework for the elderly, and we can assure you that the services will be provided at a price that the elderly can afford and sustain, and also at a price that we, as a society, can afford and sustain.

Mr Low Thia Khiang: Sir, can I seek a clarification from the Minister?

The Chairman: Yes. 2.30 pm

Mr Low Thia Khiang: Sir, the Minister in his answer said that seven more nursing homes will be built and run by VWOs. I would like to know where are these homes going to be located. Will they be located in convenient places in housing estates? Or only nursing homes run by the private sector, and the land tendered out at a high price, are going to be located in convenient places in HDB estates?

Mr Lim Hng Kiang: All our nursing homes will be located close to our community, because that is an important consideration. By the year 2010, we expect to have about 70-80 nursing homes. So we can expect practically one nursing home in every constituency. That is the kind of facilities we need to have, because of the ageing population. Today, we have 50 nursing homes. We are building another seven more over the next two years, and we are going to tender land for a few more private nursing homes. Our plan calls for 70 to 80 nursing homes by the year 2010, which practically means one nursing home in every constituency. So Members will be able to serve their residents quite well with one nursing home per constituency.

Dr Michael Lim Chun Leng: Sir, my parliamentary colleagues before me have spoken about the healthcare services for the elderly, and the Minister has assured us about the funding policy and the facilities. But the key to any healthcare policy will be the doctors themselves and without good doctors, it will be difficult to deliver any form of quality healthcare.

The restructured hospitals have had a large number of their medical officers and specialists leaving the hospitals. I am glad that adjustments have been made to the salaries, and with these adjustments in salaries and also an increasingly saturated private sector, the pull factors have diminished. Also, the administrators that we have now appear to be much more equipped to cope with the changing health environment, and it is time to address some of these push factors.

The medical officers work extremely long hours and are the work horses of the department, doing the bidding of their Registrars and the consultants. If they do not intend to specialise, there is no career path for them, and there is no systematic training for them. With such working conditions and no career development opportunities, there can be no job satisfaction. We need to look into this area and what we need is a department that will look after their needs and future. This is not just an administrative department to deploy them in one hospital or in one department, but beyond that, to look after their career plans, to look at their training programmes and to help them seek job satisfaction and job security. Perhaps the Ministry may want to consider setting up a medical officers division in each cluster, which will look at the deployment, career planning and training for medical officers.

We also need to retain specialists. Some of the problems that specialists face include, for example, workload. The workload in the restructured hospitals is extremely high. There is also pressure on the doctors from the Ministry to meet certain "lead times"; in other words, the time from when the appointment is made to the time the doctor sees the patient, and also to reduce the waiting time for patients. When placed under pressure, doctors work in very difficult conditions. One surgeon in one of the restructured hospitals told me that it is a norm for his team to see between 40-60 new patients a morning, or at least attempt to see. So you can imagine what sort of quality of care he can deliver. When one tries to impose certain time lines on the doctors, certain things will give. And as the consultants are so busy with delivering the clinical services, there is not much time that can be apportioned to the training of more junior doctors, and these doctors later on in life will become consultants. So this is a vicious cycle.

The distribution of specialists in the hospital is not even. For example, some hospitals like NUH will have a higher portion of consultants in a department as compared to junior doctors, whereas some hospitals like Tan Tock Seng Hospital will have comparatively fewer consultants, even though the workload would be comparable. Hence, across-the-board, on paper, it may seem that you may have an acceptable ratio of doctors to patients for different specialties, but there is a significant asymmetry or disparity from hospital to hospital. Perhaps the Ministry or the clusters may want to take a more proactive approach in redistributing the specialists so that the workload is evened out.

There are also inter-departmental differences and these are often resolved at the medical board level (differences between departments, differences between specialties). And because the medical board is an internal board, many doctors or departments may feel that if their head is not holding a significant position there, they may not have a say. One may want perhaps to consider either a board of appeal or seconding doctors from outside that hospital to sit on the medical board to give it a more unbiased perspective.

Sir, I think it is time for us to relook at some of these issues because, ultimately, retaining good doctors will help to improve the quality of healthcare in our healthcare services.

Mr Bernard Chen: Sir, there has been quite a lot of publicity lately on doctors in the public sector. The Government has initiated various measures to stem the exodus of experienced doctors from the public service. Doctors' salaries have been raised. The Ministry has also reintroduced a faculty practice plan which allows selective senior consultants to do part-time work in the private sector, and allows a reverse flow of similar doctors from the private sector to the public sector.

Some private doctors have indicated that these measures are not enough to stop the exodus. They claim that many doctors left not because of pay. Although I have yet to know any one, including doctors, who openly admit that they leave their jobs because of money, it is always something else. This includes working conditions like having long hours, unappreciative bosses and family sacrifices. To a certain extent, these grouses may be true, as there will be in almost every profession. Within the constraints of the system, however, remedial measures can be taken to resolve them. This could, however, be the chicken and egg situation. For example, to reduce the long working hours, we can recruit more doctors. But this is one snag against the outflow of doctors to the private sector. It boils down then to managing a balance of resources and constraints. I think there can still be room for improvement. I would like to know the measures the Ministry has taken, apart from salary adjustments, to make it more conducive for doctors to stay in the public sector, given all the operational constraints.

Dr Michael Lim Chun Leng: Sir, doctoring is becoming a difficult profession. Many have read in the papers recently that even doctors now are subject to abuse by members of the public. Quite often, not surprisingly, almost every other month, you will read something in the papers that would carry negative and sensational comments during legal suits against doctors, and these reports put doctors in a very negative light. And during legal suits, usually the sensational comments put up by the prosecution would always be highlighted and the defence side is always so boring, because they just relate the facts and are usually not carried. And that gives a distorted image of how doctors perform their duties.

One must not forget that doctors are human beings. Yes, they can prolong life, but they are unable to ensure that all outcomes will be what patients expect. Even the best surgeons in the world cannot ensure that all his patients will have good outcomes. We need to put the work of doctors in the right perspective. Doctors work long hours and have very little social life. It is one of the few professions that they have to work virtually every day, including Sundays and public holidays. Doctors do their best to give the patients the best of care. But due to the constraints of time, the constraints of the workload, they may not always be able to give the best that they want to.

For example, I am a visiting consultant to one of the hospitals - Tan Tock Seng Hospital - and I can see that in a hospital like that, where the workload is extremely heavy, they have very few consultants. And because of that, the Registrars and the medical officers do not get any formal training programme. Unless we improve the services, we will not be able to lighten the workload, improve the quality of care. One must understand that doctors have a very difficult time in the restructured hospitals. And the recent newspaper report, which highlighted the routine of the doctor, does help to give the public an insight into what sort of time lines doctors have to meet. The perception is always distorted because, to the doctor, he has 60 patients to look after. But to a person, his relative is the most important person, and why can the doctor not give him that due attention and that due time that is needed for his relative.

Recently, the Ministry of Health has allowed a reverse brain drain, tapping the private sector expertise, and has actually brought in some specialists from the private sector back into the public sector. This has generally been well received by the public for beefing up the services in the restructured hospitals. Ultimately, the aim is to tap on the talent pool so that if we can draw either foreign talent or local private sector talent, we will be able to improve the workload. And that will mean that there is increased quality time for patients, and we will also be able to improve the training of doctors, which means that they can deliver better care to the patients. Perhaps the Minister can tell us whether there are any other plans to perhaps tap the resources outside the public hospitals to improve the workload on the doctors in the public service.

Sir, my next cut is on primary healthcare. Because of our involvement in new towns, we began to learn a bit about how primary healthcare delivery is done in the new town. I was surprised that when we had a population of more than 20,000 households, which would be equivalent to roughly half the size of Ang Mo Kio town, we only had two clinics tucked in one corner of the estate. In other words, all we had were two clinics providing primary healthcare service to the entire estate. When I raised this with the different Government departments, it appeared that everybody thought that it was a good thing to locate clinics only in big shopping malls. But I raised the point that when people are sick, they do not want to take

buses. They do not want to drive a car to a shopping mall to see a doctor. They want to be able to walk to the nearest clinic which is within walking distance to seek treatment and relief for their illness. At the meetings that we had with the Ministry, I was given to understand that the Ministry does not have any planning advice or planning norms as to what sort of number of clinics that we should provide in the new housing estates. Perhaps the Ministry may want to be more proactive in this area in coordination with other Ministries.

Also, as a town grows, there is a growing need for a public primary healthcare service in the form of polyclinics or other forms of public primary healthcare service, to be provided in this growing new town. Perhaps the Minister can help enlighten me as to what the Ministry's plans are for this new town.

The Chairman: I intend to stop discussion on this amendment at 3.00 o'clock. So I think we have to press on with relentless efficiency. We want to give other Members a chance to speak.

Encik Ibrahim Bin Othman (Bishan-Toa Payoh): Sir, Parliament recently passed the Health Promotion Board Bill. With the formation of a new statutory board, ie, the Health Promotion Board, Singaporeans can look forward to a more focused, integrated and concentrated approach for better health outcomes. The Board will spearhead health education, promotion and prevention programmes to overcome health problems in children, adults and the elderly. 2.45 pm

Sir, one of the functions of the Board is to provide medical, dental, health screening and immunisation services to school children and all other persons. I believe this is a good move by the MOH because they can monitor the medical history of all Singaporeans. I wish to ask the Minister whether the Ministry could set up a central registry of all the medical records of all Singaporeans from birth until they reach old age. This move will allow Singaporeans to know more about their medical history. They can also provide this medical history to their respective doctors who are treating them. This may save them time and perhaps cost while getting treatment for their present illnesses. The doctors can also advise them to maintain a healthy lifestyle to prevent their previous illnesses from recurring again.

I hope the Minister could comment on these points.

Mr Ahmad Mohd Magad (Pasir Ris): Sir, on the premise that our people are our key resource in the country, it is incumbent upon the Government to ensure that every Singaporean, regardless of age, stays as healthy as possible throughout his life. I believe there is no better way to ensure this than to inculcate healthy living habits so that Singaporeans ultimately embrace a healthy lifestyle and lead a balanced life.

Sir, it is a recognised fact that from the student bench in our schools to the workbench in our workplaces, Singaporeans, young and old, are subjected to an increasingly competitive and stressful environment. Adoption of a healthy lifestyle can help Singaporeans cope better with the pressures of life, provided they know how. It is not uncommon for us to stumble upon reports of increasing obesity among students in our schools, higher incidence of breast cancer among our women, and Singaporeans' increased exposure to coronary heart disease. Much of these may be attributable to stress, poor eating habits and lack of physical exercise. I am particularly happy to note the Minister announcing the 68% increase in health promotional programmes earlier but would nevertheless like to pose the following measures for the Minister to consider, so as to increase awareness of the importance of a healthy lifestyle while also enhancing the already available infrastructure so that Singaporeans could benefit from them.

First, the Health Ministry should consider forging a strong and compelling healthy lifestyle vision to achieve this objective. I know Sports for Life was launched several years ago but I think this is not comprehensive enough for a healthy lifestyle vision.

Second, the Ministry's preventive healthcare and health education programmes should be beefed up and publicised.

Third, in conjunction with the Ministry of National Development, more health clubs or exercise facilities should be built in HDB and industrial estates to encourage people to exercise more and stay fit. Facilities should be made available and easily accessible for Singaporeans to exercise at or near their homes or workplaces. Wherever possible, make these available for free or levy very small fees if absolutely necessary to charge.

Fourth, facilities in housing estates should be family-friendly to encourage whole families to indulge in healthy lifestyle. When entire families begin working out in community health clubs, they not only do something for their health but also meet other families doing the same thing. This also achieves the much desired effect of strengthening community bonds within the neighbourhood. It is like killing two birds with one stone.

Finally, Sir, the Health Ministry should seriously consider implementing the recommended two-pronged approach to looking after the healthcare needs of the elderly, as put forth by the Inter-Ministerial Committee on healthcare for elderly: firstly, health promotion and disease prevention to enable the elderly remain healthy and active in the community; secondly, when disease and disability set in, the system must be able to provide appropriate and cost-effective healthcare according to each elderly person's needs so as to achieve maximum functional capability.

To further help the elderly, the Government could consider giving them special rebates when they buy healthcare products, such as vitamins and special food supplements to keep themselves healthy and fit. Perhaps the Health Ministry could work with NTUC Healthcare for consideration of special discounts when senior citizens purchase health products in their stores, considering the fact that the aged have to fork out more in healthcare expenditure.

Mr Sin Boon Ann (Tampines): Sir, last year, the Government announced that it would embark on a systematic health screening programme in collaboration with charitable organisations to detect diabetes, hypertension and cholesterol level in people who are aged 55 years and above. I wholly support such a programme as I think it will benefit us greatly in the long term. At a personal level, early detection and treatment can help stave off the complications that may arise from such medical conditions. On the other hand, from a national standpoint, such measures help to reduce the long-term cost of medical care which the Government will have to shoulder. As an illustration, the cost of treating stroke patients can be very substantial as many of these patients require long stay in hospitals and extensive rehabilitation. However, we know that the risk of getting stroke can be reduced significantly if blood pressure and the level of cholesterol in the body is monitored and controlled regularly.

Sir, much as I welcome the Government's initiative in this regard, I do have one request. Perhaps the Government should consider extending health screening exercise beyond just monitoring diabetes, hypertension and cholesterol levels. Presently, there are tests that are available that will enable one to detect other forms of serious illnesses. For instance, there are blood tests that will screen for certain forms of cancer, and we can identify certain residents with a predisposition towards such illnesses, from family records perhaps, and refer them for additional screening. The cost of such screening may be higher than the screening that is presently offered under our national programme. However, I believe early detection and treatment can help the State to spend less on healthcare in the long run. The principle is simple. It may be better to spend more now on health screening than to have to spend a whole lot more in treatment later on.

I would therefore like to urge the Government to consider extending the scope of our health screening programme to include other forms of illnesses as well.

Mr Lim Hng Kiang: Obviously, there is not very much time for me to deal with all of the many good suggestions. So I would seek Members' indulgence that we will follow this up in greater detail after this session. Let me just in the next six minutes respond to some of the key points which Members have raised.

I think managing doctors is a very important task. It is not just a HR management issue. The medical profession is a demanding profession which requires very committed people working under very difficult conditions. So I take in all the suggestions raised by Mr Bernard Chen and Dr Michael Lim. Obviously, our approach towards this is not just salary adjustments. We know that we have to keep up with the pay, but it is also a whole host of other things - working conditions, training, sense of public service, and so on.

I want to assure Members that we are working at this. We intend to keep our fair share of talent. But just to put all these reports in perspective, there are two groups of doctors that we are dealing with. One is the medical officers (MOs) whom we have to train and who have to serve five years of bond with us. The other group is the consultants, who after their training, can either stay with us or go to the private sector. Dealing with these two groups, of course, requires different considerations. For the MOs, we want to make sure we give them a good grounding in training, so that if they leave us and become GPs outside, they would have a good exposure to all the key departments in the hospitals so that they would be good family physicians. But while they are with us for the five years, we should not treat them as cheap labour. We should pay them competitive rates and we should treat them as we should treat all our employees. So this requires a bit of a mindset change in the hospitals and I can assure you that we are working towards that.

For the consultants, whether they stay with us or not, really we have to manage them just like any other employees that we manage. The hospitals have put in place several measures to make the restructured hospitals a more attractive place for these consultants to work in. This faculty practice scheme is one way to remove this very sharp divide between the private sector and the public sector. We will have to continue working at different measures to make sure that the public sector has a fair share of talent and provides the service that is required or expected by Singaporeans.

Let me next turn to primary healthcare. On this point about setting up clinics in new towns, our preference is to let the private sector determine the setting up of clinics. I think it is very hard for the Ministry to dictate how many clinics should be set up by the private sector in each new town. So the private sector will obviously respond once they know that Sengkang is building up. If there are only two clinics and people there have to be served, you can expect more private sector GPs to set up clinics there.

As far as polyclinic is concerned, our policy is to develop a polyclinic when the population in the new town builds up to a certain level. Therefore, I am happy to say that Sengkang is building up nicely and we are planning to build a polyclinic there, and we will build it in due course. Of course, it will not appear overnight. It takes three or four years for us to plan, locate the site and actually build the polyclinic. But I can assure you that a polyclinic in Sengkang will be built in due course.

Mr Ibrahim asked whether the Ministry will set up a central registry of medical records. Today, the records are already in a few key areas. When you are in school, the school health system has a record. When you enter national service, MINDEF has a record. When you enter any one of our two clusters in the public sector, we have your records. So I think we should improve the record-keeping in these key areas first. Whether we combine all of them into a central registry, we have to proceed a bit more carefully, because we have to be very careful about privacy of information, particularly of medical information. I know the technology allows us, but we would prefer to proceed a bit more carefully, to make sure that there are enough safeguards to preserve the confidentiality of all this information before we embark on this central registry.

Mr Magad posed many good suggestions about preventive healthcare and health promotion. I think we will hoist them in. I just want to respond to his suggestion about special rebates for vitamins and supplements for the elderly. The doctors tell me that if the elderly eat sensibly, they have all the necessary vitamins and supplements they need to live a long and healthy life. So they tell me that a rebate is not necessary. The only case they tell me is probably calcium supplements to make sure their bone mass is good and they do not have early osteoporosis. I am told that calcium supplements are not very expensive. So, again, there is no need for special rebates. 3.00 pm

Mr Sin Boon Ann suggested that we undertake screening in a more aggressive way. Let me assure him, that is our intention, provided it makes sense. We have done so for diabetes, high blood pressure and blood cholesterol. But for a national screening exercise to be effective, we must look at the whole scale plus the payoff. And for these chronic illnesses, there is a good payoff, and therefore, based on the evidence and research, we are embarking on it. Of course, our community health screening process is barely started. We need to plug at it, and I am sure in five to 10 years' time, we will start to enjoy the fruits of that very massive national screening exercise.

On the specific examples of cancer, there are some cancers which are amenable to national screening exercises and some which are not. Colorectal cancer, for example, is not amenable to a national screening exercise. But we will identify the high risk groups and alert these high risk groups to go for screening. Breast and cervical cancer is amenable to mass screening, and this is where we are concentrating our efforts for the time being.

The Chairman: I have stretched the discussion of this amendment by at least five to six minutes. Any more stretching, the other $10 cuts will suffer and I do not intend to do so. Mr Bernard Chen, would you like to withdraw the amendment?

Mr Bernard Chen: I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Chairman: Amendment No. (2), Dr Lily Neo.

Dr Lily Neo: Sir, I beg to move,

That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PA 1500.

Long-term healthcare. Sir, many Singaporeans are concerned about rising medical costs and this is especially so for the elderly folks in our midst who have no income but have increasing medical needs. In time to come, this increasing burden will affect even more people due to our fast ageing population. I would therefore like to urge the Ministry of Health to have good plans, insurance schemes and various safety nets put in place to ensure the affordable long-term healthcare for all Singaporeans.

I would like to suggest that we observe the 10 basic tenets for such long-term healthcare as follows:

(1) The culture of self-reliance and taking personal responsibility.

(2) The premise that early preventive measures are preferable and more effective than later interventions at points of crisis.

(3) The view that the family unit, with adequate support, is the principal way to provide care in the home environment rather than residential care.

(4) The recognition that residential care is costly and causes loss of independence.

(5) The need to involve the communities to facilitate the elderly to stay in the communities and at their own homes for as long as possible.

(6) Funding for long-term healthcare must be fair, equitable to all generations and sustainable over the long term.

(7) A combination of services may be required, including personal or medical care, equipment, transport and domestic support.

(8) Older people often have a variety of inter-related needs, including nutrition, nursing, medication and mobility management.

(9) The importance of support for family and other informal caregivers.

(10) The role of the different professions in delivering cost effective and life enhancing care.

Sir, I would like to urge the Minister for Health to incorporate the above important considerations to ensure the success of the care of long-term medical needs. Success in this area will lessen the burden of Singaporeans and the state in the long run.

The Chairman: Can you carry on with your next cut, Dr Neo?

Dr Lily Neo: Yes, Sir. Nurses constitute an integral and important part of any healthcare system. Success in training nurses and training enough of them is vital for sustaining the excellent and efficient healthcare system we now enjoy.

Sir, nurses who are well trained can do a lot and they contribute not only to better care of patients but also to lower costs in healthcare delivery. It is very much cheaper to maintain a nurse as compared to, let us say, a doctor. Well-trained nurses can carry out many functions otherwise performed by doctors and this frees the latter for other duties. A nurse in a community clinic can be trained to check patients and assess them for appropriate referral, give post-operative care, make domiciliary visits and monitor patients with chronic illnesses. Nurses can be trained to provide care in very specialised situations too. They can be trained to look after vexing psychiatric and dementia patients, taxing bedridden and incontinent stroke patients as well as disheartening terminally ill patients.

Sir, as we try to cope with our ageing problem, nurses will be required in even greater numbers. The challenge for us is not only in having adequate numbers of nurses but also in training enough of them for the impending demands of eldercare. As our policy will be to assist older people remain as independently for as long as possible, preferably in their own homes, more courses are needed to train more nurses for the community care setting to achieve this end.

Apart from training the nurses, the Ministry of Health should also have courses that cater for healthcare workers. These healthcare workers can be full-time paid personnel, family members, community volunteers, and so on. Such healthcare workers can be trained in a matter of a few weeks. In England, it takes only three weeks of intensive training to equip them with the necessary skills. They are certified at the end of the course which teaches them in assisted feeding, catheter care, prosthesis use, simple dressing and simple grooming as in toenail cutting for non-diabetics using sterile techniques.

We are still very short of nurses in Singapore. Whilst I feel that the Ministry of Health must seriously consider training more healthcare workers to help ease this shortage, I urge that we have to do much more to increase our supply of nurses. I am glad that the Ministry of Health has taken a step in the right direction with an upward revision of nurses' salaries from 1st June this year.

Sir, it is not only necessary to make the nursing profession noble; it is also necessary to make the job family-friendly and lucrative in terms of both career development and monetary unions. Shall I go on to my last cut?

The Chairman: Yes.

Dr Lily Neo: Rehabilitation. Sir, everyone who has had an illness or accident needs some time to recover. In other words, they need rehabilitation. Older people who need rehabilitation usually suffer from a wide range of conditions and their needs are often complex.

Rehabilitation involves restoration to the maximum degree possible, either of function (physical or mental) or role (within the family, social network or workforce). Rehabilitation usually requires a mixture of clinical, therapeutic and social interventions that also address issues relevant to a person's physical and social environment. Effective rehabilitation needs to be responsive to the needs and wishes of the user and has to be purposeful with the involvement of a number of agencies and disciplines. It must also be made easily available when required.

Sir, there is strong evidence that comprehensive assessments, followed by implementation of individual care plans, can reduce the risk of older people being re-admitted to hospitals or placed in long-stay care. It also improves survival rates and physical and cognitive functioning. To do all these, we need the involvement of relevant therapists, in particular, we need occupational therapists, speech and language therapists and physiotherapist.

Sir, I would like to ask the Minister for Health if he would ensure that we have enough of such therapists to give patients the ideal rehabilitation they require and whether he would expand this area.

The Parliamentary Secretary to the Minister for Health (Mr Chan Soo Sen): Sir, it is very easy to answer Dr Lily Neo's questions. We agree with everything that she says. We agree that her 10 tenets are very useful guidelines. We will try to incorporate them into our plans. We also agree that we should ensure that for the professionals, an adequate number of them should be trained and made available, including nurses as well as therapists. As far as nurses are concerned, we would like to say that, currently, we have an Advanced Diploma in Gerontology and Community Health Nursing available at the Nanyang Polytechnic. Today, we have a core group of 300 registered nurses who have received formal post-basic training in this subject, and we expect to train a further 90 nurses in these two areas in the next four years.

We also agree that there is a need to train community health workers, including family members in elderly care. And in fact, Dr Lily Neo will probably know that we currently have a project working with her Kim Seng community centre grassroots leaders to train family members and, so far, 62 volunteer nurses have been trained to undertake such training programmes.

We intend to expand the scope to work with more voluntary organisations as well as grassroots organisations to train our community so that they are better equipped to care for a more aged population.

The Chairman: Dr Neo, do you want to withdraw your amendment?

Dr Lily Neo: Sir, I want to thank the Parliamentary Secretary for agreeing with all my suggestions. I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The Chairman: Dr Neo, Amendment No. (3).

Dr Lily Neo: Sir, I beg to move,

That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PA 2300.

Surgery by beauticians. Sir, we pride ourselves for having a first-class medical healthcare system with world-recognised and well-qualified surgeons who will carry out the best operations for their patients. We also have all our doctors under surveillance to provide the best medical practices and bring them to justice for any misdoings. Whilst we ensure medical ethics and excellence with the medical professionals on one hand, we allow beauticians, who are not competent, to freely perform surgical procedures, on the other.

Sir, reports made to the media and the Consumers' Association suggest that some methods used by beauticians are invasive and come with attendant risks of injury and infection. Laser devices are being used freely. This is borne out by the profusion of advertisements promoting hair removal by beauticians using "FDA approved light activated systems". It is likely that Class 4 Laser Devices are being used for this and this would contravene the Radiation Protection Act which states that non-medical professionals are licensed to operate only Class 1, 2, 3a and 3b lasers. Other procedures performed by beauticians include silicone injections to the nose and breast, removal of tattoos using CO2 lasers and blepharoplasties.

Not only do they contravene the Medical Registration Act, these beauticians also pose potential hazards when they "operate" on unwary clients. Sir, many beauty treatments have gone horribly wrong because people have been ill-informed and were taken in by misleading and bait advertisements, especially for blemish removal, eye-lids and nose jobs. 3.15 pm

Sir, of what use are the Acts if such illegal activities continue to flourish unchecked? Medical professionals are brought to task for advertising themselves, let alone making misrepresented advertisements, but beauticians are free to advertise, lure and treat customers. Sir, these beauticians are not authorised to perform invasive surgery, and they should be stopped. I would, therefore, like to urge the Ministry of Health to pursue and address the stark discrepancy in this area.

Mr Chan Soo Sen: Sir, I think we can also agree with everything that Dr Lily Neo says, except that the beauticians are not free to advertise, lure and treat customers for unauthorised surgery.

So, we would like to advise members of the public that the Ministry takes a very, very serious view of such activities: that cosmetic surgery and surgical procedures that require cutting, stitching and putting in of implants should only be done by qualified doctors and surgeons. And the public would not be lured, unless they want to be lured. The public is therefore advised that they should not subject themselves to the risks of such procedures being undertaken by unqualified persons. Like what Dr Lily Neo says, unqualified persons who perform such surgeries would be committing an offence under the Medical Registration Act. And, if these procedures are performed in places not authorised for such procedures, they would be committing an offence under the Private Hospitals and Medical Clinics Act.

If any member of the public is aware of such procedures being performed, either by unauthorised persons or in unauthorised places, I would urge them to report to the Ministry of Health's Licensing and Accreditation Department at telephone number 3252612.

Dr Vasoo: On a point of clarification, Sir. Can I ask the Parliamentary Secretary whether the Ministry would allow it, if no stitching, cutting, etc, are involved?

Mr Chan Soo Sen: Sir, it is not very clear what procedures the hon. Member is talking about - no cutting, no stitching.

Dr Vasoo: Done by world-class beauticians, Sir.

Mr Chan Soo Sen: If in doubt, he can always call the department and ask. We need details.

Dr Lily Neo: May I seek clarification, Sir. May I ask the Parliamentary Secretary whether the Ministry would take any further action to cope with these prevalent surgeries done by beauticians, and what else could be further done to improve this area.

Mr Chan Soo Sen: We are unable to act unless we know specifically that the surgeries are done. If it is advertisements, and we read about them and suspect that such surgeries may have been done, then investigations can be initiated. But, essentially, as I have just said, we need specific information in order to be able to act effectively.

Dr Lily Neo: Sir, may I seek further clarification? To reiterate, advertisements are put up freely by these beauticians. If you say the Ministry would pursue this matter, why has it not acted earlier on all these advertisements?

Mr Chan Soo Sen: If the advertisement is a general one, then we are not able to act on this. But if the advertisement says, "You come here, we can do a double eyelid on you", or "You come and we can put some injection on you", then it is a different matter. We will investigate.

Dr Lily Neo: Sir, in fact, the advertisements were in that category. Advertisements have also been made for hair removal by FDA-approved light activated systems but they used probably Class-4 laser device.

Mr Chan Soo Sen: Sir, I do not have those advertisements with me at the moment. Perhaps Dr Neo could pass them over and we would follow up.

Dr Lily Neo: Sir, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The Chairman: Amendment No. (4), Prof Toh.

Assoc. Prof. Toh See Kiat (Aljunied): Sir, I beg to move,

That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PC 1500.

Sir, some of my colleagues in this House have asked me why I am so passionate about hair dyes. Let me assure them that I do not need them personally even though I may need some other hair products. Perhaps a hair restorer would be more appropriate.

Sir, my question arises because, since June last year, there has been an expose by CASE on some laxity and inconsistency in the administration of the Poisons Act. To refresh the mind of Members, they did a survey of retail pharmacies in Singapore to see how many were selling certain hair dyes over the counter. These hair dyes contain diamine, or its derivatives, which is listed as a poison in the Poisons Act. A high proportion of the pharmacies they surveyed did not have control procedures in place, as required by the Act.

Let me paraphrase and re-raise the questions that were mentioned then, which have not been answered by the Ministry:

1. Is the level of diamine in hair dyes so high that they pose a danger to users? Other countries in the world, including those in the developed countries of Europe and America, permit the sale of such hair dyes over the counter, without requiring the supervision of pharmacists. They are also freely available over the counter in Malaysia, and Johor Baru is just a short drive away.

2. If they are really so poisonous, why were the pharmacists so lax in the control of these sales? And if the control of the pharmacists is so critical, then why is it that untrained and unsupervised hairstylists in hair saloons can use these dyes without any safety procedures or documentation of use? The Ministry promised to prosecute errant pharmacists, but there has been no news of any such prosecution.

3. Why is such a common cosmetic item being sold under lock and key? Why are we adding a layer of very expensive professionals for the sale of something that everywhere else in the world is sold over the counter? Are we unnecessarily creating a statutory monopoly to help pharmacists make ends meet? Why are we inconveniencing consumers, who can only buy these items at times when the pharmacists are in, ie, their office hours, and this means strict hours of 10.00 am to 5.00 pm, Sundays and holidays excluded, and with a 2-hour lunch in between? Such artificial restriction on supply, in the face of increasing demand and the intervention of professionals who do not serve any purpose, will only serve to jack up the final price of the product.

4. Is there no other way of warning consumers to use the product carefully without using pharmacists, such as by appropriate labelling on the packaging and a minimum age requirement for the purchase of these products?

I hope the Minister can address these questions without any further delay.

Mr Chan Soo Sen: Sir, unlike the beauticians, in this case, we agree with Prof. Toh. So the Ministry of Health is now in the process of completing the legislative amendments to allow for the declassification of hair dyes that contain diamine, and we expect this work to be completed some time in April. The appropriate announcement would be made shortly to the public.

The Chairman: Prof. Toh, are you happy?

Assoc. Prof. Toh See Kiat: Sir, I am glad that my passion does get me some places. I am not always emotional, and I would like to thank the Parliamentary Secretary for being so agreeable. I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The sum of $1,460,150,550 for Head P ordered to stand part of the Main Estimates.

The sum of $129,291,000 for Head P ordered to stand part of the Development Estimates.

The Chairman: It is 5 minutes to 3.30 pm. I think we can end here, this being a Saturday afternoon.

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

Mr Lim Hng Kiang: Mr Deputy Speaker, Sir, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2001/2002, and ask leave to sit again on Monday, 12th March 2001.

Mr Deputy Speaker: So be it.