SUBSIDISED PATIENTS AT PUBLIC HOSPITALS (Assigning of doctors)

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SUBSIDISED PATIENTS AT PUBLIC HOSPITALS:

(Assigning of doctors): 14.

Dr Amy Khor Lean Suan asked the Acting Minister for Health if he will explain the policy regarding the assigning of doctors to subsidised patients at public hospitals and the subsequent follow-up of these patients, especially for cases of serious illnesses.

The Minister of State for Health (Dr Balaji Sadasivan): Mr Speaker, Sir, in public hospitals, the care for all patients, whether paying or subsidised, involves team work. Every patient is under the care of a medical team led by a consultant. The consultant is ultimately responsible for the patient's care although other doctors in the team may also be involved in treating the patient.

In the case of a seriously ill patient, the medical team may be quite large and often involves doctors from several specialities. This is the result of specialisation and it ensures the high standard of care for the patients. Even so, there will always be one department and one consultant who take primary responsibility for care.

Consultants are assigned to the subsidised patients, based on the medical condition and specific needs of the patients. Every speciality has a roster of consultants to ensure optimum distribution of patient load.

Upon discharge, the patients continue to be cared for by the medical team in the hospital specialist clinic.

Dr Lily Neo: Sir, supplementary questions on the subsequent follow-up of subsidised patients at specialist outpatient clinics at public hospitals. May I ask the Minister of State whether it is more time-consuming, laborious and pressing for a

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doctor to go through the case notes and learn everything about a new patient each time at specialist outpatient clinics with limited time of consultation and a long queue of patients waiting, and would such follow-up on the intention of previous doctors be less than satisfactory, especially if the writings of the notes have been less legible? Would it not be better for the same doctors to look after the same patients, for better patient care? Does the appointment system allow the matching of patients' appointments with designated doctors for continual care? Do our doctors in the public hospitals in the specialist outpatient clinics spend enough time with their patients? How many patients does each doctor see each time? And are public hospitals still encouraging and remunerating doctors according to the number of patients they see?

Mr Speaker: Dr Neo, Dr Balaji has only five minutes left!

Dr Balaji Sadasivan: That is a whole series of questions, but I will try and answer them in general.

Firstly, hospital care is a very complex organism, with so many different people involved and with specialists in different areas. In the hospital, the doctors are also involved in multiple functions. They not only look after patients, they also teach and present papers at international meetings. So, although a patient is under the care of a certain consultant, quite often the patient does not see the consultant. He goes to the clinic, but the consultant may be presenting a paper at a meeting or he may be doing an emergency operation. But what the patient wants, very often, is a familiar face. They very much like to see the same person time after time, so that they know this doctor remembers the complaint that they had eight, nine or 10 visits ago. Really, that is a function of primary care.

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So, what a patient should do is that he should have a general practitioner, someone whom he can see all the time and who understands all the complaints. What too many patients do, is that they go to a specialist clinic, once they have a problem, say, a heart problem. They try and make use of the specialist as their primary physician and expect that every time they go to the clinic, he will be there. This is very hard for a hospital to provide, because of the very nature and complexity of hospital care. So, to ensure that when you go to a clinic, the doctor at the clinic is able to read the writing that was written before and the doctor remembers all the complaints over the last 10 visits, really, a lot of patients who are currently going to our specialist clinics and trying to make use of our specialists as their primary physician, should switch their focus and think of the general practitioner as their primary physician, the one who is going to be their friend, confidant and help them navigate through the complex system in modern healthcare.

Mr Speaker: Dr Neo. We have two minutes left.

Dr Lily Neo: Sir, could the Minister of State please answer my questions, especially on our appointments system, whether we allow matching of appointments with designated doctors, and whether public hospitals are still encouraging and remunerating doctors according to the number of patients they get to see?

Dr Balaji Sadasivan: When the appointments are made, yes, the appointments are made for a specific doctor, and you can do that in our public hospitals. With regard to whether there is a specific remuneration for subsidised patients seen in the clinics, I do not think so. But I can check on that and give the system of remuneration to the Member.

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SINGAPORE LABOUR FOUNDATION:

(Funding of new programmes): 15.

Mdm Ho Geok Choo asked the Acting Minister for Manpower following the announcement in May 2004 that the Singapore Labour Foundation (SLF) is giving up its charity status to focus on funding new programmes that will benefit workers, (a) what are these new programmes; (b) how will these programmes benefit workers in general; and (c) how will SLF be classified henceforth.

Mr Speaker: You have one minute, Mr Mah.

Mr Mah Bow Tan: Mr Speaker, Sir, may I have your permission to answer this Question as the Chairman of the Singapore Labour Foundation?

Mr Speaker: Yes.

Mr Mah Bow Tan: Sir, the SLF was set up to support the labour movement in Singapore . The funds of SLF have been derived from the union movement, mainly from subscriptions by union members as well as contributions from its co-operatives and investment income. Trade unions are exempt from income tax. So, SLF was granted Institution of Public Character (IPC) status, and was exempted from tax. According to the Charities Act, 80% of the revenues must go towards charitable activities. However, most of the labour movement activities are not considered charitable activities under the Act. Therefore, during the review of SLF in December 2003, the decision was made to forgo its charity status to enable SLF to better focus on its original mission of supporting the labour movement as enacted under the SLF Act in 1977.

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SLF provides extensive support to the labour movement, for its activities, ranging from financial assistance, to training sponsorship to recreational activities. SLF will also be embarking on sponsoring training awards for union leaders. Lastly, SLF will work closely with NTUC to roll out new programmes to benefit workers in Singapore . For example, SLF will be supporting the Individual Learning Account that NTUC is going to provide for the staff of its co-operatives.

3.00 pm

Mr Speaker: Order. Mr Mah, end of Question Time.

[Pursuant to Standing Order No. 21(3), Written Answer to Question No. 15 on the Order Paper is reproduced in the Appendix*. Question Nos. 16 and 17 have been postponed to the next available sitting of Parliament.]

*Cols. 163-164