MAIN AND DEVELOPMENT - ESTIMATES OF SINGAPORE FOR THE FINANCIAL YEAR - 1ST APRIL, 1978 TO 31ST MARCH, 1979
Mr Speaker, Sir, may I first answer the points raised by the Member for Anson? It is not quite true that doctors are worse off than dentists, although dentists do not do housemanship. If we are to calculate the salaries earned by dental officers and medical officers, we find that after seven years, they all reach the same point at $1,100. The dental officers spend four years in training and are then appointed dental officers at $1,000. Three years later, they are at $1,100. In the case of the medical officer, he spends five years studying, one year paid as a houseman and then he is appointed a medical officer at $1,100. So at the end of seven years, the dental officer and his contemporary medical officer would be at the same point. However, I would like to add that this policy of not having dental officers doing housemanship was not started by me. In fact, it came as a surprise to me when I was Vice-Chancellor of the University of Singapore. I think it is probably a decision made in haste because at that time Malaysia was directly appointing dental graduates as dental officers without requiring them to do housemanship. The Ministry of Health in Singapore panicked and followed likewise. However, this is not a recantation of what had happened in the past, but the fact is that over a period of time both the dentists and the medical officers are at the same point of salary scale. The other question raised by the Member for Anson over a one day break in service before they are appointed as medical officers is entirely a legal affair. According to what I am told, housemen are apprentices under training and in order to be appointed as medical officers, they have to break service for at least one day. It is very much like a lady civil servant who wishes to get married. She has to have a one day break in service so that she can be paid a gratuity and be re-employed again. This is one of the rules put up by the Establishment and we are just carrying that out. As regards contribution to the provident fund by housemen, it is a matter for which I am not responsible and about which I am not in the least in the clear. Apparently, it started sometime in 1972. At that time, it was decided that non pensionable Government officers would be put on the provident fund, and since housemen were drawing an allowance they were also asked to contribute 5 1/2% with the Government contributing a similar quantum. 5.45 p.m. On the question of A & E unit of the hospital, I will come to that later because I believe one other Member in the House wishes to speak in greater detail and I will answer that point. I am really alarmed indeed to hear the Member for Anson saying that he has heard rumours that I am going to raise the fee in the A & E unit. I would like to know his source of the rumour. The Member for Kim Seng raised a number of points. It is true that there is a decrease of $6.78 million for Expenditure on Manpower for FY 78. This is because in the past years there has been an over-estimate of money to be spent on manpower. In the financial year 1975, the surplus was 12.9%; in 1976, 20.3% and 1977 it was 18.39%. We know very well the number of doctors that we will be able to employ this year. There will be two intakes, one in April and the other in October. It is obvious that if we are taking in the group which will be graduating in October, we will require only six months' financial provision. Likewise, the 50 super-numerary posts for medical officers on study leave do not require full financial provision. Doctor shortage is not hopeless in the long run. Neither would I say it is critical. But I would say it is not satisfactory. The reason why our hospitals can manage to carry on, I specifically mention hospitals, is the low occupancy rates in the hospitals. The allocation of staff to hospitals is in accordance with the number of bed complement in the hospitals. The occupancy rates in some of the hospitals or units are 50-60%. We find, therefore, that we are employing staff to look after beds, not patients. Because of this, the Ministry has managed to survive, keep its head above water, and provide a service for patients. But it is the intention of the Ministry that the occupancy rate of the hospitals should be increased and we are aiming at a target of 80-85%, which I think will be the ideal. It will take a few years before we can achieve that target and during the period of time I suspect more graduates will be coming out and we will be able to train them either as general practitioners or as specialists to man the hospitals and the outpatient departments. It is not always that the Member for Kim Seng see eye to eye with me on the question of doctors. I am pleased indeed to hear his remarks about national service doctors. I agree with what the Member has said, but unfortunately the Minister of Defence does not agree with me. So I presume the Minister of Defence will not agree with what the Member for Kim Seng has said. Unfortunately, I am in no position to press the Ministry of Defence to change its rules for recruiting medical students into national service. To be truthful, I believe that it is fair and equitable that those who aspire to be doctors or dentists should perform national service before they enter the university, like the students who do engineering, architecture, law or other professional subjects. I would suggest that those who opt to study medicine or dentistry in the University should do a different kind of national service. It is pointless asking those who choose to study medicine to serve in the Tank Corps or in the Artillery or to learn how to shoot. It would be better if they will first learn how the sick are treated at a lower level. I had previously suggested in this Parliament that if I were to start a new medical school in another country, the entry qualifications would be that those who wish to study medicine must first do two years, nursing service. They will then understand how hospitals are run at the lower level before they themselves become medical officers and give orders to those who are going to be their subordinates in the future. I think that will also be a test of not only their aptitude but also of whether they will understand that medicine is a vocation to which they will have to sacrifice their whole career. Some study medicine because of the status. I am very worried indeed that 50% of the intake into the medical school this year are women. According to the British experience, 15-20% of lady doctors are lost after graduation. They get married and are no longer attracted to medicine. But they have the status. They are called "doctors" and they also have got doctor husbands. It is a tremendous waste in manpower and in investment. It will be preferable if we could ask those who wish to do medicine to perform not the type of national service that the others are doing, but to get them to perform a service which will test them for their aptitude and their understanding of what medicine is all about. In this way, I believe we can have a better generation of doctors who will be more dedicated to the profession. The Member for Kim Seng is a great proponent for the working conditions of doctors. I do not blame him because he has to speak out for his peers in this House. On the question of providing housing for doctors, I have already stated that the problem does not arise. Doctors who serve within the Ministry of Health are treated like other civil servants and they are entitled to buy executive flats at Marine Parade or flats built by the Housing and Urban Development Company. There is no problem among doctors who are Singapore citizens. In fact, many of them have taken up this opportunity. It is a false excuse given by those who have resigned or have left the country to say that they have not been given housing. That is not fair indeed. It is not true. It is not because the conditions for housing are not met that they have resigned. Non-citizen doctors are looked after by the Ministry, which has made arrangements with the Housing and Development Board and the Port of Singapore Authority to rent flats to them at subsidised rentals. In fact, up to-date we have 45 such doctors who are being accommodated in Housing Board and PSA flats. Kent Ridge Hospital will be an acute general hospital. I said previously that it will not be a premier hospital. It will not be the only teaching hospital. There will be other hospitals in which students will be posted. If the Member for Kim Seng believes that the Singapore General Hospital has or will have better teaching materials than Kent Ridge Hospital, he is quite entitled to join the Ministry of Health and work at the Singapore General Hospital. But if he wishes to remain in the University, then I presume he will go to Kent Ridge Hospital. However, the choice is his. Kent Ridge Hospital will have to serve a growing population in Jurong and Clementi New Town, which is expected to grow to about a quarter million by 1990. In answer to the Member for Potong Pasir, I do not know why he quotes The Lancet and asks me about aspirin, paracetamol, ferrous sulphate, aluminium hydroxide, senna and a multivitamin preparation. I am not a pharmacy student. He is always testing my knowledge of consumer drugs because he is very familiar with them. Under section 7 of the Medicines (Advertisement and Sales) Act, it is required that all medicines sold over the counter must have the formula printed on the label. Information as to purpose, dosage, administration, is normally given on the label. In some instances, those who do the marketing will also include pamphlets together with the drugs sold. Part V of the Medicines Act deals with containers, packages and identification of medicinal products. I would like to do whatever is practical. I can tell the House that there are 20,000 drugs on the market, and if we try to oversee that every drug is labelled in great detail, we are going to create a great inspectorate and a bureaucracy within the Ministry of Health, which will not at all help to promote the health of the population. However, I will take note of the article which the Member for Potong Pasir has cited from The Lancet and I will discuss with the Chief Pharmacist on what can be done as far as these six products are concerned.