Mr Speaker, Sir, with your indulgence, may I make a couple of points for clarification? First of all, it should be noted by the press and the Hon. Minister that I do not sermonize nor do I lecture in this House. I merely participate in the debate. Secondly, one or two quotes from the Bible do not constitute a sermon. A sermon begins with "Dearly beloved" and ends with "Hallelujah". The second point of clarification, Sir, concerns job-hopping. Now, whenever reference is made to Japan, people always conjure up the Zaibatsu, the trading company, the big company. They talk of seniority, lifelong employment, loyalty, and so on and so forth. But they forget that the Zaibatsus account for less than half the Japanese economy and that much of the adjustments needed in a Japanese economy is borne by the other half of the economy comprising very small firms which are subject to frequent bankruptcies, turnover and high mobility of labour, or job-hopping as the Minister chooses to label that economic phenomenon. I would hope that in revising his schemes of incentives and disincentives to discourage job mobility, he would study the Japanese economy more realistically. 2.53 p.m. The Minister for Trade and Industry and the Minister for Health (Mr Goh Chok Tong): Mr Speaker, Sir, as I have to cover several areas, I propose to be concise and precise. On Research and Development, the Member for Boon Lay suggested that we should set up a National Coordinating Committee to implement R & D. Perhaps this suggestion can be considered at a later stage. In the meantime, the Ministry of Trade and Industry will perform the role of coordinating R & D. R & D must not be divorced from the end-users in particular industries and hence my Ministry will, wherever possible, consult the end-users and the National University of Singapore in undertaking this task of coordinating R & D. The Member for Changi suggested that the Skills Development Fund should be used to promote R & D beyond manpower, for example, safer ways of manufacturing products. I do not believe the Minister for Finance will agree that that is the proper use of the Skills Development Fund which is meant for upgrading manpower. Research staff can, however, have recourse to the Skills Development Fund if further training and upgrading are required. In fact, SDF has provided a total sum of $233,000 to three companies to train engineers for R & D work. The Member for Chong Boon suggested that young professionals be encouraged to go into ventures through joint participation with multi-national companies. He thought that finance was the least important problem. Here, I would disagree with him. Generally, young professionals who work in multinational companies have picked up the relevant experience and they feel that they can branch out into supporting industries on their own. Finance to them is an important problem and the Small Industries Finance Scheme will help the young professionals to branch out into ventures on their own. The point, however, is taken that wherever possible we should encourage joint ventures between multi-national companies and these young professionals or executives. But we operate a free enterprise economy. We cannot require multi-national companies to have local shareholders. It is a decision which we leave entirely to the investors. Despite the number of Members of Parliament who have made comments on the economic restructuring and other matters, there are really very few points for me to answer on the economic side. Moving on to the Public Utilities Board, several Members of Parliament seem unable to reconcile what they call the hefty surpluses of the PUB with the frequent increases in PUB charges. They appear to labour under the misconception that the PUB is out to make profits. The Public Utilities Board does not have shareholders. There is, therefore, no vested interest for the PUB to make huge profits because who would it distribute the profits to? It is true that the PUB had an operating surplus of $119 million in 1979. Taken in isolation, this figure appears to be hefty but related to the total investments in property, plant and equipment at historical cost, the return on these investments comes up to only 4%. The surplus is required to repay loans taken from the World Bank, the Asian Development Bank and other sources which were used to finance development. The Board has an outstanding debt of $1.2 billion which has to be repaid and hence the need to generate a small surplus. If there were no surplus generated every year, the Board would be regarded by banks as a non-credit-worthy enterprise and the Board will have difficulty in getting-fresh loans to finance development. The PUB intends to spend some $2.2 billion over the next five years. Half of this would have to be borrowed. The other half could be financed from operating surpluses generated over previous years. The point remains valid, however, that as a monopoly a statutory board must exercise all care to ensure that there is no inefficiency. The PUB is aware of this and looking at the cost of generating electricity, it would appear to me that the Board has exercised due care in keeping costs low. Fuel oil accounts for 77% of electricity. Interest on loans and depreciation 15%, maintenance of equipment and so on 5%, and wages only 3%. Oil price has gone up from S$39 in 1972 to S$479 per ton in 1980, an increase of 1,130%. The average price of electricity per kilowatt hour was 6.38 cents in 1972. In 1980, it was 17.74 cents, an increase of only 180%. This, to me, proves that the PUB has in fact minimized price increases through higher productivity and efficiency, through the proper use of plants ind manpower to produce electricity. There is a limit, however, to the extent that the escalating oil prices can be offset by improvement in efficiency. Once they have purchased better equipment, it is more difficult to absorb the next round of increases in the cost of fuel oil. One Member suggested that the abolition of promotional block rates might affect industries which are desirable and yet, at the same time, are high energy users. I can assure the House that the abolition of promotional block rates should not affect the overall attractiveness of Singapore as an investment centre for such industries because the cost of electricity in Singapore is still lower than in Hong Kong or Japan. And then there is also the point of whether Singapore should encourage industries which are large users of energy. If there are other desirable attributes of such industries, of course, we should encourage such industries despite the fact that they are big users of energy. Some Members have suggested that we should avoid wastage in the use of energy and I could not agree more with the suggestion. My Ministry intends to have an energy conservation campaign very shortly, sometime in May. The thrust of the energy conservation campaign will be on the inculcation in consumers of the need to conserve energy, good housekeeping in other words, and also to look into the enforcement of regulations to ensure that conservation is taken seriously by industrial and commercial enterprises, in particular, offices and hotels. A point was made by several Members of Parliament that in any revision of PUB charges, consideration must be given to the lower income group, i.e. those who use the minimum amount of energy or water, and that cost increases should not be passed on to them provided they are not the ones who are wasting water. The point is well taken and, in fact, that is the philosophy of the Public Utilities Board. All consumers who use less than $80 per month are granted, for example, a concession of not paying the 10% Government tax. We indicated in the Addendum to the Presidential Address that water rates may be revised. The rationale for this is the big increase in the rate of water consumption. In the last two years, the demand for water has grown too rapidly, by 7.4% in 1979 and 7.7% in 1980. If this rate of water consumption continues, there will be a water shortage in times of crisis, in times of drought, given our limited water storage facilities in Singapore. There are two ways in which we can control the rate of increase in the consumption of water. One is through rationing and the other is through the price mechanism. We think the price mechanism is the lesser of the two evils. When the water rates were revised in early 1973 and late 1975, there was an immediate reduction in the growth rate, from 7.7% in 1972 to 1.6% in 1973 and 1.8% in 1974. In 1975, the growth in water consumption was 9% and it was reduced to 1.7% in 1976 after the price revision. Therefore, price revision has a salutary effect on wastage of water. The minimum amount of water required by the lower income group will be taken into consideration in any water rates revision to ensure that these people are not adversely affected. May I now have your permission, Mr Speaker, Sir, to wear my other hat, that is, the Ministry of Health? The Member for Ayer Rajah commented that promotion of Singapore as a medical regional centre should not be at the expense of the national health care. We agree with that observation and I would give the assurance that turning the health industry into a prized industry to cater to regional requirements will not be done at the expense of national health care. He made several points, more of an administrative nature, regarding improvements to the GP referral system and so on. On his suggestion that patients be allowed to be referred by GPs directly to the specialist clinics instead of through the outpatient dispensary, I would like to say that the differential pricing for specialist clinics is, in fact, intended to keep the workload off from these clinics. If GPs are allowed to refer patients directly to specialist clinics, there is always the possibility of abuse. Of course, the Member for Ayer Rajah has suggested that these direct referrals be limited to clear cut cases. But we know that very often doctors have different opinions as to the diagnoses or the diseases the patients may be suffering from. We therefore require the patients to be referred to the OPD so that the Government doctors can serve as a screen before these patients are passed on to the specialist clinics. It is better for the OPD to take on this additional load than for the specialist clinics. The Member suggested that GPs be allowed or be encouraged to take over post-operative and follow-up cases from hospitals. This suggestion is a good one provided he can come up with a list of takers. We shall be more than happy to come to an arrangement whereby patients can be passed on to GPs to attend to when these are follow-up cases. We may, however, have to insist on some control over the kind of charges which they intend to levy on the patients so that there is similarity in their charges and what the OPD would charge. The Member's suggestion that Government laboratory and X-ray facilities be opened for use by the GPs can be considered. In fact, GPs at the moment have free access to Government laboratory facilities for infectious diseases. For diseases outside this particular scheme, their request could be considered when they wish to use Government facilities but there must be a charge. The Member's proposal that polyclinics be turned into processing centres for GPs amounts to posting specialists to polyclinics from our point of view. We cannot afford this at this point of time as manpower is a problem which we have to tackle in the Ministry. The Member for Ayer Rajah thought career development or the lack of it is a primary reason for young medical officers to resign from the medical service, and he went on at some length to plot a possible career path for the medical officers. I do not think career development is the major reason for doctors resigning from the medical service. The doctors in the private hospitals have no career development plans and I have yet to come across any of them resigning from the private sector to join the Government hospitals where we have such plans. The Member appears to have his facts wrong when he said that the Ministry has no career development scheme for doctors. The Ministry has. The housemen, for example, are required to undergo three postings of four months each to give them exposure in selected areas. For appointment as medical officers after their housemanship, they are put on two years' probation during which they are rotated at six monthly intervals. The compulsory postings are to give them rounded experience. On confirmation in the appointment, those who wish to specialize can apply for further training under a traineeship scheme. The Ministry has a Personnel Section and also a Training Unit that not only look after the deployment of staff but also their welfare. Whilst career advancement or lack of it, from the Member's viewpoint, may not be an important reason for staff resigning from the medical service, it is nevertheless an important aspect of the medical service. We will, of course, look into the areas whereby we can improve working conditions for the medical officers. For example, in hospitals medical officers are not given adequate facilities in the rest room; there is only one bed where the doctors can take a rest. If there is more than one doctor, they have to take turns to use the single bed, like those who rent beds in the old days in China Town. They have to take turns using it, except in this case they do not have to pay a rent or a charge. We will look into the improvement of working conditions for the doctors. We will also see how we can involve them in greater participation in policy decision deliberations so that their morale can be raised. There was one criticism by a Member as to the charge of $10 per attendance at A & E units. The A & E attendance fee was raised from $4 to $10 on 1st April 1978. The purpose was to discourage non-emergency cases from overcrowding the congested A & E departments at hospitals and to encourage them to visit the Outpatient Departments or the general practitioners. It is right, therefore, that the fee should be higher than what the general practitioner charges. Prior to 1978, attendances at A & E departments increased steadily by 12.1% in 1976 to 17.6% in 1977. After the increase in the charge from $4 to $10, the rate of increase in A & E attendances dropped to 5.1% in 1978. Again, the price mechanism seemed to work very well. However, here it seemed to work only for a while, as the rate of A & E attendances went up again to 12.8% in 1979 and 10.6% in 1980. About 46% of those who attend A & E departments are not emergency cases. It is a matter for consideration, therefore, as to whether the A & E fee should not be further increased. We are not suggesting this for the time being but certainly we will not decrease or reduce the fee of $10. The Member for Telok Blangah observed that medical benefits for civil servants were downgraded in the revision on 15th September 1980. Prior to this date, the ward eligibility for civil servants was pegged to income. After that, it was pegged to divisional status, which is a better basis for pegging eligibility because with regular increases in pay through the National Wages Council wage increases, civil servants who should be eligible for lower class wards are being pushed up to higher class wards. In the fiscal year 1978-79, civil servants and their dependants represented 41% of all Class A, 38% of all Class B and 7% of all Class C admissions into Government acute hospitals. Obstetrics and Gynaecology admissions of civil servants and their dependants in Class A were 50%, in Class B 48%. The use of Government facilities by civil servants and their dependants was high in relation to the general population. Subsidized medical benefits for civil servants are recognized as a service perk. However, this should not be at the expense of the paying public who has to bear the burden of periodical increases in hospital fees. Hence, the need to peg the medical benefits for civil servants to their divisional status and not to their income. The Member for River Valley went to great lengths to argue that the Abortion Act should perhaps be amended to tighten implementation. We need not go into the arguments, the merits or demerits of the Act. The matter has been debated for many years. I will therefore just limit myself to one point, i.e. whether his suggestion that abortion is being used as an alternative means of contraception is correct or not. When he looked at the increasing number of abortions, he conceived that this was so. But I think he has misconceived. Maybe this is because he has his feet firmly planted in the air. It is true that the number of abortions have gone up, but if he were to look at the charges for abortion in private hospitals, which I believe range from $100 by private doctors when the procedure is done by doctors without higher qualifications to about $500 for abortion by doctors who are about the equivalent of the Registrar or Senior Registrar, it is clear that very few people would use abortion as an alternative form of contraception. The charges by Government hospitals are, of course, much lower, but then there is also the inconvenience of having to go to the hospital and staying there for quite some time and the added risk of being recognised for mothers who are married. Hence I do not think the increasing number of abortions is an indication that the Act is loose and that it is being abused by some members of the public as a form of contraception when it is not meant to be. Finally, I shall move on to the point made by the Member for Thomson that chest X-rays should not be done on an annual basis. First, I wish to clarify that this is not a requirement of the Ministry of Health. It is a requirement written into the collective agreement by some employers and employees. His observation is valid. Frequent X-rays can have injurious effects. In 1979 the Singapore Anti-Tuberculosis Association performed routine X-rays on some 139,000 persons. Approximately 50% of these individuals were in the 20-29 year age group and a further 25% in the 30-39 year age group. Their pickup rate of active tuberculosis in the persons X-rayed was 0.06%. This is an extremely small yield and does not warrant an annual X-ray check up. The Ministry of Health wishes to state categorically that in its view the present status of tuberculosis control in Singapore does not warrant routine annual X-rays of people below 40 years of age and this practice should be stopped because of the possible harmful effects. Over the age of 40, specific groups require X-rays but this can be done at two-yearly intervals. This group will include teachers and others working in schools. Teachers are required to go for more regular check-ups because they deal with children. The only country in the world which encourages individuals over the age of 60 to have yearly X-rays at present is, surprisingly, Japan and this is one area which we are not following. 3.29 p.m.