Hansard, 2000-03-14

asked the Minister for Health (a) what are the reasons for the long queues at specialist outpatient clinics of restructured hospitals; and (b) whether any steps are being taken by his Ministry to improve the situation.

Mr Speaker, Sir, our Specialist Outpatient Clinics (SOCs) see a disproportionately large number of patients, some of whom could have been treated by their family physicians. This situation arises because patients, by and large, prefer to be seen by the specialists and the charges at the SOCs are not significantly higher than those charged by the family physicians. Patients therefore may experience long queues and waiting times at the SOCs from time to time for the following reasons: (1) Patients' preference to be seen by certain specialists who have a long waiting list. To shorten the appointment waiting time for patients, the clinic sessions for these specialists are therefore overbooked, which would invariably contribute to a longer queue and waiting time; (2) Appointments made at the SOCs are scheduled assuming that they are "normal" cases with average length of consultation time. However, in the clinic situation, some consultations turn out to be more complex and require more time. This leads to a cascading effect whereby the waiting time for consultation for subsequent patients would be affected; (3) From time to time, a patient's medical condition changes or deteriorates such that he requires to see the specialist earlier than the given appointment date. In such instances, based on medical need, the SOC may have to arrange an urgent appointment for the patient even though the specialist is already fully booked for the day; and (4) Occasionally, the specialists are called away to attend to emergencies in the ward or operating theatres. The Ministry and the public hospitals have instituted the following specific measures to improve the waiting times at the SOCs: (1) To increase the number of clinic sessions for specialists with long waiting lists; (2) To extend clinic operating hours for specialists with very high patient-load; and (3) To initiate an active discharge plan for patients no longer requiring specialist care for follow up by their family physicians. These are, however, short-term palliative measures to deal with the high patient load at our SOCs. We need to do a more fundamental review of outpatient care by specialists and family physicians to achieve our objective of ensuring that patients receive care appropriate to their needs. Ideally, patients should turn to their family physicians first when they are ill. The family physicians will manage their medical condition with appropriate referrals and collaboration with the specialists. However, this is a complex issue which would involve patient education, ensuring high quality of family physicians, and review of the specialist referral system and fees charged. With the formation of the two networks, we will make a start by interfacing the polyclinics with the SOCs. Where the patient is adequately looked after by the polyclinics, it will be done there, and not at the SOCs. The networks will extend this collaboration to the private family physicians subsequently.

Mr Speaker, Sir, I would like to declare that I am a doctor in private practice. May I ask the Minister why specialist outpatient clinics take appointments from any patient who so wishes through the phone and without any referral? Would not such practice run counter to the basic tenet of cost efficient and effective medicine? Surely not every sickness needs the care of specialists?

Mr Speaker, Sir, I agree entirely with the Member. Ideally, every patient should be managed by his family physician, and see the family physician first and if the condition requires the care of a specialist, then he should be referred to the specialist. In Singapore, we do not enforce a compulsory referral system. We encourage referrals by the polyclinics and family GPs. We do not make it compulsory that if a patient is not referred by a private sector GP, he is not allowed to see the specialist. This is the situation today. I think we have to work on the education of the general public that they should see their family physicians first.

Would the Minister condone such referrals? Would not such referrals to specialist outpatient clinics cause an inappropriate use of medical facilities, and tax our public hospitals unnecessarily and frivolously?

Sir, compulsory referral is the ideal situation, but I think we want to be more flexible. In some cases, patients make appointment with the SOCs. In some cases, they are discharged from the hospitals and they have recovered. But if they think that something has recurred, they may want to make an appointment with the SOCs. Today, we have adopted a more flexible approach. Unlike some countries, for example, they may insist on a compulsory referral. We have not reached the stage where we feel we need to insist on a compulsory referral situation.

Mr Speaker, Sir, I think the Minister did not get me correctly. I did not mean subsequent check-ups with the specialist where they can go back any time. I am talking about first-timers who just call up the outpatient clinics for an appointment and they just walk in to see the specialist.

I think the Member also did not get my answer. We do not enforce a compulsory referral system. Today, we are a bit more relaxed and we allow patients to refer themselves to the SOCs. Of course, we can adopt a compulsory referral system, meaning that if a patient is not referred by a private sector or a polyclinic GP, then he is not allowed to see the specialist. We can discuss and see whether that is indeed a better system. But today, the practice is that we allow Singaporeans the flexibility to go to the SOCs. In a way, I think it serves us well. Of course, it leads to a longer queue in the SOCs, but this is the trade-off. And Singaporeans seem prepared to accept this trade-off. If the feedback from all the Members is that Singaporeans want to have a compulsory referral system so that the queues in the SOCs will be shortened, I am prepared to consider that.

Can the Minister be more explicit in his reply, Sir? How do we expect patients to know the severity of their illnesses to warrant specialist care all the time if we just allow them self-referrals?

Sir, I think we have to be quite pragmatic about the situation. Singaporeans now serve the Net. They read all kinds of things on the Net. They do quite a bit of self-diagnosis. It is not the ideal thing to do. But when Singaporeans think that they have a problem with, say, incontinence, they would want to see a specialist first. They do not want to see their GP. Unless we say no, that is not allowed, and we change to a completely different regime, but today the rules allow them to go to the specialist and we accept that practice.

Mr Speaker, Sir, as I understand the Minister, he seems to attribute the long queues partly and for a greater part to the reluctance of people to go and see their own family physicians. Does he think that perhaps cost may be a factor in this? Has his Ministry ever considered getting private doctors into a scheme of voluntary service? The specialists outside could help and the Government could subsidise their fees, if they would only collect a certain amount from the patients. Has the Minister thought about this at all?

Mr Speaker, Sir, in my answer, I attributed to two main reasons for the long queues in the SOCs. One, is the tendency for people to want to see the specialists rather than their family physicians. And I agree with Dr Lily Neo that it is not the ideal practice. In fact, my Ministry encourages and is putting in place measures to encourage Singaporeans to see their family physicians first before seeing the specialist. The share of the workload between the family physicians and the specialists today is weighted to the specialist, because Singaporeans operate on the understanding that if they have a specific problem, they want to see a specialist before seeing the family physician. The second point which I put in my answer is cost. Not that it is more expensive to see a specialist, but that the cost of seeing a specialist in our SOCs is not significantly higher than seeing a private sector GP. So the price differential between a private sector GP and SOC is not so big that Singaporeans will be encouraged to see a family physician first before seeing SOCs. Singaporeans can afford to see a specialist. The differential is not so high. So they go straight to the specialist. The Member suggested getting doctors to provide voluntary services. I am sure if doctors are prepared to do so, we will work with them.

Have you suggested a plan?

We have to be quite realistic. The specialists in the private sector run their clinics. They charge private sector fees. Many of these specialists are involved in community work and we encourage them to do so. But to expect private sector specialists to run voluntary clinics on a fee or subsidised basis is something that is not so pragmatic.

Mr Speaker, Sir, the Minister may not be aware that the practice of referral to see a specialist in the past was actually by way of a referral system through the general practitioner. My question is: is this change from the previous type of practice, where referral is through a general practitioner, a way for the restructured hospital doctors to get more income? That is one thing. The other thing is this. Is the Minister aware that it is not affordability that should allow people to go and see a specialist on their own? I think it is the proper approach to the whole healthcare delivery system that the Ministry of Health is trying to put out. This means that patients should actually get the correct information, the correct direction from his general practitioner before seeing the appropriate specialist. They might see the wrong specialist.

I agree entirely with Dr Tan Cheng Bock. That is the ideal practice. We are actively encouraging it. But we have not made it compulsory that if a patient does not come with a referral, we will turn him away. So we are still flexible. If people do not come with a referral, we will, of course, counsel them and say, "Next time, please see your family physician." But we do not turn them away if they do not come with a referral. I think it is a multi-faceted problem. At the same time, we must get our GPs and our family physicians to upgrade themselves, so that they offer such a good level of service that Singaporeans have a very high level of confidence that their overall medical needs can be looked after effectively by their family physicians. So it is not just making it compulsory for the patient to see the family physician. I think the family physicians themselves must also upgrade and do continuing medicare education, so that the level of expertise, the level of skills and the confidence can also be raised. Then I think we will reach a situation where people want to see their family physicians and not be forced to see their family physicians.

Sir, the Minister said earlier that he agreed with me. Does it mean that he is going to stop this type of referrals to the specialist outpatient clinic now?

Sir, I agree with the Member that it is an ideal case, but I am keeping to the present system of having the flexibility.

Sir, could the Minister assure this House that he will ascertain that there are no inappropriate practices existing in the hospital now, and whether he could avert other unhealthy policies in the future, basing it on the fact of cost efficient and effective medicine?

Mr Speaker, Sir, I have got no idea what is the Member talking about. Could she clarify?

I will clarify. Certain practices surely must be based on criteria that are sound. Therefore, all the policies that are being adopted by the Ministry of Health should be based on certain basic principles and one of which, of course, is cost efficient and effective medicine. Are we not using our national funds and public funds unnecessarily?

I agree entirely with Dr Neo that we want to have a cost effective health care system. But as I said, the fee structure of our SOCs today is not so significantly higher than the private sector family physician. Singaporeans now are better educated. They want choice and, therefore, we have not moved to a compulsory system. Today, they have a choice. We discourage them. We try to educate them. We try to work with the College of Family Physicians to upgrade themselves so that the public can have more confidence in the ability of their family physicians. It is not just one side of the coin. I think the family physicians must also show to the public that they can handle a wide range of problems when a patient sees them, if not, the patient would want to see a specialist straightaway.

Sir, is the Minister aware that referral to a specialist is different from what he is trying to tell us that if a general practitioner is very well equipped, then there is less chance of him referring patients to the specialist? Yes, I agree with that. But there are certain situations ---

Order. Dr Tan, can you ask your question?

The Minister's argument is that if the general practitioners are very well trained, there is no need for us to refer patients to specialists. That is the impression I get. Is that correct?

Mr Speaker, Sir, I did not say that. I said that the family physician should upgrade himself so that he understands the full range of problems that the patient is likely to raise with him and be in a position to provide the confidence to the patient that he will refer him to the correct specialist. It must be cost effective for the patient to do so. If the patient thinks he has got a specific problem and the cost is not so significant in going straight to see a specialist, he will want to do so. We could make it a compulsory system to say that you are not allowed to see a specialist until referred to by a GP. We can do that. But today we are not doing that. We encourage everybody to do that, but we are not making it a compulsory system. So I am keeping the system as it is without making it compulsory. If all the MPs feel that this is crucial and that it will reduce health care cost by forcing everybody to the GPs first, I must be satisfied that the GPs can undertake their role. I do not want to force patients to the GPs if they are not equipped to handle their requirements.

I agree with the Minister on the need to retain flexibility. I think we should leave it to the patient. But can the Minister confirm that the rates that the patients are paying to the specialists are, in fact, market rates so that there is no subsidy by the Government on all these consultations and there is no impact on the cost efficiency?

Sir, I thank the Member for trying to help me out. There is a tremendous subsidy in our SOCs. More than half of the patients going to our SOCs enjoy a subsidy of 65% and all the rents and GST of our SOCs are fully subvented by the Government. Even for those who do not enjoy the subsidy, the so-called private patients in our SOCs, the fees which they are charged in the SOCs are much lower than the private sector. Therefore, as I have explained in my answer, one can understand why many Singaporeans troop to the SOCs straightaway without seeing the family physician. I am not saying this is a good practice. I am saying we are trying to change it through better patient education, through upgrading of the physicians. But to have an edict to say that, tomorrow, nobody is allowed to go and see the SOCs unless they are referred to by a family physician is a step which I am not prepared to take for the time being.

I will allow one last question. Mr Low.

Judging from the Minister's answer, is the Minister contemplating increasing the fee of SOCs?

As I have explained in my answer, it is a multi-faceted problem and we have to look at all avenues to solve the problem. One of the avenues we have to consider is adjusting the fees so that it reflects the value of the specialist.

asked the Minister for Education, since there are many mature individuals pursuing external degrees, whether statistics have been compiled to show that these individuals are able to derive any increase in their compensation package or improve their economic wellbeing.

Mr Speaker, Sir, the answer is no. The Ministry of Education does not have data on the compensation packages of individuals pursuing external degrees.

In the papers today, we find many advertisements on external degrees which are offered by the various institutions of learning. The costs of pursuing these degrees are very high. Very often students who ---

Order. Can you move straight to your question, Mr Ong?

Could the Ministry of Education come out with a list of recognised long-distance institutions of learning so that our people will have some guide?

Sir, I have explained this before and I will do so again. There are many institutions which offer qualifications of various kinds, including degrees. They can be offered by long distance, as the Member has said, they can be by twinning programmes. They can be offered over the Internet. They can be offered by correspondence. The Ministry of Education is not in a position to accredit or to make a judgment on the quality of any of these qualifications because they can be offered by institutions in a number of countries. So it will have to be left to individuals to decide for themselves, when they take up a particular programme, on the quality of the offerings of that particular institution, and it will have to be left to the employers to decide, when they are employing particular individuals, what are the qualifications of the persons who are applying for the job. That is the only practical way of dealing with the situation when there are large numbers and varieties of qualifications that are on offer.

Order read for consideration in Committee of Supply [6th Allotted Day].

Head P (cont.) - Amendment moved [13th March, 2000], "That the total sum to be allocated for Head P of the Main Estimates be reduced by $100." - [Mr Bernard Chen] Question proposed.

(In Mandarin): Sir, in the last one to two years, I have frequently heard complaints about the services at the restructured hospitals. Basically, the complaints could be in two categories. The waiting time is too long and services rendered by the medical staff are not satisfactory. Patients have to wait too long to see the doctors at the Specialist Outpatient Clinics (SOCs), and at the A&E unit, patients inadvertently have to wait for a long time before being admitted to the wards. A survey published recently in the Straits Times confirmed that the waiting time at the 18 specialist clinics at the Singapore General Hospital and at the NUH is about two hours. With regard to the service level, the people are not happy with the services of the medical staff. Secondly, they are worried about the nurse-to-patient ratio. For instance, patients complain that the hospital staff lack the necessary skills in administering intravenous drips or inserting gastric tubes to suck out fluids from the patient's stomach. When they ring for a nurse to come and assist them to go to the toilets, the nurse does not turn up even after a long wait. Some cannot help but urinate on the bed. Patients who went back to the specialist clinics at the hospital told me that after waiting for 1 1/2 hours they were merely given a five-minute examination. They wonder if the doctors really understood their problems. Some patients who complained about their pains were told that there were too many problems and that these could not be diagnosed at one examination and were told to come again. Sir, of course these were isolated cases. I could not say for sure what the overall service performance of the whole staff was. I was worried after reading the newspaper report of 7th February in the Straits Times that the number of patients had increased by 20% whereas the number of staff had increased by only 11%. Some doctors said that they were too tired to maintain the requisite level of service. I quote from the Straits Times: A cardiologist said, "I spend about five minutes or less on a patient. It is not enough. I want to spend more time, but there are so many patients to see and so much to do." Is it true that as a result of the Government's plan to restructure, the hospitals have to look at the bottom line and thus have to cut cost, resulting in not enough doctors and nurses being recruited? Hence, the quality of service is affected. I would like the Minister for Health to give us an audit on the quality of service in the hospitals. How frequent is the audit conducted? Could the Minister tell us what kind of benchmark the Ministry of Health has with regard to the various types of services in the hospitals and the level of service Singaporeans can expect in the healthcare.

Sir, I would like the Minister to consider setting up a hospital to specifically treat patients who are not responding to established treatments and medicines. Such a hospital will be a place of last resort and could be known as the Hospital of Hope. There should be stringent entry requirements. A person wishing to be admitted to the Hospital of Hope must obtain the certification of at least two specialists to confirm that he is not responding to established treatments and medicines. The hospital will be a place where new but untried, and experimental treatments and medicines are applied with the patient's consent. There is no guarantee of a cure, only the hope for one. From a negative perspective, the patient is a test subject. His condition may worsen. However, on the positive side, the patient is participating in the search for a cure of his condition. If a cure is found, the benefit is not just for one person but it will be for everyone else in the world that suffers from this illness. Its existence will provide hope to a person who would otherwise have only one option, to await certain death. The cost for the patient must be minimal, perhaps even free. Such a hospital could attract some of the world's best researchers. The Hospital of Hope would be a congregating place for researchers. Knowledge will be shared and accumulated for the good of all.

Sir, more national health programmes must be introduced to highlight the prevalent illnesses in Singapore, especially those that will benefit large numbers of sufferers. One good example that has been neglected in this respect is the very common condition of asthma. 1.00 pm In Singapore, asthma is a highly prevalent problem, seen in 5% of the adult population. In a study that examined the healthcare, utilisation patterns for asthma in Singapore between 1986 and 1993, asthma was ranked 5th among principal conditions with the highest number of discharges. Among 0-14 year olds, asthma was ranked second, only after accidents and injuries, as the condition with the highest number of discharges. It was estimated that there were approximately 20,000 accident and emergency (A&E) room visits for asthma per annum. In the primary healthcare setting, asthma ranked 6th among leading conditions seen by the general practitioners and Government polyclinics. Among under-15 year olds, asthma ranked as the second leading condition, behind upper respiratory tract infections. Sir, this study showed that asthma is a significant cause of morbidity in Singapore. As in many countries, there has been a marked increase in the prevalence of childhood asthma over the past 20 years. It is estimated that 140,000 individuals have current asthma and more than 100 individuals die of this disease annually in Singapore. There is also a substantial degree of under-recognition of asthma among school children in Singapore. A recent local study estimated the economic cost of asthma, both direct and indirect, to the patient and community. The total cost of asthma in Singapore was estimated to be more than US$30 million per annum. Sir, the study concluded that the economic cost of asthma is considerable and justifies the need for a concerted effort to reduce asthma morbidity. This is especially so with such prevalence in children. Asthma is an eminently treatable condition with good evidence that newer interventions and adherence to treatment can be cost-effective in the long run. Studies in Singapore have reflected sub-optimal management of asthma in the community; this area will benefit from a national health programme. What is required is a Comprehensive Asthma Programme, aimed at reducing asthma mortality and morbidity at all levels of the healthcare system, with the long-term goal of improving the care of asthma cost-effectively. Sir, there is a need to make asthma a healthcare priority, in the same league as other common diseases such as cardiovascular disease, cancer, stroke, hypertension, diabetes, etc. The school environment is particularly important to children with asthma because acute exacerbations can lead to decreased ability to concentrate, decreased participation in activities, and high rates of absenteeism. Sir, identification of children with the disease, communication with parents and health-care providers, removal of triggers in the immediate school environment, and maximisation of access to medication when needed are all key factors in managing the disease. We can tap the expertise of the doctors from the Singapore Asthma Association to train teachers to handle asthma in schools. In order to significantly reduce asthma morbidity, an integrated approach is required, involving individuals from a broad range of backgrounds and interests. There is also a need to coordinate the efforts of such individuals and institutions involved in asthma care. Sir, I hope the Minister for Health could consider my proposal. Sir, may I now go on to my next amendment on medical establishments?

Yes.

Thank you. Sir, I would like to urge the Minister for Health to look into greater integration of the public and private medical sectors concerning medical establishments. I would like to declare that I am a general practitioner in private practice. When the Ministry of Health is able and willing to treat the private hospitals like "private wings" of restructured hospitals, and use the multitude of general practice clinics as extensions of polyclinics, integration in a lateral manner can become a reality. This would involve a fairly major mindset change by all the relevant people in our healthcare institutions. Sir, lateral integration of all the medical establishments in Singapore will be a good thing and I would like to point out some of the advantages that we may reap. An area of benefit from integration between public and private hospitals and clinics is in the "shared use" and "free flow" of available personnel, especially in those areas where there is a shortage. This will save cost as the integration and cooperation minimises expensive training of more and more people. This will maximise our efficiency and enable optimum use of our resources. The savings can then be passed on to the patients. Sir, another advantage of integration is in the shared use of expensive equipment in both the private and public sectors. There is a need for better planning and collaboration in this area between these two sectors. There are many instances where it makes no economic sense to support two expensive machines, such as 4 million-dollar a piece PAT-Scan or Positron Axial Tomogram Scan in both the private and public sectors. We do not have enough users to justify the availability of more than one scanner. Capitalising on existing equipment that is available and much too under-utilised in the private sector should be made available to the public sector and vice-versa. Patients from the public hospitals may not be able to afford the cost for using such equipment in a private set-up. Sir, this can be overcome if the private set-up weighs its options of leaving the equipment to stand idle or of letting the equipment be used by the public hospitals at special (out-sourced) rates. Bulk order of standard requirements of hospitals and clinics, like catheters, needles, sutures, medicines, and so on, jointly by all medical estalishments, makes good economic sense. When the lowered costs are made available to all medical establishments, including private clinics, all patients will benefit. They get to pay less for their treatment and general expenses. The savings in cost can amount to a few hundred dollars, a 50% reduction at times, for some patients each month. Another example of useful area of cooperation through integration is a centralised sterilisation for all medical establishments. This is one area worth considering. Sir, I hope the Minister for Health would consider my aforesaid suggestions.

Sir, the White Paper on healthcare has spelt out the requirements for doctors and nurses for both the public and private sectors. Over the years, there have been so many changes in Singapore and in the region which have also impacted on projections for medical personnel required to sustain and improve the quality of medical care. For example, we thought that the regional crisis will lead to a decline of patients from the region which, in fact, it did for a while. The rapid recovery of Singapore's economy and to a certain extent, those in the region, has renewed the demand for more medical services, leading to more doctors and nurses needed to service them. The problem, of course, is that we cannot simply turn the tap on and expect more doctors and nurses to come out. Training of doctors and nurses take time, in particular when it comes to specialists. There is also a close nexus between the public and private sectors in both good and bad times. The national centres that were established would also tend to take the bulk of the specialists, leaving the private sector with less. How do we strike a proper balance between the two, as each can contribute its part to make Singapore an eminent medical hub? Can the Minister elaborate on what are the steps being taken to adapt to these changes?

Sir, I share the views of my GPC Chairman, Mr Bernard Chen. However, I wish to focus on our nurses in the health service. Nurses play a very important role in the care of patients in our hospitals. They are constantly in direct contact with patients. If we visit our hospitals nowadays, we find that there is a big percentage of nurses who are foreigners, especially from the Philippines, China and even some from the advanced countries. I believe these foreign nurses are taken into our service due to the shortage of our locals wanting to become nurses. I hope the Minister can enlighten us on the reasons for the lack of Singaporeans who are keen to be nurses. What steps is the Ministry taking to attract more young Singaporeans to take up nursing as a career? Sir, in 1998, there were a total of 15,568 nurses and midwives registered with the Singapore Nursing Board. However, almost 20% or 3,060 of them are not in active practice. I think it is such a waste because almost one-fifth of them are not practising their skills that they have learned during their training to be nurses and midwives. I hope the Ministry can do something to attract these nurses not in active practice to come back and serve our health service. Finally, Sir, according to the national health manpower to population, the ratio for nurses is about one to 250. I wish to ask the Minister whether there are plans to improve this ratio, bearing in the mind the higher standard of living in Singapore.

Sir, I would like to urge the Minister for Health to look towards the greater integration of our public and private medical sectors concerning doctors. I would like to declare that I am a doctor in private practice. The doctors in the private sector are not tapped to the fullest potential. The doctors in the public sector are not exactly content with their lot. Sir, we need to soften the divide between the two sectors for the better of all concerned. Let us first consider the case for doctors in private practice. It will be advantageous if we can have them contribute to the public sector. The most overt effects of such a situation would be: (1) The reduction of the very heavy workload of doctors in the public sector. We can revamp the present "visiting consultants" scheme and implement a structured permanent scheme for private doctors to contribute to patients in public sector positively. At the moment, the existing consultant scheme is only a token. A comprehensive type of contribution is not possible perhaps because the agenda does not call for it. It is not implemented wholeheartedly and this scheme is not very successful because there may be distrust and fear amongst doctors regarding motives and vested interests. Private doctors have to depend on the friendship and courtesy of their colleagues in public hospitals to be offered "visiting consultant" posts and, even then, some may still feel redundant and unwelcome. Sir, a new scheme should be in place to allow private clinicians to come back either part-time or full-time in the public hospitals. (2) Many private doctors are more than willing to serve subsidised patients and to teach in the public hospitals given the opportunity. There are private doctors who are willing to come to the public sector on the same remuneration as the public doctors, if given the chance. Turning to doctors in public hospitals, integration would mean the chance to practise in the private sector in whatever form that is evolved in time. Of course, the Ministry can always specify that only those who have attained a certain degree of seniority and expertise are eligible for such options. The effect of this would be: (1) The eventual establishment of a pool of doctors that is in a continuum of movement in and out of the two sectors. In fact it would be all the better if there is mandatory movement of senior doctors to the private sector. This would make the prospects of promotion and progress of junior doctors more attractive. (2) Now, the integrated system would have the doctors eventually coming back into the public sector. The constant hassle of the exodus of doctors from the public to the private sectors would be curtailed. Sir, the details for a fully workable model for all this to work can be worked out and in due course a truly integrated system of healthcare can be evolved. It is my hope that the Ministry of Health will look into this issue on doctors and implement the necessary steps.

(In Mandarin): Sir, from young, I have always respected two types of people. First, the teachers and, secondly, the doctors. At that time, the SGH and TTSH might not be as good as what they are today, but the doctors have left a very unforgettable impression on me. When I was in Primary Five I went to the hospital for an operation to remove my appendix, and I stayed there for three days. In Secondary Two, I had high fever and was warded in TTSH for five days. The doctors there were very professional and very caring to the patients. They always tried their best to alleviate the fears and suffering of their patients. These are things that we do not see commonly in Singapore nowadays. The young doctors in the outpatient department care only for high efficiency. They only think about how many patients they can see every day, but do not care about the feelings of the patients and their family members. Generally speaking, the doctors have blank faces. They do not have a caring heart. They do not want to communicate with the patients. And some friends have told me that doctors in the hospitals say only two words, "How" and "Next". They are mechanical. They are all the same. Let me illustrate the "how" and the "next" in this short episode: 1.15 pm Mother took leave to take her sick child to see the doctor in the hospital. They waited for a few hours and finally, their turn came to see the doctor. The doctor took a look at the worrying mother and the sleepy child, and asked expressionlessly, "How?". The mother replied nervously, "My son has a high fever and is coughing." The doctor took the temperature, checked the throat of the child and wrote the prescription in quick succession. He then looked up and said to the nurse, "Next!" Everything was done very mechanically and without showing any feeling or emotion. This description may be somewhat exaggerated, but many patients and myself have the same feeling that our doctors have been more mechanical than caring. They are too focused on efficiency. This is like operating a production line in the factory. I do not think this is a good thing for doctors to do. Many people have also told me that there seems to be a lack of urgency in the A&E Department in the hospital. I feel we should review the mode of operation at the A&E Department. We must understand that to the patients an illness is an illness. To them, if they do not feel well, the matter is serious and it requires immediate attention. The patients and their family members are naturally very anxious and they regard their cases to be the most serious among all the patients, especially when the patients are young children or old people. It is best to have a screening system at the A&E Department whereby the nurses will examine the patients immediately upon their arrival, and make professional judgement to decide on how the case should be classified and dealt with accordingly. The cases could be classified as A: critically ill, and B: emergency. The A&E Department should have two clinics: Clinic A to deal with the critically or life-threatening cases, while Clinic B will deal with other not life-threatening but emergency cases. As for other ailments, such as cough and cold, flu, fever, etc, they should be streamed to the non-emergency departments. In this way, you can lighten the workload of doctors at the A&E Department. At the same time, there should be more doctors on duty at the A&E department. Otherwise, doctors on duty will be over-stressed and will lose their zeal to attend to the patients. Sooner or later, they will become doctors who could say only two words - "How" and "Next". I hope the Ministry of Health can look into this matter.

Sir, the 1998 National Health Survey found that Singaporeans above the age of 50, particularly those above 60 years old have the most health risks. Many in this age group suffer from high cholesterol, high blood pressure and high blood sugar content. This means that there are more than 655,000 stroke candidates here. Sir, in 1999, 10,000 Singaporeans suffered a stroke. Perhaps, it must be pointed out that high incidence of illness among Singaporeans, particularly the elderly, is due to lifestyle much more than age. Sir, I am a firm believer of prevention is better than cure. Whilst we invest millions of dollars towards medical treatment, I hope the Ministry of Health could also spend much thought and more budget on preventive measures. I would also like to urge the Ministry of Health to consider tax incentives for employers who invest in workplace health programmes to help their employees stay healthy, like those schemes we have in place to provide for those industries who promote industrial safety. Sir, we have a Government who cares and recognises that healthcare must be of high quality and affordable. The Government has instituted many schemes and programmes towards this end. The 3Ms - Medisave, MediShield and Medifund - are prime examples. However, our challenge remains. How do we ensure that the premium and co-payment for Medisave will remain affordable? There are literatures issued by private insurance companies which pointed to the fact that hospitalisation bills will increase. Hence, will the 3Ms be sufficient? Can the MediShield remain affordable and effective, such that the premium, the co-payment and the number of illnesses excluded from prior coverage will not rise? And moreover, how do we assure Singaporeans that, despite the escalating hospitalisation bills, they will continue to have sufficient savings or monies in their Medisave accounts?

Sir, my concern is something which I have constantly raised and that is the cost of healthcare, and I say this, particularly, for our people who are not well off. I am concentrating on those whose income is below $2,000 a month. I once previously asked for a breakdown of the cost to the Government of maintaining a patient in a Class C ward. I got a general answer, there was no breakdown given, but a general answer about the land cost that goes into the cost and what else goes into it. Can we not have something which the ordinary man can understand, a White Paper on how much it costs the Government to keep a patient in a Class C ward for a day, saying exactly what the cost is, and how it is provided for so that the citizens may then understand the problems of the Government and be able to appreciate what the Government is trying to do? So will it be possible now for the Minister to seriously consider putting out a White Paper on the cost to the Government of providing healthcare in Class C and Class B2 wards because that is where they say the subsidy is the greatest? Then we will understand what the subsidy is. Finally, before I sit down, may I again renew my plea to this Government? Will it consider seriously setting up a committee to study the implementation of a health insurance for the whole of Singapore? Why can we not even study it instead of dismissing it? The object must be to provide, as has been stressed this morning, healthcare at effective cost. Is it not possible that a national healthcare insurance might provide healthcare at effective cost? Will the Government please consider setting up a committee? It would appear, from what I heard this morning, that the Government attacks every problem as it arises. Why do we not have a comprehensive study on what the problems are and how much it will cost the Government to provide the answers to these problems?

Sir, I move this amendment not to highlight the problem of casemix implementation which the Ministry of Health must surely know, but to share with you, Sir, and Members of this House the implications on the community when hospitals are funded using the casemix model. The Ministry of Health has announced that, by the year 2000, that is this year, all public sector hospitals will be funded by case mix for acute inpatient and day surgery. Casemix funding is supposed to -

Simple surgeries are performed outside the hospital.

Nursing care has been moved to intermediate-care facilities or is given during home visits.

Recuperation is occurring outside the hospital, where patients and families have more responsibility in the recovery process."

Sir, the above observations are significant. Not only has hospital care changed, but outside hospital care has also changed. There is need to upgrade and improve community healthcare institutions to meet the new hospital development. All these have political implications as the community is thrust upon to play a greater role of care giving. Why is this so? I think this is because the clinical management of patients has changed dramatically. Even for the elderly in the United States, conditions that had been diagnosed and treated in hospitals are now being handled outside hospitalisation, and patients treated in hospital leave sooner. Thus, patients admitted to the hospital today in the US are more severely ill and more complicated to treat. Thus, one of the startling results of casemix based funding of hospital payment was the expansion of post-acute long-term care and home care business. Are we prepared for this development? If the Ministry of Health wants all public sector hospitals to be funded through casemix by the year 2000, then the numbers of post acute long-term care institutions must also expand. And I do not see the Ministry emphasising on this aspect, except a $37.2 million subvention grant to voluntary welfare organisations. This is out of a total of $629.38 million subvention grants to restructured hospitals. Invariably, the voluntary welfare organisations and community hospitals are going to bear the brunt of all those post-acute long-term care. My point is, we must quickly learn from the experiences of the other countries who have used casemix findings and not reinvent the wheel. 1.30 pm The Ministry of Health must move in this area fast. Thus, the Ministry must, in the next Budget, make provisions for the establishment of these institutions and encourage more voluntary welfare organisations to come along by giving better subvention grants to them. We will need to move to high-end nursing care institutions and rehabilitation centres, apart from the community hospitals, as the United States' finding is quite clear that recuperation is occurring outside the hospital setting, and patients and families have more responsibility in the recovery process. There must not only be an increase in the number of such institutions, but also in the quality of such institutions. Let me explain why quality and special care will be expected. One of the downsides of casemix funding is the hospital may discharge patients earlier than needed. This is what we call "quicker and sicker", that is, patients are not too well, but they are discharged because of the funding method. Let me explain in very simple terms. You see, Sir, if a case of appendix requires a four-day hospital stay, you get full funding if you discharge the patient in four days. If you exceed the four days, you will become what the system calls an outlier, and an outlier is not funded fully. Therefore, it is the duty of the hospital unit to discharge the patient within four days. Thus, when patients are discharged quicker and sicker, the need for post-acute institutions to manage these community hospitals and special nursing and rehabilitation institutions must surely be the order of the day. Let me give you some statistics from the United States to prove my point. Between 1990 and 1997, the number of Medicare (this is the United States Government funded health institution) beneficiaries using home care services jumped from 1.9 million to 3.4 million. You can see this sudden jump of almost two times. Home care visits per home care patient per year grew from 34 to 69, again, almost double. The number of home healthcare businesses grew 5,718 to 9,147 and, again, almost double. Nursing home and home care expenditures under Medicare have been expanding more rapidly than any other category of personal health expenditure, including hospital and physician services. Home healthcare, in particular, has been growing at incredible rates of 20% to 25% per year. You will observe that there is emphasis on home care services. We do not have such services but this should be looked into in the future. However, looking at the present position of our community care institutions, I wonder if we can manage if most of our acute hospitals go casemix. Bearing in mind that our nursing homes are always at full capacity, and there is usually a long waiting list in the Government-supported institutions and VWO homes ---

Order. Dr Tan, you have exceeded the time allowed. Dr Jennifer Lee.

Sir, I would like to pick up a point or two relating also to home healthcare services and on where Dr Tan has left off. The Minister has spoken on various occasions in recent months, regarding putting in place measures that will facilitate the provision of nursing home care for the elderly by the private sector to supplement the services in this area being rendered by the VWOs. I would like to propose to the Minister that the private sector should also be encouraged to participate in the provision of home healthcare services. Although the provision of this care is not so capital intensive as the establishment of nursing homes, there will be a growing need and an even larger clientele for home healthcare than for institutional care for the elderly. I do not think that in the longer term, we can expect the VWOs to be able to meet the home healthcare needs of our growing population. And enabling and supporting families to care for the ill and frail elderly members at home as far as possible, is very much in line with the philosophy and the approach we wish to take. For this to happen, it has to be of interest to the private sector to develop home healthcare services. There needs to be some change in the funding principles which currently exist in the subsidy for institutional care, but not for ambulatory or home healthcare for VWOs, in allowing the use of Medisave mainly for institutional care, and in the limited role of insurance to help the defraying of healthcare expenses for the private sector. I note that in the report of the Inter-Ministerial Committee for Healthcare for the Elderly, long-term care insurance was proposed as a component of financing healthcare for the elderly. In the subsequent Inter-Ministerial Committee on the Ageing Population, this proposal underwent a modification to a proposal for severe disability insurance. If I read this nuance correctly, the implication is a drawing back from the first willingness to consider supplementing family financing of an ambulatory healthcare service for chronic but not necessarily disabling illness, back to our current position that supplements direct out of pocket payment only largely for institutional care. I think this is counter to our efforts, both to promote preventive healthcare to the population, as well as to keep our senior citizens at home with their families and in the community as far as possible. I hope the Minister will give these points consideration and that he will also look at the development of both institutional and home healthcare services for the elderly concurrently and not defer attention for the latter as I believe both sectors are equally important.

Sir, Singapore has a quality primary healthcare system that is also very affordable. However, I feel that we can still tap our resources and better the potential of our existing system for the benefit of this nation in the future. I would like to suggest that we look at the following areas to bring our primary healthcare to even greater heights. Sir, at this juncture, I would like to declare that I am a general practitioner in private practice. The private medical practitioners should remain the main providers for primary care. At the moment, they provide primary healthcare to about 80% of the patients. But they should be more involved in step-down care from the tertiary and secondary institutions. Sir, we need to look for more practical and prudent ways to integrate and tap all sectors of our available healthcare facilities. The Ministry of Health should devise a scheme to encourage this, especially in terms of shared care and step-down care. This will save a lot of wastage on the more expensive facilities and medical personnel in our public hospitals. Moreover, when these patients are transferred to primary care, they also benefit from the lower costs, the convenience of seeing doctors near their homes and the luxury of staying in their homes with their loved ones. This will spell efficiency at its best. We should induce the primary level care providers to cater for the increasing numbers of the elderly and the chronic sick. Perhaps, they can work more closely with the hospitals in shared care schemes. The Government can remunerate them in a reasonable and controlled manner so as to ensure affordability. The advantages of such schemes would be the significant savings on cost, the decreased demands on the hospitals in terms of beds and medical staff, and more importantly, the positive effects of having patients continuing to stay in their own homes with their loved ones. Preventive medicine, as the key towards maintaining good health in any population, cannot be over-emphasised. This therefore is one area we can ill-afford to cut back on. Instead, we must seek out all avenues to help the healthy maintain their well-being for as long as possible. In the long run, it will be the ministry of continuous and concerted efforts in promoting preventive medicine that would contain the escalating costs of healthcare. The involvement of the primary care doctors in this, with the encouragement from the Ministry of Health, will be the way to go in promoting this important area of healthcare. The Ministry should devise a plan to maximise the relationship of doctors and patients in this aspect. The availability or the convenience of the geographically placed private clinics will be an advantageous asset for success. Sir, the primary healthcare doctors usually have better rapport and more time with the patients. They are therefore ideal for promoting preventive healthcare, especially so when patients give scant thought for preventive care or routine medical check-ups when they are not sick. We have to change the mindset of people and reaffirm the idea that prevention is better than care. The Ministry of Health would be doing well if it could get one and all to go for preventive healthcare. Sir, I hope that the Minister for Health can enlighten us on my proposals.

Sir, I would like to address this preventive healthcare issue more at the elderly or those of us who are going to be getting old ourselves. I once asked my old friend, who was in his 60s, how he was doing. He said, "Every part of my body is falling apart." As we get older, this will happen to us too and we will get sick more often. One way to prevent this from happening is to keep monitoring ourselves to enable us to take preventive measures in good time. If we find that we have high blood pressure, we should start taking medication before we get strokes. Health screening, although not 100% effective, at least helps us to spot these symptoms early. Most of us are, however, reluctant to go for health screening. Some of us are dead scared about it because every time we go, we find something wrong. And the older we get, the more wrong things we get. So, it may be better not to go at all. This is a wrong approach, especially for the elderly. It is vital that we should detect the signs earlier for us to take steps to reduce the risk of serious illnesses and costly treatment. We need to convince them that health screening is not only good for them, but also necessary. We know that we are providing, at the moment, some health screening at the community centres and other institutions. We should widen the net and catch as many of them as possible. Above all, we need to provide this screening at reasonable cost that they can afford. It is not necessary to test everything, but the basic fundamental tests must be carried out and if we can confine these tests to the essential ones, we will be able to keep cost to a minimum. I do not know whether the Ministry has a programme in this respect.

Sir, "prevention is better than cure" is a fact that each one of us here would accept wholeheartedly. In fact, my parliamentary colleague, Mr Yeo Guat Kwang, had just reaffirmed this. I beseech the Ministry of Health to establish firm directives on promoting preventive healthcare. The successful implementation of preventive healthcare will translate into quality life for our people and the enormous savings for the people and the nation on healthcare cost. Sir, I have spoken on this important issue several times in this House and also have moved an adjournment motion on it not too long ago. I would like to re-emphasise that the core directives to ensure success of preventive healthcare are as follows: (1) The Ministry of Health must campaign for a mindset of acceptance in the age-old dictum - "prevention is better than cure". Many Singaporeans still believe in seeking for remedy only when they are sick, and in many unfortunate conditions, it is too late. An example of this is when they are seeking the remedy for renal failure due to the end-disease of untreated diabetes or hypertension. If we can succeed in persuading people to look after themselves better, half of our battle is won. The Ministry of Health should therefore step up health education about healthy living and on responsible awareness and care for one's health. Excessive campaigns, with effective use of television media, may make the people more responsive, especially when they realise what the end-results of many uncontrolled common diseases are. Sir, do not let the lack of information to the people cause efforts on preventive healthcare to fail. 1.45 pm (2) The other important tool to ensure the success of preventive care is to get all doctors throughout the island, not just those in public institutions but also all those in private practice, involved in the whole concept. The Ministry must, therefore, find ways to engage all our doctors in all the different aspects of preventive healthcare. Furthermore, we should encourage all our doctors to be mindful of the need to promote preventive healthcare and to be committed enough to consistently influence their patients on the value of preventive healthcare. (3) Sir, a more integrated approach, with the involvement of the community, grassroots organisations and voluntary organisations, will help in the implementation of preventive healthcare. The involvement of immediate family members with regard to preventive healthcare for their aged parents is another important area that should be pursued. (4) A "Department of Preventive Healthcare" of its own should be set up in the Ministry of Health to ensure continuity and lasting follow-through of all efforts on preventive healthcare. It will be the department's job to continuously identify prevalent diseases that can be given greater attention, and to continuously monitor and study the trends for prevention of common diseases as well as the many different aspects of preventive healthcare. Some basic tenets of preventive healthcare make it necessary to adapt constantly. For instance, whilst it would be impossible to try and prevent all cancers on an equal basis, we should pay more attention to the more prevalent and devastating cancers in Singapore. We need to make sure that essential preventive healthcare programmes are geared to reach the at-risk folks at the local community level. We must always remember that the morbidity and mortality from any disease can be dramatically reduced when the diseases are treated in their early stages. (5) The most important item to success is the allocation of adequate funds for preventive healthcare. The dollars allocated for preventive healthcare programmes today will enable our people to lead healthier and happier lives, and also save us the heavy expense in building more and more nursing homes and hospitals. Sir, I am sure the Minister for Health will have the rightful considerations for this concept and apportion due importance for it, so that we can have a lasting legacy for a better life in Singapore.

Mdm Chiang is not here. Dr Neo, would you like to continue with your next cut?

Sir, Singaporeans are living longer now with an average life span of about 78 years. This is expected to improve further with newer medical advances. As our population will age at an exponential rate, there is an urgent need for the Government to cater for the requirements of long-term healthcare of many more people who have chronic diseases due to chronic illnesses such as diabetes, hypertension, cardiovascular diseases and so on. It is of paramount importance that we address these issues quickly so that we have a well-planned medical system in place to cushion the burdens of long-term healthcare. Sir, there are three areas that we need to consider here: first, is the financing of long-term healthcare; second, is the medical care to best cater for long-term healthcare; and, third, is the provision of tertiary care of long-term healthcare in hospitals. On the financing of long-term healthcare, I have raised in this House more than once the issue concerning the inadequacy of the present "medi-plans" for elderly Singaporeans for this purpose. I have suggested that perhaps another insurance scheme, say, "Medicare" - a patient-Government co-payment scheme - may fill this inadequacy. Sir, I am delighted, therefore, that the Inter-Ministerial Committee on Healthcare for the Elderly has recommended an insurance scheme to solve this problem. The success of long-term healthcare will be based on the basic tenet of promoting preventive care to prevent complications of chronic diseases. In other words, help patients to care for their chronic diseases as best as can be, so that with lesser complications, they can lead a better life with less pain to bear physically and financially. Long-term financing must be made available to address this area, and to facilitate care of patients outside the hospital setting as well. We must seriously consider implementing one of the most effective ways to cater for the chronic sick in the future. This is to get the primary healthcare doctors to care for the chronic sick, as much as possible, without hospitalisation. There must be greater integration between the public hospitals and primary healthcare doctors in the private sector. Sir, I would like to declare that I am a private general practitioner. Encourage shared care and step-down care to the primary medical practitioners, and we will certainly reduce the use of acute hospitals and community hospitals. Most patients will also benefit when they can stay at home and close to their own families. Sir, I would like to suggest that chronic healthcare requires that a standard protocol be put in place for chronic illnesses in terms of long-term healthcare financing. This will ensure better treatment for all the chronic cases. This will also ensure conformity, in terms of care, to all conditions. Patients can also have the assurance that they are given the best care as recommended by this protocol and follow-up wherever they seek treatment. For example, in the care of diabetes, the protocol on the frequency of blood check-ups, eye testing, ECG testing and so on must be determined. I would also like to suggest that the Ministry of Health make it easier for face-to-face discussion of patient care between doctors in the public and private sectors. This will be especially useful in the shared care and step-down care of chronic cases. Sir, I hope the Minister for Health could enlighten me in the issues that I have raised.

(In Mandarin): Sir, with the aging of our population, a lot of resources utilised for creating wealth may have to be used to nurse the aged sick. So more Government policies will have to be formulated towards the elderly and health sector. There will also be enormous burden and responsibility placed on the fewer younger Singaporeans in looking after their aged sick, and the price that they pay will be greater day by day. Therefore, whilst we should continue to review our health programmes to provide a high standard of healthcare, we must also intensify and strengthen the cooperation between the various healthcare sectors to ensure that cost of healthcare services for our older people remain affordable. The Ministry of Health recently announced that it plans to increase the private sector's share for nursing homes to 40%. Is 40% the right balance? How could we ensure that we will have adequate nursing care for the aged be provided by the private sector, because the commercial nursing homes are more concerned about business bottom line? Therefore, under such circumstances, is it proper to ask the private sector to shoulder this responsibility of looking after our aged sick, and to provide them with a high quality of service?

(In Mandarin): Sir, because of the higher educational level and the rapid economic development, Singaporeans are spending significantly more time in reading and working. There are more and more people suffering from myopia, glaucoma, diabetic retinopathy and cataract. Particularly, in recent years, with the emergence of the computer and Internet and the ever increasing number of international TV channels, international news and interesting events can be easily accessed from PCs and television. In other words, Singaporeans are spending more time on computers and on watching television. As a result, many of our citizens and our working class people are suffering from various types of eye diseases. According to a local opthamologist, many primary and secondary students are suffering from myopia, and some of them are as young as six years old. When they grow up to 12 years old, their shortsightedness can be as high as 1,000 degrees. About 12% of our primary students are shortsighted and up to secondary school, about 56% are suffering from myopia. In the SAF, about 48.5% of the Chinese NS boys are having myopia and among the Malays, 24% of them are myopic. If we do not look into this problem seriously, then our primary and secondary students will have more and more complicated eye diseases when they grow up. The specialist told me that this is not just simple myopia. There are also many complicated eye diseases. This is certainly a cause for concern. With the development of the IOL implantation technique, many developing countries are introducing advanced techniques of phacoemulcification to train their own eye doctors to treat their eye patients. Our National Eye Centre, established by the Ministry of Health, has also played a very important role in this aspect. With Singapore moving very rapidly into a modern IT society, there is bound to be an increase in the number of patients with various eye diseases. This is a matter not to be overlooked. I do not wish to see that in the not too far distant future, Singapore leads the world in IT development, and the proportion of people in our country suffering from myopia and other eye diseases also tops the world. This will be a pity. In this year's budget, I see that only $6 million is allocated to the National Eye Centre. If we want to step up our R&D, I think this is not enough. I hope that the Ministry of Health would grant more money for the study of eye diseases to improve the eyesight of our people.

Sir, you have not heard from me for some time. Thank you for allowing me to join in the debate. An hon. Member: Keep it short!

Sir, the judgment of good hospitals is by how they treat their customers, particularly the patients. It is no point having good hardware, good buildings, good facilities, but the people who manage them are not responsive in dealing with the needs of the patients. So it is very important for hospitals to be proactive and to see how they can provide the best for the patients, and I am sure you would agree with that, Sir. From time to time, we have patients who do not have sufficient money or identification when they appear at the Accident & Emergency Department for treatment. I know of cases, from time to time, who faced difficulties in seeking treatment. Some of them will have to go back to get their ICs before they are seen. Others may have insufficient money and they are probably asked to raise money for treatment. I think the recent case in point at Mount Elizabeth Hospital would suggest that there are some lapses in the way that patients are being treated. It is a community concern about how we handle and manage emergency cases. It would be very tragic if patients who really need treatment and who do not have identification and who do not have enough money in their pocket do not get treatment in time. And we can understand the gravity of the problem. 2.00 pm Sir, in this case, I want to find out from the Ministry whether there are any standard operating procedures to deal with emergency cases. How do they deal with private hospitals? Do they come under a purview of audit and supervision in relation to dealing with emergency cases?

Mdm Claire Chiang is not here. Mr Goh.

Sir, there are currently about 2,100 kidney patients on dialysis. I understand that the number of kidney patients increased by about 500 each year. The problem will be compounded with an ageing population. It might not be a shortage of facilities for this group of patients at the moment, but are there plans to cope with the increase? How many dialysis centres do we need in the next five years? With more and more kidney failure patients, the queue for kidney transplants would get longer if supply of kidneys remains static. More kidneys need to be harvested for transplant purposes. The Human Organs Transplant Act may have to be amended as currently only accident victims' kidneys can be harvested for a transplant. Public education in preventing kidney failure needs to be stepped up. I have seen people suffering from diabetes and on medication still merrily drinking away coca cola every day. Sir, dialysis is costly. Inevitably, there will be some patients who are too poor to bear the cost of undergoing dialysis treatment. But they are not able to get Medifund assistance. Can the Minister consider the possibility of extending such assistance to needy kidney failure patients?

Sir, Singapore's only natural asset is its people. The main way we enhance the value of this asset is to focus on education and training. Even during the economic downturn, we continued to invest materially in education and training to ensure that our human resource is well equipped with knowledge and skills. One additional way in which the nation can enhance the value of its human resource is to ensure that it has access to various knowledge bases. Today, I am focusing on the knowledge base of medicines and medical treatments. Such a knowledge base will be a depository of knowledge on medicines and medical treatment, established and experimental, and case studies. There should also be chat channels so that a doctor treating a disease could share the experience with others and also benefit from the experience of others. I believe that setting up such a knowledge base can establish Singapore as a Centre for Medical Knowledge. It is not a novel idea but it certainly requires the commitment of a large organisation to achieve a meaningful and workable model. It is for this reason that I am requesting the Ministry of Health to consider this proposal. I am urging the Ministry of Health to take the initiative of setting up such a knowledge base that all medical practitioners and researchers can access and contribute to. It should not be restricted to just access in Singapore, but it should be opened to global access. In the same way, I hope that there will be global participation and therefore knowledge being deposited from all over the world. If the knowledge base is designed to provide active exchange of ideas, I foresee that there will come a day when no one needs to miss out on a treatment that is known to be effective somewhat in the world. Such a database can usefully collate data and establish patterns to provide early warning alerts of potential epidemics and perhaps the necessary course of action can then be taken to prevent it from happening. Perhaps this is something that the World Health Organisation could participate in and the Singapore database could be its central source of knowledge. The spin-offs are many. It will certainly help to establish Singapore as the medical centre of the region. It will be of great assistance and therefore be an attraction for medical researches to be conducted in Singapore. Singapore is well suited to establish such a global database because of its excellent telecommunication facilities and advancement in the field of IT. This is not something that should be left to the commercial sector. Such knowledge should be openly shared and not be hogged for commercial purposes.

Mrs Lim is not here. Mr Lim Hng Kiang.

Sir, first, I would like to thank all the Members who have spoken for their various comments and suggestions. I will take them up individually and follow up, even if I may not have the time to give them a full reply today. First, I would like to address the key themes that are raised by the Members and then I will take the specific issues point by point. The first theme is really how to ensure that we have the best delivery of health care services in Singapore. In this, we are talking about how to make the healthcare providers in the public sector, the polyclinics, the hospitals, the national centres work together and how to get the public sector and private sector to work together. My Ministry announced its plans to reorganise the public healthcare providers into two vertically integrated delivery networks last November. Each network will comprise healthcare providers ranging from the polyclinics, the regional general hospitals, the tertiary hospitals to the national specialty centres. The networks will provide more integrated and better quality healthcare services through closer cooperation and resource sharing. This will then minimise the duplication of services and ensure the optimal development of clinical capabilities. This vertical integration will involve interfacing the polyclinics with the regional general hospitals, the regional general hospitals with the tertiary hospitals, and the acute hospitals with the national specialty hospitals. Mr Bernard Chen asked how would the national centres fit into this framework and their relationship with the acute hospitals. The role of the national centres as spelt out in the White Paper remains unchanged after the two networks are formed. The national centres will continue to deal with the more complex cases requiring more expensive equipment or highly specialised expertise. They will centralise all the more complex cases so that the workload can sustain the very special skills and expertise needed. Based on this rationale, my Ministry has worked with the national specialty committees to define the level of medical care that will be provided at the national centres and the acute hospitals. The acute hospitals will continue to provide secondary care in these specialties, and refer the more complex cases to the national centres. The national centres will also be the centre for research and teaching for their respective disciplines. The national centres are to treat the more complex and rare medical conditions, and therefore understandably the fees would be higher because more resources are incurred for these very specialised treatments. We have centralised these specialised manpower and equipment in the national centres, thus avoiding the higher cost which would have resulted if we duplicate all these in all the hospitals. For B2 and C class patients, the costs of land and buildings are fully subsidised by the Government. In addition, they are provided with 65% and 80% subsidy of the running costs. The national centres are grouped with the network that they are co-located with so that they can leverage on the network's administrative support. However, the services and expertise of the national centres will continue to be made available to patients across the two networks. Patients from one network can be referred to the national centre in the other network and will be given the appropriate level of service and standard of care. So as far as the patient is concerned, there is no change. The changes will be made to the integration of the backroom support and services. Next, let me turn to the integration between the private and public sectors. I agree entirely with Dr Lily Neo that in addition to the vertical integration between the hospitals and the primary care, there should also be greater lateral integration between the private sector and the public sector. We already have several avenues for the private sector doctors to contribute to health care in the public sector. Let me give a few examples. Firstly, we have the Visiting Consultant Scheme that Dr Lily Neo also talked about. I think there is room for improvement in that scheme. Secondly, we involve the private sector doctors to contribute their expertise in complex procedures, like heart and liver transplant programmes. The transplant teams involve doctors from both public and private sectors. Thirdly , private sector doctors are appointed to various committees to assist the Ministry to formulate policies in clinical practice, medical research, medical ethics and training matters. Dr Lily Neo has suggested that public sector doctors be allowed to practise in the private sector. This is already done. The issue is really how to extend the scope. Currently, consultants in the public sector hospitals attend to both subsidised and private patients. My Ministry is studying whether we could introduce greater flexibility to the private practice scheme by allowing public sector doctors to practise part of the time in the private sector. There could also be other ways to extend the scope. Dr Lily Neo also made several suggestions on the shared use of expensive equipment, bulk order of standard medical items, and the centralised sterilisation of medical equipment. All these suggestions are worth exploring. If it is mutually beneficial, I see no reason why the two networks should not take this up. I envisage that, with the reorganisation of the public healthcare delivery system, the networks will be able to work out new and innovative ways to involve private sector specialists and general practitioners in the provision of healthcare services and together provide Singaporeans with good quality health care. To run this system, we need the people. So let me now turn to the concerns raised by Mr Bernard Chen and Mr Ibrahim Othman. First, the issue of doctors. Over the past 10 years, the number of doctors in Singapore has grown steadily. As at end 1999, we had about 5,320 doctors in Singapore, or around 1,750 or almost 50% more than in 1990. While at the national level we may have sufficient doctors, we share Mr Bernard Chen's concern that the public sector should continue to have its fair share of the national talent. With the re-organisation of the health care system into these two networks, one of the key tasks of the networks is to come up with innovative methods to develop and retain their medical specialists. For example, development of talent would be done across the hospitals in each of the networks. The remuneration system would also be more sensitive to market conditions and commensurate with the calibre of the talent. The networks will also provide a more conducive environment for good calibre doctors to practise, teach, do research and develop themselves professionally. In this way, the two networks can be more competitive in training and retaining their staff. At the same time, I would convey the comments of Mr Peh Chin Hua to the networks to make sure that doctors are more communicative and go beyond the two words 'How' and 'Next'? On the issue of nurses, my Ministry is also concerned about the shortage of local nurses. We have to anticipate the demand that would come from the development of step-down care services to meet the healthcare needs of our ageing population. This need will include nursing homes, community hospitals and home care services that both Dr Tan Cheng Bock and Dr Jennifer Lee talked about. In the short term, we will need to recruit well-trained foreign nurses. But for Singapore, it is better for us, in the long term, to ensure that the nursing profession is attractive to young Singaporeans. Nurses form the backbone of the healthcare system. We want to encourage capable and bright young people to join the nursing profession, to build up the profession and raise the level of nursing services. Over the years, the Ministry has taken various measures to enhance nursing as a profession. But I think the key thing is still competitive remuneration. Therefore, we have recently reviewed the nursing salaries together with the restructured institutions. The nurses' salaries have fallen behind those in the other professions with people of equivalent educational level. There is therefore a need to adjust the nurses' salaries so that we can continue to attract a sufficient number of Singaporeans to take up nursing as a career. There must also be incentives to compensate for the onerous nature of the job. The restructured institutions will, therefore, be taking action to increase nurses' salaries in FY2000. The proposed revisions will increase the nurses' salaries by around 13%. This is not an across-the-board increase. We will increase the starting salaries of Assistant Nurses and Registered Nurses by 21% and 10% respectively. Corresponding adjustments will be made to the rest of the salary scales. The new salary package will include better shift allowance and other measures to better recognise the efforts of the nurses in providing 24-hour care to patients. We expect that the proposed revision will increase costs for the hospitals by an estimated $33 million. 2.15 pm Sir, I would now like to turn to the second theme which Members raised, which is how do we approach the problem of the ageing population. As I mentioned in previous sittings, this is not the first nor the last time we are going to discuss this issue. So, again, today, let me take through with Members what we intend to do to address this tremendous challenge. As we all know, the number of elderly persons in Singapore, aged 65 and above, is currently 7% of the population and will rise to almost 20% by the year 2030. This will put some pressure on our healthcare services. My Ministry recognises that therefore we have to start preparing ourselves early and put in place a framework to meet this challenge. So what is this framework? As can be seen from the various points raised by Members, I think the first step we must take is to keep the elderly fit and healthy for as long as possible. Second, to encourage regular health screening so that health problems can be picked up early for treatment. And, third, for those who fall ill or acquire severe disabilities, there must be a whole continuum of healthcare facilities, programmes and services to provide care in the most appropriate setting to the elderly and at affordable cost to them, their family and the Government. In doing all these, the public, the private and the people sectors will have important roles in this framework. So let me first address preventive healthcare. These are the points raised by Mr Bernard Chen and Dr Lily Neo. The challenge is how to keep the elderly fit and healthy for as long as possible. I think we agree entirely with the speakers on this. We all realise that a healthy lifestyle is really the key to the prevention of many chronic diseases which can eventually lead to disabilities. This applies not only to the elderly but also the general population. Therefore, my Ministry sets high priority on preventive healthcare, health promotion and public education to prevent the onset of chronic diseases. I think Members are all familiar with the various campaigns that my Ministry runs to educate Singaporeans on a general healthy lifestyle as well as on specific illnesses. These programmes all adopt a multi-strategy approach which involves the media, direct contact and many avenues to try and raise the awareness of Singaporeans on this. The second stage is health screening. Through health screening we can check whether the various health promotion messages that we have put forward have been translated into good health. I agree with Mr Bernard Chen that regular health screening is very useful. The issue is what do we look for in the screening. Members are aware of the National Health Survey in 1998 which showed that the prevalence of diabetes, hypertension and high blood cholesterol level increased markedly from the age of 50 years and above. If these conditions can be detected and treated early, then we will be able to avoid the high social and medical costs associated with them. The next issue is how do we encourage regular health screening for the elderly. As Advisers and MPs, we do this at the constituency level with the help of VWOs but often times, our best efforts are inadequate. In fact, those who need health screening most are the ones not likely to turn up for the screening. Instead, the more enlightened residents will turn up regularly. They are also likely to be the ones who are more healthy. Also, our efforts on the ground are often not comprehensive enough to cover all the elderly citizens in our constituencies. As Advisers and MPs, we also have limited resources to mount this effort year in and year out. After the screening, I think most of us feel that there is inadequate follow-up. Therefore, to redress all these shortcomings, my Ministry will reinforce what is being done now on the ground. We will embark on a systematic National Health Screening Programme in collaboration with the charitable organisations to detect diabetes, hypertension and high cholesterol level in people aged 55 years and above. The screening programme would start in the second half of this year. The plan is to complete screening all 374,000 of those aged 55 years and above within three years. To make it convenient for the elderly to participate in this programme, the health screening will be conducted at venues near to their homes, for example, in the void decks. Every senior citizen would be given a health booklet to track his screening results. I think Members will remember that this is one of the suggestions put up by Mr Ang Mong Seng, and we are pleased to adopt his suggestion. My Ministry will maintain the central database for all these screening exercises. All those screened and found to have abnormal results will be counselled on site and referred to their family doctor or the polyclinic for follow-up treatment. We plan to extend the screening programme to those who are 50 years and above when the plan is well established after three years. We would also like to encourage each person to attend screening once every two years. The estimated cost to screen each person is about $20. The Government will subsidise $15 while the resident will co-pay $5. The participating charitable organisations will pay for those who cannot afford the co-payment. The pilot programme will involve 10 to 12 divisions in the first phase. I hope MPs will volunteer their divisions for this programme. Sir, I would like to stress that there is a tremendous long-term potential for this mass screening exercise. I would put this akin to the mass vaccination of our young. If we can organise this properly, we would be taking full advantage of Singapore as a small urban, compact society. I think no other country will be able to embark on a similar ambitious programme such as this. I hope over the years, such screening exercises in our constituencies will be as regular as our meet-the-people sessions that we conduct every week. I envisage that we will be doing this screening practically once every two or three weeks and systematically encourage all our senior citizens to go for the screening. And we can help manage the medical conditions for those who have these illnesses. Sir, let me go to the next stage of the framework. If, after the screening, we identify those with health problems, then we would like to encourage them to be managed by their family doctors in an outpatient setting. Most of the health care needs of the elderly can, in fact, be met in the outpatient setting. So it is important for people with chronic illnesses, like hypertension and diabetes, to be treated and managed properly so that they do not acquire complications, resulting in severe disabilities. If we do this well, and if we do this systematically, then those who suffer severe disabilities and require long-term institutional care will be minimised. Dr Lily Neo urged for more shared care programmes between the primary care doctors to jointly manage patients with chronic medical problems with the specialists. I agree with her. There are some programmes already in place. We can encourage both the private and public sectors to do more. Dr Lily Neo also commented that private GPs should remain the main providers for primary health. This is indeed the case, because at the primary care level, the private sector GPs cater for 80% of primary care needs. In a rapidly ageing population, if we can move the centre of gravity of managing the chronic illnesses to the outpatient setting, then I see the role of the primary care providers continuing. As I said earlier, there is pressure for the primary care providers to upgrade themselves and raise the confidence of the general public in their capabilities. We will do so by better training of the family doctors through various programmes, like the Masters in Family Medicine and the Diploma in Geriatric Medicine. If we can upgrade the doctors through continuing medical education, then the GPs would be equipped to provide better care. Beyond care in the outpatient setting, both Dr Jennifer Lee and Dr Tan Cheng Bock raised the issue of home care. We also anticipated this requirement. Just as in the US where the acute hospitals will only look after the more severe cases, there is now a general sharing of care through other step-down facilities. In Singapore, in fact, we are taking measures to develop this overall supporting structure. There will be a community hospital next to every regional general hospital. We are already starting to build the rehabilitation hospital in Tan Tock Seng Hospital and that is provided in the budget for this year. We have embarked on many, many nursing homes. So I can assure Dr Tan Cheng Bock that the full range of supporting facilities for step-down care is already in place, and the funds are available. But how to provide this full continuum to meet the various needs, both from the nursing homes to the chronic sick to home care? Dr Jennifer Lee has spoken eloquently several times on the need for more home care services so that the elderly can be cared for in their homes. I agree entirely with her that institutional care should be the last resort and where we can, we should encourage home care. But home care is a more complicated and a more complex delivery system. Although we are working on it concurrently, I think Members will have to bear with us if we take a little longer to develop this full range of home care facilities and services. Today, we have six VWOs who provide home care, home nursing and home help services for about 6,500 elderly. My Ministry is actively encouraging other VWOs to provide home care services and is also currently working with another seven VWOs who have expressed keen interest to do so. We are also currently reviewing the subsidy framework for home care services to ensure that the lower income group will have access to such services. Many GPs, nurses and private hospitals are also providing home medical and home nursing care services. My Ministry will encourage the private sector to reach out to more elderly sick in the homes and we will provide the necessary support to facilitate the development of such services. Beyond home care, we must also develop the nursing homes for the elderly with severe disabilities who cannot be cared at home and must be looked after in an institutional setting. Recently, we announced the development plan for nursing homes up to the year 2010. Mr Yeo Guat Kwang has asked whether the 40% private sector share for nursing homes is the right balance. Let me explain the rationale for this decision. Today, the VWOs are the main providers of nursing home services, providing around two-thirds of the total nursing home beds. As the population ages rapidly, I think it would be a tremendous challenge to find increasing numbers of volunteers who are able to raise increasing sums of money from the community each year to run the VWO nursing homes. We therefore need to establish the nursing homes on a more sustainable basis. The VWOs are charitable organisations and should focus their efforts on the indigent and the poor. They should also concentrate on upgrading their professional capabilities and level of care. If the VWOs can look after 60% of the nursing home requirement, I would see that as a tremendous achievement. To complement the VWOs, my Ministry will set up the private nursing home market share at 40% by the year 2010, so as to provide more options to Singaporeans. We will step up the development of private nursing homes with the following measures. Firstly, we will help the existing operators using these buildings to secure longer tenancies. This will encourage the operators to upgrade their facilities and their service. Secondly, we encourage the private sector to develop purpose-built nursing homes by tendering out sites for such homes. At least 10 sites, each sufficient for a 200-bedded nursing home, will be offered by the year 2010. We will, of course, monitor and review these plans over the next few years, taking into consideration the overall supply and demand of nursing homes. 2.30 pm Another key element in this framework is to be able to make sure that Singaporeans can afford such nursing home care. My predecessor has announced previously the consideration of a severe disability insurance to meet the high costs of such long-term care. We expect to launch this in about two years' time after we have completed the actuarial study to determine the appropriate levels of premium and benefits. Once we have this severe disability insurance scheme, then Singaporeans can save for their old age and be covered by insurance if they suffer severe disabilities. Dr Jennifer Lee was concerned that by changing the name of the scheme from "long-term care insurance" to "severe disability insurance", she reads the nuance as a diminution in the scope of the coverage. Let me explain that, when Mr Yeo Cheow Tong announced last year the thinking behind the long-term care insurance, he said that this insurance would not cover chronic conditions, such as diabetes and hypertension, which are not severe disabilities in themselves, but require outpatient treatment. So the intention all along is to restrict ourselves to those who have to incur a very heavy financial burden as a result of severe disabilities. Members will appreciate that if you are running an insurance scheme, you want the appropriate pay-out ratio. The more generous you make the pay-out ratio, the higher the premiums will be. That has been our experience with MediShield. If you have a pay-out ratio of 1:10, then you can keep the premiums low and everybody can afford the premiums. If you make the coverage wider and the pay-out ratio higher, then the premiums will be much higher. So we need to strike the right balance. We have changed the name to "severe disability insurance" to better reflect the policy intention and not to reduce the coverage. I hope this sets out the framework of what we intend to do for the ageing population. We will continue to concentrate on preventive healthcare. We will undertake this very ambitious programme to screen all senior citizens aged 55 and above and, over time, to bring it down to also 50 years old, screening once every two years. Then those with medical problems, to manage them in the outpatient setting, and those with more severe disabilities, to allow them to be looked after both in the home setting as well as the nursing homes. We have put in place the financing for the low income group. They will be subsidised through the Eldercare Fund. For the average Singaporeans, in two years' time, we will set up the severe disability insurance so that they can save and pay for their long-term care. The third area that I would like to cover is the whole issue of affordable healthcare. This was raised by Mr Low Thia Khiang, Mr J. B. Jeyaretnam and also Dr Tan Cheng Bock. Mr J. B. Jeyaretnam is not around. Every time he is not around, he does not listen to our answers, the next time round, he will ask the same question. He asked for a committee to be set up to study national healthcare insurance. In fact, that committee was set up in 1992 and the White Paper on affordable healthcare was a result of that committee. That committee deliberated and decided that Singapore would not have a national healthcare insurance system, but our system will cover the 3Ms - Medisave, MediShield and Medifund. Today, our healthcare expenditure constitutes approximately 3.1% of our GDP. So this is very affordable and it is a very good level of care at very reasonable cost. The national healthcare expenditure means the total expenditure by the country, people, employers and the Government. If you look at the household expenditure on healthcare alone, it is only 2.5% of household expenditure. Individual households spend on an average 2.5% on healthcare. This is again very affordable. And we have done so because of this very sound 3M financing framework - Medisave, MediShield and Medifund. For Medisave, 84% of our people have Medisave accounts. This is a very high percentage. But I think we can do more. We will want as many as possible to have Medisave accounts. 71% today are covered by MediShield, insurance or its equivalent. This is again a very high level of medical insurance. So instead of the national healthcare insurance that Mr J. B. Jeyaretnam talked about, first, we ask people to save through Medisave and then we put people on to MediShield and equivalent catastrophic insurance schemes. And 71% of our people are covered by MediShield. For those who cannot afford to pay their bills, they can apply through the Medifund for assistance. Last year, 97% of all applications for Medifund was approved. In the FY99 budget, the Government has topped up the Medifund by an additional $100 million, bringing the total now to $700 million. So our healthcare financing scheme is very robust and helps keep our healthcare costs down. Mr J.B. Jeyaretnam asked for a breakdown in the cost. Every patient who goes to the hospital gets this breakdown in cost, systematically setting out how much it costs to look after him, whether he is a C or B2 class patient and what he has to pay and what is the Government subvention. A typical hospital bill for a C class patient is less than $700. We track this all the time. And the Government subsidises 80% of the total cost. So the breakdown of the cost is given for every bill that every patient gets from the hospital. So I do not quite understand what Mr J.B. Jeyaretnam wants when he asked for a breakdown. It happens all the time in every case in hospital. Let me also touch on the implementation of the casemix and some of the issues raised by Dr Tan Cheng Bock. He is concerned that casemix may lead to premature discharge and a poorer quality of care. First, let me state that casemix does not dictate to the doctors in all the hospitals how they should manage their patients, nor does it help hospitals or clinicians decide when to discharge the patients. As always, the patient shall only be discharged when medically appropriate. Casemix is only classified after the patient is discharged. So the whole professional system will continue to look after the patient as before, based on their professional judgement. And the whole issue of subvention and classification only takes place after the discharge. Dr Tan Cheng Bock gave the example of outlier cases. Let me try to explain this to the House. Casemix assumes certain standard cases, say, for example, the case of appendicitis that Dr Tan mentioned. In general standard, typical cases, it will take about four days and the person will be well enough to be discharged. If the case is more complex and requires seven days for him to stay in the hospital, the doctors will continue to keep the patient for seven days in the hospital. At the end, when he has recovered, he will be discharged based on the decision of the doctors. In the subvention for the subsidies, the Government will pay to the hospitals the four-day standard rate for appendicitis, in this example. And for the three days extra, the Government will continue to pay the hospital a per day rate. So it is not true that the hospital is under pressure to discharge the patient because he wants to stay under the four-day standard rate. If it is an outlier case, the Government will continue to pay both the standard rate plus the extra days on a per day basis. So I want to assure the House that the casemix system will not result in premature discharge of the patients. Dr Tan Cheng Bock is absolutely right about this shift in the management of patients because we recognise that hospitals are very expensive institutions and they should concentrate on acute care. As can be seen in many developed countries and also, in Singapore, there is a trend towards day surgery, and there is a trend towards step down care and there is a trend towards recovery in other institutions, other than the acute hospitals. As I mentioned earlier, we have to set up this full range of supporting facilities so as to accommodate this shift in looking after the patient. Let me also address Mr Low Thia Khiang's point about the quality of care in our hospitals. I can assure him that we are able to achieve very good quality healthcare in Singapore at affordable prices, both to the individual as well as to the country as a whole, and this is not at the expense of quality. When we audit the hospitals, we look at four key parameters. First, accessibility, to make sure that everybody has full access to the services and facilities in the hospitals, and nobody is turned away because he cannot afford to pay. Second, the charges are affordable. We track the total bill size. We track the cost to the patient for the different ward classes. Third, we track the clinical outcomes of all the major operations in the hospital. So it is not good enough that you can go into a hospital, the cost is affordable, we also track the clinical outcomes that when you go in for a particular ailment, you come out properly cured. The clinical outcomes are rated with other reputable hospitals around the world. Fourth, we check the service quality - how the staff deals with the public, whether it is the waiting time, courtesy, the whole range of PS 21 parameters that we also set for our hospitals. We do monitor the performance of our hospitals in a very rigorous way. We are mindful that we want to ensure good quality affordable healthcare to Singaporeans, and not just look at the bottom line. So even though the patient load has gone up, the hospital manpower may not have gone up as much because of productivity and efficiency. But as I said earlier, we must keep our fair share of doctors, nurses and the whole array of people to run the hospitals, and we must continue to keep pace with the market remuneration. This means the cost to the hospitals will go up. The Government will bear its fair share of these cost increases through higher subventions to the hospitals. But the public must also pay for their share of the increases. Healthcare is an expensive business because 60% of healthcare is in manpower cost. It is not possible for us to ask the doctors and nurses to give us good quality healthcare and expect them not to receive their fair salary. We have to continue to give them a fair remuneration and that means we expect 60% of our cost to be increased every year. Drugs are also very expensive. They constitute 10% of our cost and we must expect to deal with better drugs, new medical technology and Singaporeans' expectations that they get the new drugs which are available in the market. So there is an increasing pressure on cost. We will manage it well. But at the same time, as I mentioned, the healthcare burden on Singaporeans is manageable because of the medical financing that we have put in place. Sir, I would like now to ask my Parliamentary Secretary to take over and answer the specific questions. 2.45 pm

Sir, both Mr Low Thia Khiang, as well as Mr Peh Chin Hua, mentioned A&E services and long waiting time, quoting some people having to wait for one or two hours. I would like to say that in A&E, we aim to triage patients within five to ten minutes of their arrival. After triage, patients are treated based on how serious his medical emergency is, not on a first-come-first-served basis. We can assure Mr Low, as well as Mr Peh, that all the genuine emergency cases are given treatment in good time. The average waiting time in A&E is perhaps long, because we continue to have plenty of non-emergency cases coming to A&E Department. We certainly agree with Mr Peh Chin Hua that to the friends and relatives of some patients, everything is an emergency, perhaps because of lack of knowledge. That is why we have to continue to mount public education exercise to tell the public how to identify emergency situation and where to bring the patients to if it is a non-emergency case. As Members also know, we have a two-tier system of charging people who come to A&E Department, higher charge for the non-emergency cases. Mr Peh Chin Hua is also concerned about eye problems among our population, citing myopia, cataract, diabetic retinopathy, as well as glaucoma. Yes, we agree that these are all serious concerns and problems. The last three conditions, cataract, diabetic retinopathy and glaucoma, are related to an ageing population. The strategy to deal with such conditions really is "prevention is better than cure". We will look into organising more screening activities to try to identify such conditions early, so that early treatment can follow. Myopia, on the other hand, is a serious problem amongst our younger generation as Mr Peh Chin Hua has mentioned, citing some very pertinent statistics. One problem is that it has got so prevalent that I know of many parents, when their children start wearing glasses, they do not feel sufficiently upset. We will try to intensify public education programme in order to persuade members of the family to pay serious attention to this problem. We will also mount educational programmes in schools and for parents on proper lighting, as well as proper inculcation of good reading habits. Some schools have even introduced eye exercises. We will also be embarking on a national myopia programme to increase awareness of myopia amongst all Singaporeans, to educate them on the preventive measures. As far as research on eye problems is concerned, we would like to assure Mr Peh that this is indeed a priority. In fact, it is so important that in 1997, we set up the Singapore Eye Research Institute (SERI) to function as a research arm of the Singapore National Eye Centre. We have not been stingy on funding for research. To-date, the National Medical Research Council has committed $27 million to various subjects of eye research. This amount has been committed but it may not have been spent yet. As you know, the money is spent as and when the research is introduced. Dr Lily Neo mentioned asthma amongst children. Yes, we consider this as an important medical concern. In terms of death rate from asthma in Singapore, it is not abnormally higher than those in the developed countries. However, over the years, various initiatives have been put in place. The School Health Service currently screens all students during their annual check-ups for their suggestive history or signs of asthma and refer them for treatment where appropriate. KKH has also conducted workshops to train PE teachers on what to do in the event that some of the students suffer an acute asthma attack in school. Standards of asthma care for children have also been set with the development and publication of clinical practice guidelines for the management of paediatric asthma. A number of hospitals, including KKH and SGH, have established shared-care programme with GPs that will allow complicated cases of asthma to receive specialist attention early. Currently, the School Health Service, KKH and the Asthma Association of Singapore are working with the Ministry of Education on a scheme to equip all schools with inhalers and spacers for emergency use by students who are known to be asthmatic. Mr Gerard Ee mentioned IT and the potential of exploiting IT for professional exchanges, as well as for teaching. We would like to assure Mr Ee that doctors in Singapore today have global access to information on state-of-the-art medical treatment and knowledge through various means. Mr Gerard Ee also mentioned Internet. In fact, he would agree that our doctors are very Internet savvy. In addition to Internet, our doctors have also been active in participating in local, as well as international medical conferences, and that includes tele-conferences to discuss with their colleagues on the medical treatment of patients and all these are done regionally, some are done globally. Some of our hospitals have, in fact, established professional links with renowned medical centres overseas, such as Mayo Clinic, Stanford and Johns Hopkins in the United States. Suffice to say that there are really a lot of initiatives in these areas. I think we should allow the enthusiasm and the initiatives to take its course. In fact, our health administration here has also been very active in exploiting IT for health administration, and in the use of info-communications technology to capture patients' records for use within the hospitals. The Ministry has set out to develop a National Info-communications Masterplan for Health. The concept is being studied with the medical community, not only for the public sector, but also with private hospitals. Universities, IT vendors and so on have all been invited to give input on what they expect out of this Info-communications Masterplan. Of course, there are quite a lot of professional and ethical issues involved. We will examine these carefully when we establish the Info-communications Masterplan. But suffice to say that Mr Gerard Ee's suggestion of using IT is something that we share.

Order. Mr Chan, just to remind you that we have another amendment to take.

If that is the case, I will just address Dr Vasoo's point of patients coming to hospitals not carrying documents with them, and as a result, have no money to pay for the deposit, and unable to be admitted. I would like to say that all hospitals are required by law to admit all emergency cases. They are supposed to treat them first and talk about administration and money later. This is provided for in the law. As for the case of the Filipina lady, investigation is in progress. We would like to get to the bottom of the matter. But since investigation is in progress, I think we should leave things as it is for the time being.

Sir, I would like to seek a clarification from the Minister. Earlier on, the Minister said that the long-term disability insurance would not cover chronic diseases. May I ask the Minister: are we not leaving a crack in our financing system in medical care because chronic disease sufferers in the future will be flocking to our hospitals as these are places where they can get paid through Medifund, Medisave and Medicare?

Sir, my Parliamentary Secretary also left out the answer to Mr Gerard Ee on the hospital of hope. I will take this up first. We thank him for his suggestion, but I think it is too ambitious a programme for us to embark on. We do have today research programmes, experimental drugs, experimental treatments that people who may not avail themselves of standard treatment can go for. But to expand it into a hospital of hope is too huge a programme for us to undertake. As to Dr Lily Neo's point about chronic illnesses, we will keep an open mind. I just want to lay out the general principles. When we start talking about insurance, there is trade-off between premiums and pay-outs. The wider the coverage, the more pay-outs. If we include all kinds of chronic illnesses, then you must expect a very high level of insurance premiums. Just to give you an example. In Germany, they have a similar long-term care insurance. For them, it means every worker setting aside 1% of his salary from the day he starts work until 65. That money that he saves becomes the premium to pay for long-term care insurance. That is the kind of money we are talking about. The more you are able to narrow the pay-outs, the more affordable the premiums. We keep an open mind. We would like to cover as wide as possible, but insurance means that somebody in the end would have to pay. Our experience with MediShield is that the more narrow you can keep the pay-out, the more affordable, and therefore the easier it is for you to encourage everybody to buy into the programme.

We have two minutes left on this amendment. Dr Tan, make your clarification quickly.

Sir, I just want to clarify with the Minister about the funding of outliers. He said that they would be funded. I agree that they would be funded but at what level. Is it below the level of the running cost of the hospital?

Let me just say that the bottomline is that we are subventing the hospital at the same level as we did before. It is just how we manage it. For example, if you discharge your patient earlier, if his medical condition is so good that he is discharged in 3.7 days, we still pay you 4 days because it is the standard rate. If you discharge him in 7 days, we will pay you 4 days plus 3 days per diem, on a per day basis. That is the formula. 3.00 pm

Sir, I think the Parliamentary Secretary should have one minute to answer my question.

He has less than one minute.

Sir, as regards kidney patients, there are two key priorities. First, public education so that more adopt healthy lifestyle. Second, encourage more people to donate kidneys, because kidney transplant is the fundamental way of solving the problem. I have pledged to donate mine. Maybe you want to join me.

Mr Chen, do you like to withdraw your amendment?

Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.

Amendment No. (2), Mr Chiam. There are four minutes left.

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. Sir, I just like to touch on admission fees of Government and restructured hospitals. Although the Minister has said that medical cost is affordable and also accessible, my feedback is that some residents in my constituency say that when they want to get admitted into a hospital, the staff insist that they pay the full cost for both the operation and the ward charges. I do not know whether the hospital staff are over enthusiastic in collecting money first. Sir, I understand why they want to collect the money first. They want to make sure that all the services rendered are fully paid. But this may cause some problems to the poor people, because they are suffering and they may be turned away. They are turned away in the sense that the officers insist that they pay and they feel bad that they cannot pay. So in that sense, they are turned away, and they may really suffer. As far as I know, there are no reported cases of Government or restructured hospitals turning patients away. But the case mentioned by Members of Mount Elizabeth Hospital turning away a Filipino lady in a state of advanced pregnancy, just because she could not pay, she was turned away. Soon after, she gave birth in the toilet and, in despair, she put the baby in the toilet bowl. Fortunately, the baby cried. A nurse heard the cry and saved the baby.

Mr Chiam, are you expecting a reply, because we are running out of time? I think you should allow the Minister to reply.

I heard from the Parliamentary Secretary that investigations are going on in this matter. I think the woman will be charged for attempted murder, but I think the hospital is equally responsible and they should answer for it.

Sir, let us get the facts right. First, as my Parliamentary Secretary said, for emergency cases, the hospitals, under the law, have to treat the patient first and deal with the payment administration later. And we will deal with the investigation of this particular case. For the hospitalisation that Mr Chiam talked about, nobody is turned away in Singapore hospitals if he is a Singapore citizen for inability to pay. If a person tells the hospital that he wants to be admitted to a C or B2 ward, he does not even need to put a deposit. Lawyers collect deposit from their clients. Hospitals do not collect deposits from their patients when patients turn up for B2 and C wards.

Sir, I do not wish to go into an argument with the Minister. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $1,023,832,900 for Head P ordered to stand part of the Main Estimates. The sum of $230,417,400 for Head P ordered to stand part of the Development Estimates. Head K -

Head K, Ministry of Defence. Amendment No. (1), Dr Ong Chit Chung.

Sir, I beg to move, That the total sum to be allocated for Head K of the Main Estimates be reduced by $100.

Sir, the Asia-Pacific has gone through a severe economic crisis. It was like being on an endless roller coaster of political upheavals. New fault lines have opened up. Primordial forces of race and religions have been unleashed. In some countries, people are hungry, people are unemployed, and people are restless. Developments in the past year have been unsettling and discomforting, to say the least. Though the situation has somewhat stabilised, the problems are by no means over. We must continue to be vigilant and on our guard, and not be overcome by surprises. Professor Michael Howard, a well-known military historian, states that when there is a lull and all is quiet, we must all the more expect the unexpected. Events may suddenly take a nasty turn for the worse. We must hope for the best, but prepare for the worst, and not be taken by any surprises. There was a time when some people thought that they could just walk in and walk over us. Now, there is a strong SAF with the necessary firepower and mobility. We are fully committed to strengthening and upgrading our defence capabilities, as without a strong and invincible SAF, there will not be a Singapore. There will not be an independent and sovereign Singapore. The defence budget is $7.4 billion, amounting to 25.6% of the total budget allocation for expenditures. It is 4.48% of our GDP, still way below the 6% cap of the GDP for defence, set voluntarily by the Government some years ago. In this context, the GPC for Defence and Foreign Affairs fully supports the defence budget. We hope it is sufficient for the needs of the SAF. Our only worry is that it may not be enough. So, please let us know if it is not enough. Though we are prepared to support a bigger defence budget, we want good value for the dollars we put into defence. Money should be well spent. Our defence dollars must work for us. Usage of land and facilities should be optimised and weapon systems wisely selected. With wise management and fearless commanders, the SAF will definitely be a force to be reckoned with. The strategy of deterrence, coupled with a balance of power in the region, will help protect and preserve our national interests. We will then have peace and security to pursue our economic interests and development. In this context, I would like to ask the Minister if the SAF is operationally ready to deter and, if necessary, destroy any would-be aggressor. Sir, while we go for strong defence capabilities, and anchor ourselves in the strategy of deterrence, we should, at the same time, use other instruments of geopolitics and diplomacy. We should make use of the balance of power, encouraging more big powers like the United States to be actively engaged in the region, promote multi-lateral security arrangements, like the Five Power Defence Arrangements (FPDA), engage in security dialogue through the ASEAN Regional Forum, pursue confidence and security building measures, and work on preventive diplomacy and conflict resolution. We should also be aware that the security landscape is ever changing and shifting, and there could be a variety of threat scenarios. Such threats include terrorist attacks, subversion, competition for vital resources like water and oil, biological and chemical warfare, and even cyber attack. May I ask the Minister if Mindef is prepared and ready to counter such unconventional threats?

Sir, the years 1997 to 1999 were good years for the SAF. It brought home to the people of Singapore the sobering truth on the vitality of the region and the importance of a strong, credible SAF. The SAF enjoys tremendous support among our people. It is important that the SAF continues to remain vigilant and further strengthen Singapore's defence capability to protect the sovereignty of the country. Sir, the regional security situation remains uncertain. China continues to rely on threats and plans to use armed force to limit Taiwan's behaviour. Tensions on the Korean peninsula still continue. The multiple claims to the islands in the region still remain unresolved and skirmishes surface intermittently. The nuclear arms race is on in South Asia. The US-Japan alliance is still the cornerstone of US strategy for the region. It has been a cardinal policy of our Government to keep the US engaged militarily in the region, as a balancing force. However, an article in the International Herald Tribune, which is carried in today's Straits Times, highlights that the US will reduce its military profile in the Asia-Pacific. Admiral Dennis Blair, Commander-in-Chief of the US forces in the region, outlined the US military's new approach to Asia and the Pacific by stating that the US intends to achieve this by encouraging local armed forces to work more closely together and to take the lead in any regional crisis. Sir, I would like to ask the DPM to share with the House the strategic situation in the region and, in particular, the US defence policy in the region. Is the new US military policy for Asia-Pacific the beginning of the end for US commitment to the region? Are we doing enough to keep the US engaged in the region? How could we respond to this new US policy by participating in more regional military exercises which are aimed at creating better understanding and help bring the armed forces in the region together? Could these regional military exercises be the harbinger for a future regional military apparatus to be created in the region? And could it lead to a future regional military alliance among the neighbouring countries? Sir, could the DPM share Mindef's policies and view on these matters?

Sir, much to our relief, the relationship among the United States, China and Japan - three countries which hold the key to the security of East Asia and South East Asia - has stabilised. A small state like Singapore may seem to be at the receiving end of this triangular relationship. But we really do not have to and must not allow ourselves to be just a small pawn in a big-power game. Through our relationship with these three countries and other countries in the region, we have been training to help create an environment of peace and stability. Can the Minister inform us how this approach has helped advance our interests and security? How has our defence relation with neighbouring countries developed over the past one year? While the overall security situation in East Asia has stabilised, what about the situation in South East Asia following the economic crisis and intensified separatist movements in areas like Aceh in Indonesia? Then there is the potential flash point in the South China Sea. While much attention has been given to the cross-strait relationship between China and Taiwan, or North Korea, or especially Indonesia, what about the situation in South Asia, where India and Pakistan have both tested nuclear weapons? Can the Minister give his assessment on these matters and the possible impact on us? I believe Singaporeans appreciate the Government policy on defence spending, especially in the last two years when there were economic, social and political turmoil in many countries around us. The policy to cap defence spending at 6% irrespective of our economic situation is appreciated, as the defence policy has brought about confidence among Singaporeans of their own security and among investors who put in their money here. We have invested much in defence technology and equipment. What about staff development? Are our defence forces able to recruit and retain the good people that they must have? 3.15 pm

Sir, the security framework of Singapore includes not only the Singapore Armed Forces but also bilateral and multi-lateral arrangements with countries in the region and possibly strategic partners in the world. In defence spending, one would say that the SAF has over the years built up substantial capability, and this capability has been broadly recognised by many as one that is seriously credible. As one would have it, we have built up a credible SAF in the hope that our soldiers would never have to fire a shot against another in anger. In order to minimise this possibility, it is important that we recognise the goal of bilateral and multi-lateral cooperation with other countries. Over the years, we have developed our broader security framework well. For instance, at a multi-lateral level, we have continuously strengthened and worked with such arrangements as the Five Power Defence Arrangements (FPDA). The FPDA is the longest standing multi-lateral arrangement and has provided for the defence of Singapore and Malaysia since 1971. One does not deny that FPDA has contributed quite substantially to the region's security architecture and the region's business stability. Another example of our efforts at promoting the international framework to strengthen security interest is the ASEAN Regional Forum. This vehicle promotes regional peace and stability. At the moment, although the ASEAN Regional Forum is not akin to that which is available in Europe, it has nonetheless started out on the right premise which commits the parties to the appropriate dialogues and discussions to resolve outstanding security issues. Apart from multi-lateral arrangements, Singapore has been engaged in bilateral ties with our neighbours. For instance, Singapore has very strong defence ties with Malaysia and Indonesia. Sir, we must recognise that bilateral and multi-lateral defence cooperations are essentially confidence building measures that help countries in the region resolve disputes through peaceful means and also to seek regional security cooperation to achieve common strategic interests. By providing a platform for alliance, the bilateral ties and multi-lateral arrangements allow the respective countries to develop cooperative programmes to complement rather than to compete with each other. In order to achieve this, there must be a certain amount of inter-operability of the armed forces. To this end, the parties would need to cooperate with one another better as alliance partners. It is obvious therefore that by promoting bilateral and multi-lateral arrangements with foreign countries, we are providing a framework towards better cooperation and understanding at the armed forces level. Hopefully, this would pave the way for resolving differences by peaceful settlement rather than to resort to war as an alternative. Sir, we note that the multi-lateral security dialogues and cooperation of defence establishments in the region remain a relatively undeveloped area. With various forums, we have varying degrees of success. For instance, our ties with the Malaysians have been relegated to the backwaters for now. We should continue with pursuing closer cooperation. Such ties and cooperation would pave the way towards a reduction of suspicion of one another, which will be the case, if we had no cooperation. I would like to ask the Minister, Sir, whether the Government would pursue this area of bilateral and multi-lateral defence cooperation as actively as we have been able to build our defence capabilities.

Sir, the Five Power Defence Arrangements (FPDA) did not conduct the Stardex air and sea exercises in 1998. The joint military exercises resumed in the South China sea in 1999. But the Malaysians had restricted the use of their air space during the exercise so much that during an accident the training forces had to apply and obtain permission from the Malaysian authorities for emergency rescue cooperation. The Malaysians had also indicated that in 1998 they would reassess their membership of the FPDA in a defence review by mid-1999. Sir, the FPDA is not a NATO-like military alliance. It is a regional security treaty linking Britain with Malaysia, Singapore, Australia, and New Zealand. The FPDA only requires the three western nations to consult with the two ASEAN Members should they be subject to attack. There is no automatic commitment to come to their aid. I am concerned as the FPDA, being a loose regional security alliance, requires total commitment from all its signatories for it to be credible and a sound deterrent. The natural question that arises is whether all the signatories are serious about their commitment to the FPDA. Could the DPM please update us on the developments in the FPDA and whether the defence arrangement still has a critical role to play in the defence of Singapore? I would also like to ask the DPM for his assessment on the commitment of the Malaysians to the FPDA.

Sir, from time to time, there are reported incidents of piracy in the seas around us. They are not just a nuisance, but also a threat to shipping and the orderly conduct of trade. There is also the problem of illegal immigrants coming by sea or waves of refugees sailing in and attempting to come ashore. Singapore is a sea port. It is situated at the hub or crossroads of Southeast Asia. Through our port, we export as well as import materials and essential food supplies. The sea lanes to and from Singapore, and through the vital Straits of Malacca, are not only our livelihood, but also our life-lines. We must keep the sea lanes of communication open. May I ask the Minister what measures are being taken to tackle the problem of piracy, illegal immigrants and potential refugees, and if the SAF is able to secure, and ensure, that the sea lanes of communications are kept open at all times for trade and essential supplies.

Sir, most of the points that I had intended to raise have already been said by Dr Ong Chit Chung. I will therefore not repeat them, other than to state that the problem of piracy is a regional problem. It requires the coordinated effort and the cooperation of regional countries in order to address this problem. Could the Minister tell us if there has been any collaboration with the regional armed forces to eliminate or at least to control piracy in our regional waters?

Sir, in certain scenarios, instead of big predators, there could be sharp and pin-point attacks by terrorist groups. And terrorist attacks could happen at any time, any place. Remember that in March 1991, four Pakistani terrorists hijacked Singapore Airlines flight SQ 117 flying from Kuala Lumpur to Singapore. They issued an ultimatum and threatened to kill the passengers one by one. Fortunately, the SAF commandos successfully stormed the place, killed the hijackers and freed all passengers. And years earlier, if Members remember, in 1974, there was the hijack of the ferry boat, the Laju. Indeed, President S.R. Nathan was involved in this rescue exercise successfully. I therefore wish to ask the Minister whether we are ready and able to deal with any terrorist attack, at any time.

Order. I propose to take the suspension now. Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House.

Order. I suspend the Sitting and will take the Chair again at 3.45 pm. Sitting accordingly suspended at 3.24 pm until 3.45 pm. Sitting resumed at 3.45 pm

Debate in Committee of Supply resumed.

Head K (cont.) -

Sir, in today's issue of the Straits Times, there is a report about the arrest by the Philippines Police of two suspected foreign terrorists with links to the Moro liberation organisation. According to the report, the police authorities believed that international terrorists were using the Philippines as a training ground, with some Moro rebel leaders acting as hosts and getting technical knowledge in modern urban warfare. In recent times, there have been incidences of hijacking of airplanes in the Indian subcontinent, raising much concern about the security of travelling by air and airport security in general. Closer to home, arms are easily available in some high tension areas in Indonesia, particularly in East Timor and its neighbouring areas and in Aceh. My concern is, are our defence forces ready and capable in handling the possibility of terrorist attacks at our airports and the hijacking of airplanes? Would the Minister inform the House about our capability in handling the potential attacks by terrorists?

Sir, as a small nation, with limited resources and manpower, we cannot count on mass in numbers to overwhelm the potential enemy. In any case, it is the skills, the firepower, and the mobility that matter. Our critical mass has to be in technology. It is the cutting edge of technology that will give us a cut above the rest, ensure our competitive advantage, and win the war for us. There was always the danger that the generals were fighting the last war. On the eve of World War II, for example, the Polish Army still had the horse cavalry, which was, of course, no match for the German tanks. It is the same today, even more so with the galloping pace of advancing technology, which made equipment and doctrines fast becoming obsolete. So fast is the pace of change that there is now a revolution in military affairs or some call it RMA. This revolution encompasses electronic information system, advanced information technology, precision strike technologies, stealth technology, unmanned technology, and cyber warfare, just to name a few. I would like to ask the Minister if the SAF is keeping track of the changing nature of warfare and is on top of the revolution in military affairs.

Sir, I thank the Members of Parliament for their comments and I will endeavour to answer their questions. Sir, our economic growth has rebounded strongly and we can all look forward to more growth this year. There will be challenges, and there will be opportunities. It is up to us to meet the challenges and to seize the opportunities. The speed of change is quite awesome and we shall have to continue to try to ride the changes to our advantage. In our efforts to achieve our vision of a best home for Singaporeans, we must never forget that our most basic requirement is security. For the past 35 years, Singapore has grown and prospered because we have peace and stability. Singaporeans know that they have a safe home, and investors know that it is safe to invest here. Singaporeans and foreign investors alike know that the Government is committed to investing in a defence capability to ensure the security of Singapore. Our firm commitment to defence must continue. If there is one thing that the exciting events in our region over the past few years have taught us, it is that we would be wise to be vigilant and prepared so that we can confidently and effectively deal with any negative fallout from economic and political developments elsewhere. We have also learnt how quickly things can take a turn for the worse; in fact, things can practically unravel, without any warning - I think a point made very cogently by Dr Ong Chit Chung. And when the situation turns bad, we have seen in recent years how quickly a country can deteriorate, but also how quickly a country emerges from a crisis situation depends on how solid its foundations are and what is the attitude of its people. While almost all Asian countries are today well on their way to economic recovery, there is greater uncertainty in the regional security environment - a point emphasised by Dr Ong Chit Chung and Mr Ravindran. There are still areas of political and social instability and a number of potentially destabilising issues remain unresolved. Examples are the Korean Peninsula, the Taiwan Strait and the Spratlys. Time and time again over the past few years, we have seen just how quickly such disputes could trigger tension and threaten security and regional stability. Sir, it would not be wrong to say that all nations today desire peace and stability, and understand the importance of co-operating for mutual benefit. Unfortunately, it would also not be wrong to say that while we all hope and strive for peace, conflicts and tensions are very much unfortunately a fact of life. As a small and young nation, it is only prudent for Singaporeans to ensure that we continue to have a defence capability that is able to protect our sovereignty, territorial integrity and Singapore's national interests. For the past 35 years, we have done well in developing the SAF into a well-trained, highly motivated and technologically advanced armed force. The SAF has safeguarded our security and given Singapore more room to adopt policies and take actions which best serve our national interests. Without the SAF, Singapore may not have been able to remain the oasis of calm that we have been, amidst the turbulence and tensions in the region particularly in the past few years. But the SAF was not built up overnight. The professional force that we see today is the result of years of consistent effort and commitment - in training people, developing doctrines and investing in capabilities. It has long been our policy to cap our defence spending at 6% of our GDP and maintain this in a steady manner. This policy has served us well as it allows the SAF to take a long-term view of its capability development programmes and to structure them in the most efficient manner. Defence technology and doctrines are constantly evolving. We must continue to maintain a suitable level of defence spending each year to ensure that the SAF stands ready to meet any security challenges. In doing so, we are saying to our people: Singapore will remain a secure home for you and your children. We are saying to our investors: You can safely put your money in Singapore because it will remain a stable and secure place for your business. And we are saying to any potential aggressors: Singaporeans are vigilant and prepared to defend our country against any threats to our sovereignty and our vital national interests. Sir, as a result of our commitment and efforts, the SAF is today a balanced, integrated and operationally ready armed forces. The punch of the SAF comes not from its size but from its ability to fight as an integrated whole that is more powerful than the sum of its individual parts. Many established armed forces recognise the professional standards of the SAF and they are keen to exercise and train with us. Sir, I come to the point about technology in defence which has been raised by Dr Ong Chit Chung. Looking ahead, the advances in technology in the 21st century will confer new advantages to a small armed forces like the SAF. Traditionally, victory in combat depended on the ability to mobilise, deploy and utilise larger divisions or naval or air fleets. Skills certainly counted but numbers were decisive. However, technology is changing that balance. The incorporation of advanced technology in weapon systems is enabling military forces to see the battlefield more clearly, make better informed decisions in a timely manner, and strike with more deadly accuracy, from greater distances than ever before. The upshot is that in war, having superior numbers is no longer enough. What is required is the capability to integrate platforms into a unified, flexible and effective fighting system. The side that can make the best use of technology will have the edge. The implication is that even a small country, like Singapore, can tilt the odds in its favour if it can make smarter use of technology than its opponents. The SAF is well placed to exploit technology. Many of those going into National Service have the education standards to be quickly and effectively trained to operate high-tech weapons and equipment. 60% of each cohort has at least A-level or Polytechnic qualifications. The SAF is constantly exploiting the opportunities presented by advances in technology. This goes beyond merely buying more advanced weapon systems. It also means being able to exploit the hardware to the fullest by constantly improving on our organisation, doctrines and training to keep the SAF highly capable. 4.00 pm Mindef will continue with our two-pronged approach to strengthen our technological base. Besides building up a strong indigenous defence technology capability to meet the SAF's requirements, we will also continue to expand our international linkages and strategic partnerships with foreign armed forces and research bodies. With the setting up of the Defence Science and Technology Agency (or DSTA), which comes into effect tomorrow, we will be able to respond more quickly and flexibly to technological changes, as well as to transcend our manpower limitations by leveraging on external engineering expertise from either local or overseas organisations. But advanced weapon systems by themselves cannot win a war. It is people who win the war. And we must have good soldiers who can make good use of these high-tech weapon systems to the SAF's best advantage. Mindef has therefore always given priority to the recruitment and retention of good people in the SAF. And I thank Mr Hawazi Daipi for pointing this out. We launched a manpower management initiative in 1998, called "The New Partnership" for the SAF officers corps. The New Partnership aims to provide a first class career that is both challenging and rewarding. The New Partnership programme included changes to the career structure, remuneration package, career management and performance management of the officers. These changes have now been fully implemented. In January this year, we announced the New Partnership for Warrant Officers and Specialists who form the backbone of the SAF. Under this initiative, the Warrant Officer and Specialist career structure will be restructured into two parts. The Specialist stage covers the first 10 years of service in the SAF and emphasises the acquisition and application of skills-based knowledge. The second stage, the Warrant Officer stage, emphasises skills proficiency, experience and continuity. The plan also offers warrant officers more opportunities to upgrade themselves and to prepare high-performing servicemen for positions of leadership by giving them assistance for upgrading their qualifications. To support the new career structure, Mindef is introducing a savings and retirement plan for Warrant Officers and Specialists known as the Premium Plan. This provides financial flexibility and stability to better cater to their needs. Sir, while a strong SAF remains central in our defence strategy for the 21st century, we recognise that we also need to co-operate more closely with others to enhance Singapore's security. In the 21st century, there will be increasing interconnectedness among countries - not just in the economic sphere but also when it comes to security. The security and prosperity of a small and open country like Singapore are particularly vulnerable to developments elsewhere, many of which are beyond our control. Both our security and economic well-being will become even more susceptible to any instability in our external environment as we become more closely integrated into the global economy. Our borders may also become more porous to a diverse range of security threats, including non-conventional ones. We have to take a more integrated and co-operative approach to enhance our security. At the regional and international level, Singapore will work closely with friendly countries to promote dialogue, confidence-building and co-operation to maintain a peaceful and stable regional and international environment. Sir, over the years, we have built up extensive and good defence ties with many armed forces and defence establishments all over the world. And this is the issue raised by Dr Ong Chit Chung, Mr Hawazi Daipi and Mr Sin Boon Ann. We will do what we can to help promote greater defence co-operation and dialogue - not only within our region but also between our region and those outside. By doing our part to promote regional and international peace, we would also be enhancing our own security. Sir, at the national level, Mindef and the SAF will work more closely with other government agencies to enhance Singapore's capabilities to deal with a range of non-conventional threats, such as terrorist threats, piracy and cyber-attacks. I would like to assure Dr Ong Chit Chung and Mr Hawazi Daipi that we are very much alive to the dangers which terrorists can inflict on Singapore. This is a dimension of Total Defence that will take on greater significance in the years ahead. Sir, all these efforts will not be adequate without the backing of a united population committed to the defence of our country. Every Singaporean has a part to play in the defence of Singapore. The SAF's strength comes from each and every National Serviceman. As a small nation, we can only maintain an effective deterrence if we draw in all Singaporeans in Total Defence. Every in-camp training that our NSmen go to and every civil defence exercise that we participate in, is an investment in our own future. Sir, our success over the past 35 years would not have been possible without a defence capability. We have developed a thriving economy, our own distinct values and way of life, and above all, we have built and can be proud that we have a nation of our own. If we want to be able to carry on enjoying the fruits of our own work and the hard work of the Singaporeans who came before us, we must continue to ensure that we have the defence capability to protect us and to provide a firm foundation for Singapore's future development. Only then can we secure more good years of peace and stability and achieve our dreams and aspirations for ourselves and our children. Sir, I have dealt with some of the issues which have been raised by Members of Parliament who have spoken. My colleagues in the Defence Ministry will deal with the other issues which they have raised.

Sir, I want to thank the DPM for his comprehensive overview of the defence policies. Sir, the Auditor-General, in his report for the financial year 1998/99, has highlighted the irregularities and non-compliance with the Government financial procedures in the Ministry of Defence. The Auditor-General noted that five full-time National Servicemen were seconded to DSO National Laboratories, a privatised unit, in 1997 for about one to two years and another 14 National Servicemen were on loan to ST Automotive Ltd, a private company, in 1998. The Auditor-General deemed that there were irregularities in such a scheme. Audit revealed that in February 1998, full payment of $976,000 was made to a supplier for goods that had not been received by Mindef. The Auditor-General classified this as a "false declaration". The Auditor-General also reported irregularities in contracts awarded to DSO National Laboratories. Mindef officers who also served as the company directors were involved in decisions leading to the award of contracts to the company. Security deposits were not collected and banker's guarantee for advance payments of about $30 million was waived without proper approval. Audit also highlighted that a bank account for fixed deposits of $180 million was opened without approval of the Accountant-General, as required under the financial procedures. Sir, the Auditor-General noted that there was repeated failure to refund security deposits no longer required, amounting to $196,000. On the other hand, there was delay in clearing and collecting long outstanding personal advances to officers for official expenses, in some cases, up to six years. Sir, this is not the first time that such weaknesses are brought to the attention of the public by the Auditor-General. It would not do Mindef's reputation any good if this continues. I, therefore, urge Mindef to act, take remedial actions, exercise tighter supervision and undertake preventive measures so that such incidents would not recur again.

Sir, our military is held in very high regard and Mindef has earned its reputation as an efficient, credible, disciplined and honest organisation. Therefore, it was with much concern that I read in the Auditor-General's report for FY 1998-1999 where it was highlighted that certain financial procedures were not adhered to and that some financial irregularities had taken place in Mindef. Mindef enjoys tremendous bipartisan support both within the House and among the ordinary people. Naturally, when the AG's report came out, there were eyebrows raised among the public. The matter is compounded by the fact that Mindef has to operate in a cloak of secrecy. Parliament assents to this cloak of secrecy by asking for few details on the budget of Mindef which amounts to $7.4 billion this year. The grant of this cloak of secrecy by Parliament in turn requires an even higher standard of responsibility and accountability for public money when compared to other Ministries. Sir, I note that the Auditor-General's report was brief on Mindef's reply. I would like to ask the Deputy Prime Minister, firstly, as to whether the Auditor-General's report is accurate on the matters raised; secondly, whether there was any loss of money to the Government on the matters raised in the report, and lastly, what measures will be taken to ensure that such lapses do not recur in future.

Sir, like my colleagues before me, I do have some concerns on the matters expressed in the Auditor-General's report. I would like to add my comment on the false declaration. I perhaps understand that the idea was to make it easier to facilitate payment to the contractor. In this case, it was fortunate that the certificate of completion was given not because of any attempt to cheat the Government, but to help the contractor with the payment of the goods. Although malice was not intended, it nevertheless shows up a weakness in the system. Rather than counselling the parties involved, I would like to ask the Minister whether further improvements can be made to the whole process. Perhaps, a system of double signatures be put in place or an alternative scheme to ensure that similar breaches will not take place in the future. On the second concern raised by the Auditor-General, it was noted that contracts were made with Mindef-related companies resulting in numerous instances of non-compliance with the Government procurement procedures. It appears that Mindef officers who were appointed as company directors, were involved in decisions leading to award of contracts by the Government. Sir, the instance cited by the Auditor-General is an indication of how defence contract between two related parties in a cosy relationship can lead to an oversight of Government procurement procedures. I would urge the Minister to be on a vigilant safeguard to ensure that such breaches are not repeated again in the future. We also note that in the case of transfer of funds, some monies were transferred to a bank account which was opened without the approval of the Accountant-General as is required by law and standing instructions. The Auditor commented that this was a serious break-down in controls as the funds in the bank could have been siphoned off for unauthorised use. Would the Minister kindly explain how these accounts came to be opened and whether steps have been taken to prevent a repeat of such breaches. Like my colleague before me, I would like to emphasise that Mindef enjoys a high level of confidence among the members of the public. These instances cited by the Auditor-General must be addressed by the Government if the confidence of the public is to be maintained for the future. 4.15 pm

Sir, I rise because I am a bit uncomfortable about the brevity of information contained in the Budget statement under the Defence Ministry as it does not give me a good idea of how we are allocating resources to meet our defence objectives and priorities and I would ask the Minister for greater disclosure of information in the Budget statement. Sir, I understand that there is a need to maintain confidentiality on national security matters but would like to attempt to persuade the Minister to give this House a little bit more information on the various expenditures so that Singaporeans know how much we are paying to keep the peace and stability in Singapore through the various programmes and strategies. Singaporeans understand the need to maintain a very strong total defence capability and that we need to maintain a consistently high level of investment so that the SAF can remain to be a strong defence force. Therefore, we need to take a very long-term view that even during periods of economic crisis, we have maintained a very high level of expenditure so that our long-term goals are not compromised. Singaporeans also accept the fact that due to our limited resources, it is necessary for us to conduct training overseas, which is not only a complex matter, but a very expensive matter. As local training becomes more scarce, more sophisticated training facilities will need to be built to provide training conditions which are as realistic as possible. It will be good, and Singaporeans should know how much it would cost them. Singaporeans also understand that as part of our defence policy, we need to strengthen dialogue, confidence-building and cooperation in the region through military relations and commitments through multi-lateral defence agreements. We have witnessed how important these military relations are. For example, the personal relationships between SAF officers and TNI officers have been significant in maintaining ties during the difficult Habibie administration. While we continue to maintain relations at all levels between SAF and other armies in the region, can I interpret from the budget that the financial resources available for these programmes are available entirely from the public relations budget? How much are we doing and spending to develop better military relations with our neighbours? Sir, Singaporeans also recognise that we need to make in-camp training more convenient and as least disruptive as possible as people find it increasingly difficult to juggle between their work and their responsibilities towards the SAF. This is a small price we have to pay, but certainly we need to know how much it would cost us. I am aware of the on-going innovation, process improvement of procedures and practices to make training more relevant and realistic. As this would become increasingly important, perhaps we need to ask whether we can do more, or whether there are enough resources allocated towards this objective. Making in-camp training more relevant and meaningful is certainly an on-going commitment. As Singaporeans, we need to ask ourselves: are we prepared and how much are we prepared to pay for this? Singaporeans can also be proud to be able to contribute to international peace, for example, to be part of the United Nations effort in dispute and conflict prevention worldwide, and in terms of donation, assistance of equipment and personnel. How much of our defence budget is allocated for this purpose? In terms of community relations, we realise the significance of maintaining good communication and support with the public. In this regard, I am specifically asking the Minister to consider setting up another RECORD Committee to recognise the contribution of NS men, in view of the changing economic profile of the NS men. Sir, I said that on matters of developing strategic components of the SAF, building strong and indigenous technologies and purchase of military hardware, it may be best kept confidential in view of its implication on national security. But on all other matters that I have mentioned, I hope the Minister will not hesitate to inform this House how much has been spent on the various programmes to keep peace in this country. I think transparency, and a more open disclosure of information on the one hand and, the need to balance and maintain confidentiality and secrecy on the other hand, can be achieved and possible.

Sir, under this cut, I had originally intended to speak on new security challenges for the SAF. I note in the Minister's reply that the SAF is committed to meeting the new security challenges and I am much comforted by the assurance given by the Minister. I shall therefore not be making any further speech in this area. Can I have your permission to take the next cut?

Yes.

Sir, in the recent debate on the Defence Science and Technology Agency Bill, my parliamentary colleague raised the question of the Agency's accountability to Parliament. In the debate, it was noted that under clause 19 of the Bill, the Minister dispenses money given by Parliament to DSTA although Parliament provides the money. The Bill only requires that the annual report be given to the Minister for Defence and he in turn will give the report to a Committee to be appointed by the Prime Minister. It does not appear that the money appropriated by DSTA is a matter that is subject to public scrutiny through Parliament. Some concern was raised as to the issue of accountability on the use of funds. Sir, I understand that the work of DSTA has to be shrouded to some extent by secrecy as by its defence-related work, and by its very nature, it has to be secret. DPM has in his reply confirmed this. I agree that the fact that DSTA is now a statutory board does not remove any requirement of secrecy and the same has to be maintained for many of the detailed activities of the DSTA. I can well appreciate the argument why matters of financial provisions of DSTA should not be a subject of public debate. However, I would like to mention that there is a distinction to be made between public accountability on the one hand, and private accountability to a group of people who commands the trust and confidence of the members of the public to play their part in ensuring that the relevant agency is doing their work properly. In this debate, we are not saying that the Agency should subject its agenda or its programme to public scrutiny. What I believe our parliamentary colleagues are asking for is that a mechanism be set out which comprises independent parties who can help ensure that the funds appropriated by the agency are properly spent. Indeed, it did not help to inspire much confidence in members of the public when the Bill allowed for the appointment of an auditor and not the Auditor-General, who is an independent official of the State. We know that there are fixed financial procedures that are in place to ensure that the integrity of public administration is not compromised. However, I am sure, Sir, that you will agree with me that unless we institutionalise checks on our systems, lapses may occur. We note the recent report of the Auditor-General of the numerous instances of non-compliance with Government procurement procedures. This happened in a situation where we have two contracting parties who are in very close relationship to one another. Without an independent body to watch over the work of the DSTA, we cannot be sure that lapses in financial procedures may not occur in the future. Sir, it is in the light of our concern that I would urge the Minister to consider appointing the Auditor-General and members of the public, including MPs, who are seen to be independent bodies, to sit on the relevant committees to ensure that funds which are dispensed by the Minister and which are not subject to parliamentary scrutiny, are properly utilised.

Sir, I understand Mr Ravindran is not taking this cut. Can I take the three cuts together?

Yes, but you have to speak on this cut first as Mr David Lim has indicated that he will reply immediately after this.

Sir, the SAF is made up of a judicious mix of regulars, full-time National Servicemen and operationally-ready National Servicemen. And every year, the SAF has to make do and make the best use of the cohort of male citizens enlisting for full-time National Service. It emphasizes higher productivity and reliance on technology, and at the same time outsourcing non-essential functions. I am also glad to note that Mindef will adhere to the maximum of two and a half years of full-time National Service, and will not seek further extension of the period of service. I would like to ask, with the changing roles of the SAF, whether the SAF can cope with the increasing manpower requirements. With the recovery of the economy, are the various manpower schemes sufficiently attractive for the recruitment of regular officers and men? We know, at the same time, that it is the declared aim of the SAF to renew itself and keep the SAF young and fighting-fit. Is this working out well? While the SAF may be achieving its overall aim, may I ask if some officers are being moved up the chain of command too fast, such that field commanders may not have sufficient ground or command experience at various levels of command. I must say that it is not just a matter of pay. It is also about ethos, people management, the art of leadership and staff welfare. It is this common bond and team spirit that hold a fighting unit together in times of crisis and in the line of fire. Are our unit commanders trained and groomed to motivate the men in their command?

Sir, I would like first to take the cuts on the Auditor-General and financial procedures in Mindef. I would like to thank Dr Ong Chit Chung, Mr Ravindran and Mr Sin Boon Ann for raising their concerns regarding the Auditor-General's report on Mindef and this opportunity to clarify the issues raised. Mindef takes the Auditor-General's report very seriously. Firstly, I would like to emphasise that in all the breaches raised by the Auditor-General, there was no loss of funds due to the misuse of public funds or fraud. All the breaches have been rectified and all monies were at all times accounted for. Most of the breaches were the result of administrative lapses. Mindef appreciates the Auditor-General's observations and help in discovering these lapses and measures have been taken to ensure that the same problems will not recur. However, in some instances, Mindef felt that the breaches did not have the severe consequential effects noted in the Auditor-General's report. Sir, I would now like to take some time to give a more detailed explanation of the key issues raised by the Auditor-General. Firstly, bank account for deposits of $180 million opened without approval. The Auditor-General's report said that the bank account for three fixed deposits, totalling $180 million, was opened without the approval of the Accountant-General. It is said that this is a serious breakdown in control as funds in the bank could be siphoned off for unauthorised use. This is a fairly complicated case. Allow me to briefly explain the transactions and assure the House that the funds were, at all times, fully accounted for and could not have been siphoned out of Mindef's accounts for unauthorised purposes. The funds in question were part of a SAVER fund. The SAVER fund board had decided that the SAVER funds were to be invested in bonds, equities and cash instruments. Separate accounts would be opened for each category of instruments. At the material time, accounts had been opened with the approval of the Accountant-General for bonds and cash instruments. The funds in question were earmarked for the cash account for investment in cash instruments, that is, this $180 million. They were placed instead in the bond account. However, they were not invested in bonds because the bonds manager at that time had not yet been appointed. Instead, they were invested in fixed deposits, that is, in a cash instrument for two months. The officers in charge had done this because, at that particular time, the bank operating the bond account was able to offer a much more attractive interest rate for fixed deposits compared to the fixed deposit rates offered by other banks. The higher rate earned Mindef more than $400,000, in additional interest over the two months. But the placement of funds earmarked for the cash account into the bond account was wrong. The officers who authorised this transfer have, therefore, been reprimanded for this. However, Mindef would like to point out that the officers were able to transfer the funds into the bond account, instead of the cash account only because both accounts were properly set up with the approval of the Accountant-General. These accounts are subject to the usual financial controls adopted by the Government. The funds in question were, therefore, at all times, accounted for within Mindef and could not have been siphoned off to any unauthorised account outside of Mindef. Secondly, irregularities and contracts awarded to DSO National Laboratories. The Auditor-General reported certain irregularities in contracts that Mindef have entered into with a related company, DSO National Laboratories (DSONL). For example, it said that one contract was signed before the company was incorporated, and that Mindef officers signed several contracts on behalf of the company. It also said that Mindef officers, who were appointed as the company's directors, were also involved in decisions leading to the award of the contracts to the company. These observations imply that because Mindef officers were acting for both parties to the contracts, the dealings were not at arms length. 4.30 pm Sir, these irregularities occurred during the transitional period when the Defence Science Organisation was converted from a Government department to a corporate entity. The formation of a corporate entity meant that extant or existing projects in the department had to be converted overnight into formal contracts between Mindef and the company to ensure the continuity of projects. Mindef officers were involved on both sides of the contracts because DSONL was set up specifically to serve Mindef and the SAF, and Mindef officers were therefore appointed to hold key positions in the company. There was no collusion to award contracts unfairly to the company, nor to bypass tender or other procurement procedures as these contracts were made to regularise work that was already being done by DSONL before its corporatisation. I can therefore assure Mr Sin Boon Ann that this was not due to any cosy relationship between Mindef and DSONL. Sir, the Auditor-General's Report said that Mindef had made a full payment of $976,000 to a supplier for goods that had not been received by Mindef. This matter concerned the purchase of computer equipment. The project engineer had issued a post-dated acceptance certificate before he physically accepted the goods. The report pointed out that this was a false declaration. Sir, the issue of a post-dated acceptance certificate was a wrong action on the part of the officer. It was not done so much to help the contractor, but it was done for reasons that only the project officer would know. Perhaps it was to expedite payment towards the end of a financial year. However, Mindef has investigated this matter, and found that all the goods under this contract have been delivered and certified to be in good order and condition. We also noted that payment was made only after the goods had been physically inspected, certified and accepted. Mindef has issued instructions prohibiting post-dating of the certificate of acceptance. The Auditor-General also observed that the computation of employer and employee CPF contributions was incorrect. This was due to the different rounding-off method used by Mindef because of a different interpretation of the guidelines. Following the Auditor General's input, Mindef has since amended the computerised payroll programme to apply the rounding-off method adopted by the Central Pay Office. The earlier rounding-off method adopted by Mindef had resulted in an overall net over-contribution of CPF by Mindef of about $613,000 over a period of five years, from 1993 to July 1998. Essentially, for some servicemen, there were over-contributions of about $1 to $2 per serviceman per month. As it was not cost-effective to recover the net over-contribution, Mindef has requested the Ministry of Finance for permission to write off this amount. The Auditor-General felt that it was irregular for Mindef to second 19 full-time national servicemen to two companies that were not gazetted as designated organisations for national service under the Enlistment Act. Mindef referred this matter to the Attorney-General for advice. The Attorney-General has confirmed that the secondment and loan of the servicemen to the external agencies were lawful. However, Mindef has returned all payments received for the deployment of the servicemen to the two organisations since the servicemen were in the employment of SAF at the material time. Sir, the Auditor General also reported on several instances of non-recovery of various types of monies, and the failure of Mindef to refund deposits and clear other long outstanding accounts. Mindef has replied to the Auditor-General on these matters. If Members are interested, I will give them a full account upon request. Mindef has investigated these cases and rectified the matters raised. Sir, Dr Ong and Mr Ravindran have also asked what measures Mindef has taken to ensure that such lapses do not recur in future. Mindef has implemented various programmes to enhance the financial and procurement management in Mindef and the SAF. In the area of education and training, Mindef has launched new communication channels to quickly disseminate lessons learnt and best practices to the relevant Mindef and SAF personnel. In addition, all audit findings are circulated to the various commanders so that they can take steps to prevent similar problems occurring in their units. Mindef is also stepping up training on financial and procurement procedures. For finance appointment holders, our aim is for such officers to pass a proficiency test before they are allowed to perform their duties. When fully implemented, this system would ensure that only trained and certified competent personnel are appointed to handle financial matters and payments can only be made if the claims are handled by certified personnel. In the area of accountability, procurement agencies are now providing annual declarations that they have observed and complied with all procurement policies and procedures. This is in line with the Ministry of Finance's requirement. Sir, in conclusion, I would like to reiterate that there are strong and sound systems of control in place in Mindef. As a large organisation, occasional administrative lapses may happen from time to time. Nonetheless, Mindef is committed to complying with Government procedures in procurement and financial management. We continue to simplify and clarify our internal guidelines, and to take various measures to further strengthen our systems. Sir, Mindef is mindful that it has a big responsibility to ensure that defence funds are fully accounted for and well spent to build up a strong SAF and defence capability. I would like to thank Members for their continued support, and assure them that Mindef will continue to be vigilant and prudent in its financial and procurement activities. Sir, I now move on to the cut by Mr Zulkifli on defence expenditure and also by Mr Sin Boon Ann on accountability and secrecy in the SAF. Both these Members have expressed that they would like to see greater disclosure on the part of Mindef. Mr Zulkifli has suggested that without compromising secrecy, we should have more disclosure on things such as the cost to send troops overseas for training or for in-camp training or to maintain good military relationships with other armed forces. Sir, by its very nature - and the Members have noted this - matters of defence and security must be kept within the realm of secrecy, and cannot be subject to open discussion in public. Public disclosures of details of Mindef's procurement and the SAF's operations will compromise security. It will be prejudicial to the national interest. For this reason, Mindef has always kept details of its finances secret. Mindef has also never published details of its defence procurements. This practice, which is also the case in many other countries, will therefore continue. Nonetheless, Mindef is very conscious of the need to maintain high standards of prudence and accountability. And as I have just mentioned, measures exist to ensure that the defence budget voted by Parliament to Mindef is well used, and that the SAF continues to be an effective force able to defend the country. Within Mindef, there are comprehensive processes and controls to ensure that every defence dollar is well spent. There are also internal checks provided both by Mindef's internal audit department and this is in addition to the external checks by the Auditor-General. Ultimately, the Prime Minister and Cabinet being responsible for Singapore's defence and security will ensure that defence money is channelled to the right projects and procurements. These various checks are a safeguard to ensure that the defence budget is used prudently and responsibly. Sufficient safeguards therefore exist to provide a check and balance for defence spending. The public can rest assured that Mindef and the SAF will continue to maintain high standards of accountability in its operations and processes. Sir, Mr Sin Boon Ann raised a matter of the annual report and suggested that certain external members be appointed to look through this report. The Defence Science and Technology Agency Act already provides for the Prime Minister to appoint a Committee to receive and to examine this report, and I think we can leave it to the Prime Minister to ensure that persons of integrity will be appointed to this role. Mr Sin also suggested that the Auditor-General should be appointed to audit the Defence Science and Technology Agency rather than an auditor to be appointed by the Minister for Defence. I think the issue is not so much whether it is the Auditor-General who audits or whether it is any other auditor, but that again this task is done conscientiously by men and women who are independent and take their jobs seriously. I can assure Mr Sin that the people who will be appointed to this task will be such people. Sir, there was another cut by Dr Ong Chit Chung about manpower in the SAF. As my Deputy Prime Minister and Minister for Defence has already noted, wars are not won by technology or by machines but by people. Manpower is our most important asset and Mindef spares no effort to ensure that we are able to recruit and retain sufficient numbers of good people for the SAF. As the Deputy Prime Minister mentioned, the new partnership schemes that were announced recently for military officers and warrant officers are examples of some of the measures that we have undertaken to ensure that the SAF is able to compete effectively in the job market for limited manpower. In addition to this, we have in place many schemes to attract talented people to join the SAF. For example, we offer scholarships. And at the apex of SAF is the Overseas Scholarships Scheme to attract some of the brightest school leavers to join the SAF. The Overseas Scholarship Scheme is second only in prestige to the President's scholarships, and it is instrumental in ensuring that each year we have a fair share of the national talent pool. Besides the overseas scholarships, we have arranged for other local and overseas awards also to attract bright students to take up military careers. So, Dr Ong can be assured that upon joining the SAF, military personnel can look forward to a challenging and rewarding career. Dr Ong also mentioned his concern that there may not be enough time for commanders to spend time in specific commands because the routes of advancement and their careers are rather short. I would like to assure Dr Ong and Members of this House that this is an area that Mindef pays particular attention to, and routes of advancements are carefully designed to ensure that commanders have sufficient command as well as staff responsibility before they move on to a higher level of command.

Sir, can I ask the Minister of State for his comments on my request whether he would consider setting up a RECORD committee to recognise the contributions of national servicemen?

I am sorry I missed that question. Sir, the last time we had a RECORD committee was some four or five years ago. I would be happy to consider the Member's suggestion and make an announcement on this at some later date. 4.45 pm

Sir, first I want to thank the Minister of State for his frank responses and trust that Mindef will put measures in place to ensure accountability and proper procedures are observed. Sir, we talk about maximizing our defence dollar and getting maximum value for each dollar we put into defence. With our scarce resources and limitation in manpower and space, we must optimise the use of manpower as well as land. Land use could be optimised by relocating and redesigning camps, let units share common facilities, put some facilities underground, for example, putting the ammunition dumps underground, train more intensively overseas and use IT and simulation technology to cut down the use of space. In terms of manpower, courses and exercises should be well designed to optimise the time available. Idling time should be minimized. Those who have been through NS know often times the NSmen have to wait a long, long time at the range for their turn to shoot. It was a very long wait. Can we not revamp the system and cut down idling time at the ranges, for example? May I ask the Minister what further progress SAF has made in optimising the use of land as well as manpower? Sir, I will go to my next cut. Some three years ago, we had a number of unfortunate casualties in the SAF during training and exercises. The whole SAF was geared up to give the highest priority to safety measures in training. I wish to ask the Minister for an update of the safety measures implemented, and whether such measures are being followed religiously by all units.

Sir, I support what has been raised by Dr Ong Chit Chung and I appreciate that SAF training has to be realistic enough to prepare our servicemen for actual combat situations. I understand that the SAF has very comprehensive safety measures already established. However, could the Minister tell us what additional measures have been initiated to enhance safety in training, especially at unfamiliar overseas training areas and whether these measures are indeed effective?

Sir, ultimately, defence is everybody's business, not just that of the National Servicemen. It is the business of each and every Singaporean. It is the total defence. It requires the support of the family: the father, the mother and the siblings. National Service is now accepted as part and parcel of life, part of the Singaporean's way of life. National Service is so institutionalised and ingrained, that it has become a people's movement for the defence of the homeland. I call it "homeland", because we are defending our homes, every home and every inch of our land. Nowadays, at the meet-the-people sessions, we see more and more cases of petitioners appealing for upgrading rather than downgrading of medical classifications in NS. Our young men would rather be in the combat vocations. They compete fiercely for a place in the Officer Cadet School. This is indeed a good sign. There is no doubt that young National Servicemen are now better prepared and enlist with the right attitude and aptitude. This, no doubt, is helped by the improvement in the facilities and services in the SAF. The food, for example, has improved tremendously. Some even told their mothers that the food in camps is better than that of mum's cooking! I am sure mum does not mind a little bit of competition. My son told his mother that. The point here is that if all appreciate the importance of defence and National Service, then we would have achieved the aim of Total Defence and the strategy of deterrence. As Sun Tzu, the strategist, said, we would win the war without fighting. The enemy would not dare to make the first move. May I ask the Minister if Mindef will further enhance the national education programmes in the SAF, and work closely too with the Ministry of Education and the schools to further promote the concept and practice of total defence.

Mr Ravindran, you could take your three cuts together.

Sir, total defence highlights the critical role everyone has to play in the defence of our country. It is important that our citizens be constantly reminded to be ever vigilant and prepared for a sudden change in the security situation. I was happy and impressed with the recent spate of advertisements that were shown on television. It was a wake up call to Singaporeans who are complacent about national defence. The advertisements were direct and hit home the message clearly. I must compliment Mindef for that bold initiative in strengthening Psychological Defence which is one of the five key elements in Total Defence. Sir, increasingly, more and more foreigners are taking up PR and citizenship here. Many of them do not undergo the growing up and shared experience of a Singaporean. They have not studied here nor done NS. I see a challenge in making this group of new Singaporeans committed to the defence of Singapore. Sir, I would like to ask the Minister in what other ways the Ministry intends to further inculcate the importance of Total Defence among the people of Singapore, particularly among our new migrants. I would also like to ask the Minister whether a co-ordinating committee exists to coordinate our efforts at Total Defence. If so, the work done by such a committee. Let me move on to the next topic on the SAF and East Timor. I must commend the SAF for the quiet but essential role by the SAF in East Timor as part of the INTERFET team. Our LSTs, though old, played a critical role in the transfer of much needed logistics. Our soldiers were also said to have conducted themselves in a professional and friendly manner with all the other INTERFET participating forces. They have done the SAF and Singapore proud. Sir, the United Nations Transition Administration for East Timor (UNTAET) is now in place in East Timor. I would like to ask the Minister in what ways the SAF is helping UNTAET and the people of East Timor in rebuilding the country. I would also like to ask the Minister for an assessment on whether there are any threats to the safety of our men and the challenges faced by them in East Timor. Sir, I will move on to the third topic, defence science and technology research. It has become a simple truth that superior technology capability is a force multiplier in war. Jane's Defence Weekly in its 9th February edition highlighted the future role of autonomous weapons, robotic warfare and how they will greatly impact military doctrine in future. It is clear that superior technology is vital in winning wars. Sir, the setting up of the DSTA will provide the SAF with a one stop agency that will take care of the SAF's defence science and technology research needs. In view of the fast changing pace of technology and equipment, it is critical that we do not rely on DSTA's inhouse capabilities for all our research needs. In fact, many overseas defence science and technology research organisations have gone into both local and overseas joint collaboration to conduct R&D in these fields. I am glad that Mindef has also embarked on this path recently. It will certainly help reduce the learning curve and minimise the time to bring a product into use. Sir, I would like to ask the Minister the following questions: (1) What are the measures taken by Mindef to work closely with the industry, the academic institutions and overseas research establishments to ensure quality research and that there is transfer of knowledge from the private sector to Mindef and vice versa, particularly in R&D which has civilian applications? (2) Whether DSTA has plans to implement a scheme similar to the one in place by the DEFA in the UK called the "Pathfinder" Programme which can allow industry to bid for DSTA funds for novel defence research in areas which meet both the companies and the DSTA's priorities and represent ideas which are superior to those coming up within DSTA. (3) Whether DSTA would consider setting up dual use technology centres where new technologies being developed can be used both by Mindef and for civilian use. (4) Whether DSTA has plans to sell its research facilities and services for civilian application directly to the industry. (5) Whether Mindef is going to set itself a minimum percentage benchmark figure in their budget for annual research so as to ensure that research is never neglected as was found in some countries.

Sir, Mr Sin Boon Ann and Mr Ravindran asked about the Five Power Defence Arrangements. Since its establishment in 1971, the FPDA has been an important element of the security architecture in our region. The underlying principle of the FPDA is that the defence of Malaysia and Singapore is indivisible. Or as the then Malaysian Defence Minister Dato Abang Abu Bakar put it last year, "Cubit paha kiri, paha kanan pun sakit," or "If the left thigh is pinched, the right thigh also feels the pain." Hence the indivisibility of defence. FPDA members would immediately consult together on what measures should be taken to deal with an attack or aggression against Malaysia or Singapore. Any aggressor will therefore have to take into account not only the individual responses of Malaysia and Singapore, but also the collective response of these two countries plus Australia, New Zealand and the UK. This is a deterrent. Although FPDA exercises were suspended for a short period between 1998 and 1999, the FPDA is now back on track. The exercises and activities resumed last year. This year the FPDA will conduct two major exercises. Exercise Flying Fish 2000 will coincide with the 4th FPDA Defence Ministers' Meeting in Singapore this July. FPDA members have also been reviewing how the operational arrangements and exercises can be enhanced for greater professional benefit for the participating forces and to ensure that the FPDA continues to be relevant to the security of Singapore and Malaysia and the region. Sir, Malaysia has assured the other FPDA members that they are fully committed to the FPDA. Since the resumption of exercises last year, they have participated fully in FPDA activities. Arrangements have also been worked out to facilitate smooth and expeditious search and rescue should that be necessary. Dr Ong Chit Chung and Mr Charles Chong have asked about piracy and illegal immigrants. The problem of piracy has been discussed within ASEAN and the ASEAN Regional Forum (ARF). ASEAN has agreed to intensify bilateral co-operation, while the ARF will explore co-operative approaches to deal with the problem. On a bilateral level, Singapore has a standing arrangement with Indonesia called the Indonesia-Singapore Co-ordinated Patrols (ISCP) to help us deal with piracy in the seas around Singapore. Our Navy and Police Coast Guard and the Indonesian Navy and Police work together on this. The arrangement allows an effective exchange of information and facilitates cross-border pursuit. This co-operation has been going on smoothly and effectively. The incidence of sea robbery within the ISCP area of operations has been significantly reduced since this arrangement started in September 1992. There were some incidents in the first quarter of last year but after the ISCP stepped up surveillance and patrols, there has been no report of sea robbery since mid-April last year. The navy has also been supporting the efforts of the Home Team to prevent illegal immigrants from reaching our shores, both in the planning process as well as in assisting the Police Coast Guard at sea by providing surveillance to detect suspicious vessels carrying illegal immigrants. And the Navy will continue to do so. Mr Charles Chong and Dr Ong also asked about training safety. The SAF takes training safety very seriously, whether the training is conducted locally or overseas. Today, the culture of training safety is deeply ingrained in our system. There is a strong and continuous emphasis by commanders at all levels of the need and importance of safety training. The process begins at all our training schools where future commanders of the SAF are exposed routinely to briefing and frequent updates on training safety so that they learn to accept safety as an integral part of military training. The challenge for our ground commanders is not to avoid training but to proactively manage these activities to minimise the risks. For training in unfamiliar training areas, both local and overseas, the accompanying risks are identified systematically through the use of Risk Assessment Matrix beforehand. Thereafter, the potential risks are proactively dealt with through such measures as safety briefings, ground orientation to unfamiliar terrain and rehearsals prior to the conduct of the actual training. Safety audits are also carried out by Training Inspectorates in the Army, Navy and Airforce. Lessons learnt from their audits are shared with other units and the findings of the Inspectorates are routinely reported to the highest levels in the Ministry of Defence. 5.00 pm Sir, I am glad to report that these and other measures taken by the SAF have been effective. The number of fatal accidents in 1997 was six. Last year, in 1999, there was unfortunately one fatal accident. The number of training injuries dropped by 45% between 1997 and 1999. This improvement is a result of sustained efforts by the SAF to improve safety and has been achieved without lowering the tempo of training and training standards. The SAF will strive to improve on this because even one accident is one too many. The SAF will continue to ensure that our training is realistic and, at the same time, develop measures to proactively manage risks. Sir, Dr Ong Chit Chung has asked about optimising of land use. The SAF works closely with other national agencies to identify commercially less viable areas to locate its military camps and to conduct its training. The development of the Basic Military Training Centre and the School of Infantry Specialists complexes in Pulau Tekong are notable examples. New camp designs have allowed for more intensive use of land. In addition, where possible, bigger camp complexes are built to replace several smaller ones. The sharing of common facilities and services in the big camp complexes has resulted in land savings. As a result, in the last five years alone, a total of 27.48 hectares of land were returned by the SAF to the Land Office for other use. This is quite considerable, given the activity level of Mindef and the scarce land resources in Singapore. Sir, Mindef also continually seeks out new construction technology to optimise land use. For example, in 1999, we launched the plan to excavate a large cavern for an underground ammunition dump out of solid granite. This innovative solution will free more than 300 hectares of surface land area for more intensive use. The underground ammunition dump is located in Mandai and is expected to be completed in 2003. The SAF has also invested heavily in simulators. The benefits are numerous. Simulators provide a high degree of realism, reducing the need for large training areas. Tank crews are now trained using the Integrated Armour Tactical Trainer. Simulators also enable training to be carried out under different conditions, some of which you cannot do even with live training. We also train extensively overseas and this helps to relieve the problem of training area shortages in Singapore, and we will continue to use our scarce land resources as well as possible. Dr Ong also asked about optimising training time. In the 1990s, we took a fundamental review to ensure that full-time National Service training is focused and that the time spent by full-time National Servicemen on mundane chores is minimised. Where possible, maintenance services are now commercialised. Full-time National Servicemen are no longer required to perform general housekeeping duties for common areas, such as wash room cleaning, maintenance, etc. This enables them to devote more time for training. Some people complain, especially the older National Servicemen, that we are going soft. But I think that if we can make use of the time better for training and we can differentiate between things which are done for domestic purposes in the camps and actual live training in the training areas, and keep the live training in the training areas as realistic as possible, while making the domestic aspects as convenient as possible, we will still be able to achieve our objectives. In addition, those who are fit, for example, those who have attained at least a NAFA silver before enlistment, are exempted from six weeks' physical training phase. So they are enlisted later compared to those who did not attain at least a silver and have to undergo the six-week programme. Dr Ong also asked about time spent at ranges. I know it is very frustrating for people who go to the ranges. We will see what more we can do. But already we have done a number of things. Simulators are used a lot more for train-fire with rifles and that cuts down the number of times people need to go to the range and makes more productive use of the time that they do spend on the range. So it is quite common for soldiers who go for the first time to the range now to score very, very well, because they have become so used to it with simulators. We also have automated many of the ranges so that soldiers spend much less time sticking up and down targets and pasting targets by the butt party. And we will continue to find better ways of doing this. For National Servicemen, we know the in-camp training is disruptive to their civilian life and what we would like to do is for the time that they are back in camp, to use the time as usefully as possible. For example, we minimise call-ups on NSmen by grouping several activities together so that they would not be called up so many times. I think we can still do better. We also do not call up all the NSmen in the unit altogether. We stagger it so that those who need to come back earlier like the Commanders and so forth, come back first, and the men come back later. Also, Unit Commanders can release their units early if they achieve the training standards. We have also been using IT where we can. For example, training materials are given to NSmen in the form of CD-ROMs, so that they can train on their own and at their own pace, whereas in the past we had to call them back to camp to undergo that kind of training. We will continue to seek improvements so that time spent on training to prepare to defend the country is well used. Some questions have been raised on National Education. National Education is a key element in helping to strengthen our Total Defence. The Ministry of Defence is working together with Ministry of Education and other Ministries on Total Defence and National Education, to make Singaporeans and new Singaporeans more aware of the need to be loyal and to defend Singapore. And there is a coordinating committee chaired by PS (PMO), who is also the PS (Defence), to oversee the National Education effort undertaken by the various Ministries and Government agencies. I would like to thank Dr Ong for his complimentary remarks about the food. Regardless of that, I still would look forward to an invitation to his home for dinner. I would also like to thank Mr Ravindran for his compliments on the recent Total Defence awareness programmes. Mr Ravindran raised some points on defence science and technology research. Technology is strategic to Mindef and the SAF. As a small country with limited resources, it is important for us to leverage on others to obtain the technology we need. Mindef actively seeks out centres of excellence in our industries, universities and research institutes, as well as those in other countries who are open to collaborate with us. Of course, there are some limitations because of security considerations, both on their part and our part. Mindef will continue to do this in the new Defence Science and Technology Agency (DSTA). Funding is awarded to the most competitive proposals and joint funding is the norm where two or more parties are interested. The DSTA will continue to look at the best ideas regardless of their origin for the benefit of Mindef and the SAF. In fact, today, defence R&D is not just done in the DSO National Laboratories but also at our two universities and national research institutes as well as with foreign partners. We have been doing this with our universities for over 10 years and a number of dual-use research centres have been established to better tap universities' expertise. This effort will be expanded further with the setting up of DSTA. DSTA's funding for science and technology will be directed at solving problems of defence. But this can often be applied to commercial arena. And where such applications are beneficial to the nation, DSTA will be open to explore their exploitation. Currently, Mindef does set aside a portion of its R&D funding for the exploration of future technologies and system concepts to ensure a good balance between technology push as well as the demand pull. That is, what the users want today and what the technology can offer perhaps tomorrow. This has been an integral part of Mindef's policy on research and development for many years. This approach will continue with the establishment of DSTA. Sir, Mr Ravindran also asked about East Timor. During the INTERFET phase - from mid-September last year to the end of February this year - Singapore contributed three Landing Ship Tanks, a C-130 aircraft, a medical detachment and a military liaison team. Our LSTs were the main strategic lift assets of INTERFET. I understand that they carried some 60% of the sea lift cargo for INTERFET. They helped meet INTERFET's surge requirements during the build-up phase and transition to UNTAET, lifting about 2,400 tonnes of cargo in all descriptions, shapes and sizes. As of last month, our medical team had treated about 6,500 people, both INTERFET personnel as well as East Timorese. All in all, close to 400 SAF personnel participated in INTERFET. And this number includes 43 full-time National Servicemen who have volunteered for the mission as well as eight regular servicewomen. For UNTAET, Singapore has contributed a 21-member SAF medical team, three military officers to UNTAET headquarters and 40 civilian police from the Singapore Police Force. Singapore is also prepared to provide technical assistance to East Timor within our means. We hope that East Timor will be able to achieve a smooth transition to nationhood under UNTAET. But East Timor's requirements for rebuilding the country are enormous, and the assistance of the whole international community and not just the regional countries will be needed. As for the threats to the safety of our personnel in East Timor, when we send our people to such missions and in such situations, there will always be some inherent risks. But our people are professionals, and I am confident that they are trained to deal with such eventualities. Sir, I believe I have dealt with most of the issues that Members have raised. The Ministry of Defence wishes to thank Members for their questions and contributions during this debate and also for their support. Mindef will continue to endeavour to do its best with the resources allocated to it by this House to fulfill its duty of defending Singapore and Singaporeans.

Sir, I want to thank the DPM and the Ministers for their very full and comprehensive replies and we are rest assured that Mindef is in good hands and that we are able to defend our country. Also, I am glad that we have used our time very efficiently and that we have finished before the "guillotine" time. It is a very rare occurrence. On that note, Sir, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $6,562,000,000 for Head K ordered to stand part of the Main Estimates. The sum of $861,000,000 for Head K ordered to stand part of the Development Estimates.

It is indeed very rare that the debate on a Head has finished way ahead of schedule. The Chair would like to thank Members who have just taken part for being so merciful. Perhaps for the remaining days, hon. Members could take the cue from those who have just spoken. Head J -

Head J - Ministry of Community Development and Sports. Amendment No. (1), Dr Vasoo.

5.14 pm

Sir, I beg to move, That the total sum to be allocated for Head J of the Main Estimates be reduced by $100. Sir, in view that we have some time - it is a bit of a bonus for me - I would take the opportunity to elaborate on an area which is of interest to me, and I hope that other Members would be able to join in the debate to make it as lively as possible. Sir, in connection with family and sports policies, I see it is a very important issue. As we have just finished debate on the Ministry of Defence, we are now entering into an area of social defence and this is a very important area that we should examine and see how we can strengthen the people sector. We should particularly re-examine and revisit some of these areas in order to see how we can make Singaporeans more caring and more supportive in terms of others who need support within our community. This is very critical because we need not only the hardware that we have built over a period of time, but also the heartware. We require people to build better communities. This is an area that we feel more funding can be deployed so that in the longer term, we will be able to build a more viable community. Singaporeans can be more reciprocal and be able to provide the necessary support to those Singaporeans who may require assistance. In short, what I am saying is that those who can must support those who cannot. The question is: how do we encourage and cajole Singaporeans who have the ability to contribute to those who are less able than themselves? To do that, I would urge all Singaporeans to stand tall and find ways that they can contribute meaningfully in community building and bring about a better social cohesion within the community. We have talked about the digital divide, we have talked about communities with different social classes; we want to prevent abrasions in the community; we want to look at how we can socially integrate communities and between the races, social classes and the different intellectual gaps that we have. All these are essentially important and we have to seriously examine what we can do as a community so that Singaporeans will be able to respond quickly to participate in social defence, an issue which remains very critical and important. I would urge our community to examine what each of us can contribute. It requires serious gumption, analysis and review of what we can do, as Singaporeans, to contribute to the social development of our community. And we are talking about people development, an issue which is very important, other than defence and economy. It is the people sector that we will have to seriously look at and find ways and new strategies to see how we can strengthen the tenacity and capacity of Singaporeans further. This is a serious business because dealing with people is very complex. And it is a very complex issue that requires the examination mobilisation of different effective people strategies to build people to be better people. I hope my fellow Parliamentarians will be able to join me to see how we can encourage and support the Ministry of Community Development to undertake its new mission and role because the Ministry has added a new portfolio, that is, sports within its purview. This is a welcomed change and we are not only trying to build a sporting community, but also a group of people who are viable, caring and supportive. Sir, I must draw your attention that we will be facing serious consequences in view of our declining population. As you know, we are now having about eight persons supporting one retiree. In about 20 years, it will be half. We will have only four persons supporting one retiree and it is indeed a burden that we will be running into. It is a very important arena and Singaporeans need to examine what they can do to arrest this declining population other than allowing immigrants and others to come in and inviting foreign talents and other people to contribute to our economy. Singaporeans themselves must critically study what they can do to contribute to this declining population that we have. This issue would have serious ramifications for our community, as you would appreciate. We will have insufficient people to defend ourselves. We have just talked about defence. We will have less people to defend our nation and to participate in National Service. Eventually, what do we do? Where do we get sufficient people to serve in the National Service? Dr Ong, Member for Bukit Timah GRC, has just spoken that we have a very viable defence policy. But there is nothing to defend if we do not have any people. That is an issue that we need to look at very seriously. It is indeed a serious business that we need to examine and see how we can encourage Singaporeans to replace themselves. It is very important to find a reasonable replacement level. If we are unable to defend ourselves, where do we get the people? If we do not have enough people, we have to import mercenaries to defend us. That is a serious question which we have to look into. I hope that we would not get to that stage. Therefore, we will have to see how we can cajole Singaporeans to find a reasonable replacement for themselves. The other serious consequence is that we will have less manpower to man our social and economic sectors. This will in the long term affect our viability. I am sure you will agree with me that we require people to manage the economy, run the industries and to meet the challenges ahead. That you will require the people's contributions. With less people available, the burden will increase in the hands of the few that we have. When we do not have enough people, the economy is likely to run down. We will become less productive and therefore less able to manage and mobilise resources to revitalise and make further economic progress. That is a very serious issue that we have to think about. Who is going to man the industries, the manufacturing sector and the different enterprises that we have? We have talked about a knowledge-based economy. We have talked about entrepreneurship. If we do not have people, all this comes to naught. But the question is whether we would be able to arrive at that level if we are going to face the problems of population decline. I would like to draw the attention of Members that our replacement rate, in the last 20 years, had fallen from 2.8 in 1970 to 1.5 in 1998. Therefore, we are reducing by nearly half. This is indeed a very important issue. Let me try and round up, Sir. There are some pressing issues that I need to highlight and I hope you will give me a few minutes to just round up.

I will give you one minute.

We have young people whom we need to cajole. Therefore, it is very important that we give them the right signals. I appreciate that it is a challenging task to bring up children. There are different complex issues facing the family today and we need to appreciate some of the problems so that we can make child rearing and bringing up children a pleasant task. But it is a challenging task, I must say, because there are competing demands on the family itself. Sir, the Ministry of Community Development is trying its best to strengthen the work of the Family Development Division. And I feel it has a very important role to play in developing more programmes to support young families in childcare and encouraging the bringing up of more children. So the issue of procreation requires the attention of more Ministries than MCD. I do not think that MCD is sterile of ideas. Given the current resources, MCD is doing a good job and with more help given it can be effective.

Order. Dr Vasoo, that is enough. Please resume your seat.

Sir, pleading the cause of the family to the Minister for Community Development is not just like preaching to the converted, but to the bishop himself. Nevertheless, I think it may sometimes be useful for the bishop to be able to say to the other monsignors at the Vatican that the parishioners are clamouring for attention. Dr Vasoo has laid out in great detail the philosophical and conceptual ground work on which we can start this debate. I am going to talk about a few nitty-gritty details. Firstly, I am really very happy to see in the budget the provision for 49 new childcare centres and 25 student care centres. I remember previous briefings that I have had, while serving on various committees, from MCD officers who have spoken of plans to gradually increase child and student care centres. And I would like to commend the Ministry for delivering these commitments. 49 childcare centres equate to about one new childcare centre every week and 25 student care centres, one every fortnight. However, numbers, although important, are not the be-all and end-all of the issue. The recruitment and training of childcare teachers and assistants, both in numbers and in calibre, remain a concern. Last year, MCD developed guidelines for qualifications required of supervisors and teachers in early childhood care and education. But I suspect that we may be in a bit of a bind here as the poor salaries that these jobs command will attract and retain staff of only a certain level of education and calibre. Yet attractive salaries can only be afforded with higher fees and/or higher subsidies. I wonder if the Minister can share with us if there is any review plan being undertaken on this subject. Standards and quality of care provided, methodology used and curriculum covered and their consistency across the range of centres run by different operators with childcare centres under the supervision of MCD and kindergartens under MOE are a major concern, and there has been an extensive and impassioned media coverage of the subject in recent weeks. I will not delve on the subject here as I know the whole issue of pre-school is currently being reviewed by a committee under Senior Minister of State for Education, Dr Aline Wong, with participation and representation from MCD. I am sure we will get a comprehensive and lively debate on the subject of pre-school education under the MOE cuts. Suffice for me to say that I do hope that many issues brought up in public discussion in recent weeks will be ironed out and we will see a system put into place which will put a stop to the spiral of increasing expectations on our very young children. 5.30 pm One other item, with regard to childcare centres for the Minister's consideration is whether the provision of infant care services for children from 2 to 18 months can be encouraged, through increasing the subsidy for this service to offset the higher cost that comes from the higher staffing ratios that this age group of children require. Currently, very few childcare centres take in children below 18 months and it will be most helpful to those parents who wish to use such a service if more places were available. Moving to student care centres, my main request here is for more school-based centres, as I believe this will be much more convenient for parents who would then not need to worry about transporting the child to and from school and community-based centres. For both child and student care centres, I hope that the Minister will periodically review subsidy levels. As the financial burden of childcare arrangement is not insignificant, even with the Government subsidies, the dollars quickly add up, especially if the family needs to care for more than one child.

Sir, thank you for allowing me to get into the debate again. The family is under competing demands today. As you know, many of them are dual income families. They have to look after children. They have to manage their work, and they have to cope with their household demands. These are issues we need to address and I understand the Ministry of Community Development has set up various support services for the families but I think it is very important for us to understand the changes that have taken place in the family and there are more changes to come. There will be various competing demands on the families of the future. It is important that we set up at least an Inter-Ministerial Committee on Family Life and Development to look into the matter more carefully. I feel that the Ministry alone will not be able to manage and tackle the problem because it requires the intervention of other Ministries. Therefore, it is very important that we draw the participation of other Ministries to examine the issues of family life which have implications on young children and young persons. In relation to this, we are also concerned about the increasing number of issues related to juvenile delinquency because families are unable to provide care and supervision for some of them. We have latchkey children and therefore there is an increase in juvenile-related problems in the community and this problem is related to the family as a whole. I would like to find out from the Minister what has happened to the revision to the Children and Young Persons Act and what steps would be taken to deal with the juvenile delinquency problem. In connection with sports, to encourage children and young persons to become sportsmen, and as we want to be a sporting nation, we need to produce a number of international sportsmen. There is a need to mobilise more resources to promote outstanding sportsmen in the different areas. I would like to find out from the Minister what plans there are to deal with the whole issue of sports and sports development.

Sir, I would like to ask the Minister to comment on how youth affairs are managed in Singapore. To the best of my knowledge, there are a whole range of organisations that deal with matters of interest and importance to youth. We have the People's Association Youth Movement, which is involved through its multi-various agencies in the community centres, the Youth Executive Committees. We have the National Youth Council, which is also involved in youth-related affairs but largely working through VWOs. The Ministry of Community Development itself has some degree of focus on youth-related matters through its division, and other Ministries, such as the Ministry of Education and the Ministry of Home Affairs, for example, deal with certain aspects of their work which pertain to the youth. It will not be far-fetched to argue that there would be significant scope for synergy in bringing some of the issues together in dealing with matters that affect the youth. In particular, Sir, about a week or so ago, the National Youth Council held a seminar with young Singaporeans in which many voiced out this concern, that is, whether the interests of the youth are well-taken care of, especially when we have an ageing population which will appear, at least, in theory, to compete with the interest of the young and also as many other social pressures are brought to bear on our young Singaporeans. The question I have for the Minister then is whether there is scope to establish a focused central body, perhaps a statutory board, or a department under the aegis of the Ministry of Community Development, to address youth matters on a holistic basis. This could be a variation of what we already have, in the form of the NYC or the PAYM or it could be something entirely new and it need not encroach into the areas that are traditionally the responsibility of MOE or the Ministry of Home Affairs. But certainly, on the social aspects of youth matters, this can be addressed. There have been calls for a Youth Ministry but I suspect the arguments there are not strong enough or compelling enough, but there is a reasonable case to be made for a more centralised approach to coordinate certain efforts targeted at the youth. I would appreciate it if the Minister could give us a response on this.

Sir, the dual-income families are a normal phenomenon in Singapore these days and female workers account for about 40% of our total workforce. The contributions of women to their families and to their country are indeed substantial. A majority of our working women are holding full-time jobs, just like our working men. But women continue to bear the primary responsibility for family and childcare tasks. Studies have found that women in dual-income marriages encounter more role overload than their husbands. Working mothers, who are torn between the demands of home and the workplace, are sometimes troubled by problems such as unsupportive and demanding husbands, and rebellious and wayward children. On top of all these family problems is job stress. Sir, I would like to beseech the Ministry of Community Development to look at the help that can be rendered to our dual-income families to support them. If we can be successful in this area, we will be able to ensure more ideal families, especially in areas of stronger marriages, better procreation and stable families. It will be best if the effort in this area is done jointly by the Ministry of Community Development together with other concerned Ministries. Sir, it is very important that we encourage a change in the mindset of many Singaporeans. Husbands cannot depend on their wives to care for the entire household and parenting tasks and, at the same time, bring in additional income for the family. Many men see participation in household tasks and child rearing as a threat to their masculinity. There was one Aryee's research in 1992 in Singapore that found that job-homemaker conflict experienced by professional women in Singapore is significantly reduced when the husbands contributed more hours in doing housework. Spouse support, both physical and emotional, is therefore a vital recipe for working women to cope better and a formula for a successful marriage. The Ministry of Community Development should steer a campaign on this issue urgently and successfully. Childcare is always an essential consideration for many dual-income families. The Ministry of Community Development should therefore continue to provide for more childcare centres. Could the Ministry of Community Development also provide other new childcare assistance initiatives such as "share-a-maid" and "borrow-a-granny" schemes? Sir, with the "borrow-a-granny" scheme, a retired but well and able elderly baby-sits on an ad-hoc basis for other residents in their constituency. Such a scheme is best operated from our Centres of Activity for the Retired and Elderly where there are many suitable elderly who may be willing to render such a service. Sir, it will be beneficial if the Ministry of Community Development and the Ministry of Manpower work closely to facilitate flexible work arrangements for working women. The Government may consider providing more incentives to encourage this arrangement and to ensure its success. Employers should be encouraged to transform part-time work from being temporary and casual in nature to that of a permanent scheme, in terms of job security, remuneration, benefits, training and promotion prospects to the part-timers. Another area that is worthy of attention is job security while families are pursuing procreation. Could the Government persuade employers, maybe in the form of certain incentives, to allow women to take longer unpaid maternity leave (up to one year) to care for their infants? Would the Ministry of Community Development, in collaboration with other Ministries, for example, Ministry of Manpower, facilitate the option of job sharing? This has worked well in other countries and a significant number of working mothers job shared effectively. Could we also look at more opportunities being made available for working women to work from home either on a part-time or full-time basis? Yet, another consideration is for the Government to approve paid leave for a parent to care for sick children. This should apply equally, both to a mother and to a father, and this will be a strong signal from the Government in encouraging the equal role of child parenting in our families. Sir, I hope the Minister for Community Development could consider these issues and help us have our families strong and stable.

Sir, may I take my two cuts together?

Sure.

Sir, MCD runs a family life education programme. The Ministry, through its various agencies and working with other Ministries, for example, the Ministry of Health, runs a whole series of talks and organises workshops and seminars and produces a massive array of brochures and publications on marriage, married life and parenting. Unfortunately, the reach of these efforts is very limited. The people who come for the talks and pick up the brochures are the ones already in the right church, sitting in the right pew, nodding their heads in agreement with the sermon. The vast majority of Singaporeans are, in the meantime, carrying on chasing economic success with no time at all to pay any attention to matters which, to them, are of such secondary importance. Life in Singapore is couched in economic terms, that is, gains and profits, productivity, value-added propositions and marketability. We have little time for family relationships and values. Young Singaporeans are delaying marriage and the commonly cited reason is to achieve financial stability first. The importance of marriage as an institution is undermined by the monetary value attached to the first matrimonial home that young couples aspire to own. I know of two young couples who rushed to the ROM to get registered to get into the HDB queue, only to now be filing for separation after finding out that they are not so compatible for a life-time together after all. Parents abdicating their responsibilities to domestic helpers in their efforts to pursue careers so they can afford the trappings of material success. Students are focused totally on academic achievement. Who has time for values? 5.45 pm We need a much more concerted and comprehensive effort to address this culture and mindset which we have built up over the past couple of decades than it is possible with MCD's current resources available for family life education. We need to involve and engage many more agencies in all sectors, public, private and people, the media and individuals themselves. We should start in our schools to broaden the life skills programme to include making right life choices, gender sensitivity, civil and familial responsibilities and care giving skills. We need to think of all the ways we can reach out to catch the attention of Singaporeans, the young and the not so young as well, as they set the examples for the younger ones to follow, through the community, CDCs and grassroots organisations, VWOs and employers. The Senior Parliamentary Secretary to the Minister for Community Development spoke over the weekend about a family life ambassador initiative which the Ministry is preparing to launch with companies at workplaces. We need this and other such efforts. Hospitals could work with MCD and VWOs to reach young couples who come to these institutions when they have their first and subsequent babies. My own hospital is working on one such initiative. MCD can be the resource centre preparing the informational, training and counselling materials, doing the research on trends and tracking other countries' experiences for us to learn from, and the coordinator and the facilitator. But we need many, many more parties, all sectors and individuals to be engaged in this effort. Dr Vasoo has asked for an Inter-Ministerial Committee to be established to bring together a coordinated effort to sustaining and strengthening the Singapore family. I wholeheartedly support his call. Obviously, many Ministries must be engaged in this. It is hard to divide clearly where the responsibility and impact of one Ministry stops and another begins. I understand, of course, that there may be other similar requests for such attention to be given to other issues that cut across Ministries, especially with the fine example of the effectiveness of such an approach following upon the good work done by the Inter-Ministerial Committee on the Aging Population. In anticipation, I would like to suggest that every one or alternate years, the Prime Minister's Office selects one major issue of concern for which an IMC be set up to drive and coordinate the national effort. And the first one on the list must surely be an IMC on the family.

Sir, we read in the papers recently that babies were abandoned by parents. Some were left at rubbish bins. One was even found in the toilet bowl. Although the number is still small, there seems to be an increasing trend since 1996. These babies are at great risk and may even die if they are not found in time. May I ask the Minister what is being done to educate young people about the help that they can receive even if they are pregnant? Sir, I also want to know what studies have been done to understand the profile of the parents who abandoned their babies. What percentage of abandoned babies were reunited with their parents? In some cities such as Hamburg in Germany where about 20 babies were abandoned in a year, the authorities have introduced what is known as babies slot, where desperate mothers can deposit unwanted babies. When a baby is placed in the chute located at a daycare centre, it will fall into a warm bed and is then registered at that centre. Parents were given a few months to change their mind and they claim back the baby. Some other cities in developed nations have implemented similar baby deposits. Sir, what is the Minister's view of such a baby deposit? Could the Ministry try out one pilot site with a VWO? The whole idea is to try to save as many babies as possible.

Sir, building a cohesive and resilient society by fostering strong and stable families is one of the missions of the Ministry of Community Development. The way MCD aims to achieve this target is to try and reinforce the value of marriage, procreation and family. As dual-income families have become the norm in Singapore, childcare issues have also become an important component for the MCD and its mission. I would like, therefore, to raise the following issues in this area. Sir, we have a shortfall of about 20% of childcare centres at the moment. Some popular centres have, in fact, an uncomfortable waiting list of a few years. What are the steps taken by the Ministry of Community Development to address this shortfall? Could the MCD rectify this shortfall as soon as possible? New and densely built condominiums with many young families are the ones that need childcare centres the most. Disappointingly, they are the ones that have no childcare centres within easy reach. Residents of new HDB flats have to wait quite a while to get their centres. Could the Ministry of Community Development have better provision and planning, in collaboration with other relevant Ministries, so that sites for childcare centres for both the private and HDB estates can be designated? Sir, I hope that when it comes to national issues like this, the Government will not aim to cater only for the public housing residents. The Government should provide for all Singaporeans to reinforce the values of marriage, procreation and family. Sir, some private childcare centres are doing very well and are in great demand. However, many VWO childcare centres cannot do as well, because they are stifled by Government's intervention in "fees fixing". May I suggest that the Government allow privatisation of the VWO childcare centres? The Government could instead subsidise the more needy end-users. A "means test" could be applied. The Government should have a hands-off approach in the actual setting up or running of such centres. Let more private organisations run such centres. The Government should just confine to stipulating certain basic requirements to ensure standards and conformity. Some may cite the fear of escalation in the prices charged by VWO childcare centres as the stumbling block for such an idea. Sir, this fear will be unfounded when there is competition and prices are reached through market forces. Furthermore, the Government can still control the market through planned release of permits or premises for childcare centres. Sir, I hope the Minister for Community Development could give us a favourable response to my above-mentioned requests.

Sir, currently, there are 532 childcare centres providing service to more than 33,759 children. With so many childcare centres set up by different organisations ranging from VWOs to profit-making entities, there must be a variation in the standard of service. While there are MCD guidelines on the physical standards of the childcare centres, there are variations in the service provided by the childcare teachers. Has the Ministry done any studies to profile the different standards of service and try to normalise the standards? In October last year, MCD announced that in five years' time, the qualification requirement for supervisors of childcare centres would be raised from the current advanced certificate level to diploma level. I support this move by the Ministry to raise the quality of care which children receive in the childcare centres. Many families make use of childcare centres and the children spend long hours in the centre. It is therefore important that the centre is able to provide a nurturing and stimulating environment for the children. Recent research has shown that the early years of a child's development is crucial and can have a long-term impact. This adds to the need to focus attention on this area. Since the Ministry is raising the standard of the supervisors, is there any plan to gradually improve the standard of the childcare teachers and to raise the standard of service? Sir, I am aware that the Ministry has licensed childcare centres for many years. With increasing evidence that the early years of development are important, what other measures the Ministry has taken to ensure that the children are given good care in our childcare centres?

(In Mandarin): Sir, for young parents living in new HDB estates, looking for a childcare centre to look after their young children is invariably a big problem. In the new estates like Punggol and Sengkang, because of the great number of young couples, the need for childcare centres is also very great. Last year, in my constituency, I requested the NTUC to open a new childcare centre. This childcare centre has yet to start operation but already the list is full. Some parents are very anxious, particularly those who have no relatives to look after their children. The MCD should also coordinate with HDB in the development of these new towns, providing more childcare centres to satisfy the needs of the people. I hope that MCD would empathise with the worried young parents and should not only depend solely on the old data of demand and supply. We should also consider other factors. In Singapore, working mothers' participation in the workforce is relatively low compared to other countries. The main factor is because there is no one to look after their children. Can we do as in the European countries to provide more subsidy to professional childcare providers so as to encourage more women to go back to work? More importantly, providing more childcare facilities will reduce our dependence on foreign domestic help. Sir, we now have 100,000 foreign maids. I hope that we should let children in the 3-6 years old age group be looked after by well qualified and trained childcare operators, and we should not leave them to foreign maids who come from different cultural and language backgrounds. The formative ages of 3-6 years old are very important to the development of children.

Sir, marriages to foreigners have been a subject that has received much media publicity and interest. Not too long ago, we read in the papers of a widely publicised divorce between a lady from Shanghai and the son of a family that runs a successful shipping business. That case generated much interest because of the substantial amount of money which this lady received following the divorce. In the minds of many Singaporeans, I am sure, is of the view that this lady from China had a windfall as, but for the marriage, she would probably not have acquired even a fraction of the assets that were given to her. This case has also left many Singaporeans wondering whether this lady actually married the man for his money. Sir, I am not passing judgment here, as I do not think I am in a position to. However, this anecdote does highlight one potential problem of Singaporeans marrying foreigners. Objectively speaking, one would often ask how many of such marriages are really out of feelings for one another and how many are contracted by the foreign party as a means to escape the harsh realities of the home environment, and that there was not any serious intention of settling down with the party concerned. Sir, let me tell you yet another story. A constituent came to see me one day. He walks with a limp and is handicapped and I learned subsequently that he is handicapped because of a gunshot injury that he received in the course of his duty as a policeman. He was compensated for his injury. Upon his discharge from the force, he managed to set up stall as a canteen operator to support himself. However, life was lonely for him. Being unable to marry a local lady, this man resorted to looking for a bride from China. He found one from a big city and married her. He thought he had found marital bliss. This was not to be. I learned that his wife was not really keen on helping him to manage his business. Soon she left him and filed for divorce, even though, as he claimed, he had been very nice to her. She claimed a substantial portion of his assets, and even got his car seized to satisfy the order of court. On top of it all, he tells me that she started cohabiting with a man in the same flat that she paid for out of the monthly maintenance sum that he gives her. This man has seen me many times and pleads for justice. I did not hear the full story. It may be that she genuinely wanted to start a new life with another man, or it may be that she is the devious scheming lady who took advantage of my constituent. If the latter were true, it would indeed be a tragedy for him. 6.00 pm This episode raises a basic question of whether the State has any responsibility towards Singaporeans of similar circumstances that I have described. I know that it would not be possible for the Government to keep a look-out for every Singaporean who is gullible or weak. Neither can it be said that the Government has no duty in a situation like this. Instinctively, our sense of justice tells us that what has happened to Singaporeans who married scheming spouses who took them for a ride, is not right. It is not easy to deal with this problem. However, given the immense trauma that broken marriages bring about, I would like to ask the Minister to consider getting proper marriage counsellors to help Singaporeans come to a carefully thought out decision. Additionally, the Women's Charter is primarily meant to protect the rights of women. However, the Women's Charter should not be abused by others for their own benefit. This was certainly not the intention of this House and should not be seen by others as such. Perhaps the Women's Charter should be looked into again to see how such abuses can be avoided.

(In Mandarin): According to the records, there is a clear decline in our birth rate in Singapore. In 1988, the average birth rate was 1.96 child per family. In 1999, it has reduced to 1.48 per family. This clear decline of birth rate is a very serious trend. We are already approaching Japan's low birth rate of 1.42 per family. We have to do something seriously and urgently to address the problem. In the 1980s, the problem then was that there were some highly educated people who were not married. Now, in the 1990s the problem is further extended. Even among the non-graduates, there are many who are not getting married. According to statistics, about 15% of our people above the age of 40 are single. Our society has also faced the problem of people getting married very late and had their first child late. The average age of having the first child increases to 28.5 last year from the 27.5 in 1990. The situation now is that we are unable to replace ourselves. This would imply that in future we would face the problem of an ageing population and it will affect us socially and politically. As it is, we are expecting that by 2030 every four economically active persons will have to support one senior citizen above the age of 65. So our economic burden will be very heavy and it will certainly affect our quality of life. More importantly, we may not be able to look after our aged relatives and we may have to depend on foreign maids to look after them. On the other hand, our economic prospects for the 21st century are quite optimistic. We are forecasting some 5-7% annual growth rate. However, if our population is not growing enough in the next 30 years, this vision of a 5-7% annual growth rate cannot be sustained. Just now, Dr Vasoo asked Dr Ong who is going to defend us in time of war. Even with the most sophisticated weapons, if we do not have enough people, who shall operate these weapons to defend us? If we cannot replace ourselves, our population will shrink and we may have problems in our national defence in the future. A few days ago, our Minister for National Development painted a picture of how Singapore is going to become a vibrant city, that is, by the year 2040. Our society will be able to accommodate some 5.5 million people. We want to have a population of 5.5 million in 2040, but our people are simply not giving birth to enough babies to make up this number. Then, perhaps some 30% of the population will have to be foreign immigrants and not descendants of our present population. This will result in great changes to our social structure. Now we are talking about how to enhance our social cohesiveness, how to preserve our roots and how to maintain our traditions and social values. If we have to depend on the large inflow of immigrants and their number become significant in our society, then all these values we talk about will, therefore, no longer be relevant. More importantly, the political scene at that time may be quite different from what we may imagine it to be. This is a very serious problem. We have to resolve the matter and find thorough solutions to the problem before it becomes worse. This is not a new problem. The problem is that before the measures taken could have been effectively solved, the problem happened in the past, new problems have emerged and resulted in the awkward situation that we are now in. In the past, we gave a lot of incentives to encourage our people to have more babies. We gave tax concessions, priority for HDB flats, longer maternity leave, etc. But these measures were unable to reap the desired results. Come to think of it, if we had not done all these, the situation could well be worse now. In my view, this problem should not be left solely to the Ministry of Community Development to solve. It has to be resolved by a high-level Inter-Ministerial Committee. This is a very complicated matter because every individual in our society has his or her own problems. The needs are different, the aspirations in life are different. We have to resolve it according to their needs. I would classify the reasons for people not having more children into the following six categories: (1) Can give birth and willing to give birth, but no opportunity to give birth - non-marriage; (2) Willing to give birth but cannot give birth - infertile; (3) Can give birth, but unwilling to give birth - unwilling; (4) Can give birth and willing to give birth, but unwilling to give birth early in life - unwilling to give birth early; (5) Can give birth, willing to give birth but unwilling to have many children - limited birth; and (6) Can give birth, willing to give birth, and willing to have more children but received no encouragement - refused birth. There is no simple solution to all these problems. For those who would like to have children, they may not be able to give birth. Some of them do not want to get married. Some want to get married but do not have the opportunity. For example, one well-known local columnist mentioned in her column that she could have lost her chance in life. In the past, we had the SDU, the community centres and even the universities trying ways and means to create opportunities for young people to be paired up, to develop a courtship, with the hope of leading to marriage. But the results have not been encouraging. Among those who are 40 years old and above, 16% are not married. This is a high figure. Perhaps in the past we had not done enough. In this respect, we have to redouble our efforts and the Ministry has to spend more money and organise more activities. The Ministry of Education has to work on the school children. As for cases of infertility, we have now all sorts of scientific methods, such as the test-tube babies and surrogate mothers, etc. to help the infertile couples. However, notwithstanding all these advanced technologies, the cost is still exorbitant. Only those who are from the well-to-do families can afford such methods. This is a very important problem. The Government should see how it can help to cut cost or subsidise the needy, so that even ordinary citizens can avail themselves of all these medical technologies to give birth to their own children. For those who are willing to have children but are not prepared to have them at a young age, some do not have the confidence to be father and mother, they need plenty of encouragement.

Prof. Low, you have exceeded your time.

Let me conclude. Generally speaking, this is a matter which has to be taken beyond MCD. It has to be done through an inter-ministry effort. This is not for just one Ministry to tackle. I hope the Government will set up an Inter-Ministry Committee to thoroughly resolve this matter

Mdm Claire Chiang, you can speak now.

Thank you, Sir, for the opportunity. I will take my first cut on restoring family ties. In our efforts to globalise in a pace that results in fragmentation of the self and family ties, the family has become an endangered institution because of the pressures which are building up from within and without. These issues concern me because the weakening of the family ties erodes a fundamental capability - our ability to mobilise our people and enterprises to upkeep our national resilience. Allow me, Sir, to give a quick snapshot on some trends. (1) Marriages are not the norm. Statistics show that better qualified females are more likely to be single and single males too are on the rise. Something is happening at the dating phase between boys and girls which need our honest tackling of gender relationships. (2) The average family size is getting smaller from 4.7 in 1980 to four in 1995 because young couples prefer to set up homes away from their parents and are having fewer children. What this means is we have lost the "extended" family ties to support the needs of working couples. (3) The number of divorces registered under the Women's Charter among non-Muslim couples increased 14% between 1997 and 1998, the Muslim divorces increased in the same period by 21%. What we are saying is that in 1998 we had 5,651 divorces. (4) Family violence was another cause for divorces, increasing from 978 in 1995 to 2,000 in 1997. It was forecasted that by end of 1998, there were 2,600 complaints being filed. Some cursory observations also noted that older persons were divorcing due to mainly incompatibility. What this all means is the rise of single family households with women looking after the needs of children on their own. (5) With more parents working, children who were unsupervised easily fell prey to bad company. We saw the rise in juvenile delinquency among those aged between 7 and 15 years old by 14.5%. Of the 495 rape victims between 1994 and 1998, 32% were between 10 and 14 years old. Parents were often shocked to find out afterwards what their children had been up to, indicating the loss of communication and proper supervision. (6) The Singapore population is aging. We have highlighted in this House the real problems of their employability and declining healthcare compounded by inadequate savings and social isolation. Worse still, children are caring less of their parents. The Minister highlighted in a written reply that more than half of those ordered to pay maintenance to their aged parents defaulted on payments last year. In some families, parents took up enforcement proceedings against their children, resulting in sentencing them to a term of imprisonment. 6.15 pm Fortunately, this is a small number. It nevertheless points to an increasing pressure felt by the children who cannot afford to meet the needs of parents. Of the total number of calls in CDCs National Helpline for 1999, close to 60% were training enquiries, job matching and financial assistance, including help with school fees, indicating that Singaporeans were facing real pressures of employment and financial insecurity. Sir, we are finding difficulty in forming family ties and once formed, we are seeing faultlines at all levels, between spouses, between parents and children, between elderly parents and mature children. We also see more households consisting of siblings, grandparents, aunts and uncles who offer invaluable support to strengthening family ties. In particular, the singles are the ones who continue to care for the old and the young. In changing times, with increasing pressures, family ties will be forged by different components within the clan, creating a new understanding of "extended family" which must be respected and provided for. In view of all these permutations, the family cannot reach its goals to make Singapore our Best Home by itself. It needs many helping hands from the social service sector as well as the public and private sectors, that is the "community, infrastructure" to restore the "hardware" within the family members. Restoring family ties no longer can be the sole responsibility of MCD, because as every Ministry fixes policies on taxes, work arrangement, housing, healthcare, transportation and education, their decisions impact on the resources of family. The more resources we can pour into organising these areas, in line with what Dr Jennifer Lee and many Members of the House had passionately put across, the better we are in restoring family ties. I hope the Minister will not delay in visibly putting this important agenda on the family at the forefront of Singapore's development. Whether you set up an Inter-Ministerial Committee on Family, or whether it should be a Family 21, which I raised in last year's Budget debate, let there be a mechanism set up for deliberation and consultation on family policies. Family care may not configure in our GDP calculations and the return on investment in this area may not be as tangible as the financial sector, but a commitment to restoring family ties is providing Singapore families a stronger rudder to control its direction of travel in ever rougher waters ahead. Personally, I would desire several small Inter-Ministerial committees which are issue-specific instead of one large and formal one, which often lacks the kind of processes and intimacy that encourage free-flowing of ideas and exchanges. I look forward towards a mechanism which includes representations from the people sector, parents, social workers, educators, human resource officers and volunteers, so that we really make the strengthening of the family the business of the community. Sir, can I proceed to my second cut?

Yes.

Thank you. I will do my cut on parent care. If I have to indicate a crisis which the family is facing at this point, I will say it is our parenting role. Sir, parents are a special category of people who needs focused attention, the same way we focus on children, students, elderly, entrepreneurs, and so on. Parents and children are pulled by social forces between the pressure of work, school work, friends and entertainment which resulted in them spending less time as family. Having time to parent, knowing how to parent and willing to parent and co-parent between husbands and wives are all significant issues which require our deep reflection to restore parenting as the cornerstone of family development. Permit me, Sir, to chart a wish list by parents in different stages of development so that policy makers with the help of CDCs and VWOs can plan their outreach programmes with a more focused strategy. A parent with children from 0-6 years old looks for childcare facilities and good pre-school education to provide the foundation years for the child's growth. It does not matter whether the parent is working or not, the search for good instruction to maximise children's total development is a strong desire in all parents. A parent with children from 7-12 years is obsessed by making sure that their children pass examinations well. One of the best attended seminars in Singapore are those organised on "How to raise a successful child?" or "How to increase your child's IQ?" This pressure to perform well has resulted in hot-housing which stresses both parents and children. What this portends for the development of creativity which requires a free-will spirit is something to think about. Parents want to learn how to balance expectations and capabilities without destroying the natural inclinations of the child. A parent with children 13-16 years old looks for instructions on how to discipline and teach his children good values, how to transmit life skills and communicate about boy-girl relationships. This is the most critical and difficult phase of parenting, yet this is one area that many parents do not know how to take charge because they lack the know-how, resources and time. As most children lack the communication skills to express the conflicts and anger in them, they act out by shutting themselves out, or sometimes in defiant ways like joining street gangs and indulging in all sorts of undesirable behaviour. Parents want to learn how to re-connect and communicate with their teens and their peers. Parental re-education and retraining becomes just as necessary. A parent with growing teens from 17 to 20 is most concerned with making sure that his children do not mix with the wrong crowd. This is a real dilemma. Given the fact that many households are double income families, with husbands and wives working long hours with little rest and energy left to mend and repair the home front, children are hence left to TV and friends to shape their growing years. Parents wish to learn how to spend quality time with the family and more tips about how to stay "cool" with their growing teens. Presumably, by the age of 21, the role of parent is less custodial and protective because by this time, the child should have some cognitive and emotional fundamentals to take on life independently. Sir, we need good programmes for parenting education. No one can assume that parents know how to parent. They must be given the tools, skills and encouragement to attend seminars, to share and hear how other people cope at different stages of family development. The serious challenge to all this is: how do we get these parents who most need the programmes to come forward in the first place? How do we change their mindsets about parenting and ask them to look at this responsibility seriously. Sir, I will start by encouraging every company in Singapore to allot one hour a month for such talks to be organised for their employees. I look towards MCD and the National Youth Council, as well as CDCs, for their leadership in prioritising parenting education as a paramount component in family development strategy. And a side point, I hope the Leader of the House will, in next year's Budget meetings, not schedule Budget sittings on the week of the school vacation because this deprives a lot of parents in having this vacation with our children during the whole week.

Sir, Assoc. Prof. Low Seow Chay who spoke before has already touched upon the declining birth rate in Singapore. I agree with him that nations that cannot reverse their declining birth rate are effectively committing collective suicide. In Asia, Japan has the most severe challenge in this respect as the number of children per woman in that country has dropped to 1.

38. The Japanese government recently commissioned a survey of young men and women of the marriageable age group to determine the reasons. I thought it would be interesting to share some of the key findings. Of the men surveyed, 30% considered marriage a burden, and of this, 50% gave financial factors as reasons. Secondly, 40% of the women surveyed also viewed marriage as a burden, and the reasons given included house work, child rearing, looking after aged parents-in-law and coping with the dual responsibilities of work and homemaking. Asked whether they felt that married couples should have children, over 20% of the women between the age of 18 and 39 said "no". And this is close to twice the percentage for men. Sir, it would be interesting to find out the views of young Singaporeans regarding child rearing today. In response to the survey I mentioned earlier, the Japanese government is introducing some of the measures to help to promote child rearing support and they are: (1) establishing day care facilities near train stations, which is quite interesting, and (2) extending child allowance for children from birth to pre-schools. Sir, to me, of the various conveniences and incentives that Members have come up with, all are remedial actions. I think it is more important to determine what is the root cause of declining birth rate. We should dwell into what are the perceptions of young men and women regarding family life. It must be stating the obvious, Sir, to say that the number of children a family would have is largely determined by the wife. Whether a woman would like to have a large family or a small one depends on the values inculcated in that young lady many years ago. Presumably, those growing up in large families that are warm and loving will hopefully prefer larger families, and those growing up in small families will naturally consider small as beautiful. I would like to use my own family as an example. Growing up in Singapore, I was conditioned to believe that two was the right number. On the other hand, my wife grew up in Hawaii in an extended family So when we married 19 years ago, her ideal family was to have five children. Reality set in very quickly as we both discovered that bringing up children was a very demanding process. And the end result, we ended up with four. But the important thing is we should start with a large number and hopefully you end up with something close to what we want to have. To me, Sir, the lesson learned is that it is very important for a man to find a wife who wants a big family in the first place. Sir, I am not asserting that we can draw conclusion based on a sample size of one. But I believe, unless we inculcate the desire for children in our young women, we cannot reverse the trend towards our declining birth rate. Since we do not have large families today as role models, we have no choice but to turn to the schools. But I doubt this is a task that the Ministry of Education considers as part of its portfolio. So somehow we must change the perception, especially among the young women, towards family. In this aspect, I think I am treading on very thin ice. If we need to change the woman's perception from career orientation towards family orientation, and it is the only way to reverse this trend, I think we have to do it. However, turning around this view will require the concerted effort of the whole Government and not just one or two Ministries alone. In this respect, I would support wholeheartedly the call by Dr Jennifer Lee, Dr Vasoo and Prof. Low Seow Chay to have an Inter-Ministerial Committee to work on this very important matter.

We will now move into the sporting arena.

Sir, I would like to first declare my interest as the President of the Singapore Table Tennis Association. Sir, the Government has provided a strong injection into the development of sports by incorporating sports into the Community Development Ministry. The National Sports Associations have embraced this move as a positive inclination towards Government's emphasis on the growth of the sports industry in Singapore. At present, the Singapore Sports Council's Sports Excellence programme, with a number of assistance schemes, provides a basic framework and infrastructure for our sports development. Our National Sports Associations have been categorised and received different amounts of subsidies from the scheme. However, this is not sufficient. More support should be considered for the areas of concern, such as technical development of the core sports and a more structured leadership development programme for all the NSAs. Another key area of concern is the housing scheme for the various NSAs. Homes for our National Sports Associations are important. I hope the Government could evaluate on the various sports housing schemes for our National Sports Associations. Sir, the local sports fraternity also needs human capital. Scholarships and a tailored tertiary education programme should be considered and provided in this respect to assist the growth of the industry. And I hope more support would also be given for the organisation of international sports events in Singapore, like the recent 14th Commonwealth Table Tennis Championship. This will give Singapore a new light as a country with a positive outlook towards international sports development. In conclusion, in propelling Singapore's sports industry in a new time, injection of subsidies for housing development, leadership development and assistance in organising international sports events for our National Sports Associations are very crucial.

Sir, with the expansion of the MCD to include sports at the Ministry level, sports finally have a higher profile. The signal is that the Government is finally serious about sports. In 1990, the formation of MITA allowed the arts to take off in Singapore. Hopefully, we see the same results in sports. Besides Sports for All and Sports for Life, the message is now Sports Excellence, Sports Tourism. This will spawn a whole new sports industry with many exciting careers. When we think of a career in sports, we probably think of the professional athlete winning the championship, world famous coach, sumo wrestler or sports commentator on TV. But these high visibility roles are only the tip of a business that spawns professional sports, sports education, amateur sports and all the services that support them. So if a person loves sports and wants to spend a sports career, there is probably a role that will match the passion and skills set that will provide a sports career. The sports industry in Britain generates more than pound8 billion sterling in revenue per year. The number of sports-related jobs in British sports increased from 10,000 in 1985 to 470,000 in 1990. There are literally thousands of different jobs related to sports encompassing virtually every business discipline in addition to actual play and coaching. The Americans spent about US$6 billion a year on spectator sports. 6.30 pm Sir, until now, the main concern of parents when they decide whether their children should go into training for sports excellence is whether there is a good career path. Sportsmen and sportswomen themselves are also asking, is there any sports career? Even that we want more sports persons. We need to consider what is being done to develop the sports career or sports persons. What is the Ministry's plan on this? To give our sports a boost and lift it to higher levels, foreign talents would have to be imported. While they can play a supporting and aspiring role with local athletes, challenging and motivating them to excel, they should not replace our local talents. With money, we can buy the best sports persons and field them in our national teams. But we must ensure that the foreign talents must be able to assimilate into our Singapore society. Sir, I would like to know what strategies and programmes would be put in place to provide our local sports talents a good sports career. The field lives of many career sports persons can be limited perhaps due to injuries during play or to ageing. The Ministry must therefore have a comprehensive retraining programme for the career sports persons so that by the time they retire from the field, they can also have a rewarding second career.

In December last year, at the Timesport 50 Greatest Athletes' Ceremony, our Prime Minister said that the time was right for Singapore to seek more ambitious goals in sports. In order to reach these goals, I believe we need a whole array of people, and not just the sportsmen alone, to support this effort and build a general infrastructure for sporting excellence. First and foremost, we need to identify and cultivate sporting talents. I believe there are such talents, among our young, who have the ability and inclination for sports. However, some may not have the ability to do well in mainstream subjects and who may drop out of school if they were to pursue extended curriculum. I believe there is a way to allow them to pursue their talent more effectively, that is, to set up sports schools to give them a customised programme to match their interests, career aspirations and abilities. These sports schools could be modelled after the Institute of Technical Education (ITE). In this case, we would be offering subjects that are related to sports and sports businesses. Besides scheduled training, they could study other subjects, such as nutrition, sports psychology, training methodology and principles, sports sociology, basic bio-mechanics and sports management. Students would also have access to facilities, equipment and training that most could not otherwise afford. Such institutions could stand these students in good stead, helping them carve out a future as a sportsman or woman, or being a part of sports management promotion, or as Dr Ho mentioned just now, as part of the sports industry. Such an alternative educational offering would also dovetail nicely into the Ministry of Education's goal of mass customisation to give students a basic education and yet provide them with teaching in other selected areas. Sports schools are common in other countries that have produced world class athletes. Such schools are formidable, offering boarding facilities, sports experts in various subjects along with teachers in basic curriculum. Such schools can play an essential part in providing the infrastructure for building accomplished athletes.

Sir, may I begin by stating that I am the President of the Singapore Badminton Association. The Prime Minister has set goals for the nation to achieve in the international competition for football, badminton and sailing. For Singapore to achieve consistently high standards in all these sports and other core sports, there should be a concerted effort to train the athletes. Obviously, the skills, interest and commitment of the athletes have to be inculcated from young. The best period is actually when they are in schools. However, the Ministry of Education views sports as only part of its core curriculum programme. In order to win honours for Singapore in the top league competition, it is necessary for the new Ministry to take on producing athletes as its mission. Today, we are depending on chances for young boys and girls to emerge who are prepared to sacrifice the standard career path to pursue their interest in sports. Furthermore, to do so, they need to have the support of their parents in this area. Given the Singapore environment, therefore, producing champions is going to be a random and very rare event. If we were to have any chance of meeting the goals set by the Prime Minister, I believe we need a process, something that Mr Ong had pointed out, to produce a steady stream of young athletes so that some might go on to become champions. Perhaps, the Ministry should take this on as part of its mission for producing sportsmen and women who are able to stand on their own in international competitions. One way of doing so is to establish sports schools for young and budding athletes. The sports schools could be modelled after those in Malaysia where students with the talents in sports could focus their energy in developing their skills and yet receiving a quality academic qualification with classes tailored around their training schedules.

(In Mandarin): Sir, the Ministry of Community Development will be renamed the Ministry of Community Development and Sports next month. It shows that the Government is very serious about sports and has long-term objectives to attain good results in the sports arena. We are now competing in the Asian level. The Prime Minister has set his goal for our national soccer team to fight for a place in the World Cup tournament proper by the year 2008. In other sports, we have also set certain goals. For the attainment of these goals, I have some suggestions to make. First, we must set up a sports training school in Singapore. For the arts, we have the Nanyang Academy of Fine Arts. For sports, we should have an Academy of Sports. While we have upgrading for our HDB flats, and even private housing estates, we should also have plans to upgrade our National Stadium and Indoor Stadium and develop them into a centre for sports training and competition, or a sports village. We should have facilities to house our sportsmen and sportswomen so that they can train in an in-camp environment to have better concentration to undergo more focused training in order to improve their performance and go all out to win medals for Singapore in international competitions. Secondly, we must also set up scholarship schemes for our talented sportsmen and sportswomen who have the aspiration to be world-beaters. The Government has all along been giving scholarships to students who excel in academic studies. I think it is time for the Government to consider giving sports scholarships to encourage our young people to contribute in the field of sports. These scholarships would enable them to go overseas for professional training. I read in the newspapers about our crop of young talents in the various sports such as martial arts, bowling, swimming, table-tennis, etc. There is no lack of sports talents in Singapore. We should identify them from young and give them the much-needed encouragement and incentives in the form of sports scholarships. We know that horses can run. But not all horses can run well all by themselves. They need training to turn into top race-horses. We must devote our resources to encourage and train our sportsmen so that they have good training facilities, good coaches and good environment to bring out their best performance. Thirdly, we must ensure that there will be a career for our sportsmen. We note that our youths, and their parents, are not very keen to take up competitive sports seriously, because they worry about their future. While young they could be very good and could put in some good performances. But what happens after they have passed their prime? There is no safeguard in their career. For example, we have Chen Yeow Chuan and Ong Chin Hai who excelled in the martial arts and won medals for Singapore in international competitions. They were spotted by TCS and were offered a career as TV actors. For their future, they have to make acting their career, rather than staying on as sportsmen. They are the lucky ones. At least they can still practise their martial arts. But there are many other sportsmen and sportswomen who simply faded out of the sports scene in order to pursue other careers as a means to earn a living. I feel the Government should do something to provide some safeguard for the sports people by guaranteeing them some form of job security. We should help to map out some kind of career path for them so that they will have the peace of mind to concentrate on their sports training to bring out the best in them and win medals for Singapore. Fourthly, we must have sufficient budget for all the sports associations. Many of our sports associations have funding problems and they seem to be spending more time trying to raise funds than to promote sports. Council members in the sports associations spend a lot of time organising all sorts of events to raise funds, year in and year out. They have simply no time to develop their sports and their associations. I hope MCDS can consider giving these sports associations 1 to 2, or 1 to 3 matching subsidies, like it is done for the Community Development Councils. This way, the sports association will have more time and resources to help our sportsmen and sportswomen develop their potentials to the fullest, and hence bring glory to Singapore.

Kenneth Chen is not here. Mr Ong Kian Min.

In promoting sports, I believe that there is one more sport in which Singaporeans can attain international standing, that is, the sport of figure skating. Singaporeans can do well in figure skating for two reasons. First, we can skate on ice indoors all the year round. While it may be too hot and humid to play football outdoors in the sun, at noon, it is not a problem to practise and train on the ice skating rink indoors throughout the whole day. We also do not need winter to have a frozen surface of ice. Unlike skiing, when you need a mountain covered with snow, you do not need a frozen lake to ice skate. Whatever the temperature is outside, ice can be man-made by machine, whether it is rain or shine, hot or cold, night or day outside. We can ice-skate indoors any time of the day. 6.45 pm Second, figure ice-skating does not require a strong physique. In sports like athletics, swimming or basketball, a tall or well-built person has a distinct advantage but in competitive figure ice-skating where both artistry and athleticism are required, a small built is not a disadvantage. In fact, there are examples where ice-skaters have overcome their own physical disadvantages and excelled in the sport. These examples can be an inspiration to our young, whether they are budding sportsmen or not. Scott Hamilton is a four-time world and gold medal Olympic figure skating champion. He was a normal healthy kid until he mysteriously stopped growing when he was five years old. The doctors never knew what was wrong with him. He just had no physical development at all. For four years, his body was unable to absorb virtually any nutrition from the food he ate. For four years, he thought he would never grow another inch. One day, he tried figure ice-skating and said, and I quote, "It was the one thing that I could do on an equal basis with the other kids." After taking up the sport, Scott regained his health and had grown some more. All signs of his illness had disappeared. Some attributed it to the vigorous exercise of ice-skating. He never grew taller than 5 feet 31/2 inches but he certainly stands tall on the ice. Another example is Kristi Yamaguchi, an American born Japanese, who herself overcame her small stature and a turned-in foot condition to become an Olympic gold medallist in 1992. Sir, beyond the competitive level, ice-skating can also provide viable career opportunities for ice-skaters. If Singaporean ice-skaters can excel, they can even be full-time professional figure skaters. One example is the Disney World on Ice, which is currently performing in our Indoor Stadium at this time. Skaters could also end up as coaches to teach the next generation of young students. In order to promote and encourage ice-skating among Singaporeans, I would like to suggest two things we can do. The first is to put in place the infrastructure by building a world-class ice-skating rink. Kuala Lumpur has a number of international standard ice-skating rinks which have allowed the staging of several regional competitions and attracted good international participation and coverage. The second is for the Ministry of Education to accept ice-skating as a core curricular activity and to encourage students to take it up. In spite of our physical limits, I believe that Singapore could very well produce future champions in ice-skating. Given proper support, I believe that figure ice-skating will be one of the sports in which our athletes will shine. I hope the Ministry will support this sport and pave the way for aspiring skaters to succeed.

Sir, thank you for allowing me to make some points relating to MCD. Each year, I have urged the Minister to try and see what he can do more for the voluntary welfare organisations and I would like to remind him this year again that the subventions provided to voluntary welfare organisations are not as attractive as it should be. I know his hands are tied but I will try and help him to urge the Ministry of Finance. I am sure that Members here will join me to urge the Ministry of Finance to find ways to allocate more funds to the people sector. As I have said earlier, this is very important because the people sector too requires more support in order to build a healthier community. This year, I see that $42.8 million has been allocated as subvention grant to the voluntary welfare organisations. This is, to my mind, indeed too small. I feel that a bit more could be given so that the voluntary sector will be more viable and will be able to take on additional responsibilities. This is one of the missions of MCD and the Government to encourage more helping hands. In order for them to participate in more self-help programmes, it is essentially necessary to find ways to increase the subventions to voluntary welfare organisations. I feel that the dollar-to-dollar contribution which is being given at the moment to programmes could be reviewed. I suggest that a 60:40 formula be considered so that the burden of fund-raising by the voluntary welfare organisations could be reduced. The volunteers could therefore be able to look at how they could extend their programmes and find new strategies to address the challenges which many Members have brought up relating to families, population decline, young persons, family conflicts and other related problems. These are issues which are very complex and therefore if you want the voluntary sector to be more involved, I would urge the Ministry to re-look at the funding formula which will provide a new headstart for the organisations to be involved in promoting more self-help in the community.

(In Mandarin): Sir, I support the appeal by Dr Vasoo. We should give more help to the voluntary welfare organisations, because feedback from many voluntary welfare organisations indicate that it is becoming increasingly difficult for them to raise funds to finance their activities and projects. Based on the report on the Inter-Ministerial Committee on Healthcare for the Elderly, the VWOs are encouraged to continue providing long-term care services at community hospitals, chronic sick hospitals, nursing homes, day-care centres and in the elderly people's own homes. In view of the increasing needs of an ageing population, VWOs are needed to provide more such services to accommodate the increase in demand. Not only are more VWOs needed, the services that they provide must also be of high quality. To ensure that the care they provide is of good quality, the VWOs are expected to actively explore and implement various assistance programmes to help to improve the process and outcome of care for the elderly. To carry out these programmes, much time and efforts are required from them. This leaves them with little time to raise funds to run the services. In order to ease the burden of the VWOs and to encourage more VWOs to provide services for the elderly, the Government should provide more funding to them, even more than before. In view of this, perhaps the Government would like to consider reviewing the current funding principles of up to 90% for capital expenditure and up to 50% of the recurrent expenditure or the VWOs' deficit, whichever is lower. This would help to reduce the burden of fund-raising for the VWOs to enable them to concentrate on their core activities.

Sir, I echo the call by Dr Vasoo and Mr Ong for more funding for the VWOs. May I just use one case study as a concrete example to show what are some of the difficulties faced by the VWOs in the area of funding. Let me use the example of Bukit Ho Swee Social Service Centre. It was in existence since 1969 and in their 30 years of service, they have taken up the challenge of establishing separate facilities for the family and youth services. They wanted to appeal for more funds to start up another family service centre to cater to expanding needs and more youth activities. The move for them was not an expansion for expansion sake, but was a much needed response to curb juvenile delinquency and to increase family functioning among the disadvantaged low-income community. In my view, I know that it was a very good initiative, especially when we are aware and from what I said earlier, that teenage crime has been on the rise since 1990. Street corner gang activities were widespread and if this phenomenon is not arrested, many young people would either be victims of senseless violence or ended up in penal institutions. These youths come from multiple-problem families and they need various kinds of methods to reach them. Because they are trapped in a culture of poverty and delinquency, their needs are varied. The activities and the plan will have to be of a wide range and the attention given to them is intense and extensive, but resources are scarce. This group had appealed for funding but the Ministry has declined. My question is: what criteria should be used by the Ministry to fund or not to fund? What sort of guidelines have been drawn up to identify the continuum of social services to meet the range of needs faced by young people, dysfunctional families, disadvantaged families and the rest of it? I would also urge the Ministry then to review the funding principles. The 90:10 formula in capital funding is a good one because it is co-sharing of responsibilities. But could the Ministry not review the 50:50 percentage operating funding instead and amend it to 70:30 or even 80:20 so that VWOs are less stressed by having to seek for funds to run their operations? Because their job is really to service the clients, to look at therapy programmes and to reach out to all the disadvantaged families. Their job is not to raise funds. If the Ministry could re-consider these principles, it would be very helpful.

I think it will become a bit disorderly if we move into Community Development Councils and since we have gained some time today, as a matter of bonus to the Defence people, we can stop here. Do I have the assent to stop here? Hon. Members indicated assent. Thereupon, Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House.

Mr Deputy Speaker, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2000/2001, and ask leave to sit again tomorrow.

So be it.

Resolved, "That Parliament do now adjourn." - [Mr Abdullah Tarmugi]. Adjourned accordingly at Two Minutes to Seven o'clock pm.