Hansard, 2005-03-09

Under the provisions of clause 2(d) of Article 46 of the Constitution of the Republic of Singapore, the following Members have been granted permission to be or to remain absent from sittings of Parliament (or any Committee of Parliament to which they have been appointed) for the periods stated: Name From (2005) To (2005) Dr Ong Seh Hong 11 Mar 11 Mar 17 Mar 21 Mar Dr Geh Min 12 Mar 23 Mar Mr Inderjit Singh 14 Mar 15 Mar Mr Ong Kian Min 15 Mar 20 Mar

ABDULLAH TARMUGI Speaker Parliament of Singapore

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

Head O - Ministry of Health (cont.) -

Resumption of Debate on Question [8th March, 2005],

"That the total sum to be allocated for Head O of the Estimates be reduced by $100." - [Mdm Halimah Yacob].

Question again proposed.

Regional Medical Hub

Sir, I wish to declare my interest as a medical practitioner.

The gap between Singapore and its regional competitors has narrowed significantly. Top doctors from the region, whether they are from countries like Malaysia, India, Philippines and China, are no less than many of our top doctors. In India and China, procedures are done at a fraction of our cost. Many of their top doctors have been trained in top western foreign medical institutions. Today, the reality is that a large number of nurses, medical technologists and radiographers come from our neighbouring countries.

The Government tells Singaporeans to be entrepreneurial, take risks, grow the economy, create jobs; and on its side, it will provide incentives, regulate lightly and remove bureaucratic hurdles.

I dream of a Singapore Regional Medical Hub where we combine the best of Singapore and the region by drawing upon the talent of some of the brightest and best doctors from the region, including Malaysia, India, Philippines and China. In this sense, where the large majority of the patients are foreigners, these foreign consultant specialist doctors can be allowed to practise independently to service our large foreign private sector pool. They are allowed accreditation to

perform procedures based on their training and experience. They adopt Singapore standards of medical practice.

We work with the medical MNCs to become regional centres of excellence in various areas of medical advances. As we continue to maintain high standards, we provide cost competitive healthcare services which make us a magnet for foreign patients. When we grow sufficiently big to have a big pool of local and foreign specialists, we will set up outposts where we use Singapore standards but local costs. In a few years, Singapore Regional Medical Hub will compete in the home ground of our ASEAN neighbours and in South Asia and China.

Drawing talent from the region, being reference centres for medical technology, practising the highest standards of medicine and remaining cost competitive, Singapore Regional Medical Hub eventually becomes the medical centre of choice in Asia.

Singaporeans dare to dream, take the risk and raise the standards. We want to lead in the world and are not content to be just followers of other countries. We may run into competition with the public sector but we need not fear if the competition is open and transparent without resorting to bureaucratic hurdles, turf protection measures and harassment through Government agencies.

Singaporeans know what they must do to beat the competition, but the steps ahead require rapid changes in the system. Is the Ministry of Health ready? As one senior healthcare official told me - you are too far ahead of the time, we cannot change fast enough.

I do not know whether all these will continue to remain a dream or whether it will become a reality. But one thing I know for sure is that in India and China,

their large pool of foreign trained specialists will post a formidable challenge to Singapore. If we do not act fast enough, not only will the number of foreigners coming to Singapore decrease, the number of Singaporeans seeking private healthcare treatment overseas will increase.

Future Development of the Two Hospital Clusters

Sir, our public healthcare delivery system was reorganised into two vertically integrated delivery networks - the National Healthcare Group (NHG) and the Singapore Health Services (SHS). This was to enable more integrated and better quality healthcare services through greater cooperation and collaboration among public sector healthcare providers.

Let me declare that I am a director on the board of the National Healthcare Group, one of the two public healthcare clusters. Having seen the genesis and the early-stage transformation of this cluster, I know that there were numerous challenges to meet, as expected in any new organisation with new management, newly created and reformed competition, the changing patient demand picture and the newly crafted regional segmentation of the restructured hospitals. There was great impact on staff at many levels, leading to movements between hospitals and clusters, due largely to the perceived imbalance of medical disciplines between the two clusters at the start, and the perceived difference in management styles as well.

In any case, five years after the birth, these two hospital clusters have stabilised their respective operations. The entities seem to be driven by well staffed mission oriented management teams supported by their respective boards. There have been critics of the cluster system as well as

supporters no doubt. The rising development of competing hospital systems in the neighbouring countries as others before me have talked about, plus the continuing public attention on healthcare costs, may have also added some doubt as to whether the original goals and objectives of hospital clustering are being achieved. I would like to ask the Minister how he assesses the situation and whether he views the clusters as fulfilling the original goals and objectives, whether there is a need to change these goals and objectives and therefore whether there is a further change anticipated to the clusters.

Dr Chong Weng Chiew, you have two cuts. Please take them together.

Third Health Cluster for Premium Services

Sir, currently, there are two medical clusters providing a wide and comprehensive range of public health services to Singaporeans. At the same time, they have the objective to pursue medical excellence and thus provide certain premium services. This is definitely an inspiring and exciting goal in line with our desired status to be a centre for medical excellence. However, the availability of premium services in public facilities often leads to very high cost for certain families. For example, whenever a patient is admitted regardless of the class of the ward, the family of the patient would normally request that the medical personnel choose the best available treatment for their loved ones. More often than not, there is little discussion over cheaper alternative treatment, particularly because the filial piety is part of our Asian culture.

There may be some marginal differences in their effectiveness but the cost difference can be substantial. Thus, I would like to recommend that our

current two clusters focus on providing basic health services only, and if the two medical clusters are to pursue premium services to set up the third cluster, if necessary, for these premium services. The third cluster would have the freedom to pursue excellence for more cutting-edge medicine in our quest to be the world class centre for excellence.

Traditional Chinese Medicine

Sir, my next cut is on traditional Chinese medicine (TCM) and I wish to speak in Mandarin.

(In Mandarin): Sir, I wish to thank the Minister for Health who has, after listening to my repeated appeals in Parliament, finally decided to allow qualified Chinese physicians to treat patients in the wards of approved public hospitals. This is much welcomed and praised by the traditional Chinese medicine practitioners, as well as patients who prefer TCM treatment.

Such a cooperation plan can help to promote better mutual understanding and recognition between the western-trained doctors and the TCM physicians. I hope that, in the not too distant future, similar cooperation plan may be extended to more Government hospitals and clinics. However, to arrive at such a stage, as pointed out by Minister Khaw Boon Wan, the pre-requisite is that the professional standard of the Chinese physicians must be raised.

At present, we have two colleges providing specialised training for Chinese physicians. There are some 2,000 registered Chinese physicians in Singapore, and another 1,000 or so studying in the two colleges.

May I ask the Minister whether his Ministry is keeping track of the number of

TCM students and registered practitioners to ensure that there would not be a situation of over-supply of TCM practitioners? At the same time, we must ensure that the TCM bodies in Singapore go for quality rather than quantity.

(In Mandarin): Sir, I would like to ask the Minister for Health whether he could enlighten this House as to how many students are currently studying in each year of the six-year part-time training course in the two TCM colleges.

Whenever we mention primary healthcare service, we would inevitably think of the western-trained family doctors. This is an incomplete perception. In fact, from the patient's point of view, there is a variety of primary healthcare services available, including western-trained doctors, retail pharmacists, natural cure practitioners and Chinese physicians.

At the moment, there are two privately-run TCM colleges recognised by the Government. I understand that the two colleges are actively training a considerable number of Chinese physicians. In recent years, there is an upward trend in both enrolment and number of graduates. Since we do not have any TCM hospital, the number of outlets available to the fresh graduates is limited. Generally speaking, they can only play the role of the primary healthcare providers after graduation.

In the field of western medicine, our only NUS Medical School trains more than 200 western doctors each year. About half of them will eventually become family doctors. The second medical school will start its enrolment soon to train even more western doctors. In other words, there will be some 100-200 western-trained doctors becoming family doctors.

In the situation of an over-supply of western doctors, we may face the following problems:

First, the crisis of “suppliers inducing demand�? as mentioned in the MOH's 1993 White Paper; and

Second, the TCM practitioners will be first to face the impact. As the Chinese saying goes, “Too many monks with too little porridge to go round�?. After all, under our present healthcare system, the outlets available to the TCM practitioners are more limited than the western doctors.

Can the Minister state categorically that we have unconsciously trained excessive western-trained family doctors and TCM practitioners? I would also like to know whether the Minister is of the view that the Government should directly or indirectly control the number of training places for TCM practitioners, as it did for the western-trained doctors, thereby providing some form of security for basic job opportunity for the newly graduated Chinese physicians.

Chinese Massage Therapist Certification

(In Mandarin): In our daily lives, very often we would fall down and either sprain our ankles or dislocate our joints. More often than not, the ordinary folks would go to the traditional Chinese massage therapists or die da sinsehs for treatment. If the sinseh is known to be effective and well-established, he would be very popular. People may go all the way from one part of Singapore to another part to seek treatment from him.

Most of these massage sinsehs hail from martial arts background and learn their skills from their fathers or masters. They come from all schools of Chinese martial arts, such as the Shaolin “Touch Vital Point�? therapy.

The Chinese Physicians' Certification Examination currently being conducted in Singapore covers a wide range of medical

subjects such as internal medicine, acupuncture, etc. The traditional die da sinsehs may have been practising all their lives and are very experienced, but this kind of certification examination is just not their cup of tea.

I urge the Government to allow them to take an alternative form of certification more attuned to their specialty so that they could continue to practise their skills for the benefit of the community.

12.15 pm

Mr Chairman, I thank Dr Michael Lim for his comments on our ambition to become the regional medical hub, an initiative which we have codenamed SingaporeMedicine. I share his dream, not every single detail, but at least the larger plot.

The Economic Review Committee felt that we could succeed in SingaporeMedicine. Years ago, we were a clear leader in the region. But as Dr Lim pointed out, our competitors have quietly narrowed the gap with us. It is not just Parkway in Malaysia, or Bumrungrad in Bangkok. It is now also Apollo, Escorts, Max Healthcare and Fortis in India. If we are not careful, it will soon be Shanghai, Beijing and Dubai.

Dr Lim asked if MOH is ready to make his dream come true. SingaporeMedicine is not strictly an MOH portfolio. But from MTI where I was for seven years, I knew that without MOH's support, SingaporeMedicine will be so much harder to achieve.

To secure our lead, we have many things to do: increase supply, step up training, let in more foreign talent, make our cost more competitive and work more actively with world-class partners.

Ministry of Health's past ambivalence on SingaporeMedicine is not without good

reasons. As increased demand would have to be supported by more specialists, there were concerns that more specialists, in turn, would lead to higher demand. The assumption is, as what Dr Tan Sze Wee has just noted, that supply could induce demand in healthcare. The end result is higher healthcare cost.

Supply-induced demand is real but is not unique to healthcare. Wherever there is market failure and unequal power between provider and consumer, the potential for supply to induce demand exists. For example, where sellers know more than the buyers, what economists call information asymmetry, an irresponsible seller can creatively induce spurious demand.

Look at motor repair workshops. Most of us know how to drive, but I think very few of us know exactly how engines work, let alone how to fix a car problem. So this is a classic case of information asymmetry between the mechanic and the car owner. So, bad luck, you go to a mechanic who is irresponsible, he will say: fix this or fix that, this is the bill. I think very few of us will be able to argue with him or to even know whether we have been taken for a ride. And if insurance is going to pick up the tab, most car owners may not even care. They are more interested in how soon they can get the car back in good shape.

There are many examples of such market failures. When you go to a strange city where you are not familiar with the roads, you hop into a taxi - information asymmetry - and you say, "I'm here. I want to go there," and the taxi driver took you on a long way, you may not even realise it; hence, the expression "taken for a ride".

The way to address such market failures is not to restrict supply and expect demand to go down. The correct

response is to make as much information as available to consumers, reduce the information asymmetry so that consumers can make better informed choices. If they cannot digest the information, they can seek third party advice, for instance, from their family physicians or their insurers. That is why it is so important for every Singaporean to have a good family physician. It is crucial - very important. Equally important, we need to put in place a framework which generates incentives for hospitals to provide good basic healthcare with minimum resources.

For some time now, we control the supply of specialists as a policy, on the premise that this would moderate healthcare demand. But from an economic point of view, this logic may not be entirely correct. As I said just now, it is wishful thinking to hope that with fewer specialists, demand for their services will go down. This is particularly so when demand is largely driven by exogenous factors, like in our case, by our ageing population and our aspirations to be a regional medical hub. Over-restricting supply in the face of independently-rising demand will simply drive up healthcare costs, as prices will adjust to the excess demand. This is Economics 101.

That is why I favour taking a more market-based approach to manpower planning. We must be responsive to market demand and we must be flexible in adjusting supply. Yes, there are valid concerns about supply-induced demand. We will watch the situation carefully. But, at the same time, we must take care not to rigidly control numbers and overly-choke supply, creating a severe excess-demand situation. After all, if SingaporeMedicine makes progress and we still restrict the training of specialists, queues will simply lengthen, and prices just go up.

We must also step up training, but not just for ourselves. We must help train our

neighbours, particularly Malaysia, Indonesia, Thailand, Vietnam and China. Many are very keen to learn from us. Every year, our hospitals play host to thousands of such doctor visitors. We should welcome such trainees, even from countries which we may not have traditionally recruited from. The best amongst them, we hope, will eventually settle down here, and become Singaporeans; the rest will go back and they become very important links for us to their region. Moreover, with a larger patient base, we can train our own doctors better and faster.

Look at India and China, which Dr Michael Lim described. The number of organ transplants, coronary artery bypasses and joint replacements that their doctors get to work on is mind-boggling. What our trainees get in one year, they can get in one month; sometimes two weeks! Coupled with their vast pool of talent and hungry ambition, it is a matter of time their skills will surpass ours.

We should not be afraid that we are training our competitors. The strength of Singapore is our ability to get things to work and maintain operational efficiency over time. We are good at operating complex systems.

Just look at Changi Airport and PSA. Others can buy the same hardware, the same cranes, the same IT equipment and so on. But we stay ahead of competition by operating what we have, effectively and efficiently. Likewise, our regional healthcare competitors can buy the same technology that we have. But I am confident that our hospitals have what it takes to stay ahead of competition.

Dr Michael Lim has painted his dream. Let me share with Members my vision. It is that our hospitals can be the best in Asia and be acknowledged as such by our peers. But let me quickly clarify what “the best�? means. To be the best does not

mean the tallest, shiniest buildings or the most expensive equipment. "The best�? means we have the best clinical outcomes, the lowest morbidity and mortality, the lowest complication rates, the fastest recovery, the lowest usage of resources. And we come up with new productive devices, new effective techniques, and new processes.

Not all specialties can achieve this. But, hopefully, a handful can produce results within a few years, which will then encourage the other specialties. Can we make it? I know it is a tall order. But we have proven our abilities in other areas before. Yesterday, I spoke about our SMs model of funding healthcare, totally made in Singapore. Our response to SARS was world-class, and again made in Singapore. With some of our best students in medicine, and some of our best talent in healthcare, we must put these top brains to work.

Dr Michael Lim spoke obliquely about “bureaucratic hurdles, turf protection and harassment through Government agencies�?, all of which could turn his dream into a nightmare. He spoke, presumably, from his own experience. I listened carefully; I got his “coded�? message. Let me encourage him not to lose his passion. Changing mindsets overnight is not possible. But there are people within the Ministry who share his dream. Count me as one. Together, let us make it happen.

The medical leadership is keen to work towards this vision, but acknowledging the challenges. If we stay focused and we are prepared to be bold in our approach, with determination, I think, after five to 10 years, we should be able to produce significant results. But we must be prepared to change, re-engineer our processes, and work with the best.

Since Dr Chong Weng Chiew mentioned traditional Chinese medicine

, let me use that as an illustration. It is a very difficult subject, given our lack of domain knowledge. There is a certain mystique about it because we do not know what we do not know.

Take the regulatory regime for TCM herbs as an example. We have two options: do nothing, keep them largely unregulated and hope that no accidents happen. Or we can proactively engage the TCM experts and the industry to see whether we can develop a regulatory and certification system which can, in fact, be a global model.

Consumers all over the world always have problems differentiating real herbs from fakes - and there are many. Often, we get conned. I had been conned before too. I bought some cordyceps from somewhere, and once you started boiling it, it became something else! Can we develop the standards and the tests to help certify authentic TCM products? Can we aim to be the certifying body for the world market? Singapore is a trusted brand. I think if it comes with the Singapore chop, most people will trust that and say, "Aw, done by Singapore, certified by SISIR (or now called SPRING), should be reasonable." That will create a whole new industry in Singapore.

Ten years ago, Minister George Yeo planted a seed in Ang Mo Kio Hospital when he started acupuncture there as a pilot. There have been some developments since. Even our Zoo finds application for TCM. Last week, I read Ah Meng somehow benefited from acupuncture!

12.30 pm

I am giving TCM a booster shot. That is why I said “yes�? to Dr Chong Weng Chiew's request to bring the full range of

TCM services into Ang Mo Kio Hospital

which he runs. My hope is that the local TCM practitioners take this opportunity to climb up the ladder.

Success is likely to come if they actively partner with the best in China. We must acknowledge that our TCM is not as developed as in China, and see how we can bring the best in TCM here, to help us evolve a model which can bridge east and west. We should jointly conduct scientific studies and clinical trials of TCM practices and TCM herbs and then publish the results in international scientific journals, actively contribute to a better understanding of this ancient art of healing.

They should invite the best TCM physicians to come here regularly to conduct clinics, treat patients, teach and give lectures. They can come as experts on temporary registration. To achieve best results, we must not be protectionist or fear that such foreign talent would take away our lunches. They can already do so, operating from China. I think it is far better that they are with us here, even if it is temporary.

At the same time, as Dr Chong pointed out, the local TCM community must upgrade and professionalise.

That is why I am not sure if I can accept Mr Ong Ah Heng's approach of allowing “die-da�? practitioners to continue with their traditional way of training, often from father to son.

"Die-da" is a branch in TCM dealing with injuries to bones and soft tissues. The correct practice of "die-da", like the practice of any specialty in TCM, requires full knowledge of TCM. That is why we require those who wish to practise "die-da" to undergo the complete training in TCM and be registered as TCM practitioners. This is also the regulatory regime in China and Hong Kong. You know at the hospital end, we have seen

some of the damages done by some of these so-called "die-da" practitioners.

However, we are sympathetic to the incumbents who had no opportunity for such training in the past. And that is why we have special provisions allowing them various chances to try to study and pass examinations, and quite a few do. A few dropped out for various reasons. But I think, from now on, for all new practitioners, we have to require them to be fully-trained and fully registered as TCM practitioners. I think let us not compromise on standards here.

Dr Tan Sze Wee asked about the enrolment in our local TCM schools. We have two schools. They offer 6-year part-time course or a 3-year full-time course. And I am quite glad both have tied up separately with TCM universities in China.

Last year, about 100 graduated from both schools. Currently, about 800 are at various stages of studying, another 200 are doing the 3-year full-time course. So there is a total of about 1,000 stretched over several years. I just read today's newspaper that NTU is starting a double degree course with Beijing TCM University. So there will be a few students from there too. I welcome that development.

Dr Tan asked about the impact of TCM training on western primary healthcare. But TCM has always co-existed with western medicine, playing a very useful complementary role. Their market share is about 12%, and I have been looking at those data for several years. It has remained quite stable at 12%.

Dr Chong Weng Chiew expressed a concern that we may be over training. We have now about 1,800 on the TCM register and, as I said, there are 1,000 still in the pipeline. It seems like a very large number. I have no idea whether the

market will be able to absorb 1,000. As always, as I said so yesterday, let the market work. But the market can only work if you provide useful information. What we would do and what the TCM community ought to do is to publish information, how many are you training, what is the job prospect of graduates. Like NUS and NTU, every year, they systematically publish within so many weeks or months, their graduates get jobs, their starting pay, etc. And I think the students need to know. My fear is that if you have two competing TCM schools and they start competing to produce as many as possible, it is troublesome, you get over-training and the students come out, they cannot find jobs. I do not think that will be fair to the students. I am not saying that the students are finding no jobs. I do not know enough about the industry yet. But I would urge the community to publish more such information into the public domain.

Let me now move west to our hospital clusters. Mr Alex Chan and Dr Chong asked whether cluster formation has achieved the purpose and whether excellence can be better achieved through a third cluster. Frankly speaking, the key to medical excellence is seldom due to organisational structure. I have seen various kinds of organisational structures among the top institutions, from Cleveland to Stanford. Top performance comes from leadership. Are the leaders serious? Are they clear of their goals? Are they able to attract like-minded people to join their cause? Are they ready to drop team members who are distracting or are distracted?

So whether it is one cluster, two clusters, three, or five, the more important question is whether we are clear about our mission and do we have good people who are passionate about our vision. Do we know when to cooperate,

and when to compete? This is increasingly the key to winning the global competition.

As I see it, the only way SingaporeMedicine can stay ahead of competition, is for all hospitals, public and private, to work together as Singapore Inc. when it comes to professional matters. We fight as one team.

Last year, I advised the two clusters to stop organising competing annual scientific meetings but jointly organise much bigger annual scientific meetings with far greater impact on the region. I am glad that they are taking up my suggestion. They are now planning to upsize the many small local professional meetings to include the professionals from the region. Then you have meetings involving thousands and not just a few hundreds. They will also share and consolidate their databases of conference participants so that we can market our meetings more effectively. They will also try to leverage on the many world-renowned scientists, Nobel Prize Laureates, that A*STAR brought into Singapore, to help project Singapore as a thought leader for all things medical. I am very cheered by this development.

Last year, one of my grassroots leaders had a mild heart attack. He was a former patient of SGH Heart Centre. He had a heart attack at home, called the ambulance and because he lived very near to Tan Tock Seng Hospital, the ambulance brought him there. After stabilising him and discovering that he was a former patient of SGH, Tan Tock Seng Hospital, different cluster, called up SGH, informed them that they were sending him over. They put him into an ambulance and sent him to SGH. SGH was ready to receive and admit the patient. He stayed in hospital for seven days, recovered, he came out. Then only he told me about his experience of a very pleasant encounter

with the two hospitals. Mind you, he was a subsidised patient.

I was very happy to hear his experience. Obviously, the rivalry between the two clusters must have eased. I dare not say that it has disappeared, but it has eased, at least in this instance, and SGH and TTSH have been able to cooperate for the welfare of their patients.

In short, it is not about how many clusters we have. The key is focus and leadership. What counts is how we take care of our patients at the front line, in the clinics and the wards. If our clusters compete to have the latest equipment, inflating pay to poach staff from each other, and shifting costs to each other, then we are headed for disaster. But I am confident that we have enough sense to know that the competition is not against each other. Competition is against diseases. Our focus must always be on how to improve health, how to reduce illness, how to do better and more with less, for the sake of all Singaporeans.

Our success will depend on whether we have the right leadership at the front line: hospital CEOs who see the larger picture and share the vision, and yet at the operational level, are hands-on at the helm of a tightly-run ship. They serve the doctors, the nurses, the frontline staff, make sure that the right systems are in place, the right people are well-trained and well-deployed, and facilities and equipment are working optimally so that our professionals can care for their patients in the best and least-costly manner.

If we stay focused on the right thing and have the right people in charge, I see no reason why we cannot be the best in the region.

Mdm Halimah, can you take your cut, please?

Manpower Supply and Development for Healthcare

Sir, I think on the issue of manpower development and supply for the healthcare sector, we all agree that having an effective and adequate supply of manpower for the healthcare is extremely crucial for an effective delivery of healthcare services in Singapore. In this respect, there have been many developments, one of which has already been alluded to by the Minister when he spoke recently about the establishment of the second medical school and focusing on how to create greater specialisation and sub-specialisation for doctors. These developments will contribute towards developing better healthcare service through the doctors.

The other development is, of course, the establishment or allowing nurses to continue to upgrade themselves through a degree in nursing through the second medical school that is being set up. For a long time, this has been the bugbear of nurses that they have no opportunity to do so to improve themselves. This is definitely a step in the right direction. I would like to ask the Ministry also to consider not only on the direct staff providing healthcare services, like nurses and doctors, but also to look at the para-professionals. Because to have an integrated, holistic healthcare delivery system, particularly with an ageing population, we do need para-professionals, ie, podiatrists, psychotherapists, to provide palliative care as well. There is some concern that this group probably has not been receiving enough attention, and there may also be a shortage of this category of para-professionals. So I would like to urge the Ministry to look into the needs of this group of people and also to ensure an adequate supply of such para-professionals in the public health service.

Health Manpower

This is relating to health manpower. Can the Minister inform the House what is the exact number of doctors working in the polyclinics of each cluster in each financial year from 2001 to 2004, particularly those doctors who are registered under Temporary Registration with the Singapore Medical Council (SMC). The reason why I ask this is that I understand that the temporary registered doctors in polyclinics are not Singaporeans. Singaporeans are either provisional, conditional or fully registered with SMC. Can the Minister provide the nationalities of these temporary registered doctors in the polyclinics? Also, can we request for this data from the cluster hospitals as well?

The second question is, what are the average salaries of our doctors, say, for a first year medical officer after his housemanship who has graduated from either NUS, or Singaporeans who are trained overseas, either UK, Australia or approved universities, versus the temporary registered doctors who are working and employed in the same service. Third, with the onset of block funding, should there be a difference between those under temporary registration and the other two categories? Would the clusters be, therefore, more inclined to hire more doctors under temporary registration versus locally-trained or overseas-trained Singaporean doctors? Fourth, can the Minister assure the House that, with block funding and possibly increased use of such foreign doctors under temporary registration, quality care to our Singaporeans will not be compromised in the public sector?

Finally, I understand that these doctors are registered under the temporary SMC registration. Having read through the relevant sections of the Medical Registration Act (MRA) on Temporary Registration, which is section

23, and given the nature that these doctors are purely here to give service with skills that are already commonly available amongst Singaporean doctors, I am uncertain how they can qualify for temporary registration on such a prolonged basis. Temporary registration is for doctors to "engage themselves exclusively in teaching, research and postgraduate studies in medicine". These doctors are here in our polyclinics to give a service primarily. Therefore, would it be better to amend the MRA to create a special class of conditional registration instead?

12.45 pm

In addition, in a reply to my learned colleague,

Dr Lily Neo in 2002, Dr Balaji, SMS for Health, said that there would be many more doctors entering the workforce in 2007. Can MOH confirm now that we will no longer need such temporary registered doctors working in our polyclinics from 2007 onwards?

Preventive Healthcare

Sir, preventive healthcare aims to have those who are healthy to remain well for as long as possible without getting ill from especially the lifestyle-prone diseases. Life expectancy for Singaporeans is about 79 years, and I would like MOH to start paying more attention to the needs of the elderly and ensure that they keep fit and healthy for as long as possible. I am advocating adding life to years.

What are the steps taken by MOH to ensure that the elderly also keep fit and healthy? Will MOH step up health promotion and prevention of diseases for this target group? MOH should partner MCYS in the setting up of centres of activity, especially for those less well-off retirees in the community. There should

be at least one centre per constituency to keep the mobile elderly physically, mentally and socially fit.

Sir, early preventive measures are preferable and more effective than later interventions at points of crisis. Will MOH promote and reinforce the axiom of "disabilities in old age are often due to disease and early treatment of the disease can prevent disabilities"? Will MOH ensure that those with diagnosed chronic diseases get their regular long-term medications? Chronic diseases, such as hypertension and diabetes, are big problems to the poor, as they have limited resources. By stinging on the required regular long term medication, they end up with diseases, such as stroke, heart diseases and kidney failure that cost them and the society more in the end. Will MOH include chronic diseases care for those eligible poor elderly in the Primary Care Partnership Scheme?

Sir, I want to declare that I am a doctor participating in this scheme.

Chronic Sick Services to Complement Polyclinics

Sir, I would like to declare my interest as a health practitioner in a few charity welfare organisations.

In fact, I agree fully with what hon. Member Dr Lily Neo has mentioned.

Currently, only patients who seek treatment for chronic illnesses follow up at polyclinics qualify for Government subsidies. However, there are limitations to the reach of our polyclinics to the needy. Many of the elderly sick have mobility problem and thus have difficulty going to the polyclinics without assistance. As a result, many of the sick, the poor elderly postpone or even to the extent of defaulting on their visits to the polyclinics until, very often, which is the

case, their conditions are irreversible or untreatable. Such situations lead to unnecessary sufferings and could result in even heavier medical bills for them subsequently and their families, as well as the taxpayers, who would subsidise the more aggressive and usually more costly treatments to help them recover.

To alleviate the situation, may I suggest that the Ministry of Health consider allowing means-tested patients to seek subsidised chronic sick follow-up at private clinics. Our network of private clinics is excellent, at least one within walking distance of almost every HDB block.

Next, besides giving grants to our two current health groups, would the Ministry consider allowing qualified charity welfare organisations who offer chronic sick follow-up medical services to the needy to claim similar grants? This way, voluntary welfare organisations can also assist in serving the poor and sick by offering subsidised services which complement those already offered by our current medical agencies. This would be perfectly in line with the many-helping-hands approach of our Government.

Dr Tan Sze Wee, you have two cuts. Take them together. Five minutes, total.

Polyclinics

Sir, let me first declare my interest, although very little as a part-time GP on weekends when I do not travel.

On the anecdotal feedback from my medical colleagues that the two cluster polyclinics have very different objectives and modus operandi, one is rather conservative while the other is quite aggressive, and hence the growth rates for the two polyclinic clusters are quite different. This has also been compounded

by the introduction of night polyclinics back in 2001 which led to further growth. If these growth rates are sustained in the future, will block funding be able to sustain these growth rates? If not, what can we do about it?

Will the Minister kindly furnish us with the following information:

The year-on-year growth in workload and year-on-year growth rate of the polyclinic workloads of each of the two clusters from 2000 to 2004 inclusive;

Give us the possible explanations to account for the differences in growth rates between the two clusters, should the rates be quite different;

Given that the rates obtained in (1) above, does the Minister expect these growth rates to continue to vary very significantly in the next five years; and

Reassure us that the proposed block funding mechanism will be able to continue funding these rates of increase, as given in (1) above of the two clusters' polyclinics in, say, the next five years and, if not, are there any plans to fund the polyclinics along these rates of historical expansion or to curtail demand for polyclinic services.

In developed countries all over the world, it is established wisdom and common practice to "de-market" subsidised primary healthcare. The exceptions being that of immunisation, whereby it is treated as a public good with positive externalities as well as certain disease screening, such as pap smear and mammography. However, from the years 2000 and 2004, it is largely perceived that the polyclinic went on a marketing spree to market its services. Because there is no means test currently in practice in the polyclinics, the capacity to abuse through a "buffet mentality" or "moral hazard" remains pretty large.

The other issue with block funding of polyclinics is the disproportionate distribution of market share between the two clusters. One cluster has almost two-thirds of the polyclinic cluster while on the other hand, it only has 40% market share on the hospital, ie, secondary and tertiary, level. So, it is not 50-50 down the line vertically integrated. Going forward, is this mal-distribution sustainable? With the advent of block funding, what is there to prevent one cluster from dumping subsidised patients on another cluster by getting polyclinics to refer its patients to the other cluster?

Infectious Diseases

As brought up by Mdm Halimah Yacob yesterday as well, it was mentioned that during the SARS outbreak in 2003, Singapore did not have enough infectious disease specialists and public health specialists. Can the Minister inform the House how many doctors have been recruited for the Basic Specialty Training (BST) and the Advanced Specialty (AST) for the disciplines of infectious disease and public health respectively?

Sir, I would like to thank the hon. Members, Mdm Halimah Yacob, Dr Tan Sze Wee, Dr Chong Weng Chiew and Dr Lily Neo for their comments. Mdm Halimah and Dr Tan asked about the medical manpower situation. Dr Tan made particular reference to the polyclinic.

Sir, manpower planning in healthcare is not an exact science. As we recently announced, there will be a second medical school. This school will take 25 students in its first batch in 2007. They will be housemen in 2011, finish their advanced training around 2017, and become specialist consultants around 2020, ie, about 15 years from now. Likewise, the

number of doctors and specialists we have today was influenced by the admission policies of the last 30 years. Fortunately, the number of doctors working here is not solely dependent on rigid manpower planning. This is because a significant number of Singaporeans study medicine abroad and a number of them return home to work. We also take in foreign doctors who have augmented our numbers. And we have Singaporean doctors who leave to work abroad in the US, UK and Hong Kong. They reduce the local supply but they are an asset to Singapore because they form a Singapore network around the world that we can tap into. Just as Singapore hospitals recruit foreign doctors, foreign countries try to recruit our doctors. Some time ago, there was a team from the UK which visited Singapore. It was led by a distinguished surgeon and they were trying to recruit surgeons for the NHS. Three years ago, two of my former neurosurgical trainees who became consultant neurosurgeons were offered salaries of US$500,000 each, tax-free, to work in an oil-rich country. They turned down the offer.

Today, there is a global market for skilled medical manpower. Our healthcare system works within this market. The global market helps us import doctors in the areas where there is a shortage and allows our doctors to work abroad if there is a temporary oversupply in any specific area. In the same way, there is a global market for nurses and the health sciences professionals like physiotherapists and radiotherapists. Our nurses are targeted by foreign recruiters. I am told that the recruiters hand out leaflets to nurses at the bus-stops and MRT stations serving the public hospitals. The existence of a global market means that we have to pay globally-competitive wages if we are to hold on to our healthcare workers. But it also means that we can meet shortfalls in our manpower requirements by recruiting foreign-trained workers.

Of the 7,000 doctors registered by the SMC, about a fifth are foreign-trained. They have been a plus to our healthcare system. Let me give two examples of foreign-born foreign-trained doctors who have contributed to our healthcare system. Prof Abu Rauff and Dr K C Tan are foreign-born and did not graduate from the local university. Prof Rauff was Chief of Surgery at NUS and was teacher to many of the top surgeons in practice today. Dr K C Tan is, of course, Singapore's liver transplant surgeon who saved both Ms Andrea D'Cruz and Mr Suleiman when their livers failed.

By welcoming talented foreign doctors, our healthcare system has been able to deliver better care to the public. There is no reason to discriminate against them. In answer to Dr Tan, there is no difference in the pay structure between foreign-trained and locally-trained doctors. The starting salary for medical officers is around $3,500 a month. Temporarily-registered doctors receive less because they have to be supervised. Those on temporary registration who perform well should eventually be given full registration. In answer to his specific question on the number of temporarily-registered doctors, there are 219. They work in both clusters and about 30 of them are in the polyclinics.

In looking at medical manpower, we need to also consider the distribution of doctors between the various specialties. Specialisation makes it difficult to redeploy medical manpower. The United States, which has a sophisticated training system, has 24 specialties and includes family medicine as one of the 24 specialties. Singapore has 35 specialties, and we exclude family medicine. Specialisation creates silos with walls that prevent the movement of work or doctors across specialties. Even within specialties, doctors sub-specialise further and are reluctant to be deployed elsewhere within the specialty. This can create a relative

over-supply or under-supply within the specialty. For example, since the number of deliveries in our public hospitals has dropped from an annual peak of about 40,000 to less than 20,000, the number of neonatal beds should be halved. Instead, the neonatal specialists tell me the number of beds remains the same and that they are working at 110%. When there were 40,000 births, the neonatal specialists had the modest goal of reaching a standard equal to that in a good hospital in the UK or Australia. Now, they want to be one of the top three centres in the world. With more than enough skilled manpower, relative to deliveries, they can set themselves this goal. The neonatal specialists are a dedicated and hardworking group, and they may achieve their goal. I am proud of their work. But this is an example of supply-induced demand. Since the supply of neonatal specialists has increased greatly in relation to the number of deliveries,

they have just set higher standards for themselves.

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Mdm Cynthia Phua yesterday expressed concern about the high cost of drugs and diagnostic tests. The clusters buy in bulk and this has reduced the cost of medicines. With regard to radiological tests, there are many new diagnostic machines. In countries like the US, rules have been relaxed so that other specialists are allowed to own and operate these diagnostic machines. This is not yet the case in Singapore. Our regulations reduce the supply of specialists who are allowed to operate the machines to only radiologists. The cost of radiological investigations in Singapore is sometimes twice that of neighbouring countries. This is not a problem restricted to the private hospitals. The MRI and CT scan charges at our restructured hospitals may, in some cases, be higher than the private sector. Patients bear this cost. MOH will study

how to safely deregulate and introduce more supply and more competition so that the unit cost for radiological tests is brought down. This will benefit patients.

I have given these examples to show that market principles apply in healthcare and, at the same time, to show how supply can create its own demand.

For the market to work, our hospitals must have autonomy in making decisions on how they employ their doctors and what services they wish to provide. So, in answer to Dr Tan on the differences between the clusters, there must be differences because NHG and Singhealth do not have identical practices. They have the autonomy to make their own management decisions and compete with each other. This gives patients choice and the competition between the two will lead to better service and lower costs. They have different manpower recruiting strategies and different plans for future expansion. The CEOs of the clusters, hospitals and polyclinics are on the ground and they are in the best position to make decisions. I believe MOH should not try and micromanage the polyclinics or hospitals. And we should not unnecessarily set restrictions on them on what they should do in 2007. I do not have a crystal ball to look into and say in 2007 what the situation will be and what decisions they should make.

Mdm Halimah wanted to know what the doctor-patient ratio was. She was concerned about the number of doctors we have. In 2000, it was 1:720 population. It is now 1:650 population. So there has been an improvement. The second medical school will increase the supply of new doctors starting seven years from now. At the same time, we are going to need more doctors as our population ages. So looking ahead, I think supply will match demand, but even if the

two did not match up exactly, any shortfalls or excesses will be evened out by the global market place in healthcare manpower.

Mdm Halimah was also concerned about other health sciences professionals. I agree with her. We must support the training and development of other healthcare professionals like nurses and the allied healthcare workers.

Dr Lily Neo highlighted the problems of chronic diseases in the elderly. Looking after the chronic diseases of the elderly will become the biggest sector in healthcare. With our high healthcare standards, Singaporeans can look forward to living into their 80s and 90s. This is good news. But it also means many will develop one of six chronic diseases in their lifetime, namely, hypertension, diabetes, heart disease, stroke, cancer or dementia. We must therefore be able to manage these diseases better and in a holistic manner.

Unfortunately, many members of the public think that specialist care is better than the care of a GP or a polyclinic doctor. Perhaps, this is because of the word "specialist", which is derived from the word "special". So patients think they get ordinary care from a GP and special care from a specialist. This is not so. The "special" refers not to special care, but to a special part of your body. The part of your body considered special is not really special - it could be your liver, or your lung or your colon or skin. It is considered "special" by the doctor because that is the usual part of the body he treats. So depending on the number of parts your body is divided into, you will need that many specialists to look after you. A specialist is therefore a body-part expert and not a whole-body expert. I have said there are 35 specialties in Singapore. If we exclude pediatrics and obstetrics, which I presume a man will not need, a man may need 33 specialists for his care.

So that is why many patients in our hospitals end up seeing multiple doctors which costs them a great deal. Even then, sometimes things are missed because there will be gaps between the body parts covered by the specialists looking after the patient.

We need to educate the public that GPs, family physicians and polyclinic doctors are experts in looking after the whole body just as specialists are experts in looking after one part of the body.

The chronic sick often have multiple problems and they need holistic care. The polyclinics will be piloting specialist Family Clinics to look after chronic diseases. They will start with clinics that will look after hypertension and diabetes. They will announce the details when they are ready to roll out the service. If the pilot is successful, then GPs can be brought into the system to provide holistic care. We will study how best to model this scheme, possibly similar to the PCPS scheme, as suggested by Dr Lily Neo. Similarly, we can study how VWOs can be involved in chronic care, as suggested by Dr Chong.

Looking after the elderly requires a "many helping hands" approach. The grassroots can take the lead. And if any technical assistance is needed, my Ministry will help. I agree with Dr Chong that VWOs can play an important part in looking after the chronic sick. Like MOH, VWOs can employ competent doctors to provide primary health care. But there is a difference between MOH and a VWO. The great strength of the VWO is that it is a people-driven organisation, and that means it is an organisation with a heart that beats in tune with the community and that it is closer to the community.

Dr Tan had asked about the adequacy of infectious disease manpower. There are 18 infectious disease specialists, of whom 15 are in the public sector. There are also over 70 trained public health specialists

and there are about 10 trainees in each speciality. For the exact details on the numbers, we can send it to the Member. Is this enough? Having more specialists is always better but I think our numbers are adequate.

In November, I had forecast that the rate of increase of AIDS was such that, in 2004, we will cross the 300 mark in terms of new cases diagnosed. The final tally is in. Sadly, the total number of new cases for 2004 was 311. In 2003, the number of new cases was 242. This means there was a year-on-year increase of 28%. Currently, 90% of these newly diagnosed patients are males, with one-third being gays. We had a low prevalence rate of HIV in the past, even in the gay community. We do not know the reasons for the sharp increase of HIV in the gay community. An epidemiologist has suggested that this may be linked to the annual predominantly gay party in Sentosa - the Nation Party - which allowed gays from high prevalence societies to fraternise with local gay men, seeding the infection in the local community. However, this is a hypothesis and more research needs to done by the experts. The reported new cases are only the tip of the iceberg. In total, we have more than 2,000 HIV/AIDS patients. But for every AIDS patient we have diagnosed, there are possibly two to four undiagnosed patients with HIV in Singapore. That means there could be anywhere between 4,000 and 8,000 undiagnosed HIV patients in Singapore. Last month, there was an alarming report from the US. The AIDS virus has mutated and the new virus is drug-resistant and kills quickly. Even those who are already HIV-positive can get infected by this strain.

We therefore have to make testing simpler for people at risk. MOH is currently studying the introduction of over-the-counter HIV test kits. These test kits are easy to use because they test the

saliva. Any member of the public should be able to do it themselves. This will allow those at risk to test themselves. If those with HIV are diagnosed early, they could receive treatment early and hence minimise the development of complications. They could also take precautions so that they do not spread the disease.

Recently, we made testing of HIV in pregnant mothers an opt-out option. This increased the overall screening rate from 37% to 77%. As a result of screening, in the last two months, we have saved at least one child from getting infected. MOH is studying proposals to make testing of pregnant mothers compulsory so that we can achieve 100% screening.

Sir, besides gays, the other major risk group are heterosexual men who have casual sex. In many cases, this puts the wife at risk. In countries where the AIDS epidemic is full-blown, the majority of AIDS patients are women. This is because it is easier for the infection to move from man to woman than from woman to man. Currently, 10% of AIDS patients in Singapore are women.

If we do not act to protect women, many women will get infected and we will have a situation where women form the majority of AIDS patients. Do we want this to happen? There is a need to balance the right to confidentiality of the AIDS patient with the right to protect those at risk. The current legislation appears to be tilted in favour of the patient and exposes the spouse to the risk of catching AIDS. It also prevents the healthcare system from performing its public health duties. This is one reason why the AIDS epidemic is not coming under control. We need to treat AIDS like any other public health problem. We must give public health workers the tools needed to screen for the infection and contact-trace the infection. We need to protect the women of Singapore.

There has been a reluctance to deal pro-actively with AIDS because of the fear that the AIDS patient will be discriminated. Hence, many measures were put in place which hindered efforts to diagnose HIV. But if the HIV patient is not diagnosed and even the person who is HIV-positive does not know he has HIV, how can we effectively stop the transmission of the disease? We need to de-stigmatise testing and, at the same time, we must prevent discrimination against AIDS patients. A lot of education is going to be needed. And the Health Promotion Board in Singapore will be busy this year working on this. Those who test positive for HIV should be able to lead normal lives in society. MOH will consult with the public and stakeholders before proposing any legislative changes.

Finally, there was some fear expressed by Dr Tan over the block budget system affecting clinical services. Minister Khaw has outlined to this House our approach towards block budgeting. There is no perfect health system. The health administrator has to work in a market-based system and is forced to be as efficient as he can. At the same time, the block budget ensures that the overall growth of the healthcare sector is moderated so that healthcare remains affordable. So, in answer to Dr Tan, the clusters will have to see what their block budget is and then determine what service they should expand. If they think polyclinic services should be expanded more because there is such an overwhelming demand, then that is what they should expand. If they think they should invest more in inpatient services, that is what they should do. I do not think we want to set a rigid guideline for what they should do over the next five years and then guarantee this House that that is what they are going to do and guarantee that the block budget should be used for that. As far as possible, we should let those on the ground decide how best to use the funds available

and match what

new services they are going to provide with what is needed by the people of Singapore.

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For the doctor, he must do the best for his patients with the means available to him. He should do what is reasonable and correct in the provision of care to the patient. The standard of care we expect is that set by his peers. So, there will always be some tension between the two - the doctor and the administrator. But this is a healthy tension, as long as both realise that the other is also working for the benefit of the patient.

Mr Ahmad Khalis is not here.

Eldercare

Sir, would MOH endeavour to improve the quality of life for the elderly? I would like to ask MOH for the policy planning on the medical needs of the elderly in the next 10-25 years when the elderly population will increase from 14% to 20% of the population. Such a policy planning should be prioritised by MOH so that the heavy burden in the future will be cushioned.

What progress has MOH achieved to provide for the three-fold increase in the resident population above the age of 65 in 25 years' time? Are there plans to increase the capacity of the various healthcare services such as acute hospital services, nursing homes, day centres, community daycare centres? May I urge MOH to ensure that we do not leave it too late for this provision in the coming years.

Sir, I would like to ask if MOH agrees that homecare in Singapore is at its infancy and if MOH considers homecare as an integral part of healthcare in an ageing population? Does MOH see it as a priority presently and, if so, would MOH

develop homecare services in professional medical caregivers, domiciliary services, daycare with rehabilitation facilities, occupational therapy services, as well as equipment and adaptations at homes? Would it also look at a variety of inter-related needs such as nutrition, nursing, medication and mobility management and, thus, the services of personnel, transport and domestic support? Should MOH involve the community help and community volunteers to deliver part of the homecare services? Most caregivers in the community are family members and maids. Would MOH help to provide the proper know-how and homecare support?

Sir, MOH should aim to provide seamless integrated care services for all discharged elderly patients from public hospitals to placement of patients to stepdown care facilities that look into their medical, social and psycho-social needs. Would MOH ensure coordination and effective implementation of these services and make them user-friendly as well?

Home Therapy

Sir, once again I agree wholeheartedly with hon. Member, Dr Lily Neo. She always has the privilege to mention those points before me.

The Ministry has introduced subsidies for homecare providers three years ago. I think that is in line with the Ministry's objective of promoting homecare or rather home-based or community-based care as compared to institutional care. However, currently, the subsidy does not extend to many other services including home therapy services. Thus, I hope the Ministry will reconsider this decision in view of our growing ageing population.

An increasing number of elderly Singaporeans will require physiotherapy

and other follow-up care services that are conducted at their homes and in the community. This is because many elderly people are either living alone or are alone in the day, when their children or caregivers are at work. Hence, they are home-bound. Yes, there are daycare centres at various locations island-wide but, even so, elderly with mobility problems will have problem accessing these services. In addition, not every estate has daycare centres. In fact, those people who will benefit maximally from therapy are actually those who are home-bound. If a person has the ability to go to a daycare centre for rehabilitation, probably his disability is not as bad as one who is home-bound. Thus, without MOH's subsidy, the elderly poor will not be able to benefit from treatment and therapy just when they need them most. If the Ministry could subsidise such services, many elderly will benefit from this improvement in their health, as well as their quality of life. Thus, I hope that the Ministry will review its position on this policy.

Sir, I thank Dr Lily Neo and Dr Cheong Weng Chiew for sharing their views and concerns, especially with regard to the elderly population. I agree that there are immense challenges in transforming our healthcare sector, and in ensuring more efficient use of resources, as well as more effective delivery of services. The MPs have highlighted the importance of a multi-pronged and seamless approach for public health policies and programmes, from preventive healthcare to ensuring that the services are delivered to the elderly population.

Today, the healthcare service delivery in both the private and public sectors remains fragmented. Both of them are healthcare practitioners, and they are in a

better position to understand and to know that. This lack of integration gives rise to disconnects in service delivery and optimal healthcare outcomes. Except within small groupings of providers, there is very little sharing of critical information, when a patient moves from one provider to another. To compound the issue, we continue to be concerned with chronic diseases such as diabetes, hypertension and heart disease, each of which can cause significant health and financial burden.

Tremendous effort lies ahead of us, and to date the progress has been slow. The technology needed to link up different health care providers has existed for many years, yet very few, if any, providers have taken the initiative to come together. Why is this so? Many chronic diseases can be detected early and actions taken to prevent their deterioration. Prevention or delayed onset of such diseases will help individuals achieve a higher quality of life, as well as lower their healthcare costs.

We need to address this more systematically. To have better disease management and proper care for the chronically-ill, it is crucial that we continue to transform our healthcare delivery system innovatively and on various fronts. More of the same certainly is not sustainable. With the advice and wisdom from our MPs who understand the issues on the ground, we are confident that these problems could be overcome.

To facilitate this journey of change, the Health.connect concept that was mentioned in this House last year has now been fleshed out in more detail and piloted in the Jurong area since July 2004. Jurong Health.connect is an initiative that MPs like Mdm Halimah, Dr Tan Cheng Bock, Dr Lily Neo and Mr Ahmad Khalis are actively involved in, with the strong backing by Mr Lim Boon Heng. This is not an easy pioneering effort. Jurong

Health.connect requires active support to integrate healthcare services across both public and private healthcare sectors, across hospital and step-down care, across carers and patients. When completed, it will deliver holistic care from all providers working as a team, with the Electronic Medical Records as the backbone.

Let me start with the first transformation needed in preventive healthcare. One key to a successful healthcare system is the early detection of diseases. Thus a primary component of Health.connect is health screening. Today, we have many players who reach out to different subsets of the community for health screening, under the Check Your Health programme, NKF screenings and ad-hoc outreach projects conducted by NGOs and religious groups. The GPs and polyclinics also conduct opportunistic screenings for their patients.

Unfortunately, there is no consistent health screening standard that these providers adopt, resulting in disparate datasets that are not effectively managed for useful analysis. Follow-up for those who require further attention is not systematically monitored. Jurong Health.connect is moving forward in this regard, with various providers agreeing on a standard screening approach. There is a call centre. The call centre under the Health.connect framework will reach out to those identified as needing further attention, allowing early intervention to manage the disease. This is part of the seamless process that we want to try to facilitate.

Since the launch of the call centre hotline and website in mid-October 2004, the last four months or so, it has fielded more than 100 calls, with 36 referrals generated, within the community. Cases helped by JHC include, for example, a woman who obtained a referral for a home nursing service for her 100-year-old

mother who was recently discharged from hospital. Another example is a woman who obtained information on services for her mentally-disadvantaged uncle. These cases were given information and access, referrals to facilities that are within the community. JHC is gradually building up a network, one step at a time, to link up healthcare providers in that area.

Sir, while we applaud the move towards better coordination of early screening, it remains a great challenge. Although the Government keeps the cost of screening affordable, we need more Singaporeans to be forthcoming. For example, a few years ago when a Community Health Screening Programme was launched to detect diabetes, hypertension and high cholesterol, at minimal charge, only a quarter of the target group turned up. The situation has now improved for ad-hoc screening programmes with larger numbers turning up, but not for regular periodic screenings.

The feedback from our healthcare providers and partners is that people do not realise the importance of regular check-ups, or of follow-ups, after an initial diagnosed medical condition. Singaporeans must do their part in preventive healthcare. We have provided the infrastructure, created the opportunities, but they must come forward for the screenings as well as follow-ups.

Sir, on a broader level, preventive healthcare is about healthy living. MOH and the Health Promotion Board actively encourage Singaporeans to lead healthy lifestyles, so that they remain healthy and disease-free for as long as possible. Promoting healthy lifestyle requires a multi-pronged approach to reach out to different segments of our population, such as school children, working adults and the elderly.

With a significant proportion of our population being working adults,

employers have an important role to play. In 2003, the National Workplace Health Promotion Survey showed that 86% of the Singapore workforce has access to a comprehensive Workplace Health Promotion (WHP) programme. We hope they capitalise on the opportunities that are presented.

Sir, international studies show that adopting a healthy lifestyle could significantly reduce the risk of chronic diseases. It would also significantly reduce the individual's healthcare spending. Research in the US, for example, has found that healthcare spending for obese Americans accounted for 27% of the growth of overall healthcare spending, and healthcare cost incurred by the obese individuals was 37% higher than that of normal weight individuals.

Sir, there is some good news at home. Preliminary results from our latest National Health Survey in 2004 show that Singaporeans are exercising more and smoking less. 24% of adult Singaporeans now exercise regularly, up from 17% during the previous survey. The proportion of smokers has fallen from 15% in 1998 to 13%, although there is a worrying prevalence of young female smokers. Singaporeans with diabetes declined from 9% to 8%, with high blood pressure also falling from 22% to 20%, and with high blood cholesterol falling also from 25% to 19%. This is between 1998 and 2004. The survey is conducted every six years. These figures are indeed very encouraging. But, whether this improvement is sustainable remains to be seen. We will, however, continue our efforts to encourage Singaporeans to remain healthy.

Sir, Dr Lily Neo raised some pertinent concerns with regard to the elderly population. I thank her for being a

constant voice for our senior citizens, and constantly reminding us of the plight of this group of Singaporeans. We acknowledge that as our society ages, more effort will have to be put in place to meet the health care needs of the population.

We have put in place an active programme of primary prevention and early detection and management of chronic diseases like hypertension and diabetes for Singaporeans at large as well as specifically for the elderly population. I mentioned earlier the HPB's “Check Your Health�? programme and other community health screening programmes, which are being enhanced to encourage more participation by the elderly. The cost is kept very affordable and the screenings are conducted on Sundays in HDB town centres to increase accessibility to the elderly. Where possible, the elderly are personally invited to undergo the screening.

For those elderly who have acute medical conditions, our polyclinics and hospitals are able to provide them with affordable care. We have set up the Integrated Care Services (ICS) in 2001, to ensure the proper discharge and post-hospitalisation handling of elderly patients, and that they are able to access long-term care if required.

To date, there have been 7,000 referrals through the ICS, 70% of which have been referred to nursing homes. The remaining cases either had families which found alternative arrangements or were not suitable for nursing homes, and some subsequently would have passed away.

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The elderly who require step-down care can access a comprehensive range of institutional and community step-down facilities - community hospitals, nursing homes, day rehabilitation services and home medical/nursing services - which

are subsidised by the Ministry. The ICS has been effective in reducing the waiting time for nursing homes, from three months to two weeks . This is with regard specifically to the concerns that Dr Lily Neo raised to ensure that there is seamless process of ensuring the patients who need step-down care when they are discharged from hospitals are taken care of.

The MOH is also working to improve referrals to day rehabilitation centres and other community facilities through further publicity with public hospitals as well as community referral mechanisms like the Jurong Health.connect. We will continuously review our processes to ensure that the movement of patients from acute hospitals to step-down facilities is quick and smooth for patients and their families.

The provision of health care services in an ageing population will continue to be a challenge for us. MOH is working with its partners, including agencies like MCYS, People's Association, the Singapore Sports Council, VWOs, CDCs and other grassroots organisations, to look after the health of elderly Singaporeans. We will continue to monitor the adequacy and effectiveness of these elderly care facilities.

The above and other inter-agency ageing issues are discussed through the key platform of the Committee on Aging Issues, co-chaired by SMS Balaji and myself. Recognising the multi-faceted nature of aging issues, this committee comprises relevant agencies such as MCYS, MOH, MND, MOT and MOF, as well as the people sector. We recognise and we realise that elderly issues are not the responsibility of only one particular Ministry, but it is a combination of the responsibilities of various different Ministries. So this platform of the Committee on Aging Issues will address those concerns that are relevant and related to the elderly population.

Sir, to date, a sizable number of ideas are being discussed for testing. The committee is also currently deliberating on the Eldercare Master Plan for the next five years. Dr Neo asked for the next 20-30 years. I think it is reasonable to work towards a five-year plan with a long-term understanding of what the implications are of the elderly population several years down the road.

Healthcare is one main issue affecting the elderly which the committee will monitor closely and provide further recommendations to ensure the healthcare concerns of the elderly population are addressed.

Sir, Dr Chong Weng Chiew raised the issue of home rehabilitation services for home-bound patients, just like Dr Lily Neo also. Indeed, we are keen to ensure that the elderly are placed with their family and within the community as far as possible. This ensures that the primary responsibility of the family is not compromised.

Today, MOH is already subsidising a range of home care and day rehabilitation services for the elderly who live in their own homes. The subsidies cover: (a) home medical and home nursing services by 14 VWOs; and (b) 27 day rehabilitation centres and therapy services, many located in HDB void decks. In addition, the current capacity of existing services for the elderly can be stretched. For example, the day rehabilitation centres can be further utilised, as the current utilisation rate is only 63%.

Our low-income elderly patients today already have access to subsidised rehabilitation, therapy and home care services in the community. We are assessing the availability and cost effectiveness of alternative services in the community, as well as the level of need in the community.

Dr Lily Neo asked whether the current services are adequate and whether we have any projections in terms of the need. At this point in time, the home care nursing services are very well subscribed. We have over 6,000 users of home nursing services and over 800 users of home medical services. We do not have an existing waiting list. I think we will continue to monitor the extent of need of the elderly population for both home medical and home nursing. And we certainly will look into how best we can further develop the services to ensure the needs are continually met.

Sir, a service like home therapy, as suggested by Dr Chong, requires one-to-one despatch of a therapist to a patient's home to provide rehabilitation services and comes at significant cost. And because of high subsidies required, it is not sustainable if the numbers are not big. So what we try to do now is actually to ensure that the medical and the nursing needs of the elderly who are home-bound are met first, bring them to a level that they may be able to travel with aid to the community rehabilitation facilities and then subsequently ensuring that they get the rehabilitation services that are already available in the community. I think the rehabilitation services in the community are sufficient because, as I mentioned earlier, the utilisation rate is now at 63%. We want to make effective use of those resources that have already been put in place. The principle behind it is to ensure that services are available close to the community such that more can access those services. If access is an issue, then we have to look at access issues.

The Ministry is aware of Dr Chong's point that there are some elderly patients in need of rehabilitation who have problems travelling to day rehabilitation centres. Today, there are a small number of private and non-Government

organisations, with some private foundation support, which offer home therapy. Some home nurses and therapists help develop home exercise programmes and train family members and caregivers to give simple physiotherapy for these elderly disabled until they can be brought to day rehabilitation centres for therapy. We will monitor the current situation.

Sir, the healthcare system is indeed a complex issue with many dimensions - quality of service, efficiency, cost, to name just a few. The solution is not simply to build more hospitals and clinics or to keep on expanding our existing services.

We believe that making the system work requires the co-operation of all the stakeholders - the Government, healthcare providers, and the people. The Government has put in preventive programmes including screening, and is investing in more public health education programmes which promote a healthy lifestyle. Singaporeans must take ownership for their well-being and go for regular screening and any necessary follow-ups.

Health.connect is an innovative experiment towards achieving seamless health care for our community - the issue that Dr Lily Neo raised. Health screening is an important step under Health.connect, but it is just a first step. Those patients who need acute treatment will enjoy seamless access to an appropriate treatment centre or hospital, accessed within the community as far as possible. Once discharged, Health.connect will facilitate the return and reintegration of these patients into the community through step-down facilities, including home medical and nursing care.

The small steps we take with Jurong today will one day lead us to a new model of healthcare delivery for Singapore. It will not be an easy journey. If successful, we may eventually have one nation-wide

Health.connect which integrates and delivers healthcare to all Singaporeans who require it. Certainly, for this to materialise, every stakeholder must play his part.

Sir, three clarifications for Minister Khaw Boon Wan, please.

Earlier on, he mentioned about supply induced demand. Could I ask him whether he has control over such practices in the public sector? Has he identified these practices? And what are the steps taken by his Ministry to stem out such supply driven demand in our public sector?

My second clarification is that the Minister earlier talked about Singapore being the regional medical hub, which I concurred with and which I spoke at length in the past in this House. May I ask him that in order to achieve this, we need to maximise our medical resources; therefore, will he endeavour to try to integrate the public and private sectors as much as possible and not just the clusters? And what are his plans on this?

Lastly, yesterday, he talked about the exodus from MediShield. Could I ask for an explanation from the Minister why he does not favour a national coverage of MediShield, so that the exodus of MediShield which he talked about would not be an issue?

Sir, since my name has been mentioned, I have got to respond. I thought I could relax already!

Dr Lily Neo asked about supply induced demand and what are we doing in the public hospitals. If Members had listened to what I said yesterday, what I am trying to evolve is an approach, because the bottom-line is this: we cannot possibly micro manage every department, every operator. My job is to make sure that the framework is as market-friendly

as possible, to allow operators themselves to have the incentive to do what is right. That is the larger picture. It is easier said than done but I think, progressively, if we eliminate distortions, we make the framework better. So some of the moves that I made in the last 12 months - block budgeting is a good example - where as long as the incentive is to reward volume, as Mdm Halimah pointed out, then, of course, supply induced demand would just grow and grow. But if I now say, "Sorry, this is your budget. It is an increase over last year. This is what I can afford. This is what I can get from the Ministry of Finance. Do the best with this budget. If you make savings, you can keep the savings or you can use those savings to introduce new services, improve on other activities and so on. Or pay your staff better so that you can retain your staff." Then I think CEOs and hospital departments would begin to think and do what is rational. Whereas if we try to micro manage and tell them to do this and do that, I can do that. I spent many years running hospitals but I always remind myself every day, when I walk into the Ministry of Health, not to try to become a hospital CEO or Permanent Secretary. That is the discipline that I always constantly remind myself. So I focus on what is the larger picture, the larger framework.

Her second point is about SingaporeMedicine and integrating the public and private sectors. Certainly. I made a major message in my earlier speech that we fight as one team, if we want SingaporeMedicine to succeed against the rising competition from China, India and so on. If we have civil war inside, treating each other like enemies, then I think the battle is lost. The important thing is that the competition is outside. And within Singapore, the only competition is against diseases and illnesses,

and we are all partners fighting this common enemy. It is like SARS. So

whether it is SARS, whether it is obesity, diabetes or stroke, that is the enemy. And where we can work together to improve the welfare of Singaporeans through better health, that is what we should do. But in practical terms, I have got to make sure all this starts from the public hospitals first. Then I am on moral high ground when I tell the private GPs or private hospitals to join me in this cause.

1.45 pm

Dr Lily Neo is helping us out in a significant way in the Jurong HealthConnect that Dr Maliki mentioned just now. That is a huge skunk works, pioneering work. Nobody is doing it in the world. We are at least attempting to try to solve this problem. I outlined this concept last year at the Budget debate. I was very happy that Dr Tan Cheng Bock, Dr Lily Neo, now, Mdm Halimah, and others are chipping in because it is a challenge. At the same time, if we can get it fixed, I think we would have made a major contribution to transforming how we deliver healthcare.

What is the end point? The end point is that everybody begins to look at the patient as a person. And we are all partners, as a team, trying to bring about better health for this patient. Instead of I looking at you, when you step into my hospital, then I am interested in you, and the moment you are discharged, goodbye; or the moment you walk into my clinic, I am interested in you, and the moment you leave, sorry, you are another digit, another medical record. But to bring that about, there are huge challenges. Fortunately, technology is beginning to help us.

So yesterday, when I outlined the vision of one Singaporean, one electronic medical record, it is crucial. Because without that infrastructure, how can I

share information with the GPs? Because, today, you may come and see me; tomorrow, you may walk into another private doctor. But how to share it? You require this infrastructure. From the IT planning point of view, it is no big deal. We only have 4 million people. So it is actually only four million electronic medical records. What is the big deal? In the financial sector, all those multinationals, like CitiCorp, you can go anywhere in the world, there are ATM machines, you have got the right password, and you can access your account. And that is global. Why can we not do it in the tiny little place called Singapore?

Who has done it in the world? Nobody has done it. I have a certain sense of optimism that because we are small, we are compact, we are better organised, and more importantly, the political leaders here enjoy a certain level of goodwill and trust by the people that we can have a better chance of making it happen. And if we do, then I think we will have made a major contribution to the whole practice of healthcare which can be a model for the rest of the world.

The last point is about exodus. I used that word in relation to Mr Low Thia Khiang's comment yesterday. He said, and quite rightly so, that the elderly premiums are high, a few hundred dollars. But at a stage when you are probably on pension, no income, and yet your premium is high. So he says, "Why can't we average it out?" So for MediShield insurance, average it out means everybody pays the same rate, young or old. It means the young subsidise the old. But I reminded him that the premium range is as wide as $30 for the young per year to over $500. So, if we average it out, it means that it may be around $300 to $400. That means we expect everybody to pay $300 to $400, instead of $30 today. That is 10 times more.

Can he guarantee that there will be no exodus of the young from MediShield? Because if there is, we will be in trouble. Then what is left would be all the old people, and what have we achieved? So that was when I used the word "exodus" in that light.

Since we still have 5 minutes, let me elaborate a little bit about the young and old. This is a very complicated subject - young subsidising the old. There are two aspects to it. Are you talking about today's young, like Miss Penny Low, supporting tomorrow's old when Miss Penny Low becomes older 20-30 years down the road? That is one aspect. The other aspect is today's young, again using Miss Penny Low as an example, subsidising today's Khaw Boon Wan. The first aspect is easier to handle and is probably more equitable. You are talking about the same person. We are just saying, "All right, when you are young and working, you pay more, so that when you grow old, you get these services." I have incorporated that into our MediShield reform. So we have a loyalty programme. The longer you stay with MediShield, when you become 70 years old, you will stand to get discounts as high as 40% off. So that is cross subsidy. That aspect can be settled that way.

The other aspect is more complicated - today's young subsidising today's old. The westerners did that. All the welfare states in the world "pay as you earn". And that is how the pension scheme was developed. It is wonderful when your demographics are in your favour. So for decades, it is the most kind and gentle system that one can evolve. But when they now go into the second half of the demographics curve, when the old are growing while the young are not growing, especially with very low birth rates, they know they are heading into insolvency. So if you read the newspaper reports, all the pension reforms, all the huge debates in

the US and Europe are all over the same issue.

We are a young society. I think we better learn from these older societies their problems. It is a huge trap that you are creating if you try to follow them. This is not to say that the young should not subsidise the old. But I think we have to subsidise it in a way which is sustainable for the long term. So what is Singapore's solution? What we have evolved over the years is top-ups. So whenever the economy can support, we top up. Whenever there are good budget surpluses, we set aside in endownment funds. And I think that way it is a much more sustainable model. More importantly, we make sure that we do not take away the role played traditionally by families.

It is an Asian tradition that parents sacrifice for the young and when they become old, the young people, when they can earn money, support their parents. But society comes in to supplement. So filial piety, which was mentioned by Dr Chong Weng Chiew just now, is a fundamental value. It is part of our heritage and culture. If you look at the Chinese word "educate", jiao comprises two parts. It is xiao and wen. In other words, education is the art of filial piety. So filial piety forms the crux of Asian education. I think that piece of Asian wisdom we should never forget.

My question was, why not national coverage of MediShield, which the Minister did not answer?

I have explained this before. If I were to design MediShield from day 1, 15 years ago, I would have done so. I would have preferred to make it compulsory. So it applies to all because it benefits everyone. Unfortunately, we started off on an opting-out scheme. Having opted out and to go back to make it compulsory, I think it is a step backward. Will Singaporeans support

that? I know NTUC heavily supported it. It is also my preference. But when I look at reality, opting out ---

Time is up, Mr Khaw.

--- has been able to generate 90% coverage, which is good enough.

Sir, first, I would like to thank the Minister, Senior Minister of State and Parliamentary Secretary for their extensive and comprehensive replies to this House. We have heard various initiatives and many changes which were introduced to our healthcare system. Many of these changes are good changes, and they will make our system more resilient and robust. In particular, we now have a more transparent system.

Mdm Halimah, I am waiting for you to withdraw the amendment.

Yes, I am making the points. And we look forward to many more initiatives on the part of the Ministry to put the patient at the centre, as the Minister is saying. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The sum of $1,689,007,260 for Head O ordered to stand part of the Main Estimates.

The sum of $102,490,200 for Head O ordered to stand part of the Development Estimates.

Head K - Ministry of Education. Mr Gan Kim Yong.

Education Policy

Sir, I beg to move,

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

Sir, our policy of offering greater variety and customisation according to the capability of the students is a correct approach. We ought to produce a few peaks of excellence while maintaining a high general level of academic achievements. However, I would like to stress that our education policy cannot be focused only on academic achievements. We must provide a holistic and balanced education for our children. In Chinese, there are five words that describe the five key aspects of education, de zhi ti qun mei, meaning moral values and character building, intelligence and knowledge, physical development, social skills and artistic skills.

Sir, we have done very well in the academic aspects. But I feel that we should strengthen our moral education and character development programmes. Moral values are important as they provide a sense of responsibility, accountability and respect for others. This is the basis of any interpersonal relationship, without which we cannot build a strong community. Character development, on the other hand, is important as it gives the person strength and determination to overcome obstacles and realise his dreams in life. I would like to repeat my call to the Ministry to review the moral education and character development programmes in our schools, such as the co-curriculum activities, the community involvement programme and the National Education programme. Perhaps, it is time that we revamped these programmes to make them more relevant and more effective. We could use the tsunami incident to teach our children values and character. Perhaps, the older children may even be able to be involved

in part of the relief and rebuilding efforts. This would help reinforce what they learn in the classrooms. I think more can be done in this area. And it would be useful to form a taskforce to review our present programme.

Sir, in our strive for excellence, we must also be mindful not to neglect students that need additional help. This is in line with our philosophy of building a caring and inclusive community. There are three categories of students whom we need to pay more attention. Firstly, slower students. We need to help slower students make progress and achieve success. We need to give them encouragement and build their confidence. In this regard, I would like to urge the Ministry to consider doing away with the remaining EM3 streaming at the primary level. We can give schools more flexibility to decide how to differentiate among its students and provide learning support for them, without explicit streaming.

Secondly, disabled students. We must improve our facilities to allow greater integration of students with disabilities. I have run kindergartens which include autistic children, and it is tough. They need more time and more attention. These students will also need greater financial support as they would require additional therapy to help them cope with the normal education programme. The Government has provided additional funding for them, or perhaps more could be done.

Thirdly, delinquent students. We must provide counselling and support for students who have disciplinary problems. Our objectives must be to try to keep them in schools, rather than to keep them out, so long as they do not affect other students in the school. Therefore, I would like to urge the Ministry to take a more lenient approach in re-admitting students who have dropped out of schools. The Minister has explained that these students must demonstrate a sincere desire to

return to school before they are re-admitted. I feel that this somewhat punitive approach is counter productive and I would like to urge the Ministry to reconsider. If at all, the penalty should be on the parents, not on the children.

Sir, education is the key to our future. It is for this reason

that many changes have taken place over the last few years to finetune our policy and programmes. However, education is a partnership. Parents play a crucial role in this partnership. It is therefore important that we communicate to the parents, explain to them and convince them. The confusion during the recent registration exercise is a case in point. Although the Minister has apologised, to be fair, it is not entirely the fault of the Ministry. Parents and students are also partly responsible.

Therefore, I would like to suggest that there should be a communication department within the Ministry that focuses on communicating its policies to the schools and to the parents. This way, we can strengthen the educational partnership and make our education policy more effective.

Sir, bold changes have been proposed for and made to our education system. In part, due to complaint of excessive stress on our students, adjustments are being made to the syllabi and course content. Yet, it may seem ironical that some people, probably who had also asked for the changes, are now concerned that these changes could undermine its quality. Yet others are concerned that this could be seen as an attack on our work ethics, which could send the wrong signal to our young that their traditional emphasis on hard work and efforts is wrong, and that one only needs to be creative and entrepreneurial to be successful. Yet, we all know that hard work and efforts are important factors of success. These

concerns are genuine and not misplaced. There are thus calls from the public to the Ministry to ensure that the changes do not lead to a reduction in the quality of our education system and the erosion of the value of hard work and efforts.

There is also the perception that despite the announced changes, things are not really different, and children are working just as hard as before, if not harder. This, they say, is aggravated by the shift to the 5-day week. Schools are perceived to cram the 5 1/2 days' workload into five days. As a result, some parents of secondary school children told me that their children who used to leave school at 3.00 pm now do so at about 6.00 pm. Another told me that his son leaves his school even later, after 7.00 pm. Because of this development, the family now has even less time together. Parents perceive different causes for the problem. But they all have one plea to the Ministry and schools: please look into ways to give time back to the children and the family. Some parents are impatient with the pace of change. They felt that the time between the announcement of the change and the implementation is too long. A case in point is the change to the teaching of the Chinese language. The proposed changes will not take effect until 2008. They do not want their children to miss out on the changes. Can the Ministry thus reduce the time lag between the announcement and the implementation of our policy change and hasten the changes already announced?

Some employers have also expressed their concern over the perceived fall in young job applicants' mastery of the English language. They asked: how could this be happening when students are getting better grades in the subject? They asked whether the examination grades are suffering from high inflation. Yet another group of the public has expressed concern

that our young lack the appreciation of our history and the life experiences of our older generations. They wonder what is happening with National Education in schools. They asked whether National Education is achieving its purpose.

Sir, three major points.

Certainty in syllabi. While Singaporeans often complain that the school system is stressful, the question is often whether the stress is from the school or whether it is from outside the school, namely, the parents. My children tell me that their schoolmates from China find it more relaxed and less stressful when they study in Singapore as compared to their schools in China. The Ministry may take measures to reduce workload on children to reduce stress. It has initiatives, such as "Teach Less, Learn More". When there is an announcement on syllabi reduction, instead of being happy, parents get frantic. When you tell parents that examinations will not be based on the standard textbooks, they panic. Parents will tap into their intelligence network to find out the right tutor who had helped a friend's child get solid grades for the last year's PSLE. It is the element of uncertainty that drives parents bananas in their endeavour to over-compensate for that void created in the reduction in school work. What the Ministry and the schools must do is to communicate to the parents as to what is required and spell out clearly what is in the syllabi at the beginning of each year. Nothing causes more stress and drives up the level of kiasu-ness than uncertainty.

Outcomes of education. As the education system evolves and we churn out more diploma and degree graduates, the Ministry will need to assess the quality of graduates that come into the workforce. Employers' feedback provide an excellent source of feedback. Only

then can we assess the outcomes of our education system.

I would like to take the case of medical technologists who graduate from Singapore Polytechnic. Compared to medical technologists from overseas, our graduates are armed with theoretical knowledge but have very little practical skills. More often than not, we have to get our foreign-trained technologists to give further practical training to our local technologists. The main reason is that when they are posted to the public hospitals for their practical attachment, the technologists there are too busy to teach them to allow them hands-on training. Examinations do not tell everything. Performance in the real world does.

Learning Malay. Sir, I remember that, as a primary school child, I had to attend Malay classes for the first four years. Most of us thought that it was a waste of time as it was a non-examination subject. However, in the course of work, the basic foundation I had in Malay became important. Today, I converse in Malay with many of my foreign patients, and it has made a difference. With Malaysia and Indonesia as our neighbours, it will certainly be useful to foster better relations with our neighbours by being able to communicate with them in Malay. We need to allow an avenue for our school children to be exposed to basic conversational Malay. However, learning has to be made interesting. As one student put it, "No one will pay attention to non-examination subjects." Therefore, the onus is on the Ministry to come up with better creative teaching tools.

Mr David Lim has withdrawn his cut. Mdm Ho Geok Choo. Six minutes.

Education System

Sir, the education system has been going

through a strict diet regime. When it is deemed to be too full, it gets trimmed, as in the latest "Study Less and Learn More", and when it is deemed to be too lean, it gets loaded, as in the past when the curriculum was beefed up to ensure that our students stay all-rounded. All these measures were so targeted to keep our education system in good shape. But, just like any dieting programme, the best results are obtained from a combination of a regular exercise regime and an accurate diet prescription.

I am glad to note that MOE is slowly evolving to that desirable state of outcomes. For this, we need to engage all stakeholders. To date, we have been engaging academic staff, parents and students in some of the policy matters. I say some only because it is only in recent times that the MOE has made the conscious effort of holding dialogue sessions to hear out the views of students on matters pertaining to their education or to the society in which they live in. I have three issues to raise.

On the first issue, I would like to comment on the CCA/CIP for JCs and the schools in general. Sir, I understand that the PEARLS system framework has been provoking the outcries of students for many years since its implementation in 2000. I note in several of the tea sessions that I conducted with the ITE, polytechnic, JC and university students in 2003 and 2004, under the Feedback Unit, students did not hesitate to share the downside of a system that served to inculcate and perpetuate a paper chase mentality, except that this time they literally chased points. This is a sad state of affairs, as we know that CCA/CIP should throw up desired attributes, such as leadership, passion, commitment and time involvement, which are less quantifiable than the descriptors of "Participation", "Achievement" and "Representation" under the PEARLS system.

In fact, the emphasis on the points to be attained had driven students to the point that some students had learned to "outbeat" the system by taking advantage of the score descriptors. The score descriptors "Representation" and "Achievement" under the PEARLS system are not an accurate reflection of the bigger purpose of what the CCA/CIP should be inculcating in a character. For example, two students A and B could both be engaged in a school approved-initiated outside club activity.

Student A displayed top ratings in all attributes of leadership, commitment, passion, time and effort devoted to the activity. Unfortunately, under the PEARLS framework, he failed to fulfill the descriptor of "Representation", as points given under "Representation" are only for competitions. Moreover, more points are given to MOE-organised competitions. Being in an outside club activity, even if it was possible to organise competitions, the fact remains that the scoring will be at a lower rating because they are not MOE-organised.

Student B may be less involved in the outside activity, so that some time could be spent in the school activity, such as the chess club. He would have fulfilled the descriptors of "Representation" and "Achievement". All that student B needed to do was to attend a few chess games, then sign up for a competition. In this instance, student B would be allocated points for "Representation" and "Achievement" even if he did not win the competition, whereas student A who excelled in the outside activity would have gotten a zero for both "Representation" and "Achievement".

Sir, many students have been affected negatively by the PEARLS framework, especially if their scores are at the border of an upper and lower grade, eg, between

an A and B because of failure to fulfill the "Representation" and "Achievement" descriptors.

Sir, on the recognition of CCA and CIP for scholarship awards, I would like to ask whether the PEARLS framework would be the only evaluation tool to be used. I would request that, as a supplement to verify the true involvement of a student in an activity, perhaps a testimonial written by the mentor or coach of the activity and verified by the school could be used.

Next, on CIP assessment, I understand that under this scheme, students had also learnt to "outbeat" the system simply by going round to chalk up hours but not actually getting involved in a meaningful way. Sir, I would like to know what is MOE's proposed implementation process to ensure the continuous involvement and feedback of all stakeholders on matters that impact them.

On my second issue, I would like to raise about teachers in school. It has been reported that teachers have left the profession because they could not cope with the additional administrative demands imposed on them. How does MOE intend to go about helping these teachers to cope?

Thirdly, I would like to touch on students with disabilities in learning. I would like to relate the experience of one particular Primary 2 student who has a learning disability. In the eyes of his project team mates, he had become responsible for slowing down the work of his class because of his slowness. This child undergoes the Learning Support programme in school. His classmates have creatively changed the label of Learning Support to "Lousy and Stupid" and he is called lousy and stupid by them. This has affected him much, such that he has developed eating disorders.

Sir, I am not against integrating children with disabilities in the main

school. But I would like to know what are MOE and the schools doing about situations like this.

Streaming

(In Mandarin): Sir, in the year 2000, MOE launched the subject-based pilot classrooms plan. I would like to ask the Minister whether his Ministry is ready to fully implement the plan with a view to ultimately replace the current streaming system. I think the true spirit of "teaching according to students' ability" is to respect individual students' natural endowment and strength and teach them the corresponding contents and methods. Give them the corresponding space and opportunities so as to lead students to realise their potential.

By euphemism, the current streaming system is described as "teaching according to ability". In reality, it favours the two subjects of English and Mathematics. The Mathematics examinations seem to test the students' proficiency in English to comprehend the questions that are set rather than their mathematical skills. This type of elimination system based on the command of English fails to fully assess and discover the students' natural endowment and aptitude.

If a student should lose the chance to go on studying their strong subjects such as Chinese or Science just because their English is poor, can it be said that we are streaming them according to their ability? Worse, the superficial elimination system has left in the minds of many students the intangible branding or inferiority complex.

School rankings have caused principals to avoid putting resources and attention on such students. This makes them feel rejected and hopeless, consequently giving up on themselves and become a

social problem aggravating juvenile delinquency.

At the same time, the polarisation of streaming results in elitist education and "elite schools". Many parents push their children to learn with intensive tuition hoping for their children's admission into these elite schools. This jeopardises the health of students and the meaning of the quest for knowledge is distorted. Streaming system also results in serious social contradictions. There is this student from one of the "elite schools" who sparks a war of words with the neighbourhood school students over the issue of boy-girl relations. They use words full of class discrimination and set up the alarm bell of social segmentation.

If we sit on the fence and do nothing, then this will become a heavy price to pay later. Year in and year out, I have repeatedly asked for a review of the streaming system because its ill implication is far-reaching. I sincerely hope that the Education Minister will boldly deal with the present streaming system to fully meet the demand and concept of teaching according to the students' ability. To truly develop our talents, we must resolutely abolish this narrow and rigid streaming system and expand the concept of subject-based classrooms by implementing the subject-based teaching system that is customised based on students' ability and interest. This will provide greater opportunity to maximise the potential of students, allowing the full play of maximum ability of each student. This is in contrast to the current system of streaming in determining one's fate by English language.

Development of a society depends on development of each individual within that society. An education system which is flexible with a customised system of teaching to foster individual development is helpful in building a reservoir of human capital for our nation. This will enable us

better face the challenges of this rapidly changing world. The current streaming system lacks these positive factors.

Recognising Excellence and Helping the Academically Challenged

Mr Chairman, Sir, I have said in the Chamber before that I am glad that we are beginning to recognise excellence in education in all its possible forms and not only in academic performance. But I have a small concern which I would like to ask MOE. Once we have recognised our brightest, whatever field it may be, should we not continue to develop them even further? I would like to ask MOE what are the resources that are being allocated to further develop our young in whatever area apart from academic.

There is also the need to develop the balanced individuals. Holistic education is what we want, as what Mr Gan has mentioned earlier. A child whose only strength is academic will exhibit inadequacies, some of them may be disruptive to family and society.

Emotional development is extremely important, for instance, compassion for others, culture awareness and appreciation, especially in a multi-racial Singapore. This must be imbibed in our young during their early years. We do not want a lopsided emphasis on the academic aspect of education at the expense of other important areas like character building, soft skills, appreciation of the arts and others.

Sir, I would like to ask MOE what are we doing to enlighten parents in this area. I know that it may not be MOE's view to seek to educate parents, but as partners in education, parents must be made to understand that their children must be educated in all aspects, not only on

academics. This overwhelming emphasis on academic education is something we have created in our desperation to develop as a nation, something we must unlearn and discard.

My third point, Sir, is in relation to the academically challenged. Our teachers must be given proper resources and skills to identify the academically challenged children at their early age. Time may be of the essence in these cases. What more can be done to assist this group of children apart from the LSP programme that has been mentioned many times? I would like to know what MOE is doing and what kind of resources is being provided to assist our teachers and the system to assist the young who are academically challenged. Addressing this early will bear us fruits in the long term.

Mindset Change

Sir, there is a need for MOE to promote a mindset change in our people with regard to stressful education in Singapore. Stress of education is still being faced by students and parents despite the announcement of MOE for significant cuts in curricula, change of teaching and examination systems, modified ranking and admission procedures.

There should be more effort put in to better inform parents and teachers about the recent initiatives of MOE. MOE should step up public education to enhance a positive approach and correct attitudes of parents and teachers alike. Should there not be more emphasis on preparing our young children to be the successful individuals of tomorrow who are innovative, confident, inspired, informed and globally savvy citizens? Parents must be convinced that there are the attributes that their children need for a leg-up in the job market and for success in their careers.

Innovative skills and creativity in our children, the attributes which we want to

cultivate, will not come from just getting good academic scores. Young children may lose the joy of learning, questioning, exploring if they are overloaded with school work and other extra-curricular activities with no free time of their own.

There is a need to promote a mindset change that every child will be given the opportunity to develop his or her best potential, albeit not limited to just the few popular professions. Success must be further defined without stereotyping of certain professions only. MOE must ensure that teachers observe the guideline changes that were announced. It would certainly defeat the purpose of cutting the syllabus of various subjects if the teachers still insist on teaching them.

Dr Neo, your time is up. Dr Loo Choon Yong.

Student Development

Sir, we have allocated $6.16 billion or 20.8% of total expenditure of Government to education. This is the second largest expenditure. I believe it is a very worthwhile one.

Education for our children rightly deserves our attention and resources. They are our future. More importantly, education provides social mobility that the meritocratic society must have. It is a social leveller. A boy from a poor family can make it to the top. He can be educated at the finest university at public expense. This is something I am very proud of Singapore.

I support the Government's spending on education and the PM's Edusave top-up for every student. I know I am speaking on the cut, but I actually hope we can spend even more money on educating our children because this is virtuous welfare.

Sir, the Prime Minister has promised that our schools will teach less so that the students can learn more. And I agree with Minister Tharman that we should nurture and inspire the next generation of Singaporeans. And through their ideas, convictions and passions, we will make the future of our country.

But how is the Minister going to make all these noble ideals a reality? The teachers, principals as well as many MOE officials have grown up in our schools and universities that have emphasised content, grades, rote learning. Can the Minister share with us his plans and strategy and methodology for retraining the teachers and principals to the mindset that my colleague, Dr Lily Neo, talked about?

I know it is a lot easier to teach content than to inspire and nurture students to new habits of mind. Contents are more tangible and measurable. So teachers, principals and inspectors will find it easier to account for their work. But we all know that the content rapidly becomes outdated in this fast changing world. Even medical knowledge has a half life of seven years only.

Sir, I urge all of us to be brave, the teachers especially, to be bold, as we embark on this new course. This is a bold fundamental shift of direction for our education system. Or in sailing language, it is a tack and not just trimming the sails. For myself, if at the end of the 10 years' education, we have instilled in our youths the curiosity and passion for learning and impart to them the arts and skill of learning, we would have succeeded and all the money would have been worth it.

Sir, recently, I re-read PM's Address at the National Day Rally last year - 23 insightful and inspiring paragraphs, the result of his conversations with 10 school principals and, of course, his own

experience. I recommend that the Minister make these 23 paragraphs compulsory reading for every teacher and principal if he has not done so. It will inspire teachers and principals to be bold and creative and be agents of change and not obstacles to change.

Sir, I am optimistic. Last Sunday, I am sure we have all read about the "zi cha" man - a hawker who sells seafood guotiao or whips up a 10-course dinner, shark's fin, suckling pig, etc. This is a hawker who has a dream to sail around the world. He is forking out $8,000 to sail from the Caribbean to Liverpool. To prepare for this sail, he has to learn about navigational rules in the Atlantic, sail routes, currents, coastal, coordinates, hazards and so on. He continues to nurture his passion - to learn and grow. He is a hawker. This is the kind of people we hope our schools will produce. We will then have a learning nation and we will excel. Workers will no longer need REAP and other retraining programmes because if workers are constantly improving themselves, they will actually be ahead of the curve.

Now, parents. Most parents are interested in the education of their children. Would the Minister be considering new and novel ways to tap this large resource of adjunct teachers free of charge? Parents want their children to do well and get ahead. Unfortunately, many of them are responsible for killing their children's interest in learning when they force-feed them with assessment books, home tuition and, in recent times, enrichment classes.

Sir, can the MOE not work out ways for parents to participate more constructively in the education of their children and have a stronger parent-teacher partnership in experiential

learning? For a start, may I suggest MOE prepare materials to guide parents so that they can bring their children on outings where they can bond as a family, as well as learn things together?

Opportunities abound in Singapore - visit the Arts Museum for art appreciation, tree-top walk to learn more about nature, flora and fauna and protect the environment, visit Sungei Buloh to learn about mangrove swamps and the life forms there, visit the Wax Museum to learn about Singapore's history, and Chinatown and Little India to learn about our heritage. The materials should contain information, learning opportunities, learning points, highlights and thoughtful questions, not the assessment book type of questions, one question only one answer. This will equip the parents for the task so that they would not find it too daunting. If we do this well, we will kill three birds with one stone. The children's curiosity gets aroused or stimulated. They will feel loved, parents will feel purposeful in educating their children and the joy of doing that is a great experience. And maybe even the fourth bird, some parents may actually be rekindled to want to learn again. We can also extend this to the area of community service.

Your time is up, Dr Loo. Mr Chiam See Tong. Four minutes.

Foreign Students

Sir, I wish to address on two issues: one, the competition in local schools for foreign students; and two, the admission of foreign students to our recently opened Music Conservatory.

Recent reports in local press indicate that the students in Victoria Junior College are not coping well with the challenge from foreign students. One pupil complained, "When I see them getting better results than me, I feel inferior and

pressured." Others suffer emotions, ranging from jealousy and envy to awe and admiration. A local parent commented that, "Foreign students would also take away jobs from our kids at the end of the day."

What disturbs me is that we have taught our pupils almost everything in school, except confidence - how to be confident in oneself. I think confidence in oneself is an important element which could determine whether a person succeeds or fails in his life's journey, which is a long one. It is often said that life is a marathon. So the success or failure in junior college examinations is only a very small part in the life-long journey. The important point is that it must not be able to destroy the confidence of a student.

In response to the said newspaper report, SM Goh said that, "What the junior college students experience is nothing. Wait till they go out into the globalised world. They shall meet challenges which are many times stiffer than what they experienced from the foreign students in schools."

Whatever it is, our students must be brought up to have confidence in themselves. If they have that kind of positive attitude they shall have better chances of succeeding in life. Maybe a good example is what Dr Loo has said, the zi cha man, he has got so much confidence he is willing to sail alone around the world.

I hope the Minister could arrange for regular talks by successful Singaporeans in schools to inculcate confidence in the students.

My second point is on the enrolment of foreign students in our newly opened music conservatory. Singapore has only one conservatory and has proven to be very popular. The enrolment to the conservatory is high and competition for places is keen. I know Singapore observes

meritocracy. In the case of admissions to the conservatory, I am certain that only those who qualify could get admitted, yet, I read in the newspapers that parents are complaining that too many foreign students are enrolled in the conservatory and their own children, who are Singaporeans, have missed out. Has the admission procedure not been made clear to those parents? Could the Minister explain whether there is a policy to gain foreign talents in our conservatory at the expense of local students?

Character Development

Sir, with the recent changes in the education system, I would like MOE to give more emphasis to character building of our students to develop values in them that will enrich their lives as individuals, and as members of society. Desirable basic character traits, such as courtesy, honesty, responsibility, fairness, filial piety, consideration for others and obedience to legitimate rules, in other words, knowing the good, desiring the good and doing the good, should be fostered. May I ask MOE what steps are being taken to ensure the character building of our students?

It is important that such values be reinforced without being indoctrinated and made interesting through interactive modes instead of being a study subject. Could MOE ensure that such character building education yield effects that students could relate to and apply to themselves?

The character traits should permeate the students' environment. How does MOE ensure that students see good examples in all aspects of school life such as through the behaviour of teachers, the administrative staff, the faculty and the policies of the institution?

(In Mandarin): Mr Chairman, Sir, in October 1997, MOE

implemented the student Community Involvement Plan (CIP). I support the scheme because, apart from inculcating knowledge to the students, the teachers also have the responsibility of teaching the students how to become good citizens. Such community involvement would build up the students' sense of responsibility and their compassion for the old.

During my visits to my constituency, I notice that younger people are now more willing to be involved in community activities. Now that it has been seven years since we implemented this scheme, what has been the progress? Are we encouraging more young people to become volunteers? During the tsunami episode, we find that Singaporeans are more concerted in their efforts to help others. I know that some schools have also mobilised their students and rallied their support for such a charity work. I think we should have more such activities so that our people could work towards a caring society for all.

Religious Knowledge

Mr Chairman, Sir, I rise to speak on the importance of deepening the teaching of religious knowledge in our schools.

Sir, our students in school are at an age where they are most receptive to learning. Our educators have made excellent progress in imparting a wealth of academic knowledge to them in their formative years. Recent changes in the education system envision that our students will become thinking adults. I applaud this approach and look forward to seeing more thinkers than rote learners.

Sir, while we are in the midst of effecting these changes in how our young are taught, I ask that their personal development too be considered. Our

multi-cultural, racial and religious heritage demands that we develop a more mature society through imparting knowledge about how we live in harmony. Religious knowledge, imparted in a way that is not politicised, will be an effective tool because it teaches our youth to recognise and respect the beliefs of their fellow citizens. I understand that currently, in higher primary schools, the students are taught a little bit about the festivities celebrated by other races, while the secondary school students learn some very basic information on religions. I find that inadequate.

I hope the Ministry will consider the introduction of teaching more about the different religions and starting them in early primary school years. We should not just touch on religions superficially. We should gradually build up the students' understanding of all the major religions in Singapore. We must aim that, at the end of the lower secondary schools, our students understand the fundamental principles and values of each religion, such as the five pillars of Islam, the four noble truths of Buddhism, and so on. We should let students know the significance of one another's religious practices. In addition, we should also arrange for our students to visit places of worship of the different religions. In so doing, we could nurture cultural and religious sensitivities of our students and build a more gracious and even more harmonious society.

Sports as Co-curricular Activities

Mr Chairman, every year, we hear repeated calls to make the system less stressful, less competitive, allowing our children to enjoy school, etc. I used to hear them but was not able to fully appreciate the extent of these calls until my children started going to school.

Stress level is high, not only in classrooms but also outside the

classrooms, not to mention in our own homes, especially outside the classrooms during CCAs. Sir, my concern is how these CCAs are conducted, the spirit behind it and the implications on the children. Specifically, I would like to focus on CCAs for sports.

When I was in school, I remember that the policy then was to have every student to be members of one uniformed group, one sports and another from another category. This ensured that students had a well-rounded exposure to the different categories of CCAs, or ECAs then, which offered diverse and unique experiences. Sir, this does not seem to be the case today. In fact, in the spirit of decentralisation of MOE, my fear now is that every school has its own way of managing their CCAs. Sir, while I appreciate the value of providing school autonomy, I urge the Ministry to keep a close tab on what is happening on the ground and its impact on the children.

I understand that in some schools the focus on sports CCA is primarily competitive sports. Thus, in the old times, we joined a particular sport as a CCA because we enjoyed the game. Today, at least in some schools, students can only join the CCA for a particular sport, only if they are competitively good at. They have to undergo a trial or an audition, and only those who are good at, and who will be able to represent their school competitively, will be selected.

Sir, within such a system, obviously there will be a sizable number of children who will end up not being selected as the school will only take in the numbers that are necessary to focus their resources that will bring glory to the school. The end result is that you have students, eager initially, to be part of the sports fraternity, being rejected from one sporting group to another. Rejection is an understatement. I know it personally because I have seen it in my daughter and

several of her friends. I know I am not the only parent who is saying that.

Sir, I would like to ask the Minister to ensure that the Ministry has a consistent policy with regard to CCA for sports in school so that we do not have a situation where sports is seen only in the competitive sense but rather that one can actually enjoy the sport. This is very much in line with our approach of encouraging sports for all.

Sir, first let me thank the Members who have spoken so far for their constructive comments and the broad support that they have expressed for the directions that we are pursuing in education. I should also thank them for the passion that never escapes a debate on education in this House, a passion that is really not surprising because, as Mr Gan Kim Yong has said, children are our key asset in Singapore. So, if we prepare them well, if we help them each to discover their own strengths and talents, and nurture in them the qualities they need to do well in life and to play a responsible role in the community, we will be preparing Singapore well for the future.

Mr Gan, together with Dr Tan Boon Wan, Dr Lily Neo, Dr Ong Seh Hong, Mdm Ho Geok Choo, Mr Zainudin Nordin and Dr Loo Choon Yong, had a common theme in their comments. They all spoke about the need to develop our students holistically. I agree with them that education is much more than about grades. The knowledge that our students acquire in school, and are tested on, is important. It is often the building block for future knowledge and learning. But more important is to nurture an enquiring spirit, a certain zest for learning that carries them through life. And just as important, we want our children to be imbued with sound moral and social values - especially the compassion and respect for others that

make for a cohesive society - and to develop the strength of character that allows them to ride over difficulties and live life to the fullest. Values and character development have always been integral to the education our schools provide and are now more relevant than ever. So I fully agree with Members who have spoken about the need to keep in focus these broader dimensions in education.

There have been several changes in our education system in recent years. There are not too many and they are not taking place too soon. If we do not keep evolving, as Mr Gan Kim Yong put it, our children will grow up unprepared for the world - a fast changing world. In the leading Chinese cities, major changes are taking place in curriculum every year, even in the learning of the Chinese language and in the way the schools and universities are being freed up to pursue new paths. They are looking outwards, taking ideas from around the world and implementing them quickly.

In the UK, Germany, Japan and the US, there is great dissatisfaction with the state of schools, and the desire to move ahead with reforms. But their problems are complex, the ideological currents often run deeper and their teachers are often organised to oppose reforms.

So our ability to move ahead with educational reforms in Singapore is a major advantage - our ability to revise the curriculum, to keep it relevant, to train our teachers, recruit new ones and to let some schools run ahead with the new models of education.

The recent changes in our schools are summarised in the blue booklet that Members might have picked up before the debate. But the thrust of the changes and refinements we are making in education

can be summarised in two words - opportunity and flexibility. Across the system, we are opening up more choices, more doors and paths to help our young discover their talents and develop them as far as we can. That is the essence of what we are doing, and we will keep communicating this to parents and students so that they understand the options being put before them and which are open to them.

Our schools now provide far more diverse opportunities than they did five years ago. It is most clearly evident amongst our secondary schools and junior colleges, but now our primary schools are also developing distinct strengths in diverse areas, from sports and arts, to outdoor adventure, and in the way we are bringing IT into teaching and learning. This is a new phase of diversity that we have embarked on. It is diversity that will be built on a common commitment to a high quality core curriculum that every primary school will deliver to prepare every child well for secondary education. We have just awarded 16 primary schools additional resources, up to $100,000 a year, to develop their own special strengths under the Programme for School-based Excellence. We will scale the number up in the coming years as more good proposals come through for schools wanting to develop niche programmes.

We are also recognising more diverse strengths amongst students, beside their performance in national examinations. This is an important step in education. Last year, we introduced the discretionary school admission system for our integrated programme schools which were given the flexibility to take in students on their own merit-based criteria. This year, we will be extending the discretionary scheme to our independent schools, our autonomous schools, other schools with well-established niches and our junior colleges for between 5-20% of their total

intake of students. This will take place at the end of this year for admission 2006.

Mother tongue language learning is also being reformed to help students develop an abiding interest in the language. We have been making refinements to our system of ability-based education by introducing more flexibility within the streaming system.

2.45 pm

Mr Gan Kim Yong and Mdm Ho Geok Choo also spoke about the need to cater to students with special needs

in our schools. We will continue to find ways to provide them opportunities, encourage and spur them on, and to help them reach the full potential. We have committed $220 million by 2008 to improve the special education schools and accelerate the redevelopment of nine existing special education schools. And we are looking at new ways to include certain groups of special education children within mainstream schools. My colleague, MOS Chan Soo Sen, will elaborate on this later.

MOE shares Members' views on the importance of character building, as part of the holistic education that our children should get. We want to give them a broad range of experiences as they grow up which provides them with the opportunities to develop character, to learn critical life skills and imbibe values.

To provide this, we have to do less of some things in education. The system is already full to the brim. So if we want to provide more space for character education, sports participation, independent learning or research, we have to reduce some other things that we do in education. Otherwise, we are overloading our schools and teachers, and run the risk of turning off our students.

We, therefore, have to make careful choices on what to take out as much as

what to put in. And as we do so, we have to avoid eroding the core strengths that have got us here. We have to achieve a new balance in education that provides broad-based holistic education for our students without compromising the rigour of learning in school that prepares our students well for post-secondary education wherever they go.

Our basic approach, as we go forward, is to go for more quality and less quantity. We will focus on the quality of learning, quality of CCA and community engagements and the quality of the whole school experience that the student goes through. We will seek to cut back on quantity, careful and calculated cuts, so as to provide more "white space" in the curriculum, space which gives schools and teachers the room to introduce their own programmes, to inject more quality into teaching, to reflect more, to have more time for preparing lessons and to give students themselves the room to exercise initiative and to shape their own learning.

We are reviewing this thoroughly in MOE and in our schools. We are working towards a 10-20% cut in our secondary school syllabuses in 2007-2008, similar to what we will do in the new JC curriculum from next year. We will do this judiciously. I absolutely agree with Dr Tan Boon Wan that any cuts should not undermine the core knowledge and skills that our young should have, or lead to an erosion of an ethic of hard work. And I should clarify that our objective is not to reduce stress per se. Our objective is to redistribute the load that students currently occupy themselves with, from an excessive focus on the academic and on examinations towards a broader focus consistent with our holistic aims in education.

Our schools are moving ahead with their own initiatives. Victoria Junior College decided this year to shorten

teaching periods and end school an hour earlier each day, to signal students the importance of engaging in their own learning. They also created on-line discussion forums instead of regular General Paper lessons to encourage students to express their views freely. They now find that, on their own, students participate more actively in the on-line discussions.

Schools are also reassessing the number of tests and examinations that they conduct. Tests and examinations have an important role to play in giving both teachers and students a sense of how they are progressing, and in motivating our students to go over what they have been taught to make sure they have understood it. But an excessive focus on examinations tends to narrow teaching and learning. It discourages students from venturing beyond what might be tested.

Many schools have gone ahead to experiment with different approaches to assess how pupils are progressing, particularly in the primary school years. Ms Eunice Olsen had asked during the Budget debate whether MOE would consider removing examinations for Primary 1 and 2. These are decisions which the schools will have to make. This year, two-thirds of our primary schools have decided to remove at least one of the two continuous assessment (CA) tests that they had conducted for Primary 1 students. Many have done likewise at the upper levels. Most schools have retained their mid-year and year-end semestral examinations in order to get timely feedback on student performance.

I agree fully with Mr Gan Kim Yong and Dr Lily Neo that we have to keep up communication with our stakeholders, especially our parents, as we proceed with changes in education. We will keep

doing this, first and foremost, through our schools themselves. We will also continue to use the media and MOE information booklets like the one we have just distributed. We want parents to know where we are heading, and how they can help their children and guide them in making choices in education. Parents should not equate large amounts of homework and frequent tests with effective learning. We should also not have unrealistic expectations of our children's abilities and push them so hard that they lose all joy in learning.

There are encouraging signs. A growing number of parents are looking at success in education more broadly than by examination performance alone, just as schools are recognising more diverse measures of success. Parents are helping their children find their own strengths and selecting schools that can best develop those strengths. We will keep up our communication with parents so that they support the schools' efforts to give children a holistic education and provide room for them to pursue the things they have a talent in or enjoy doing.

Dr Michael Lim asked specifically whether schools will keep parents informed of changes in the school syllabus before the start of the year. Our syllabi are posted on the websites of MOE and the Singapore Examinations Assessment Board. Syllabuses of the various examination subjects are also updated on the Internet for the public to access at the start of the year. And schools also keep parents and pupils informed on the parts of the syllabus to be assessed.

I will now turn to issues raised by Members concerning character development. Let me first address the specific point raised by Mr Gan Kim Yong on students who drop out, before I move on to the broader issues that he and others raised on character building. Mr Gan wanted the Ministry to be more lenient in

re-admitting students who had dropped out. Fortunately, our drop-out rates are low. And the majority of those who left school because they were expelled or for other reasons, and who want to return to school, are able to do so. But I am not keen to change our stance, that students should only be re-admitted if they show a genuine desire to learn and abide by school rules. It is not a “punitive approach�? as Mr Gan puts it, but one that preserves a culture of discipline in our schools. If we were to let students move in and out of school at will, we would demoralise the majority who remain. We will also lose the happy situation we have where the vast majority of students are keen to remain in school.

We should do all we can to keep this culture of discipline and avoid the drop-out and delinquency problems we see in many other countries. In the UK, the government has spent more than S$2.7 billion since 1997 on schemes to tackle truancy in schools with virtually no success. They now intend to spend an additional $1.7 billion in the coming two years to try to entice 50,000 students who skip classes every day back to school. About 40% of schools in the UK reported pupils bringing weapons into the playground or classroom at least once a term - previously thought to be an American problem, it is now British.

In the US, a recent Harvard University study found that 32% of American youths do not complete high school. In Japan, there has been a rising tide of serious crimes among students - crimes including pre-meditated homicide. Violence in school grounds is reported to have increased five-fold over the last decade. There is a sense of crisis in the Japanese society as a growing number of students seem to behave in ways that are completely alien to their parents, let alone their grandparents.

We are fortunate that our social fabric is still intact and strong. The number of

serious disciplinary cases in schools has not risen in recent years. We should keep the culture of respect for school rules and respect for fellow students. But we will do more - to help students at risk of dropping out or of falling into delinquency, and to help students who are keen to resume their studies and observe school rules after they have dropped out and want to come back.

By next year, we will have provided every secondary school with a full-time counsellor. By 2008, all primary schools and Junior Colleges will also have a full-time counsellor. This is in addition to the two teacher-counsellors we have already trained in our schools, and the two more we will train in secondary schools. They will help schools identify and assist students who need help.

Let me move on to the broader agenda of character development in our schools. It is an agenda we are giving more importance to. But while the Ministry provides various platforms and resources for character development, such as through the Civics and Moral Education Programme (CME), pastoral care programmes, co-curricula activities (CCA) and Community Involvement Programmes (CIP), we cannot be too prescriptive about the specific activities we expect to see in schools. There is no single fix, no formula in education to impart sound values or to develop strength of character. Schools have to see what works for their own students - students with different backgrounds and needs - draw on their own school traditions, and develop their own programmes and practices over time. And it will take time. As the Chinese saying goes, it takes a hundred years to raise a man of character.

So we will encourage schools to explore their own ways to develop the character of their students - ways that have to work in their own context. We

will recognise schools that work consistently and effectively at character development through the new Character Development Award that we will be introducing in year 2006. These schools can then share their best practices, particularly their processes, with other schools.

But schools will have to rely on the support of parents and the community, without which the job is always incomplete. It is the total experience of the child - how he is raised at home, the experiences and relationships he develops in school, right through his years of schooling, his encounters in the community, what he sees in the media - as he grows up that shapes his character, quietly, in unseen ways, in the classroom, in the playing field, on the performing stage and in the cinema theatre. Schools cannot do it alone.

I agree with Dr Lily Neo that character education can be more authentic where we engage our students in interesting and meaningful activities. It cannot be a textbook subject. One way is to expose the students to real-life stories - stories of men and women who have shown strength of character in difficult times and who have made significant contributions to society.

This is what Yangzheng Primary School did recently. It got 50 students to interview 20 prominent ex-students about their life experiences, and especially on how their personal values helped to make them what they are today. Some of the students were so inspired by the project that they hope to publish a book about these real-life stories. The stories brought to life for them useful lessons on hard work, thrift, honesty, uprightness and community spirit.

CCA and CIP programmes are integral to character education in all our schools. Mr Ong Ah Heng asked about the effectiveness of the CIP. It is now in its seventh year. On the whole, the CIP has been a very positive experience. The results of our annual CIP surveys and direct feedback from students in dialogue and feedback sessions indicate that CIP has made an impact in developing a spirit of volunteerism in our students during their school years.

The tsunami relief effort that Mr Ong also asked about was a good expression of this. Because you can really tell what is working when you see it happening, and not in what they tell you. Our schools raised a total of $3.5 million for aid agencies helping in the relief efforts.

The students did not just stand with tins in street corners. They organised bazaars and charity fairs, washed cars, painted faces, and all kinds of other things. They were also active in mobilising other schools. Pioneer JC, for example, led other schools in its cluster to collect tents, clothings and blankets for Sri Lanka. And tomorrow, 10th March, National Junior College will send some of its students to the Maldives, as part of its Overseas CIP to help rebuild some of the IT infrastructure that previous NJC students had in fact helped to build and which was destroyed by the tsunami.

We are making changes that will give JC and CI students greater ownership over their CCA and CIP programmes. I agree with what Mr Gan and Mdm Ho Geok Choo have said about the need to adopt a more qualitative approach. Student's CCA performance in JC is currently scored under a points system called PEARLS, as some Members know, for the purpose of applying to NUS and NTU. The CCA points are included in the applicant's University Admission Score with a weight of 5%, the remaining 95% being computed from their "A" level grades.

Since last year, we have also allowed NUS and NTU to select students on their own independent criteria, under a new, discretionary admission scheme. It allows the universities to consider students on the basis of a broader range of intellectual and character attributes, besides their "A" level scores. NUS and NTU are currently allowed to admit up to 10% of their students under this discretionary scheme.

The universities are now ready to take a further step that will allow for a more holistic and meaningful assessment of students' qualities. A student's CCA, which is currently given a single numerical score, will instead be assessed qualitatively under the universities' discretionary admission scheme. This change will take place in year 2007 which is when the current cohort of first year JC students applies for university. NUS and NTU will look at the student's involvement and achievements in CCA and CIP for evidence of desired attributes, like leadership, creative flair, perseverance and the pursuit of excellence. This would be similar to the qualitative assessment of CCA that SMU has had from the outset. It is also similar to the way in which many reputable overseas universities consider applicants, ie, a holistic qualitative assessment, besides their academic scores.

MOE agrees with the universities' decision. With NUS and NTU's move to a more flexible and qualitative approach for considering CCA, there will no longer be a need for a fixed system or points for CCA in the JCs and the Centralised Institute. Starting from this year's JC1 students, we will no longer score the CCA achievements and involvements of junior college students. The junior colleges will also move towards a more qualitative record of students' involvement in CCA and CIP, by reflecting their involvement and any special achievements and contributions in the School Graduation Certificate. In line with these changes, the

Public Service Commission (PSC) will continue to look at scholarship applicants' achievements and participation in CCA and CIP within the new qualitative framework that JCs will implement.

We will also remove the present six-hour minimum requirement for CIP in the junior colleges from this year. The CIP scheme, introduced in 1998, as I mentioned, is now a vibrant feature of junior college life. MOE is therefore comfortable with giving the junior colleges full autonomy to integrate CIP into their schools' curriculum in a way that best meets the needs and interests of their students. CIP will however remain an integral component of the junior college curriculum. The shift from a minimum time requirement for CIP is expected to help students to focus on authentic and enriching involvements, as many already do.

The changes in CCA and CIP are consistent with feedback, extensive feedback, from students and the junior colleges over the last year. They would encourage students to take greater ownership over these activities, follow their passions and build camaraderie, rather than engage for the sake of getting points for university admission. The moves are also timely as they come before the new "A" level curriculum that will be introduced in 2006, which aims to give students greater room and more "white space" to pursue their passions and interests.

However, for secondary and primary students, we will continue to keep the requirement for six hours of CIP. For secondary students, we will also continue to have a grading system for their CCA which counts for entry to junior colleges and polytechnics. They are still young and will benefit from some structure and guidance to ensure that they get a holistic education, and to help them get the most

out of their school years through CCA and involvement in the community.

Dr Maliki asked about sports in schools. Our aim is to promote sporting excellence among students through training programmes and inter-school competitions, as well as sports for recreation for as many students as possible. Schools plan their own sports programmes, depending on the available manpower and physical infrastructure and the school's tradition. A school would typically offer some sports at a competitive level and others at the recreational level.

While we aim to provide every student the opportunity to take a sport that he or she desires, the reality that we are faced with is that we do have resource constraints, both in terms of infrastructure and trained teachers and coaches. But I would like to reassure Dr Maliki that I am equally concerned about this, and that we are studying ways to overcome these constraints.

We are making progress. The number of students participating in sports, outdoor activities and other physical fitness activities increased by 9% last year. This year, more than 80% of Secondary 1 students were also assigned the CCA they most wanted to do, in other words, their first choice CCA. That is a significant improvement. I will give you an example, Loyang Secondary School. This year, Loyang Secondary was able to give all Secondary 1 students their first choice of CCA. The school also has a sports programme that aims to involve all students who do not do a sport as a full CCA with some exposure to sporting activities. Even its operational manager has got into action and started a weekly Floorball session. And from term 2, the school hopes to introduce two other sports, Pushball and American football, for mass participation. I am sure Members

know the differences between each of these games - Floorball, Pushball, American football!

Our schools are also pooling their resources to enable students to take part in mass sports events. For example, the North Zone Primary School Sports Council has set aside funds that schools can use to organise fun activities for pupils not representing their school in sports.

At the zonal level, we are organising many activities and competitions for students who do not take a sport CCA. In fact, last year, we had 12,000 primary school students and 700 secondary school students benefiting from these zonal activities organised by the Sports Development Committees.

Another theme that has emerged in today's debate is the issue of how we should meet the learning needs of different ability groups in our schools. Mr Gan Kim Yong suggested that we remove the EM3 stream in primary schools. Mr Low Thia Khiang asked if we could not adopt a modular system, instead of streaming, in our schools. Mr Low's suggestion accepts that we need differentiation in the system to cater to students with different strengths.

Let me first say that streaming in schools is not an article of faith in MOE. It is a practical approach aimed at helping every student to develop himself to the best of his abilities. It is an approach that we keep refining. And it has worked well. By differentiating the curriculum for students of different abilities, it has allowed us to motivate all our students to sustain an interest in learning, work hard to achieve realistic learning targets and get recognised, get some form of merit, for their achievements. It has helped us avoid the large drop-out rates that you see in many other countries or the fact that large numbers of students are graduating from high schools without

basic competence in literacy and numeracy. We have avoided the pretence of inclusiveness in undifferentiated school systems. We have focused instead on getting real outcomes and real learning among all our students. It is not done perfectly and we can do better. But the vast majority of students in Singapore leave school with a real foundation of skills, ready for post-secondary education and to pick up further skills that they need in the workplace.

It also happens to be the way the rest of the world is moving. I give you the example of Korea, because it is a driven society, Asian society, Confucianist majority, not very unlike us. Korea has historically not differentiated its students much by ability. They had minor variations but, by and large, they had an egalitarian approach. I quote what a recent editorial in a leading daily said in January this year, "It is already a proven fact that the standardisation policy of 30 years has failed at nurturing exceptionally bright minds. It is now clear that the policy is also not effective in increasing scholastic abilities on the whole."

What are the Koreans doing? They are now setting aside 1% of pupils in elite classes, something like our gifted stream, and they are setting aside 5% of pupils who will take more advanced classes so that they can graduate faster than the others. And they are going to differentiate pupils in 50% of their schools by ability; they are moving towards streaming. I cite them because they are, as I mentioned, a driven and competitive society. It would be much easier for me to cite examples of societies which are not particularly competitive or efficient. The Koreans have found out after 30 years that it does not work, and that they need to do better. Because they like us face the same competition, from China. And in China, the top schools, the elite schools, the elite streams are moving faster than us. And the Chinese have absolutely no

compunction about putting the best resources - better facilities, better gymnasiums, heated swimming pools, the best teachers from universities coming down for their brightest students. Why? Because they want their brightest to help China leapfrog the competition.

So we are up against that. Korea is up against that. We are lucky we did not make the same mistakes they did in the last 30 years. We have got a system that is imperfect but working fairly well, constant refinement, constant need to make it more flexible, but we are on the right track.

Mr Gan has suggested doing away with EM3 and letting all students take the same PSLE examinations. To put matters in perspective, let me provide a few facts. Our EM3 pupils comprise just 7-8% of each age cohort. Students who fail every subject are given the option of taking the EM3 curriculum when they get to Primary 5. It is an option given to parents. And parents who accept this option do so because they know their child will benefit from a pruned down curriculum, that they can master at their own pace. To illustrate, the EM3 Mathematics curriculum is pitched at about 60% of the content of the regular PSLE Mathematics curriculum. Further, EM3 students spend 30% more curriculum time on Mathematics as other students do on Mathematics. They get good teachers. In fact, some of the most committed teachers I meet on my school visits are often the EM3 teachers. So it is not true, as Mr Low says, that schools have neglected the EM3 group as there are fewer resources for them. It is simply not true on the ground.

Altogether, it is an arrangement that helps the majority of them pass their EM3 Mathematics examinations. However, some 20% of EM3 Mathematics students still fail to get a grade in the EM3 final Mathematics examinations; in other

words, they get what we call Ungraded, in their final assessment. Would EM3 students do better if they had stayed with the regular curriculum, and taken it at the same pace as other students?

Our differentiated curriculum through streaming was, in fact, one of the strengths highlighted in a recent study by the American Institutes of Research funded by the US Department of Education, that is, their Ministry of Education, entitled “What the United States can Learn from Singapore's World-Class Mathematics System�?. In contrast to the Singapore system of ability-based learning, the authors noted that in the US, “we expect all students to meet the standards in state frameworks, but the standards do not help teachers address the needs of slower students. In fact, US standards do not acknowledge that students learn at different rates�?.

There is no reason to give up the EM3 stream. It keeps our weakest pupils keen on attending school, gives them a foundation of knowledge that they can master or pass, and prepares them for secondary school. Some EM3 students when taught at a slower pace in Primary 5 and 6, in fact, catch up and do well enough to go to the Normal (Academic) stream. Some make it to polytechnic

and a handful even make it to JC. That does not mean that it was a mistake to have streamed them. It is often because they were given the opportunity to step back, start from basics again, get their foundations in place, gain confidence because they pass an examination instead of failing repeatedly, and then go on to their secondary school years with more enthusiasm for learning.

3.15 pm

What we are doing, however, is to introduce greater flexibility into the

streaming system wherever practical. Streaming need not be absolute, where a student takes every subject within his own stream. Some students will have strengths in specific subjects, which may allow them to study those subjects at a higher level or at a faster pace. We are letting them do so, both at the primary and secondary level. We have, in effect, been allowing for increased modularity and flexibility within the streaming system. We are doing it in steps, and learning as we go along.

In primary school, we now allow EM3 students who are strong in their mother tongue language to take the subject at a higher level. Some are already doing so. But Mr Low mentioned that there is a bias in the assessment system towards English and Mathematics instead of the mother tongue. I have an interesting bit of feedback to relate to him which I get from schools quite often. There are, in fact, some EM3 students who can take advantage of the scheme we have opened up for them to study the mother tongue at a higher level. But their parents choose for them not to do it. Why? Because their parents want them to spend more time on English and Mathematics at the foundational level rather than mother tongue at the higher level. That is a valid parental choice and we should respect it.

Schools are also taking a more flexible approach to how they deliver the EM3 curriculum. We have given schools the flexibility to integrate EM3 pupils with their peers for specific subjects where there is educational merit in doing so. This is similar to the way in which schools are banding pupils in the regular classes according to their strengths and weaknesses in a specific subject. For example, many schools band their pupils by Mathematics ability and then, during the mother tongue period, they take them out and rearrange them in mother tongue classes in a different order. This is banding by subject strength.

This year, eight out of 10 primary schools no longer have "pure" EM3 classes, where EM3 students take all their subjects together. In other words, EM3 students are now integrated with their peers in regular classes in subjects such as Social Studies, Art and Craft, Music, Health Education and Project Work, and Physical Education and Civics and Moral Education (CME), all of which are not examined at the PSLE. They are then taught in separate classes typically in the four core academic subjects, where their gaps in ability, compared to the regular students, are usually greatest. Depending on the profile of the EM3 students and the size of the class, sometimes the EM3 students also join the regular class for some other core academic subjects. But we leave it to the school, trusting their judgment as to what is educationally sound.

What we will also do is to focus on early interventions that can help bridge some of the deficits in learning in the early primary years, as Mr Zainudin pointed out. The Learning Support Programme (LSP), which caters to students who are weak in their language and literacy skills in the early primary years, is working well. It has helped many of our weaker students catch up with their peers after one to two years in school.

Mr Gan and Mr Zainudin have asked if we could do more for the academically weaker pupils, besides the Learning Support Programme. At the end of Primary 2, schools determine the most appropriate form of support for those students who continue to face difficulties in learning and reading, usually through customised remediation programmes as they go on to Primary 3. Where schools have the additional resources, the Learning Support Coordinators would actually cater to selected groups of Primary 3 students, typically those who

were ex-Learning Support Programme students.

Besides the Learning Support Programme, we have the Enhancing Achievement and Better Learning (ENABLE) Programme which provides support to Primary 2 and Primary 3 pupils with at least average academic or intellectual abilities but whose academic performance is not commensurate with their abilities. Here, too, the scheme is progressing quite well. What can we do further? We are providing more teachers to our schools and, through a variety of schemes that schools have, for example, “buddy reading�? programmes, various customised remedial programmes, parallel teaching that allows two teachers to split up a class in a particular subject or lesson in order to train the students at a different pace, or take them through different topics, all these things will become more the norm, as schools get more resources. But it will take time and, over the next four to five years as we recruit more and we are able to put more teachers into schools, there will be greater scope for differentiation and a more refined system of ability-based learning. So we are getting there.

Our approach, therefore, is to recognise the diverse talents and needs of our students, and find practical ways to motivate them to go as far as they can. We will keep refining our methods and keep the system flexible, and never assume that anything is an article of faith in education. We will also provide schools with more teachers in the coming years and improve teacher-student ratios, so that they will have, as I have explained, more room to experiment with flexible classroom arrangements.

Mr Chiam asked about our students showing lack of confidence and fearing the competition from foreign students. There will always be soundbites to that effect. In every society, you will find that

if you put a microphone in front of an average local, some nasty things will come out about the nearest foreigner, be it Indian, Chinese, Korean or Vietnamese. The most liberal, open and confident societies have that latent, not far beneath the surface. We are no different. But I think the weight of opinion in Singapore, youths and students included, is one of broad acceptance, not just of the need for foreigners from an economic point of view to be part of our system, but also the benefits the students themselves get by having foreigners in the class, pushing them on in their Chinese, sometimes edging them out from the table tennis team but which spurs them on to train harder and get back in. They like the fact that we have a more diverse international climate in our schools than we would if we were a parochial and closed society. Our students know they benefit from the exposure to the world that comes from this easy way, of bringing foreigners in. And if we were to rely only on Singaporeans to compete with each other, we will never make it.

Dr Tan spoke about the five-day work week, and I will explain very briefly that it is not the policy of the Ministry to move all Saturday activities to the weekdays. The five-day work week was implemented as part of the larger civil service move to be more pro-family. Our teachers are parents. They have their families, so they deserve their Saturday off as well. But we want to make sure we do not compromise on the quality of education we provide our students, including depth and quality of their CCA, CIP and the informal curriculum of the schools. So, in implementing the five-day work week, we have to balance these two considerations. We would not overburden the teachers, but should not compromise on the quality of education, particularly the quality of holistic education that we have been talking about.

The school day has indeed lengthened in some schools and junior colleges. Many students are getting home later, and getting home more tired, and that is not good for family life. So, schools are learning from the initial experience, first few months, and are re-calibrating their approach.

In general, I am encouraged by the progress of schools to rationalise their existing activities, and not merely shift all Saturday activities to weekdays. It will take a bit of time to settle, but I think there is good sense and a pragmatic attitude that our schools have on this matter. They are trying to find creative ways of using their teachers where they are most needed, relying more on external coaches, parent volunteers and, in the secondary schools and junior colleges, relying more on student leaders themselves to organise CCAs, so that we can still deliver a high-quality broad-based education without overburdening our teachers.

Finally, Sir, Dr Lily Neo asked whether we are preparing the teachers adequately to implement the changes we are making. That is absolutely important. We have found that one of the most effective ways to implement changes in policies in education is to engender ownership amongst our teachers and our schools. But the implementation of our policies will seldom be perfectly even across the board. Some of our schools are ready earlier to take on the changes we are making. We will let them press on, and not hold them back until every school is ready. These leaders will set the pace for the rest to follow. What is important is that we should be able to encourage innovative teachers and innovative schools to share their best practices with each other. In that way, we level up the system over time.

I must say that, in the midst of all the changes that are happening and in the

midst of the seeming stress that we often hear about on the part of both teachers and students, I am quite heartened by some of the tangible results that we are getting. Our recruitment programme is going very well. Last year, we recruited 2,000 teachers, right up to target, despite the recovery of the economy. So far this year, we are well on target, in fact, slightly ahead. We had a recent survey commissioned by MOE of members of the public, a large sample. They ranked the teaching profession as that which contributes the most to society, above doctors and lawyers. This positive perception of the teaching profession is what helps us in our job, and it becomes a virtuous circle. As we get more teachers into the system, push them out into schools, improve the teacher-student ratios, give them more time to deliver quality teaching, the attraction of the profession also goes up.

Members have raised a few other issues that I have not dealt with, including Dr Ong Seh Hong's point about religious knowledge and several points on Special Education which my colleagues, MOS Chan and SPS Hawazi will be dealing with later.

Order. I propose to take the break 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 3.50 pm.

Sitting accordingly suspended

at 3.25 pm until 3.50 pm.

Sitting resumed at 3.50 pm

Debate in Committee of Supply resumed.

Head K (cont.) -

Chinese Language

(In Mandarin): Sir, there is an ancient Chinese saying, "zi yi, xing nan", that is, to know is easy but to do is difficult. For any plans or measures to be successful, the key is in knowing how to specifically and thoroughly implement them, once the direction and principles are determined.

The Chinese Language Pedagogy Reform report is a landmark in the language education in Singapore. Having extensively discussed it in Parliament, we should put our hearts and souls into pushing forward the implementation details as recommended.

I understand that MOE has studied and explored various teaching methods, including "recognising first, writing later". I hope the Minister would enlighten us on the conclusions and suggestions of the Ministry's studies.

Apart from the teaching method, one other very important area is examination. This is because the process and style of examinations tightly restrain the teaching directions of the teachers, their teaching content at the schools and the learning attitude of the students.

For the pedagogy reform to be successful, the mode of examinations should also be thoroughly reformed and be closely linked to the expected outcome of the learning process. The important point is that it has to be more diversified and more innovative. Only then, can we change the present phenomenon whereby students study just to pass their examinations. Once the examination model is defined, the teachers would be able to adapt to the new direction,

thereby changing their teaching modes and make the students' learning process more varied and diversified, and relevant to daily lives, so as to further enhance the students' interest in learning and change their learning attitude.

However, we must recognise that teachers are the key and soul of the implementation of the reform. I am somewhat worried that up till today, the MOE has not proposed any specific training plan for the teachers so as to prepare the teachers for the implementation of the pedagogy reform. The MOE seems to be "great boast, small roast - much said, but little done". The action does not follow through.

Recently, MOE suddenly announced a reduction in the syllabus and some modules of the Chinese curriculum. This is actually a good measure. However, there seems to be a lack of communication in the implementation, resulting in many teachers, students and parents being caught by surprise. When interviewed on TV, one primary school student said, "All of a sudden, the school deleted the text which I have learnt. How am I going to prepare for the PSLE?" The student's remark illustrates two serious problems: first, the student's learning of the Chinese Language remains tailored at preparing for examinations; and second, it seems that the school, parents and teachers do not know what to do when they suddenly discovered that the teaching modules are reduced.

By right, cutting out the text and teaching materials which are compulsorily fixed as curriculum is a good thing to do. In this way, the teachers could have more flexibility to lead the students in participating in more interesting learning activities, thereby laying a solid foundation for their language. However, when MOE takes the interim measures,

from the reaction of the primary school student, we can see that we need, first of all, to help the schools prepare the students and parents. I understand that in some schools, they are taking out the Primary 3 to Primary 5 textbooks and teaching them to fill the curriculum time vacated by the reduction in Primary 6 curriculum.

Another preparatory work which cannot be delayed is that since we are going to commence the Chinese Language Pedagogy Reform in the primary schools in 2008, the pre-school sector, ie, kindergarten 1 and 2 classes must also have their curriculum revamped accordingly so as to prepare the students to dovetail into the new primary school reform. Otherwise, it would hamper the reform.

(In Mandarin): MM Lee has said that we must develop a pool of 150 to 200 Chinese elites each year to strengthen our competitiveness.

China is playing an increasingly important role in the world's economy and politics. If we do not have bilingual Chinese elites, the role we play in East Asia and the world in trade and economy will soon be weakened. However, the university admission criteria have been changed. The mother tongue scores will no longer be counted. This has become an obstacle to our goal of developing a pool of Chinese elites. Students who have done Higher Chinese in secondary school may choose not to continue with Higher Chinese at "A" level and JC, since their scores will not be counted for their university admission in the future.

If the number of JC students taking Higher Chinese was reduced, enrolment in the Department of Chinese Studies will also drop. This is detrimental to our plan to nurture a pool of Chinese elites. I would suggest that in order to encourage

potential students to continue taking Higher Chinese, we should give them some incentives. May I suggest that the students who score "A" or "B" in Higher Chinese and intend to take Chinese in the university be classified as "linguistic talents". The bonus points for mother tongue should be increased from two points to four points. This would attract more students to take Higher Chinese.

In addition, the Minister announced yesterday that the Ministry does not impose restrictions on schools which wish to open primary level Chinese elite classes. This has been welcomed by the parents. May I ask the Minister, currently, how many schools conduct Higher Chinese classes and if the Ministry would consider opening specialised Higher Chinese learning centres, for the convenience of students who wish to pursue Higher Chinese.

Mother Tongue

(In Mandarin): Mr Chairman, yesterday at the Parliament library, I was having a chit-chat with Minister of State, Mr Chan Soo Sen when, full of zest, he suddenly recited an old Chinese poetry:

"Or be a Liaodong hat, my integrity can brave the icy snow;

Or be the command to send out the troop, even the ghosts will weep at the heroic and glorious deaths;

Or be the oar of the boats crossing the river, vehemently conquering the barbarian enemies;

Or be the tablet to hit at the traitors, breaking their heads.�?

I marvel and admire MOS Chan for his mastery of the Chinese classics and his remarkable memory. Fortunately, I could at least remember that this came from the

"Zheng Qi Ge" (Ode to the Noble Spirit), a heroic poem by the renowned General Wen Tian Xiang of the Song Dynasty.

Coincidentally, I saw Dr Wang Kai Yuen reading a book of ancient poems yesterday. The first page of the book read:

"I have the strength to move the mountain, But the time and luck are not with me; Even my faithful horse refuses to move, My beauty, my beauty, what can I do?"

Immediately I saw, in my mind, Xiang Yu, the Conqueror of Western Chu Kingdom (西 楚 霸 王),

crying out at the bank of the river at the end of his resources. A good man caught in extremely difficult circumstances immersed in love with his beloved concubine. What a sad and heroic picture!

These are two passages of literature from the Chinese classics which are familiar to many Chinese school students of the past. However, this morning, when I read these passages to my young colleagues who came from the SAP schools, they seemed dazed and were completely at a loss.

I do not blame them because over the last two to three decades, after rounds and rounds of reforms to the Chinese education, it seems that the standard of Chinese has gone down again and again. This is an undeniable fact. Our only hope now is on the implementation of the recommendations of the Chinese Language Curriculum and Pedagogy Reform White Paper which we endorsed last year.

In the early part of this year, MOE announced the relaxation of the Chinese language syllabus by cutting out a substantial number of prescribed texts.

This is worrying to many. By this reduction, the students would be learning less words and it would naturally impact on the learning of the Chinese language. Would it also imply that the standard of Chinese language would slide again?

The key now is whether or not our students and teachers could make use of the time vacated by this relaxation of the syllabus in other ways and deploy more flexible methods of teaching and learning. If the schools and teachers stick to the old methods of teaching Chinese, the standard of Chinese will definitely slide further. I think we should make the learning of Chinese livelier, then, and only then, can the standard of Chinese be raised. I am very glad to see that many schools are deploying all sorts of ingenious way to make the learning of Chinese more relevant to daily lives. On 6th March, Lianhe Zaobao had a comprehensive report on this. Now even the kung fu novels have gone into our curriculum. Some SAP primary schools are going to conduct "Chinese elite classes". I hope that the Ministry of Education will encourage all the schools to do likewise.

Apart from teaching, the examinations should also be livelier. We should not be testing the students on the number of words and phrases they can memorise any more. On the other hand, I think we should make them livelier so that the students would learn how to use Chinese for their daily conversation, to use Chinese to absorb knowledge, to upgrade themselves and to cultivate themselves to become virtuous persons.

The Government wants to cultivate a pool of some 200 Chinese elites each year. I think this is not enough. We should not be confining ourselves to the cultural and educational fields only. We should cast the net wider to take in Chinese elites in the fields of politics, business and

the arts as well. We should involve even the civil servants and the professionals so that we have a lot of people who know the culture and language of China, in depth and breadth.

Bahasa Malaysia

The Malay language or Bahasa Melayu has a chequered existence in Singapore. In the 1950s, nearly all Singaporeans could speak bazaar Malay. English in those days was not spoken by the common working people, except a minority of Singaporeans who were educated in the English medium schools.

In 1954, the PAP was formed and it proclaimed inter alia in its first party manifesto as follows, "A lingua franca is necessary and moral, political and practical considerations make Malay, rather than English, the obvious choice. The alleged inadequacy of the Malay language as a lingua franca is not disinterested propaganda. The Malay language in Indonesia, freed from Dutch colonial restraints, is rapidly becoming a comprehensive means of expression and communications in science and technology, commerce, industry and the humanities. By contrast, the Malay language in this colonial country remains static."

In 1954, the PAP's aim was to make Malay the lingua franca of Singapore. It nearly succeeded when Singapore joined Malaya to form Malaysia. In 1963, Malay was a compulsory subject in all Government and Government-aided schools, and all civil servants were required to study Malay. They all had to pass Standard One Malay; otherwise they could not be confirmed.

During that period from 1963-1965, when Singapore was part of Malaysia, the promotion and study of the Malay language amongst Singaporeans was at

its zenith. But the fall of the popularity of the Malay language as its rise was just as fast. After 1965, with the advent of the mother tongue policy in Singapore, where only Malay students were allowed to study Malay as a mother tongue or second language, all Singaporeans, who were non-Malays, did not study Malay and were quite ignorant of the subject. It is sad to know that almost all younger Singaporeans have not had the opportunity to learn basic Malay.

Singapore is in the heart of the Malay world. Indonesia and Malaysia are our close neighbours. They have over 220 million people between them. Their economies, although not as strong as ours, are improving. I think it would benefit Singapore, if Singaporeans could communicate with people in these neighbouring countries in their language.

I am pleased and happy to read in the Straits Times of 18th February 2005 that the Education Ministry is considering an option to let students learn Malay or Bahasa as the third language - read, speak and understand it, without having to master the writing. I think Malay is a language important enough for Singapore to make it a compulsory subject at the elementary level. I would like to know whether the Minister is willing to make ML3 a mandatory, but not examination, subject in our schools.

Mr Chairman, Sir, I shall speak first in Mandarin.

(In Mandarin): Mr Chairman, Sir, I would like to thank Mr Yeo Guat Kwang, Mr Ang Mong Seng and Dr Ong Seh Hong for their support for the Chinese language pedagogy reform and the many good suggestions they have made. For many of the issues raised, we have already deliberated very extensively during the debate on the White Paper. So I do not intend to go through them all over again.

I would just like to report on what we have done after the adoption of the White Paper.

Although this reform would be fully implemented only in the year 2008, that is, four years from now, we have been following up intensively since the debate. Soon after the debate on the reform to the Chinese language pedagogy, we sent a MOE delegation of experts to Hong Kong and China to learn the teaching of Chinese language there. We discovered that from 1999, the concept of "recognise first and write later" has already been a main stream teaching strategy for CL in China and Hong Kong. We were surprised that in such traditional Chinese-speaking society where Chinese was read and written by everyone, they still consider it necessary to adopt this strategy in the teaching of Chinese to the young. I met some of the officials in China and they told me that it was very difficult for the children to learn Chinese using the ancient method. So, now, the new method of "recognising first and writing later" was to ensure that the students would be able to read at a younger age. The younger they start to learn, the younger they would be able to read the Chinese classics and story books. This is exactly the same argument we had when we debated the White Paper.

There are also other points we could learn from PRC's approach in teaching CL. For example, they let the students learn, first of all, the radicals and the basic strokes. And, at the same time, for example, the characters 人 ren (man), 从 cong (follow) and 众 zhong (public) all consist of the basic character 人, except that it appears once, twice and thrice respectively. Likewise, the characters 木 mu (wood), 林 lin (woods) and 森 seng (forest）. As a matter of fact, more often than not, the Chinese characters are formed by combining the radical and the basic strokes in fairly logical patterns.

They also line up characters which look alike but are totally different in meaning. For example, 清 (clear)，情 (feeling) and 请 (invite). The right hand side is the same but they follow different radicals, hence giving different meanings. For us, who already know Chinese, this may not appear intriguing. But, during our school days, there was no such systematic learning, and we just have to swallow them hook, line and sinker, learn them all by heart first and discover the logic later. Then, there was memorisation and dictation to test how well we remembered them. All these are hard work. If we insist on all these in today's context, we risk losing a lot of interest in the learning of the Chinese language. If we were taught more systematically, perhaps my Chinese would have been better now.

As Mr Yeo Guat Kwang has said, it was important for us to communicate with our teachers. I agree, and we are still in the process of doing so. Since we have not reached out to all teachers yet, I thought I just be general today in replying to Mr Yeo by giving him a maxim in 16 Chinese characters. First, we 多�?�多讲, develop proficiency in oral and aural skills first by listening more and speaking more. Secondly, we go for 有效认字, that is, recognise the characters effectively. After that, 多读多写 - follow with reading and writing, and finally we hope that our students would 学习愉快, enjoy learning the Chinese language.

With this maxim of 16 characters, I could sum up our strategy, that is, we want to listen more, speak more, effectively learning and be happy in our learning. In the not too distant future, and after our discussion with our teachers, we will announce the details.

We have also formed a Committee to Promote Chinese Language Learning

to rally the strengths of the community so that we would be able to implement and realise all the solutions that were proposed in the White Paper. This Steering Committee comprises people from various quarters who are concerned with the Chinese language and, in fact, a number of our MPs are also members of the Committee.

We have decided in our first meeting that we had done enough talking and it was time for us to get down to action. So we have started five taskforces. One taskforce is for reading and reading materials; the second is to promote writing of Chinese; the third concerns the media; the fourth is to promote cultural exchange, and the fifth is on pre-school Chinese Education. Mr Yeo Guat Kwang heads the taskforce for Chinese in pre-school education. Just now, he talked about the solution for this aspect. I think he could include the excellent suggestions he gave just now for the work of his taskforce. When you want to communicate with the players in this field, do remember what you said in Parliament today.

Dr Ong Seh Hong and Mr Yeo Guat Kwang expressed concern over the teaching of Chinese language. They asked about the reduction of the text and some modules in the Chinese language. I think from this incident, there are a few things that we can learn. First, as Dr Ong Seh Hong has said, when we assess the standard of Chinese of our students, we should not just test whether they can memorise Zheng Qi Ke or Haixia Ke. It should not be based on how many words, phrases or idioms that you can memorise. The important thing is whether or not you have that confidence to use the Chinese language and spoken Mandarin, such as to converse, to read newspapers, and to write reports or file some applications to the relevant authorities. The teaching and learning of Chinese language must be

down-to-earth. It must be relevant to our daily lives.

I remember during my younger days when we were learning Chinese, it was a different story. We had 92 pieces of selected work to learn and these included Zheng Qi Ke and Xiang Yu Ben Ji where Haixia Ke came from. Our teacher told us to memorise these 92 chapters and the whole examination will be based on them. Today, our examination is not like that. It does not matter what chapters or what passages you have read. You will be examined on how you apply your knowledge of the language. When we cut down on the number of prescribed texts, so long as your practical application of the language is not affected, you will still be able to sit for the examination and get good results. There is therefore no question of cutting down on some prescribed texts, and CL standard is lowered.

The curriculum is to define your study direction and objective. This objective need not be attained by studying the prescribed text. For example, if you read Jin Yong's kung fu novels, and if you can attain the expected outcome of teaching, it is a good thing. The important thing is that we want to give the teachers more free time so that they can put their creativity and ingenuity into action. They are in the frontline. They are the best people to know what the needs of the students are. They want to do their job well. They are all professionals. Therefore, if we give them more space and time, they will be able to use their ingenious ways to teach the students with materials which are more relevant to their daily lives, and it will enhance the students' interest in learning. Such teaching methods would be more effective.

Mr Ang Mong Seng mentioned Higher Chinese. He expressed regret that the

Chinese results were not taken into consideration for university admission. We had actually discussed this before. For university enrolment, it would have to be assessed on whether or not the student has the aptitude to take the course that he wants to pursue. Perhaps the university can stipulate that if students want to apply for admission to the Chinese Language Department, priority will be given to those who have scored well in Higher Chinese. But if their Chinese is very good and we give them four merit points to get into any faculty whose subjects of study have nothing to do with CL, then I think this will affect the enrolment in the university, and it will be regressive.

In fact, the status of Chinese today is such that we need not go through entry requirement to attract students to learn Chinese. All parents know that Chinese Language is very important. When we are conducting the bi-cultural course, we did not expect some 800 students to apply for the 200 places. In the end, the schools tried their best to accommodate and accepted 300 students. So we can see that the students really know the importance of learning Chinese. We do not need entry requirement to induce the students to learn Chinese. The status of Chinese is so obvious that our students would want to learn Chinese, and the parents would encourage the students to learn Chinese, and to learn it well.

(In English): Since I am unable to reply in Malay, perhaps I will respond to Mr Chiam's question about Bahasa Melayu in English. I did study Malay during those early days. After I joined the civil service, I also went to a Malay class.

We agree with Mr Chiam that Malay language is important. It is an important regional language. But this has got to be seen in context. All the examples cited by

Mr Chiam were during pre-independent days. The setting at that time was very different. Since then, English has become a working language and our bilingual policy requires all students to study English as well as their mother tongues.

When we debated the White Paper on Chinese Education, the point that it is very difficult for students to master two languages is already established. In fact, the number of students who can master two languages effectively is very small. If, in addition to English and mother tongue, all students are made to study Malay, I fear the pressure on students, teachers and parents may become unbearable. But having said that, allowing students who are already doing well in English and mother tongue to study Malay as an elective subject is already available since the mid-80s. There is a Malay Special programme where students, who are within the top 30% and do very well in mother tongue as well as English, can opt for this special programme at Secondary 1, leading to an examination and qualification at 'O' level. The equivalent standard is Standard 2, which is slightly higher than Standard 1. There are about 300 students who are doing this subject.

This particular programme will continue, and we are confident that when people begin to understand that to be proficient in an additional language is like holding an additional passport, more would study Malay language, as in the Malay Special programme.

We also have schools who, on their own initiative, have initiated some conversational Malay programmes for their pupils. We, in the Ministry of Education, support these initiatives on the part of the schools.

As far as the civil service is concerned, the Civil Service College still

offers basic conversational Malay course. Civil servants who need to study Malay can enrol in this course. Of course, there are also public officers whose jobs require them to be more proficient in the Malay language, such as some SAF or Ministry of Foreign Affairs officers. The Ministries have their own programmes for them to learn the Malay language. In other words, all the channels available for those who want to study Malay are already there.

Finally, I need to respond to Mr Ang Mong Seng's point about the elite Chinese programme.

(In Mandarin): This is a new initiative by Tao Nan School. We do not know how our students and parents would take to the programme. If the students spend more time learning Chinese, then they will have less time for English. The result could be that their standard of Chinese would be raised, probably at the expense of their standard of English being lowered. So let us see how it goes. More importantly, it depends on the parents. If the response is good, the Hokkien Huay Kuan has already said that they intend to extend the project to other Hokkien Huay Kuan schools. If other schools find this project a good idea, they may also conduct similar programmes. MOE is prepared to let them try these out.

(In Mandarin): Sir, a point of clarification. The Minister said that we have four years to do things slowly. But I have just worked it out and it is only three years and three months. We would start in January 2008. I do not know how the Minister did his calculation.