The following question stood in the name of Mr Alex Yam –
1 To ask\tthe Acting Minister for Culture, Community and Youth (a) if he can give an update on any changes to the religious landscape in Singapore due to the arrival of new immigrants over the years; and (b) whether the Ministry is monitoring the religious practices of new immigrants to avoid any conflict with our multi-cultural multi-religious society.
\tAsst Prof Tan Kheng Boon Eugene (Nominated Member): Question No 1.
\tThe Acting Minister for Culture, Community and Youth (Mr Lawrence Wong): Mdm Speaker, Singapore's religious landscape is diverse, reflecting our broader multi-racial and multi-cultural society. Over the years, our religious landscape has evolved and will continue to do so. But this is due to many factors, and cannot be linked to immigration alone.
In MCCY, we have regular dialogues with our religious leaders, for example, through the National Steering Committee on Racial and Religious Harmony which I chair. The National Steering Committee (NSC) brings together the leaders of the main religious groups in Singapore, as well as key community leaders and I have been engaging them. Talking to the religious leaders, my sense is that the new immigrants within their own religious groups are generally able to integrate well.
At the community level, we also have various platforms to ensure that new citizens understand the importance of racial and religious harmony in Singapore. For example, the milestone programmes that new citizens go through help them to appreciate our culture and heritage, and the importance of respect for those of different faiths. The Inter-Racial and Religious Confidence Circles (IRCCs) also seek to build local networks of trust for our religious and community leaders. These networks help to promote engagement across
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different religious groups at the local level. They create opportunities for our people, including new immigrants, to interact, foster ties, and widen the common ground we all share together.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Scheme for Housing of Foreign Talent (SHiFT)","subTitle":null,"sectionType":"OA","content":"The following question stood in the name of Mrs Lina Chiam –
2 To ask the Minister for Trade and Industry if he will consider suspending immediately JTC Corporation's Scheme for Housing of Foreign Talent (SHiFT) to alleviate the housing concerns of Singapore citizens who cannot afford HDB flats, such as by renting the housing units currently under SHiFT to them.
\tAsst Prof Tan Kheng Boon Eugene (Nominated Member): Question No 2.
\tThe Senior Minister of State for Trade and Industry (Mr Lee Yi Shyan) (for the Minister for Trade and Industry): Mdm Speaker, the Scheme for Housing of Foreign Talent (SHiFT) was started in 1997 to address the lack of affordable housing for foreign talent. In those days, HDB owners could only rent out rooms and not the entire flats to locals and foreigners alike.
Since 2003, however, HDB has allowed the rental of entire flats to both Singaporeans and foreigners. As rental supply increases, JTC has been gradually phasing out the SHiFT through the sale of flats to eligible buyers meeting HDB's home ownership rules. JTC expects to continue to run down the stock of the remaining SHiFT flats as the tenancy agreements expire.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Singapore's Imported Beef Products","subTitle":null,"sectionType":"OA","content":"3 Mr Yee Jenn Jong asked the Minister for National Development (a) what are the major sources of Singapore's imported beef products; (b) how much of our beef products are from Europe; and (c) what measures does AVA have in place to ensure that tainted beef products in Europe do not find their way into Singapore.
\t
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The Senior Parliamentary Secretary to the Minister for National Development (Dr Mohamad Maliki Bin Osman) (for the Minister for National Development): Mdm Speaker, we import 80% of beef and beef products from Australia, New Zealand and Brazil. Beef from Europe, in the form of whole beef cuts, constitutes less than 0.5% of our supply.
AVA has an integrated meat safety system of accreditation and post arrival inspections to ensure compliance with our food safety, veterinary public health and animal health requirements.
First, only meat imports from sources accredited by AVA are allowed into Singapore. In 1996, AVA imposed restrictions on import of beef from Europe when the Bovine Spongiform Encephalopathy (BSE) or Mad Cow Disease broke out there. Since 2010, AVA has approved some European countries such as France, Ireland and the Netherlands, to export whole beef cuts to Singapore, only whole beef cuts. These countries are subject to additional requirements to mitigate against risks of BSE. Processed beef products from Europe are not approved for import. They include minced and canned beef, and those food items involved in the current horsemeat scandal.
Second, AVA inspects and tests meat imports before they are released for sale in Singapore. AVA regularly conducts tests to ensure that our meat imports are not substituted or adulterated with undeclared meat from other animal species. To date, AVA's testing has not found any horse meat adulteration in meat imported into Singapore.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Investigations into Purchase of Bicycles by NParks","subTitle":null,"sectionType":"OA","content":"The following question stood in the name of Mrs Lina Chiam –
4 To ask the Prime Minister what is the status of CPIB investigations on the purchase of the 26 Brompton bicycles by NParks last year and when will the outcome be disclosed.
\tMr Gerald Giam Yean Song (Non-Constituency Member): Question No 4, Mdm Speaker.
\tThe Deputy Prime Minister (Mr Teo Chee Hean) (for the Prime Minister): MND referred to the CPIB the findings of the internal audit of the
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procurement of the 26 Brompton bicycles by NParks. As there were possible indications of corruption in the procurement, CPIB investigated the matter and submitted the findings to the Attorney-General's Chambers. Upon direction from the Attorney-General's Chambers, CPIB conducted further investigation into these purchases.
CPIB has completed its further investigation recently and forwarded the case to the Public Prosecutor for assessment and determination on whether there is any offence disclosed. As the case is under assessment now by the Public Prosecutor, it is not appropriate to make any comment on its outcome.
Mdm Speaker: Order. End of Question Time.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Estimates of Expenditure for the Financial Year 1 April 2013 to 31 March 2014","subTitle":"Committee of Supply – Paper Cmd 3 of 2013","sectionType":"OS","content":"[(proc text) Order read for consideration in Committee of Supply [4th Allotted Day]. (proc text)]
[Mdm Speaker in the Chair]
Er Dr Lee Bee Wah (Nee Soon): Mdm Chairman, I beg to move, \"That the total sum to be allocated for Head L of the Estimates be reduced by $100\".
This morning, I attended the launch of the Singapore Environment Council School Green Award at the Naval Base Secondary School; and I must say that students in Singapore do care for the environment rather passionately based on what I saw at the school. There is a lot of hope for a greener and cleaner Singapore. Since the launching of HABIT (Hold on And Bin IT) by Minister last
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year, residents of Nee Soon South have been taking part actively in our monthly litter picking. We had also rolled out a whole series of educational campaigns. These include MOU with all the schools in Nee Soon South, training of litter-free Ambassadors, purpose design stickers to be placed at all void decks, tables, dustbins and so on.
Besides all these educational efforts, many residents think that we need to do more, that is, more stringent enforcement. I would like to ask the Minister to seriously look into enforcement regimes and get all NEA officers to be trained and empowered with enforcement power. I have feedback from residents. They said that they saw some uniformed NEA officers in Nee Soon South and they walked up to the NEA officers and tell them about littering, just nearby; and the officer's reply was, \"We are here to catch mosquitoes, not here to catch the litterbugs\".
Since the latest extension of smoking ban on 15 January 2013, non-smokers have been supportive and have called for smoking to be banned in more areas like public parks. While the smokers have appealed for clearer designation of smoking areas, may I know what are MEWR's next steps on smoking in public places? Will MEWR consider putting up designated smokes chambers like what is done in Japan?
I also have residents who become second-hand smokers because their neighbours smoke at balcony or window. Is there anything that can be done to help them? With the projected higher population density, the prospect of being in the vicinity of a smoker and consuming second-hand smoke increases. I hope more can be done to safeguard our babies, pregnant women and fragile elderly.
Every now and then, I receive emails from residents showing me the photos of smokers puffing away at bus stops, at linkways and the residents are asking for more enforcement, and I would also like to ask for more education to be done together with Health Promotion Board.
Next, it is about affordable cooked food. Hawker centres are an integral part of life in Singapore. I applaud the revival of building new hawker centres by the Minister. Last year, MEWR announced the locations of the 10 upcoming new hawker centres. May I know what is the current progress on these centres? Many of my residents have been asking for the one in Yishun to be completed earlier. It was announced to be completed in 2015, but they worry about the three new BTOs coming up, which is in 2014. Is there any plan to build more? Recently, I also heard of the plight of the 2,000 hawkers whose leases are going
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to expire. I would like to ask the Minister if there is anything being done to address their concerns?
Following the infamous flash floods at Orchard Road, expert panels were appointed. The expert panel report advocates a wide range of solutions rather than delving into the costly affair or simply deepening or widening drains and canals. Besides drainage improvement works, what other plans does PUB have to minimise the risk of future flash flooding?
Last but not least, on climate change. May I know what does the 2007 National Climate Change Study show? What more is the Government doing to improve our understanding of climate change and its impact on Singapore. Madam, I beg to move.
The Senior Parliamentary Secretary to the Minister for Health and Minister for Transport (Assoc Prof Dr Muhammad Faishal Ibrahim): Madam, many of us cheered when the Ministry set up the Department of Public Cleanliness, DPC in short, to integrate the cleaning functions of all the agencies. I would like to ask the Minister to update the House on the progress of the integration. Has the Ministry tracked the level of cleanliness of the areas under the purview of the DPC pre and post its formation? Specifically, has it resulted in improved service quality and cleaning standards of the areas under its care? How do the DPC engage the public in keeping the areas clean? Finally, how is the one-stop call centre coping with the public engagements?
The Chairman: Mr Liang Eng Wah, you have two cuts, please take them together.
Mr Liang Eng Hwa (Holland-Bukit Timah): Thank you, Mdm Chair. Living in a clean environment is what every Singaporean yearns to have and, in fact, are accustomed to. Before the setting up of the Department of Public Cleanliness (DPC), cleaning of the public areas, including drains, pavements, roads and parks, were undertaken by the various agencies, such as NEA, PUB, HDB, NParks, JTC and the list goes on. In addition, if the public wants to feedback on the cleanliness of a certain area, they must ascertain which agency is in charge of the area before they can provide the feedback. In April last year, DPC was set up to integrate the cleaning of public areas in stages and to ensure that all of us have a clean environment to live in. I also understand that DPC has set up a one-stop contact centre to handle and coordinate all public feedback
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on the cleanliness of public areas and I want to applaud these efforts by MEWR.
It has been almost a year since DPC was set up; I would like to seek the Minister's update on the progress of the integration.
Keeping Singapore clean is a long-term effort that requires everyone to do their part. Under the refreshed Keep Singapore Clean efforts launched by the Public Hygiene Council (PHC), PHC will be working with the Non-Government Organisations (NGOs) to step up to promote greater civic mindedness amongst Singaporeans and pilot a conversation to forge a new norm in public cleanliness and hygiene. It also intends to change the mindsets of our residents from a cleaned city to a clean city led by community initiatives.
Over the years, Singapore has earned the title of Garden City and achieved world-class infrastructure but our social etiquette, there is still further room to improve. Often, high rise littering in lift areas is one of the top issues brought up by residents during my house visits. I hope that the refreshed Keep Singapore Clean effort can motivate the community, NGOs and individuals to play our citizenry part to continue to uphold Singapore as a clean and green Garden City.
I would like to ask the Minister what progress has been made so far and what are the plans going forward?
Mr Lim Biow Chuan (Mountbatten): Madam, in Mountbatten constituency, more than half of my residents live in private estates. There has been feedback from several residents that the cleanliness of the roads and public areas around the estates is not satisfactory. Sometimes, bottles, plastic bags and other kinds of rubbish were left along the roads or by the side of the roads and some were also found in the drain.
The rubbish has not been cleared for many days, and residents have to make calls to the Department of Public Hygiene before action was taken by the cleaning companies to clear the rubbish and to clean up the public areas. When I visit the residents, they all complain that they do not see the cleaners for many days.
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Last year, I had asked MEWR about the accreditation of cleaning companies. May I ask the Minister for an update? I understand that there has been an enhanced Clean Mark Accreditation Scheme launched in November last year. Has this enhanced scheme improved the quality and reliability of the cleaning companies? I would like to know whether this enhanced accreditation scheme would bring about better standards of cleanliness for the private estates, and whether the private estates would be cleaned on a more regular basis?
Other than this enhanced accreditation scheme, is MEWR taking any other steps to improve the quality and standards of the cleaning industry? Would any of these measures improve the salaries and working conditions of the cleaners working in these cleaning companies? In the Marine Parade Town Council which I chair, we employ conservancy cleaning contractors to clean the common areas of HDB estates. In support of NTUC's Progressive Wage Model for cleaners, we will impose conditions in these conservancy cleaning contracts that cleaners employed in these companies be paid fair and progressive wages. However, I ask MEWR what else can be done to persuade the cleaning companies to improve their professionalism, quality and productivity, so that the fees paid by the Town Council to the cleaning companies will represent good value to our residents.
The Senior Minister of State, Prime Minister's Office (Mr Heng Chee How): Mdm Chair, Singapore has for many years now been known as a clean city, and it is something that as citizens we are very proud of. But in more recent years, some parts of Singapore have become dirtier. One of these areas has been the roadways or road sides. It is not uncommon nowadays to see plastic bags \"crossing the roads\", empty bottles, drink cans and discarded lunch boxes. In some of these roadways, they are not accessible to pedestrians. Clearly, that litter has been thrown from vehicles. I observe that nowadays, more and more vehicles have in-vehicle video cameras, and they are installed for various reasons. I would propose that NEA and DPC come up with an incentive scheme to rally the drivers of vehicles to submit the video camera footage as an evidence and information to the DPC and NEA, so that the identity of the vehicle owner can be established. From there, the identity of the litterbug can be established.
The fines that are meted out to the litterbugs can then be used to recognise and reward those who provide the information. When litterbugs know that they
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could be captured on video camera by any number of cars behind them if they littered, there will then be a greater deterrent value. I hope in this way we can bring the entire population of the vehicle owners to work together, and keep our roadways free from litter.
Ms Sylvia Lim (Aljunied): Madam, Singapore is currently subject to another onslaught of the dengue virus. It seems that the current dengue outbreak has peaked at an unusual time of the year at end of 2012 and the start of 2013, rather than the usual July-August periods in the past. The affected areas appear to be mostly in the eastern and north-eastern sectors of Singapore, including residential estates, and the Yio Chu Kang and Serangoon areas.
I would first like to acknowledge the tireless efforts by the teams at NEA in their outreach and enforcement efforts – going door to door in their inspections and public education. NEA has also collaborated with the Aljunied-Hougang Town Council and our Members regularly in responding to the dengue situation. NEA's work and surveillance, public education and enforcement are well-known.
However, according to the NEA's dengue website, one of the key thrusts of its approach to dengue includes research. I understand that NEA has been active in research under the auspices of its Environmental Health Institute (EHI). In 2011, EHI has been recognised by the World Health Organization as the global centre for reference and research. Research is critical to improve the current treatment responses as there is no drug to treat or prevent dengue yet. Sufferers have to wait for the disease to play out and be treated via fluid replacement.
It was reported that last year, a team of researchers from our university medical schools and the Defence Science Organisation laboratories manage to discover a human antibody which may have the potential of limiting the damage caused by the dengue virus Serotype 1 while inside the human body. Does NEA collaborate with such external agencies to synergise its research efforts, especially regarding prevention and treatment responses? What are its current research priorities concerning dengue generally? A breakthrough in research may finally remove the impotence with which those affected by dengue meet their fates.
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Mr Pritam Singh (Aljunied): Mdm Chairperson, in 1999, the then Ministry of Environment set up a Rodent Eradication and Control Committee after identifying 11 areas in Singapore, which included HDB estates overrun with rats. In 2004, a Straits Times report noted that about 8,631 rat holes had been identified across the island, where separately noting that the Ministry has spent $280,000 to address the problem that year in five estates, with NEA footing 75% of the bill and Town Councils paying the other 25%.
In 2009, a Sunday Times report observed that the rat problem in the Orchard Road shopping belt had worsened. In 2010, NEA found 1,687 areas in Singapore populated by rats – three times more than the 443 that were found in 2009. More recently, in November last year, Ang Mo Kio Hub was also hit by the rat problem.
With the increased construction activities all over Singapore, there is a growing perception that the rat problem requires greater attention from the Ministry.
The Minister only last month noted that 900 mosquito breeding offences were detected in construction sites in 2012, with 626 being first-time offenders. These suggest that there is scope for greater public scrutiny of construction sites in general, especially those located in or close to HDB housing estates. With larger numbers of people on the island anticipated in the years to come and more food sources inevitably available, there is a concern that the number of rats will be on the rise in future.
I would like to request the Ministry to step up its anti-rodent enforcement and education efforts, and to consider raising the profile of these efforts to the level of anti-dengue efforts, so as to work towards a cleaner Singapore going forward. It will also be helpful if the Minister could update us on the number of annual cases of leptospirosis and murine typhus infections – both being rat transmitted diseases which were reported in 2008 as between 10 and 30.
In addition, as many anti-rodent education efforts centre on the proper disposal of waste, there are likely to be other positive public health spinoffs that can buttress the effort to keep Singapore clean.
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The Chairman: Mr Charles Chong, you have two cuts. Please take them together.
Mr Charles Chong (Joo Chiat): Thank you, Mdm Chair. At the start of this year, the operation of a Chinese restaurant in the central part of Singapore was suspended for more than a month over a suspected food poisoning outbreak involving more than 453 people. It later emerged that the cause of the outbreak was norovirus gastro enterovirus or stomach flu. This was not a small restaurant nor was it situated in a location where one might question its cleanliness. Rather, it was one of Singapore's most well-known Chinese restaurants in a five-star hotel.
Mdm Chair, if food safety standards cannot be observed even in such a setting, then I think it is something which we need to be very concerned about. The results of the NEA investigations which followed were very disturbing. Food handlers going to work even though they had displayed symptoms of norovirus, improper cleaning of work surfaces, and inadequate hand washing by chefs and food handlers, to name just a few of the findings.
I would like to ask the Minister if we could consider shortening the period within which refresher food hygiene certification must be obtained, which is currently three years. Three years is indeed a very long time between certifications. If these ideas are not ingrained into food handlers, it is easy for them to set aside best practices in the stressful environment of a kitchen.
Having a shorter food hygiene certification shelf life will emphasise the importance we place on cleanliness in our F&B industry. It will also help boost confidence in our F&B outlets from hawker centres to five-star restaurants. It will certainly drive home the point to food handlers that food hygiene can literally be a matter of life and death. It is not something to be taken lightly.
Mdm Chair, on the air quality. We are very fortunate that on the whole, we enjoy very good air quality in Singapore. Partly because of our geographic location, the biggest visible concern is transboundary smoke haze which sometimes blows into Singapore.
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This is an issue which has been going on for many years now, and it is one which does not seem to have any visible end in sight. It will continue for as long as \"slash and burn\" agriculture is practised in our neighbouring country. Could the Minister provide an update on what is being done by NEA to address the issue of transboundary haze? In particular, is the NEA providing any sort of assistance to our neighbouring countries to help educate farmers on the consequences of \"slash and burn\" agriculture?
Also, on the topic of air pollution, would the Minister please provide us an update on the number of Euro V compliant vehicles on the road today, as a proportion of the total number of diesel-powered vehicles? While Euro V diesel emission standards are intended to come into effect only in January next year, it will certainly be relevant for us to understand the positive environmental impact we would benefit from for having the new emission standards adhered to.
Finally, sulphur dioxide is one of the major pollutants in Singapore, and the main source of sulphur dioxide emissions here, according to information publicly available from NEA, is oil refineries, power plants and shipping. These three contribute a staggering 96% of total sulphur dioxide emissions in 2007. Three power stations and three refineries alone produce approximately 118,000 tonnes of the 151,000 tonnes of sulphur dioxide emitted in Singapore that year. This is very worrying that such a small number of sources contribute to such a high proportion of sulphur dioxide pollution.
In contrast, sulphur dioxide contribution of all motor vehicles was less than 1% of the total. Sulphur dioxide emissions inventory figures on the NEA website now appear to be outdated based on data obtained in 2007. Now, I would like to ask the Minister if he is able to provide an updated set of figures, which hopefully would show that our efforts to get industries to use fuel of lower sulphur content have paid off over the last few years.
Dr Teo Ho Pin (Bukit Panjang): Madam, the Active, Beautiful and Clean (ABC) Waters Programme by PUB has been successful in making our water bodies more attractive for recreational and community bonding activities. To date, there are more than 20 ABC projects around our island and many Singaporeans are beginning to use these facilities more frequently. But there are certain barriers which deter Singaporeans from visiting these ABC Waters projects: (i) limited and paid carparks; (ii) lack of toilet facilities; and (iii) lack of
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repeat visitor's attractions.
Madam, we need to make our ABC Waters projects more user-friendly and attractive so as to attract more Singaporeans to appreciate its beauty. We must provide features that will draw repeat visits of users especially for residents living near ABC Waters projects. There are three groups of users ABC projects should attract, namely, elderly who exercise in the morning, families and children who wish to play at the amenities, or individuals or groups doing regular physical exercises. Thus, PUB should consider building multi-purpose hard courts for seniors, children playground for juniors, and park connector for brisk walkers, joggers and cyclists in the ABC Waters projects.
To further encourage seniors to use the facilities, PUB should install self-cleansing toilets at their ABC Waters projects. Ample free parking should also be provided so that families and users can spend more quality time at the ABC Waters projects.
Madam, I wish to ask the Minister the following questions: (a) how many ABC Waters projects will be implemented by 2030; (b) are there new attractions of ABC Waters projects that will encourage frequent visits and promote healthy lifestyle among Singaporeans; (c) will there be any ABC Waters projects in Bukit Panjang?
Mr Heng Chee How: Mdm Chair, I agree with the hon Member Dr Teo Ho Pin that the ABC Waters project is a very worthwhile project, and it really beautifies the canals and make them into river-like features, so that the residents can enjoy their leisure at using the water.
In Whampoa estate, there is the Whampoa River. It is actually a canal that runs through it. Some years back, the MEWR has identified it as one of the areas where ABC Waters project will be conducted. I understand that each year, some 20 to 25 projects are identified and each year I have been enquiring about the Whampoa River project. So, I would like to, once again, request for this because the residents very much would like to see the vibrancy of the estate enhanced by this very worthwhile project.
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Mr Gan Thiam Poh: Mdm Chair, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Mdm Chair, MEWR announced a series of hawker centre policies last year, such as the removal of reserve rent, subletting and stall assignment policies to help moderate rental costs.
Can the Minister of Environment and Water Resources give an update on how we have fared so far? I read that social enterprise NTUC Foodfare was appointed in June to run the first of the new hawker centres. Kampung@Simpang Bedok, also operated by a social enterprise, was also recently launched.
I understand that 10 hawker centres will be ready within the next five years. Will the Ministry directly operate some of the new hawker centres and apply same social enterprise practices to them or will social enterprises run all the 10 hawker centres?
The Chairman: Mr Gan, your time is up. Mr Liang Eng Hwa.
Mr Liang Eng Hwa: Madam, last year, MEWR announced a series of hawker centre policies, such as the removal of the reserve rent, subletting and stall assignment, to help moderate rental costs. Hopefully, these measures would reduce the food prices. According to NEA, since then, more than half the successful new bids are below original reserve rents.
Some hawker centre stalls' rents have dipped to as low as $21 a month in Taman Jurong Market and Food Centre in the June 2012 tendering exercise and stalls that were vacant for a year are now being taken up. Besides removing reserve rents, NEA also rents out hawker stalls that receive single bids over two tenders, instead of requiring competition from multiple bidders.
NEA has also banned new stallholders from subletting their stalls. According to some experts, the value of a stall will become nearly zero following recent rule changes that outlaw the transferring of operating licences. But a report in The Straits Times also pointed that the new measures have not curbed rents at popular food centres such as the Maxwell Food Centre and the Newton Food Centre. So, can the MEWR give an update on how we have fared
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so far?
Mr Seah Kian Peng (Marine Parade): In 2014, the lease of many hawker centres will expire and the land of these hawker centres will go back to the Government. There have been concerns raised by these hawkers as to what will happen to them when the time comes.
Given that these hawkers have depended on their stalls for their livelihood these last 20 years, an end to their lease, if not renewed, will cause much distress and disruption to their lives. Furthermore, they would have to pay new rental rates to the Government then, which may in turn affect food prices. So, I would like to ask the Ministry what the plans are for these affected hawkers.
In addition, since the pilot project in 2010 where Kopitiam opened the first privatised wet market in Sengkang, what has the situation been like?
Wet markets are part and parcel of our Singapore heritage, and they are great for community bonding and building a local identity. However, there have been concerns that with the privatisation of these wet markets, the corresponding increase in rent has also affected the livelihood of not only the stallowners, but also the customers who buy from them. My fear is that if care is not taken to help these stallholders to maintain their competitiveness, both their businesses and consumers will stand to lose out eventually.
So, I would appreciate if the Ministry can give an update of the privatisation of wet markets, and an assessment of whether such a scheme has met its objectives.
Mr Nicholas Fang (Nominated Member): Mdm Chair, this year's Budget has focused on creating a better Singapore and a critical aspect of this is the provision and maintenance of a healthy environment for all residents and citizens to work and live and play in. Even as we work to address concerns that have been raised with respect to economic growth, among other issues, the Government needs to reassure Singaporeans and others living in the country that the clean and sustainable environment would be a key priority now and in the future to provide an attractive home for current and future generations.
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Among the biggest threats facing our environment is the increasing risk of climate change. Already, we are seeing shifting weather patterns and more extreme weather changes which could be attributed to global climate change. Last June, the National Climate Change Secretariat (NCCS) released the National Climate Strategy 2012 which outlined the country's plans to address climate change through a whole of nation approach.
Among the key elements of this climate strategy are reducing emissions across sectors, building capabilities to adapt to the impact of climate change, forging partnerships on climate change, action and also improving energy efficiencies. But the key element of the strategy requires every single Singaporean to play his or her part in combating climate change and this could require changes in lifestyles or adjustments in business processes.
The recent concerns surrounding the future of Singapore's population demographic and the impact of this in the evolving global economic landscape would have on our economic growth have dominated public discussion and debate. There has been little to suggest that all Singaporeans have accepted the gravity of the climate change issue and are actively adjusting their lifestyles to become more environmentally conscious by recycling more, for example, or lowering the individual and household carbon footprint.
The Government can take a leadership role in this area to ensure that the NCCS strategy gains greater traction across the whole nation and this could be in the form of awareness building campaigns or other such activities.
Mdm Chair, if developments in our regional neighbours are anything to go by, the issue of declining air quality is likely to be another major challenge facing residents in Singapore. Singaporeans have recently expressed the range of views over the off-Budget measures to adjust the restrictions on car loans and the additional registration fee for cars. Most of these centred on whether cars have become too expensive for Singaporeans to own and concern over road congestion.
What has not been widely discussed is the impact that increased numbers of vehicles would have on the quality of air in our city. Like many other major cities, air emissions from industries and motor vehicles are the two key sources of air pollution for us domestically. While we enjoy an air quality that is better than many cities in Asia and comparable with US and European cities, this may not always be the case. Already, overseas visitors tell me that they can notice a difference in air quality when they are in our CBD area compared to outlining
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parts of the country and this is unlikely to be due to industrial emissions but caused by the dense concentration of vehicles in the city.
While transboundary smoke haze from the land and forest fires in the region is also a problem that affects our air quality intermittently, this is largely beyond our immediate control. But we do have the ability to affect the number of cars on our roads and their pollutive impact. The Carbon Emissions-based Vehicle Scheme (CEVS) which was rolled out this year incentivises people to buy cars with low carbon emissions, but decreases the focus on nitrogen oxides and particulate matter which can directly affect the health of people.
It is heartening to note that the NEA has announced Singapore will adopt the World Health Organization's Air Quality Guidelines as a target to be achieved by 2020 enabling us to achieve a high standard of public health and economic competitiveness compared to our regional rivals like Hong Kong. That being said, this is still an area that bears monitoring and the impact of poor air quality on Singapore's status as a liveable city as well as on the health of Singaporeans can be significant and safeguarding our clean city air will require all Singaporeans to chip in.
Mdm Chair, I would like to turn very quickly now to the aspect of the Land Use Plan announced earlier this year which is that of green spaces. Under the Plan, 85% or over eight in 10 residents will be living within a 10-minute walk to a park by 2030, up from the current 80%. But there are also significant plans to maximise land use by developing and re-developing spaces to cater for a larger population in 20 years' time. This could come at the expense of natural green spaces even as man-made parks and spaces increase and become more accessible.
While such artificial green spaces have benefits and offer a conducive environment for exercise and other such activities, it is different from being able to explore an untouched jungle in its natural form. These natural environments offer many learning opportunities and life experiences for younger generations who spend a majority of their time indoors in artificial air-conditioned climates staring at books and computer screens.
As we continue planning for economic growth and sustainability for our current and future generations, it is imperative that we do not forget to also work to protect the natural environment that sustains us all.
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Ms Faizah Jamal (Nominated Member): Madam, the White Paper and the Land Use Plan envisage a very substantial increase in population size in the coming years. As both documents are silent on two areas of concern, I would, with respect, like to seek the Minister's clarification.
Firstly, I note that most of the new developments will occur at Singapore's northern shores as well as Pulau Ubin and Pulau Tekong. These areas lie at the mouth of the massive Johor River. Missing in the Land Use Plan, unfortunately, is any mention of planning for climate change and rising sea levels.
I would like to ask if MEWR has plans to take into account the possibility of more rainfall and storms and how these may change water flows down the Johor River which in turn may adversely affect Singapore.
Secondly, in the wake of the projected increase in population, there will be a strain on at least three major areas of concern: first, water needs and supply; second, waste management; and thirdly, energy conservation or energy consumption.
Water. According to the MEWR website, water demand is expected to double over the next 50 years. Would the Minister clarify if this number has taken into account the projected increase in population as set out in the recent White Paper? If not, what would the new demand look like? Also, with the heavy dependence on large scale expensive technology in making water available for our future needs, would this translate into even higher costs to the consumer?
Waste management. At the rate that we send 200,000 tonnes of solid waste and ash to the Semakau Landfill a year, there will be no more space left there in 40 years. Even if everyone becomes responsible citizens and minimise waste right away, with the increase in population happening already and with more to come, will this not cause an even bigger strain on Semakau and would we, in fact, run out of space earlier than projected? How will this also impact on our capacity of the existing incineration plant as well?
Lastly, energy consumption. Of the many issues I am concerned with under energy, I will focus on just one. With our residential buildings getting even higher to maximise space with some in the range of 40 storeys or more requiring high-speed elevators, will this require more energy to provide and maintain and how will this impact on our demand and cost of energy consumption?
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Dr Teo Ho Pin (Bukit Panjang): Madam, promoting energy conservation and efficiency among households requires consistent outreach, education and ownership. Due to the wide range of domestic electrical appliances available in the market, it is challenging to provide adequate information to guide consumers into making environmentally friendly appliances purchases. Furthermore, consumers are usually influenced by pricing and budget constraints when purchasing domestic electrical appliances.
Thus, over the years, many residential units were installed with inefficient home electrical appliances which consume lots of energy. These appliances add on to the cost of living of Singaporeans and increase our carbon footprint in Singapore.
Madam, air-conditioners, refrigerators and heaters consume the most amount of electricity in the households. Many of these appliances have relatively long life spans. Thus, it will take many years for all our households to go \"green\" if we were to rely solely on the Minimum Energy Performance Standards and mandatory energy labelling schemes of the Ministry. The replacement cycles of home appliances are long and replacement may not be the most energy-efficient due to price considerations.
Madam, one way we can expedite the greening of our homes is to incentivise home owners to replace their inefficient electrical appliances as soon as possible. The Ministry can consider giving green grants or green tax rebates for households which install four ticks air-conditioners, refrigerators or heaters.
Madam, I wish to ask the Minister the following questions:
(a) What is the Ministry doing to promote energy conservation and efficiency in households?
(b) Will the Ministry consider implementing a Green Mark Scheme for households?
(c) Can the Ministry update the progress of the Energy Conservation Act in promoting energy conservation in the industrial, domestic and transportation sectors?
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Miss Penny Low (Pasir Ris-Punggol): Madam, how do we leapfrog the 3Rs of reduce, reuse and recycle and live green? I think we need everyone to be in it and there is now a huge incentive to do so via collaborative consumption or a sharing economy.
Madam, we clutter our tiny homes with our wants, which are seldom used. In a sharing economy, access to goods and services are more important than ownership. So, imagine if we can encourage people to share, trade, swap or rent out their clutters, the benefits of 3Rs would be realised and monetised. A picture from the March issue of The Economist magazine shows that everything in the house can be rented out from the voids in house to the cars to the parking lots and even to a saxophone. The trouble, however, is that there is no efficient clearing house of what is available today and of when, where and how to get it.
Thankfully, this can be overcome by encouraging local community sharing portals that creates a peer-to-peer experience at the local, consumer and business levels. Government agencies, too, can tap into these sharing portals to lead the way.
Technology can also motivate action and change habits. For example, in the energy crisis aftermath of the Japanese earthquake, an app was born. It is called the \"Teiden Kensaku\" or the \"Blackout Alert\". It gives information about the real time energy usage in a town and connects it to the larger consequence at the regional and national level. It prompts voluntary individual action to prevent disasters. For example, when the energy usage reaches a critical point and an outage is possible, it sends alerts to its users, who could turn off their cooling, heating or unused appliances to avoid an outage. The app features a fun, competitive yet educational game, so that users can see how they do and challenge each other to be on the billboard chart. The idea is to instil green civic responsibility and change behaviour.
Such social innovations can work a lot for water, energy and waste usage. Could MEWR consider some of these technologies and co-create them with the community?
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Mr Yeo Guat Kwang (Ang Mo Kio): Mdm Chair, Singapore has built up its water self-sufficiency through our four national taps – desalinated, recycled, rain and imported water.
I would like to ask the Ministry whether our current programme to be self-sufficient before our water agreement with Malaysia expires is on track. With increased demand and changing external factors, I would propose that the roadmap towards our self-sufficiency be reviewed to ensure adequate water for all of us.
Madam, an adequate water supply must also be matched by water conservation. I am pleased that our households have done well to meet the goal that we have set. It has already now come down to 152-litres per capita, down from 165-litres 10 years ago. This shows that we are really on track to achieve the goal of 140-litres per capita in the long run.
I hope the Minister could review water pricing system to incentivise households to do more to save water. Our water pricing tariffs currently are on a more punitive way – with higher tariffs even for households that have actually already been consuming less than the average. Can we move the pricing mechanism to one that would reward those who actually use less than the average?
I also want to urge the Ministry to review its water prices for industry. It is estimated that the industry is expected to account for about 70% of our water demand in the long run. What is being done to meet this demand and how can water prices be adjusted to ensure that conservation is practised all in the companies?
The Second Minister for the Environment and Water Resources (Ms Grace Fu Hai Yien): Thank you, Mdm Chair. I would like to thank the Members for their questions and suggestions. My Ministry is determined to steadily lift standards of cleanliness and to make Singapore a liveable environment. Last year, we outlined three key objectives – to build an inclusive society, enhance our quality of life and ensure a sustainable future. We have made progress on these fronts.
One key aspect of our living environment is public cleanliness. Er Dr Lee Bee Wah was concerned enough about this to move a Motion in Parliament last
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year. Many Singaporeans share her call for a cleaner Singapore. I agree with her that we are not as clean as we would like to be. I have heard many said that we are not as clean as before. Members Mr Lim Biow Chuan and Mr Heng Chee How have also made their comments. I agree and I feel we can certainly do better. All of us should play a part, not just the cleaners. We should not just be a \"cleaned\" city that depends on our army of cleaners. We want to be a clean city because our people care enough to keep it clean.
Dr Faishal and Mr Liang Eng Hwa asked about the progress of the integration of cleaning functions amongst agencies. Since its formation in April last year, the Department of Public Cleanliness (DPC) has taken over the role of taking public feedback on cleaning issues for the Government agencies. It has since received close to 21,000 pieces of feedback as of February 2013. This is an increase of 30% over the year before, about one-third of which were related to areas under the charge of other agencies like Town Councils, NParks, LTA and HDB. The DPC has worked with these agencies to resolve the cases expeditiously, about 62 cases per day, mostly within two working days.
DPC has taken over the cleaning functions of areas like footpaths and roads from LTA, JTC and HDB, and will be taking over areas like drains and car parks from PUB and URA this year. The first integrated contract for cleaning of expressways will be called in April this year. Integrated cleaning contracts for cleaning of public areas, including roads, footpaths, drains, vacant lands and parks within a defined area will be awarded from 2014 onwards, and the level of cleanliness of these areas will be tracked by DPC as part of the performance measurement of contracts.
We are also transforming the cleaning industry. By improving the productivity and development on standards of the industry, we hope to uplift the jobs of 50,000 resident cleaners that we have.
Last November, we introduced the Enhanced Clean Mark Accreditation Scheme (EAS) to encourage cleaning companies to provide better training and employment conditions for their cleaners. To hasten the pace of change, we announced last year that the Government will take the lead as a major cleaning service buyer in engaging only accredited cleaning companies for new contracts with effect from 1 April 2013. And I am happy to hear from Member Mr Lim Biow Chuan that his Town Council has already started doing the same.
Since the launch of the enhanced scheme, 55 cleaning companies have submitted their applications. Ten cleaning companies have been accredited.
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These are early days but we are beginning to see some heartening results for the cleaners. With your permission, Madam, may I display a series of slides on the LED screens? [Slides were shown to hon Members.]
This is Mr Rosli bin Abdul Majed. He joined M/s Veolia ES Singapore Industrial Pte Ltd, a recipient of the enhanced Clean Mark Gold Award, as a cleaner in 2007. A father of three, Mr Rosli has been given opportunities to upgrade his skills through Workforce Skills Qualifications (WSQ) modules for Environmental Cleaning. With systematic training, he was promoted to be a team leader after he completed the certified cleansing crew level training. The training and development roadmap has given him steady progress in his job scope and salary. The lives of his family members have improved. I hope to see this example replicated many times so that many more Singaporean cleaners can benefit.
Mrs Josephine Teo mentioned yesterday that it was essential to encourage private sector service buyers to come on board. We are very happy to hear that. I am pleased to inform that my Ministry is ready to table a Bill later this year to introduce the mandatory licensing of all cleaning companies in 2014. Mr Zainal Sapari and Minister Lim Swee Say have called for licensing to hasten the pace of change during the Budget debate. This will set the standards that all cleaning companies must meet before they can operate. The key licensing requirements include mandatory training courses and progressive wage model for the cleaners. With better training and employment conditions, our cleaners can look forward to better lives.
However, an integrated and revamped cleaning industry is only one part of the solution. No matter how productive or hardworking our cleaners are, there will never be enough of them if we think nothing of throwing things out of the window or discarding car park coupons and cigarette butts from our car when no one is looking. Should we tolerate such inconsiderate behaviour? Should we have harsher penalties for the recalcitrant minority who persistently litter?
We need everyone in the community to take personal responsibility and set high standards for our social behaviour. I believe the majority of us want a clean living environment for our families. We are proud to call this place our home and we want to keep it clean for all to enjoy. We feel bad when our home is defaced and dirtied by littering. To keep Singapore clean, and not just a \"cleaned\" country, we need to harness the energy of the community to first act responsibly; do not litter, and two, to build a strong sense of societal norm.
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I would like to show a photo of Facebook page on \"A Litter At a Time\".
Ms Elisa Ng and her children have been regularly picking up litter in their neighbourhood in Bishan East. They have also started a Facebook campaign called \"A Litter At A Time\" to encourage residents to go the extra mile and pick up just one piece of litter a day. This is a great example of an effort on an individual basis.
What about on the community basis? There are many groups that are harnessing the strengths and energies of the community to encourage residents to keep their neighbourhood clean. Er Dr Lee Bee Wah has mentioned this HABIT or Hold on And Bin IT or, in short, \"HABIT @ Nee Soon South\". It is an excellent example of how the community come together and Er Dr Lee has earlier described what they do to remind residents to keep the place clean. And another one, \"ACTION @ Bedok\" initiative. This is a sustained initiative jointly run by the East Coast Town Council, grassroots leaders in Bedok Constituency, NEA and the Public Hygiene Council – another good example of local community effort.
But many in the wider society also feel strongly enough to want to help us enforce against litterbugs. NEA has just completed the training of the first batch of 28 volunteers from groups, such as the Public Hygiene Council, Waterways Watch Singapore and Singapore Kindness Movement, Singapore Environment Council and Cat Welfare Society. These volunteers will be empowered to act on behalf of NEA to educate litterbugs to pick up their own litter and record offenders' particulars for enforcement when offenders refuse to do so.
To support our anti-littering efforts, the Public Hygiene Council launched the refreshed Keep Singapore Clean Movement, together with the Singapore Kindness Movement, and the Keep Singapore Beautiful Movement. We thank Mr Liang for mentioning this and also paying attention to this important community effort. He asked about the progress of the movement and I am happy to update that it has so far involved close to 15,000 volunteers including students, NGOs volunteers, grassroots leaders and residents who are relentless in their efforts to keep Singapore clean and green.
The Public Hygiene Council will soon hold the first Keep Singapore Clean Conference in May to engage the public in dialogue and build public support to turn Singapore into a cleaner city. It has been working with the schools, businesses and community organisations to turn community spaces into \"Bright Spots\". There are 44 \"Bright Spots\" so far and I wish the Council the very
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best in reaching its goal of achieving 100 Bright Spots this year. And I thank Er Dr Lee Bee Wah for mentioning Naval Base School. Indeed, our schools are really energised in keeping our environment clean and we are really encouraged by the enthusiasm that our younger Singaporeans have displayed.
Despite the many efforts, the number of feedback on littering has been increasing. To more effectively deter littering, we will enhance our enforcement regime to penalise those who defy our littering laws.
We will enhance our surveillance and enforcement efforts. Er Dr Lee Bee Wah has asked that we empower all our NEA field officers. They are already empowered to do so and we will accord greater priority to enforcement against littering. NEA will increase its enforcement hours by about 50%. We will be deploying more plain-clothes officers and increasing the enforcement rounds at littering hotspots. In addition, we will leverage on technology for better surveillance. We are currently piloting the use of surveillance cameras with video analytic capabilities to monitor littering at hotspots. We will also work with the Police to tap on their surveillance cameras, including those that will be installed at all 10,000 HDB blocks and multi-storey car parks as mentioned by Second Minister for Home Affairs, Mr Iswaran, last week.
Mr Heng Chee How has suggested that we enlist the help of the public in our enforcement in combating road side littering. Over the past three years, 336 offenders have been successfully convicted for littering from vehicles. Some of these cases were helped by the submission of photographic evidence by the public. In one case, a member of the public reported to us that a litterbug was throwing tissue onto the road while driving and provided a photo of the vehicle. We took the litterbug successfully to Court and he was issued a Corrective Work Order. We will further facilitate the use of public-generated evidence so as to encourage more members of the public to report littering, spitting, pet defecating and other anti-social behaviour.
Besides greater enforcement efforts, we are considering increasing the penalties against the recalcitrant minority. Currently, on top of the composition fines, recalcitrant offenders can be sent to court where, either a fine of up to $1,000 for the first conviction in court or a Corrective Work Order requiring them to clean public areas for up to a maximum of 12 hours, or both, may be imposed. We are considering increasing the maximum court fine for recalcitrant offenders to $2,000 for the first court conviction, $4,000 for the second
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conviction and $10,000 for the third and subsequent convictions.
We need the public's support for more effective surveillance, enforcement and deterrence. Through greater community involvement, we can build a strong sense of social pressure against littering. Through effective and enhanced enforcement, we can send a strong signal that it is better to dispose of your litter properly. In short, we will not tolerate littering and cannot rely solely on cleaners to keep Singapore clean. We need everyone to help us make the transition from being a \"cleaned\" city to a \"clean\" one.
Next, I would like to address the public health issues of second-hand cigarette smoke, dengue, rodent and food hygiene.
We have just extended the smoking ban on 15 January 2013 to more areas to protect non-smokers from the effects of second-hand smoke. The ban now includes common areas within residential buildings, sheltered linkways and walkways, overhead pedestrian bridges, outdoor hospital compounds, and a five-metre radius around all public bus shelters. Our officers and ambassadors are going around to the new prohibited areas to educate smokers about the new rules. To give smokers time to understand and adjust to the new law, we have been issuing advisories, instead of summons, to smokers caught smoking at these newly prohibited areas. Over 3,000 advisories have been issued since 15 January.
Er Dr Lee Bee Wah also asked about our next steps on smoking in public places. My Ministry will explore further extensions of the smoking ban and clearer designation of smoking areas as she has suggested.
On dengue, as shared by Minister Balakrishnan last month, we have observed an increase in the less common Dengue Type 1 (DEN-1) and Dengue Type 3 (DEN-3) viruses against which the community has lower immunity. This contributed to the latest spike in dengue cases.
We agree with Member Ms Sylvia Lim that research is important to improve prevention and management of dengue cases. Our Environmental Health Institute (EHI) has actively collaborated with dengue research and control communities locally and internationally. Its designation as a World Health Organization (WHO) Collaborating Centre is a recognition of its quality and extensive collaborative network.
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As part of the local dengue consortium comprising universities and hospitals, the EHI has worked on STOP Dengue, a Translation and Clinical Research programme funded by the National Medical Research Council. Ms Sylvia Lim mentioned the human antibody which could potentially limit the effects of Dengue 1 – this is one of the many projects the consortium is working on.
Until we find a vaccine against dengue viruses, the most effective strategy remains source eradication. Our officers are deployed to carry out daily operations particularly in areas where dengue is currently transmitting.
NEA's inspections show that 70% of dengue breeding sites detected are in homes. I urge everyone to conscientiously check potential dengue breeding spots, such as flower pots and roof gutters, at least once a week. Please also protect yourselves and your families against mosquito bites so that we can break the chain of transmission. We need to work together to manage dengue.
Rodents thrive where there are sources of food like uncovered food waste or improper storage of food. The root cause of rodent infestation is poor refuse management and housekeeping. As such, maintaining good sanitation and housekeeping is our key rodent control strategy. Member Mr Pritam Singh asked what the Ministry would do to help curb the rodent population.
Rodent infestation is a more serious problem in town centres and areas with high concentration of food premises. Eighty-one percent of rodent burrows found were in HDB estates. To address this problem, NEA has worked with the Town Councils since 2011 under the Rat Attack Programme to mitigate rat problems in their estates. The Rat Attack Programme resulted in a significant 40% decrease in the number of burrows. At the same time, residents and food shops operators should also play their part in proper refuse management and housekeeping practices to reduce the food sources available to the rodent population.
Last year, the Rat Attack Programme was carried out in 13 public areas with high number of food retail establishments, also with high human traffic and frequent observation of rodent activities. The programme led to a significant 93% reduction in the number of rodent burrows, from 348 at the start of last year to 26 by December 2012.
NEA has also carried out outreach efforts to engage the stakeholders. A rodent control seminar was jointly organised by NEA and the Singapore Pest
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Management Association (SPMA) in August last year with participants comprising building managing agents, food court operators and pest control operators.
Good housekeeping can also prevent the public health threat of food poisoning that Member Mr Charles Chong talked about. We have seen food poisoning incidents occur in a range of establishments from hotels – that Mr Charles Chong mentioned – to childcare centres. In particular, food catering tended to be of high risk. Caterers typically prepare a wide variety of food, in large quantities, store the food for some time before it is consumed by the customers. In 2012, food caterers had the highest food poisoning incidence rate amongst all types of food outlets. In addition, the average number of people affected per food poisoning incident was the highest for food caterers.
Mr Charles Chong suggested shortening the period within which refresher food hygiene certification must be obtained. Currently, food operators whose licences are suspended for hygiene lapses will have to send their food handlers for retraining before they are allowed to resume work. Aside from training, we need to do more to maintain high food hygiene standards at all times.
In February last year, NEA introduced the food time-stamping system where catering companies are required to indicate the time by which the food should be consumed. NEA and SPRING have also been working with the industry to develop a Singapore Standard on Food Safety Management. The Singapore Standard will guide the industry on the design and implementation of a Food Safety Management System (FSMS) which will include Standard Operating Procedures on food hygiene and risk control measures. One such risk factor is human. Under the FSMS, operators have to ensure that food handlers practise good food and personal hygiene at all times and that they do not work when they are ill.
With effect from 1 June 2014, new applicants for catering licences are required to submit an FSMS plan to NEA within the first three months of the licence issuance date. Existing caterer licensees will be required to submit a plan three months before the renewal of their licence. With this new measure, we aim to improve the standard of food hygiene in Singapore so as to better protect the well being of Singaporeans.
Madam, many of the things that we do in NEA and MEWR are not considered exciting or glamorous in the eyes of the public. They are nevertheless executed with determination and commitment as we are deeply
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aware of their impact on the well being of Singaporeans. From keeping the environment clean, maintaining a high standard of public and food hygiene, curtailing rodent and insect infestation, our officers take pride in our work knowing that we help keep Singapore clean and give Singaporeans a good living environment.
I would also like to pay tribute to the many thousands of cleaners that we have in Singapore who tirelessly work to keep the environment clean. We call on all Singaporeans to help us, help ourselves in keeping Singapore clean and free of publicly transmitted diseases. Let us be gracious and considerate to one another, to our cleaners, to our enforcement officers as we aspire to be a truly gracious society with a big heart.
The Minister for the Environment and Water Resources (Dr Vivian Balakrishnan): Thank you, Mdm Chair. The Ministry's mission is to secure public health, to upgrade the quality of life for all Singaporeans, to foster an inclusive society and to ensure Singapore's resilience in the long term – the very long term.
As a doctor, I am always reminded that, actually, it is the engineers and the staff of PUB and NEA that have saved far more lives through the provision of clean water, modern sanitation, clean air, safe food and public hygiene.
These staff save far more lives than doctors like me curing patients in a hospital. This is something which we should not take for granted and I hope Members of the House and, in fact, members of the public will also give due recognition to all these engineers, all these staff, all these cleaners, who work so assiduously to protect our environment and, ultimately, protect our welfare.
I believe it is worthwhile spending a few moments contemplating the key principles behind all the work of the Ministry. First, our primary concern is really the welfare of human beings. I know many people talk about protecting Mother Earth, protecting the environment. But let me be quite frank – the Earth will survive human beings no matter what we do to it. What is at greater risk are human beings and the welfare of human beings. So, really, human beings are both responsible for protecting the environment as well as being exquisitely vulnerable to the damage that we cause to the environment. The point I am making is that we do all these for the sake of ourselves. When we protect the environment, we are protecting ourselves and our children.
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The second key principle is that we are all in this together. This is ultimate democracy. We all breathe the same air, drink the same water, eat the same food, and are susceptible to the same dengue, leptospirosis or all the other diseases. So the point is that we are all equal before the environment and, in fact, one very gratifying point is that I am glad that in this House there has been bipartisan support for the work of this Ministry.
The third principle is that we have to think long term. For water and for waste, and in fact, for all the major infrastructural projects of our Ministry, we think 50 years and beyond. We have to make long-term investments and we cannot just kick the can down the road.
Allow me now to address some of the specific issues which Members have highlighted.
We set very high environmental standards for Singapore, not because this is an ideological obsession or because it is fashionable, but because this is an obligation in the governance of a dense city-state. Paying attention to the environment is an investment in our future and our health. Even our economic viability depends on it. For instance, our high quality environment is a key competitive strength, and it is the reason why companies and people decide to base their families and situate their headquarters in this safe, secure, liveable and lovable city called Singapore. It is not a trade-off between the economy and the environment. In fact, it is a virtuous cycle.
A clean environment starts with the air we breathe. I know we often take this for granted but we have not experienced scenes like these [Slides were shown to hon Members]. The first is from the volcanic eruption in Iceland. I remember that because I got stuck in London; I could not fly for a few days as a result of that. The other scene you will recognise is the smog in Beijing. We quibble here about the PSI being 10 or 20; but over there, we talk about a PSI of 500. You will appreciate it when you miss it.
Mr Charles Chong and Mr Nicholas Fang asked about measures to improve air quality. Last August, we announced that Singapore would adopt new air quality targets pegged to the more stringent WHO Air Quality Guidelines by 2020.
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You will notice from this slide that we have not yet reached those targets. That is why we need to step up our game and enhance standards. So, for instance, in order to reduce sulphur dioxide emissions, MTI and MEWR are jointly working with the major emitters – and as Mr Nicholas Fang has said – there are only six suspects in the room as far as sulphur dioxide is concerned.
We are working directly with the power generators as well as the oil refineries to improve their processes and to invest in appropriate technology. Quite frankly, technological solutions are available. It is a matter of cost and viability. In the case of the electricity-generating companies, the switch to natural gas has been a big benefit for the environment.
We are also concerned about Fine Particulate Matter, in particular what we call PM2.5, smaller than 2.5 microns. The paradox here is, in fact, it is the stuff that you do not see that is more dangerous, because PM2.5 is inhaled deeply into the lungs, embedded in those tissues and often never leaves our bodies.
Vehicles account for 57% of all PM2.5 that we have in Singapore. We have progressively tightened standards for diesel vehicles for the past six years, and we will next impose Euro V standards for all new diesel vehicles with effect from 1 January 2014. I think Mr Charles Chong asked for the percentage of Euro V-compliant diesel vehicles that are currently on the roads. It is very small – there are only about 3,400 such vehicles on the road. Over the years to come, we hope that with these new standards in place, the fleet will gradually be replaced.
Speaking of replacement of the fleet, we currently have 38,000 very old diesel commercial vehicles of pre-Euro or Euro I emission standards. Commercial diesel vehicles have a statutory life span of 20 years, so that means they actually have a very long tail. MOT and my Ministry will be implementing an Early Turnover Scheme which will incentivise the owners of these old commercial diesel vehicles to retire them early and to upgrade them to vehicles that meet the Euro V emission standards. We will provide more details of this scheme within the next two months.
We also need to deal with motorcycles. There are more than 143,000 motorcycles in Singapore, and most of them are of the Euro I standard. We will be raising the emission standards for all new motorcycles to the Euro III standards with effect from 1 October 2014. These new motorcycles will emit less than a fifth of the pollutants compared to the current fleet.
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Finally, we also need to address air pollution from beyond our shores, as Mr Nicholas Fang and Mr Charles Chong have emphasised. This is a chronic recurrent problem, and as I have said before, in fact, this is a commercial problem. It is cheaper, unfortunately, for oil plantation owners to clear land by burning forests and, unfortunately, a lot of these lands are peatland which continue to burn subterraneanly for weeks or months thereafter.
Working with our fellow Ministers and Ministries in ASEAN, we are trying to put pressure on these companies by the use of technologies such as digital geo-referenced concession maps, satellite and other mapping technologies so that, ultimately, we can name and shame the culprits who are engaging in such anti-environmental and anti-social activities.
Let me now turn to the ABC Waters Programme. I totally agree with Dr Teo Ho Pin. This has been a programme which has been very welcomed by members of the public. They have gained access to our reservoirs. We have converted canals into riverine attractions in their own right. I will take his suggestions about improving car parking, toilets and facilities, and catering facilities specifically to different segments of our population – the seniors, the children as well as the long-distance joggers. We will make sure that we will interconnect these blue ribbons of water with the national green Park Connector Network, so that you will be able to have access throughout the island. You can run many marathons along these routes.
We have completed 20 projects so far, but the good news is that we have identified about 100 sites that could potentially be developed over the next 15 to 20 years. I am not saying we can do all 100, but I am saying that there is potential to do many more sites.
The ABC Waters Programme has encouraged new lifestyle activities in many of our waterways and the surrounding lands, such as the Sengkang Floating Wetland Project at the Punggol Reservoir and the urban wetlands at the Alexandra Canal. PUB will work with NParks to do more of such projects including mega projects like the Bishan-Ang Mo Kio Park.
I am pleased to update Mr Heng Chee How, who has asked obviously for his own constituency, that PUB will explore another ABC project along the stretch between Whampoa Drive and Kim Keat Road, taking into account the opportunities that will open up when there are new developments, such as the new HDB project opposite the Whampoa Community Club.
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There are three more ABC projects which are due for completion later this year – Sungei Pandan, Sungei Ulu Pandan and the Geylang River. Construction will begin at another five projects later this year at Sungei Tampines, Sungei Api Api, the Kallang River next to St Andrew's School and Siglap Canal.
Between 2014 and 2017, construction will commence on new projects at the Kallang Riverside and the Jurong Lake.
Let me now move to a topic which Er Dr Lee Bee Wah, Mr Gan Thiam Poh, Mr Liang Eng Hwa and indeed many Members of this House have focused on. This is something close to our hearts. Actually, more accurately, it is closer to our stomachs – hawker centres. They are a source of livelihood for hawkers and a space where all Singaporeans have access to delicious, freshly cooked food at affordable prices.
We started off as a hygiene project to move mobile hawkers with no running water and questionable sanitation into centres where they will have running water in order to improve public hygiene. But over the years, hawker centres have become part of our uniquely Singapore identity. The fact that we can go there in slippers, shorts and T-shirts, it reflects the informality of life in Singapore. The fact that all of us, including politicians on both sides of the House, go to hawker centres to meet people also reflects that multi-cultural cohesion and that uniqueness of Singapore life the way it is today. So, hawker centres are an essential part of social infrastructure.
More than half or 53% of our cooked food hawkers today currently pay subsidised rents. What this means is that these are the original hawkers, or their immediate family members who have inherited the practice from them. They were, as I said earlier, re-settled from the original mobile stalls.
For the more recent hawkers, that means the other 47% of people who have come in later in the decades since then, one question then is: on what basis do you allocate these stalls? The newcomers have been allocated stalls on the basis of open tenders in the interest of fairness. Their rents, therefore, vary according to location. So, for instance, if you are going to bid for a stall in Newton Hawker Centre or Maxwell Food Centre, it is going to be much higher than a stall, say, in Taman Jurong or elsewhere. It varies according to location, food type, traffic, size, frontage and business conditions overall.
In 2011, we announced that, after a hiatus of 26 years, we would re-start our Hawker Centre Building Programme, and I announced where the new
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hawker centres will be. In case you ask me on what basis we chose those locations, those were areas which are relatively under-served with respect to cooked food.
My objective of re-starting this programme and injecting supply was to put downward pressure on rentals. In addition to the fact that there is new supply coming on, we also changed policies. For instance, we removed reserve rents and this has led to falling tender prices. Fifty-five percent of the stalls awarded in the past one year were awarded at below the previous reserve rents. Successful tenders, as low as $21 for cooked food stall at Taman Jurong and $5 for a market stall at Changi Village, have emerged.
That said, I want to make this point, that rent is only one component of a hawker's operating costs. In fact, raw materials and cost of labour are higher component costs of a hawker centre. Rents are important but not the key determinant. In fact, I went to check on the vegetarian bee hoon that Mr Png Eng Huat highly recommended. I went there yesterday; unfortunately, it was closed at 2 pm. I then did research. I identified nine other vegetarian bee hoon stalls along Jalan Bukit Merah; and guess what? The two stalls selling at $1.50 are paying market rates; the three stalls who are enjoying subsidised rents are charging more than that. I think it makes the point that rental is important but not the key determinant of prices. Ultimately, hawkers will charge what they think the market will bear and to reach out to the volume of work that they are aiming for.
Besides the rent policy, we also changed the rules on subletting and assignments because we wanted hawkers to personally operate their stalls. We will uphold this principle even as we pilot new not-for-profit management models. I think Mr Seah Kian Peng in his Budget speech gave a very eloquent explanation for the special role of cooperatives like the NTUC FoodFare and I cannot add to what he has already said. Having said that, I want to say that FoodFare will not have a monopoly on the new hawker centres. And, in fact, I hope to see several different not-for-profit operators enter this space.
NEA will continue to be the regulator, the developer and exercise oversight over all hawker centres in Singapore. I am pleased to inform Er Dr Lee that the planning works have begun on the 10 new hawker centres – five will be completed between 2015 and 2016 or thereabouts, including the one at Yishun. It will be on time, do not worry.
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Mr Seah has also asked for an update on wet markets. That was in his earlier speech. The new hawker centres like the one at Bukit Panjang will have wet markets selling fresh produce. But I want to sound a caution here that whilst I am very confident that there is a demand for cooked food, the demand pattern for wet markets is not so clear cut. So, this is something which will evolve as time goes on and we will respond according to demand.
Let me now just touch on another point which, I think, Er Dr Lee brought up. The nearly 2,000 hawkers who bought their sold stalls about 20 years ago, their leases are coming to an end over the next few years. All of these centres will continue to operate after the leases expire. There may need to be a short period where we do refurbishments, renovations, or redevelopment, but I will ensure that there will be centres thereafter.
All stallholders who are interested to continue their businesses will have the option to do so. Stallholders who were previously on the subsidised scheme, I intend to emplace them back on the subsidised scheme and they will only pay the current subsidised rental rates. For those who were not previously subsidised stallholders, I will give them the option to continue but they will pay the prevailing market rate. In other words, I am doing my best to ensure that we are fair to everyone concerned and that these centres will continue on a not-for-profit basis, and hopefully, the residents will continue to patronise them and enjoy the food options that they provide.
Let me quickly move on to water. Water is an existential issue for us. That is why the two water agreements were part of the Separation Agreement that marks our Independence as a nation. We have obsessed about water for five decades. Our water story is one of political will, meticulous planning, long-term planning, technology innovation and sound economics. Finally, today, we have the four national taps and we are in a secure position. I can give assurance to this House that we will certainly be water independent well before the expiry of the last agreement with Malaysia. I can even go further than that and assure Ms Faizah Jamal that, in fact, water is not going to be the limiting factor. You can produce as many babies as you like, you can build as many houses as you like, water will not be the limiting factor. We can continue to produce more than enough water for Singapore for the long-term future.
The second big desalination plant in Tuas will be ready in July this year and that will add another 70 million gallons of water per day to our capacity. In the
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long run, desalination will meet about 25% of our water demand.
We are also commencing on Phase 2 of our Deep Tunnel Sewerage System (DTSS). This is a superhighway for used water that will drain water from the western part of the island to a new water reclamation plant in Tuas which will also produce NEWater in the future.
I will also just quickly address this point on the cost of water and the need for water conservation. I agree that water needs to be correctly priced to reflect its scarcity value. It needs to facilitate long-term investments in this sector. There is a need, therefore, to constantly invest and the key variable in the future for the cost of water is the cost of energy. I cannot predict what the future cost of water will be without knowing what the cost of energy will be. But what I can say is that, on our current trajectory and with the hard work that is being done by PUB, there is no need to raise water prices this year.
Let me move on to waste which Ms Faizah Jamal has raised. We have made some changes. We have reduced the number of Public Waste Collection sectors from nine to six in order to improve economies of scale. Again, I am trying to bring the cost of waste collection down, whilst recognising that the cost of energy, cost of transport, trucks and all that is going up.
We are also building a new Waste-to-Energy incineration plant in order to maximise resource recovery and to reduce the landfill space.
If I could show the picture of Pulau Semakau, Members would see that we already got that area marked out for Phase 2. Again, I can give this House the assurance that we are good to go until 2035. We are not going to run out of space. But, in fact, the beauty of Pulau Semakau is that it is probably the only landfill in the world that is a tourist attraction. Just last December, Prime Minister himself went there. If you go to his Facebook page, you will find some beautiful pictures of that site. The point is that it can be done. It will be there for the long term and it can be beautiful at the same time.
Dr Teo Ho Pin asked about water and energy efficiency, and for an update on the Energy Conservation Act (ECA). This Act requires large energy users to implement energy management practices. It will come into effect in April this year for the industry sector and it will be rolled out to the transport sector subsequently. We will continue to work with companies, incentivise them and provide schemes like the Grant for Energy Efficient Technologies (GREET) as well as extend the Singapore Certified Energy Manager training grant. All these
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will enhance capability and technology.
PUB will also continue to encourage non-domestic users to develop and submit Water Efficiency Management Plans to help them analyse usage and potentially save water.
Let me quickly move on to households – energy and water usage. The Mandatory Energy Labelling Scheme (MELS) and Minimum Energy Performance Standards (MEPS) have been effective in expanding the range of energy-efficient appliances on the market, making them more affordable. Quite frankly, people will save money in the medium to long run if they buy more energy-efficient appliances, whether it is air-conditioners, refrigerators, washing machines or the like. We need to encourage people to look beyond just the initial sticker price to the total cost of ownership.
Let me move on to reducing household waste. Our recycling rate in households, to be honest, is still not good enough. In fact, in survey after survey, people have said they want to recycle but for some reason, this is not translated into practice. We will continue to try to make recycling facilities more convenient for households by enhancing recycling infrastructure in neighbourhoods. In some new HDB flats, we have even tried to pilot projects with dual-refuse chutes or recycling chutes in order to make it more convenient. There is some early data which shows that this perhaps may increase our recycling rates.
I want to agree with Miss Penny Low's suggestion about trying to promote a less wasteful culture, and a more sharing culture. This concept about \"Reuse, Reduce, Recycle\" – it used to be in our values system. All of us can remember our parents saying \"Don't waste.\" But somehow, perhaps as we became more prosperous, we have forgotten that imperative.
In the future, the era of cheap energy, cheap resources, cheap food is going to come to an end and we will have to rediscover the wisdom of our grandmothers of not wasting. Having said that, I also support her idea that we can promote more community-generated solutions for this. I will give you one example. NEA is organising a \"Clean & Green Hackathon\" next month. Basically, we will be setting aside a time, and we award prizes to people who come together and devise apps which can be used on smartphones. It basically creates a platform for people to share ideas and to use these ideas to improve the environment.
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Let me quickly touch, in the last few minutes, on a Sustainable Singapore. There is just one point I want to make which is counter-intuitive. A very dense well-planned city is actually the most sustainable way of life for human beings. Many people think being green means living in a rural area. But if you stop to think about it, living in a dense city is the cheapest way of providing food, water, healthcare, education, jobs, entertainment, ideas, cultural exchange simply because you have to move around less.
We now have seven billion people around the world. More than half of the people live in cities. By the turn of the century, 80% of us will live in cities. A dense well-planned connected city is the greenest and most sustainable way of life for our future. And Singapore can take the lead.
One key unique feature about Singapore is if you fly over Singapore, you will see a lot of it is green. Almost 47% of Singapore is green. But why is it green? It is green paradoxically because we are so high-rise, because nearly 90% of us live in apartments. The point I am trying to make is that if you really think about sustainability in the long run, the answer lies here. And in Singapore, we are building a working model of the future.
Of course, this working model of the future has to take into account long-term threats like climate change. The Member asked about whether we are worried about rising sea levels. Yes, we are. We are anticipating that they could go up anything from between 24 and 65 centimetres or more. That is why in 2011, we changed our platform levels for all reclaimed land, and added another metre. All reclaimed land now will be at least 2.25 metres above the highest recorded tide level. This is buying insurance for the future. If it does not happen, treat it as a sandbank. If it does happen, we are prepared and we must be prepared to adapt faster and to be aware of what is going on in Science.
That is also why the Meteorological Services Singapore (MSS) has established the Centre for Climate Research Singapore (CCRS) which will officially open later this month. This Centre will collaborate with researchers from all over the world in order to spearhead studies, and their academic output and scientific output will be the basis on which we make plans for the future.
We initiated the first Climate Change Vulnerability Study in 2007 to give us a better sense of what is going on. This study, conducted over two phases, has just been completed and we will be embarking on the next study soon. This will be a joint project between the CCRS and the UK Met Office Hadley Centre.
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Let me conclude by reiterating our core principles – that this is about human beings, our responsibility and our vulnerability, that we are all in this together and that we have to plan for the very long term.
I want to thank Members of this House and all Singaporeans for sharing ideas and for working so passionately with us to ensure that this beautiful, precious and fragile home of ours is sustainable and will be protected for the long run.
The Chairman: We have a bit of time for clarifications. Er Dr Lee Bee Wah.
Er Dr Lee Bee Wah: Mdm Chair, I would like to seek a clarification in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] Regarding my question on the lease problems faced by the 2,000 hawkers, I am happy with the answers from the Minister, and I am glad that the Minister will do his best to assist them.
I would like to ask the Minister, when will the National Environment Agency contact the hawkers to discuss the lease issue, so that they can continue their business with a peace of mind?
Ms Grace Fu Hai Yien (In Mandarin): [Please refer to Vernacular Speech.] I thank Er Dr Lee Bee Wah for her question. Allow me to clarify on this matter. Dr Balakrishnan mentioned that aside from the new hawker centres, we are also concerned about the operations of existing hawker centres. Between 2014 and 2017, there will be almost 2,000 hawkers from 15 hawker centres, whose 20-year leases will expire. They will have the opportunity to continue their business.
The leases at these 15 hawker centres will expire in four phases. The first batch of expiring leases are located at hawker centres in Bedok, West Coast, Aljunied and Ghim Moh. These hawker centres may need to undergo renovations, refurbishment or redevelopment, depending on the needs of the vicinity. After works have been completed, they can continue with their operations. Current stallowners will be able to decide if they want to continue with their business.
For stallowners who enjoyed subsidised rental rates before buying the stalls 20 years ago, if they choose to continue, they will be reinstated on the subsidised rent scheme. If they do not wish to continue with their business, they
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can return the stall to us, and receive an ex-gratia payment. They can also choose to assign their stall to another hawker at market rates.
For stallowners who do not come under the subsidised rental scheme, we will allow them to continue their business if they choose to do so. They will bid for the stalls according to market rates. We will treat all affected stallowners fairly. We will soon begin close consultations with various hawker stall-owners and Hawkers' Associations, and we hope to announce more details by 2014, before the leases at the first four centres expire.
Mr Zainal Sapari (Pasir Ris-Punggol): I would like to thank the Second Minister Ms Grace Fu for supporting and working with NTUC to push for the Progressive Wage Model to be embedded in the future licensing scheme for cleaning companies. Could the Second Minister share specifically the expected quarter in 2014 when the new licensing requirement for the cleaning companies will be made mandatory?
The Chairman: Second Minister Grace Fu, do you want to respond?
Ms Grace Fu Hai Yien: Mdm Chair, I thank the Member for his question. I think we will announce the details shortly.
The Chairman: Mr Yee Jenn Jong.
Mr Yee Jenn Jong (Non-Constituency Member): Thank you, Mdm Chair. I would like to seek further clarification from the Minister about the management of the new hawker centres. I would like to know the basis of which the first centre was awarded to NTUC Foodfare and the second one to the other social enterprise in Bedok. I would like to know what sort of rents these social enterprises are expected to pay to the Ministry and how are they in turn expected to select the hawkers and to pass the rent cost down to the hawkers, and how the prices will be kept affordable.
Dr Vivian Balakrishnan: Let me first deal with the very interesting social enterprise model which has been developed in Simpang Bedok. First, this is a purely private initiative. It is not a NEA hawker centre. Nevertheless, a group of people, good-hearted, business-minded, passionate people got together and said, \"We want to operate a hawker centre.\" They negotiated with the private
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landlord for the space which had not been very well utilised and they started it. I had the honour of opening it. I was very impressed with what I saw. What impressed me most is not the physical infrastructure but the attitude and the cohesiveness of the hawkers there − people who were given a second chance to start life anew, to start a business, to explore some new concepts, new ideas. And the fact that this started in a private area completely without subsidies, or, indeed, without even any urging or pushing from me, is to me something to be celebrated. So, that is for the centre at Simpang Bedok.
For the one at Bukit Panjang, Dr Teo will know that − he has been campaigning for a new hawker centre in Bukit Panjang for, I think, well over a decade. When we announced that we would re-start the building programme, to me, it was an obvious choice that I should accede to a longstanding request. Having said that, the next point was the choice − I could either operate it directly as another NEA centre or, I said, \"I want to try out new models and give social enterprises an opportunity.\" Because it was the first one, at that point in time, in fact, Foodfare was the only game in town. The people who started Simpang Bedok were not yet available. The role, however, is that it is NEA that is developing the centre. It is NEA that is paying for the cost of construction of the centre. In fact, it is NEA that has to pay the Government on the basis of what the Chief Valuer assesses is the rate for it. Foodfare's role is that of a managing agent. They do not own the place. They will not decide the policies of the place. But I want them to inject social responsibility, I want them to inject new ideas, I want them to try out new experiments and I want them to be able to manage the hawkers but still maintain the personal operation − the personal to holder nature of our hawker centres. So, it is a pilot and we will see how that has gone.
We have had extensive negotiations at arm's length on what, in effect, NEA has to pay them to perform this managing agent's role. I now look forward that we have got at least another nine in the pipeline, to see who else put up their hands and enter this field. I would stress, however, that all these are pilots and just because we award a contract for three years does not mean this will go on ad infinitum. So, it is my standing invitation to anyone here or if you know of people, both with a good heart, business experience and want to enter this field, please send us your proposal and we will look at it favourably.
Mr Lim Biow Chuan (Mountbatten): Going back to the sold food stalls, some of these food stalls that have been sold have been tenanted out to operators of the food centres. So, when you are going to renew the extension of the lease for the food stalls, who are you going to give to – the owners or the current people who are selling food?
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Dr Vivian Balakrishnan: We will have to deal with the owners who, in a sense, are the people who currently have some\tlocus standi\tfor the stall. Our condition is that once we take over, we will insist that it be operated personally. If the owner is not in a position to operate it personally, I would expect that he or she would transfer that stall to someone who is willing to subsequently personally operate the stall. So, the key principle is personal operation of the stall. The changes to our policies for the last two years on hawker centres have been to remove the element of property speculation and arbitrage from it. I think this is a principle which I probably say all Members of this House support, so that it is not property play. Hawker centres are about good, cheap, hot, wonderful food and a relaxed place for all of us to get together.
Er Dr Lee Bee Wah: Mdm Chair, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] The Minister mentioned that the new hawker centres will be completed on schedule. I would like to ask if the new hawker centre at Yishun can be completed ahead of schedule. While the scheduled completion date is 2015, yet three new BTO projects will be completed in 2014 in Yishun and a lot of residents will be moving in.
Ms Grace Fu Hai Yien (In Mandarin): [Please refer to Vernacular Speech.] I would like to thank Er Dr Lee for her question. We fully understand how the Member of Parliament feels about this issue. We know she sincerely hopes that the new hawker centre will be completed as soon as possible. The National Environment Agency feels the same way too, and we are working day and night to complete its construction as soon as possible for the residents. Evidently, we are also aware that the construction industry is facing manpower constraints, and the entire industry is under a lot of pressure. Of course, we will try, where possible, to bring hawker food that is delicious and value-for-money to residents of Yishun as soon as we can.
Miss Penny Low: I would like to ask the same question on behalf of the Punggol New Town residents. It is the fastest growing town and we have got many, many BTOs coming on-stream, and I think one of the biggest issues in Punggol New Town is the lack of the choices of food that is available. There are coffee shops and there are very few restaurants but there is no hawker centre at all in the entire new town. So, that is the first question. The second question is on \"recycling, reuse and reduce\". One of the biggest issues that the residents face is the lack of such facilities. There are some mega bins that are put in between a few blocks but they are too far and few. What happens is that, at most times, these bins are overflowing and they are not being collected on time
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as well. So, my question is whether the Minister has some plans to upgrade and increase the number of such bins and collection times as well.
Dr Vivian Balakrishnan: I totally agree with the Member that as Punggol continues to grow, the demand for cooked food will grow and we have to address this shortfall. I cannot give her specific numbers and dates yet, but I hear the Member and we will certainly look into meeting this need. On recycling, I agree with her that the design of the bins, the frequency of collection, the convenience and the overall infrastructure need to be looked at, and we are trying to improve that. We are working together with the public waste collectors to do so. Even for some of the demonstration projects in Punggol, you will be aware that we have tried having separate chutes and all that – one for disposable waste and another one for recycling waste. But it is really trying to persuade people one at a time, households at a time, to adopt recycling as a way of life. We will continue to work on public education and improve infrastructure.
Ms Lee Li Lian (Punggol East): Like Miss Penny Low, I am equally concerned for my ward, Punggol East. May I ask the Minister whether there will be any potential plans for hawker centres in Punggol East?
Dr Vivian Balakrishnan: I am just trying to recall the last time I walked there. I guess it was the eve of the election. I could not find any space but I will look at it again.
The Chairman: Mr Gan Thiam Poh, last clarification.
Mr Gan Thiam Poh: Yes, thank you, Madam. I want to ask a different question, not on hawker centre but on public cleanliness. I want to find out from the Minister whether there is any plan to resolve the issue of feeding of stray dogs, stray cats or birds in a public place by residents. Will there be any measures taken by the Ministry to tackle this issue, because it has caused some public hygiene and public cleanliness issue?
Ms Grace Fu Hai Yien: Mdm Speaker, as Members of Parliament who are hard at work on the ground, we know that these are not easy issues to tackle. There are always two sides to a story. There are always people who feel that they need to take care of the strays or feed the birds. On the other hand, if they do not clean up the food waste, it causes public hygiene problems. So, on this particular issue, I think we really need all parties to come together. First of all, residents need to be considerate, understand the impact of their actions on
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public hygiene and on the possibility of disease transmission. On the other hand, Town Councils, if it is within a Town Council's permit, need to also look at how we should enforce some of the local rules and what are the actions that can be carried out. I think that is where local decisions can be made. Where the situations are serious, as in where there is a total disregard of public hygiene and we really need to take strong enforcement action, NEA will step in and take the necessary enforcement actions.
The Chairman: I am sure that we all would love to have new hawker centres in our constituencies and I am sure the Minister has taken note of all our needs and demands. Er Dr Lee, would you like to withdraw your amendment?
Er Dr Lee Bee Wah: On behalf of GPC Members, I would like to thank both Ministers for their comprehensive answers and patience. And I would also like to thank Minister Vivian for recognising the great works of engineers. It will be a great morale booster. Madam, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $959,180,600 for Head L ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $327,846,500 for Head L ordered to stand part of the Development Estimates. (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head O (Ministry of Health)","subTitle":null,"sectionType":"OS","content":"Dr Lam Pin Min (Sengkang West): Mdm Chair, I beg to move, \"That the total sum to be allocated for Head O of the Estimates be reduced by $100\".
I would also like to declare my interest as a medical professional working in a restructured hospital.
Healthcare has always been an emotive issue for many Singaporeans, as it affects all of us in one way or another. Everyone seeks healthcare services at one point in our lives, whether we are newborns, children, adults or senior citizens. It is also one of the essential services expected of a responsible
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government.
Singapore's healthcare system has developed and evolved through the years to what it is today, through a mix of pragmatism and eclecticism, learning and adapting from best practices to arrive at a formula that works for us. Our healthcare system is generally cost-effective with a National Healthcare Expenditure (NHE) at 4% of GDP. In comparison, OECD's average is 9.6%. Even then, I am glad to note that Singapore has achieved good health outcomes, in spite of spending less than many other developed countries when measured as a percentage of GDP.
However, I have often received feedback from residents and friends on the increasing cost of healthcare. The old adage that \"It is better dead than to be sick\" seems to resonate with many Singaporeans. Why is this so? MOH has always pledged to provide affordable healthcare for all Singaporeans.
As parliamentarians, we have debated for years in this House on affordable healthcare. What then is affordable healthcare? Many academics have tried to define what affordability is. Some measure affordability as the amount of money a household can spend on healthcare costs, while still having enough left to pay for other necessities. Should it be measured as a percentage of total income, such as 5%, 10% or even 15%? Or should it be measured as a percentage of the total bill size in the form of out-of-pocket costs for the patient?
While I do not have an answer for that, I would like to highlight some issues and concerns that have contributed to the perception that healthcare in Singapore has become less affordable.
Mdm Chair, Singapore's version of healthcare financing hinges on one of the key philosophies of individual responsibility. Coupled with the time-tested 3M framework of MediSave, MediShield and MediFund, the Government has been able to keep our national healthcare expenditure below 4% of GDP, of which only one-third comes from the expenditure from the Government. However, with the rapidly ageing population and the ever escalating medical inflation, the burden of bearing the higher cost of healthcare has begun to fall significantly on Singaporeans.
Many Singaporeans have called for the Government's share of healthcare expenditure to be increased. Compared to many OECD countries, the Singapore
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Government's share of the national healthcare expenditure has remained enviably modest.
While the 3M system has served us well, we need to ensure that the 3Ms remain relevant, to commensurate with the socio-economic-political situation and needs of Singaporeans. The restriction imposed on the use of MediSave is a big bugbear amongst Singaporeans. Many lamented: \"What is the point of having so much money in the MediSave when they cannot even pay for their current healthcare needs?\" Many young parents also shared their concerns of potential financial strain on the family should their newborn be inflicted with congenital illnesses. On this note, I would like to thank the Ministry for finally including the MediShield coverage for congenital diseases. Many of my parliamentary colleagues and I have been lobbying for this for many years.
While I would be happy if most Singaporeans can stay healthy and not require the use of healthcare services, the reality is that at some point in time, all of us would have to utilise the healthcare system. It would be extremely sad if any Singaporean were to be made bankrupt as a result of seeking medical treatment for themselves or for their loved ones.
In view of this, I would urge the Government to conduct a major review of the 3M system, in particular, with the view to enhance MediSave usage, MediShield insurance protection and MediFund assistance to low- and middle-income Singaporeans. MOH should also take a closer look at the high deductibles and co-payment which inevitably result in more out-of-pocket expenses for Singaporeans.
With increasing integration of social and medical care under MOH, should we also consider allowing MediSave usage for social care facilities like senior care centres? MOH should also regularly review Means Tested Subsidy Levels, MediShield and ElderShield insurance payouts to ensure that they keep pace with medical inflation.
I have also received numerous feedbacks on the affordability of drugs. MOH's classification of standard drugs seems to be too stringent, resulting in many drugs that are commonly used for many common conditions being listed outside the standard list for Government subsidy. One way the Ministry can help lower the out-of-pocket payment for Singaporeans is to subsidise the cost of more essential drugs.
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Another way to ensure that healthcare stays affordable is to make the fee structure transparent. Physician charges in the private sector can be rather arbitrary, especially after the Singapore Medical Association (SMA)'s schedule of fees was discarded in 2007. The recent introduction of the ethical limits on doctor's charges by the Singapore Medical Council (SMC) has also taken many practitioners by surprise as this will have implications on the way doctors charge. Can MOH elaborate and better define what this ethical limit is to avoid ambiguity in future? I would also like to suggest to MOH to introduce some form of consolidated information on bill sizes and professional fees for all private and public sector hospitals and have them published and updated on a regular basis for the benefit of both doctors and patients.
The Minister had announced MOH's Healthcare 2020 masterplan in last year's COS debate. To quote the Minister on the objectives of this masterplan, he said: \"Healthcare 2020 will focus on three strategic objectives – enhancing accessibility, quality and affordability of healthcare for our people. This means that Singaporeans will receive healthcare when we need it; our healthcare services will be of good quality and effective and Singaporeans will be able to afford such services.\" I would like to ask the Minister for an update on the masterplan.
Mdm Chair, affordable and accessible healthcare must remain a basic right for all Singaporeans. The Government must ensure that healthcare remains affordable and will not deny any Singaporeans because of their inability to pay.
The Chairman: Mr Low Thia Khiang, you have two cuts. Please take them together.
Mr Low Thia Khiang (Aljunied): Madam, the MOH website states that: \"Restructured hospitals are different from the other private hospitals\" and \"they are to be managed like not-for-profit organisations\".
At present, restructured hospitals appear to be managed like profit-driven companies. International Medical Services that solicits business from foreign patients is present in most of the restructured hospitals. The common argument is that money earned from private and foreign patients is used to support treatment for local, subsidised patients. If so, then what proportion of the overall patient load should private and foreign patients constitute – 20%, 30%
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or more? Who provides and oversees the implementation of the guidelines?
If they are such guidelines, are they department-specific or hospital-specific? I understand that while the hospital as a whole may see more subsidised patients than private or foreign patients, how about individual departments? Moreover, given the current patient load of restructured hospitals, is it justifiable to allocate resources to serve foreign patients?
Next, I would like to discuss remuneration schemes for specialist doctors. Many specialists in restructured hospitals are under a remuneration scheme that rewards them for treating private patients, that is, non-subsidised patients.
I believe that the remuneration scheme is one of the factors hindering the hospitals to improve the situation of long waiting time, especially for subsidised patients. Despite the long waiting times to consult a specialist in the hospital, there is little incentive for the hospital to re-appropriate the ratio of subsidised to private out-patient specialist clinics.
There is also a policy for selected specialists from SGH to see private patients at Gleneagles and Mount Elizabeth hospitals. The Minister for Health explained that this frees up physical resources for subsidised patients. However, if the specialists are outside of SGH to treat those \"off-loaded\" private patients, then one may assume that junior doctors have been delegated to treat the subsidised patients in SGH.
The waiting time for surgery is also long, especially for subsidised patients. This is because the current remuneration scheme favours shorter waiting times for private patients. In addition, subsidised patients may also be encouraged to upgrade to private status.
I am of the view that the current remuneration scheme incentivises specialists to treat private patients over subsidised patients. As a result, there is unequal distribution of workload among specialists. Morale drops and specialists leave. Over the years, pay increases alone have not been able to stem this tide of resignation.
Other remuneration schemes should be considered to incentivise doctors to treat both subsidised and private patients equally. Perhaps, remuneration should be based on the number of patients seen and the complexity of patients managed.
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A variant of this scheme already exists in some restructured hospitals where specialists accumulate \"points\" for care or service rendered. Each \"point\" has a monetary value. However, such a scheme has been overshadowed by the more favourable incentives to treat private/foreign patients over subsidised patients. I think it is time for restructured hospitals to remove the incentives for the treatment of private or foreign patients and to move to a \"point-based\" remuneration scheme. Madam, my next cut in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] This year, the TCM Practitioners' Board decided to implement a two-year voluntary TCM Continuing Education Scheme. According to the guideline, participating in continuing education courses is voluntary.
According to the understanding of TCM practitioners, however, the first two years is the trial stage and from the third year (2015) on, it will become compulsory. No licence will be issued to those whose scores are not up to the requirement.
I would like to ask the Minister what is the purpose of this TCM Continuing Education Scheme? Will this be misinterpreted as a tactic to reduce the number of registered TCM practitioners? Does MOH believe that if the Chinese physicians do not undergo continuing education, they will necessarily be eliminated?
Within the TCM industry, besides professional TCM practitioners, there are also many voluntary TCM doctors who practice a few hours a week at their spare time. They are concerned that with the compulsory credit accumulation system for licence renewal, it will be a challenge for them to find time in their busy schedule to practise on a voluntary basis. In addition, they have to pay out of their own pocket for the continuing education. Even if their license can be renewed for one year, next year they will face the same concern all over again. Under this circumstance, how long can they last? If the number of the voluntary practitioners drops, what impact would it have on the VWOs providing TCM services?
In view of the current TCM status, if the purpose of the Board is to improve the TCM standard, expertise and skills, then I suggest establishing a TCM Specialist Registration regime, which is more stringent than the current TCM registration system. We can then incorporate the continuing education
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requirement into the new registration regime.
Ms Tin Pei Ling (Marine Parade): Mdm Chair, I would like to ask the Minister whether the MOH will look into shortening the waiting time between the point of referral to the point of appointment scheduled? This is so that those who require further examination or medical attention can receive them promptly.
Secondly, will the MOH be reviewing the adequacy of subsidies to help the majority of Singaporeans, especially the elderly, better cope with healthcare expenses?
The Chairman: Mr Low Thia Khiang, you have two cuts. Please take them together.
Mr Low Thia Khiang: Madam, the increasing and ageing population has further stressed our current healthcare delivery system. The mechanism for referral to subsidised specialist healthcare in the Government-restructured hospitals can be improved.
I understand that currently, the provision of primary healthcare is shared between the Government-run polyclinics and the private general practitioners (GP). Polyclinics provide only 20% of the primary healthcare while GPs provide about 80%. There is, thus, a much higher chance that a patient will consult a GP rather than a polyclinic doctor.
However, if a patient sees his GP and is deemed to need a specialist consultation at the Government-restructured hospital, he will not be considered as a subsidised patient by the specialist clinics of the hospital on the basis of his GP's referral.
To qualify for subsidised outpatient specialist care, he has to make a trip to the polyclinic, wait many hours to see the polyclinic doctor and pay for this additional consultation in order to get a referral letter that allows him to be seen as a subsidised outpatient at the hospital.
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Such a cumbersome referral system increases both direct and indirect healthcare costs, that is, double consultation with two primary healthcare doctors in addition to time lost from work for the patient and possibly for the accompanying family member. With the increasing and ageing population, the limitations in the current system will be aggravated.
I believe that it is timely for MOH to review the referral system and allow patients the same default subsidised status for outpatient specialist clinic care regardless of their referring primary healthcare doctor.
Madam, during last year's Budget Debate, the Minister for Health spoke about strategies to improve the quality of healthcare delivery. The twin pillars of achieving this goal are the Regional Health System and the National Electronic Health Records.
With regards to the Regional Health System, I would like an update on the progress of the formation of this system. One such example is the Eastern Health Alliance that was established in late 2011. What are the main lessons learnt from the initial planning to the final implementation of the Eastern Health Alliance? How have patients benefited either directly or indirectly from this Regional Health System? How does the Regional Health System address the overall health issues of the community that it serves? And what are the plans for the other regions of Singapore?
With regards to the National Electronic Health Records, to what extent has this programme been developed? Is it a single system applicable to all institutions across different health clusters or multiple systems stitched together?
To what extent have we achieved the goal of shared electronic medical records between Government restructured hospitals, community hospitals, nursing homes, private practitioners and other users, such as the Agency for Integrated Care (AIC)? What information is shared through the National Electronic Health Records? Examples include laboratory results, radiology results, histopathology results and clinical notes.
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Lastly, has the National Electronic Health Records been able to reduce the need to print out hard copies of patients' records thus reducing the carbon footprint of our healthcare system?
Mr Laurence Lien (Nominated Member): Madam, Singapore has done very well in a number of health areas. However, there are some areas that we struggle with. Singaporeans on average spend seven to eight years in poor health prior to death. The prevalence of risk factors such as obesity and chronic diseases like diabetes are increasing. High prevalence of these conditions reflects poor health prevention and sub-optimal lifestyle.
Even with recent improvements, we must do much better in preventive health, primary care and chronic disease management. We are investing a lot in new healthcare infrastructure and improving affordability. But our software still lags our hardware development. There needs to bolder innovations in healthcare service delivery.
Today, our model of care focuses resources on keeping people alive, not necessarily keeping them well. Downstream services, like acute care, are world-class in quality, even if there are issues in affordability, availability and accessibility. But an inordinate amount of resources is spent when the person is already unwell and in their last stages of life; too little is spent upfront to keep the person healthy. Care is fragmented and compartmentalised, with people often getting episodic care from organ specialists.
We need to focus on providing holistic care, that is whole person care and end-to-end service delivery that joins the dots so that people do not fall through the cracks.
We need to move towards a relationship-centred approach, particularly in primary care. Key attributes of primary care must include comprehensive care, coordination of care and a personal relationship over time.
We have more than 2,000 private GPs in what is essentially a cottage industry serving 80% of the primary healthcare demand. There is too much choice for uninformed patients and too much individualism among providers. This hinders interagency cooperation, and the building of relationships and a social network support that is integral to delivering effective healthcare that
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keeps people in good health and out of hospital.
A relationship-centred approach, which is different from the transaction-based model we have today, focuses on improving the relationships of the whole person in his or her own life context – between healthcare professionals and patient, and between the community and patient.
There must also be stronger relationships among healthcare professionals and institutions. Primary care should be delivered through a team-based multi-disciplinary approach – including home nurses, tele-carers, therapists, other allied health professionals, social workers and counsellors – who can sit in different centres, rather than through a system that depends on individual doctors. Collectively, these professionals can better understand the patient's full needs, provide comprehensive healthcare services and help them navigate the complex healthcare system to get the care they need, when and where they need it.
Government should invest significantly in developing such a regional primary healthcare ecosystem. Scandinavia and UK have examples of such cost-effective systems. Professionals need to come together to form a dense network. We cannot have lone rangers. As a proper system, holistic end-to-end care can be provided. Multi-agency integration through community groups is especially critical for preventative healthcare.
Care must be patient-focused. Patients should only register with one practice at a time, so that they can develop a personal relationship with their GP and access a continuity of care. Day and night, they should be able to call one telephone number to access services.
It will take us some time to get to the ideal state. As a start, Government should provide the incentives for both patients and GPs so that they develop good relationships. For example, Government should start networking GPs willing to change. Community Health Assist Scheme (CHAS) could also give more subsidies, or insurance companies give greater premium discounts, to patients each time they keep going back to the same GP. Alternatively, there could be a CHAS loyalty scheme, where higher subsidies and free health screening are given, if a patient is prepared to stick to one GP. Overall, out-of-pocket payment must be minimised for community-based and primary care services, as these are much cheaper than institutional care later on.
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GPs themselves must be incentivised, for example, to tap into the regional and national infrastructure. GPs that function well as care nodes should be recognised, for example, with Practice Accreditation or a Quality Service Award. Some GPs can be paid by the Government directly or be even on the Government's employment, so that GPs can focus on the public good aspects like preventative health.
In addition, family, caregivers and the community must be mobilised such that the primary care ecosystem is fully functioning. It is through mobilising the larger community network that good practices, such as screening on schedule and medication compliance, are reinforced in patients. In short, we do need to slaughter a few sacred cows. But that is necessary if we really desire a healthy nation.
Mr Gerald Giam Yean Song (Non-Constituency Member): Madam, currently all hospitals and nursing homes conduct means-testing to determine a patient's eligibility for Government's subsidies. Patients have to submit documentation to prove their income and that of their family members. These include up to three months of payslips, CPF contribution statements, or income tax returns.
Obtaining salary documentation is onerous for some patients, including those who are not IT literate, who do not have a SingPass to retrieve their CPF statements, or are odd-job workers who are not issued payslips. Some need to contact their employers to request for letters to prove their income. Others may have difficulty obtaining documentation from family members, who may not want to reveal their income or may be estranged from the patient themselves.
All these present administrative and emotional burdens to patients at a time when they are already with saddled with worry and pain from their illnesses. As a result, many of them do not complete their applications and lose out on receiving subsidies that could ease the cost of their treatment. I hope MOH would review its means-testing process to ensure that it does not burden patients or their family members, so that patients receive all the subsidies that they are eligible for.
To reduce the hassle for patients, can means-testing be conducted without the need for the patient or his family to submit their income documentation? The process should be automated such that the patient and his family only need
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to give their consent for the hospital to assess their income records with CPF Board or IRAS. This is much more convenient for the patient, and it better preserves their confidentiality.
I know that this is already being done for the CHAS applications. Can the same be done for all hospital and nursing home means-testing?
Dr Lily Neo (Tanjong Pagar): Madam, our Healthcare 3M system, an envy of many countries, is supposed to adequately take care of the medical needs of our citizens. MediFund guarantees that no one is deprived of medical care due to the lack of funds. Why then are so many of our elderly still concerned about healthcare costs? It cannot be explained simply that they are less knowledgeable or less well-informed about the various available schemes. Otherwise, their concerns would have been resolved and not be perpetuated till today.
My analysis is that their concern is not unfounded especially for those with the lowest incomes and for many retirees. This group often has little personal savings and MediSave accounts. Our system requires everyone to co-pay the initial amounts for any medical care.
Although I personally believe in having some co-payment to prevent the buffet syndrome, I think we need a tier-system with reduced co-payments for the retirees and the lowest income Singaporeans. Even hospital outpatient treatment costs can be hefty out-of-pocket payments for this group; this is quite apart from co-payments for hospitalisation. It is time to tweak our medical financial framework in view of an ageing population with increasing smaller families. It is getting difficult for siblings of small and especially low-income families to share the healthcare burdens of parents.
I believe in insurance risk pooling. It is definitely a necessary way forward. May I ask the Minister whether he can further strengthen this insurance framework? Are there too many retirees or low-income families who cannot afford to join MediShield? Is it not better to assist them to join MediShield rather than to face costlier payments in the end when they need hospitalisation?
In view of the increasing healthcare needs of an ageing population, there is an urgent need of planning task for MOH in the area of medical infrastructure,
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to cope adequately and in a timely manner.
My concern on healthcare is the exponential increase in demand for nursing homes, community hospitals and acute hospitals. It is, thus, necessary to have good projections on demand, early planning and proactive measures in place. We also need to increase our healthcare personnel, nurses and doctors, especially geriatricians.
Preventive healthcare has and should always be the hallmark of our healthcare system. It is ideal if we can keep our citizens healthy for as long as possible through prevention of chronic diseases. Let us spare no effort in promoting preventive healthcare. Can MOH, therefore, provide incentives for our people to eat healthily and exercise regularly?
Obviating long-term care in institutional settings should remain the basis of eldercare. Step-down care facilities such as community hospitals, day-care centres and community-care centres must be adequately provided so as to reduce the overload on expensive hospitals beds.
We need one new aspect of preventive healthcare in the community for the elderly. It is to facilitate the elderly to live as independently and for as long as possible in their own homes, with given support as in homecare and community support as with Seniors Activity Centres.
Mr Sitoh Yih Pin (Potong Pasir): Mdm Chair, this year is the 10th Anniversary of the severe acute respiratory syndrome (SARS) outbreak in Singapore. The SARS outbreak was arguably the worst health crisis we ever faced. Our healthcare workers displayed tremendous courage and professionalism to pull us through. Unfortunately, we lost a few healthcare workers and quite a few patients. But, during SARS, we turned our darkest hour into our finest moment.
One of the lessons learned in SARS was that we run the danger of over-optimisation to the point of vulnerability. Our public hospitals and polyclinics are very optimised in terms of service delivery. But optimisation is based on assumptions. To quote Henry Ford, \"Any customer can have a car painted any colour that he wants so long as it is black.\"
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This may be an extreme example of optimisation, but the reality is the more you optimise, the more narrow, precise and accurate your assumptions have to be, which in this case is that you assume that everyone only wants a black car.
But reality is full of variations and unexpected twists and turns. So, I would suggest to MOH that even as we ramp up our healthcare services, we spend some of these resources to cater for the unexpected.
The next issue I would like to dwell on is long-term care and dementia. I am pleased to note that MOH is embarking on a comprehensive exercise to increase the number of nursing home beds in Singapore over the next three to five years. In addition to this capacity building, I would like MOH to also look into capability building. Nursing homes have to be funded better to developing capabilities to cater to dementia patients.
Madam, we will have about 500,000 Singaporeans aged 70 and above in 10 to 20 years' time. Based on comparable studies, we may have to provide for 6,000 to 10,000 patients suffering from moderate to severe dementia who will likely need institutional care then.
I urge MOH to look into this quickly and develop the capability in nursing homes to handle these patients as well as the community to handle tens of thousands of mild dementia patients.
My third issue is on community-based elderly care. Due to the very large numbers of elderly in the next 10 to 30 years, the bulk of care for the elderly will remain in the community. Unless absolutely necessary, the vast majority of the elderly will wish to stay in the community, and not in an institution. We need to help these elderly and their families to achieve this. The recently announced increase of the Senior Mobility and Enabling Fund from $10 million to $50 million is a step in the right direction.
I would also suggest that MOH enhance accessibility and affordability to homecare as well. Good homecare delays an elderly's entry into a nursing home. I hope MOH can look into funding and developing the homecare sector so that more sick elderly can remain in the community, as they would prefer to.
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Mr Cedric Foo Chee Keng (Pioneer): Madam, I join Mr Sitoh Yih Pin in paying tribute to the many fine men and women when they tackled SARS and when they lifted the nation out of the crisis. I also recall that at that time, we had the Courage Fund. I would like to ask the Minister if we have used it well to recognise the many contributions of these fine men and women.
Madam, as our population grows and ages, many people will require access to primary healthcare facilities. In Jurong West, for example, the population has grown significantly, and we have seen a corresponding rise in the demand for primary care. The nearest polyclinic for Jurong West residents is at Jurong East, and many elderly residents find it very inconvenient to get there. The waiting time at Jurong East Polyclinic has also increased. Could I ask the Minister to consider setting up a new polyclinic, perhaps at Pioneer constituency and near the transport hub there?
Madam, the Community Health Assistance Scheme (CHAS) is an excellent one. With a stroke of the pen, MOH increased the access for needy residents to primary healthcare. They no longer need to visit just polyclinics, but they can visit private GPs as well. However, the number of private GPs who have signed up for CHAS remains limited, especially in Pioneer constituency. So, I would like to ask if the Minister can work on this and see if more GPs can sign up.
Secondly, a suggestion to extend CHAS to dental care: whether that can be done, or is it already done? And if so, can more dental clinicians be brought into this scheme?
Dr Teo Ho Pin (Bukit Panjang): Madam, polyclinics provide affordable and accessible primary healthcare services to Singaporeans especially low-income heartlanders. Today, we have 18 polyclinics in Singapore providing about 20% of primary healthcare to Singaporeans. But many polyclinics are experiencing heavy patient load and long waiting time. This could be attributed to the high demand for their services and the short operating hours of polyclinics. Polyclinics are open five-and-a-half days from 8.00 am to 4.30 pm.
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Many Singaporeans who need outpatient medical services after these hours would have to consult private GPs or go to the Accident and Emergency (A&E) departments of hospitals. The charges of GPs and A&E departments are much higher, thus posing financial burden on Singaporeans, especially low-income households.
In Singapore, medical services after office hours are not easily accessible or affordable. Many housing estates do not have 24-hour clinics. As a result, many Singaporeans have to activate our ambulance services to go A&E for emergencies.
This has put additional strains on our limited ambulance services and caused long waiting time at our A&E departments at hospitals.
Madam, this situation will aggravate if we were to have more babies and elderly in the future. With such population profile, our existing hospitals and medical facilities will not be able to cope with any National Emergencies such as disease outbreak or disasters. Thus, I would urge the Ministry to consider building more polyclinics, operate polyclinics 24 hours, seven days a week, and equip polyclinics to be National Emergency medical centres.
Madam, I wish to ask the Minister the following questions. How many polyclinics will be built by 2030? Can the Ministry consider building a polyclinic in Bukit Panjang Town? Can the Ministry operate polyclinics on a 24-hour basis?
Dr Lam Pin Min: Mdm Chair, the primary healthcare sector's importance to the overall health landscape in Singapore cannot be overstated. Today, there are some 2,400 private medical clinics and 18 polyclinics in Singapore. Primary care professionals are often the first point of contact with the patients in the community.
During last year's COS, Minister mentioned that the Ministry would seek to explore new models of care for this sector. I would like to ask the Minister for an update on MOH's strategy in delivering better primary care services to Singaporeans.
With the ageing population, many age-related medical conditions including mental illnesses, will become more prevalent. How will the ministry ensure that our primary care sector, especially our family physicians, stay relevant to cater
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to the needs of the elderly?
The current 18 polyclinics serve about 20% of the primary healthcare market. They provide affordable primary healthcare services to many Singaporeans, especially those from the lower- and middle- income families. What is the number and capacity of polyclinics required to meet our future needs? What role will the polyclinics play in ensuring affordable primary healthcare for Singaporeans? I have received much feedback on the long waiting times and over-crowding in polyclinics, especially the one in Sengkang. Like Dr Teo Ho Pin, I would like to request the Minister to consider introducing some 24-hour polyclinics in certain areas with extremely high demand to help alleviate this problem.
CHAS is very helpful in providing affordable and accessible primary healthcare services to lower-income Singaporeans above the age of 40. However, younger low-income Singaporeans, below the age of 40, are deprived of this subsidy and convenience of seeking treatment from the nearby participating family clinics. Will the Minister consider lifting the age criterion for this scheme so that all low-income Singaporeans can benefit from the scheme?
The Chronic Disease Management Programme (CDMP) has also benefited many Singaporeans by minimising the out-of-pocket expenditure when they consult their doctors for the management of their chronic diseases. However, I have received many negative feedback about the administrative fees imposed when using their MediSave for this programme. Can Minister consider waiving this administrative fee, especially for those from the low- and middle-income families so as to allow them to stretch their MediSave dollars further?
The Chairman: I am beginning to think that Christmas has come early. Miss Penny Low.
Miss Penny Low (Pasir Ris-Punggol): Madam, I too wish that my Christmas wish can be fulfilled. So, like some Members who have clamoured for hawker centres for 10 years, or some have clamoured for this and that for many years. In the case of polyclinics, it is the same. As one of the fastest growing new towns in Singapore, the demand for primary healthcare services continues to grow in Punggol New Town.
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At the 2011 Committee of Supply, MOH had announced the building of a polyclinic in Punggol. Can the Minister give Punggol New Town residents an update on the progress of the polyclinic's development? And also, could the Minister elaborate on what residents can expect, from this new and much needed facility, whether it will have 24-hour service or not?
Punggol is a young town and we want to encourage fertility as well. So, what is MOH's planning parameters in catering to residents on: (a) gynaecology and paediatrics care; (b) facilities for the elderly, step-down homecare; (c) dental services; and (d) the need for affordable healthcare?
As Punggol 21 is being developed to be a model town, perhaps MOH can also review its current planning parameters, and apply design thinking into meeting the healthcare needs of the residents, making it a role model in the care of our residents.
Dr Lam Pin Min: Mdm Chair, according to the Bloomberg Global Health Survey in 2012, Singapore has emerged top as the healthiest nation in the world. This is, in part, due to our highly efficient healthcare system, as well as the major role played by HPB in promoting healthy living among Singaporeans.
Yet, let us not rest on our laurels. We need to do more to promote healthy living, with regard to obesity and smoking. Obesity is of particular concern. While our obesity rates are much lower than that of the Organisation for Economic Co-operation and Development (OECD) average of 17%, USA 34% and Australia 25%, our statistics show that Singaporeans are getting fatter. Obesity in Singapore rose from 6.9% in 2004 to close to 11% in 2010. Coupled with a global obesity pandemic, more food choices and affluence in Singaporeans, we face an uphill task.
In our fight against obesity, would MOH or HPB consider strengthening food advertising? This would follow international norms where many countries, like the UK and South Korea, have already regulated the food advertising market. Countries like Finland, Denmark and Malaysia have also set out government guidelines on food advertising. Children, in particular, are of concern as, most of the time, they are easily influenced by temptations in persuasive advertisements.
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The health of the individual is very much affected by the consumption of the type of food. Many of our school children consume meals sold in the canteens. In order to minimise the consumption of unhealthy and junk food, can the Ministry consider mandating that only healthy diet are served in school canteens? To encourage Singaporeans to eat healthily, the Government can consider making healthier choice products sold in supermarkets cheaper and more affordable.
While the Government has imposed controls on harmful products like cigarettes, it is worrying that the prevalence of smokers amongst the young and the ladies are increasing. The recent extension of the smoking ban is also a step in the right direction. Non-smokers will have more reprieve from second-hand smoke and avoid the harmful effects of second-hand smoke. While we have banned smokers from lighting up in public places, it would not eradicate the harmful habit of smoking.
Smoking has been linked to many medical conditions including ischemic heart disease, chronic obstructive lung diseases and cancers. We can do more to eradicate this harmful habit among Singaporeans. One radical suggestion would be to gradually introduce a ban on smoking on certain segments of the population. Would the Ministry consider totally banning the sale of tobacco-related products to cohorts of citizens born after a certain year? While it is often difficult to make smokers change their habits and quit smoking, this would gradually eradicate the habit in the next generation of Singaporeans as they would not be exposed to the bad habit of smoking?
While looking after one's health and well-being is an individual choice and responsibility, the Government can facilitate and encourage Singaporeans to do so. Can the Ministry consider working with the insurance industry, or even MediShield to incentivise Singaporeans to lead a healthy lifestyle? This can be in the form of insurance rebates or further premium reduction.
Last but not least, will the Minister consider allowing MediSave to be used for medical screenings of some common medical conditions? This would enable diseases to be detected and treated early, enhancing the prognosis and minimising preventable complications.
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Mr Patrick Tay Teck Guan (Nee Soon): Madam, I would first like to thank MOH for responding to my call during COS last year, and joining hands with NTUC, our healthcare cluster of unions and institutions to form a tripartite workgroup looking at progressive wages and productivity for the healthcare cluster. The Progressive Wage Model implemented has started to raise the salaries and productivity of the lower wage earners in our public healthcare institutions.
Next, the increasing cost of dental treatment in Singapore is putting people off regular dental check-ups until such time they get a throbbing pain. This is especially so with our senior citizens who need it the most.
I recently had to embark on a dental treatment at the National Dental Centre because of a chipped molar and the entire treatment cost me almost $3,000 because of root canal, gum surgery plus a crown.
I, therefore, urge MOH in its review of the healthcare financing framework to address this issue of affordability of dental care and treatment, the use of MediSave for certain dental procedures, including for crowns – which, in my case – was not for cosmetic purposes.
I further submit that with the increasing number of elderly suffering from mental illnesses, there is an urgent need to increase the number of nursing homes for the elderly with dementia and other psychiatric illnesses. Currently, Singapore has 60 nursing homes with about 9,300 over beds, and only a few of these are catered to the elderly with psychiatric conditions.
By the same token, I am equally concerned and thus am requesting for MOH to look into setting clear and specific standards and quality of care across our nursing homes, daycare centres and the intermediate- and long-term care sector as a whole.
With a rapidly greying population and a stressful living environment, I would also like to ask the Minister to look at expanding the scope of MediSave usage, be it for inpatient or outpatient care and treatment. The maximum amount of MediSave to be withdrawn with respect to different treatments should also be reviewed with increasing healthcare costs.
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We need to have an integrated approach between different Ministries to take care of the needs of those in this silver tsunami. One example is that with age, there are more orthopaedic conditions requiring the use of MRI scans. MediSave usage is currently allowed only for inpatient MRI, but not outpatient. In the same vein, can MOH look into re-classifying non-standard drugs used for chronic disease management such as diabetes, hypertension, asthma, stroke and so on to standard drugs so that thousands of Singaporeans will benefit. Also, can MOH share, on average, based on all CPF MediSave account holders, how much MediSave monies are left behind after they have passed on?
By the same token, I also hope to hear from the Ministry sharing more on the Seniors Mobility and Enabling Fund to subvention of assistive devices, aids, transportation and consumables?
Ms Lee Li Lian (Punggol East): Madam, I would like to ask the Ministry to look into expanding the scope of outpatient treatment which can be covered by MediSave. Last year, MOH announced an increase in the withdrawal of MediSave for outpatient treatment for approved chronic diseases, raising it to $400 a year. However, the list of approved chronic conditions did not change.
Currently there are 10 approved chronic conditions that one must suffer from in order to be entitled to use MediSave for outpatient treatment. Many elderly suffer from other common ailments, which though not approved chronic conditions, are health problems that are persistent and require continual medication to control or manage.
These health problems may include things like cataract, osteoporosis, or Parkinson's disease, to name a few. Some of these age-related health problems may be controlled or managed with long-term medication, while other problems may require further tests or health screenings in order to detect them. A more flexible use of MediSave would greatly benefit the elderly since many of them may not suffer from an approved chronic condition but have other illnesses that require costly long-term care and constant medical attention.
The cost of healthcare for elderly Singaporeans is a real concern. Many elderly I have spoken to during the course of my Meet-the-People Sessions (MPS) in both Eunos and Punggol East, and also in the course of my recent
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election campaign, tell me that they struggle with high medical costs and wish they could use their MediSave to cover age-related illnesses that are currently not on the approved chronic condition list.
I urge the Minister to consider expanding the scope of treatment as it not just chronic illnesses that are problematic and costly. And our elderly have a peace of mind knowing that they have the ability to cover any illnesses that plague them today.
Mrs Lina Chiam (Non-Constituency Member): Mdm Chairperson, the Minister for Health stated in Parliament on 21 October 2011 that out of the total amount of MediSave withdrawn for healthcare expenses for the elderly in 2010, about 45% was from their children's MediSave accounts. We cannot keep expecting those with insufficient MediSave to ask their children or family members to top up from their own MediSave accounts. This is not a sustainable plan. What if they require money in their own MediSave accounts when they themselves are old and sick? Are they expected to withdraw from their own children's MediSave account? This is simply kicking the can down the road. This will have the effect of deepening inequality. It will also aggravate the plight of lower income families.
Similarly for MediShield, the Ministry urges children to apply for MediShield coverage on behalf of their elderly parents. It expects all children with elderly parents to be able to pay such premiums.
Late last year, the Ministry noted that 35% elderly Singaporeans aged 76 to 85 are not issued under MediShield. That figure for the general population is 8%. Current payouts from ElderShield are insufficient. What happens when the bills of some patients are twice the amount, as is sometimes the case?
The 3M accounts for less than 10% of total healthcare expenditure which itself is currently at 1.6% of GDP. At last year's Budget, the Minister for Finance said that he would increase that figure to 3.5% GDP by 2030. Let us not wait that long. Other countries and economies in the region like South Korea, Taiwan and Hong Kong have already achieved this level of healthcare spending at 3% to 4% of GDP some years ago.
Prof Phua Kai Hong, an academic on healthcare policy, has characterised the standard of Singapore's long-term care as third world. If I may ask the
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Minister, what is holding us back from spending a little more of our GDP on healthcare?
The Minister for Health (Mr Gan Kim Yong): Mdm Chairperson, I would like to thank Members for their comments and their questions. As Mr Sitoh Yih Pin and Mr Cedric Foo have reminded us – 10 years ago, Singapore faced our first major health crisis as an independent nation when SARS broke out in March 2003. The outbreak dealt a significant blow to our economy and severely affected our community and our social life. Singaporeans rallied together during this trying time and emerged stronger from the experience.
Madam, with your permission, I would like to share a video clip with the House on SARS [A video clip was shown to hon Members]. Madam, we will be holding a series of commemorative events later in the year.
Mr Cedric Foo asked about the Courage Fund. We will also be reviewing the use of Courage Fund to make it more effective in helping our healthcare workers. I would like to take this opportunity to pay tribute and to recognise the contributions and sacrifices of everyone who was involved, in particular, my colleagues in the healthcare sector, some of whom fell ill and some who lost their lives as they cared for their patients. We will and we must remember them.
Madam, over the years, our healthcare system has grown from strength to strength, achieving good outcomes and delivering good care for our people. The global Burden of Disease Study 2010 ranked Singaporean men and women as having the second and fourth highest healthy life expectancy at birth in the world. We were also very happy to find out last year that Bloomberg ranked Singapore as the world's healthiest country. Premature deaths from cancer, heart disease and stroke have also steadily fallen over the years. However, it is not time to celebrate yet as there remain key challenges ahead of us, which my colleagues and I will be talking about.
Our National Health Expenditure in 2011 amounted to 4% of GDP. It is lower than the OECD's average of 9.5% but we must bear in mind that several OECD countries have older populations than we do, and our expenditure on healthcare is likely to grow as our population ages. Ageing will be a key driver of demand for healthcare services. An older population means a higher incidence of admission to hospitals and, for each admission, a longer stay. Lifestyle changes are another driver. Many of us have sedentary lifestyles and do not exercise enough. More young people are taking up smoking and becoming obese. Non-communicable diseases, especially cancer, heart disease
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and stroke, account for 60% of deaths in Singapore each year. Therefore, I agree with Mr Laurence Lien that we need to do more and be more innovative to keep Singaporeans healthy.
Last year, I announced my Ministry's Healthcare 2020 Master plan to build an inclusive healthcare system for the future – one that will provide Singaporeans with affordable, effective and good quality healthcare. Dr Lam Pin Min asked about the progress of Healthcare 2020.
First, on capacity to meet the needs of our patients. Over the past five years, resident bed days rose by about 4% each year from roughly 1.5 million to 1.8 million bed days in total. A significant proportion of this increase was contributed by an ageing population. Over the years, foreign visitors have remained at about 2% of the public sector's total patient load – a question that Mr Low asked. Our hospitals adopt various strategies to actively manage the increasing patient load. For instance, they deploy inpatient medical teams to the emergency department to ensure that prompt medical assessment and definitive care can be provided at the emergency department (ED) even before patients are warded.
In the short term, we will increase our capacity by adding beds in existing facilities. NUH current renovation project will make available an additional 79 beds by December. Ang Mo Kio Thye Hua Kwan Community Hospital has just added 50 beds and St Luke's will add a similar number by year end.
We will also be opening two new facilities this year. The new medical centre at the NUH will open by July 2013. This will allow NUH to expand its specialist outpatient clinics and day surgery operating theatres. The building will also house the National University Cancer Institute. The new National Heart Centre, on the other hand, will allow for expansion in our cardiac services. We are on track with our infrastructure plans for the medium term. The Ng Teng Fong General Hospital will begin to serve patients from end-2014. Let me show you how the hospital looks like [A video clip was shown to hon Members].
Madam, I wish I could build the hospital as fast as the video shows. This is our next upcoming acute hospital. Jurong and Yishun Community Hospitals will be ready by end-2015. Sengkang General and Community Hospitals are scheduled for completion by 2018. In the central region, Outram Community Hospital will be ready by 2020. Altogether, we will add 4,100 more acute and community hospital beds. This is 400 more than what we announced in
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Healthcare 2020.
Dr Lily Neo talked about planning for our future healthcare needs. Beyond 2020, we are planning for new hospitals in new population centres and in areas where demand is likely to grow. We anticipate that we may need to build four more new acute hospitals between 2020 and 2030. We currently studying regional demographic profiles to identify potential locations for these new hospitals, and we will review our infrastructure plans nearer 2020.
Madam, we are also improving our delivery of primary care to Singaporeans which Dr Lam Pin Min asked about. As more Singaporeans develop chronic diseases, a good GP in the neighbourhood, who is familiar with our family's medical history, will be well placed to advise us on how to manage our health. This is also a point raised by Mr Lien. We have taken steps to make primary care more accessible and affordable for patients. We introduced CHAS to help lower- to middle-income patients receive subsidised treatments at GP clinics as well as for dental care, which Mr Patrick Tay asked about.
Last year, we enhanced CHAS significantly. More Singaporeans have benefited as a result. The number of CHAS cardholders has grown from 35,000 to about 250,000 since we made these changes – more than a seven-fold increase. We will monitor the scheme for a while more before reviewing it again, but I note Dr Lam's appeal to review the age criteria. Participating GPs can already refer CHAS patients to public sector's specialist outpatient clinics at subsidised rates, as Ms Tin Pei Ling and Mr Low Thia Khiang had asked about. They do not need to visit a polyclinic anymore as long as they are a CHAS patient.
During the Budget debate, Dr Fatimah Lateef asked about progress on community health centres (CHCs) and the family medicine centres (FMCs). There is growing support from the GP community for the idea of CHCs which provide allied health and other support services to GPs and patients. To provide more patients with convenient access to such support services, we will be setting up three more CHCs this year, in addition to Tampines. The next CHC will be opened in mid-2013 in the Bedok area while centres in Jurong East and Tiong Bahru will open by year end.
We will pilot four family medicine clinics (FMCs) this year. This is a group practice managed by private GPs in collaboration with other healthcare professionals with the support of ancillary services. Here, patients will be looked after by a regular care team and receive comprehensive care. Our first four
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FMCs in Clementi, Lakeside, Ang Mo Kio and Bedok will come on-stream later this year. We will continue to work with GPs to explore different models that will best suit their needs and those of their patients.
We will also need to build more polyclinic capacity to meet the growing needs of our population. We have refurbished Geylang polyclinic to increase its capacity and incorporate age-friendly features such as barrier-free access throughout its premises. Similar improvements are being made to Tampines polyclinic, and we will also be redeveloping Ang Mo Kio and Bedok polyclinics.
In regions where there may be gaps in coverage, building a new polyclinic will be necessary. I am happy to let Mr Cedric Foo know that we will be constructing a new polyclinic in the Jurong West area near Pioneer. This new polyclinic, along with the new Punggol polyclinic, which Miss Penny Low asked about, will open by 2017.
I anticipate that we will need another four new polyclinics by 2020 and another six to eight more polyclinics by 2030. All our polyclinics are equipped to handle basic emergencies, a point which Dr Teo Ho Pin raised. However, for serious emergencies, patients will be triaged and referred to the emergency departments of our public hospitals.
Polyclinics continue to play an important role in our primary care sector. Our polyclinics, together with a wide network of GPs and CHAS, provide the public with good access to primary healthcare services.
Mr Low Thia Khiang asked for an update on the Regional Health Systems (RHS). Developing the RHS is an ongoing effort. I can share with Members the example of the Eastern Health Alliance, which Mr Low mentioned. It is collaborating with HPB on the Eastern Community Health Outreach (ECHO) programme. This combines community-based screening with appropriate follow-up care, as well as lifestyle advice such as diet plans and workshops to help patients control their chronic conditions, such as diabetes and high blood pressure.
Strong and lasting RHS partnerships will take time to build. One of the lessons that we have learned from this Eastern Health Alliance is that trust and understanding among providers from the various sectors – public, private, as well as the community sector – are critical to forge strong partnership and
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deliver coordinated, holistic care to our patients. While each region has its own unique needs, and will therefore develop quite differently, I am confident that we can share lessons from our experience in Eastern Health Alliance, and forge strong partnerships in these other regions as well.
Mr Low also asked about the progress of the National Electronic Health Records (NEHR). This is a multi-year, long-term project, which aims to facilitate information flow to improve care delivery. The system has been rolled out to almost 5,000 clinical users in the public healthcare sector, including eight hospitals, six specialty centres, and all our polyclinics. Access to NEHR has also been provided to the Agency for Integrated Care (AIC), some GPs and long-term care providers, with more nursing homes to follow.
To help our healthcare providers understand how to use the system, our teams conduct on-site training, and provide comprehensive information packages to all clinical users. Providers can share information such as patient diagnosis, lab results, medications, and discharge summaries. We will next work towards enriching the system's functionalities, including case management and shared care plans. With information shared across providers, we will have a system that is better connected, better coordinated, and better able to provide good care to each and every patient.
Let me update the House on our progress on initiatives under the Ministerial Committee on Ageing to take care of our seniors. We have moved decisively to enhance the access and affordability of aged care. Last year, we announced that the Government will invest $500 million to build 10 new nursing homes, 39 senior care centres, and 56 seniors' activity centres by 2016.
Some of the new capacity is already on stream. This year, three existing nursing home providers will begin their operations at their new sites. Bright Hill Evergreen and Singapore Christian Home are slated to start within the first quarter of FY2013, followed by Villa Francis. By the end of 2013, we will add more than 500 new beds to our nursing home capacity. Three senior care centres providing day rehab and day care will also open this year.
We have raised the subsidies for community hospitals, nursing homes, centre-based care, and home care last year. Let me also clarify a point raised by Mr Gerald Giam. We have simplified the means-testing process and criteria in the intermediate and long-term care (ILTC) sector to reduce hassle to patients and their families. They only need to give consent for us to access their CPF or IRAS data to carry out the means-testing, as Mr Giam suggested in his speech.
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In fact, we are already doing so. This has been implemented, in fact, since last year.
One beneficiary of our subsidy enhancements was Mr Tan Cheng Lim, who needed rehabilitation for his spinal cord injury. Mr Tan also has other chronic conditions, including high blood pressure. With the changes to our subsidies, Mr Tan now receives an 80% subsidy, as compared to 50% previously, at St Andrew's Community Hospital's Day Rehabilitation Centre. Mr Tan is happy to have his total healthcare bill reduced.
This year, we will pay greater attention on two areas. First, enhancing the quality of aged care. We have started workgroups comprising service providers as well as relevant agencies to look at care standards in nursing homes and centre-based care. The nursing home workgroup has proposed a new set of guidelines and standards, and we will be launching an industry consultation on this shortly. Dr Amy Khor will provide more details later.
Second, we will enhance the access and affordability of services to help the elderly to be cared for in their own homes and in the community. We are making significant efforts to expand home nursing, home medical and en suite home personal care services. MOH will convene an industry-led committee comprising professionals and home care providers to develop the home care sector, to chart new directions, new strategies, and set new standards to develop the home care sector so that home care can provide a viable alternative to nursing homes.
To make care more affordable, the Deputy Prime Minister has announced that the Seniors' Mobility and Enabling Fund will be expanded from $10 million to $50 million to subsidise more devices and consumables needed by frail seniors. We will also provide transport subsidies to a wider population of wheelchair ambulant seniors who need to travel to day centres to receive care. Dr Amy Khor will provide more details on this in her speech.
Mdm Chairman, seniors who need care often have complex care needs spanning social, medical and sometimes financial needs. In order to provide more holistic and person-centred care to our seniors, we will merge the aged care functions of the Centre for Enabled Living with those of AIC, under one roof at AIC.
Let me now move on to talk about how we are developing our healthcare workforce. In the past year, our healthcare professional workforce grew by 3,700,
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or about 8%. We are on track to growing our professional workforce to meet the healthcare needs of our population, as outlined in Healthcare 2020. Our priority continues to be to grow our local healthcare manpower supply.
We will continue to invest in the training of our healthcare professionals. In addition to classroom training within educational institutions, healthcare professionals also undergo supervised training in the public healthcare institutions. MOH will provide an additional $50 million to our institutions in FY2013, to enhance their capacity to deliver good quality clinical training, in view of the increasing number of students.
We also aim to raise the attractiveness of careers in healthcare. Last year, we increased the salaries for all healthcare staff in both the public and VWO long-term care sectors. This includes specialists, which Mr Low Thia Khiang asked about. The salaries of our specialists take into account their contributions in all areas – patient care, education, research and leadership. Their skills are especially valuable in our public hospitals where patients are cared for by a team. We need experienced specialists to supervise and lead the team and ensure that we deliver good quality care. We allow our specialists to see private patients – but within certain guidelines – as this helps to retain them within the public sector. We will be introducing a new remuneration framework in 2014 and we intend to pool part of the professional fees, a point that was made by Mr Low.
MOH has also started a campaign to increase the awareness of the diverse and fulfilling work that nurses and allied health professionals do, to attract more Singaporeans to join healthcare. With Mdm Chairman's permission, I would like to show a snippet of our nursing campaign, which by the way is a real story [A video clip was shown to hon Members]. This is just one of the campaigns that we will be running, to raise awareness of the work that nurses do and their contribution to our society.
Beyond our local training pipelines, we will continue to supplement our healthcare workforce with overseas-trained professionals, especially overseas-trained Singaporeans. The pre-employment grant for Singaporean medical and dental students studying overseas has proven to be successful, with 189 grants given out since 2010.
Foreign healthcare workers also help us meet our healthcare service needs, add diversity to the sector and help develop our capabilities in various clinical specialities. Public healthcare institutions have put in place various initiatives to
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help them adapt to our practices and working environment, so that they can be effective members of our teams in serving our patients.
Mdm Chairman, I have outlined MOH's efforts to ensure that our healthcare system provides for the care needs of Singaporeans. But better healthcare is only part of our strategy. More importantly, we should all aim to achieve better health by living healthily. Ageing need not be a burden if we stay healthy. Instead, ageing can be fulfilling and meaningful. If we stay healthy as we age, we can continue to live good quality lives and contribute positively to society and family.
Each of us is responsible for our own health. The first thing we need to tackle is our own behaviour. I agree with Dr Lam that we should start as early as possible, targeting at our youth and young adults, so that healthy habits are inculcated early in life. Let me outline two key ideas.
MOH and HPB are looking into introducing a set of food advertising guidelines for children. There is growing evidence that advertising affects children's food choices and dietary habits. As such, we will strengthen the standards for advertising to children and for food and drink products which are high in fat, sugar or salt.
We conducted a broad-based consultation process on this issue last year. Responses from the public were overwhelmingly supportive for restrictions on food advertising to children to be introduced. MOH and HPB, together with the Advertising Standards Authority of Singapore, an Advisory Council to the Consumer Association of Singapore (CASE), will jointly work out the details for implementation, to be announced later.
Today, our smoking prevalence is relatively low, at 14.3%, compared to about 20% in New Zealand, 21% in the UK, and even higher in some developed countries. But it is on the rise, especially among our young adults. Smoking prevalence among young adults aged 18 to 29 years has risen at a faster pace than that of the general population – from 12.3% in 2004, to 16.3% in 2010.
An effective way of discouraging individuals from smoking or picking up smoking is through a ban on point-of-sale display. This means that when you go to the retail shops, they will not have these products on display. Customers will have to ask for tobacco products specifically. Vendors can store these products in areas that are not visible to the public, such as in closed drawers. In the coming months, MOH will seek the views of the public on the point-of-sale
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display ban.
Finally, let me share with the House our broader vision for healthy living. We aim to catalyse a whole-of-Singapore effort, in which healthy living becomes a shared vision.
To lead this effort, we have formed a Healthy Living Master Plan Taskforce, chaired by Parliamentary Secretary Assoc Prof Muhammad Faishal Ibrahim. This Taskforce will develop a plan on how we can change our current landscape to encourage healthier living. But such change must come from within. We want this plan to be created and owned by the people, and to enable Singaporeans to make decisions for themselves that favour healthier living. The Taskforce has done a lot of preliminary work and developed a 3P approach: Place, People, and Price, and it will consult extensively before finalising its recommendations. Assoc Prof Faishal will elaborate on this later.
Mdm Chairman, I have outlined the progress on the Healthcare 2020 Masterplan. We are on track to enhancing access to healthcare services. We are also making good headway in building up our capabilities to provide these vital services. I have laid out our vision for a healthier Singapore – one in which individuals, organisations, and the community must work together to change the way we think about health. The conversation on healthy living must go beyond the boundaries of the healthcare sector. We need a whole-of-Singapore approach in order to keep Singaporeans healthy and give them greater peace of mind.
Dr Chia Shi-Lu (Tanjong Pagar): Mdm Chair, inpatient hospital expenses are reasonably covered by the 3Ms framework. But I am going to focus this cut on out-of-pocket expenses for outpatient care. Many Singaporeans are still concerned about these expenses, despite the heavy subsidies already provided for primary and specialist outpatient care by the Government.
The Chronic Disease Management Programme (CDMP) has indeed improved affordability for patients with chronic conditions, covering many conditions such as diabetes, hypertension, stroke and major depression. CHAS, which has been alluded to by many Members in this House and by the Minister, also helps Singaporeans who wish to remain under private care with their
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family doctors, to still enjoy healthcare subsidies from the Government, and also to be able to be referred for subsidised care in Government's restructured hospitals.
I would like to renew my call along with that of many Members of this House that MOH continues to consider the liberalisation on the use of MediSave for outpatient care, whether for existing schemes such as CDMP and CHAS mentioned earlier, or for intermediate and long-term care, and perhaps for new segments, such as paediatrics, cardiological and cancer specialist care. These medical services, typically provided by specialists in hospital-based specialist clinics, require frequent and sometimes costly investigations, and often involve medications and treatments that are long-term and may be expensive. By further extending the use of MediSave, we can encourage better patient compliance with respect to management of these diseases, thereby improving outcomes and reducing chronicity and disability.
I call upon MOH to review the sacred cow of MediSave adequacy calculations. It may not be prudent to accumulate too much in MediSave, as the power of MediSave to buffer healthcare costs is limited and it should primarily be considered as a supplemental source of healthcare financing in the short-to-middle term, rather than to prepare for expenditures eight to 10 years away, or beyond. This \"sinking fund\" concept works better for insurance schemes with preloading considerations, but less well for what is essentially a savings scheme which, in real terms, functions mainly to cover smaller costs in the near term of three to five years. I also hope that MOH can explore health insurance schemes for outpatient care.
I also call for MOH to consider calibrating subsidies to inflation, across the entire healthcare delivery chain. Such an inflation peg would help cushion Government-subsidised patients from inflationary pressures. And my final point is to renew the call —
The Chairman: Your time is up, Dr Chia. Assoc Prof Fatimah Lateef is not here. Mr Muhamad Faisal Manap.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Madam, there are currently two types of ambulance services in Singapore – the Emergency Ambulance Service (EAS) operated by SCDF and the non-emergency
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The non-emergency ambulances provide services such as ferrying patients to and fro hospitals, polyclinics and medical centres for their checks, scheduled appointments and follow-ups. The non-emergency ambulance service cost a family between $60 and $120 for a one-way trip; for a two-way trip, the cost of basic transport services is between $70 and $180. Additional surcharges will be imposed in the event that additional medical attention is required.
Madam, I would like to highlight a family of three that I came across recently. The sole breadwinner was previously employed and earns about $1,500 a month. However, due to his wife's medical condition, he left his job to take care of his wife, who is wheelchair-bound and has multiple medical conditions. Her condition requires her to frequent the hospital for her check-up. In order to ensure smooth and safe transfer to and from the hospital, a private ambulance is engaged. I subsequently wrote an appeal letter to AIC but I was informed that there are currently no subsidies in place for families who engage the private ambulance.
For this family and many other families who have to use this service on a regular basis, the cost of hiring a private ambulance constitutes the financial burden for them. As such, I urge the Ministry to introduce a non-emergency ambulance subsidy scheme for families with a monthly household income of $1,700 and below, or per capita income of $550.
Ms Tin Pei Ling: Mdm Chair, to many Singaporeans, MediSave is a compulsory savings account to cater specifically to their healthcare needs. They see their MediSave as their hard-earned money and they feel they have the right to use it as and when they need it. Such thinking is understandable.
Madam, the principle behind imposing criteria such as annual withdrawal cap and minimum sum requirement on MediSave is to ensure we set aside enough savings to meet our future healthcare expenses. However, for senior citizens, especially retirees who no longer have an income, they have limited means and they will look to their MediSave to pay for their healthcare needs.
So, firstly, can the Ministry allow greater flexibility in the use of MediSave with a higher annual cap and lower minimum sum? Can the Ministry extend the coverage of MediSave to more areas? For instance, can we have a definition by
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exclusion? For example, MediSave can be used for all medical needs except aesthetic medicine.
When I raised a cut on the use of MediSave for senior citizens in last year's COS debate, it was suggested that if MediSave and MediShield cannot be tapped on, or tapped on further, the elderly can turn to MediFund. However, some elderly feel extremely uncomfortable with having to apply for MediFund, especially if there is still money in their own MediSave account, but which they are unable to use. They also fear they will have to incur out-of-pocket expenses if they fail to secure financial assistance.
Furthermore, there is an administrative fee chargeable on MediSave deduction transactions. While the fee may appear modest, it can add up to quite a sum if a senior has to go for several medical appointments or treatments and thereby, has to make several MediSave deduction transactions. With each fee payment therefore, it means that a senior will have even less money in his or her MediSave to pay for subsequent treatments. This is as a result of their admin fee charged. This will adversely affect Singaporeans who are needy and without family support, and particularly our elderly.
Moreover, with the advancement of technology, better process design and economies of scale achieved, would there not be cost savings gained over the past years? Therefore, can the Ministry waive off the administrative fee for MediSave transactions so that Singaporeans' hard earned money can be fully utilised for their healthcare needs?
Mr Yeo Guat Kwang (Ang Mo Kio) (In Mandarin): [Please refer to Vernacular Speech.] It is best to stay healthy; falling sick is no fun. Chronic illness will take an even higher toll on the patients. I would like to ask MOH about its plans and efforts to support Singaporeans who are chronically ill patients, particularly those who need expensive and long-term care. I am concerned especially with those suffering from kidney failure and needing dialysis. Is the Ministry doing enough to support them and the organisations that help them live a better quality of life?
Take kidney failure, for example, I understand that about 750 people are diagnosed with end-stage kidney failure every year and this figure is rising. In Singapore, NKF is the biggest and only provider of dialysis treatment in Singapore and cares for about 60% of the kidney failure patients. The increased
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demand means organisations such as NKF are struggling to build enough centres and are facing cost pressures associated with caring for their patients. How would the organisation invest in building its capacity to meet the increasing demand? I would also like to ask the Ministry about the current demand for dialysis and how many private service providers are starting up? What is the ratio of this private-to-public supply of dialysis? The Government must step up its effort in providing citizens with such services.
Currently, breakdown of dialysis funding for an average patient is that NKF foots 40% of the cost, paid for by donor contributions. Insurance or MediShield makes up about 38%, employers pay 2% and the patient pays about 8% of the bill. Government assistance comes up to about 9%. Can the Government look into reviewing its quantum of assistance for NKF and other VWO dialysis organisations? If organisations such as NKF fail, the consequences would be dire.
In the USA, the support is more comprehensive with concerted efforts from the Government, insurance companies, the community and dialysis centres.
With an ageing population, I hope the Government will go more into preventive healthcare and provide more support to Singaporeans who are chronically ill.
The Senior Minister of State, Prime Minister's Office (Mr Heng Chee How): The health of the population has a direct impact on that population's spirit, morale and strength, therefore, its ability to have a better future. With a rapidly ageing population in Singapore, the upkeep of our health, individually and for the entire population, is even more important. Hence, I fully support the Health Minister's two-pronged approach, both to look after the healthcare cost as well as to promote health.
I believe that the two need not be done in a separate or silo manner, but could be integrated. So, if you take the case of the ElderShield for example, as it is currently structured, it is a straight bet. That is at age 40, you enter ElderShield. At any subsequent point, if you are unable to perform, say three or more activities of daily living, that is beyond a certain level of disability, there is a cash payout for an X number of months according to the policy.
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I feel that it is not only about how much money it is being paid out under the policy. I think we can do more to use such kinds of insurance programmes to motivate the current kind of behaviours towards healthy living and active ageing. For example, I hear that in some other developed countries, such as in the US, places like Kaiser Permanente for example, they have programmes which integrate the wellness practices and participation in wellness programmes of insured persons together with the insurance programmes. In this way, through premium differentiation for example, they motivate the right kinds of behaviour amongst more of the insured, and there are other examples. I believe this is one area in which the eldercare programme could be reviewed.
Secondly, when the money is paid out upon the claim, there is no question of how the money is being spent. In other words, it is not necessarily spent on better eldercare or disability care. I believe that if it is a programme meant for ElderShield – the claim is to do with the elderly and meeting disability requirements – then I think more could be done so that the payout is also used to support better eldercare and disability care.
The Chairman: Dr Chia Shi-Lu, you have two cuts. Please take them together.
Dr Chia Shi-Lu: Mdm Chair, let me begin by saying that I believe ElderShield to be an excellent safety net to maintain the livelihoods of our senior citizens should they have the misfortune to become significantly disabled.
There are concerns about the scheme though. Even with supplemental policies, many have questioned whether ElderShield can adequately support them should they become permanently disabled, particularly since it is unsure whether future payouts will be corrected for inflation. Hence, there are many who have opted out of the system. I hope that MOH can address these concerns and strengthen ElderShield in future reforms, such that it becomes more robust and universal, so that it will achieve its stated aims as a social insurance policy.
In 2007 and 2012, as claims were not as high as feared, rebates were returned to policyholders. I hope that consideration may be given to use future surpluses instead, either to adjust for inflation for future payouts, or to extend the payouts for claimants who only have basic coverage. The basic ElderShield coverage is for 60 months or 72 months, but most disabilities in seniors are
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permanent, and it would not be unreasonable to extend the payout period with these surpluses.
I have constituents who are reaching the end of their ElderShield payout after six years, and they are understandably very concerned. I would like to ask what alternative means of support such claimants can turn to, following the end of the payout period under ElderShield.
For my second cut, I welcome the introduction of MediShield and MediFund Junior for children, as having a severely ill or chronically sick child presents a great emotional and financial burden on the parents. We, as a nation, should provide these families with all the assistance we can.
This issue concerns the treatment of rare childhood diseases, most of which fall under the classification of inborn errors of metabolism, and this has been brought up in this House before. However, I feel it is important to bring this again to the attention of the Ministry. Some of these diseases, such as Pompe's and Gaucher's disease, can be effectively treated by medication, such that the children can grow up to lead normal productive lives. But the treatment is lifelong, and due to the rarity of such conditions, the medications required are prohibitively expensive and may cost several hundred thousand dollars a year.
Presently, these costs are borne to a large extent by the Government and various charitable organisations, and parents contribute what they can. I understand that MediFund Silver can also be used in these situations.
However, parents of these children are understandably concerned about whether these costs will continue to be covered, and I seek assurances from the Minister that we will continue to support the costs of such medications for this small group of patients. These children also typically require other treatments and considerations that incur extra costs to the family, and I hope that the Ministry will take these special needs into consideration and extend the necessary financial assistance.
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Dr Lam Pin Min: Mdm Chair, Singapore's National Childhood Immunisation Programme (NCIP) has been in place for several decades and has been effective in protecting against the targeted diseases. Its schedule has been revised regularly, with the last amendment in 2008. In many ways, vaccination works on the old adage \"Prevention is better than cure\". By protecting children against certain infectious diseases, vaccination can reduce mortality and morbidity of preventable diseases.
Today, NCIP covers over 10 different diseases, but only two, measles and diphtheria, are compulsory. Moreover, some vaccinations are provided free while some, such as Hepatitis, though listed in the national programme, are charged at cost with the option of paying through MediSave.
I would like to seek clarification from the Minister on the following:
(a) How does MOH determine which diseases are compulsory for vaccination? Should MOH not make more diseases compulsory under the NCIP to offer a better and more comprehensive coverage?
(b) Can the Minister consider including more preventable diseases, such as chickenpox, Hemophilus influenza and human papillomavirus (HPV) in the national immunisation programme?
With higher air, land and sea connectivity and the large influx of immigrants from countries without comprehensive immunisation programme and coverage, the risk of localised outbreaks of infectious diseases is enhanced. How would the Ministry mitigate this risk and prevent the resurgence of infectious diseases, such as tuberculosis (TB) and poliomyelitis?
Mr Gan Kim Yong: Mdm Chair, several Members – Dr Lam Pin Min, Mr Lim Biow Chuan, Ms Jessica Tan, Ms Janice Koh, Mrs Lina Chiam – have raised a concern shared by many Singaporeans and, that is, how to keep healthcare affordable.
How do we help Singaporeans pay for their healthcare costs? Today, we have a financing framework comprising four pillars – subsidies, MediSave, MediShield and MediFund, or what we usually call subsidies and \"3Ms\". In 2002, we introduced ElderShield. Let me now explain briefly how all these work
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together to help our Singaporean patients.
First, Government subsidies. All Singaporeans can enjoy significant subsidies at our public healthcare institutions – up to 80% for inpatient care and 50% for specialist outpatient care, as well as up to 75% in our polyclinics. Let me give an illustration. Take, for example, the median bill size for C Class wards at SGH which is about $4,300 before subsidy. After subsidy, this is brought down to about $1,100.
Patients can then use MediSave to cover up to the full amount of the balance, while MediShield helps Singaporeans cope with the larger bills. With MediShield and MediSave, for eight out of 10 subsidised hospitalisation bills, patients only need to pay $100 or less in cash. Those who still have difficulties after MediShield and MediSave subsidies, can tap on our MediFund. While our framework has served us well, we need to plan forward as our needs change in years to come.
I, therefore, initiated a major review of our financing framework last year. We have also held two sessions of \"Our Singapore Conversation\" and engaged many Singaporeans, including patients, to hear their views. Let me elaborate on four areas of feedback that we have received.
First, Singaporeans are concerned about rising healthcare costs. Today, we spend about 4% of our GDP on healthcare, or about US$1,700 per person. This is similar to what Hong Kong spends. Over time, we can expect National Healthcare Expenditure to continue to rise as our population ages.
So, what drives healthcare costs? First, cost of the same treatment goes up over time due to rising cost of manpower, supplies and so on. This is inflation. Next, as we age and our health deteriorates, we will spend more on healthcare. On average, annual expenditure on hospitalisation, after subsidy, for a 65-year old is three times that of a 45-year old.
The third reason, and a key one, is that healthcare is getting significantly better and more accessible. We have adopted more advanced medical treatments and technologies that achieve better outcomes for patients, and these have become more common than before. However, they are also more costly. For example, 10 years ago, a heart attack patient would have been given an injection to dissolve the clot in the heart arteries. Nowadays, it is standard practice for a similar patient to be treated with ballooning or angioplasty, which improves patient survival rates and long-term outcomes, but at twice the cost
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or more.
A second concern of Singaporeans is with how much out-of-pocket cash they have to pay. Dr Lily Neo and Dr Lam Pin Min have highlighted this. Expenses for outpatient care, including diagnostic tests, such as MRI, ongoing medication and long-term care, can become large cumulatively over time.
Ms Tin Pei Ling, Ms Lee Li Lian and Mr Patrick Tay have asked for more flexibility in the use of MediSave in the outpatient care setting, or for long-term care. Some Singaporeans have asked for more subsidies, especially in these areas, to further reduce their out-of-pocket bills. I will discuss our thinking on these areas later.
A third area of concern arises when we hear stories of Singaporeans who incur exceptionally large healthcare bills and wonder – \"what if this happens to me?\" While such large bills may be rare in the subsidised public institutions, it is natural for us to worry about them. We need to provide Singaporeans with more assurance on this. We will carefully explore how we can provide Singaporeans with greater assurance against very large out-of-pocket payments and we will take into consideration the various suggestions made by Members.
Finally, many Singaporeans have told us that while there are many help schemes, they do not know how to get the help they need. As Ms Tan Su Shan mentioned in the Budget debate, we need better outreach and communication to the public, to reassure Singaporeans that help is available, and that everyone will have access to good healthcare.
I should add that it is not just the elderly who are concerned about the cost of healthcare, but also the sandwiched generation, who are helping to pay for their elderly parents' healthcare and retirement needs, while raising young families. While we want to encourage family support, there are limits to this approach. Mrs Lina Chiam raised this point. We need to calibrate our policies to ensure that reliance on future generations is within reasonable limits.
We also want to help the middle-income with the cost of healthcare, as Mr Vikram Nair suggested in the Budget debate. This is why many of our schemes, such as the CHAS for GP care, the Medication Assistance Fund (MAF) for drugs, and subsidies for long-term care have been extended to the middle-income. We will do more for this group.
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Madam, there is a strong desire among Singaporeans for greater peace of mind – the assurance that I will be able to afford healthcare when my family and I need it, whether now or when I grow old. We take these concerns to heart. We want Singaporeans to be confident that they can always afford the care they need.
Part of this involves managing costs in our system. We work with our hospitals to identify and introduce clinically proven and cost-effective treatments, and provide sound advice to patients on the choice of treatment. This ensures good outcomes for patients, at the most reasonable cost possible. To enhance productivity, we are making strong efforts to upskill our workers, leverage on technology and automation, and redesign jobs and work processes. Right-siting of care is also crucial in keeping our healthcare costs low.
While we manage costs and ensure that we are effective in the way we deliver care, we also need to enable patients to pay for their portion of the cost. The subsidies and 3M framework have served us well so far. But we need to further strengthen this, as the healthcare needs of our population evolve over time. The review of our healthcare financing system will be extensive, and will involve fundamental shifts. Therefore, it will take more than a year to complete. Let me take this opportunity to share some of our initial thinking.
Even as we seek to give Singaporeans greater assurance today, we must not inadvertently create a problem for future generations of Singaporeans. If we get it wrong, we leave a heavy burden of debt for our children and grandchildren. This is why it is important to retain some key principles that have served us well.
The starting point is for every Singaporean to take ownership of his health, to live healthily, seek treatment early and make informed choices in seeking treatment. I was heartened that in our dialogues, including the Our Singapore Conversation (OSC) sessions, participants understood this well.
For this reason, it is important to preserve the principle of co-payment, but we will also have to ensure that co-payment is affordable. With this in mind, let me elaborate on how we intend to shift the balance of the way we pay for healthcare.
The first major shift is to increase Government's share of national spending to provide Singaporeans with greater assurance that care will remain affordable and accessible. Government spending will not only rise in tandem with the
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increase in national healthcare spending. We will, in fact, take on a greater share of national spending, from the current one-third to about 40% and possibly even further, depending on various factors such as demographics and our ability to manage healthcare costs and target our subsidies. This will help to reduce the impact of rising healthcare costs on Singaporeans, especially the lower- and middle-income Singaporeans.
However, how we spend the additional money is also crucial. Today, the bulk of our subsidies go towards hospitals, where the cost per episode is high. As our population ages, delivery of healthcare will increasingly extend beyond hospitals.
Many Singaporeans, including Dr Chia Shi-Lu, have given feedback on the cost of outpatient care. We have enhanced CHAS to make primary care at GP clinics more affordable, and raised subsidies for drugs to help lower- and middle-income patients.
In our review, we will explore how we can provide more financial support in a targeted way for specialist outpatient care, primary care, preventive healthcare, dialysis and long-term care, to reduce the share that patients have to pay.
The second major shift is on MediSave. We have been expanding MediSave use progressively since 2006, to include outpatient treatments for chronic diseases as well as selected vaccinations and screening. Now, Singaporeans can use up to $400 per MediSave account to pay for these each year.
MediSave has been sized primarily to pay for subsidised care in the inpatient setting. As we grow old, we are more likely to require hospitalisation and each hospital stay is longer. If we allow unrestricted use of MediSave, many of our elderly may not have sufficient MediSave for their needs in the future.
But I hear the concerns expressed by several Members and we do exercise flexibility on the ground for cases with exceptional circumstances. I believe if we calibrate carefully and put in place some safeguards, we can allow greater flexibility in the use of MediSave to reduce out-of-pocket costs, without jeopardising our future. We will review MediSave policies to see how to have greater flexibility in the use of MediSave. We raised the cap on use of MediSave for chronic diseases from $300 to $400 last year. Can we raise it further? Should we expand the Chronic Disease Management Programme (CDMP) to include more diseases, as some Members have suggested? Should we allow MediSave
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to be used for outpatient treatments beyond the CDMP? How do we prioritise the different needs, to ensure that MediSave will not be depleted prematurely? How do we ensure that providers focus on necessary and cost-effective treatments, so that each MediSave dollar is well spent? These are issues that need to be addressed in the review.
The Government will continue to provide additional help for the lower-income and the elderly to save more through MediSave top-ups under the Workfare Income Supplement (WIS) and the GST Voucher for MediSave. In the Budget, Deputy Prime Minister Tharman announced higher WIS payouts for lower-income workers and doubled the GST Voucher MediSave payout this year for eligible elderly. In addition, $200 will be provided to all citizens 45 years old and above. We will study what else we can do to help Singaporeans build up their MediSave balances, so that we can allow more MediSave to be used.
The third shift is on the role of insurance. As Dr Chia Shi-Lu mentioned, we need to calibrate the balance between personal savings through MediSave and the role of MediShield by risk pooling.
For us to stretch the health dollar and to give Singaporeans a greater peace of mind, we need to enhance the role of insurance schemes such as MediShield and ElderShield. But we need to do this carefully to guard against over-servicing and over-consumption, both of which will lead to rising costs and higher premiums for us all.
We will study how we can shift the balance towards greater insurance coverage, without driving up demand and consumption, and allow insurance to carry a larger share of healthcare funding. Together with an enhanced Government share I mentioned earlier, this can help to reduce the need for individuals to pay more from MediSave or cash.
We recently enhanced MediShield to include congenital and neonatal conditions and gave each Singaporean baby a hongbao of $3,000 in his own MediSave account. This is a significant step towards making MediShield coverage universal for the younger generation. We will next need to look into how to help the older Singaporeans stay insured under MediShield, a point which Dr Lily Neo raised.
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MediShield is designed to be a catastrophic insurance primarily for larger inpatient bills. As we review how we can strengthen insurance coverage, we will also examine whether it should remain so, or if we can expand it so that it can offset a higher proportion of costs, while keeping premiums affordable. We will also have to address Singaporeans' concerns about exceptionally large bills that go beyond the current cap on MediShield claims.
Let me now turn to address the specific concerns of our elderly today. Budget 2013 will deliver an additional package of one-off MediSave top-ups for the elderly. But in addition to these ad hoc top-ups, we will need to review how best to support the healthcare needs of our elderly, especially the very old today. Many of these are our pioneers and they may not have accumulated enough MediSave by the time they retired. We need to take care of their healthcare needs. And this is a priority area that we will be looking into in the review.
Dr Chia and Mr Heng Chee How raised the issue of ElderShield. As the care needs of our seniors expand and become more complex over time, there is a need to revisit the coverage of ElderShield. We have started the review of ElderShield but rather than to review ElderShield on its own, we really need a more fundamental review of the roles of Government subsidies, insurance and individual share of healthcare costs and how aged care fits into this big picture. We will review ElderShield as part of the overall review of our financing framework.
While we carry out this review which will take some time, we will make a few immediate changes to strengthen our safety nets, to keep healthcare affordable.
First, on MediFund. MediFund plays an important role as a safety net, to help provide peace of mind for both lower-income patients, as well as middle-income patients with larger bills.
We introduced MediFund Silver in 2007 to take care of our needy seniors, and we recently announced the establishment of MediFund Junior to help needy children.
MOF will be topping up the MediFund capital sum by $1 billion. This will increase the annual MediFund assistance by about 20% to $120 million, to help more needy patients with their healthcare bills.
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We will use some of the additional MediFund monies to close existing gaps in MediFund coverage. Mr Patrick Tay expressed concern about the high cost of dental treatment. From 1 April 2013, we will extend MediFund assistance to patients at the National Dental Centre. In addition, Singaporean mothers who face difficulty paying for their antenatal care and delivery can also be assisted by MediFund. By June 2013, we will also extend MediFund to the polyclinics, including dental services there. This will provide some relief for needy patients. We will continue to see how we can make our safety net more effective in giving Singaporeans greater assurance. Dr Chia Shi-Lu mentioned rare diseases. We will also explore how we can help this group.
Next, on cost of drugs. The cost of drugs is also a concern for many Singaporeans. We provide subsidies through the Standard Drugs List (SDL) and the Medication Assistance Fund (MAF) to ensure that drugs are kept affordable for our subsidised patients. From 1 April this year, we will add 17 new drugs onto the SDL and MAF. These drugs include second generation insulin products and insulin penfills, to help lower the cost to diabetic patients. I previously mentioned that Atorvastatin, which is a drug for high cholesterol, was being reviewed. This drug will now be placed on the MAF. A patient who requires this drug to treat chronic high cholesterol can enjoy potential savings of up to $375 a year, and pay just $125 instead of about $500 a year for this drug, depending on his dosage and subsidy level. These enhancements are estimated to cost the Government $5 million per year.
Finally, let me address a topic that many Members have raised over the years, which was also raised by Ms Tin Pei Ling and Dr Lam Pin Min recently, or at this debate. Dr Chia Shi-Lu also asked about this just now. This refers to transaction charges for MediSave claims. This is a fee of about $3 for each MediSave claim that patients make. As I explained last year in a PQ reply to Mr Ong Teng Koon, this charge goes towards the costs of operating the MediSave scheme. However, I understand that this fee may pose a burden on patients, especially the lower income, or those who need to use their MediSave frequently to pay for chronic disease treatment. My Ministry has reviewed this and I am happy to let Members know that with effect from 1 April, MOH will absorb the transaction fees fully.
Madam, let me sum up. Over the years, we have established a healthcare financing system that has served us well. We have made changes to our financing policies and revised them regularly to respond to the needs of our patients and their families.
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Looking ahead, the landscape is shifting rapidly, demographics are changing and there is a need to strengthen our framework, to give Singaporeans better peace of mind. There will be key shifts in Government subsidies and the 3M framework. The review will take more than a year to complete, but I hope to be able to give the House an update and introduce some of the changes by the next COS.
While everyone has to play his part to live a healthy life and to save ahead for his own future needs, the Government will increase its funding share, and put more money in prevention, primary care and aged care. Insurance will be further expanded, to enhance risk-pooling across the population. The MediFund safety net will be strengthened and made more accessible. Ultimately, the purpose of this review is to give Singaporeans better health and greater peace of mind.
The Chairman: Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Mdm Chair, MOH has announced that by 2020, it will be adding 6,600 nursing home beds and tripling the number of rehabilitative care places from the current 2,100 to 6,200. Correspondingly, we will have to increase the number of staff under home healthcare from 4,000 to between 8,000 and 10,000 and under home social care, from 2,000 to 7,500. I would like to request an update on how MOH is achieving these target recruitment numbers.
Currently, many of our elderly care services are running at full capacity and also face manpower shortages. We have been quite reliant on foreign manpower as not many Singaporeans are attracted to the sector due to the challenging working conditions. Can the Ministry provide an update on the Healthcare Professionals Conversion Program which is designed to encourage and facilitate locals to consider a career switch to the healthcare sector?
I also asked last year what are the steps the Ministry is taking to maintain the quality of services under these conditions and prevent cases of abuse. Could MOH provide an update of their efforts to ensure that homes comply with the guidelines on handling patients and safeguard against abuse and lapses of care?
As we build a City for All Ages and encourage aging-in-place, I also request the Ministerial Committee on Aging to provide an update on efforts to promote
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community-based services and ageing-in-place initiatives for seniors. One issue in particular is the monitoring of the elderly who live alone or with other elderly. I hope that efforts will continue to explore effective but yet minimally intrusive ways of monitoring the well-being of these seniors in their homes.
Finally, I welcome the enhancements to the Seniors' Mobility and Enabling Fund because mobility is a critical element for building a City of All Ages. And the Seniors' Mobility Fund has been a great success since its launch. However, many Singaporeans may also look at mobility as not just about devices. Some patients, for example, may require taxis or special vehicles to transport them from their homes to healthcare institutions and back and such transport is costly. I hope that the Mobility Fund can be expanded to help defray these transport costs.
The Chairman: Assoc Prof Fatimah Lateef is not here. Mrs Lina Chiam.
Mrs Lina Chiam: Madam, the labour force participation rate of women is lower than that of men usually because women are expected to be caregivers for the elderly or for the young children. Figures from MOM show that a large percentage of women are not in the workforce. Much more has to be done to recognise their work in financial terms. How else can they retire one day in security if they do not have CPF? We cannot assume they can rely on their spouses as a breadwinner as the current system does. What if they are not married in the first place?
Perhaps hospitals and homes could initiate a programme for nurses and social workers doing part-time and flexi-hours to visit caregivers to offer basic nursing care and training. Retired nurses should be encouraged to come back to join the workforce.
Another plight of caregivers is single parents who do not get the same childcare subsidies like fatherhood benefits and housing benefits. The Government has to adopt a different mindset to accept children born out of wedlock. Every child is a gift from God and should be counted as only to caregivers and their parents, whether single or married so that we can nurture them.
I want to stress the importance of diapers for elderly, particularly important because I believe they are being rationed in nursing homes and they are costly.
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Perhaps the Minister could look into giving more subsidies for this item.
The Public Assistance (PA) scheme is designed for those who are either disabled through illness or with physical disability with no dependents to get support from the Government. Currently, adults on the PA scheme living alone receive $100 a month while those with dependent child receive $50.
Could I ask the Acting Minister for Social and Family Development: how many PA recipients in Singapore currently have a dependent child and whether the cash component for a PA recipient with a child can increase to allow better development for the child, as a growing child would need more money than an adult?
Ms Ellen Lee (Sembawang): Mdm Chair, Singapore has become a very stressful society where people often demand for instantaneous results. This has to a large extent impacted our physical health, personal well-being, family and inter-personal relationships. For people who can cope or are open to seeking help, they can safely claim to be sane, save perhaps for some idiosyncrasies that may raise eyebrows but cannot be called \"insane\". But for people who cannot realise their own abilities or cope with the daily stresses of family, work, neighbours and relationships, they may act strangely and be unkindly labelled as \"insane\"! As they bottle up their anger, frustrations and hurt, they become even more distanced from their family, friends and community.
For many years, counselling has become prevalent in Singapore. However, there are still people who view counselling with suspicion as they think it pries into their privacy. Many people still resist counselling as it is perceived to be for people who have done wrong or who are emotionally or mentally weak.
In some developed countries, mental health and substance abuse go hand-in-hand. They have affected people from all walks of life, intensify personal suffering and interfere with family and life goals.
I would like to ask the Minister if substance abuse is common among the patients who encounter mental health issues. What more can the Ministry do to promote mental wellness and what are the plans the Ministry has to encourage Singaporeans not to stigmatise or discriminate against victims of mental wellness and their caregivers or family members?
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Ms Tin Pei Ling: Mdm Chair, over the past year, the MOH has put in commendable efforts on the front of mental health. However, I urge the MOH to continue paying attention to this area. There are four points that I would like to raise.
First, on capacity for public mental healthcare sector. The Institute of Mental Health (IMH) is the authority in the mental health sector in Singapore. Many look to the IMH when encountering mental health issues. It is commendable that there are satellite wellness centres, which are under the purview of IMH, in some neighbourhoods, and there are also community health teams that go into the community to assess and provide support to those with mental health. However, more can be done.
Firstly, there are those who suffer from moderate to severe mental health problems. They may not be violent but do require constant attention and care. They may also not have caregivers or their caregivers are no longer able to provide care. The IMH is currently operating at near full capacity. Hence, would the MOH consider increasing bed space at IMH or setting up more homes that can permanently care for those suffering from serious mental illnesses or whose families can no longer care for them?
Second, there are those who exhibit certain anti-social behaviours but who are not violent, which is typically the barometer for the Police to intervene. However, they do not seek treatment either because they have no insight to their conditions or they fear being stigmatised. Those who were once IMH patients or with family members who can persuade them to get help and treatment are more likely to get help with their conditions. However, there are also cases not known to IMH and without family or friends available or willing to approach them. In such cases, what other levers do the MOH have in getting them to seek treatment?
Third, can the MOH consider a mechanism to ensure that people who have mental health issues but not yet known to IMH will be treated? For example, having a community health assessment officer to conduct preliminary assessment at the person's residence and then make the necessary recommendations to the IMH. If the person is assessed to suffer from moderate
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to severe mental illnesses, the person is required to seek treatment.
This may sound intrusive, but the main aim, really, is to make sure that those who have mental health issues can receive help and treatment and recover as soon as possible. This will no doubt enable the well-being of the individuals and those who are around them in the family or community.
Clearly, what I have just shared will require more space and manpower and, hence, will the MOH look into increasing the capacity and capabilities in the public mental healthcare sector?
Perhaps MOH can also leverage on NGOs or VWOs more to achieve better outcomes. For instance, can MOH work with and give funding support to these organisations to outreach to the community and do early detection work? Currently, I know that organisations such as the Silver Ribbon Singapore are often tapped on by Government agencies to visit, befriend and conduct preliminary assessment – more in terms of detection work and not intervention – of residents who are suspected to require mental healthcare. Can more be done to support such organisations which play a complementary role within the public mental healthcare sector?
The second area is to give more support for caregivers. We should give more support to them. They play the main role in caring for those with mental health issues. They also play a role in helping those with mental health issues to rehabilitate and integrate well into the community.
MOH has set up a fund for caregiver training. This is useful, but apart from equipping them with the needed skills and knowledge, their welfare is also important. As caregivers, they make many sacrifices – in terms of jobs, which impact their financial capability, and personal time, which, in turn, impacts their own personal well-being. Thus, could the MOH consider providing more financial support? For instance, for those who need foreign domestic helper, can the levy be reduced further?
Could more respite care services be provided so that caregivers can catch a breather while comforted in the knowledge that their care recipients will continue to be well cared for? Caregivers are often assumed to be strong and resilient and I believe they are. However, they, too, need to catch a breather at times to refresh, recharge and then soldier on.
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The third area is to combat stigma. Public and self-stigma hinder early detection and intervention of mental illnesses. Public stigma makes fund-raising to help those with mental health problems more difficult, and makes it much harder to find meaningful employment for those with low or moderate mental health issues. The latter could have been due to misconceptions and scary portrayal of people with mental illnesses portrayed in the media.
Following my call on the Government during last year's COS debate to do more in combating stigma, can the Ministry provide an update on what has been done to address this issue?
Would the Ministry also consider:
(a) working with the mass media to provide a more objective and balanced coverage of mental illness by avoiding linking crimes or \"bad\" behaviours to mental illness and instead, highlighting and celebrating inspiring models, such as successful individuals who have overcome mental illnesses or showcasing great works by famous persons known to have mental illness, for instance, Sylvia Plath, Van Gogh, Isaac Newton, Beethoven, Abraham Lincoln and John Nash.
(b) organising a national campaign to promote deeper understanding of the range of mental illnesses – from depression, eating disorders, sleep disorders, general anxiety disorders (GADs), personality disorders, bipolar, OCD and psychosis – and to re-image mental illnesses as being no different from any other illnesses any person may have at some point in life.
(c) working with and give financial support to NGOs in destigmatising efforts. These organisations can help share the agencies' load in mental health efforts and destigmatising mental health ought to be a national effort in a society aspiring to be inclusive.
The fourth area is enabling confidence and meaningful employment. I applaud the launch of the handbook for employers and employees, which aims to help raise awareness and promote greater understanding amongst employers and colleagues of those with mental health issues. This is a good initiative and definitely a step forward in the right direction.
However, the readiness of employers to hire or continue to hire those with mental health issues needs to be addressed too. For instance, I have heard of some employees not daring to present MCs issued by the IMH, or to inform
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bosses that they need to go to IMH for appointments and, hence, have to take no-pay leave or miss the appointments altogether.
One reason for such behaviours could be due to the stigma and inaccurate stereotypes of those with mental health issues. Unfortunately, the more people try to shun stigma and do the \"normal\" thing, the more it reinforces stigma. Hence, efforts to combat stigma need to continue and be reinforced.
I believe that giving help to those with mental health needs is an important signal of our priority and governing philosophy. Singaporeans with mental health issues need help but are not in a position to advocate for themselves. In many cases, giving more help might improve their lives and will not generate immediate tangible returns to the society. But in adding this as a focus area, we are sending an important message that we, as a people, believe in carrying everyone together with us, even those who cannot ask for help, and that we help not for gains but to share, as a society, the burdens of those less fortunate. It shows that Singapore is a nation with a strong, pulsating heart.
Ms Ellen Lee: Mdm Chair, MOH has consistently been promoting health screening for women. At ground level, I have led a few organisations, including the HPB and the Singapore Cancer Society, to hold at least eight roadshows called \"Celebrate Wellness\" since 2010 till now to promote healthy lifestyle and wellness in general and breast screening for women aged 50 to 69 years old, in particular.
However, despite sending personal invitations to eligible women who need to pay only $25 for a mammogram and another $25 for follow-up screening two years later, the response was disappointing. It seems to me that it may not be an affordability issue but other root causes that have still eluded us.
I wonder if a holistic whole-life approach to women's health is to be preferred than a disease, specific intervention approach. Perhaps, it is not affordability of the tests but the changing of health behaviour, lifestyle, addressing risk factors, although the presence of risk factors does not mean the happening of the risk. Would it be more effective or efficient to focus on vulnerable groups, such as those from lower income or low educational level?
Can the Minister please share with us the success rate of the screening at national level? Are there new plans in relation to women's health screening
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programmes? Are there new preventive measures targeted at women?
The Minister of State for Health (Dr Amy Khor Lean Suan): Madam, I will first address Members' questions on ageing and mental health before updating Members on the issue of women's health.
Let me start with ageing. Our population is ageing rapidly. We need to make sure that Singapore is ready to support our ageing population in every way. Our goal is simple: for our seniors to live happy and fulfilling lives, and to age gracefully.
Last year, the Government introduced a suite of initiatives to make Singapore \"ageing ready\". We raised the subsidies for intermediate and long term care (ILTC) substantially; and we announced that we will build more than 100 aged care facilities over the next five years to meet both the social and healthcare needs of our seniors.
To support the expanding aged care sector, we project a need to increase manpower from 4,000 in 2010 to 15,000 in 2020. Dr Chia Shi-Lu asked about our manpower efforts. Last year, we provided additional funding to support the sector to raise salaries and to enhance staffing ratios.
With these initiatives, we grew the workforce in the aged care sector by about 30% over the last two years to about 5,600 in 2012. As mentioned by Deputy Prime Minister and Minister for Finance in his Budget Speech, even as we expand our local supply of healthcare manpower, we will still need a significant pool of foreign healthcare staff. We will, therefore, continue to ensure flexibility in terms of our foreign worker policy so that healthcare institutions are able to fulfil their staffing needs.
Separately, Dr Chia also asked for an update on the Healthcare Professional Conversion Programme. In 2012, we enhanced training allowances to encourage mid-career professionals to make the switch to nursing and allied health professions under WDA's Healthcare Professional Conversion and Place-and-Train Programmes. This has led to an increase in enrolment from about 30 in 2011 to more than 50 this year.
This year, we will place emphasis in two more areas: one, enhancing the quality of aged care; and, two, developing more options for seniors to be cared for at home and in the community. Let me start with enhancing the quality of
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care, an issue raised by Dr Chia.
First, we want to remake our nursing homes. We are actively engaging Singaporeans and tapping on the creativity of architects to build nursing homes that are not just clinical care facilities, but welcoming, serene and modern homes for our seniors to recuperate.
For the new nursing homes that we are planning, we give careful thought to the design to make them aesthetically pleasing yet functional. An example is the future nursing home in Jurong East. Instead of a squarish residential block, the architect \"breaks up\" the massing to create a more interesting form. Green balconies are injected in between the towers, making the whole development more visually pleasing to the surrounding community. This will not look out of place within a residential area.
Another example is the new Lions Home in Bishan East. As you can see, lush greenery features prominently to enhance natural cooling and to be aesthetically pleasing. From the outside, the effect is one of a waterfall of greenery. On the inside, there is also a garden and communal spaces on the ground floor where people living in the surrounding estate can enjoy.
Beyond the hardware, we are evolving our nursing homes to be eldercare hubs that can benefit a wider community of seniors and their caregivers. Where space allows, we will expand their suite of services beyond nursing home care to include day care and other services for caregivers.
The Man Fut Tong Nursing Home in Woodlands, for instance, offers day care, day rehab and home therapy services to seniors in the community. Sixty-nine-year-old Mdm Ahesah Bte Abdullah is one of those who have benefited from Man Fut Tong's expanded services. In 2011, she suffered a stroke that rendered her wheelchair-bound and she needed to undergo physiotherapy. Because she lives near Man Fut Tong, her caregiver can wheel her to the Home three times a week for her therapy sessions. Mdm Ahesah's condition has improved vastly and she is now able to walk again, as shown in the slide.
Second, we want to set clearer standards for different aged care services. Dr Chia asked about nursing home standards. I am pleased to inform him that MOH intends to introduce an enhanced set of nursing home licensing standards by 2015. Last year, we set up an industry-driven committee, comprising nursing home operators and healthcare professionals, to review our existing licensing standards and identify areas that can be enhanced. The committee has since
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drafted an enhanced set of standards for the nursing home sector. These enhanced standards differ from the current licensing conditions in a few areas.
First, there is more specific articulation of standards in various aspects of clinical care, such as oral hygiene, continence management and falls prevention. Currently, these areas are implied but not specifically articulated in the licensing conditions.
Second, the committee has enhanced standards in the social aspects of nursing home care, such as respecting residents' dignity and caring for their emotional well-being.
Third, the committee has added new standards in organisational excellence, covering the areas of human resource and financial management. This stems from the committee's belief that good care must be underpinned by good governance.
The set of standards is a first draft for consultation. We will engage the nursing home sector in the months ahead, to discuss these enhanced standards. These standards largely reflect the good practices existing in the sector today, so we do not expect a significant increase in costs. Nevertheless, MOH will continue to invest to develop the capability of the sector and allow ample time for nursing home operators to achieve these enhanced standards.
Mr Patrick Tay also asked about setting standards for day rehabilitation, day care and the upcoming senior care centres. I would like to inform him that we have similarly set up an industry-driven committee to review and set standards for the centre-based care sector. The committee started work in September last year and is expected to complete the standards by the end of this year.
Let me now move on to the second area of focus, which is to develop more options for seniors to be cared for at home and in the community. We are stepping up our efforts to develop home care services, to support caregivers who would like to care for their seniors at home rather than in a nursing home. Last year, we added 750 new home healthcare places, bringing the total capacity to more than 4,500.
Take, for example, 94-year-old Mdm Yap Leng Im. Mdm Yap suffered a stroke seven years ago and was wheelchair-bound since. Her family initially
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considered placing her in a nursing home, but opted to take care of her at home instead. Today, Mdm Yap lives in the comfort of her own home with her daughter-in-law and two grandsons, through the support of home care visits by the Home Nursing Foundation (HNF). HNF also provided training to Mdm Yap's family members and foreign domestic helper so that they can better care for Mdm Yap at home.
After the subsidy framework was enhanced last year, Mdm Yap now receives an increased subsidy of 80% to help cover the costs of her home care visits. And because her foreign domestic helper has been trained in caregiving, Mdm Yap's family is eligible to receive an additional cash grant of $120 per month to offset the cost of hiring the helper. They will also receive a concession on their foreign domestic worker levy and have to pay only $120 instead of the normal rate of $265 per month.
MOH will be going a step further. To encourage and facilitate home care, as my Minister had noted earlier, we will be convening an industry-led committee to review and chart new standards and strategies for the development of the home care sector in Singapore. The committee is tasked to recommend a common system to assess the care needs of home care patients, articulate common standards of home care and identify new home care services that can be developed to meet unfulfilled needs today.
We are also beefing up support for our seniors' caregivers. Mr Christopher de Souza, during the Budget debate, suggested giving an allowance to caregivers. We do want to give families support in caring for their seniors. But we must not inadvertently monetise family ties and filial piety which come from the heart, and they are intangible.
There are practical ways to help caregivers. We can help them relieve the cost of caregiving at home. The Deputy Prime Minister and Minister for Finance announced in his Budget Statement that we will expand the Senior's Mobility Fund (SMF) into the $50 million \"Senior's Mobility and Enabling Fund\". The SMF will go beyond a fund to promote mobility, to a fund that supports our seniors to live independently in the community. Mr Tay asked how the fund will be enhanced.
First, we will expand subsidies beyond mobility devices to cover other assistive devices. Seniors can receive subsidies for more items, such as motorised wheelchairs, commodes, geriatric chairs and pressure-relief
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mattresses. The fund will also cover spectacles and hearing aids.
In response to feedback from VWOs and social workers, we will also simplify the application process for subsidies. Any senior living in a 3-room HDB flat or smaller will automatically qualify for 90% subsidy for devices that cost less than $350. There is no need for a detailed household income means test.
Second, for seniors receiving Government-subsidised home nursing or home medical services, and with per capita monthly household income of $1,500 or less, the enhanced SMF will provide between 50% and 80% subsidy for the cost of consumables, such as dressings, diapers and milk feeds.
Third, the enhanced SMF can also be used to subsidise transport costs for more seniors who are community ambulant, to attend day rehabilitation, dementia day care and renal dialysis centres. Dr Chia Shi-Lu and Mr Muhamad Faisal Abdul Manap also asked specifically about transport subsidies to and from hospitals for medical appointments. There are, in fact, already schemes for this. For instance, our Community Development Councils (CDCs) work with a non-profit organisation, Caring Fleet Services, to provide dedicated transportation services to people with mobility difficulties, by giving them vouchers to pay for transportation to hospitals, polyclinics or SOCs. In effect, they use retrofitted vehicles that can accommodate these wheelchair-bound residents. So, they really do not need to use ambulance which, by its nature, is really for emergency cases. In addition, through the \"SMRT Gift of Mobility Programme\", our CDCs also give out taxi vouchers to needy seniors to travel to hospitals and polyclinics. So wearing my other hat, as a Mayor of Southwest CDC, let me assure Mr Muhamad Faisal Abdul Manap that help is already available for the family of three that he mentioned earlier. In fact, the CDCs have helped such families in similar situations. So, I would like to request Mr Faisal to give either MOH or the Northeast CDC, if the resident is within his Aljunied GRC, details of the case, so that we can follow up on the case and provide help as soon as possible.
Under the enhanced SMF, we will also expand our support to help seniors accessing day services. We will provide transport subsidies for wheelchair-ambulant seniors receiving treatment at day rehabilitation centres and renal dialysis centres funded by MOH, as well as seniors receiving care at MOH-funded dementia day care centres, as I have said.
I thank Members for your positive feedback on the enhanced SMF. When the changes take effect from the third quarter of this year, we believe that the
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enhanced SMF can benefit caregivers like Ms Masni Bte Jaafar. Ms Masni and her husband not only have to support their six children, but also needs to care for her elderly parents. Her father suffered a stroke a few years back and is now bed-bound; while her mother suffers from diabetes and kidney failure. Both her parents are receiving home nursing services from TOUCH Home Care and require consumables, such as diapers, milk feed and dressings. With the enhanced SMF, they will receive 80% subsidies on the cost of consumables, saving up to $4,000 a year.
Several Members also pointed out that caregiving can be tiring. Indeed, we recognise that caregivers cannot do it for 24 hours a day, 365 days a year. At some point, the caregiver may fall ill or simply need a break, and will need someone else to take over the caregiving temporarily.
To relieve the stress of caregiving, MOH is working to make respite services more accessible and affordable. We are starting a pilot project by working with a few nursing homes to set aside some beds that can cater to respite services. Caregivers who need a temporary reprieve can place their elderly to be cared for in the nursing homes for a short period and enjoy up to 75% subsidy subject to means testing.
This pilot will support caregivers like 63-year-old Mr Koh Kok Heng. Mr Koh has been taking care of his 60-year-old wife, Mdm Choo Ngee Neo, after she suffered a head injury that rendered her bed-bound. Recently, due to a toilet leakage, their flat will need to undergo a week of renovation work next month. The noise and dust from the renovation will make it not conducive for Mdm Choo to be cared for at home. With this new pilot, Mr Koh can admit Mdm Choo into a nursing home for seven days of respite care at a subsidy rate of 75%, while the renovation works are being carried out. The seven-day respite will also give Mr Koh a chance to rest and replenish, so that he can take even better care of Mdm Choo when she returns home.
Mr Sitoh and Mr Patrick Tay asked about the capacity and capability of our long-term care facilities to cater for seniors with dementia. I would like to inform them that our new nursing homes will include wards for dementia patients. Today, we have about 515 nursing home beds dedicated for seniors with dementia. By 2016, we will increase this by more than 400 beds. We will also increase our support to help nursing homes develop the right capabilities to manage these seniors. For instance, CGH and IMH have been providing training to staff from eldercare organisations, including nursing homes, on dementia
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care and behavioural management.
Besides nursing homes, we also have 12 dementia day care centres which can serve more than 300 seniors per day. In addition, we will be developing more senior care centres by 2016 which will have the capability to provide dementia day care services.
Ms Tin Pei Ling also asked about the capacity of our public mental health sector. Today, the IMH has about 2,000 hospital beds for patients who require inpatient care, with an average occupancy of 84% over the past three years. So far, this is sufficient but we will continue to monitor the situation.
Our objective is, as far as possible, to have persons with mental illness reintegrated with society. But as Ms Tin pointed out, some with more severe illness may need longer term care. Today, there are three psychiatric nursing homes with a capacity of about 650 beds. We will be expanding the capacity to 1,200 beds by 2020. We also have two psychiatric rehabilitation homes with 280 beds for those who need temporary residential care to help them reintegrate into the community. We will be increasing this to about 400 beds by 2016.
I agree with Ms Tin Pei Ling and Ms Ellen Lee about the need to reduce the stigma of mental illness. Because of this stigma, many people who need help do not come forward for treatment. To address this, our strategy is to shift the locus of mental healthcare from institutions into community-based settings that are more accessible and to integrate mental health services with those for physical health.
We piloted two Assessment and Shared Care Teams, or ASCAT in short, last year to provide mental health treatment in the community. One team is located at Ang Mo Kio Polyclinic and the other, which is temporarily sited in Khoo Teck Puat Hospital, will be moving out to a community location later this year. The two teams have helped around 400 patients to date. We intend to set up a total of six ASCAT teams across Singapore by 2016 to support up to 9,500 patients at any point in time.
General Practitioners (GPs), too, play a crucial role in encouraging people to seek treatment for mental health, as they are often the first point of contact. Today, we have about 70 GPs collaborating with IMH to provide mental health care in the community. We hope to recruit a total of 100 GPs by 2016.
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To support the GPs, we also worked with VWOs to pilot Community Mental Health Intervention Teams or COMIT teams last year. COMIT teams provide counselling and psychotherapy services to support GPs in managing patients with mental illness. There are two COMIT teams today, in Upper Boon Keng and Yishun, and they have helped over 100 patients to date. By 2016, we intend to set up a total of 10 COMIT teams to serve up to 10,000 patients.
To further combat stigmatisation, we are increasing community outreach and education on mental health. Today, AIC works with a few senior activity centres to start up teams of volunteers in the community who can identify seniors with symptoms of dementia and depression, and refer them for early treatment, which is similar to what Ms Tin had proposed earlier.
HPB is also working with community partners, such as Silver Ribbon (Singapore), Singapore Association of Mental Health and grassroots organisations, to promote awareness of mental well-being. In 2012, over 30 such events were organised, reaching out to about 25,000 people in the community.
Ms Tin asked for more support for caregivers of patients with mental illness. The enhanced SMF and the residential respite pilot I described earlier will be able to support these caregivers. In addition, we are working with VWOs to provide support targeted at caregivers of dementia patients.
The Alzheimer's Disease Association (ADA), for instance, offers elder-sitting services. Seniors can be brought to ADA's centre or be visited at home, where the elder-sitters will befriend and engage them in simple mind-stimulating activities, giving their caregivers a few hours of respite.
Another example is the \"Dusk to Dawn\" programme at St Joseph's Home. Some dementia patients have what we call \"sundown\" syndrome, where they cannot sleep at night, thinking it is day. This is a programme whereby caregivers can leave their loved ones with dementia at the Home at night, so that they can catch up on sleep and bring them home again the next morning. There will be staff and volunteers in the Home to engage these dementia patients in meaningful activities through the night.
Mdm Chair, MOH hopes to engage the community at large, to build an inclusive and caring Singapore for our people. In the past year, reports of
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\"NIMBYism\" have made the news. But being an optimist and having confidence in Singaporeans, I think these isolated incidents are hardly representative of the majority of Singaporeans.
Dr Chia asked about the City for All Ages (CFAA) project. I am pleased to inform him that the project is progressing well in its four pilot sites of Marine Parade, Bedok, Whampoa and Taman Jurong. While the project started with the objective of innovating new solutions to create senior-friendly communities, we were pleasantly surprised to see how the project has served as a platform to garner community action for seniors.
The energy I see on the ground is incredible. I see many volunteers, both young and old, walking their towns in the hot sun to identify areas of improvements to the town infrastructure that will make it safer for seniors to move around. In Marine Parade, as a result of volunteers' efforts, the Town Council and the LTA, improvements to the town hardware are being systematically rolled out, such as levelling of void deck aprons and longer traffic light crossings.
On top of that, over 50 new rest stops will be installed across the town so that our seniors can sit down and rest when they feel tired. This rest stop is a suggestion from Marine Parade residents themselves. Even the design is chosen after a vote among the residents!
The software of Marine Parade has also been enhanced. For instance, the local senior activity centre called Goodlife! is now providing one-stop information and referral services for senior-related issues. The centre also links up with the Agency for Integrated Care or AIC to provide outreach and public education on dementia and depression, and works with the Changi General Hospital to provide social support for recently-discharged seniors.
A group of volunteers has also been formed to befriend seniors living alone in Marine Parade. And the oldest volunteer you see here is Uncle Wai Chong and he is all of 83 years old!
We want to continue this positive momentum. I am pleased to inform the House that MOH plans to expand the CFAA project to another five to 10 more constituencies over the next three years, and will provide an award of up to $80,000 for each constituency which wants to start its own CFAA project.
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Mdm Chair, our seniors have contributed much to Singapore. Now that they are old, we should create an environment that allows them to age happily and with dignity, in our midst. Our aspiration is to create a people movement across the island in every town, to make our city a senior-friendly one, and the best place for our seniors to grow old in.
Ms Ellen Lee asked about health screening rates among Singaporean women. I agree with Ms Lee that more can be done to improve on our women's cancer screening rates. According to the National Health Survey conducted in 2010, only about 48% of women aged 25 to 69 undergo regular cervical cancer screening and about 40% of women aged 50 to 69 go for regular breast cancer screening.
The Women's Health Advisory Committee (WHAC), which I chair, aims to encourage more women to undergo screening and to promote health among our women. In September last year, we introduced a resource kit called \"My Journey to Better Health\" to provide women with important health information on issues, such as starting a family, weight management and breast and cervical cancer across various stages of their life. To date, the kit has been distributed to more than 30,000 women. We target to reach 200,000 women by the end of this year.
The Committee and HPB also work closely with healthcare providers and grassroots organisations to increase public awareness of breast and cervical cancer through regular exhibitions and road shows held in the community during the Breast Cancer Awareness Month (BCAM) and the World Cancer Day (WCD).
This year, we aim to make cancer screening more affordable for women, particularly those from lower-income households. The Committee and HPB will, over the next two years, work with VWOs and the private sector to help cover the cost of breast cancer screening for 15,000 women from low-income households. Eligible women will only need to pay up to $2 for a mammogram, compared to the existing subsidised rate of $50 under BreastScreen Singapore. This two-year project will be introduced from 17 March this year. Eligible women will receive an invitation letter to go for screening at a participating polyclinic X-ray centre.
In addition, we are making screening more accessible by expanding the coverage of BreastScreen Singapore's mobile mammogram screening service, the Mammobus, to more estates. As noted by Ms Ellen Lee earlier, it may not
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just be an issue of affordability. We will also be organising ferry services at selected estates to bring women to the screening centres.
To encourage working women to adopt healthy habits, HPB will expand the existing $15,000 annual Workplace Health Grant by another $5,000 a year for employers to create a supportive work environment to promote health, especially among working women. Employers can use the additional grant to organise health promotion programmes tailored for working women, such as talks on child and maternal health, workshops on managing work and family, and classes on healthy cooking. But, of course, the men would be welcome, too, if they want to join these programmes. The grant can also be used to subsidise costs of breast and cervical cancer screening.
Before I conclude, let me thank Mr Low Thia Khiang for his feedback on the Continuing Traditional Chinese Medicine Education Programme. The objective of the programme is to help TCM practitioners raise their professional standards and acquire new skills to better serve their patients. We believe that continuing education is integral to their professional development, just as it is for doctors, nurses and pharmacists. Let me clarify also that the TCM Practitioners Board has put this in place after discussions and town hall sessions with TCM organisations and practitioners. The Continuing TCM Education Programme is currently on a voluntary basis. I would also like to point out that we are not the first country to introduce Continuing TCM Education Programme. Participation in CTE for TCM practitioners is, in fact, compulsory for the renewal of their licence in countries like Taiwan since 1993; Hong Kong since 2005; China, 2006; and Australia, 2012.
We have received feedback, similar to the ones raised by Mr Low earlier. This is a fairly new pilot, on a voluntary basis, having only started in January this year, just about two months ago. So, I assure Mr Low that the TCM Practitioners Board will carefully consider all the feedback received during this pilot phase when they review the programme.
Mdm Chair, every Singaporean wants to live healthily and age gracefully – to add life to our years as we add years to our lives. As a Government, we must help our people to reach this goal. Besides our aged care services, we must also encourage Singaporeans to lead healthier lifestyles. After all, a healthy lifestyle today is critical for healthy ageing tomorrow.
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The Chairman: Order. I propose to take the break now and resume the Chair of the House.
[(proc text) Thereupon Mdm Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mdm Speaker: Order. I suspend the Sitting and shall take the Chair again at 4.05 pm.
Sitting accordingly suspended
at 3.41 pm until 4.05 pm.
Sitting resumed at 4.05 pm
[Mdm Speaker in the Chair]
[(proc text) Debate in Committee of Supply resumed. (proc text)]
[Mdm Speaker in the Chair]
Ms Faizah Jamal (Nominated Member): Madam, I am happy to hear from Dr Amy Khor's description of the facilities incorporating green spaces as it ties in really nicely with what I have to say.
Madam, apart from intensifying good programmes for fitness, exercise and nutrition, I think it is about time we pay attention to the role that nature-based activities play in healthcare. I would like to suggest just two. The first is gardening. As long ago as the 1800s, American doctor, Benjamin Rush, a mental health pioneer found that \"digging in the soil has curative effects on the mentally ill\". It is now well documented scientifically that such activities help to counter depression and raise self-esteem. So, I would go so far as to suggest that MOH consider putting aside spaces in facilities for healthcare for what is called \"edible gardens\" where patients can take part in planting fruits and
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vegetables. Apart from the fun of growing food and the satisfaction of harvest, it also creates community and celebration, creating positive emotions that support patients to get well faster.
My second suggestion is for the Minister to seriously consider including visits to nature spaces as a major component in providing physical, emotional and mental healthcare and step-up efforts for such activities as a preventive healthcare method for members of the public. Many years ago, the pioneering work of people like Ulrich showed that patients recovered faster from surgery in a room with a view of a natural scene than those without such a view. Now, the most recent work of environment psychologists, Rachel and Stephen Kaplan, showed that experiences in nature have what is called \"restorative\" ability, turning negative thoughts and emotions to that of positive self-image. This shows increasing scientific evidence of the link between nature and our well-being resulting in hope, resilience and courage to continue to deal with life's challenges constructively.
So, what I would like to suggest is structured programmes where patients are taken on nature walks on a regular basis, not just to the manicured areas like parks and gardens but also to our nature reserves like Bukit Timah and Sungei Buloh wetlands. As NParks already has an established pool of experienced volunteer nature guides at our nature areas, this service can be tapped for the benefit of patients. In this way, patients get a holistic view that they deserve.
The Chairman: Ms Faizah, your time is up. Dr Teo Ho Pin.
Dr Teo Ho Pin (Bukit Panjang): Madam, preventive medicine or preventive care involves taking measures to prevent disease or injuries rather than treating or curing their symptoms. It can save lives and reduce healthcare costs if effectively implemented. In order to work out effective preventive care strategies, we need to understand the causes of preventable deaths or injuries. Research has shown that leading causes of preventable death include hypertension, smoking, high cholesterol, obesity and physical inactivity.
In Singapore, we have an effective preventive care vaccination programme for children, which includes polio, measles or mumps vaccinations. However, we do not have a nationwide programme for vaccination of the elderly against flu or pneumonia. Thus, I would urge the Ministry to consider subsidising a
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national vaccination programme for the elderly.
Our health screening efforts are also ad hoc and, therefore, not effective in the early detection of diseases or illnesses. There is a general lack of focus on preventive care services to prevent diseases or injuries. As a result, today we are faced with problems of obesity, chronic illnesses, pneumonia and injuries, especially among the children and elderly.
Madam, I would urge the Ministry to consider implementing a comprehensive programme for preventive care services for health screening. We need to set up the infrastructure to provide preventive care services to improve the health of Singaporeans. For instance, health screening can be better organised to ensure that high health-risk Singaporeans are encouraged to go for regular health screening.
Madam, General Practitioners (GPs) or family doctors are in the best position to identify high-risk Singaporeans and advise them to go for health screening, and ensure that they take up action to stay healthy. Thus, I would urge the Ministry to engage the services of the GPs at market rates for health screening.
Another area of preventive care is the promotion of healthy lifestyle among Singaporeans. We need to constantly encourage Singaporeans to exercise regularly to stay healthy. More outreach, education and encouragement are needed to help Singaporeans to lead a healthy lifestyle. We have done a lot in terms of health promotion education. It is about time we start to encourage or incentivise Singaporeans to exercise regularly to keep fit.
Sir, I wish to ask the Minister the following questions:
(a) What are the key preventive care services provided by the Ministry?
(b) What are the key strategies in providing preventive care to promote healthy lifestyle to prevent chronic illnesses and disease infection among Singaporeans?
The Senior Minister of State, Prime Minister's Office and Deputy Leader of the House (Mr Heng Chee How): Mdm Chair, in agricultural societies, farm work gave farming families and farm workers the exercise that
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they need even as they earn a living. But with industrialisation and also post-industrial societies, much of the manual work has been taken out. Whereas people now still spend a lot of time at work, the amount of exercise that they get from work is not like last time in agricultural societies.
When we look at the situation in Singapore and as we have discussed, the implications of an ageing population and an ageing local workforce and the need to strengthen the Singapore Core, then we recognise the importance of making sure that health promotion is a core part of what we do at work. In the community, there is already a more structured programme, such as the wellness programme, that reaches out to members of the community to enable those who are interested, especially those who are older, to take better care of their health and to stay connected and, in that way, enjoy a better quality of life and more years of health.
With the population spending a large amount of time at work and the need to strengthen our Singapore Core, there is a reason for us to pay greater attention to further systematising our workplace health promotion programmes and to see how best to model that after the community wellness programme and customise it to workplace application so that we can keep the Singapore Core, not only numerically, but healthwise.
Dr Chia Shi-Lu: Mdm Chair, health maintenance and promotion is critical for the continued wellness of Singaporeans while ensuring that healthcare costs do not spiral out of control, in view of the challenges that an ageing population presents us. Now, this may sound like an MTI cut, but healthy workers are also known to be more productive and enjoy a longer and happier working life which would also help with the population and resident workforce difficulties that face us over the next two decades.
Our disease burden is a function of our intrinsic constitutional makeup and extrinsic environmental and behavioural factors. We all know that we cannot choose who our parents are, but our genes do predict a certain propensity to health or disease. However, we can choose how we live our lives and so have a significant say in our own health. There is much that can be done to nudge Singaporeans to take greater ownership of their health. Unhealthy behaviour, such as smoking or poor diet, could be penalised but, by the same token, healthy lifestyle choices can be incentivised.
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Some countries have been studying the effects of imposing taxes on unhealthy foods or limiting the portion sizes of unhealthy foods. For example, New York City has recently attempted to curb the unhealthy consumption by limiting the size of soda servings, although just yesterday this move has been blocked by the courts. As I suggested last week, perhaps healthy foods like fresh fruit and vegetables or wholemeal grain can be made cheaper to make them more attractive to cost-conscious consumers. Singaporeans who participate regularly in approved wellness programmes or demonstrate that they adhere to a healthy lifestyle could receive tax rebates or pay discounted rates at public healthcare institutions or pay lower healthcare insurance premiums. We can also consider rewarding companies that support exercise and wellness programmes for their employees, and which also invest in the health of their workers.
While I appreciate that MOH already has subsidised health screen programmes in place, I would support the use of MediSave for such health screening which further lessens out-of-pocket expenditures.
More effort should also be spent educating the public about healthy living, and how they can improve the health of themselves and their families. Sometimes the approach can be blatant; for example, explicit front-of-label labelling of calorie counts and even health risks on unhealthy foods, similar to what is being done on cigarette packs.
Finally, I would support expanded recognition and benefits for volunteers who help to promote healthy lifestyle; for instance, the Health Ambassadors of the Health Promotion Board. This could be similar to the system for frequent blood donors, so that they can enjoy privileges for care at polyclinics and Government restructured hospitals.
The Parliamentary Secretary to the Minister for Health (Assoc Prof Dr Muhammad Faishal Ibrahim): Madam, Minister Gan had earlier emphasised the importance of health, rather than just healthcare: I fully support Minister's view and this is a motto that I often tell my residents, family and friends. In my experience, I have found that at the heart of every issue or policy, are our people. The success of a policy or programme hinges upon what we make out of it. This is especially true when it comes to health promotion initiatives.
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Very often, Singaporeans tell me that they would like to lead a healthier lifestyle. Many have also shared that they appreciate the Government's effort to encourage them to do so. It is heartening that we have made some inroads over the past years.
Dr Teo Ho Pin and Ms Ellen Lee asked about preventive care services for children, elderly, and in relation to mental well-being, respectively.
MOH has a range of preventive care services for Singaporeans of all ages. We want to provide good support, especially in the early years and through childhood. This lays the foundation for good health habits to continue into adulthood. We have various programmes from conception through birth and pre-school. The HPB's School Health Services provides annual medical checkups, vaccinations and oral health services.
For our elderly, there are initiatives, such as the Community Functional Screening Programme, which aim to detect functional decline in older adults. MOH will look into introducing a vaccination schedule for adults and the elderly.
Health is not just about physical health. Indeed, health promotion also needs to address mental well-being. We have mental well-being programmes tailored for the different stages in one's life: There are online Mental Well-being Scales for Children and Youth as well as for adults. For the elderly, there is a Mental First Aid Kit Programme that improves mental well-being through positive experiential activities. Next month, HPB will be working with the National Arts Council to roll out an \"Arts for Mental Well-being\" programme that makes use of drama and recycling art and craft.
Dr Teo Ho Pin would be happy to hear that we do measure the effectiveness and health outcomes of health promotion programmes at the national level.
The National Immunisation Registry monitors immunisation coverage. For school-going children, the Student Health Survey assesses key health behaviours.
Regular nationwide health surveys monitor the prevalence of chronic diseases, behavioural risk factors, and preventive health behaviour in adults and the elderly.
These surveys show progress in many areas. However, some trends continue to be worrying: more Singaporeans are getting obese, and more
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young adults are taking up smoking. As we age, our risk of developing chronic diseases, such as diabetes and high blood pressure, increases. Doing things the same way is simply not enough: as individuals, as a Government, and as a society, we need a new approach to healthy living. One way or another, healthy living should be everyone's business; it should not be something we have to think about; it should be second nature to us.
Our purpose is to ensure that no Singaporean is deprived of a healthy lifestyle. To achieve this, it means, first, that the right environment needs to be developed throughout Singapore, so that leading a healthy lifestyle is not just easy, but natural for all of us. Second, everyone is actively engaged and aware of opportunities for leading healthy lifestyles. Last but not least, adopting a healthy lifestyle need not be the more expensive option.
In summary, our vision for healthy living is to be healthy together – anytime and anywhere through the 3Ps: Place, People and Price.
We want to translate this vision into action. Earlier, Minister Gan mentioned the Healthy Living Master Plan Task Force, which I am leading. We aim to develop a national blueprint for healthy living.
The Task Force is studying the factors that motivate Singaporeans to change behaviour and to maintain a healthy lifestyle. In our discussions, we were very heartened to hear that some ideas are already being considered by various agencies for implementation. I will go into more detail later.
The Task Force has also studied innovative practices from other cities. One inspiring example is New York: they reported a successful 5.5% decrease in childhood obesity rates from 2006 to 2011. This is after years of multi-agency efforts to improve nutrition and the built environment to encourage physical activity. For example, New York requires restaurants to post calorie information on their menu boards. They also came up with active design guidelines to create healthier buildings, streets and urban spaces. Learning from such examples, we aim for similar success in Singapore.
Staying healthy concerns every one of us. During a recent Our Singapore Conversation session, one of the participants, Mdm Rohani, provided much inspiration. She told us about how she prepares healthy snacks, such as carrots, cucumber sticks and cherry tomatoes, for her grandchildren. They also exercise together as a family at least once a week. This is a fine example of how we, as individuals, families and as part of society, can encourage one another to live
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healthily. I was encouraged that there was strong support among participants for a healthier lifestyle.
Therefore, Healthy Living Master Plan is about making connections at three levels: firstly, across Government. Secondly, it is about connections across communities. Thirdly, between communities and the Government. We hope to strengthen these connections so that everyone gets involved in working towards a common goal. This involves initiatives that cover the Place, the People and the Price, or the 3Ps. Let me share with members in more detail.
Firstly, the \"Place\" element of the Master Plan involves changing the physical environment that we live in, so that we can go about our daily activities in a healthy way without even thinking about it.
Ms Faizah Jamal asked about access to nature spaces as a health promotion measure. We know that Singapore has limited land, yet we have innovatively maximised the use of spaces, whether natural or man-made, for physical activities to promote healthy lifestyles.
We have designed our built environment to promote healthy living. MND, MOT and other infrastructure agencies have also contributed to the health agenda. Our housing estates are designed to encourage residents of all ages and abilities to go outdoors for fresh air, exercise and even gardening. These estates have facilities, such as parks, park connectors, playgrounds and cycling paths.
With the right infrastructure for physical activity in place, the next step is to experiment with programmes and micro-designs, such as innovative signage. As such, we will be working with town planners and Government agencies to create visual cues in public spaces to prompt physical activity. For example, you will see more exercise maps, and appealing visual designs to encourage the use of stairs at workplaces, shopping malls, schools and public places like train stations.
By connecting the dots between the different Ministries and agencies and the community, we are all working together to achieve the common goal of good health for our people, Singaporeans.
One example is the Healthier Hawker Centres initiative. I am pleased to say that the pilot was a resounding success, with up to a 30% increase in sales of wholegrain, and with the hawkers reporting a 20% increase in business. A
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conducive environment for healthy living also includes food establishments. During the Our Singapore Conversation sessions, some of us were asked, \"Why can't you scale up Healthier Hawker centres faster? We want them in our neighbourhoods, too!\" I am pleased to say that Healthier Hawker Centres will be extended to 40 more hawker centres, food courts and coffee shops in financial year 2013. For greater impact, we are also reaching out to centralised kitchens that supply workplace canteens, coffee shops and household tingkat meals to use healthier ingredients. The target is to reach out to five centralised kitchens, supplying more than 50,000 meals per day, by end of financial year 2013. Dr Lam Pin Min would be glad to know that we have similar initiatives in our schools. More than 90% of our schools subscribe to healthy eating guidelines under the Healthy Eating in Schools programme.
As Mr Heng Chee How had emphasised, healthy living should also occur in workplaces. Employers are realising more and more now, that health is very much linked to productivity at work. We have a comprehensive health promotion support infrastructure for companies, such as the Workplace Health Promotion Grant, and capability building courses.
The Healthy Living Master Plan Task Force visited an SME called UMW Equipment and Engineering Pte Ltd. We wanted to learn first-hand how an SME can use its limited resources to build a strong health-promoting workplace culture. I found that their philosophy, \"a healthy worker is a safe worker\", to be a good start. Some of their staff got together to form a workplace health executive committee that plans and drives health promoting initiatives. In order to encourage active participation, many of these programmes are free and held during office hours. They even have a small gym for employees. This is a good example of how a company and its workforce come together to take ownership of their health.
Some industries that employ many low-wage workers, such as the cleaning and security sectors, have limited access to health programmes. We have not forgotten about them. As such, I am pleased to announce that HPB will collaborate with NTUC to reach out to workers from these sectors, to offer health screening and follow-up services.
Next, the \"People\" element of the Master Plan has two aspects. First, it means to be inclusive of all segments of society, especially the vulnerable groups, such as those with lower income, the youth, and the elderly. Secondly, the \"People\" element also means improving people's understanding of health, or health literacy, so that we can make informed choices about how we live and
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how we eat.
As part of reaching out to all segments of society, HPB will ramp up its ground-up movement. One key enabler is getting ordinary citizens – our Health Ambassadors – to champion health promotion within their respective communities. To date, HPB has trained and deployed nearly 5,000 Health Ambassadors since 2011. We target to have 10,000 Health Ambassadors by 2015.
Some of the stories of how these health ambassadors have made an impact on their loved ones are very encouraging. Mdm Peh Lek King, a 55-year-old senior Health Ambassador, shared that she first became a Health Ambassador because she started to realise the importance of maintaining health as she ages. She then thought about her family, and felt compelled to keep them healthy too. She became healthier too. As she became more active in HPB events, she started encouraging her friends to adopt healthier lifestyles as well. She has also used her persuasive skills to counsel people who come for screening at community screening events to go for medical follow-up. This is the very attitude towards health and the community that we hope will become pervasive through our Health Ambassador network.
The other aspect of the \"People\" element is about improving health literacy. We can shape food choices by more clearly labelling the nutritional contents of what we are buying. Last month, that is, 7 February, HPB announced that all products with the Healthier Choice Symbol (HCS) will also have to carry the Guideline Daily Amount (GDA) labelling on the front of their packaging. These labels will better guide consumers on the amount of calories, fat, salt and sugar that are contained per serving, hence enabling consumers to make better informed choices.
HPB has garnered the support of major multinational companies in this regard, and will continue to work with the food industry on this initiative. Our goal is that by 2014, all HCS products will carry this GDA labelling to be followed thereafter by non-HCS products.
We will also provide better guidance on how much we eat. Today, HPB's Healthy Diet Pyramid shows us the recommended number of servings of each type of food group. However, more Singaporeans are exceeding their recommended daily intake of fat and carbohydrates as compared to a few years
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ago. This means that we still need to understand what the right portion size actually looks like. We will, therefore, shift from the current Healthy Diet Pyramid to the Healthy Plate. The Healthy Plate will visually link nutrient requirements to the recommended portions that should be consumed in a meal.
Last but not least, we come to the price element of the Healthy Living Master Plan. We cannot be inclusive of all segments of society if we do not make healthy living affordable.
We agree with Dr Lam Pin Min, Dr Lily Neo, Dr Teo Ho Pin, Mr Heng Chee How and Dr Chia Shi-Lu that we should look at how to better incentivise healthy living. We are open to exploring some good ideas that you have suggested. For example, Dr Chia mentioned tax rebates or discounts for those who participate in wellness programmes. Also, volunteers who help promote healthy lifestyles, such as Health Ambassadors, can be given expanded recognition and benefits. Dr Lam also suggested insurance rebates for those who can demonstrate that they are living out healthy lifestyles. We will study various feasible incentives, including those tied to insurance premiums. It is equally important that, as individuals, we ourselves are motivated to live healthily.
We also agree with Dr Lam on the need for affordable healthier food options. HPB has worked with the ingredient suppliers and stall vendors in the Healthier Hawker Centre programme to make sure the healthier dishes offered are affordable. HPB also partners major supermarket chains to offer regular promotions of healthier products at discounted prices. We are also working with local R&D institutions and the food industry to build capacity to produce affordable and healthier foods and beverages.
Next, we need to address affordability for screening. Screening enables early detection and treatment of diseases. Yet, I appreciate that for many of us, finances are sometimes tight. We have to attend to the basic necessities first and would not even consider spending money on screening, especially if we feel \"OK\". Others may be worried not so much about the cost of screening, but more about the financial cost and affordability of treating a condition should one be diagnosed. We are, therefore, focusing our screening outreach on the groups of people who need help most.
To this end, the Task Force recently visited the Henderson Seniors Activity Centre (SAC) run by the Thye Hua Kwan Moral Society. We wanted to understand the voluntary welfare organisations' outreach work and the issues that they face on a day-to-day basis. I was struck by how the SAC's programmes
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helped give the elderly residents a greater purpose in life, and motivated them to enjoy better physical independence and mental well-being. I enjoyed talking to the seniors, and, in fact, I learnt a lot from this engagement and how we can better our engagement with Singaporeans to enhance their lifestyles and towards a healthier life. However, I asked myself, \"Can these programmes be even more effective, if different organisations got together to implement them?\"
I am, therefore, happy to announce that such public-private connections are already being made. HPB's pilot Senior Holistic Engagement Programme (SHEP) will bring health programmes to low-income seniors through connecting with VWO partners and SAC platforms. It will tap on HPB's expertise and the reach and passion of VWOs, to provide free health promotion programmes and subsidised health screening initiatives.
Lastly, in response to Dr Lam's question on vaccinations, we have an Expert Committee on Immunisation (ECI) which advises MOH on which vaccines to include in the National Childhood Immunisation Schedule (NCIS). This is based on factors, such as how common and serious a disease is, and the availability of safe and effective vaccines. Dr Lam will be happy to hear that we will be adding the vaccine against Haemophilus influenzae type B (Hib) into the NCIS.
We appreciate Dr Lam's concern that increased connectivity and movement of people across borders heightens the risk of local outbreaks of vaccine-preventable diseases. Our strategy is to ensure high local vaccination coverage to protect our residents. Vaccination coverage has been maintained at above 95% in Singapore.
To improve affordability for childhood vaccinations for Singaporeans, I am pleased to announce that the five-in-one combination vaccine will be available for free at the polyclinics. This vaccine covers Hib, diphtheria, tetanus, whooping cough and polio. We will also introduce free Hepatitis B vaccination at the polyclinics. In addition, we will also allow MediSave use for all vaccinations recommended on the NCIS, up to a cap of $400 per MediSave account, be it in the public or private sector.
We will soon provide the public with a schedule of preventive health services that apply from birth till old age that includes screening and immunisation. As part of our commitment to preventive care, we would like to consult the public on how we can make it more accessible and affordable.
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I have shared some initial thinking and ideas today. The Master Plan is still under development. We hope to touch the hearts and minds of Singaporeans, and gather ideas on how we can together achieve a healthier lifestyle. As such, the Ministry would be holding a public consultation on the Healthy Living Master Plan in the coming months. Please give us your ideas and feedback.
Madam, most people know the common taglines: we should be active, eat wisely, be happy, not smoke and attend health screening. Saying it is the easy part. Translating it into action requires a radical change in our mindsets. We hope that you will join us in this journey to be healthy together, anytime and anywhere.
The Chairman: We have a bit of time. Any clarifications? Dr Lam Pin Min.
Dr Lam Pin Min: Thank you, Mdm Chair. I have three clarifications for the Minister. One is on Government spending. We know that it is inevitable that healthcare spending will increase. The current Government share of the national healthcare expenditure is only one-third and I am glad that the Minister has announced that they will be increasing the Government's share of this healthcare spending. Whatever this national healthcare expenditure will be eventually, I would like to ask the Minister what this fair and manageable proportion of the overall healthcare expenditure borne by the Government will be, as this will directly affect and will decrease the financial burden on Singaporeans.
Secondly, on polyclinics. I am glad that the Minister has announced that there will be two new polyclinics in Punggol and Pioneer by 2017. However, from now till 2017 is a long four-year wait. What are MOH's plans to alleviate the high demand and long waiting time in Sengkang polyclinic?
Thirdly, the Minister did not reply to my call for a transparent professional fee structure. Can the Minister elaborate and explain what this ethical limit, as announced by the Singapore Medical Council is, and whether there can be some form of updated fees publication to better inform patients as well as to guide doctors?
Mr Gan Kim Yong: Mdm Chairman, let me thank Dr Lam for the clarifications. First, a clarification on the first question about Government's share – what is the proportion? I mentioned in my speech that we expect the Government's share to grow from the current one-third to about 40%, or maybe even more than that eventually, of the overall healthcare expenditure. The
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remaining part of the expenditure will be borne partly through insurance schemes and partly through savings – MediSave and other schemes. We are still working on the details. As I mentioned, there will be a major review of the financial framework, and I will share more at the next COS when we have made some progress on the review.
On the second issue on Sengkang Polyclinic, I understand many Members have asked for polyclinics. In the meantime, while we are building two new polyclinics at Pioneer and Punggol, we are also looking at expanding existing capacity in some of the polyclinics that have heavier patient loads.
At the same time, we are also looking at the new model of Family Medicine Clinics (FMCs) working with the private sector, tapping on the existing capacity already existing in the private sector. So that instead of building more capacity, we balance the load between public and private sector. Through the FMC model, coupled with CHAS, we will then be able to encourage the private sector to become part of our team to look after our subsidised patients, especially those with chronic diseases.
I will be very happy to work with Dr Lam, if he has an interest in looking at developing further FMCs in Sengkang. We will work with the private GPs in the area and see how we can develop more FMCs in the Sengkang area.
On the third issue on professional fees, yes, during the last COS, I did mention that we are looking at the possibility of publishing some of the professional fees charged, at least within the public hospitals, so as to increase the transparency, and also serve as a reference for patients who want to decide which hospital or doctors to go to. We are working on this, and our intention is to look at the possibility of publishing some of these professional fees, starting first with our public hospitals and maybe, eventually, extend to the private health institutions.
With regard to the ethical limits, I think this is an issue that the industry and the professionals themselves will have to determine what they deem as ethical, and what they deem as appropriate. Generally, there is a sense that there are certain limits, but since there is currently a case in the legal process, so I would refrain from commenting further until the case is resolved.
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Dr Chia Shi-Lu: Thank you, Mdm Chair. I would like to seek two clarifications on two points raised by the Minister of State earlier. The first is that I do welcome the announcement that guidelines for nursing homes will be tightened and I also note that she did mention that the cost will be kept under control despite these new guidelines. But I am sure we all appreciate that cost is one of the major considerations and I would like to seek more clarifications or assurances that MOH is looking at this in terms of cost containment.
The second question refers to the Seniors' Mobility Fund. I think when this was first announced, there were some headlines when my colleague Ms Indranee Rajah was reported in the papers how she and her grassroots leaders made house-to-house visits to increase awareness of this scheme. I think many Members are doing the same. So, I would also like to ask MOH how do they propose to increase awareness of this programme this time round.
Dr Amy Khor Lean Suan: First, I would like to thank Dr Chia for his clarifications. With regard to cost, I think it is a fair and genuine concern that Members would raise this. As mentioned in my speech, the enhanced guidelines are a result of discussions by the nursing home representatives in the Nursing Home Standards Workgroup. In fact, these enhanced guidelines reflect current good practices that exist today among the nursing home operators. We do not expect this to lead to a significant increase in cost.
Secondly, the way we have phrased the enhanced set of guidelines – which will be put out for public consultation with the nursing home operators particularly – it is outcome-based. It does not list specifically input requirements. This is to give flexibility to the nursing home operators so that they can innovate in order to achieve the outcomes. So, it is a set of outcome-based guidelines instead of something that is very, very prescriptive.
Thirdly, we are pacing the change, so we are not implementing it today or at the end of this year. In fact, we hope to finalise the enhanced set of guidelines into a set of licensing standards by the end of this year, after public consultation. And then, we will give the nursing home operators a year to prepare for and to be able to develop their staff to achieve the licensing standards once they come into effect in fiscal year 2015.
Finally, AIC is going to develop an interpretation guide to help the nursing home operators understand the requirements of this enhanced set of guidelines as well as to invest in resources to train and upgrade the skills of the workforce in the nursing home sector so that they will be able to achieve the outcomes.
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Nonetheless, we share the Member's concerns. What we will do really is to closely monitor the impact once the enhanced guidelines are implemented, to see if there is any impact on cost and to ensure that nursing home fees will continue to be affordable for those who need the services.
With regard to the Seniors' Mobility and Enabling Fund (SMF), yes, the Senior Minister of State Ms Indranee Rajah has been a real champion for the SMF, going door-to-door, and I am sure many of the other Members are doing it to publicise and create awareness amongst the elderly as well as residents who may have elderly relatives or who know of others who would be able to benefit from the SMF.
What we are going to do for the enhanced SMF would be, firstly, to publicise it through the mass media – radio, print advertisements and, of course, on social media. It is not just to reach out to the elderly. It is really to reach out to the public, create awareness and encourage the public to refer potential residents who can benefit from the SMF.
We would also be working through AIC with the grassroots to again do an outreach in the heartlands, through roadshows, through house visits and so on because I think actually, that is really very useful. The grassroots, together with the advisors, understand the residents and may know of residents who actually will benefit from the enhanced SMF, not just in terms of assistive devices but also the transport subsidies as well as consumables if they are very frail elderly who are cared for at home.
AIC will also be working with the eldercare centre operators as well as other VWOs to get them to recommend and sign on eligible clients for the enhanced SMF.
Mr Gerald Giam Yean Song: Madam, I thank the Minister for his responses. I have two lots of clarifications. One is on means-testing and the other is on the NEHR.
Regarding means-testing, I am glad to hear that the intermediate and long-term care institutions now do not require patients in the families to submit their income documents to receive the Government's subsidies. Can I clarify that this applies not just to the basic hospital subsidies but also to the applications for MediFund and the other hospital endowment funds?
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The other thing is that, my understanding is that acute care hospitals still require the submission of income documents for these additional subsidy schemes. So, when will this convenient processing be extended to the acute hospitals?
On my clarification on the National Electronic Health Records (NEHR), the Minister said in his speech just now that only some GPs are on the NEHR. Exactly how many private GPs are actually on-board right now? Is cost preventing a higher take-up rate? Can MOH consider reducing the usage fees in view of the wider benefits that will be brought about if GPs are all on this NEHR?
Mr Gan Kim Yong: I would like to thank Mr Giam for the clarifications. First, let me clarify that for means-testing, there may be other schemes that are offered by the various institutions, whether it is an endowment fund or even the VWOs. They may have their own charity schemes. These charity schemes may not be able to tap onto the network but these are from their own welfare funds. We can continue to work with them to see how we can facilitate the application for these special funds beyond the MediFund and beyond our long-term care (LTC) subsidies.
For hospitals and the MediFund, we will look at it and see how we can further improve to facilitate applications. I believe that they are now able to tap into our CPF and IRAS records but patients do need to give their consent so that they can have access to this database.
On NEHR, we are rolling out to a select group of GPs, working with them, pilot with them. We have identified about 50 of them to test out the system. Some of them have already come onboard and some of them are in the process of training and familiarisation. We hope to be able to roll out to more GPs in time to come.
Cost is an issue because it does cost money to develop the system as well as to maintain the system. I am also very much aware that this cost can impose a financial burden on the GPs. We are working with the GPs to find a way that would ensure that it is affordable on an on-going basis. We developed this system and we really want to benefit the whole healthcare sector – not just the public sector but also the private healthcare providers. I am quite aware of the issues and we are working with the GPs to see how we can keep the system functional, beneficial and, at the same time, affordable.
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Dr Lily Neo: Mdm Chair, can I seek two clarifications from the Minister, please? On my first clarification, may I ask the Minister whether he will consider my earlier suggestion on reducing the out-of-pocket payments for patients, especially those from the lower-income group and the retirees? For example, will he consider a tiered reducing co-payment system?
On my second clarification, may I ask the Minister whether he will make available better referral systems for psychiatric patients in the community and better care of such patients in the community? The reason is that presently, there are many neurotic cases and psychiatric cases in the community that are under-diagnosed and under-treated. So, could the Minister look into this?
Mr Gan Kim Yong: Mdm Chair, I would let my Minister of State to reply on the question on psychiatric patients. With regard to the tiered reducing co-payment, I am trying to understand how the proposal works. To date, our subsidy is already tiered. Whether in the hospital or the LTC sector, the subsidies are means-tested, which means that if you are lower-income, you get a higher subsidy and, if you are higher-income, you get a lower subsidy. The patient then pays the balance. And, in that sense, the co-payment is already tiered according to your income level. If you are higher-income, the subsidy is lower, so you pay more co-payment. If you are lower-income, then your subsidy is higher, then you have a smaller component of co-payment. In that sense, the co-payment component is already effectively tiered so long as we make sure that the subsidy portion is tiered according to a means-tested basis.
The Chairman: Yes, Minister of State Dr Amy Khor.
Dr Amy Khor Lean Suan: Can I just seek a clarification to the Member's second question about psychiatric patients? The Member is saying that they are under-treated?
Dr Lily Neo: Many cases of the psychiatric patients are being treated less well because when they are in the community, they have less follow-up. And sometimes, they just ignore taking their medications and they do not have good supervision and that is posing a harm to themselves and also causing inconvenience to their family members.
Dr Amy Khor Lean Suan: Madam, I thank the Member for her clarifications. As I have said earlier in my main speech, the focus of mental health now really is to shift the locus of mental healthcare from an institutional setting, that is, hospital setting, to community-based care as far as possible, and
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that is really to allow them to integrate back into the community and continue to lead meaningful lives because many of them, actually with medications and proper treatment and follow-up, can work and lead meaningful lives.
I think it is a common concern about the lack of supervision or the fact that they may not follow up on their treatment or continue with their medication. What we have done is to set up community-based mental healthcare services through, for instance, the Assessment and Shared Care Teams (ASCAT). As I have shared in the main speech, we have two now, but we will be expanding this to six across the island.
They will work together with the hospitals, particularly IMH, as well as the restructured hospitals that have got psychiatric departments, and with GPs. So, when the patient is discharged, say, from IMH, and they go into the community, the ASCAT teams can follow up with these patients, together with the GPs. The GPs are actually trained – the 70 GPs who are now in partnership with IMH. If these GPs need specialist advice, for instance, they can refer the case to ASCAT.
There is also another level, we call Community Mental Health Intervention Teams (COMIT) which is not physician-led, unlike ASCAT, but they are actually led by allied health professionals and they can also do follow-up as well as the education of the caregivers in order to help them manage the patients in the community.
What we are trying to do really is to have a seamless and integrated care within the community and help them to re-integrate as much as possible.
Ms Tin Pei Ling: Mdm Chair, I would like to thank the Minister, the Minister of State and the Parliamentary Secretary for the very comprehensive replies, and I am heartened to know that there is a lot of attention given to the mental healthcare sector.
I have got four questions. The first question is: if a person is suspected to have a mental health issue, perhaps somewhat moderate to severe, and is causing disturbances in the community setting which may not be aggressive and violent enough for the Police to come in, and this person may also not be known to IMH yet; therefore, no records with the IMH; may have little or no family support or social network; how shall the community respond to such an instance, and cope with this case, such that this person will be able to come
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within the radar, and receive the treatment that he or she needs in order to recover as soon as possible, and to regain normalcy in life? That is the first question.
Second question, talking about stigma, will the Ministry consider working more closely with the mass media to provide a more objective and balanced portrayal and coverage of mental health issues? There have been studies which show that media is a very pervasive and very effective medium for propagating certain messages and imaging certain issues.
The third is about meaningful employment. I have also heard of many instances where people who have mental health issues do have reservations as they feel that they cannot come out into the open and tell their bosses that they need to go for medical appointments and so on. That, in a way, hinders them from getting meaningful employment or staying employed —
The Chairman: Ms Tin, please try to keep your clarifications short.
Ms Tin Pei Ling: I am so sorry. Will the Ministry share with us what is being done to address this issue? And, finally, for the respite care services, apart from dementia, does that also extend to other forms of mental illnesses as well?
Dr Amy Khor Lean Suan: Firstly, on the question of someone who might be an ex-mental patient or potential patient who is causing disturbances, I think quite a number of us have experienced this at one time or another. If they are uncontrollable, violent, pose a danger to themselves or to the community, then, you can call the Police. The Police will then bring this particular person into IMH for assessment and follow-up treatment. But in many instances, they are not violent. They cause disturbances and nuisance to neighbours and so on.
For cases like these, the resident or the grassroots or the advisor can link up with the FSC or SAC. By the end of this month, all FSCs and SACs will have staff that have been trained in call protocol as well as linking up with the Institute of Mental Health helpline. The staff can then assess this situation together with the IMH staff, and decide if they need to activate a mobile team from IMH which comprises generally of two nurses who are trained in mental health as well as crisis management to go down to the house for onsite assessment or house visit. And then decide if they need to bring the person for follow-up treatment at IMH or at restructured hospitals.
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Now, I need to say that under the Mental Healthcare and Treatment Act, unless the person is violent, pose a danger to himself or the community and so on, the Act does not allow us to compel this person to be brought to IMH for treatment. So, in many instances, the mobile team will have to work perhaps together with the grassroots or people who know the resident or work with the family if there is some form of family support, and conduct sometimes multiple visits to persuade this resident to be brought for follow-up treatment. In that sense, some patience is needed.
I would like to share that within my own constituency, we have helped a case like this. In fact, I just received an email of a case that we have just solved. Some patience is required in order to identify ways where we can actually bring this resident for treatment and follow-up. And sometimes they are ex-mental health patients; all they need really is help to get them back onto their treatment regime, medication and so on, and then they will get well again.
With regard to using mass media to reduce or mitigate stigmatisation, HPB does work very closely with the broadcast media – radio or TV – to try and weave mental health messages into some of their programmes. Recently, for instance, they worked with the Radio DJs to weave some of these messages into their programmes.
I understand that HPB has also recently worked with Channel 8 on a drama serial called \"It's a Wonderful Life\" and they have worked with them to weave some of these mental health messages into the drama serial. Where possible, we will continue to look at ways to see how we can promote awareness of mental illness, mental well-being, using mass media and other avenues.
For employment, there is a Job Club that IMH has set up to help mental patients who have recovered to find jobs by preparing them for jobs as well as setting up a network for them to get jobs. There are also other services like Temasek Cares-Employment Support Services which also does the same thing. The CDCs also pitch in and help wherever possible, even organising job fairs specifically for this group of people.
And the last question was on respite care. Respite care is not just for caregivers of patients who are mentally ill or suffer from depression or dementia specifically. It is for care-givers who need respite because they need rest, and so it is for all kinds of mental illness as well as other kinds of illness.
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Dr Janil Puthucheary (Pasir Ris-Punggol): Mdm Chair, I have one question for the Minister which relates to tobacco control. I welcome the changes to the removal of the retail display. It is a step in the right direction and represents the choice of public health over possible commercial interest. My question relates to the ability of the Government to protect its ability to make these types of decisions. In other jurisdictions, these types of decisions involving retail displays or packaging are being challenged as a result of free trade agreements – multilateral or bilateral free trade agreements.
I am aware that in many of these agreements, health is an exception. And then there is an exception to the exception which does not cover investments in intellectual property, and trade interests use that as a way of challenging these types of regulatory decisions made by governments. Especially as Singapore engages —
The Chairman: Dr Janil, you may wish to keep your clarification short; not a speech, please.
Dr Janil Puthucheary: Yes, Madam. As Singapore engages with the Trans Pacific Partnership negotiations, how would MOH ensure its ability to make these types of decisions in the future?
Mr Gan Kim Yong: Mdm Chair, let me thank Dr Janil for the clarification. We are very mindful of our international obligations with regards to our obligation to WTO as well as our bilateral trade agreements. In crafting these tobacco control measures, we have also been very careful with regard to the legal implications. Even in our negotiations of bilateral agreements, we are mindful of our own internal interests to protect the health of our citizens. These are all taken into account. As we roll out these tobacco controls, we are quite confident that we are on strong grounds, to introduce these measures, particularly in the interest of population health.
Mr Low Thia Khiang: Clarification for the Minister. Madam, I am happy to note that MOH has shifted its focus and changed its mindset from how to avoid healthcare expenditure escalating, to how Singaporeans can have peace of mind in healthcare needs, especially for those who have little MediSave in their account.
Madam, Minister earlier in his speech mentioned that there will be a new salary scheme for specialist doctors in 2014. Could he elaborate further on what
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would be the changes?
The second clarification is on the National Electronic Health Records. I would like to know if there is any roadmap for the health records to be implemented or to roll out. Where are the stages and the milestones set? I think we have started on this long ago and I think the progress seems to be quite slow.
Madam, on the referral system, the Minister's answer was that GPs under CHAS do refer the patient to the restructured hospitals and the patient will be treated as a subsidised patient. Does it mean that any patient who walks into a GP clinic under CHAS and when the GP refers him to the hospital, he will be considered as a subsidised patient? Or only a patient who is registered under CHAS as a subsidised patient, will be considered as subsidised patient when he is referred to a restructured hospital?
I understand that the recruitment of GPs under CHAS has been quite slow. What is the objection if MOH opens up the system of referral to allow any GP – instead of just GPs under CHAS – to refer patients to the hospitals to be treated as subsidised patients?
Lastly, we have been talking about long waiting time for a long time. My understanding is that currently there is still long waiting time at the polyclinics, long waiting time for patients, especially subsidised patients, to be referred to the specialist clinics in the hospitals, as well as those who are on the waiting list for surgery. What is the strategy of the Ministry to mitigate the situation, both in the long term and in the short term?
Mr Gan Kim Yong: Mdm Chair, if you would allow me, first let me explain that even as we focus on helping Singaporeans cope with their healthcare costs, it is still very important for us to continue to focus on managing overall cost. If overall healthcare cost goes up, even if the Government takes on a greater share, eventually the society will shoulder the cost. It is important, first and foremost, as explained in my main speech, that the starting point is to ensure that we manage overall healthcare costs. We do take many measures to achieve that. One area, for example, is that we want to ensure that we are productive and cost-effective in our treatment. We are very careful in selecting the appropriate treatments to make sure that we do not over-consume medical services.
Right-siting is another area. We want to make sure that we do not keep patients in a high-cost setting. If they are better off to be cared for at home, then
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we want to care for them at home. If they can be cared for in a step-down care setting, then it is better to send them to step-down care. All these measures come together to manage overall costs to ensure that, as a society, as a nation, we manage overall healthcare costs.
Even as we manage overall healthcare costs, we want to make sure that the Government's share will increase so as to keep the patient's share of the cost affordable to the patient. So, that is the major shift.
Secondly, Mr Low asked about the new salary scheme. As I explained in my speech, the new scheme will be implemented in 2014. The working group is still working through the details of the scheme. The concept is this: first, we want to emphasise that the doctors' focus is always on the interest of the patients. At the same time, we also have to make sure that our remuneration system treats the doctors fairly. We pay them fairly and competitively so that their salaries are competitive versus the private sector.
We probably will not be able to match the pay that the private sector can offer, but we cannot allow the gap to widen too much, otherwise there will be tension. Pay is not everything as far as the doctors are concerned, but it is an important factor. It also reflects our recognition of their contribution. The new pay scheme that is being worked out will take into account feedback from Members of Parliament as well as the professionals on how to balance between appropriate remuneration for the doctors versus interests of the patients so that we can shape the desirable behaviour.
With regard to the professional fees that I mentioned earlier, the intention is to look at whether we can take a portion of the professional fees, pool them together and then redistribute them to the individual physicians, taking into account their contribution to patient load, their contribution to education, their contribution to the management of the institution – maybe they are in leadership positions; they might not have a lot of time to see patients, but their contributions are equally important. All these factors have to be taken into consideration in the new framework. We will be able to share more once we finalise the framework.
On the National Electronic Health Records (NEHR), Mr Low had asked the question before and, as I have explained, it is a multi-year project and we will move from stage to stage. We are actually in a very advanced stage of our
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computerisation. Compared to international standards, our level of computerisation has already achieved a certain milestone. Moving forward in the next phase, as I also explained in my speech, we will focus on developing and enhancing the functionalities of the NEHR so as to allow more useful features to be available to the users.
Today, the basic NEHR is in place. It will take time for us to achieve buy-in from the individual physicians because habits are not easy to change. We do need a change management process to encourage our physicians, our nurses, and all our clinical users to change the way they have been working and move on to tap on the rich features that NEHR will provide.
NEHR also serves as a very important tool for us to put together the healthcare data of the nation. Every single patient ought to have a single record so that we can share the data wherever you are, whichever setting that you go to. In addition to taking care of the patients' interest, it is also a tool to give us the ability to analyse national health data to understand the population's health trends so that we will be able to then develop policy instruments to address the key emerging trends.
It is a multi-year project and our next step is to encourage buy-in, to encourage adoption, and this is not an easy task – I will acknowledge that – but it is something that we need to continue to work on. We will also be developing and enhancing the functionalities of the system.
On the referral programme, I explained in my answer that for CHAS patients who go to the CHAS clinics – these CHAS cardholders – when they are referred by CHAS clinics, will be eligible for subsidy in our SOC. The reason we do that is because when the CHAS clinics are accredited under CHAS, they would have a comprehensive system of managing the chronic diseases of these patients. The patients themselves are already means-tested through the CHAS system. To start with, the patient has to be a CHAS cardholder to be eligible for subsidy because they are means-tested. On the other hand, the referring GPs which work very closely with MOH and our tertiary institutions and our polyclinics in managing these patients are able to then assess the suitability of these patients for our specialist clinics.
As a start, we are allowing our CHAS clinics to have access to the subsidised services in our SOC. For CHAS cardholders, they will go to our CHAS registered clinics. When they are referred to SOC, they will then automatically become subsidised patients. At our SOC, if you are referred by any other GPs,
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we will also look at it on a case-by-case basis, and depending on your income, we may do a means-testing at the SOC before we decide whether or not to allow you to downgrade to a subsidised patient.
There is some flexibility at the SOC but we do encourage our patients to go through the CHAS clinics so that they are managed appropriately because when the SOC discharges these patients back to the community, it is also ideal for them to be discharged to the CHAS clinics so that they can follow up, and better manage the chronic diseases of these patients. We want to encourage a stronger partnership between CHAS clinics and our tertiary institutions as well as our polyclinics.
On the waiting list for the specialist outpatient clinics, we have adopted several strategies. I had made a reply to an earlier PQ on this matter. For example, for urgent referral cases from polyclinics, we have an expedited route, especially for cardiac illnesses or suspected cancer cases, we have an accelerated programme to allow them to see a specialist quite quickly. We also look at the acuity of the conditions. If the patient needs urgent attention, he will be attended to at our SOC.
If it is \"urgent-urgent\", then they ought to be in the emergency departments of hospitals. Once they are in the emergency department, they will be given immediate attention. If it is sudden cardiac arrest, for example, then they ought to go to the emergency departments. We have a protocol of referrals, depending on the acuity of the patients.
For electives – electives refer to those cases where you decide when you want the operation to be done – time, in many cases, is not critical. We then have more flexibility in scheduling those electives for the various surgeries. We adopt a multi-pronged approach to address the queues in our specialist outpatient clinics.
I also mentioned in my speech that we are developing a medical centre at NUH. With that, we will enhance the capacity for specialist outpatient clinics. So, we take a multi-pronged approach to address the queue issue at our specialist clinics.
The Chairman: Last clarification, Mr Patrick Tay.
Mr Patrick Tay Teck Guan: Mdm Chair, I would like to ask the Minister a question regarding utilisation of MediSave monies. Many workers and
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residents I speak to lament that they cannot bring their MediSave monies with them to the grave. Perhaps, the Minister can share with us what is the amount of MediSave monies left in the CPF account holders of those who have passed on – on the average.
Mr Gan Kim Yong: I do not have the data at hand but I would like to point out that from statistics – not just in Singapore but globally – the bulk of the medical expenses is incurred towards the end of life, most of the time within the last six months to 12 months. Even if our members today see that there is significant savings in their MediSave account, it is important to preserve these savings because as you grow older, as you become more frail, as you visit hospitals more often, you will need much of these MediSave monies.
For those that are low income, I would encourage them to approach our medical social workers. It is better for us to help through the various help schemes, including MediFund which we have just expanded, and keep the savings for yourself because eventually you may still need it as part of your co-payment when you are hospitalised towards the end of your life. Some may need to also use it for other outpatient chronic disease management. I would, therefore, not take it too lightly in talking about the balances in our MediSave accounts. Again, I am sorry, I do not have the exact number of the MediSave balance of those who have passed away at this point in time.
The Chairman: Dr Lam Pin Min, you may wish to withdraw the amendment.
Dr Lam Pin Min: Mdm Chair, on behalf of the GPC for Health and other health-conscious Members of the House, I would like to thank the Minister, the Minister of State and Parliamentary Secretary for their comprehensive replies and the many early Christmas presents. I believe MOH will continue to work hard to look into all the issues and suggestions raised by Members today and to make healthcare affordable and accessible to all Singaporeans. With that, I beg leave to withdraw the amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $4,929,089,000 for Head O ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $746,558,600 for Head O ordered to stand part of the Development Estimates. (proc text)]
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","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head W (Ministry of Transport)","subTitle":null,"sectionType":"OS","content":"Mr Cedric Foo Chee Keng (Pioneer): Mdm Chair, may I take the three cuts together?
The Chairman: Yes, please.
Mr Cedric Foo Chee Keng: Madam, I beg to move, \"That the total sum to be allocated for Head W of the Estimates be reduced by $100\".
Madam, my first cut is on public transport capacity. The 2030 Transport Plan aims to double the length of the rail network to about 360 kilometres. This should relieve congestion, reduce travel time, and improve connectivity and frequency of service in the long term.
However, commuters are facing daily problems with crowded trains and buses, long waiting times and sometimes circuitous routes. They want to know how the Government and PTOs can improve their daily commute in the short term. More specifically, they would like to ask whether there is sufficient new transport capacity to serve the projected increase in ridership. Would the current congestion get worse before it gets better? I think these are very important questions that the Government and PTOs need to address immediately and I would like to ask the Minister to share with us the Ministry's projections on the capacity growth compared to ridership growth in each of the next three years, which is, this year, 2014 and 2015.
As we know, various factors can contribute to ridership growth. These include the reduction of COE supply, the latest MAS announcement to tighten car financing, increased tourist arrivals and improved connectivity and coverage of our transport network. Ridership growth on public transport in the short term can become a very serious problem if our transport capacity cannot grow in tandem with it.
If, indeed, the congestion problem is going to get worse in the near term, would the Minister consider accelerating the Bus Service Enhancement Programme (BSEP)? In other words, can he bring forward the schedule for implementing the BSEP? Or does the situation call for more express bus
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services over and above the 800 new buses under BSEP? We also need to think about how to tackle the challenges the PTOs face in hiring more bus drivers. Would we consider raising bus driver wages even higher to attract Singaporeans to take up the job, and, if that fails, could we tap foreign workers from new sources rather than Malaysia and China?
Now, Madam, if the transport capacity is going to grow more slowly than ridership capacity in the next three years and even if we do enhance the BSEP or add more express buses, if all these fails, then I believe we should resort to more aggressive demand management tools. This would help alleviate overcrowding, especially during the peak periods.
Dr Janil Puthucheary and other Members of this House had advocated \"Ride-for-Free\" for early commuters. I support their appeal. The current SMRT early travel discount of 50 cents for commuters arriving at the city centre before 7.45 am had very limited effect. And although it remains to be seen if \"Ride-for-Free\" can shift commuting patterns sufficiently, it is definitely worth a try. There should be, in my opinion, an \"economic clearing price\" to incentivise a sufficient number of commuters to wake up early and to travel during the pre-morning peaks.
However, I have several caveats for those supporting the scheme. It should be done, in my view, only for selected routes and there must also be an end date specified upfront to coincide with the easing of peak period congestion as new transport capacity is introduced, otherwise this will become a very entrenched scheme and the Government of the future may find it difficult to withdraw.
The \"Ride-for-Free\" would work better if companies, especially those in the CBD, are prepared to implement ‘flexi-hour' workdays. In this regard, would the Civil Service take the lead and introduce flexi-hour workdays especially where their departments are within the CBD. I would also ask the Minister to update the House on the progress of LTA's \"Travel Smart\" and \"INSINC\" programmes.
Madam, my next cut is on reliability. The last few years were punctuated with unprecedented disruptions to our train services. Notably, the breakdowns on the North-South Line (NSL) in December 2011 and the North-East Line (NEL)
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in March 2012, August 2012 and January 2013 have impacted many commuters.
These breakdowns have eroded commuter's confidence in the reliability of our public transport system. An unreliable transport system has ripple effects across the economy. It affects productivity and Singapore's reputation as an efficient place for business. Also, as the Government seeks to reduce demand for cars, it must provide a reliable public transport network as a viable alternative to cars.
The Committee of Inquiry which investigated into the train breakdowns on the NSL had released a full report in July 2012. This report contains a comprehensive set of recommendations. As for the NEL, a joint team formed by LTA and SBS Transit has identified the corrosion of cables as the cause of the NEL disruptions and has also drawn up many remedial plans.
I would like to ask the Minister to provide a progress update on the implementation of the recommendations by the Committee of Inquiry as well as the joint LTA-SBS Transit team.
Only by ensuring the reliability of the train service can we restore public confidence. This, I believe, should be priority number one for the LTA and the PTOs.
Lastly, given that train reliability and service levels had not been restored, I join my parliamentary colleague, Mr Liang Eng Hwa, and others in this House to call for another gap year where fares will not be increased. This is especially so because the Fare Review Mechanism Committee which has been formed by the Transport Minister has yet to complete its findings and recommendations.
Madam, my last cut is on connectivity. This relates to Land Transport Authority's plans to build sheltered linkways within a 400-metre radius from all existing MRT stations and a 200-metre radius of all bus interchanges, LRT stations and high-usage bus shelters.
I am, indeed, glad and pleased that the Government is heeding calls from commuters to provide a more pleasant walking experience between their homes and train/bus stations. This could prompt more Singaporeans to rely on the public transport network and could also reduce the need for feeder buses in
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some cases and would help in a small way to alleviate traffic congestion.
I would like to ask the Minister to share with us on the timeframe for LTA to construct these sheltered linkways and how would LTA determine which constituencies will receive priority. When can commuters expect this programme to be completed island-wide?
Madam, my last point is on private transport. Motorists are increasingly facing congestion on our roads. MOT has announced various plans to construct new roads. It would be good to hear from the Minister about the progress on the construction of new roads and highways, especially the Marina Bay Expressway.
Dr Lily Neo (Tanjong Pagar): The Land Transport Masterplan 2013 providing more connections and better services is laudable but will take a long time to materialise. There is great urgency to solve the congestion woes in the immediate term as commuters are greatly inconvenienced in the meantime. May I ask the Minister what plans are in place now to better solve the present congestion? Apart from causing public angst, our public transport system is a contributory factor against the productivity growth we aim for. Is MOT looking at all possible ways to have immediate relief for the congestion? Perhaps to incentivise change in behavioural patterns, by giving free public transport one hour before and after peak hours daily?
The Bus Enhancement Programme 2012, with 780 weekly bus trips, has not made any impact upon commuters. Will the additional 800 new buses announced be able to make a difference? How soon will the new buses be operational? Can all the buses be rolled out sooner within the next few years? Could Minister consider other measures or enhancements in the interim to relieve the present congestion such that commuters can see and feel at least some improvement in bus and rail transport in the next few years?
May I suggest that MOT gives priority and makes a targeted approach for the use of the new buses by getting better feedback in identifying the areas where the largest numbers of commuters are inconvenienced? As there is limited immediate resource available, it is best to target such areas that need improvement with the new buses or routes or feeder services. I also hope that MOT can have better communications with residents and try not only to provide the relevant service enhancements, but also to better explain any planned
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improvements and to get the end-users' views and feedback. Also, residents should be acknowledged for their contributions, especially when enhancement services have resulted from such views and feedback.
Bus and train ridership is on the increase, and it will be so with a growing population and the curbing of car ownership. My question is whether the planned service enhancements by MOT will be overtaken by this increase in the ridership in the immediate term as well as long term. Are the projections on the demands upon our public transport system sound? Is there a KPI set for ridership with ease and convenience?
My own concern is that improvements may not be palpable by commuters in the near term. It is important and easier for people to foresee a better tomorrow and to work closely with the Government if there is something at hand to show and to grasp. Communication is key to explain the many pressing constraints that may have hindered faster progress of improvements and yet allow people to visualise that things will get better.
The land here is small and finite. How does MOT plan to improve bus services with more roads while negotiating with other infrastructure needs, such as more housing? How will the extra 800 buses affect the traffic flow on our roads in the next few years?
May I ask the Minister on the situation of taxi availability since LTA's measures to tackle the shortage, especially at peak hours? Will the new measures with more taxis on the road affect traffic flow in the near term?
May I ask the Minister whether our public transport model needs a relook and is it not better to move away from the profit-orientated business model that is answerable to shareholder-interests, which may further add on to the cost of public transport here?
What are the causes for the frequent breakdowns and unacceptable customer service standards? Are problems mainly due to natural wear and tear or due to profit considerations with cost-cutting measures? Are there any intrinsic engineering difficulties rather than operator incompetence that cause the frequent breakdowns? Were there enough considerations for aftercare maintenance, in terms of engineering and costs, made at the stage of formulation and implementation of our public transport infrastructure previously? And do we have a more concerted effort to ensure plans have sustainability and smooth operation of our public transport? Are there synergy
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and consultations amongst stakeholders concerned? I hope it is not a case of passing over and relinquishing all responsibilities from planner to operator once infrastructure is built. Is it better to have the same planner operating and maintaining the infrastructure subsequently?
Will the Minister consider targeted subvention for certain sectors of the population, such as the retirees, students and the lower income? Rather than a blanket subvention for all, subvention in this manner will go to those that need it most. Will MOT at least consider giving more concessions to retirees and the long-overdue concession to polytechnic students?
I hope that MOT will prevent any increase in our public transport fares until public transport service improvements take place. Commuters argue that the public transport operators are making healthy profits and should not require more revenue presently. Perception on the ground is that there is more weightage placed on the interest of shareholders by transport operators. How does MOT regulate operators to ensure that there is better provision and standard of services? Could MOT incentivise our public transport operators to increase their efficiency and productivity?
It was announced last year that Changi Airport's Budget Terminal will be developed. Could the Minister provide an update on the status of the development, as well as some of the design features, of the new Terminal?
Mr Liang Eng Hwa (Holland-Bukit Timah): Mdm Chair, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] The problems we face in public transport is an urgent challenge. We not only need to resolve this well but also do it as fast as we could.
In the next few years, MOT needs to resolve the daily public transport woes faced by the public in the fastest possible time. In particular, priority should be given to towns with rapidly growing populations; and we really need to speed up our efforts.
To the workers taking public transport to and fro for work, it is the most annoying routine of their daily lives – huge crowds, long waiting time, multiple transfers, traffic congestion and so on. This kind of annoyance and stress is a
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daily affair. I am glad to hear the Deputy Prime Minister and Minister for Finance say during his Budget Statement speech that he will deal with this problem urgently. We also notice that during this Committee of Supply, MOT has received the most \"cuts\" and this reflects the utmost concerns of our Members of Parliament and also the public's expectations.
The new MRT lines will take a long time to complete. So, in the short and medium term, I think the only way out is to increase the number of bus services to overcome the shortcomings in our public transport service. The problem is that the two public transport operators are currently unable to increase the number of buses rapidly. They are currently also confronted with their internal operational challenges. I feel that they do not have the capacity to increase the number of buses now. During extraordinary times like this, I feel we should temporarily put aside the policy mind-set of having only two operators for the time being. We should invite other private bus operators to come in and increase the capacity of buses and expand bus services. Once the public transport situation has stabilised, we may then relook at whether we should go back to the two-PTO model.
At this moment, I want to reiterate my call that it is not acceptable to raise public transport fares during this period.
On the issue of alleviating crowdedness on public transport during peak hours, I support Members' suggestions to offer highly attractive concessions to commuters to travel before or after peak hours.
Dr Vivian Balakrishnan, Dr Teo Ho Pin and I are Members of Parliament serving Bukit Panjang. The highest number of complaints we receive within our constituency is on public transport. On many occasions, we have gone to the bus stops within our constituencies and witnessed the crowdedness and congestion during peak hours, both on buses and at bus stops. It was not a good feeling and it made us even more determined to improve the public transport situation in Bukit Panjang.
Clothing, food, accommodation and transport are the four basic needs in our daily lives. Currently, in terms of transportation, people expect the Government to do better. Unlike other countries, our Government has enough resources and the capability to resolve our public transport problems.
Besides pressing MOT to do more, I would also like to cheer on our very hardworking Transport Minister and his team and also give some
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encouragement to them. I have full confidence in the leadership of our Transport Minister and his capability and determination to resolve these problems.
I am grateful that the Minister has very resolutely allocated $1.1 billion to the Bus Service Enhancement Plan. Some Members in this House may have different opinions, but I am very glad that the Minister persisted and this will certainly give a strong boost in our efforts to improve public transport.
Minister Lui has on two occasions visited my constituency and travelled on the Bukit Panjang LRT. After the second visit, he brought good news. He announced that the Government will set aside $56 million to help the LRT operators buy more LRT trains and to increase passenger capacity by 50%. I am very grateful to the Minister. From this, we can also see his approach of solving problems, that is, he will go down to the ground to see the problem and take actions decisively.
I firmly believe that our public transport problems can be resolved and public confidence can be restored. As I see it, there is light at the end of the tunnel. So, I would like to thank the Minister and I hope that he will continue to work hard to resolve the challenging issues in public transport.
Dr Janil Puthucheary (Pasir Ris-Punggol): Mdm Chair, in the Budget debate, I suggested a possible tool to use in demand management in the MRT – a period of free travel prior to the morning peak. Would the Minister consider this suggestion? I have a few more ideas and suggestions on this issue.
There needs to be a buffer period between the end of free travel and the start of the peak, to avoid a sudden crush. As the behaviour of our commuters changes, the timing, the duration and the interface between the free window period and the normal service may need to be calibrated. We certainly do not want to drive bad behaviour as an unintended consequence of this idea.
Another concern that was raised by the public was that the commuters who would have travelled early anyway would now enjoy free travel without changing their behaviour nor helping to ease the congestion. I agree that this is a concern, but I would add that this is an acceptable cost and an acceptable loss
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of economic efficiency to achieve a specific outcome, namely, a reduction in the peak-hour congestion.
Nothing is truly free. There will be a financial cost associated with the implementation of this idea and I have already suggested that the funds allocated to demand management may be used to directly support this initiative. If that is insufficient, as some further subsidy may be needed and, if so, I would agree with Mr Cedric Foo that any support of this nature should be temporary and specifically time-limited. The subsidy or support would no longer be needed either when the capacity is increased to the point where the crush is significantly reduced, or if the transport operators are able to develop a financing model where some revenue is specifically allocated for this. If there is going to be ongoing Government subsidy to support this, I would suggest that any fines for service lapses levied on the transport operator are linked to this process and docked from the Government subsidy and assure commuters that the fines levied are translated directly into subsidising their commute.
I also support the calls made by several of my colleagues that a shift in travel time to work should be accompanied by a shift in the travel time to go home. We cannot expect people to go to work earlier just to put in an even longer day.
The Chairman: Mr Ang Wei Neng, you have two cuts. Take them together.
Mr Ang Wei Neng (Jurong): Madam, many residents welcome the Walk to Ride scheme whereby LTA would build sheltered walkways within a 400-metre radius from all existing MRT stations. However, I would like to urge the Minister to consider building covered walkways up to 800-metre radius from the MRT stations to provide more conveniences to the residents. This is because many residents, particularly Jurong residents who stay about 800 metres away from the MRT station, still prefer to take a walk to the MRT station as compared to taking a feeder bus. Residents could control walking time better as it is not subjected to traffic conditions. In addition, we notice that the shelter across Lakeside Drive, a minor road with one lane in each direction, near the Lakeside MRT station, has been quite effective in shielding residents from the rain. Hence, I hope LTA could consider building similar shelters at other minor roads as part of the Walk to Ride scheme.
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My next cut, Madam. Before I proceed further, I would like to declare my interest in the public transport industry as I am a staff of SBS Transit. On 7 March last year, I spoke about the need to incentivise commuters who travel before and after the morning peak hours by encouraging organisations to stagger working hours while we expand the train capacity. Thus, I am delighted that Minister of State, Mrs Josephine Teo, eventually launched the Travel Smart pilot programme on 2 October last year. I understand that the pilot programme involves some seven organisations to promote a more even distribution of travel demand during the peak hours. I hope the Minister could update us on the progress of the pilot programme and other related schemes on travel demand management.
In addition, I understand that there are about 11,000 civil servants working in the Central Business District (CBD). Hence, I would like to ask the Minister whether MOT has any plan to include these civil servants as part of the Travel Smart programme.
Mr Christopher de Souza (Holland-Bukit Timah): Given the many residential developments, including condominiums, Housing Development Board estates, landed property as well as schools along the Bukit Timah-Dunearn Road corridor, would the Ministry kindly provide an update on the progress of the Downtown Line 2, especially for the following stations: King Albert Park, Sixth Avenue, Tan Kah Kee, Bukit Panjang, Cashew, Beauty World and Hillview?
Residents I have met have requested for an update on progress. With its completion, the Downtown Line 2 which runs beneath Bukit Timah Road will assist so many students to reach their schools and families to return home while also reducing the need for vehicular traffic along Dunearn and Bukit Timah roads. Hence, its timely and safe completion is a priority to our residents and to me. Would MOT provide an update on the line's progress?
Ms Faizah Jamal (Nominated Member): Madam, the Land Use Plan envisages major infrastructure expansion of MRT services and lines. I refer, in particular, to the 50-kilometre Cross Island Line that begins in Changi, moves westwards through Loyang, and cuts through the Central Catchment Nature
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Reserve to Bukit Timah, and ends at the Jurong Industrial estate. Of major concern to me is the fact that it cuts through the Central Catchment Nature Reserve because in these areas are the oldest patches and some of the least affected forests, the green lungs of Singapore, where some species of flora and fauna are found nowhere else in the world. If this proposal pans out, what is of concern to me is that beyond the MRT line and with the plans for housing so close to the vicinity, the forest habitat in the Central Catchment Nature Reserve will deteriorate.
Madam, with respect, I would like to seek clarity on how MOT made the decision to do so in a nature reserve which most people would consider inviolate. In particular, I would like to ask these questions: whether MOT had conducted any environment impact assessment (EIA), no matter how preliminary, to warrant the plan in the first place; if there had been an EIA, no matter how preliminary, whether these studies were made in conjunction with other agencies, and what were the terms of the commission and their preliminary conclusions; and lastly, may the public have access to these studies for the sake of clarity and transparency?
Mr Ang Hin Kee (Ang Mo Kio): Madam, recently I visited a block of flats near the MRT tracks in Ang Mo Kio. The daughter of the resident was studying hard but she had her earphones on to block out noise from passing trains in order to concentrate on her homework. Last year, I brought up similar concerns raised by my residents on the high noise level they have to deal with from passing MRT trains.
Many have been encouraged by the fact that there has been successful installation of noise barriers at Jurong East and Bishan to reduce passing rail noise. And recently, LTA also announced that they would install noise barriers at three more sites. We also understand that LTA has completed noise measurement studies which began in 2011 and it covered the entire length of all elevated MRT tracks island-wide.
We are very encouraged by these studies and we hope to hear from the Ministry on what are the implementation plans to build or install more noise barriers along MRT tracks. In particular, I would like to repeat my call for Ang Mo Kio to be included in this installation and especially so since the estate is fairly old and the MRT track has been there for many years. The new Cross Island MRT line will also cut through Ang Mo Kio and we hope that LTA and
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MOT will consider speeding up the installation of such noise barriers.
The Chairman: Mr Gan Thiam Poh, you have two cuts. Please take them together.
Mr Gan Thiam Poh (Pasir Ris-Punggol): Thank you, Madam. Given the significant investment in rail projects announced by the Government recently, what is the role of the public transport operators (PTOs) in ensuring that there is sufficient capacity to meet travel demands of commuters, especially in the short to medium term? With the recent fire at Newton Station and train disruption incidence, has there been an upward trend in service delays? What are the LTA and PTOs doing to improve train reliability? Are there targets set both for the short term as well as for the long term? Given the long lead time to bring about additional train capacity, what is the Ministry doing in the meantime to improve the crowding situation?
Madam, my second cut. Deputy Prime Minister Tharman announced a $1.1 billion Bus Service Enhancement Programme (BSEP) that would put 550 more buses on the road. Since the programme started last September, I understand that bus operators have already added some 90 buses, improved over 50 bus services, and opened five new routes.
Can the Minister update us on the progress of the BSEP and whether there is any scope to accelerate the implementation so that more Singaporeans get to benefit from the programme? The Minister also mentioned recently that there is an intention to involve more private operators in providing more bus services, especially during the morning peak, express services and the shorter bus routes will feed into the MRT stations. Can Minister please elaborate on how this will be done?
It was announced a few weeks ago that there is a need to look into improving en route reliability and also to ensure more regular waiting times. Can the Minister further elaborate on how this will be implemented?
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Mr Gerald Giam Yean Song (Non-Constituency Member): Mdm Chair, MOT recently said that it was exploring private bus operators' interest in new, shorter services that feed to MRT stations, and that these new feeder services could be outside of the current Bus Service Enhancement Programme (BSEP)
During last year's Budget, it was announced that of the $1.1 billion budgeted for the BSEP, $280 million had been budgeted for the purchase of 550 buses over the next five years, and $820 million was budgeted to cover the net operating costs of these buses for 10 years. My understanding then was that the BSEP budget was to supply additional buses and drivers to the current two public transport operators (PTOs). How do these new bus services, contracted out to private bus operators, fit into this budget?
Can the Minister share what is the estimated cost of this latest initiative? Is this latest move being undertaken because the two current PTOs are unable or unwilling to ramp up bus service coverage?
While I welcome additional buses and bus routes to ease congestion and reduce waiting and travelling time for commuters, do these new bus service contracts amount to a further Government subsidy of the two PTOs? And could the Minister share more details about how these new contracts are structured? I understand that the private bus operators would be paid a fixed contract price, and the fares collected will go to the Government. Hence, the operators will not bear any revenue risk.
Will there be any penalties for not meeting quality of service standards, or bonus payments for exceeding the standards? If so, what will these penalties and bonuses be like, and how will the Ministry ensure that service standards will meet the expectations of commuters?
Mr Seng Han Thong (Ang Mo Kio): The Bus Service Enhancement Programme (BSEP) was introduced to increase bus capacity and enhance bus service levels to benefit commuters. May I ask the Minister to update us on the progress of BSEP? How many new services and how many new buses have been added by now and by end of this year?
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With the shortage of bus drivers and other constraints faced by the public transport industry and the operators, how do we ensure that the new bus services can be rolled out progressively and service levels enhanced over the next five years?
The Minister also disclosed that LTA would put up some new routes under BSEP for tender. What are the kinds of routes to be tendered out and what is the response so far?
(In Mandarin): [Please refer to Vernacular Speech.] It is said that roads are generated by men. I would like to say that bus routes are also generated by men. Bus routes should go to where most people go. I want to share one experience. A few years ago, residents in our constituency asked for a change of the bus route. LTA was worried then because re-directing the route would mean longer journey on the bus. On the other hand, the old route meant more bus changes and some residents had to cross the road to catch the bus. With the concerted effort of the residents, grassroots leaders and LTA, the bus route was finally changed, to the convenience of the residents. What I want to say is that the residents would rather spend an extra 10 minutes or so on the bus, than wait at the bus stop gazing at the sky. We hope BSEP can be ASAP.
Mrs Lina Chiam (Non-Constituency Member): Madam, our buses and MRT have proven to be currently unable to cope with our population growth. Singaporeans are not sold on the Government's infrastructure plans to cope with the growing population. These plans have not yet been in sync with its population strategy. We need to bring back private bus companies and loosen regulations so that buses can compete directly with the transport giants which became monopolies through Government's assistance.
The taxi rental scheme is also not working. Rental fees are high. The curious pricing structure of cab fares forces drivers to play around the system. Due to the CBD fees, a taxi driver entering the CBD area in the early noon hours would not want to exit until he has a passenger going out. Taxi drivers may also have to strive for booking orders to increase their revenue. The general feedback we are getting from taxi drivers suggests that it might be a good idea to bring back the taxi ownership scheme. That would be a more meaningful way to incentivise taxi drivers to drive for longer durations and to clock more mileage.
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I hope the Minister will consider this.
Ms Foo Mee Har (West Coast): Madam, the 2030 vision of a high-quality public transport system shared by the Minister for Transport in support of the Population White Paper is something that many are looking forward to. But as the Minister acknowledged, we are in urgent need of nearer term solutions to improve Singaporeans' daily travel experience. Improving bus connectivity will make a big difference to the lives of many commuters, and should be achievable with better bus route planning and deployment.
Let me illustrate using bus services in my constituency as an example. Pandan Gardens and Teban Gardens are only about 2.6 kilometres to 3.2 kilometres away from the nearest MRT station at Jurong East. Many residents take a bus to connect to the MRT station before they go to their final destinations. Despite the relatively short distance, residents would regularly take up to 45 minutes to get to the station and they still have their MRT journey to look forward to.
The key issue is that, instead of feeder services, these residents only have trunk services to ride on, such as bus services 51 and 143 that begin their journey a long distance away. These buses may leave their depots at regular intervals, but after coping with irregular traffic and passenger activities along the way, they arrive at irregular intervals later in the bus route. In effect, they tend to \"bunch\" together, so that commuters find themselves waiting for a long time for the bus to arrive, before seeing two or three of them coming one after another. So, the first bus ends up being crowded with anxious commuters, the second bus would then be partly filled by the remainder of commuters waiting that could not squeeze into the first bus, whilst the third bus would then follow on relatively empty. This vicious cycle then repeats with the next set of commuters.
Madam, as you can see, not only does the reliability of the bus timings become an issue with trunk services, but bus capacities also become poorly utilised. I have made repeated appeals to LTA to provide a feeder service that allows for quicker bus turnaround and better predictability of arrival times at bus stops. Instead, LTA has added more capacity to the existing trunk services, which does little to improve the commuters' travel experience.
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I would like to ask the Minister if he would consider providing feeder services to MRT stations as a key priority under the BSEP to improve connectivity, so as to achieve better predictability and connectivity. Alternatively, would he consider directing some trunk service capacity to ply shorter routes, such as creating service \"51A\" or \"143A\"?
On the subject of more reliable arrival times, I would like to ask the Minister how the bus operators could be held accountable for timeliness of bus arrivals. Like in London and Seoul, operators should have robust fleet management capabilities to adjust their bus arrival times, so as to even out the regularity along the entire route.
Finally, I hope the Minister will direct the planning of transport infrastructure in tandem with the population growth in any one area. Over the last six months, we witnessed a 30% surge in commuters at Teban Gardens Road resulting from the relocation of households to the new SERS development at Teban Vista. Yet, our requests for bus services to be re-routed or expanded to meet increased demand were unsuccessful. Madam, I hope the Minister can look into these issues.
The Chairman: Ms Foo, your time is up. Mr Alex Yam.
Mr Alex Yam (Chua Chu Kang): Madam, I urge MOT to consider an overhaul of the transport regulatory system. I believe that the current system of zonal monopoly by the two main transport operators is detrimental to innovation and stands in the way of creating a more ambitious, more attractive and more customer-oriented transport system.
Improvements also cannot be siloed. The Swiss experience has been to enhance allied cooperation through car-sharing, taxi enhancement, expanding of grocery delivery systems, vehicle-free estates and making walking and cycling more comfortable and attractive.
In closing, unlike Ms Foo who has trunk services and no feeder service, Yew Tee, with its 82,000 residents, has two feeder services and no trunk service. So, I urge the Minister to consider the residents at the far corner of Singapore having to get up much earlier in the morning and, yet, have to contend with crowded trains and limited services.
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The Senior Minister of State, Prime Minister's Office (Mr Heng Chee How): Madam, with a rapidly ageing population, I think there is a need to look closely and re-examine the intra-estate or intra-town travel. For a younger population having to walk perhaps 400 metres to 800 metres may not be a big thing. But for the elderly, who have grown old in the estate, having to walk that distance to the town centre or to the market to shop, and then having to lug the groceries back that distance is not the same. So, the physical distance may be the same but the feeling of having to make that walk is not the same anymore. As a result of that, it may lead to greater unwillingness to venture out despite efforts by the HDB, for example, to render the estate barrier-free. You can walk, but you cannot go very far. So, I believe there is also a place for the intra-estate transportation to be relooked, to facilitate the movement of the elderly especially towards the town centre.
In this regard, I hope that MOT and LTA can work closely with other Ministries, such as MOH under the City for All Ages (CFAA) project, for example, to see how this could be piloted, and the lessons learnt can benefit the rest of Singapore, as we have to deal with the challenges of an ageing population.
Mr Cedric Foo Chee Keng: Madam, what is the right fare to charge commuters? This is a question that continues to be asked. Let me make an attempt to frame it. There are three principal stakeholders in this equation − the Government, public transport operators and the commuters. Let us take the perspective of each of these stakeholders in turn.
The Government recognises that it needs to subsidise public transport infrastructure, especially the MRT network, as all governments do for the reason that it is a very long payback investment and the private sector will not take it up. In fact, the Singapore Government does subsidise the public transport network, which some in the public are still unaware of. It builds tracks, tunnels, trains, train stations at its own cost. The reason why it does so is because these investments bring with it positive externalities for the economy and enhances the well-being of its citizenry. However, good governments, especially our Government, loathe the idea of \"unfunded liability\", a term Deputy Prime Minister Tharman used in his Budget speech. It would be irresponsible for the present Government to commit future generations of Singaporeans to fund current expenses in public transport more than it is necessary. So, it requires commuters to pay a fare when using public transport. The Government funds
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the infrastructure and the commuters pay a fare.
The Government also does not want to run the public transport network itself because it believes that this is best left to the private sector since having a \"profit objective\" drives efficiency. But when applied to Singapore's current public transport landscape, this is where the argument fails. The \"profit objective\" alone does not drive efficiency. It is \"competition\" that drives efficiency. Unfortunately, our two public transport operators (PTOs) are not subject to competition, the way we know it, except for the taxi sector.
If the two PTOs were subject to competition, they would not be able to raise fares or lower customer service because they risk losing market share. They would also do their utmost to reduce costs and improve productivity. We see this in many industries – the telecom industry, the airlines − whenever they are subject to competition, they become more efficient. Unfortunately, our two PTOs are two monopolies.
To the Government's credit, recognising that there is no competition to SMRT and SBS Transit, it formed the Public Transport Council (PTC) to regulate fare revisions. And the fact speaks for itself. Indeed, over the last eight years, from 2006 to 2012, the net cumulative fare increase, not annual, but the total increase has totalled only 0.3%. Singapore transport fares are also competitive against other major cities.
Let me move on to discuss the commuter's perspective. The average commuter is prepared to pay his fair share for transport, but he feels that price and service must go hand-in-hand. He also has sympathy for many others in the needy groups and he would look to the Government to help.
To answer the question of the right fare, I think the Land Transport Master Plan (LTMP) published in 2008 contains an answer, which is to cause the transport operators to \"compete for the market\". Since Singapore is too small to have two parallel MRT lines, competing for the market would result in competition. So, every five years, the PTOs will compete, and the one with the lowest fare will win the bid. I think, this way, commuters will come to understand that the fare is fair and transparent. I would like, Mdm Chair, for the Minister to comment on whether or not he will bring forward the implementation of the Land Transport Master Plan.
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Mr Lim Biow Chuan (Mountbatten): Madam, public transport fares are determined by the Public Transport Council (PTC). For any fare adjustment, there is a fixed formula for the fare increase. The maximum fare increase allowed under the formula is stated at Schedule 3 of the Public Transport Council Act.
Whilst the PTC has the power to approve fares, it does not have the power to order the public transport operators (PTOs) to grant concessions to any specific group of passengers. Thus, when MOT wanted to grant senior citizens full day concession fares, the Minister for Transport must wait for the PTOs to apply for a fare revision. Last year, the Minister for Transport said that he had to hint strongly to the PTOs to grant a concession.
In working out any concessions to be granted, the PTOs had to compute their expected fare revenue, and then work out how much less they would collect by granting such concessions. The PTOs will have to recover the revenue loss from other parts of its total fare revenue.
Madam, this situation is odd as the Government should not need to depend on PTOs to decide what concessions to give. Concessionary fares for seniors, school students, NSmen and any other interest groups should be a policy decision made by the Government. If there is justification for any groups to have concessionary fares, the Government should make a policy decision for these concessions to be granted.
I propose that the Government bear the costs of all transport concessions from the Budget. This is fairer to the PTOs instead of asking other passengers to cross subsidise these concessionary fares. In other words, all taxpayers share in the costs of the concessions because they are justified as necessary for policy reasons.
I urge the Government to grant fare concessions for Polytechnic students and for all passengers with special needs or who are disabled. The Minister himself had said last year that he is sympathetic to these two groups. To me, this is part of the Government's obligation to look after Polytechnic students with no income as well as groups with special needs. I also call on the Government, for seniors who are above 60 years, allow them to travel free after
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peak hours. This is to acknowledge their past years' of contributions to nation building.
If the costs of granting fare concessions are borne by the Government, there is no need for PTOs to have any fare hike as they no longer lose revenue from giving concessionary fares. The PTOs can also afford to adjust the salaries of their bus drivers to a fair market rate. And this would not have any impact on fare revision.
It would also be timely to adjust transport fares to a more affordable basis as Government will bear part of the costs of public transport.
Er Dr Lee Bee Wah (Nee Soon): Mdm Chair, despite all the rumblings about our public transport system, Singapore has come a long way from the days of the Hock Lee bus and the Singapore Traction Company and the private taxis that plied between Tanglin Halt and Capitol cinema.
Indeed, I can understand the unhappiness voiced by the public when they read about our public transport companies making millions whilst the commuters are asked, from time to time, to pay more for their fares. Hence, the question pops up why the commuters have to pay more when these companies are already making $200 million to $300 million a year.
I know the Minister has defended the decision not to nationalise these operators as he believes they are more efficiently run because they are public companies. But where has the profits gone to? Why is the maintenance not up to speed, resulting in regular disruptions in services?
I would like to ask the Minister if he could then direct the Public Transport Council to take into consideration, amongst the various factors when reviewing fare increases to recognise the overall profitability of these companies and the dividends paid out to shareholders. This will, I believe, be a more equitable way in evaluating any request for fare revisions. In fact, for the next few years, I do not wish to see any fare increase as the standard of service is not satisfactory and the PTOs are still profitable and are paying good dividends.
Secondly, I would again like to ask the Minister to consider reviewing the fares of Polytechnic students. Polytechnic students should enjoy the same concessions as Junior Colleges students do. Refusing to grant Polytechnic
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students the concession is an anomaly which should be corrected. Sympathy alone is not sufficient.
Lastly is the evening ERP on our public roads. I feel that this ERP during the evening peak should be scrapped as it is not in line with our policy to be more family-oriented. Office workers are going home later so that they can avoid paying the ERP and by the time they get home, it is 8.30 pm or beyond. For residents in Yishun who work in city area, they have contributed towards ERP in the morning along CTE, not once, but many times. Moreover, the ERP is taking a toll on businesses in areas within the city. If there is a jam, the motorists will know how to bypass the route and they do not need a nanny to shoo them around. I hope evening ERP can be scrapped totally.
Mr Christopher de Souza: Madam, the Ministry's roadmap for a more geographically connected public transport infrastructure is to be welcomed. We can build on this and make public transport connected to, and accessible by, our disabled Singaporeans. This is in line with calls by the disabled community for fare concessions.
Given last year's depiction of the Budget as an \"inclusive\" one, with the Government pumping $1.1 billion into the operation of new buses, it is once more timely to ask if the Ministry would consider specially discounted public transport fares for disabled Singaporeans who apply.
Of course, should a disabled person not want a concessionary fare, then that decision would also be respected. But my view is that there are some with disabilities who would indeed find such a concessionary rate helpful, especially in getting to and from work. We should bear in mind that the disabled community is by no means asking for entitlements with these concessionary fares, but for some basic help. It is important to take into account several differentiating factors that set the disabled person apart from an able-bodied one.
Fare concessions for the disabled are a commonly implemented practice in many other countries. It is simple and compassionate, and the Government would do well to demonstrate its \"inclusivity\" by implementing such a concessionary scheme for the welfare of Singapore's disabled community – our community.
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Ms Jessica Tan Soon Neo (East Coast): Mdm Chairperson, over the years, the subject of transport concessions, including bus concessions for Polytechnic students, has been raised by several Members of this House, including myself. And, today, we have heard the same. As this continues to be a matter that has not been addressed – and at the risk of sounding like a broken record – I am again making an appeal for MOT to consider providing transport concessions for Polytechnic students.
Polytechnic students form the largest the population of the cohort of post-Secondary students. Currently, only JC and ITE students have transport concessions as students from Polytechnics pay twice as much bus fares. Whilst I understand the cost implications and that it is not a trivial matter, it is hard to agree with letting full-time Polytechnic students pay more than their peers in JCs and ITEs. Transport costs form a good part of a student's daily and monthly expenses and transport concessions for the Polytechnic students would be greatly appreciated.
Ms Lee Li Lian (Punggol East): Madam, my colleague, Mr Yee Jenn Jong, had during the COS debate last year stated that it was an opportune time to review the need for concessionary travel to be extended for the physically disabled as well as for Polytechnic students. I would like to take this opportunity to echo the call by Mr Yee as well as other Members in the House who had spoken in the past for fare concessions to be extended to the disabled.
The disabled community has been calling for concessions for over 13 years to no avail. I hope that the concession to be given to the disabled will be significant and will ease the financial burden on this group of individuals who tend to have lower incomes and higher expenses due to their disabilities. I also hope that the Fare Review Mechanism Committee would also consider giving the same travel concessions not just to those who have physical disabilities, but to those with special needs, such as Down Syndrome.
My next point is on the affordability of taxi services. While taxis continue to be viewed as private transport, they, in fact, fall mid-way between vehicle ownership and public transport, and it is a service used by many Singaporeans.
While it is the Government's position that taxi services should be left to the free market, the free market is constrained by quotas on taxis as well as taxi driver
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licenses. What further affects the competitiveness of the industry is that it is currently led by one major player, ComfortDelgro and several much smaller companies. This leaves the smaller players with less room to set competitive fares or rentals. According to a report from Asiaone.com, the National Taxi Association urged all other players to follow ComfortDelgro's upward revisions to surcharge and fares in 2011. Following these revisions, the Consumers Association of Singapore (CASE) raised concerns, asking ComfortDelGro to justify its taxi fare revision.
This points to a need to relook at how this industry is regulated, to strike a better balance, in terms of benefits for both commuters and drivers. I would like to ask the Ministry to call for a review of taxi service provision, taking into deeper consideration the following two points.
One, we must ensure that taxi services continue to be priced reasonably for the consumer. Taxi fares have, of late, increased significantly, not just due to increments in ERP, but also the extension of taxi surcharges to the point where commuters have to pay surcharges from 6.00 pm in the evening all the way till 9.30 am the next morning, including the midnight surcharge.
The next one, a report in The Business Times on 15 December 2012 analysed ComfortDelgro and SMRT's financials. It concluded that both transport operators can actually afford to raise salaries internally, without having to pass costs on to the commuters. Taxi companies should be obligated to demonstrate how fare increases correspond with benefits for taxi drivers, should there be any in order to justify fare increments. This review should also look into alternative ways to reduce the cost to drivers, such as lowering taxi rentals, instead of just increasing fares for commuters.
My last point, unlike Ms Foo and Mr Yam, Rivervale Crescent in Punggol East do not have any trunk or feeder services.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Madam, the issue of granting similar transport concessions to Polytechnic students vis-a-vis those currently enjoyed by their counterparts in the Junior Colleges and the Institutes of Technical Education is not a new one. In fact, it has been an issue of concern to past and present Members of this House. It is a perennial issue, going as far back to 2001 where Mr Yeo Cheow Tong was Transport Minister. Certainly, many Polytechnic students look forward to the day when the transport
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concessions granted to them can be harmonised to the level that is currently enjoyed by their peers in JCs and ITEs. Thus far, there has been nothing but disappointment.
[Deputy Speaker (Mr Charles Chong) in the Chair]
Sir, as more and more of our students make Polytechnic education as a natural choice of study after their \"O\" levels, the Government must ensure that the choice in education should not become an inequitable one when it comes to the transport fares and in light of the yawning income gap which affects many of the parents of Polytechnic students.
It must also be noted that the dividends paid out by the two transport operators to the shareholders per share has been increasing over the years. A better and more inclusive Singapore would take heed of the concerns of the Polytechnic students and seek to actively address them.
With this in mind and the contacts firmly established, I would like to call upon the Ministry, the Public Transport Council, TransitLink and the two transport operators to finally grant similar concessions currently enjoyed by JC and ITE students to their Polytechnic counterparts.
The Minister for Transport (Mr Lui Tuck Yew): Mr Chairman, first, let me express my appreciation to hon Members for the many thoughtful and thought-provoking speeches and suggestions both during COS and Budget debate.
As Mr Liang Eng Hwa had so eloquently reminded us, Members have also favoured us, MOT, with the most cuts and allocated time at this COS. Let me thank Members for that. Fortunately, it is only 50 cuts and not the proverbial 1,000 cuts.
Public transport is, obviously, a topic that is close to the hearts of many of our Members as well as Singaporeans, and I will try my best to sketch out some of the priorities and key objectives in the coming years, as well as respond to as many of the questions and issues raised as possible.
Before I do so, I thought it would be useful to take stock of what we have been doing for the past five years since we announced the 2008 Land Transport Master Plan (LTMP 2008). With Mr Chairman's permission, may I request for a summary of the key initiatives undertaken since LTMP 2008 to be circulated to
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Members for reference? [A handout was distributed to Members.]
I do not intend to run through the handout. I hope Members will take time to look at it. I would like to thank Members like Mr Alex Yam for their concerns over the progress of the Master Plan and I believe that this summary should give the House an overall perspective of the commitment that we have undertaken to enhance the overall land transport system.
I appreciate and understand Members' very real concerns about the public transport system. This reflects the feedback that Members hear from your residents and your constituents. We take these seriously, and one of the ways we try to understand these concerns better is through the annual Public Transport Customer Satisfaction Survey (PTCSS), which UniSIM conducts every year.
The latest PTCSS was conducted in October 2012 – as usual – and it shows that Singaporeans' overall satisfaction with the public transport system has dipped from 90.3% in 2011 to 88.8% last year. Satisfaction levels for bus and rail reliability also fell, by around one and three percentage points respectively. On the other hand, satisfaction on bus travel times rose by three percentage points to 79% from the year before and about 64% of respondents, when asked a direct question on whether public transport had improved in 2012 compared to the previous year, about 64% had indicated so and it was a yes and no question. So, about 64% had said yes and I hope that we will continue to see further improvements as we embark on some of the measures that I will talk about a little later on.
The general drop in commuter satisfaction stems largely from crowdedness and reliability issues. From commuter feedback as well as my own experiences taking public transport, I know that it can be congested on the buses and trains along certain stretches during the morning peak hours.
With your permission, Mr Chairman, may I display some slides on the LCD screens? [Some Slides were shown to hon Members.] If we take a look at the screens, we will recognise that peak hour crowdedness is not a phenomenon that only happens in Singapore; we see it in all major cities with mature metro systems. I have divided it into two groups – one that sets a standard of about four to five passengers per square metre, as we see in Singapore, Hong Kong, Taipei, London and so on. Currently, our crowding level during the most
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crowded periods in the morning peak hours is about four to five passengers per square metre, similar to cities like Hong Kong, Taipei and London. London is a little bit more crowded perhaps because their people are generally of a larger build and size, but these are the cities in this ballpark.
The next slide shows Members what the situation is in Tokyo, Beijing and Shanghai. I want to assure Members that we certainly do not intend to move in this direction. In fact, we want to do more in order to reduce the level of crowdedness that we currently face, and I will speak more on this later on.
In addition, I know that for commuters, uncertain waiting times for buses means that the journey is less predictable, and more stressful. When service disruptions or even short delays happen, commuters are inconvenienced.
I want to state unequivocally that the Government will spare no effort to address these problems. Over the last two months, I have announced our long-term plans on increasing public transport capacity. During the debate on the Population White Paper, I also covered the improvements over the next five years. I would like to assure Singaporeans that dealing with the needs of our commuters \"here-and-now\" is the key focus for my Ministry, even as we roll out our longer-term infrastructure plans. Let me now take Members through our plans to improve public transport in the near term, before moving on to talk briefly about the medium- and longer-term initiatives.
First, we will do whatever is within our means and capability to increase our public transport capacity in the short term. We will further speed up our bus service improvements, beyond what we had earlier stated and promised under the Bus Service Enhancement Programme (BSEP). This should make for more frequent and less crowded buses, as well as more bus routes. We will also run more train trips where possible, so that commuters have shorter waiting times.
Second, we will make sure that our buses and trains adhere more closely to their schedules and are more reliable. We will do this through stronger regulation, as well as incentive and penalty frameworks.
Third, we will more actively manage peak travel demand on our public transportation network, so that we can spread out and reduce the peak hour loads. Let me elaborate.
Mr Cedric Foo asked about how the increase in demand matches up with supply. The journeys have generally increased by about three percentage
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points each year. So, I hope Members bear that in mind as I talk about some of the improvements that we are making – journeys are increasing at three percentage points each year.
At last year's Committee of Supply debate, I spoke extensively about the BSEP. This intends to increase the public bus fleet by 20% over the next five years, or about 800 new buses, with 550 funded by the Government and another 250 by the public transport operators (PTOs).
I would like to update the House that progress has, generally, been good. We launched the BSEP in September last year. And as some Members have pointed out, we have injected around 90 new buses until the end of last year, to improve about 50 bus services that are currently running, as well as to implement five new routes. By the end of this year, I would add another 190 buses or so, to make up about 280, or about half of the 550 buses that have been committed by the Government under the BSEP, to be delivered by the end of the year.
The feedback I am getting on the ground from those who have already benefited from the BSEP is actually very positive. But many are asking me, when is my turn, and can you implement the programme faster? Members like Ms Foo Mee Har and Dr Lily Neo asked if we could do more to benefit our commuters. I have directed LTA to work with the PTOs to accelerate the BSEP. And given the good progress that we have been able to make so far, we will try to complete the bulk of the BSEP service improvements by the end of 2014, instead of 2016, as we originally envisaged. Of course, this is contingent on SBST and SMRT being able to raise salaries and recruit as well as retain enough bus drivers in a tightening labour market, but I think with some effort on all sides, we can do it. So, for those who are already benefiting from the 90 new buses introduced last year, they have indeed given very positive feedback. More will be able to benefit this year, including from Members' constituencies, and certainly by the end of 2014, we hope to have introduced the bulk of the 550 buses.
As I mentioned last month, I have also asked LTA to see how we can tap on the resources of private bus operators, given that the two PTOs' resources are already very stretched. In response to questions by, for example, Mr Gerald Giam, Mrs Lina Chiam, Mr Liang Eng Hwa, Mr Seng Han Thong and Mr Gan Thiam Poh, one of the things that we will do is to design and contract out six more City Direct bus services, which will run during the morning peak hours along the expressways into the city as well as during the evening back to the homes. The proposed new City Direct services will connect towns that are closer
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to the city area such as Ang Mo Kio and Bedok, to provide their residents with an alternative to the city other than the MRT. So, in addition to the towns that are further away, we will also include some of the towns that are nearer – Ang Mo Kio, Bedok and around the Clementi area, for instance. We will put up these six new routes for tender by private bus operators from as early as next quarter, and start rolling them out early next year. This will bring the total number of parallel bus services up from eight previously announced under BSEP to 14, and of the 14, we hope that nine will be operated by private operators. I do not yet know how they will respond, because we have just started this. In terms of pricing, in terms of the amount of competition that we will face, we will see, we do not know. But the intent is not for the two PTOs to participate. It is for the private service operators with their existing capacity to be able to service these routes.
Ms Foo Mee Har asked whether bus feeder services can be improved. Apart from the City Direct-type of services, we will also work with the private operators to see if it is also possible for them to run other shorter services during peak hours, such as localised routes in estates that bring residents to the MRT stations. We intend to invite tenders for these short services from the third quarter of this year, and to implement them progressively from next year onwards, provided the response from these private operators is good. Such services will add to the existing bus feeders already run by the PTOs and help us to more quickly address the problem of crowded feeder services during peak periods. So, we will push out more BSEP buses and have the PTOs run them and they will augment either the existing trunk or feeder routes as well as introduce new routes. But at the same time, we will want to try and maximise the resource from the private operators who may have some spare capacity, depending on their routings to be able to support us in these areas.
Let me now talk about trains and what we are doing in that regard. Mr Liang Eng Hwa said that he \"saw light at the end of the tunnel.\" Let me assure him that this light at the end of the tunnel is not coming from an approaching train, even though we will have many more of such trains running in the system, because we intend to increase train capacity over the next five years, as we receive new trains and complete the re-signalling in phases from 2016.
SMRT has also shared with us their plans to buy another six trains on top of the 13 new trains that are coming in next year and the 22 trains that will be coming in 2016 – six more trains on top of those already announced plans, and this will increase the train fleet that we have today by about 30%. The train fleets for the North East Line and the Circle Line will also increase by about 70% and 60% respectively in 2015, when the trains that we ordered last year will be
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delivered.
I know many Members, like Mr Cedric Foo, Dr Lily Neo and Mr Gan Thiam Poh, remain concerned about what we can do about rail capacity in the short term. To improve the daily commuting experience on the rail network, we will be running more trains wherever possible, so that commuters will have shorter waits generally. We intend to improve train frequencies so that commuters will not need to wait more than five minutes for the next train other than during the first and the last hour or so of train operations each day when the ridership is very low. Currently, commuters sometimes have to wait as long as seven minutes, and we would like to bring that down, as I said, to about five minutes. We will also step up the frequencies of the trains during the shoulder peak periods, so that on average, each train will arrive at an interval of about three minutes. So, during the very peak periods, it is coming in now at two minutes, which is what the limit of the signalling system allows, but at the shoulders, we will step up the frequency or the headways of the trains, so that on average they will come in at about three minutes.
All these improvements will require the train operators to run, we estimate, about 10% more train trips than what they are currently doing today. Commuters on the North-South and East-West Lines will benefit starting from the second half of this year. Those on the North-East and Circle Lines will benefit when the new trains are progressively delivered starting from 2015. Let me assure Members therefore that there will be more train trips during heavy-loading periods to cope with growing ridership in the coming years.
I have talked about capacity improvements in the short term that will help us cope with high ridership. But many Members like Mr Gan Thiam Poh and Dr Lily Neo have rightly pointed out that what also matters is that the buses and trains come regularly. I share this sentiment. Even with more buses from the BSEP, commuters tell me that waiting times for buses at their bus stops can be irregular. Sometimes, they wait a long time for their bus and then two or three buses come all together, especially during peak hours, like what Ms Foo Mee Har has so eloquently described.
Let me first touch on bus speeds and reliability. We will give even more priority to buses on our roads. Today, we have about 180 kilometres of bus lanes and the Mandatory Give Way to Buses Scheme at over 200 locations. Over the next two years, we will spend around $50 million to enhance bus priority. We will add about 30 kilometres more of bus lanes, increase the Mandatory Give Way to Buses Scheme by another 150 bus stops, and quadruple the number of bus hubs, where several buses can come in and pick up passengers
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or discharge them all at the same time. Currently, we have about 10 and we will quadruple that to about 40. We will also have to step up enforcement of bus priority schemes, as infringements by motorists result in delays for buses and their commuters.
Over and above the existing Quality of Service standards, we will also introduce a Quality Incentive Framework to improve the regularity of bus waiting times for commuters. Under this new framework, operators will need to enhance their enroute management of their bus operations to earn incentives and to avoid penalties. This means making appropriate interventions and giving guidance to the bus drivers even as the buses are running on the roads. In effect, what it means is that the operations centre will have to be a lot busier, will have to be a lot more proactive and prescriptive, to help buses reduce the incidence of bus bunching or the long gaps between consecutive buses. They will have to ask the buses to speed up or to slow down where appropriate and, where necessary, introduce some buses mid-stream when this is warranted.
This is something that London has implemented a number of years ago and through their experience and revisions over a number of years, they have a system that runs pretty well today, and I am keen to take a step forward to try this out. Hopefully, this is something that, over time, will address Ms Foo Mee Har's pertinent concerns about the timeliness of bus arrivals. We aim to trial and refine this scheme on some 25 services, or about 10% of the bus services that we have today, starting in the second half of this year.
For trains, reliability is an even bigger issue because a disruption or service delay affects many more commuters. I agree with Mr Cedric Foo, who spoke about the importance of train maintenance as increasing ridership puts even greater pressure on an ageing rail system. While our rail operators fare reasonably well as compared to other metro systems around the world in reliability, train withdrawals and service delays do adversely affect the travel experience.
We have therefore been working closely with the PTOs to arrest the number of train withdrawals and delays. Here, I would like to share with Members a number of slides to show you what has been happening [Slides were shown to hon Members]. This is also data that we have put onto the website on a quarterly basis, in fact, in even more detail than this so that riders and
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commuters can go in and take a closer look.
Since the commencement of the LTA-SMRT Joint Team in June 2012, train withdrawals for the North-South and East-West lines have been reduced from about 4.5 per 100,000 train-km in the second quarter of 2012, to about 2.8 train withdrawals per 100,000 train-km in the fourth quarter of 2012, and then now to about 2.7 in the first two months. What does it mean? It means that for every 1,000 trips that the trains make, we should see one withdrawal – or roughly about 99.9% success rate of not having a train withdrawal.
We cannot stop at this, and in fact, we need to do more because the target we have set for ourselves is 2.1 for 2013. We believe that it is stretched but achievable. Over the longer term, we intend to reduce the number of train withdrawals to one for every 2,000 train trips.
The North-East Line and the Circle Line have actually relatively healthier train withdrawal rates, and they are stable at around 0.7 and 1.2 withdrawals per 100,000 kilometres respectively, compared to the 2.7 that we see for the Compass Line. Their health is not something to be taken for granted. The Joint Teams that LTA has with SBST and SMRT will also look into the reliability of these lines. Generally, they are doing good work there.
The Joint Teams are working to rectify the Overhead Catenary System for the North-East Line which had been problematic between HarbourFront and Outram on three occasions over the past 12 months as well as changing out the power cables for the Circle Line. We should aim to complete that by the end of this year.
I have also asked LTA and SBST to start planning for mid-life upgrades for the North-East Line and trains because they are now entering its second decade of operation. We have learnt useful lessons on what has been done or not done for the North-South and East-West Lines and also from our counterparts overseas, and we will apply them to the North-East Line and then to the Circle Line.
Let me talk about LRT because I think some Members are particularly interested in this aspect. LRT withdrawal rates are generally low because, basically, the driver in the loop is sometimes able to continue to drive the train even in a degraded mode. What we track instead are the trends of service delays on our LRT systems as we are mindful that even service delays without train withdrawals also cause inconvenience to commuters. The Joint Teams are
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studying the main faults causing these delays on our LRT systems, as well as ways to shorten recovery time when incidents happen. So, let me share with Members a slide on what is happening there [A slide was shown to hon Members].
Today, we see more stable levels of service delays for the Sengkang-Punggol LRT, and trends of improvement for the Bukit Panjang LRT. As Mr Liang Eng Hwa said, we visited that on two occasions, the BPLRT last year. We had LTA work very closely with the operator and they promised over a three-year programme to try to significantly improve the service delays for BPLRT, so we are seeing some improvement there and we have to continue to work even more of them on that in the coming years.
Members can see for yourselves that we have about 2.08 and 1.28 delays of more than five minutes for every 100,000 train-km on the BPLRT and SPLRT respectively. What it means is that on average, for those two systems, you should see a service delay of five minutes or more, roughly about once a week. These are systems that operate through most of the day and it is about once a week that you should see a service delay of more than five minutes.
With sustained Joint Teams' efforts to rectify these system problems and to actively carry out preventive maintenance, we do expect to see further improvements over the coming months and years.
Even as we partner the operators to refresh our MRT system and enhance train reliability, it is the Government's responsibility to set the correct standards in line with reasonable expectations of a high-quality public transport system.
We are close to completing our review of our rail regulatory and penalty frameworks, which will take effect from the second half of this year. We will be enforcing more stringent maintenance and service reliability requirements by increasing the prescribed penalties that operators will face for breaching them. We are raising the standards. We are also raising the penalties that they will face for breaching these standards.
In this regard, we are considering pegging the revised maximum penalty to a percentage of the affected MRT line's total annual fare revenue. Today, it is a cap of $1 million but we think that the more appropriate thing to do is to raise it to a percentage of the affected lines' total annual fare revenue, as a stronger deterrent against service disruptions and regulatory breaches. We will continue to review this over the next few months but we are close to finalising the
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frameworks that we want to implement.
The tightened regulatory and penalty frameworks reflect the importance that we place on a safe and reliable MRT system, but particularly on the impact that serious regulatory breaches can have on commuters. I have also asked LTA to strengthen its existing auditing capabilities so that we can more closely monitor the service quality and reliability of both the train as well as our bus services, and to be more responsive to any lapses that we face.
Let me move on now to talk about this new subject of spreading out peak hour travel demand that so many of you have spoken on. Even as we work towards increasing capacity and improving reliability, we need to better optimise our public transport capacity, particularly during the peak hours, and especially since the significant improvements to peak hour train capacity will only happen from around 2015 to 2016 onwards, with the re-signalling programme and so on on the North-South Line.
Today, the commuters who face peak hour congestion on trains are predominantly the ones who are trying to reach the city area to get to work. For example, if we take a look at the exit data for Raffles Place station, the large majority of commuters travelling to this station every morning make their exit between the 8.30 am to the 9.00 am window [A slide was shown to hon Members]. At the bottom, it is on the \"X\" axis, 15-minute intervals; on the \"Y\" axis, it is exiting passengers. This gives Members an idea of the spread of passengers exiting Raffles Place MRT station during the morning hours up to about 11 o'clock in the morning. The very high peak in commuter loading on our train system is obviously something that we should try to spread out, or what we call in technical jargon, demand management. If we can get 10%, 15% to 20% of commuters in the peak period to travel, say, up to an hour earlier, we would achieve a very perceptible improvement in commuters' daily travel experience to get to work. This will also help us to run a more efficient transport system and better optimise the capacity that we have.
Hence, over the last year, we had made our travel discount schemes more attractive to get commuters who are able to shift their travel patterns to do so. Today, under the SMRT's Early Travel Discount scheme, commuters who enter the SMRT network can enjoy a discount of up to fifty cents for the train journey if they exit at any of the 14 designated city area stations before 7.45 am. Commuters travelling off-peak, both before or after the peak period, can also accumulate more points to win cash prizes of up to $200 under another scheme, called the Incentives for Singapore's Commuters, or the INSINC scheme for short. Both schemes have had some effect in reducing peak crowding – the
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SMRT scheme has seen a three to four per cent shift to the desired level outside of the peak hours to before 7.45 am, while INSINC has seen significant growth in its membership, with more than 68,000 members since its launch in January of last year.
Shifting the peak hour demand into the pre-peak period, where there is excess capacity, benefits both pre-peak and peak hour travellers. Therefore, we are prepared to significantly increase the incentives to encourage travellers who are able to do so, to shift their travel in this manner. Over the past week, there has been a lot of discussion on Dr Janil's idea to allow commuters to travel free on public transport before the peak hours. Many other Members like Mr Liang Eng Hwa, Er Dr Lee Bee Wah, Mr Cedric Foo have chimed in, in support of his idea. Certainly, this is an idea that we will not dismiss off-hand and I have asked my staff to consider it seriously. What we are still studying is whether we should simply increase the current fifty-cent discount substantially to say, $1, or to go all the way to make it free for commuters travelling before a certain cut-off time in the morning. But rest assured that we certainly want to do more to encourage more commuters to shift out of the peak hour.
I should, first, qualify that we are not planning to shift every commuter out of the peak period. As some members of the public have since pointed out, after Dr Janil's suggestion came out, if that were to happen, we would simply be creating a new peak but earlier in the morning, and that is not our intent. So, the fact that there have been mixed views over whether commuters are prepared to shift their travel times should they be offered free travel, is actually quite reassuring and certainly no bad thing.
More importantly, even as we are studying how to enhance the Early Travel Discount scheme for the city area, we also need to work with employers in the CBD. There is simply no point if people get to work early but are unable to start and leave work early. Let me share with Members some Straits Times comics which I found quite interesting. Otherwise, what we see here if they really cannot start and end earlier is that this cartoon may very well come true – you wake up early so that you can get on the MRT in time to, say, travel for free, but because you woke up earlier than usual, you end up sleeping at your workplace. As my former military counterpart would tell me, this is exactly what is meant by \"hurry up and wait\".
I recall Ms Irene Ng highlighting during the Budget Debate the need for employers to consider and improve flexi-work arrangements for their employees who wish to travel outside the peak hours. I fully support this. If employees adjust their travel times to come earlier to the office, we hope their
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companies will allow them to adjust their working hours and to leave office earlier.
The travel demand management workgroup that is co-chaired by Ministers of State Mrs Josephine Teo and Dr Amy Khor will continue to work with employers on flexi-work arrangements. Through the Travel Smart pilot launched in October last year, the LTA is already working with 12 organisations to put in place the necessary workplace practices to facilitate off-peak travel for their employees. In response to Mr Ang Wei Neng's question, the pilot includes both public and private sector organisations. To date, three of these organisations have already obtained management approval to put in place flexi-work measures for their employees, such as staggering work hours, introducing IT facilities to enable employees to work remotely, and even providing shower and locker facilities. These include, for example, Rajah and Tann, and BP Singapore.
The public sector will also continue to take the lead in enhancing flexi-work arrangements and in encouraging it to enable its officers to take advantage of the current pre-peak travel schemes and the enhanced schemes that will follow. In fact, most public sector agencies already offer flexible hours to their officers. And depending on the nature of work, officers in these agencies can choose the time they prefer to start work within a time-band, and leave office at a time corresponding to their start-time, as long as they perform 42 hours of work a week. For instance, if they come in at 7.30 am in the morning, they can leave work at 5.00 pm to have an early dinner with their families.
I would like to end off this part of my speech on travel demand management by saying that we are committed to spreading out travel demand outside the peak hour. If we achieve a more even travel distribution, it will be a win-win situation for all. For those who have supportive employers and are able to travel earlier, then they get to enjoy the enhanced benefits that we will introduce and have a less congested ride to work in the morning. I know that there will be some commuters who will still need to travel during peak hours, for example, because of family routines like sending their children to childcare or to their parents' place before they can go to work, and so they are unable to shift their travel times even if their employers were to be very supportive of the arrangement. While these commuters may not enjoy the discounted travel, I believe that the travel demand management schemes will benefit them also because they will have a less congested and stressful ride during peak hours if
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other commuters have shifted their travel behaviour.
As we work towards faster and more reliable bus and rail journeys, let me also update Mr Cedric Foo and all Members on our plans to make it easier and faster for commuters to get to our train and bus stations.
I had earlier announced plans to build 200 kilometres more of sheltered walkways around train stations and bus interchanges under what we call the \"Walk2Ride\" programme. This comprehensive programme will greatly improve connectivity around such transport nodes and other amenities. To put this in perspective, 200 kilometres of shelter is like being able to cross the entire length of Singapore five times without going under the sun.
Commuters have asked me – what if I need to walk more than 400 metres because my walking route to the station is not a straight line but weaves in and out of HDB blocks? Mr Ang Wei Neng, too, holds these concerns and he would like it to be extended even further. Let me assure these commuters that we do take a flexible and pragmatic approach in building these walkways. In rolling out the \"Walk2Ride\" programme, we consider straight line rather than walking distance of 400 metres. So, it is a straight-line distance, we draw a radius around it, and therefore, actually, the linkways may eventually end up being longer than 400 metres, depending on the route that is chosen because we want to make sure that we make our public transport services as convenient and as accessible for as many commuters as we possibly can.
About 90 existing MRT stations and 43 LRT stations, as well as 25 bus interchanges and 100 major bus stops, will be connected. LTA is working with the local communities to plan where, how far and when the walkways should be built. The tender for the first batch of about 20 MRT stations will be called this quarter and subsequent tenders will be called every quarter. The list of stations in the first two batches of tenders will be posted on the LTA website later today. So, rather than me trying to run through the list, please refer to the website and see if you are one of the lucky ones.
A more comfortable walk to train stations and bus stops matters. So, too, does less intrusion into the lives of Singaporeans, particularly for residents whose homes are near elevated MRT tracks.
While we work with SMRT to step up maintenance for tracks and trains to minimise railway noise, we are also building some 20 kilometres of noise barriers along MRT tracks where the noise levels exceed the NEA's guidelines.
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We expect to begin works later this year and aim to complete them in phases by around 2020. And so, certainly, residents living close to MRT viaducts like those along certain stretches of Ang Mo Kio station, as mentioned by Mr Ang Hin Kee, can look forward to a noticeable reduction in noise levels once the barriers are installed.
Why does it take so long? The installation of noise barriers will need to be coordinated with ongoing renewal works on the North-South and East-West Lines, such as re-signalling as well the replacement of sleepers that are used to hold the MRT tracks in place and the regular maintenance works that needs to be done. No point putting up a barrier and then when we do the re-sleepering works, we have to take the barrier out because we need access to the space to change the sleepers and thereafter to put it back again. I think it is probably duplication of effort for which we will be held accountable. So, it needs to be coordinated with the other works that is ongoing. And, certainly, I want to assure Mr Ang Hin Kee and all Members that we will try to speed up these installation works as much as possible but there are also technical challenges like limited engineering hours available.
The next point I would like to make is that it is likely, therefore, that we would have to carry out regular service disruptions – planned regular service disruptions – during some revenue hours, so that more time is available for these works to be carried out and so that the overall improvements to residents and commuters can be completed earlier. This is something similar to what we have announced for the Circle Line when we changed the cable. We will try to, for instance, on that occasion – for some Sundays – revenue service may start several hours later than usual for segments of our rail network. For Circle Line, we announced that it was between, I think, Mountbatten and Paya Lebar, and certainly for elevated tracks, we will also have to do likewise. And we will give advanced notice and try to reduce the inconvenience to commuters as much as we possibly can. So, I ask for patience from Singaporeans as we try our best to do these works in the shortest time possible.
These numerous improvements to our public transport system entail massive investments. The Government has committed to the expansion of our public transport network for the medium to long term. The operators, too, need to fulfil their roles to ramp up capacity and ensure higher levels of reliability. As the system ages, the responsibilities of the operators on the rail system become even more important.
I thank Mr Gan Thiam Poh for his concern over the role of the PTOs in bringing out greater capacity to meet the expected increase in travel demand.
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Under the existing rail licences, the train operators are indeed responsible for replacing and adding capacity to meet ridership needs. On its part, the SMRT has committed $750 million over the next few years to purchase more trains for the North-South and East-West Lines, the Circle Line and the Bukit Panjang LRT, under plans to meet increased ridership. I believe I have made that point clear in reply to a PQ that was filed by Er Dr Lee Bee Wah. For the North-South and East-West Lines, the SMRT is also replacing the signalling system, and earlier this year, they had announced the commitment to overhaul the first and second generation trains for the North-South and East-West Lines – this is by SMRT.
These are necessary investments to enhance and renew the ageing rail system and improve the resilience of the network. We will work with operators to ensure that they set aside sufficient funds to meet their commitments to these investments where necessary.
The cost of these investments would have to be properly shared between the Government, the operators and the public. We must seek a balance where the public transport system remains financially viable for our PTOs, but fares kept affordable for all commuters.
As privatised operators, and let me share with Members a slide on the average fares [A slide was shown to hon Members]. As mentioned by Mr Cedric Foo, our PTOs are incentivised to keep costs down and improve productivity, and also to develop new revenue sources, such as rental and advertising, which help to defray operating costs. But more importantly, non-fare revenue helps to reduce the need for fare increases, and this has allowed commuters in Singapore to continue to pay fares that are among the lowest across major cities. So, regardless of whether you are talking about privatised models, nationalised model, whatever it is, the most important thing is what is the end outcome for commuters. Do you have a good, reliable system? Do you have fares that are affordable? I think, therefore, when we compare against some of the major cities around the world, our fares, generally, are quite affordable. In fact, the percentage of household expenditure that is spent on public transportation has fallen over the years.
But we know also that the reality is that operating costs have gone up. Diesel prices went up by about 55%, national wages by over 25% from the 2006 to 2011 periods, while as Mr Foo has reminded us, our fares increased cumulatively by 0.3% over the same period. So, this has put the financials of the PTOs under some amount of pressure, and I think if you were to recall from reading the press coverage, this is especially so for the bus industry. We are monitoring the financials of the bus sector very closely and we will have to
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explore assistive measures if they are indeed needed. Against the backdrop of worsening bus industry financials, I expect that it will be a challenge for the PTOs to do more to expand and enhance bus services without additional assistance.
What form this revenue assistance will take is to be decided. I am mindful of the calls from a number of Members, led by the redoubtable Mr Liang Eng Hwa and Er Dr Lee Bee Wah, Dr Lily Neo, Mr Cedric Foo, amongst many others, to freeze transport fares. This has to be considered together with the additional task of studying the affordability of public transport fares, which I had recently asked the Fare Review Mechanism Committee to undertake. Whatever fare formula is proposed, we must safeguard commuter interest in affordable public transport fares, while balancing against the very real financial pressures faced by the PTOs.
In this regard, I share the concerns that have been expressed over the affordability of fares for various groups of commuters, such as the disabled, the low-income and the Polytechnic students. Members like Ms Denise Phua – during Budget debate – Dr Lily Neo, Er Dr Lee Bee Wah, Ms Jessica Tan, Ms Lee Li Lian, all the ladies, as well as gentlemen like Mr Lim Biow Chuan, Mr Faisal Abdul Manap, Mr Christopher de Souza, Dr Teo Ho Pin, and during the Budget debate, Mr Cedric Foo, asked how we can better support them in public transport fares. And also, I thank Mr Lim Biow Chuan for not only raising the needs of these groups but also suggesting that the Government should take on the burden and the responsibility of paying for these concessions.
I thank Members for their interest in the recommendations of the FRMC, but let us be patient, let us give them a bit more time, and I think we will be better able to address questions on fares when the report is released, likely around the middle of this year. And, meanwhile, the Chairman of the FRMC, Mr Richard Magnus, has already shared some of his views on concession schemes through his blog, indicating some of his own preliminary thoughts on how fares policy can ease some of life's pressures for some of these groups who may need help. This aspect of our fares policy I know is something that we hold dear to our hearts and I believe in doing more wherever possible. So, I have changed from being sympathetic to doing more wherever possible.
When we launched our Land Transport Master Plan 2008, we were confronted with a declining public transport mode share and it was a worrying trend. However, we appear to have turned the corner five years on. According to the interim results from the Household Interview Travel Survey for 2012, about 62% of all trips during the peak periods are made on public transport, up
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from 59% in 2008. So, in 2008 it was 59%, 2012 it was about 62%. And so that partly accounts for why journeys have increased about three percentage points each year. Also, we find that more car-owning households are using public transport for daily commute compared to four years ago. Now there are more people, who despite owning a car, find that it is preferable for them whether for cost, convenience or other reasons to be using public transport instead of their cars.
Much of this shift could perhaps be due to the rail expansion programme that we have put in place over the last few years. Our rail network has increased by about 30% since 2008 – it was about 140 kilometres then, now it is about 180 kilometres today – and we have plans to further expand the rail network to 360 kilometres by 2030. And what we will hope to achieve in terms of public transport mode share during the peak periods is, as we have mentioned before, 70% in 2020 and 75% by 2030.
But we still have much to do to make public transport a choice mode. Our system and policies must be more commuter-centric and responsive to fundamental demographic changes, such as an ageing population. Commuters must be convinced that public transport can serve their needs, and get them to their destinations reliably and comfortably.
As part of the process for our Land Transport Master Plan (LTMP) 2013, we conversed with a wide range of stakeholders on the land transport system, through Our Singapore Conversation, focus group discussions, and online forums. Public transport commuters, motorists, cyclists, taxi drivers and customers, as well as environmentalists and academics, have shared their views. And I thank all stakeholders who have contributed to the formulation of LTMP 2013 which we would formally launch probably in the second quarter.
Let me assure Singaporeans, including Ms Faizah Jamal, that our partnership will not end there. For instance, as part of our preliminary planning for the Cross Island Line later this year, we will be engaging citizens, like yourself, who are concerned about the impact of the Cross Island Line on the Central Catchment Nature Reserve, which is also a natural heritage that we must share and safeguard as a nation. We will continue to converse with stakeholders as we implement the Master Plan. The diverse and sometimes conflicting views of commuters and stakeholders have helped to sharpen our focus as well as better understand the tradeoffs in addressing the key issues
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before us.
Over the last two months, I have shared some of our plans for the longer term and many Singaporeans have asked whether the plans are indeed sufficient to cope with a higher population in 2030. Given the exceptionally high level of ridership growth on our public transport system of 35% in the last five years, and the day-to-day experience of crowded public transport, many Singaporeans were concerned whether we could cope.
We can cope. First, the nation is expecting the rate of population growth to slow down, and the Government is resolute on this. Ridership will continue to increase, even as the shift mode share and the population growth in the most extreme case by some 20% to 30% from what it is today, based on the population scenario of 6.5 million to 6.9 million. So, if it is 6.5 million, it will be about 20% increase from what it is today. If it is 6.9 million, it will be 30% from what it is today. On the other hand, by 2030, we will double our rail network to about 360 kilometres, and more than double the overall MRT capacity delivering commuters into the CBD. So, I am confident that we will have enough capacity to meet demand over the long term.
More importantly, with our new rail lines like the Cross Island Line and Jurong Region Line, Singaporeans will be more connected to their destinations than ever before. I said that in time to come, eight in 10 homes will be within a 10-minute walk of a train station, and therefore it really means that many commuters will no longer need to rely on bus feeders to get to the MRT station or they will have a much shorter period than what it is today. Therefore, with shorter, more direct train routes from more parts of the island, journey times will also come down.
These new rail lines may seem very far in the future. But Singaporeans will not have to wait that long for more connections and shorter journeys. Commuters can already look forward to benefiting from the rail lines that are close to completion. Starting with Stage 1 of the Downtown Line later this year, new lines or extensions will continue to open almost every year for the next five years.
Mr Christopher de Souza will be pleased to note that the Downtown Line project is on track to serve residents previously not directly connected to our MRT lines, such as those living in HDB estates in Hillview or private estates around the Hillview area, and along Jalan Jurong Kechil. The Downtown Line will also effectively add 50% more carrying capacity in the eastern corridor.
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Residents in Ubi, Kaki Bukit and Geylang Bahru will have a choice of two MRT lines to get to the city centre. It is on track and we are watching this very closely for a variety of reasons. We have encountered some problems with conditions, sometimes marine clay and sometimes, very huge bounders that we have had difficulties tunnelling through. We have also been slowed somewhat because of the number of complaints have made regarding noise. So, as much as it is reasonably possible and with all due consideration to safety, we will make sure that we try and keep to the schedule that we have promised for the Downtown Line.
Beyond the Downtown Line is the Thomson Line and that will be completed in phases from 2019, and this will allow commuters to transfer to the five MRT lines by then with six interchange stations when fully opened. If I can show Members what the map would look like – very complicated, very congested. Today, we have about 15 interchange stations, including the LRT interchange stations, to provide connections and transfers for commuters. When the Thomson Line is completed, we will have 30 interchanges. What this means is that we think it will help achieve a better spread of morning peak commuters across the entire rail network, and it will also improve our network resilience, so that commuters have alternative routes in the event of a delay or disruption.
In the longer term, we will also facilitate more connections and integration between transport modes – bus, rail and other forms of travel like cycling. I will speak tomorrow on private transport and later on, Parliamentary Secretary Assoc Prof Muhammad Faishal will also elaborate on the extensive plans that we have for cycling and an inclusive public transport system.
So, we are planning ahead, expanding capacity, extending reach, and opening up more public transport travel options for commuters. There will be more people taking buses and trains in the long term, but I believe that they will be experiencing faster journeys on a more integrated network, which is much more extensive with many more connections. It will be a different public transport system, which will meet our nation's transport needs.
Sir, let me conclude. At MOT, we are not just focused on planning for the long term. We are actively seeking solutions to the real problems that commuters face today.
Increasing bus and rail capacity is one prong of our efforts. We are also improving bus and rail reliability, so that overall, we can reach high service levels that we should expect of a quality public transport system. We are also
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exploring ways to optimise existing capacities in our public transport system, be it through tighter regulation of operators, or encouraging shifts in commuter travel patterns.
So, let me assure Members of this House that the Government remains as committed as ever to realise the vision that was first set out in the Land Transport Master Plan of 2008. However, the public transport landscape today has changed from what it was five years ago, and we will respond to meet commuters' changing travel needs even as we refresh the Master Plan. We will spare no effort to strive towards meaningful improvements in commuters' travel experience.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply Reporting Progress","subTitle":null,"sectionType":"OS","content":"The Minister for Transport (Mr Lui Tuck Yew): Mr Chairman, may I seek your consent to move that progress be reported now and leave be asked to sit again tomorrow?
The Chairman: I certainly give my consent.
[(proc text) Resolved, \"That progress be reported now and leave be asked to sit again tomorrow.\"– [Mr Lui Tuck Yew]. (proc text)]
[(proc text) Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mr Lui Tuck Yew: Mr Deputy Speaker, I certainly beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2013/2014, and ask leave to sit again tomorrow.
Mr Deputy Speaker: So be it.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Adjournment","subTitle":null,"sectionType":"OS","content":"[(proc text) Resolved, \"That Parliament do now adjourn.\" – [Mr Gan Kim Yong]. (proc text)]
Adjourned accordingly at 7.24 pm.
\tPage: 183
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