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Helping Singaporeans Navigate a High-interest Rate Environment›Matter Raised On Adjournment Motion7 turns · 4,613w
· 25 highlighted
matter-adj-1973
The Leader of the House (Ms Indranee Rajah)18 words
[+1 sentence]Mr Speaker, Sir, I beg to move, "That Parliament do now adjourn."
Mr Saktiandi Supaat (Bishan-Toa Payoh)3144 words
[+3 sentences]Mr Speaker, I declare that I work in a financial institution in Singapore. Mr Speaker, Sir, as Prime Minister Lee has flagged in his recent National Day Message and National Day Rally Speech, the high rising inflation and cost of living is at the "top of everyone's minds" today. But, besides rising prices, rising interest rates will impact Singaporeans and their cash or payment outlays. Our domestic interest rates are likely to increase further in tandem with global interest rates as rates here are largely market determined. For example, US policy rates have been raised to fight inflation by a total of 3% in less than six months, as compared to an almost 0% interest rate for the large part of 2009 to 2021.[+9 sentences] The US Federal Reserve System (the Fed) officials have indicated that interest rates may continue to rise and hit close to 4.6% in 2023. Some market participants are even forecasting it to reach 5%. In fact, there are no stated upper limits to what the Fed can hike rates to, to achieve their inflation mandate. Recent market volatility has also led to higher cost of funds and interest rates and we are not immune to these sharp moves. Like me, many Members of this House have raised Parliamentary Questions or otherwise spoken about these issues in the last few months, both on rising prices and on rising interest rates. This Motion today is specifically on rising interest rates, what it means for Singapore and how we can help Singaporeans in this environment. In line with the Government's approach in recent times, I believe there is room for targeted interventions. For this Motion, I want to focus on helping Singaporeans transition from a low interest rate environment to a high interest rate environment. The world is unlikely to return anytime soon to the low inflation levels and interest rates it has enjoyed in recent decades. Singaporeans and Singaporean households will need to adjust to the new normal and plan their borrowings and expenditures accordingly. I note that the Monetary Authority of Singapore (MAS) and the Ministry of National Development (MND) have just announced that there will be revisions to the medium-term rate floors, to ensure that households borrow prudently for their property purchases in a higher interest rate environment, from last month onwards.[+25 sentences] I am also heartened by recent Department of Statistics data and expert assessments that households will be able to weather higher interest rates and a potential economic recession given their financial positions as at the 2nd quarter of 2022, as their household assets-to-liabilities ratio remains healthy. Nonetheless, if interest rates rise significantly higher, one might wonder whether the expected assumptions behind these assessments will remain valid. However, in the short-term, we can and should help Singaporeans make the transition to this new normal or new "abnormal" of high interest rates. Many Singaporean families have existing borrowings to finance big-ticket items like their mortgages, cars and education, and many of them have carefully budgeted, saved and invested to achieve their financial objectives, although based on the old normal. I understand that the Government is in the midst of formulating measures to help Singaporeans cope with the upcoming economic headwinds and would like to provide some suggestions for consideration. My first suggestion: more can be done in filling the information gap on higher interest rates. I am sure that many Singaporeans, like me, have received notices from their banks that their loan rates are going up. The notices are quite brief, stating not much more beyond the new rate percentage. That may not be helpful to less financially savvy Singaporeans, who might not realise how they might be impacted by that increase, including how much more income or savings they would need to service the loan subsequently. I have had residents emailing to meet me physically, to share with me their financial issues with servicing loans, where I realised that they did not understand that their payments paid off the interest first and the principal later. They thought the lender had cheated them. In this sort of backdrop, we must ensure that the banks and other institutions that provide loans of all kinds, including the non-bank financial institutions and authorised money lenders and so on, proactively clarify the impact to their borrowers. While there are various mortgage loan calculators offered by some banks and other websites on the Internet, not everyone may know of them or how to use them. One simple solution would be to shift this task to the banks, financial and other lending institutions, who are sophisticated enough to model the practical effects relatively easily. While there may be certain uncertainties that may affect the precise impact of an interest rate rise on a particular borrower, the financial institutions can provide an indicative range to give the borrower an idea. This boils down to the basic principle of balancing caveat emptor for the investor/customer versus whether banks owe a social duty of care to more than just the average bank customer. Some of the less sophisticated retail investors and retail bank customers might not have the same level of savviness as the "average median investor". This should not be unfamiliar to the financial sector. Insurance agents are already required to provide the benefits illustration in an endowment policy proposal based on different scenarios of investment rates of return. Financial institutions offering credit cards or mortgages are required by MAS to provide projections of instalment payments under different scenarios. They are all similarly aimed at giving the end-consumer an easy-to-understand picture of the financial calculations. This will also mean that the financial institutions may be able to pre-empt when homebuyers might encounter issues servicing higher home loans if their incomes and savings rates have become insufficient. In such cases, I hope the Government or relevant agencies work with the financial institutions to allow for longer-term mortgage tenures to accommodate homebuyers who struggle to pay higher instalments? Or at the very least be more alert now about such cases and offer some flexibility in the current environment as a baseline. My second suggestion: we should enhance the flexibility of some of our policies, in order to support the more leveraged and vulnerable households that may require help amidst higher borrowing costs. Our local banks have raised home loan rates from 1.15% per annum as recently as late 2021 to around 3.85% just earlier today, surpassing the 2.6% applicable to Housing and Development Board (HDB) loans.[+1 sentence] The fixed interest rate on HDB loans was certainly less attractive just months ago, when bank loan rates were as low as 1.15% to 1.5%. HDB's statistics show that 6,800 households applied to refinance their HDB loans with bank loans in FY 2020/2021.[+18 sentences] With the present global interest rate hikes set to continue, they will now be locked into a higher rate than the HDB rate which they were trying to find a lower alternative for. While I understand that the policy is that homeowners who opt for, or refinance using bank loans can no longer take up a HDB loan, perhaps the HDB can consider allowing eligible households to make a one-time transfer back to HDB loans? While I am mindful that it may have some backend implications for the banks, a refinancing sort of mechanism, if one is eligible, could be one possible approach. The HDB loan rate is pegged at 0.1% above the prevailing Central Provident Fund (CPF) Ordinary Account (OA) interest rate, and HDB and CPF have recently confirmed that the applicable rates will remain unchanged until the end of this year. I understand that the standing policy is for the OA interest rate to be reviewed every three months. Given the impact of changes in rates on borrowers' finances in the medium-term, it would be helpful if the Government or HDB is able to provide HDB borrowers more advanced guidance on potential rate changes, beyond three months. This will allow new and existing homeowners to make a more certain choice on how they finance their home, to better prepare them amidst this new normal of interest rate levels that we may be entering. On balance, the information provided will help household decisions but the impact of the extent in which this becomes a de facto forward guidance on the rates will need to be considered in totality. We must also ensure that Singapore is prepared in the extraordinary event where home loan rates rise sharply, such as if the US Fed raises their rates to above 5%. The US mortgage rates have already hit 6% for the first time since 2008. Does the Government have any contingency plans in place? Will MAS consider implementing temporary measures, such as rate ceilings to ensure that rates do not spiral out of control and become unaffordable? For example, there are already maximum annual percentage interest rates on credit card and pawn loans. Many countries around the world, including our neighbours Indonesia and Malaysia, have forms of subsidised housing loans targeted at lower-income citizens, and this is also an interim policy measure that is worth considering for vulnerable groups not captured by the concessionary HDB loan. Besides housing, education is another key reason for Singaporeans' borrowing. There has always been a strong policy reason to ensure that our students who are trying to secure a good education are not saddled with heavy debt before they enter the workforce. For example, the Ministry of Education (MOE) Study Loan allows low-income households to obtain loans that are interest-free for a limited or entire duration of the loan. The CPF Education Loan Scheme allows for the use of one's CPF OA savings to pay for one's own, children's or spouse's tuition fees for full-time diploma or degree courses at approved educational institutions. As commercial interest rates increase and study loans become less affordable, perhaps we could enhance these existing schemes by raising the $2,700 gross monthly per capita income cap for the MOE Study Loan and extend the CPF Education Loan Scheme to cover more courses including part-time accredited diploma or degree courses.[+10 sentences] This will benefit a greater pool of Singaporeans who are in the pursuit of better education, better skills and who will ultimately be an asset in our workforce. Academic studies using US data have shown that an upskilled workforce has positive externalities to a sector, beyond the individual's gains. My third suggestion: we should not stop at assistance for individuals. Our small- and medium-sized enterprises (SMEs) and firms, especially those that operate in sectors that are highly reliant on external financing, will require targeted help as well. As our economy plays catch-up from the time lost during the pandemic, there might be a need to take a targeted sector-specific approach in limiting the adverse effects that might be brought about by higher interest rates that we cannot avoid. To prevent a hard landing from steep hikes in the cost of capital, our SMEs will need some support in transitioning to have enough reaction time to adjust their plans for cashflow, servicing existing debt and taking on new debt. There might also be a need to take a targeted sector-specific approach. Construction and manufacturing are sectors that are known to be sensitive to interest rate hikes as they are capital-intensive and dependent on commercial loans. I will focus on construction firms as their cash flows are also tighter due to the longer-term nature of construction projects, which have not been helped by the labour and cost disruptions caused by the COVID-19 pandemic. The construction sector is critical to renewing Singapore's physical infrastructure, which itself is a key driver of our economic competitiveness. MND had announced in May 2022 that 58 Build-To-Order (BTO) projects were delayed by at least six months this year.[+6 sentences] This has already contributed to a tight housing supply situation and left many households in limbo waiting for their new houses to be completed. So, any uncertainty in interest rates could throw the sector into disarray again, within this post-pandemic period. So, it is important for the sector to be able to continue to access affordable loans. It may not be commercially viable to expect commercial banks to cap or limit the interest rates charged to construction firms, especially when they have to price in the fact that the construction sector has already been trending towards a higher risk of defaulting on repayments. But aside from arguments about consolidation as a form of creative destruction in this sector and that some of the firms may have limited long-term viability anyway, the Government may need to step in to provide reliable and affordable sources of temporary financing to eligible SMEs and firms – temporary financing. So, I am thinking of schemes, such as the Temporary Bridging Loan Programme (TBLP) that was rolled out during the pandemic, as well as the Temporary Electricity Contracting Support Scheme (TRECS), which offer firms the ability to lock in a favourable interest rate or electricity tariff, at times where such rates are extremely volatile. The multiple extensions of TBLP, a support measure implemented to help firms with their financing needs during the pandemic, show that it is effective in meeting its purpose. I hope that the Government can consider a further extension past the current end-date of the scheme on 30 September 2022, or a replacement that is also focused on providing eligible SMEs with affordable interest rates.[+18 sentences] For the sake of fiscal prudence, I do not mean that we should commit to subsidising firms for a prolonged duration. What I have in mind is simply a temporary measure, to help our vulnerable firms and SMEs deal with interest rates that have doubled and may perhaps triple in just over a period of months. So, I urge the Government to provide updates as soon as possible on the duration of any support measures to help our firms with their forward planning. Even as we try to enhance our long-term economic growth in this environment, we are fighting business decisions to reduce investments, made amidst higher hurdle rates for projects and investments. So, in addition, can the Government work further with financial institutions to keep the processing fees of these Government-assisted loans as low as possible? To add, we should make sure that the measures apply across both bank and non-bank financial institutions or lenders. The latter might rise in prominence in the lending sector, if the rise in interest rates makes it harder for those with relatively lower credit worthiness or urgent credit needs to access bank loans. Several of them already target SMEs primarily. My fourth and final suggestion on this front. As we transition into a new high-interest rate environment, our metrics for measuring systemic risk may need to be adjusted as well. Our efforts to measure this improperly or with a decent lag can lead to social implications. There have been numerous mentions of the Total Debt Servicing Ratio (TDSR) in this House, in response to Members' concerns over the interest rate and debt situation in Singapore, in the last few months. The TDSR framework captures a borrower's monthly expenses on all types of debt, including mortgages, car loans and unsecured debt as a proportion of income. Essentially, MAS sets a ceiling that only 55% of a borrower's income should be spent on servicing debt obligations. By lowering the ceiling, MAS can "tighten" the threshold up to which a person may borrow. The interest rate that is used to calculate loan repayments under the TDSR is the higher of 3.5% or the prevailing market rate. The idea was to build in a buffer against interest rate rises for borrowers who have taken out a mortgage in the past. However, with today's bank interest rates hitting more than 3% and the US Fed's expectation that its benchmark interest rate may hit close to 4.4% as soon as this year, and possibly some more next year, the "buffer" that is built into MAS' monitoring framework may soon be completely eroded. The MAS has just raised interest rates used to calculate loan repayments under the TDSR by 0.5%.[+7 sentences] However, is this move sufficient to maintain the robustness of MAS monitoring and stress testing? Given the rate of global interest rate increases and their potential landing points at up to 5%, is MAS prepared to raise this again, potentially in a matter of a few months? So, what is the impact of the current 0.5% adjustment on the TDSR data, and what would the projected impact of further increases be, considering the median TDSR of 43%? I ask these questions because, in part, housing loans are a long tenure, with significant overhang and forward risk exposure if the interest rates go up. And in an alternative worst-case scenario, if there is a wave of defaults/repossessions, there is always the risk of market instability with cascading social implications. These interventions I have suggested above, Mr Speaker, would require the Government's use of its revenues. I would like to ask whether the Government has done an in depth-study on how both interest rate expense and investment incomes would be affected by the higher global rates and recent market turbulence. On the borrowing side, the Government would have to incur higher borrowing rates in taking actions to manage banking system liquidity or even for our infrastructure needs. At the same time, on the investment side, Deputy Prime Minister Lawrence has also shared in this Chamber that over the medium term, rising interest rates will also help to raise investment income from our foreign asset holdings. So, has the Government also taken into consideration that the rising global interest rate environment and risk of potential US recession that may occur downstream, could cause increased volatility for our investments in foreign asset holdings?[+7 sentences] Global stocks and even cryptocurrencies have already taken a hit with the latest Fed announcements on the need for more interest rate hikes. Questions that probably need to be considered are first, what are the downside risks in the event of sell-offs in these holdings and what would be the impact on our fiscal position? And how may we also maximise the investment opportunities posed by a high interest rate environment? I hope the Minister or relevant agencies can shed some light on these questions as it has ramifications on our fiscal trajectory and outlook. Mr Speaker, Sir, it appears that a high interest rate environment is here to stay. I hope the Government will take into consideration my suggestions above in positive light to mitigate the risk of higher interest rates on Singaporean households. We will need to take considered actions to put Singaporeans and our firms in good stead to adapt to and thrive in this situation, while the Government balances the fine line between keeping prices from rising further and dampening economic expansion in the post-COVID recovery period.
Mr Speaker7 words
[+1 sentence]Senior Minister of State Chee Hong Tat.
The Senior Minister of State for Finance and Transport (Mr Chee Hong Tat)1280 words
[+8 sentences]Mr Speaker, I thank Mr Saktiandi Supaat for his Adjournment Motion. Our Government agencies will look into his points and his suggestions and I will respond to some of the key points that he raised. As Mr Saktiandi observed, many central banks have been raising interest rates to tackle inflation. Similarly, MAS has taken steps to tighten monetary policy and is closely monitoring developments on this front. It is also alert to systemic risks to our financial system arising from higher interest rates. The Government will provide assistance to cushion the impact on households and businesses. It is also important for all of us to take steps to adapt to this new environment. I share Mr Saktiandi's view that the higher interest rates we are experiencing may not be a passing phenomenon. Average interest rates over the next five years or more will likely be higher than what the world had experienced for the last 15-20 years.[+15 sentences] We need to prepare ourselves for this change. Sir, whether we are facing low interest rates or high interest rates, the Government will continue to ensure that essential areas, such as public housing, healthcare and education will remain affordable and accessible to all Singaporeans. For education, the Government currently subsidises over 90% of the costs of education from primary to pre-university level. The subsidy rate for Institute of Technical Education (ITE) is also more than 90%. For polytechnics and autonomous universities, Government subsidies amount to around 85% and 75% of total costs respectively. In addition, students can apply for bursaries and education loans to support their education-related expenses. The Tuition Fee Loan Scheme is available to all, while the Study Loan Scheme is available to students from lower- to middle-income households. Both loan schemes do not incur interest during study and require repayment only after graduation. These are important support measures to ensure tertiary education remains affordable, and no Singaporean child will be denied of the opportunity to receive a good education because of financial difficulties. On public housing, the Government will continue to sell new flats at prices below market value with significant housing subsidies. The end in mind is to encourage home ownership, and to enable as many families as possible to own their homes. Minister Desmond Lee spoke about this earlier today. On the whole, the household debt situation in Singapore remains healthy. This is because of our prudent policies on unsecured consumer lending and residential mortgages. Residential mortgages are subject to loan-to-value limits as well as debt servicing ratios, which cap the amount of debt and monthly mortgage payment individuals can take on when they purchase properties. MAS, MND and HDB recently announced measures to increase the medium-term interest rate floor used to compute the TDSR and Mortgage Servicing Ratio (MSR) for property loans by financial institutions and introduced an interest rate floor for computing eligible loan amounts for housing loans granted by HDB.[+13 sentences] These will help ensure that property buyers continue to borrow prudently. We will continue to monitor the property market and review our polices where necessary in a rising interest rate environment. We will also work with financial and non-financial institutions to better help borrowers understand their loan commitments. Mr Saktiandi highlighted the requirements MAS places on financial institutions to explain how a borrower's monthly mortgage instalments would vary if interest rates increased. Non-financial institutions, such as licensed moneylenders (LMLs) are required to explain to the borrower the terms of the loan contract and the breakdown of each repayment that goes into servicing the principal amount and other costs, all in a language that the borrower understands. In addition, LMLs are only permitted to impose fixed borrowing costs and fixed interest rates, ensuring that borrowers would not be caught off-guard by rising interest rates. Sir, for businesses, MAS assesses that most businesses in Singapore are currently able to manage debt-related risks with sufficient liquidity holdings, alongside the post-COVID-19 earnings recovery. The Government provides assistance to businesses through various credit schemes. Our economic agencies have assessed that there are available credit facilities for businesses. SME loan volumes, for example, have continued to be stable in recent months. With the expiry of the Temporary Bridging Loan Programme (TBLP), enterprises can still tap on the Enterprise Financing Scheme, which supports access to financing for a wide range of business activities. Our economic agencies will monitor the situation closely and review the need for further adjustments. Importantly, businesses would need to double down on efforts to improve productivity and upgrade the skills of their workers. This is the most effective way to improve our overall competitiveness and achieve a win-win outcome for both businesses and workers through economic growth. There are many schemes available, including the Productivity Solutions Grant, the Energy Efficiency Grant, SkillsFuture subsidies and the newly introduced $70 million NTUC Company Training Committee Grant to help improve firm and worker productivity, and to build new enterprise and workforce capabilities.[+4 sentences] The Government will also continue to provide Workfare Income Supplement and other support measures to boost the earnings of our lower-wage workers. Let me now turn to the Government's financial position. In the near term, significant market uncertainties have resulted in a weaker investment environment. The investment entities, such as the Government of Singapore Investment Corporation (GIC) and Temasek, are closely monitoring macroeconomic and geopolitical developments, including changes to the interest rate environment, and they will continue to maintain diverse portfolios to manage investment risks. The impact of short-term market volatility on the Net Investment Returns Contribution, or NIRC, is mitigated as our Net Investment Returns (NIR) framework is designed to provide stability in an uncertain investment environment. It does so by smoothening out relevant asset bases over the long-term and calculating NIRC based on the expected long-term real rate of return of the investment entities. As such, the NIRC serves as a steady stream of returns to fund our annual expenditure even in periods of market uncertainty.[+13 sentences] And we are able to benefit from this source of revenue today, and also during the COVID-19 pandemic, because previous generations of Singaporeans worked hard and built up our reserves. We must likewise do the responsible thing by safeguarding our reserves and growing it further, so that we leave behind a strategic asset and lay the foundations for a better future that will benefit our children and grandchildren. Sir, I have spoken about how the Government will look after individuals, households and businesses. Another important area is how all of us can play a role in helping one another in a caring and inclusive society. A key enabler is the high degree of trust in our society. Trust has allowed us to weather many uncertainties together, including our fight against COVID-19, and it will be a critical success factor as we face new challenges going ahead, such as rising inflation and higher interest rates. Like other Members of this House, I have come across many heartwarming examples of institutions, community organisations and also individual Singaporeans pitching in to help others who are facing difficulties. They generously provide extra assistance to complement what the Government is giving. Mr Saktiandi Supaat and I are both serving in Bishan-Toa Payoh GRC. And we are grateful to our corporate and community partners who work with us to provide additional local-level assistance to our residents, especially the vulnerable and lower-income families. For example, my volunteers and I have been distributing monthly WeCare Packs containing food items and daily necessities to our lower-income families. They are sponsored by our donors. And I have also raised additional amounts through our community welfare fund to provide National Trades Union Congress (NTUC) vouchers and angbaos to our vulnerable residents —
Mr Speaker13 words
[+1 sentence]Senior Minister of State Chee Hong Tat, you have about 50 seconds left.
Mr Chee Hong Tat124 words
— to give them additional help on top of the assistance from Government.[+2 sentences] I know many Grassroots Advisers are doing the same, including Mr Saktiandi Supaat. As we say at the Chinese Development Assistance Council (CDAC), 一人一点心，社会更温馨 . When each of us contributes a little to help others, it makes our society more caring and warmer.[+1 sentence] Mr Speaker, these experiences give me much confidence that Singapore and Singaporeans have what it takes to weather the challenges ahead. We are able to face stormy seas with greater confidence and resilience than many other countries, because of our mutual trust and our social cohesion. And we hope that every crisis will further strengthen our social compact and bring us even closer together as one united people.
Mr Speaker27 words
[+2 sentences]Just in time. Adjourned accordingly at 8.20 pm.
Building a Healthier SG›Motions34 turns · 29,555w
· 172 highlighted
motion-1968
The Minister for Health (Mr Ong Ye Kung)5116 words
[+17 sentences]Mr Speaker, I beg to move, "That this House endorses Paper Cmd 19 of 2022 on 'White Paper on Healthier SG' as the basis to transform our healthcare system by (a) focusing strongly on preventive care; (b) fostering lasting relationships between residents and family doctors; and (c) building strong partnerships within the community, so as to support individuals taking care of their own health and wellness and strive towards our vision of long and healthy lives for Singaporeans." Sir, COVID-19 has put all healthcare systems in the world under stress. It exposed the shortcomings and weaknesses of the systems. On the other hand, it made practices that used to be impossible, possible now. It was a jolt to the core of all our systems. As the pandemic dust settles, many health authorities are now in a reflective, in a soul-searching mode, rethinking how to improve their healthcare systems. For example, for Indonesia, I am constantly in touch with the Health Minister and they are making a big effort to strengthen the accessibility to healthcare services throughout the archipelago. New Zealand is strengthening central national healthcare planning, to reduce the pressure on specialist and hospital care on the ground. The UK is making a renewed push in integrated care between social and healthcare organisations. And just yesterday, we just heard Hong Kong is also doing a deep healthcare reform effort. As for Singapore, we are embarking on a long-term and profound reform effort. And there are two important considerations in driving this reform. First, our society is ageing rapidly. To reduce the disease burden and preserve the quality of life of our people in the coming years, we have to become healthier. Second, our COVID-19 response showed that as a people, each of us are prepared to do our part, have each other's backs and work together to fend off the pandemic. The things we do during the pandemic – vaccinations, tests, self-isolation – and these are all preventive care in action. We found ways to integrate preventive care with acute care in hospitals, in our treatment facilities and with home recovery. And if we can replicate that whole effort in our fight against debilitating chronic illnesses, especially those that come with ageing, then we would have made a big difference in the coming 10 years. And that is why we developed the Healthier SG strategy, which I announced in the Committee of Supply (COS) earlier this year. It is a fundamental re-orientation and reform of our healthcare system, focus on preventive care instead of curative care, emphasise on health instead of sickness, to shift the centre of gravity of care away from hospitals, into the community, to rely less on doctors for health, but to depend on communities, our families and ourselves – and live up to the name of Ministry of Health (MOH), not Ministry of Sickness. During COS, I said that we would seek the inputs of stakeholders, as we flesh out our proposals, and then we will come back to Parliament again.[+1 sentence] So, here we are. And since then, MOH engaged more than 6,000 members of the public, including 1,000 healthcare professionals.[+8 sentences] We did surveys, focus group discussions and in-depth one-on-one interviews as well. In this engagement, we did not present our stakeholders with a blank canvas and ask them what we should do to improve health. Instead, we presented a broad plan, a concept of what we planned to do. And then, we asked them – looking at this, what is missing? What are your concerns? What are the details that matter? How to make it work? What are the potential pitfalls? It is an important process to make sure that we design the system right. And we got many useful inputs, which we have tried our best to incorporate in this White Paper.[+31 sentences] So, I want to say a few thank yous. First, thanks to all our stakeholders for their contribution. They took the engagement very seriously. And I think they realised that this is a very important exercise, a very important reform, possibly the most significant in decades. And I want to especially mention about 50 family doctors. They are from the College of Family Physicians Singapore, Singapore Medical Association, our Primary Care Networks, polyclinics and the National General Practitioners Advisory Panel. They devoted a lot of time and energy in working with us in designing Healthier SG. They meet almost every week, over weekends, on top of running their clinics. I would also like to extend my appreciation to the many healthcare practitioners and partners. They range from nurses, allied health professionals, pharmacists, people who work for community organisations, unions, grassroots leaders, employers. They shared their views and contributed their ideas. Last but not least, I also want to thank the officers of MOH, who did a lot of the coordination, the staffing, the drafting and the preparatory work. I know they are very proud of being part of this co-creation effort with all our partners. Today, I will do three things. One, I will go through, very briefly, the salient features of Healthier SG as a recap. Two, explain what this means to the two most important sets of stakeholders – residents and General Practitioners (GPs). Three, I will speak more about its budget and financial implications, as this is only briefly covered in the White Paper. One, to recap, there are five key components to Healthier SG. First, family doctors. They are the lynchpin of Healthier SG. We want to mobilise them to build strong relationships with their patients and play a bigger role in preventive care. Two, health plans. These will be developed between doctors and patients. The health plan comprises an overview of the health status of the resident, the health goals to achieve and an action plan, which can include going for essential health screenings and vaccinations, and changes to your lifestyles. This whole area is what we call "social prescriptions". And doctors are saying that "social prescriptions" are often more important than drug prescriptions. This brings us to the third component, which is community partners. It may not be easy to follow diet or exercise advice and improve lifestyles by ourselves. Many of us have tried, but to no avail. So, we will draw on the effort of agencies such as Health Promotion Board (HPB), People's Association (PA) and SportSG. They are organising many health-related activities on the ground, to create that supportive environment to help us change. And once the first three components are ready, we embark on the fourth, which is the national enrolment exercise. And this will commence in the second half of 2023 next year, starting with residents aged 60 and above.[+18 sentences] Then, each resident chooses the family doctor or clinic you wish to build a long-term preventive care relationship with. And from there, we begin our journey towards better health. Finally, enablers. We need the right IT systems, manpower and financing structure to make Healthier SG work. These are invisible. They are in the background, but a lot of work has gone into these and they are extremely important. What will all these mean to people? Let me start with the most important stakeholder group – residents, whom we represent here. The greatest impact is that residents will receive much stronger support to stay healthy and prevent any existing illnesses from worsening further. And we are making a big effort to support you, because it is almost human instinct to not do the right thing because of instant gratification. "Have a puff to destress now, worry about health later"; "eat the cheesecake now, worry about sugar later"; "eat the fried chicken now, it is very nice"; "laze around instead of exercising"; "binge watch Korean drama instead of having a good night's sleep". All these instant gratifications. Everyone is smiling. We are all guilty. Nothing bad will happen immediately or next day, but they accumulate to cause serious diseases, or can aggravate existing illnesses later. Every grain of sand you keep dropping will become a bucket. And, by then, it will be a big burden. It can cost us, our organs, our limbs, our minds, our lives. I visited the National Kidney Foundation (NKF) recently. They told me that every day, six more patients in Singapore require dialysis – every day, six more.[+32 sentences] To be on dialysis means you need to visit the NKF centre three times a week, each time five to six hours. Your life is totally changed. And the staff told me, that most patients there at NKF regret not correcting their diets and lifestyles while they could. But now, it is too late to reverse. They have to live with dialysis the rest of their lives. So, let us try to live without regrets. We can still enjoy many things in life, especially the good food – the char kway teow, the prata, the mee rebus, the occasional bubble tea with less sugar – just everything in moderation and without overindulging. And we will find joy in exercising, especially with friends. We will be able to snub out smoking or Juuling and not miss them. The support to residents – we must support residents to do all these. And it comes in several ways. Let me just describe how we are supporting residents. The first and most significant form of support is your long-term relationship with the family doctor. And research has shown people with a dedicated family doctor are much less likely to develop serious illnesses. Your enrolment with a dedicated family doctor is, therefore, a critical first step. However, since the release of the White Paper, there have been a few concerns on enrolment, and I might as well clarify them in this opening speech. Some residents are worried that once you choose a doctor, it is a final decision that cannot be reversed. Not to worry, we recognise that there are times when a resident needs to change their doctor, either because they have moved houses, or have found a more suitable doctor. And so, we have provided the flexibility for residents to change your enrolled doctor. Nevertheless, when the time comes, please make your choice carefully and consciously. Other residents are worried that once they enrol with a doctor, they cannot see other doctors – banned – including specialists that they are now seeing because of their chronic illnesses. So, please be assured that this would not happen. You are free to continue to visit all other doctors, including your specialists. But please choose one to be your dedicated family doctor whom you trust, who knows your conditions well and can work with you to practise preventive care. In the same vein, some residents are worried that their regular GP may become so popular that they get squeezed out by the demand. We will try our best to manage this. In the enrolment process, there will be a dropdown list. The doctor you regularly visit will be at the top for you. So, that will give you an edge over your "competitors". And we are working with GP networks and polyclinics to let us know who their regular patients are in order to facilitate this. We are also doing this in stages, so that enrolment demand will not be so overwhelming, overnight. You may also want to enrol early when the time comes to "chope" your regular GP. The second area of support is that once you are enrolled with a family doctor, the Government will fully fund the most important aspects of preventive care. Hence, annual preventive care check-ins with your family doctor, nationally recommended vaccinations, such as influenza and pneumococcal vaccinations and health screenings will be free. Health screenings will include three very common chronic conditions – type 2 diabetes, hypertension and hyperlipidaemia, and three cancers: breast, cervical and colorectal.[+4 sentences] These are recommended for the general population and will be free. Those with specific risk factors may be referred for further tests. And there are more complex screenings, like colonoscopy, which is an invasive procedure and not appropriate to be made a standard screening for everyone. Although it is not free, it will continue to be heavily subsidised at our hospitals. The third way to support residents – if you are using MediSave to pay for the treatment of your chronic illness, you are no longer required to co-pay 15% of the bill using cash.[+7 sentences] You can just use your MediSave. These changes are somewhat of a departure from most Government subsidy schemes, where some co-payment from residents is often required to reflect the sharing of responsibility and uphold the concept of individual effort. Here, we have decided that since preventive care is very fundamental to healthcare, further subsidy is justified. It does not contradict the principle of personal responsibility, because in the context of preventive care, personal responsibility and action are needed to make changes and lead a healthier life. Fourth, we will enhance the subsidy for common chronic disease drugs at private GP clinics. Many residents gave feedback that there is a significant drug price differential between the GP clinic and the polyclinic. So, even if they wanted to stick to one family doctor at a GP clinic, when it comes to taking medications, they will go back to the polyclinic where medication is cheaper. To help residents anchor with a family doctor of their choice, we intend to level this price difference, by introducing an additional subsidy tier to Community Health Assist Scheme (CHAS) for common chronic drugs and also set drug price limits.[+2 sentences] This benefit will be available to all enrolled Singaporean CHAS card holders, including Pioneer Generation (PG) and Merdeka Generation (MG) card holders. I should add a small caveat, which is that the basis of calculating subsidies at polyclinics and for CHAS are different. There is a technical reason, but we will not be able to equalise the price down to the last cent. But we will substantively remove the current difference in drug prices between the two for individuals enrolled in Heathier SG.[+3 sentences] Fifth, we have roped in important community partners, such as PA, SportSG, HPB and others, to organise more health-related activities for residents, from ball games and brisk walking; to Zumba classes and community gardening. So, while you may see your enrolled doctor only once or twice a year, outside of the clinic, you are not alone. We are enhancing public infrastructure like sports facilities, parks and park connectors, and community partners will support your active lifestyle. Sixth, we will award Healthpoints to help encourage residents to adopt and sustain a healthy lifestyle.[+31 sentences] Many residents who already participate in the National Steps Challenge and the Eat Drink Shop Healthy Challenge are familiar with the Healthy 365 app. It is your virtual champion to nudge you to be healthy. The app awards Healthpoints for living an active lifestyle and making healthier food purchases. It does not just clock steps but also tracks physical activity through your heart rate. You may be dancing, lifting weights, doing community gardening, doing Zumba, Healthy 365 do not exactly know what you are doing, but it knows your heart rate is higher and from there, it derives that you are physically active and will award Healthpoints accordingly. Healthpoints can be exchanged for a range of rewards, such as public transport and many participating merchants. The reward is not large, but it has a way to give us psychological satisfaction that, "I have accomplished this exercise". And it is a very effective nudge, especially when gamified. We will be enhancing Healthy 365. For example, it will be able to track your calorie intake. So, you take a picture of your char kway teow and then, it will match against our database of different food and your calorie intake, and will monitor your calorie intake. But you have to take honest pictures – do not just keep taking photos of vegetables! We have also made Healthy 365 compatible with more popular digital health apps like Apple Health Kit, Fitbit and Samsung Health – all these are already compatible. We will try to link it up with other commercial digital health apps. That way, your lifestyle data captured by these commercial apps can be ingested into Healthy 365 and you can claim Healthpoints. I should mention in this House that I do notice some of our Members have become a lot fitter visibly. I noticed Mr Desmond Choo over the months, big change. Dr Wan Rizal, amazing change. And my Second Minister for Health Masagos Zulkifli. I think they should be Healthier SG ambassadors. So, what do we have? To summarise: a dedicated doctor, a health plan with social prescriptions, full subsidy for nationally recommended vaccinations and health screening, full use of MediSave for chronic disease management, enhanced subsidy for common chronic drugs at GP clinics, more community lifestyle activities, more Healthpoints for leading a healthy life. They all come together, complement each other, to support residents to take personal responsibility and action to embark on their healthy life journeys. The second important group of stakeholders are our family doctors, from both polyclinics as well as private GP clinics. They will find themselves at the centre of this strategic long-term healthcare transformation plan. GPs need to earn a living by running their clinics. We must make sure that Healthier SG works for them. Hence, from the time we conceived Healthier SG, we were very mindful that it should not take business away from GPs. So, GPs will continue to attend to their existing patients and prescribe medication to them. What Healthier SG does is to enlarge their client pool, through enrolment for preventive and chronic care consultations. In line with this, GPs should be fairly compensated by MOH for their effort and advice in delivering preventive care. MOH will, therefore, extend an annual service fee payment for each resident who enrol with them.[+22 sentences] This service fee is what we will describe loosely as a "capitated payment". That means we do not pay the GP for every consultation, every test, every prescription and every service they provide. Instead, we pay them a standard fee, which is a base, per enrolled patient for maintaining a long-term relationship with the patient. It will cover the regular check-ins, ensuring the residents adhere with their health plans, the associated administrative work and also, reviewing the health plan annually. This is over and above subsidies for health screening and medication, which are separately funded. For the Government, this method of payment and subsidy is not new. It is largely how we fund education, where polytechnics and universities receive a standard amount of budget per student. Even though some students take more classes or some students participate in more subsidised activities than others, we pay an average standard budget. For GPs, it is also not a new concept. GPs who assist our healthcare clusters to manage complex chronic patients get a "Care Plus" service fee payment today of $100 per patient. Healthier SG will broaden such schemes to cover preventive care for large segments of the population. And the fee will be similar or higher than the current Care Plus fee, depending on the health conditions of the enrolled residents. We estimate that in the coming few years, Healthier SG service fees and revenue from subsidised services can grow as more residents enrol and become a significant component of the GPs' annual revenue – maybe a quarter or a third. Hand on heart, MOH has always been a very fair and prompt as a service buyer and I assure GPs that we will continue to be so. What MOH may not be very good at, is to minimise your administrative workload. It is unfortunately inevitable, as we need medical data of patients to be captured in our national health record system and paperwork is needed for payment claims. We will try our best to ease this administrative workload. Some GPs also do not have IT systems to support Healthier SG. Some are still largely using pen and paper. MOH will also provide a grant to each GP clinic to help them be IT-ready for Healthier SG. Mr Speaker, Sir, let me now move on to elaborate more about the finance and budget implications of Healthier SG. Healthier SG requires a lot of effort and resources to set up. We need new IT systems, ground support capabilities, give GPs one-time support for the necessary IT enhancements and capability-building to bring them on board. So, we estimate a set up cost of over $1 billion over the next three to four years.[+1 sentence] Beyond that, there will be recurrent costs. This includes all the support measures for residents I talked about earlier and the annual service fee for GPs. This is estimated to be another $400 million per year.[+11 sentences] We spend about 6% of our healthcare budget on preventive care annually, such as to fund HPB. With Healthier SG, in the coming few years, we will, and we want to grow this, perhaps to double the share of total healthcare spending. In making these investments, our primary motivation is to reduce disease burden and the suffering of people and their loved ones. Will there also be a financial payback, in terms of reducing healthcare spending in future? It will be good if this comes about, but it is too early to give a realistic estimate. Because any impact in health of people would not happen immediately. The impact will, perhaps, be discernible eight or 10 years down the road. Even so, we cannot reverse the rise in healthcare spending. It is not possible with an ageing population. What we can hope for is to slow down the rate of increase of healthcare spending. Today, our national healthcare expenditure is expected to be about $22 billion a year. This is the annual medical bill for the whole nation. We are expecting it to almost multiply threefold, in the coming 10 years, to $60 billion in 2030.[+25 sentences] If this national medical bill, instead of tripling, doubles in the next 10 years, we would have saved much more than what we are planning to spend on preventive care. At the heart of Healthier SG is a philosophy of how we choose to live our lives. If we put in a small effort every day, a bit of discipline every week, a bit of restraint every week, we can avoid big, life-changing suffering later. We can illustrate this logic from a personal perspective. Earlier on, I talked about the kidney dialysis patients at NKF and how they regretted not taking preventive action earlier. If they had practised preventive care, it would have cost them very little, in terms of effort and money. They may have to see their GPs periodically for advice, moderate their food and sugar intake, which actually saves money, and take some medication as needed. But when the disease is allowed to go out of control and dialysis is required, it costs about $25,000 a year. Taxpayers and donors have to help them foot the bill. But the bigger cost, and what we are most concerned about, is the personal suffering. Some residents say, "I prefer not to do preventive care now. I prefer not to do health screening now. Better not to know. Because if I know, I need to do something about it and the bill can be expensive". I really hope we do not have such a mentality because even if you choose not to know now, the disease will make sure you know later. And when the disease makes sure you know later, it will be even more expensive – not just in monetary terms, but in suffering, for you and your loved ones. Mr Speaker, Sir, let me now say a few words in Mandarin. (In Mandarin): Mr Speaker, since March this year, MOH has engaged more than 6,000 individuals through various channels to garner their views on Healthier SG. These have contributed to the final White Paper. When we consulted the public, we did not start from scratch. We presented our thinking and implementation concepts on the Healthier SG strategy, and sought the public's views on their concerns, questions and suggestions. Through this process, we also realised our blind spots. And from the public feedback, we were able to ensure that the plan will be more comprehensive, more effective and more practical. I would like to sincerely thank everybody for their comments and support. The White Paper articulates how we will help Singaporeans to become healthier through various ways. The key components are described below: First, and most importantly, we need to ensure that every Singaporean visits a dedicated family doctor or clinic.[+4 sentences] As to which doctor or clinic, they will have a choice. They will also have the flexibility to change doctors after enrolment. I would also like to clarify that family doctors under Healthier SG are not limited to those from private clinics but will also include doctors from polyclinics. Seniors who currently visit polyclinics regularly can continue to do so and there is no need for them to transfer to a private clinic. Second, the Government will increase subsidies for preventive care.[+5 sentences] These include subsidies for MOH-recommended screenings and vaccinations, and consultation fees for regular preventive care services. The Government will provide full subsidies for these healthcare services. This means that you do not have to pay; the Government will pay in full for you. Third, many Singaporeans already have chronic illnesses, and they use their MediSave to pay for the relevant treatments. Under the current regulations, they have to co-pay part of the fees. Under the Healthier SG system, we will do away with the cash co-payment for the treatment of chronic illnesses. Fourth, we will also utilise the Healthy 365 app to expand the scope of rewards for adopting a healthy lifestyle.[+35 sentences] Many Singaporeans are already actively participating in the National Steps Challenge. Besides walking, if individuals engage in other activities, such as ball games, dancing, gardening or other workouts, they will also be rewarded. With digital technology, there will also be rewards for eating healthily. In Hokkien, we say this is "wu jia go wu gia", which means "to have something to eat and also something to take away". Some people might think that going for check-ups, receiving vaccinations and seeing a doctor regularly are not necessary. We often hear stories about individuals, for example, a friend who smokes a packet of cigarettes a day and consumes fatty meat every week, but still lives to a ripe old age of 90. This is a "lottery" mentality. The "winners" who lead unhealthy lifestyles without suffering from health issues are definitely in the extreme minority, who "struck the lottery". But we all know that out of those who bet on the lottery every week, the vast majority would lose money and only the rare few wins something. In general, those who live unhealthily tend to end up as "losers", and the risk of falling ill is high. So, we should not gamble with our health and our lives. In an earlier Lianhe Zaobao report, I came across a quote from Sun Simiao, a famous Tang dynasty physician, which I thought is very meaningful, and worthy of sharing here. To him, a lower-skilled doctor can only treat a person's illness, a mediocre doctor can take care of a person's health and a superior doctor would be able to improve the health of the entire nation. Sun Simiao also said that an extremely capable doctor treats illnesses before they surface, a mediocre one treats an illness that is just starting, while a lower-skilled one treats an individual's known illnesses. This is a meaningful saying. What Healthier SG aims to achieve is the vision of improving the health of the entire nation. Healthcare should not only depend on medicine but also on our lifestyle habits; it should not rely on hospitals but also the community; it should not just rely on doctors, but also on individuals and families. Western medicine also has similar views on healthcare. There are two systems: one that emphasises the treatment of the disease and the individual, and the other, which is the population health system, seeks to improve the health of the nation. So, both Western and Asian cultures have such concepts. Healthier SG is a long-term strategy that spans over many years. It is an important turning point in Singapore's national healthcare policy. For MOH, this initiative is a heavy responsibility with far-reaching implications. Its success requires the cooperation and effort of Singaporeans and the entire country. (In English): Sir, let me conclude. Healthier SG involves a mindset change in the way we look at healthcare. I would like to quote a passage in the White Paper. Quote: "we need to do things differently. Clinicians will need to constantly think of ways to prevent residents from falling sick, against instincts trained to treat as many suffering patients as possible. When conducting...health screening, we will have to deploy less precise but more scalable solutions, to identify residents...who have higher risks of falling ill." "Policy planners need to develop and evaluate programmes and initiatives across a multi-year Budget cycle, consciously investing in preventive care now to avoid years of pain and suffering later." "Every player needs to work closely, increasing the extent and depth of integration of their services." Unquote. Only by doing things differently and collectively can we achieve results beyond what traditional healthcare can deliver. In Western medicine, there is a distinction between different levels of health systems. The traditional understanding of healthcare comprises primary and acute care – ICUs, hospitals, clinics. But there is also the concept of population health where healthcare, social support systems and societal habits – plus personal responsibility – come together to make a population healthy.[+1 sentence] It is a higher level of health outcomes, going beyond what medical personnel alone can do but what a whole-of-society can achieve. There is a similar concept in Chinese medicine. It is well summarised by Tang Dynasty doctor Sun Simiao (孙思邈) who said, "上医医国, 中医医人, 下医医病".[+1 sentence] The saying, essentially, without translating it in detail, differentiates the outcomes of curative care, preventive care and population health. If all of us come together to make Healthier SG work, we will progress towards the holy grail of healthcare – healthy longevity. That is when the number of years we can live healthily approximates the number of years we can live biologically.[+2 sentences] Mr Speaker, Sir, I look forward to the views and suggestions of Members of the House. Mr Speaker, I beg to move.
Mr Speaker34 words
Members will be glad to know that Parliament Sittings can be part of the Healthier SG range of activities as well.[+2 sentences] Our heart rate goes up considerably at times. Dr Tan Wu Meng.
Dr Tan Wu Meng (Jurong)2462 words
[+15 sentences]Mr Speaker, I declare that I am a medical doctor in a public hospital looking after cancer patients. It has been 57 years since Independence, six decades since MOH was set up during British colonial days – nearly a lifetime. So, we should take stock, and ask ourselves, not just what comes next, but what if. What if we reimagined our healthcare system today, anew? What would we keep? What would we change? What we would we transform? Healthier SG is an important first step in this reimagining. It is an opportunity for a healthcare transformation, and I dare say, a healthcare revolution. Earlier this year, during the debate on MOH's Budget, I called for change – a change agenda. Today, speaking on Healthier SG, I will speak on helping residents and helping family doctors to help residents. Let me start on co-payment. It was a central dogma for public healthcare financing in Singapore for many years, but we must judge policy – not based on dogma but whether it gets the job done, whether it achieves the desired goals. The original idea for co-payment was to shape behaviour so that people look at the bill, consider what is value for money. But what happens if co-payment discourages some residents from going for medically recommended screenings, medically recommended vaccinations, medically recommended treatments for chronic disease, even if the illness might become a bigger problem some years down the line and cause suffering that you cannot even put a price tag on? The less well-off might well be affected the most. So, it is an important step to fully subsidise nationally recommended screenings and vaccinations for Singaporeans, to remove the need for cash co-payment when using MediSave to treat chronic disease under the care of a family doctor – as part of an MOH programme.[+24 sentences] In short, the behavioural nudge needs to be towards prevention and health, rather than a sludge that makes it harder to do what is necessary to prevent greater problems down the road. We should make it as easy as possible for people to do the right thing. Nudge, not sludge. Sir, on subsidy, the place of subsidy matters too. In our early days, with a young population, subsidy was very much centred on the acute hospitals. Over the years, subsidy has become more and more decentralised so that care can be delivered with subsidy in the community, for chronic illness, closer to home. But with our ageing population, with seniors becoming less mobile, some finding it harder to go out, we also need to look at how care and, where needed, subsidy is delivered to patients and residents in the community – seeing through the eyes of our people. Sir, I visited the funeral wake of my Clementi resident, spoke with her family who told me their story. Ah Ma had been ill for some years – ill with a major stroke, bedbound, could not get out of the home. She was a PG Singaporean with a PG card but because she was not mobile, bedbound, she physically could not get to the polyclinic near her home. That meant she could not access the polyclinic care without a means test. It meant she could not apply her PG card subsidies towards the remainder of the bill without having to go through a means test. In contrast to an able-bodied Singaporean able to go to a polyclinic, walk in the door, access polyclinic care without means testing, and apply the PG card without means testing. The family engaged a home doctor from an established voluntary welfare organisation (VWO) for house calls, writing medicines, prescriptions on a piece of paper, a paper prescription. The family would then bring the paper prescription to the nearby polyclinic and pay unsubsidised rates for the medication. Had Ah Ma been physically mobile and able to get to the polyclinic in person, there would have been no such administrative hurdle. So, we need to look at cases like this, see if there are ways to deliver care closer to patients' homes, and even have some medically necessary consultations in patient's homes, if needed. And likewise, to see if the funding journey can be more straightforward for such home medical visits, where they are assessed to be medically necessary. There are also some Clementi seniors who have regular medical appointments at hospitals, needing blood tests. They are wondering if some of these medically necessary tests can be done closer to home, or on occasion, at their homes, while still receiving some level of subsidy. It saves time waiting for some blood tests that may take several hours and it saves a trip back and forth, for blood tests that need to be done a few days before the medical appointment. Because when a caregiver has to accompany a patient back and forth, the burden, the stress, the worry, does not just fall on the patient. It falls on the caregiver who may have to take time-off from work and often it is the less well-off caregivers who have less bargaining power with the employer, less able to take time-off without worrying for the safety of their jobs. So, for medically necessary treatments, Mr Speaker, we should look at how to bring the subsidy to the patient, if it helps prevent hospitalisations, reduce the burden of suffering, if it reduces the number of visits and the load on caregivers. Because when subsidy is tied to a physical venue, to a place of bricks and mortar, it can become accidentally regressive because the less well-off – patients and families who are less mobile, they find it harder to get to the place of care, harder to access to the subsidy. And it is these families who also find it harder to apply for private medical transport, to foot the bill, to get to the place of care. So, I call upon MOH to look closely at this because if the policy intent is to provide subsidy where help is needed, then we have to keep a lookout for physical or systemic barriers.[+2 sentences] There is a broader point, Mr Speaker, how do we better support residents, and particularly, long-term patients, who continue living in the community and want to minimise visits to and from hospitals – patients with advanced neurological conditions like motor-neuron disease? I asked a Parliamentary Question in Parliament yesterday but unfortunately; time ran out and I could not ask my supplementary question. For patients with advanced neurological conditions, later-stage kidney diseases or dementia – can we find ways to better empower family doctors who have known these patients for years, family doctors who hope for better support from the hospital clusters, to care for patients in the community? I call upon MOH to look at forming a workgroup as part of Healthier SG, to look at the issues faced by long-term patients with serious medical conditions living in the community.[+15 sentences] Look more closely at patient journeys, deeper at the challenges faced by caregivers, healthcare providers, seeing through the eyes of our people. Sir, I want to talk about Healthy 365. MOH has designated the Healthy 365 app as the "digital window" to programmes by PA, HPB, SportSG and other programmes as well. But what happens for seniors who do not have a smartphone, who are not digital savvy, who are not quite comfortable using a smartphone app? We must make sure the digital window does not become a digital bottleneck. There must be careful attention to ease of use, understanding what our seniors and elderly need and find easy to use. Technology must serve, adapt and bend to the person, rather than getting people to bend to the technology. Seniors who feel left behind by digital change should not be treated as having fallen by the wayside, or not able to adapt. Just because a senior is not on a digital dashboard does not mean the senior is not there. Sir, Healthier SG also mentions residents having individual choice of healthcare provider. This must be in practice, not just in theory. I have met Clementi residents asking about what will happen at our national specialist centres that treat heart disease or cancer, for example. A cancer patient might have lived in Tiong Bahru for many years but chooses to stay with a loved one in Jurong who can be caregiver while they undergo treatment. So, she might want to see a specialist in the west, rather than in central Singapore. Some Clementi residents have asked: will it become harder to seek specialist care in a hospital outside your own geographical cluster? Will there be obstacles to patients choosing which public hospital they can go to, to receive their subsidised specialist care, once capitation kicks in? Can MOH confirm that patients will not face uphill hurdles – financial or administrative – if they wish to see a specialist at a different public hospital from the Healthier SG cluster near their home?[+17 sentences] Sir, let me speak on helping family doctors to help patients and residents. I want to talk about care and how it takes time. Preventive care, chronic care, holistic care, it takes time. Some of these discussions are as much conversation as consultation. Talking with a patient that you have gotten to know over the years, understanding why they took up smoking, why it is hard to kick the habit, persuading them to make that change, for better health and to save their life. Talking with a senior who has just been discharged from hospital after an illness, helping that senior find hope and confidence again to go back to exercising and leading a healthy lifestyle. Or making that time to be with a patient and a family through a difficult illness that may be getting worse, working through with the patient and family on what might be best in the difficult months and weeks or even days ahead. All these take time. And so, it is so important for MOH to continue looking at what happens in the real world, understand how much time is needed to deliver holistic care and to support our healthcare workers and family doctors on that journey. Paying family doctors to this important work, recognising the time needed is an important step. It sends a message that the work must be done, is being done and needs to be recognised. Will MOH also apply these important lessons to our public healthcare system too so that polyclinic doctors and healthcare workers can also be given more time, space and support to deliver that holistic preventive well-rounded care that we continue to work on and aspire to? I want to speak on enablers. The Healthier SG White Paper mentioned system enablers. We enable by making systems better, but this must also mean easier access, easier to navigate, fewer obstacles. I want to talk about medical IT, Mr Speaker. Earlier this year, I spoke on how across the public healthcare system alone, we have 14 million consultations each year. Imagine if we save one minute on waiting for computers and apps and technology-related time spent — less time spent waiting for technology or grappling with technology. That would mean 14 million minutes saved every year – 10,000 workdays, or about 27 years of someone working 24 hours a day.[+9 sentences] It is not a small matter. And with more family doctors coming on board, connecting with the public sector IT system, it is all the more important that the IT continues to improve – enabling, empowering, not getting in the way. Even as the healthcare IT is enhanced, there must be attention to ease of use. Sometimes, people prefer paper records, manual processes, not because they are afraid of technology, but because they find that existing technology platforms are more cumbersome, that it takes more time. And in our design and implementation, we must continue looking at this. I previously called upon MOH to give this the same attention and focus, as the big firms do, like Apple and Google, because today, every patient, every healthcare practitioner knows how a well-designed IT platform from a major tech firm can do things. And people will benchmark ease of use, elegance, against what the big firms do as well. Mr Speaker, some healthcare workers and family doctors worry about the paperwork and administrative overheads from Healthier SG. The White Paper mentions submission of patient data. Will MOH look at how the software is designed, how long it takes to fill up a form, whether existing clinic software may become slower and more cumbersome once it connects with the public sector IT network? Has MOH assessed whether small clinics will need additional headcounts to address the compliance requirements of joining Healthier SG.[+2 sentences] Will the subvention consider this as well? For capitation, Mr Speaker, MOH has said there will be a shift to capitation funding where clusters get a pre-determined fee for every resident assigned within a geographical area. Can I ask the Ministry: will capitation consider that different patients have different needs, some patients having more medical conditions, more illnesses, more complex needs and thereby, more attention and more funding needed to achieve the same healthcare outcome?[+3 sentences] Sir, systems and enablers in the healthcare process, it depends ultimately on our workforce, our people. Our people are what enables us to deliver care. Healthier SG means that the role of family doctors in the community will be ever more critical – doctors drawn from the community, serving, caring, looking after the community. So, we need to ensure a diversity of backgrounds and journeys in our healthcare workforce, in our medical profession, at every level and in every generation.[+1 sentence] Much work has been done. There has been progress, but we must continue giving this much deliberate attention, whether it is flexible work arrangements (FWAs) so that healthcare workers who are parents, who are caregivers to an elderly relative who need more flexible arrangements at work, that they can continue training, developing, growing, progressing on their journey.[+4 sentences] Likewise, going upstream to ensure that no matter where you start in life, no matter your background, no matter whether your journey took longer or a detour, that your starting point never deters you from stepping forward on that journey. Mr Speaker, in conclusion, as I said two years ago during the debate on the President's Address, healthcare is about all our lives – your life and mine, the lives of our loved ones, the life of every Singaporean. I call upon MOH and this Government to provide the resources, energy and imagination to do what is necessary to keep our healthcare system fit for purpose today, for tomorrow and for a generation to come. I stand in support of this Motion.
Mr Speaker3 words
[+1 sentence]Mr Gerald Giam.
Mr Gerald Giam Yean Song (Aljunied)1655 words
[+5 sentences]Mr Speaker, Healthier SG is a welcome new initiative, even though focusing on preventive healthcare is something that has been advocated for over the years. In February this year, the Member for Aljunied Group Representation Constituency (GRC), Mr Leon Perera, made a very comprehensive Adjournment Motion speech on rethinking preventive health to generate better outcomes. Among his policy recommendations were for the Government to set short- and long-term targets for reducing the incidence of chronic diseases, encouraging more people to go for health screening by providing additional subsidies for MediShield Life premiums and nudging people to buy healthier food products providing a digital currency earmarked for their purchases. To its credit, MOH is now bringing preventive healthcare to the forefront of healthcare policy, through the Healthier SG programme. My speech today will focus on managing the cost of healthcare under Healthier SG, and measuring and improving the desired health outcomes of the programme. Under Healthier SG, MOH will waive the requirement for residents to co-pay part of their bills in cash when using MediSave for chronic care management at their family doctor under the Chronic Disease Management Programme (CDMP).[+6 sentences] Can I ask the Minister if there will still be an annual MediSave withdrawal limit for chronic disease management? According to an answer to my Parliamentary Question, in 2019, some 15% of patients reached the $500 withdrawal limit – this is now being increased to $700 – most of whom had complex conditions. Fifteen percent of patients in 2019 translates to about 20,000 patients in absolute numbers. These patients were restricted in the use of their own medical savings for chronic disease treatment. It could discourage them from seeking treatment for their conditions and lead to a further deterioration of their health. This could necessitate more expensive interventions down the road, like hospitalisations or amputations, which will drastically reduce their quality of life. Given the direction of Healthier SG towards waiving cash co-payment requirements for chronic care management, I would like to call for the annual MediSave withdrawal limits for chronic disease management to be completely lifted, especially for those over 60.[+8 sentences] This will encourage residents with chronic diseases to see their doctor early and stay on with their disease management plan. In answer to another Parliamentary Question that I filed, in 2018, about 563,500 local patients were seen at polyclinics for non-CDMP conditions. These patients were not eligible for the full subsidies and MediSave withdrawal allowances under CDMP. Moving forward, under Healthier SG, can CDMP be expanded to all chronic diseases, so that more patients can benefit from it? Next, on polyclinics. Polyclinic attendance has increased from under 410,000 10 years ago, to more than 550,000 in July 2022. The White Paper acknowledged that many residents, especially retirees who no longer have company health plans, have been switching away from private family doctor clinics to polyclinics for their medical treatment. Cost is a factor in these decisions, with drug prices a key reason why medical treatment is often more expensive at GP clinics. Under Healthier SG, drug prices at participating private family doctor clinics will be made "more comparable" to those at polyclinics through a combination of enhanced drug subsidies and drug price limits.[+8 sentences] I also note that a new subsidy tier for CHAS for common chronic drugs will be introduced. Singapore Citizens who are CHAS, PG or MG cardholders can opt to obtain these drugs at the private family doctor clinic which they have enrolled with. These are welcome changes. However, the words "more comparable" suggest that CHAS, PG and MG cardholders will not necessarily enjoy the same low prices for drugs and medical consultations at private family doctor clinics as they do at polyclinics, let alone the other patients who are not eligible for these additional subsidies. The Minister mentioned just now in his speech that the basis for computing subsidies for polyclinics and GPs is different, so the prices cannot be equalised to the last cent. However, can the Minister confirm that the differences will only be in cents and not in dollars, or tens of dollars for each prescription? I am asking for these details because any price differentials will be a disincentive for Singaporeans from switching from polyclinics to family doctors. I note that Healthier SG aims to encourage residents to enrol with a family doctor by "narrowing the difference" in drug subsidies across polyclinics and private clinics. Can the Minister confirm that the "narrowing" of the difference will be brought about only by lowering the price of drugs for patients of family doctors, and not by increasing polyclinic prices to achieve parity?[+5 sentences] Furthermore, how much can drug costs be brought down, without subsidising private GPs' profits, given that GPs also make a margin from the sale of prescription medication? With all this in mind, it is my recommendation that residents who currently prefer seeking outpatient medical treatment at polyclinics should not be compelled to enrol with a private family doctor. They should, however, remain with a polyclinic in the same healthcare cluster, so that their medical records can be shared with whichever doctor is attending to them. If, eventually, most residents enrol with private family doctors, can the Minister elaborate on what will be the role of polyclinics under Healthier SG? Will the Government continue to build more polyclinics or will there be a reduction in polyclinic capacity as Healthier SG gets implemented? Another area that can potentially reduce healthcare costs in the long term, but was given relatively less attention in the White Paper is maternal and child preventive healthcare.[+11 sentences] A research study on childhood obesity published in the International Journal of Obesity found that early life risk factors increased childhood obesity. These risk factors included the father's obesity at 24 months after the child was born, the mother's pre-pregnancy obesity and excessive weight gain during pregnancy, short duration of breastfeeding and early introduction of solid foods. The study found that early life and preconception intervention programmes may be more effective in preventing obesity if they concurrently address these risk factors. Another study by local researchers published in BMC Pregnancy and Childbirth found that women interviewed had poor knowledge of the child health consequences of maternal obesity and were often unaware of reliable sources of health information. Is MOH looking to take a more preventive approach to maternal and child health? For example, family doctors could take a more proactive approach in advising expectant mothers and young parents on healthy dietary habits for themselves and their children. The Healthy 365 app could also be used to provide more continuous guidance from healthcare professionals to women who are planning, undergoing and recovering from pregnancy. Many habits are developed from a very young age and persist for the rest of our lives. The benefits in terms of cost savings and health outcomes of preventive health initiatives for expectant mothers and children could, thus, be tremendous in the long term. I would now like to discuss more about the health outcomes under Healthier SG. What gets measured gets done. Both performance metrics and targets should be set before embarking on Healthier SG.[+3 sentences] I am glad to see that the White Paper has listed some short-term and long-term metrics. However, it does not provide their targets. Without targets, these metrics hold much less meaning. I have filed PQs to be answered by the Minister tomorrow on the targets for various short- and long-term preventive health metrics. These include the target screening rates for chronic diseases, the proportion of residents actively using the Healthy 365 app, the obesity rate and the avoidable emergency department attendance rate.[+16 sentences] I look forward to the Minister's reply to these questions. The achievement of these targets should be closely monitored, so that adjustments can be made to better achieve them. Given the huge investment in Healthier SG, the public should expect an improvement in both the short- and long-term metrics. Family doctors that accept enrolment should also be held to a high standard of quality and transparency. They should publish their prices, bill sizes and clinical outcomes. This will allow residents to make informed decisions when choosing or switching to their enrolled family doctor. Other non-clinical metrics should also be used to gauge them. These include the adoption of IT systems that make it easier for patients to make and change appointments, reducing waiting time and sharing of clinical data with other healthcare institutions. Good service quality would encourage patients to more regularly seek preventive health services. Last week, I received a phone call from a market research firm doing a survey on behalf of the Government. The pollster asked me to state the extent of my agreement: from strongly agree to strongly disagree, to statements like "Singapore is heading in the right direction", "the Government is managing Singapore well" and "I approve the way the Prime Minister is running the country". This was not the first time I was surveyed this way. But this time I was also asked a series of questions about healthcare financing, which was an uncanny coincidence given that it was only a week before today's debate in Parliament on healthcare. The questions revolved around whether I was worried about being able to pay for my family's healthcare needs, currently and in the future. I must admit that the questions made me ponder about my own family's healthcare expenses. Individual healthcare expenses are unpredictable, and a large chunk of the costs are likely to come in the final years of life as a result of chronic conditions, many of which are preventable. Given that the survey was funded by taxpayers, the Government should release the survey results, so as to better inform the public on issues regarding future healthcare spending, and prompt them, as is the objective of Healthier SG, to make the necessary adjustments to their lifestyles and preparations to avert preventable chronic illnesses in the future.[+1 sentence] Sir, I support the Motion.
Mr Speaker3 words
[+1 sentence]Ms Denise Phua.
Ms Denise Phua Lay Peng (Jalan Besar)1365 words
[+1 sentence]Sir, I stand in support of the direction set in the White Paper on Healthier SG. This plan is a strategic move to transform Singapore's healthcare system from one that primarily cares for the sick to one that proactively prevents sickness.[+15 sentences] Preventive healthcare aims to prevent illnesses, detect specific conditions early and encourage the promotion of good health. Regular health screens, testing and healthy lifestyle counselling are but common features. Globally, the incorporation of preventive healthcare in national plans is not new. The United States, for instance, publishes 10-year Healthy People masterplans, five iterations now, to identify public health priorities to improve the health and well-being of the Americans. The latest is the Healthy People 2030 plan. But well-written plans may be, many people in the world, including the US, are still afflicted by poor health. For the Healthier SG vision to come to pass successfully, we need to get the planning assumptions, strategies and execution right. I have several concerns to which I seek Ministry's consideration and responses. First, on mobilising a network of family doctors. Sir, the first of the five key features of the Healthier SG plan is to mobilise a network of family doctors. "Lynchpin", as the Minister has just called it. The family doctor will consult, will develop a health plan, will conduct annual check-ins and help residents achieve their health goals. This, in theory, sounds good. But, in practice, most residents only see a GP when they are ill. If GPs are the first to be tapped upon, then their transition from the role of a GP, just addressing someone's immediate needs, chop-chop and go, to that of a family doctor or physician – this transition, this journey cannot be underestimated. How does the Ministry facilitate the transition, for example, of a GP who sees, say 50 to 60 patients a day, a popular one, to morph into one that is more consultative, holistic and takes a lot more time?[+29 sentences] Would there be prerequisite skillsets and dispositions that need to be considered? Other than their intrinsic motivation to want to do good for their residents, would the financial incentive that Minister spoke about be sufficient to cover their time and their costs? Many Singaporeans also visit polyclinic doctors as their first port of call. Working Singaporeans also tend to consult their employer's panel of doctors. How do these doctors become one's family doctor, if they may not be the same doctor who regularly attends to one? These questions need to be answered and looked into. The devil is always in the details. Next, on developing individual health plans. Developing health plans for enrolled residents is one thing, but following up to ensure outcomes is another. The White Paper correctly states, I quote, "while doctors can prescribe activities, it will only work if residents take personal ownership of their health and their lifestyles, and follow through with their health plans." The same challenges were also voiced by residents in the White Paper, quotes were given and validated also by many of our own lived experiences. The move to take personal ownership for one's own health is far more complicated than just developing a health plan. There are many theories of behavioural changes from time immemorial. If not thought through carefully, the Healthier SG vision would really just remain a pipe dream. What could be a highly effective combination of "inside-out", or intrinsic, and "outside-in", extrinsic intervention measures to address the needed change in mindsets and behaviours of residents? How does the Ministry intend to address the first target group who are the senior residents above 60, who may be even more rigid in their mindsets and their behaviours? Why is there little mention of upstream interventions when one is younger, such as those in schools, because that is when behaviours and mindsets are shaped? Surely, upstream interventions in schools, through proper eating, proper exercising and emotional management are an important part of developing good health habits for life. And then, for the even more vulnerable, what is the Ministry's recommendation for younger Singaporeans who are disabled, who have special needs and who are prone to earlier onset of chronic illnesses due to a lack of education and care? They are best served by healthcare professionals who are a bit more aware, who are more trained of their conditions, such as, for example, Dr Chen Shi Ling and her doctors at Happee Hearts Movement. Who and how does the Ministry propose to include this group of residents and to fund doctors like Dr Chen? Sir, those are the groups that need to be looked at and the details that need to be considered. Thirdly, on activation of community partners such as the HPB, Agency for Integrated Care (AIC), PA, SportSG and National Parks Board (NParks). I agree totally with the White Paper that "patients' social, mental and physical well-being, are best achieved through community assets and services." My own lived experience on the ground, trying to coordinate all my well-intended service providers, for example, for the seniors. My experience is that although the different parties are all good community assets, with good hearts, many of their efforts are usually not well coordinated and they are not quite motivated sometimes to really work together. They sometimes even "compete" for the same clientele. Situations of, example, elderly residents being repeatedly served, because they are the ones who are more forthcoming, some are under-served or not even served. Situations like that are quite common. What would the regional health system player each in charge of about 1.5 million residents do differently?[+2 sentences] How can they improve the situation? How will they, as integrators, better organise ground efforts without losing the passion and the resources of these precious community partners, for a Healthier SG? With so many partners and touchpoints, what would the typical experience of an enrolled resident to Healthy SG or the system or a "customer" look like in his healthcare journey?[+3 sentences] Some clarity would be reassuring. Lastly, on setting up enablers for Healthier SG. Sir, I find it hard to imagine the size of the beast or the initiative based on just looking at the White Paper. For Singaporeans to appreciate the big shift and the need for greater investments – I think the Minister had just announced as $1 billion for a start and I think $400 million for recurring costs.[+2 sentences] To justify that, I seek more clarity on the following levers. One, on human resources. What are the types of jobs, in detail, what are the skills pre-requisites and number of persons required to realise the vision of Healthier SG? On technology, beyond the one-time grant to assist clinics, if they do convert, to convert to an appropriate IT system, how would the maintenance and upgrade costs be treated?[+5 sentences] What would be needed to facilitate residents, as Dr Tan just mentioned, who are not tech-savvy, to use apps like Healthy 365, so that this group indeed is not left behind? On performance indicators – the selection of performance indicators – whether process or outcome indicators, whether lagging or historical or leading indicators – this selection is never an easy task, even in the world of usual management and leadership. What gets measured gets done, as they say. But what gets measured and paid for, gets done even more. Badly selected measures lead to unintended bad consequences. Resident enrolment rate or health plan completion rates can easily be ramped up through aggressive marketing, without regard for quality or follow up.[+8 sentences] So, I urge a further scrutiny and discussion on the White Paper's proposed key indicators. In conclusion, Sir, I highly support the intent of the Healthier SG White Paper. Many countries have done it, many developed countries have tried with varying degrees of success. I have raised issues and concerns from my own lived experiences trying to coordinate ground efforts and from those who are serving in healthcare and the community. I hope the Ministry will seriously consider my inputs. A transformation of this nature is complicated. But I believe that if any country can succeed in nurturing a healthier people, Singapore would be the one. Sir, I support the White Paper.
Mr Speaker4 words
[+1 sentence]Ms He Ting Ru.
Ms He Ting Ru (Sengkang)2961 words
[+23 sentences]Mr Speaker, it comes as no surprise that big changes are needed in the way we approach healthcare to keep our care systems sustainable. The plans announced are ambitious and are meant to address the long-term well-being of an ageing Singapore. As always, the actual execution and implementation of these plans and strategies bear scrutiny and discussion, along with the effect that they will have on our doctors, healthcare workers and most importantly, our residents. Such a shift in approach to put preventive health and our family doctors front and centre of our efforts to improve our population's health and to integrate our care systems in the heart of our communities, requires that a multi-faceted set of issues are tackled. My Workers' Party colleagues have and will over the course of this debate, share our thoughts and positions on important topics relating to financing changes, preventive care, patient responsibility and how we can better integrate the primary healthcare system with our Intermediate and Long-Term Care (ILTC) and social care systems to reduce the burden on care workers, patients and families as we set our foundations to navigate the new golden age of an ageing society. I will speak today on the measurement of success for the new Healthier SG approach, on ensuring that our family doctors are set up for success and finally, on some care areas that I believe need more attention. First, an observation: the White Paper most often refers to increases in life expectancy as a measure for good healthcare outcomes. Yet, this obscures the quality of those long years of life. Thus, we must look at other indicators, such as healthy life expectancy, or the proportion of life spent in poor health, that are more telling of the situation. The Government has alluded to this, attributing the rising costs of our healthcare budgets over the years partly to the increased impact of chronic disease on our population. Our population is living longer, but not necessarily more healthily. I hope that these other metrics start to form the backbone of how we measure good care outcomes. And today, as we debate a Motion that will see our health and social care systems shift towards placing family doctors at the heart of our care system, I cannot help but remember Dr Goh, who provided exceptional primary care for me and my family from when I was five. It is because of his gentle humour, patience and smiling countenance that doctors' visits never felt stressful – whether it was for a flu infection or a routine follow-up. And his practice nurses too eventually got to know our entire family – including my two ageing grandmothers – well enough to automatically pull out our patient cards without us having to provide our registration details and to chat with us about the latest family updates. As my father was often away for work, I know that it was a great comfort to Mom to know that she had a trusted team that she could call up and ask quick questions over the phone, whenever she had any medical or even quasi-medical concerns, especially when they related to her two young children. I also remember him nagging Dad to get the usual tests and health checks done, despite Dad's aversion to all things medical. Of course, I recognise that we lucked out in having Dr Goh and his team there for us, and indeed we hope that more – if not all – of us in Singapore will have the chance to have such excellent care through our various life stages. Indeed, the White Paper notes that just three in five Singaporeans have a regular family doctor and that most relationships between doctors and patients are still largely transactional in nature, with most interactions only happening during acute illnesses or episodes. The current system does not allow much space or resources for the care team to be able to support a patient's health more holistically and to develop and work out a long-term approach to each patient's care. It is therefore good that we are moving towards institutionalising and formalising that important relationship between family doctors and Singaporeans. However, as we work on getting Singaporeans more familiar with registering with a family doctor, we must also ensure that this new shift does not end up unfairly burdening family medicine and GP practices and their associated ecosystems and that care workers do not end up bearing the brunt of well-intentioned but unintended consequences, even as family doctors – and I quote the White Paper – "do much more". It also must be noted that in order to deliver the objectives outlined in the White Paper, the paradigm shift in care would mean that family doctors will inevitably end up spending more time with each patient and this would mean longer hours, the number of patients being equal. At the end of FY2021, the membership of the College of Family Physicians Singapore registered just over 2,600 doctors providing primary care, of whom there are approximately 1,600 doctors holding a graduate diploma of family medicine qualification. MOH previously estimated that in order to implement our plans, 3,500 family physicians are required by 2030 – more or less doubling the number in just seven years. Could the Minister clarify if these targets remain valid? Given the long time needed for doctors to be trained – five years of medical school in Singapore, plus the five years to serve the bond – would the Ministry clarify how it intends for such an increase in numbers to be catered for by 2030?[+13 sentences] And could we look at lowering the barriers for foreign-trained Singaporean doctors to come home to practise and serve communities back home here in Singapore? After all, it was not so long ago that our care systems were heavily strained by the COVID-19 pandemic and many of us would have experienced long queues in clinics and our hospitals, when GP clinics were so overwhelmed that they became unable to answer phone calls from worried patients. And this is despite many Public Health Preparedness Clinics (PHPCs) extending their opening hours to cope with the surge in demand for medical care. Doctors, nurses and practice staff generally come under extreme stress and pressure, and while grateful, we cannot afford to take this for granted in the future. Indeed, most of our care workers will tell you that they continue to feel the strain today of continuing to work under challenging circumstances and a generally tight manpower situation. While it is true that the pandemic was a "black swan" event, our experiences in the past couple of years in particular have taught us the severe risks and downsides of operating extremely lean and "efficient" infrastructures, ranging from healthcare to housing and "just-in-time" supply chains. It is therefore an opportune time for us to consider how we can best prepare for such instances and spikes in demand and to ensure that increasing the role of family doctors in a Healthier SG, does not end up placing too much strain and burden on family doctors, nurses and allied healthcare workers. The danger then is that it not only becomes unattractive for potential new doctors and health workers looking to serve in primary care, but may also end up, meaning the existing workers will resign. This is particularly important during the transition period while both patients and care workers are still getting to know the new approach and as we wait for the efforts of our preventive care programmes to bear fruit. Indeed, the Singapore Medical Journal in an article in 2020 stated that, I quote – "The nature of the (GP) work can predispose them to developing burnout, which in turn impacts the physician-patient relationship and patient care." In short, we must not forget to care for our care workers, to ensure that they are not burnt out while they care for us. Additionally, concerns about the amount of administrative or paperwork that doctors need to fill in, both to enrol in the programme, and also for each patient visit, need to be adequately addressed. Coming back to the capacity of our primary care system. The White Paper mentions the need to increase the number of doctors and nurses in primary and community care from the current one-fifth to at least a quarter by 2030.[+4 sentences] Given that we are now in the final quarter of 2022, this is an ambitious target. While MOH and its various partners will undoubtedly put in much effort to ensure that more will start choosing family medicine as a vocation, efforts are also hampered by what is traditionally seen to be the "lesser status" of family doctors. I recall a former classmate feeling particularly down when the time came to choose specialities, as she had "only managed to get on a family physician track". At the time, we discussed why she felt this way, despite knowing that being a family physician is, in itself, a speciality and requires a very specific skillset and years of training that may not be any less challenging compared with that of a consultant working in a hospital. She mentioned that the initial reaction to hearing that somebody is a family doctor is that they "didn't quite make the grade to become a specialist". These concerns are backed up by a pertinent study done by the Lee Kong Chian School of Medicine under the leadership of Prof Helen Smith, which found that while half of medical students would consider a career in general practice and family medicine (GPFM), the perception was that there were less career advancement options. Perhaps of more concern was the finding that students reported having encountered derogatory comments about the area, including doctors in GPFM having "poor clinical competence".[+7 sentences] The sentiment that family doctors may not be as well remunerated compared with consultants – particularly in private practice – is also exacerbated by the high costs of setting up a private practice in the first place, when compared with the career option of a senior consultant working in a hospital. Directly addressing and removing such concerns, would be essential in meeting the aims being debated here today and I hope that these are issues that we quickly overcome, to ensure that our very best and brightest medical students and even mid-career doctors see training to be a family physician as a career choice, or even "the" career of choice. Support for family doctors and their colleagues also needs to go beyond the obvious. Family doctors and particularly solo practitioners are also often effectively running a small business. Many of them operate in the heart of our communities but are also beset by increasing costs, such as increasing rent and higher utilities bills. Solo or smaller practices surely would also end up seeing their financial situation strained in the current environment. I would like to ask the Minister to clarify if the situation is being monitored to see if extra support or grants are needed. This is especially important if we are trying to attract more doctors to provide primary care. Also, would MOH work closely with the Ministry of National Development (MND) and the Housing and Development Board (HDB) in particular, to ensure that our family doctors are able to easily set up clinics in our heartlands and that their practices remain available and accessible to our communities?[+1 sentence] Next, on to the important role that the primary healthcare system will need to play in our nation's efforts to improve mental health. While the White Paper mentions mental health protocols will be developed, mental health does not appear to be part of the first 12 care protocols being rolled out to family doctors.[+17 sentences] A study of Singapore from 2017 found that those suffering from mental health conditions was the second biggest cause for ill health that debilitates residents without necessarily killing them. For our youths in the 10- to 19-year-old age group, in particular, this rises to first place. Not having adequate treatment or support while suffering from mental health conditions has an impact on all aspects of one's life, ranging from economic output to physical health. So, it is important that our plans to address mental health illnesses are firmly anchored within the primary health care system. While designing the mental health care protocols for family doctors, I also hope that attention can be paid to the intrinsic complexity of the field and that a "one size fits all approach" will not work. After all, how a practice nurse may approach a 20-year-old patient suffering from schizophrenia would likely need to be very different from approaching an 85-year-old showing signs of depression. Because mental illness still carries stigma, aside from the different spectrum of mental illness symptoms, adjustments must also be made for different attitudes and cultural nuances that may be applicable to the situation. We must ensure that the doctors and their staff are adequately trained and supported to deal with patients who suffer from ill mental health. The referral system must also not be overly complicated and doctors, nurses and other allied care workers need to have easily accessible references to know what resources are out there available out there to their patients. Finally, when we speak about a paradigm shift towards preventive care and a more holistic approach to health, we can better target healthier lives for different groups – be it differentiated by age group, gender or socio-economic status – avoiding a blanket approach to preventive health and social care and ultimately achieving better outcomes. This is especially important in the context of our ageing society where the burden of care is without doubt only going to increase. My colleague, Mr Leon Perera, who unfortunately is currently isolating at home after a positive COVID-19 diagnosis, in his Adjournment Motion earlier this year called for differentiated indices for health and care outcomes, and I would like to reiterate that call here. Indeed, a 2020 European study on active ageing constructed an individual-level index of active ageing from people aged between 50 and 90 years old and found that gender-differentiated outcomes are pervasive. Like many other previous studies, it points out that women may live longer but are more likely to suffer from chronic and disabling illnesses and also score higher on levels of pain and depression. The study also pointed out how problematic gender-blind active ageing policies are as they do not adequately address the different challenges men and women face in old age. As I mentioned during the April Women's White Paper debate, the gender health gap is also a phenomenon observed here in Singapore. While Singaporean females do have longer life expectancies, a sizeable portion of that extra time is spent in ill health. A 2017 MOH report in collaboration with the Institute for Health Metrics and Evaluation found that in 1990, the gap between life expectancy and healthy life expectancy was 2.4 years larger for females compared with males and this had increased to 2.5 years by 2017.[+5 sentences] It was also a finding by a 2011 study in Singapore that it appears that we too suffer from the gender health-survival paradox of women having more morbidities despite longer life expectancies. Thus far, it appears that we can do more detailed studies and data on this phenomenon in Singapore, and we must make sure that this paradox does not grow, especially since we are still trying to tackle the negative economic effects on women brought about by COVID-19, the gender wage gap and an increased burden of higher CareShield Life premiums. I, therefore, hope that more research and data can be collected on the nature of this phenomenon in our local context so that policies and targeted measures can both be taken and to allow the success of tackling it to be measured. The other point I brought up during my speech earlier this year was that research, healthcare systems and treatments and diagnoses have historically tended to leave women out. When it comes to gynaecological issues, it is further compounded by stigma and culturally-ingrained embarrassment. Issues such as prolapse and stress urinary incontinence due to the weakening of pelvic floor muscles, whether brought on by menopause or childbirth, are thought to affect at least 15% of women here in Singapore, yet embarrassment to discuss such matters even to obstetrician-gynaecologists (OBGYNs) probably means that many women suffer needlessly in silence for what is often a treatable condition.[+1 sentence] I, therefore, hope that these issues can be tackled sensitively and effectively by our primary care providers and that the necessary training and resources are given to support the providers to address these areas of concern together with their patients. To sum up, we support Healthier SG and believe that this approach will benefit Singapore in the long run.[+5 sentences] However, it is imperative that we quickly address any areas of concern with a positive mindset and start to evolve a national conversation around health that is multi-sided. It must not be a top-down, patronising approach where experts tell us what is good for us and that we must follow their approach. Instead, it should be a partnership between doctors, nurses, allied care workers and their patients and families. Good holistic care takes time and the right investments, as does our shift in approach. I hope that this is something we will afford to both our patients and especially our care workers. After all, we can talk until we are blue in the face about the twin "P"s of prevention and the performance of our care systems, but these will be nowhere without the two most important "P"s of the system – our patients and the incredible people who make the system run.[+1 sentence] I support the Motion.
Mr Speaker3 words
[+1 sentence]Mr Sharael Taha.
Mr Sharael Taha (Pasir Ris-Punggol)1806 words
[+2 sentences]Mr Speaker, Sir, by 2030, one in four Singapore residents will be above 65 years of age, up from one in six today. Statistically, the elderly is more likely to fall sick or suffer from disabilities. Age aside, there is a prevalence of chronic diseases amongst our population – 32% of our population has hypertension and 37% has hyperlipidaemia.[+10 sentences] If left untreated, high blood pressure and high cholesterol will lead to significant health problems. Shifting our approach from reactively caring for those who are sick to proactively preventing individuals from falling ill is an applaudable move by the Ministry. It is understandable that we first focus on onboarding the elderly with regular checkups and promoting healthy lifestyle choices. However, we must not forget the other age segments of our population and address lifestyle habits that are also of growing concern. In the March sitting last year, I asked the Minister for Education on the number of vaping cases that has been reported in schools since the ban on e-vaporisers in 2018. I also asked how we can educate our youths on the dangers of using electronic vaporisers and what action can be taken against those who supply such items to our school-going children. Unfortunately, there is no specific data point for vaping amongst students and the Ministry replied that it will continue to monitor the trend. Though we do not have specific data on hand, conversations and anecdotal sharing all point towards a worrying rising trend on the use of these illegal electronic vaporisers with our school-going youths and young adults. One of our Pasir Ris-Punggol resident volunteers shared that it is prevalently used by her schoolmates in polytechnic and it is not uncommon to hear cases of students in secondary school possessing illegal vapes. Vaping is not harmless. As of 18 February 2020, vaping has been linked to 68 deaths and over 2,800 cases of lung injury related to vaping – now more commonly referred to as EVALI, E-cigarette or Vaping product use-Associated Lung Injury, in the United States.[+2 sentences] When CNA did a special on teenage vaping a week ago on 23 September, confiscated vapes were sent to Health Science Authority for lab testing. The results of the chemical content in the liquid were shocking. Among the chemicals found was formaldehyde, a cancer-causing agent used in the process of embalming, nicotine levels which surpassed a stick of cigarette and juice laced with tetrahydrocannabinol (THC), the main psychoactive compound found in marijuana.[+12 sentences] According to the CNA report, Dr Aneez Ahmed, senior consultant surgeon for thoracic surgery at Mount Elizabeth Novena Hospital says he is starting to see cases of teen vapers with inflamed lungs. Despite its ban since 2018 and its harmful effects, vapes continue to be popular and is accessible even to our young. According to the report, one of the teenagers, Kelly, who started vaping at 16 years old, explained to the interviewer that it was simply much easier for her to get hold of a vape than to buy cigarettes from a shop as she is underage. Anecdotal conversations with youths disturbingly surface the ease in which they can obtain vaping instruments online or through Instagram chatrooms, with the product delivered within an hour to a day upon order. Mr Speaker, Sir, this lifestyle habit of vaping, especially amongst our youths and young adults, is a worrying trend. Although it is illegal, our youths still have access to it. While Healthier SG focuses on inculcating proactive preventative care and healthy lifestyle choices for our elderly and rightly so, we should not turn a blind eye to other emerging worrying trends too. We must do more to educate our youths on the dangers of vaping, and prevent and enforce the illegal sale of vapes, especially to our school children. With the ease of purchasing vaporisers, the anecdotal evidence suggest that our youths are exposed to this unhealthy lifestyle habit at a young age which may be detrimental to our vision of long and healthy lives for Singaporeans as the Motion exerts. There may also be other unhealthy lifestyle habits that we need to be aware of. Strong partnerships amongst stakeholders in the community can help to promote healthy lifestyle habits and choices instead. This brings me to the second point on building strong partnerships within the community. In the White Paper, the National Healthcare Group (NHG), National University Health System (NUHS) and SingHealth (SHS) will step up as regional health managers to look after the health of approximately 1.5 million residents in their respective sectors each and work with family doctors and other partners to reach out to as many residents as possible.[+16 sentences] Funding model will shift from a workload-based model to a capitation-based model where clusters receive a pre-determined fee for every resident assigned to them on geographical boundaries. How do we ensure the clusters reach out to its residents effectively? Being able to reach out to residents should just be one of the metrics for healthcare clusters to consider. What other metrics will be given to healthcare clusters to ensure that they are successful at engaging the residents and able to drive significant changes to reshape health and lifestyle choices amongst the residents? In the White Paper, while we have explained the role that residents, family doctors and community partners such as ActiveSG and PA can play, one community partner that is significantly missing are employers. Getting the involvement of employers is very important, considering we spend a significant part of our day working. Other than employers encouraging their company panel doctors to participate in the Healthier SG enrolment programme, how can employers also be incentivised and recognised for participating in the Healthier SG programme? Is there scope for employers to be incentivised to provide healthier meals at the workplace, for example, or even provide healthier lifestyle options such as weekly or hourly time off for exercise breaks? One of the best ways to incentivise and encourage healthy lifestyle habits is to have family members supporting each other. Dieting, exercising and visiting the doctor can be a lonely and challenging task for many individuals, especially when it is done alone. Different family members may also be at different stages of their health transformation journey and at times may accidentally do things that may not exactly help one another. I am sure many of us here have tried to be on a diet and have had a good day of controlling food intake, but the achievement is short-lived the moment a family member invites you to have a late-night supper or offers you that delicious plate of nasi lemak, nasi rawon or char kway teow which you simply cannot refuse! At the heart of Healthier SG is the relationship between family doctor, patient and the health plan. How can Healthier SG adopt a family-oriented model and place family support at the core of motivating individuals? Can the Ministry consider allowing or encouraging family involvement in reviewing and following a prescribed health plan? Can we also look into ways we can increase family engagement as part of Healthier SG, perhaps find a way to introduce gamification where families score points when they take part in an activity together? With enrolment starting for those aged 60 and above in the second half of 2023, will Healthier SG be rolled out to the rest of the population and if yes, when do we expect that to happen?[+2 sentences] As we look towards our vision of long and healthy lives for Singaporeans, I would like to briefly touch on the support for dementia patients and caregivers. A nationwide study in the Well-being of Singapore Elderly (WiSE) found that one in 10 seniors above the age of 60 suffers from dementia. Today, 60,000 people aged 60 and above live with dementia. By 2030, it is projected that 90,000 residents will be living with dementia in Singapore.[+4 sentences] That is a 50% increase. In a recent visit to Apex Harmony Lodge in Pasir Ris, a home specialising in dementia care, I was thoroughly impressed by the level of care for our dementia patients in the home. The home, led by Chairman Mr Gan Boon Jin and CEO Ms Soh Mee Choo, has invested in upskilling its staff and introducing new technologies to provide the best care for its patients. However, such healthcare for dementia patients does not come cheap. The cost of taking care of a dementia patient is above $40,000 per year and continues to rise.[+19 sentences] In the lodge, more than 90% of the residents enjoy subsidised care, some even fully subsidised. However, Apex Harmony Lodge has a current capacity to accommodate 200 dementia patients, which is really a small fraction of the expected 90,000 elderlies with dementia by 2030. How are we preparing to provide sufficient healthcare support for the growing number of dementia patients in the future that require either full board or day care services? Mr Speaker, in Malay, please. (In Malay): By 2030, one in four Singapore residents will be above 65 years of age, up from one in six today. Statistically, the elderly is more likely to fall sick or suffer from disabilities. Many Singaporeans also have chronic illness. For instance, 32% of our population has hypertension and 37% has hyperlipidaemia. If these conditions are not treated at an early stage, it will lead to significant health complications. As a community, we must give more focus towards preventive care and tackle health issues and lifestyle choices before it is too late. Therefore, we must certainly focus on the elderly, by encouraging them to watch their diet, for instance, by reducing their salt and sugar intake, exercise and to also stop smoking. However, as we focus on our seniors, this does not mean that we can allow other worrying trends to become prevalent amongst our youths. We have often heard about how easy it is to get e-cigarettes, also known as "vape" and there are those among our youths who partake in this unhealthy habit. We must do more to educate our youths on the dangers of vaping and prevent the illegal sale of vapes, especially its sale to our youths. Building a healthier Singapore will require the participation of all levels of society, especially families, which must form the core support that ensures Singaporeans make the best health and lifestyle choices. I would like to suggest that Healthier SG be launched with a family-oriented model and that family support is also placed as the core of individual motivation. More can be done to encourage and support active participation of our family members to take good care of their health. Community partners will continue to provide support, and together, we can all become a healthier, happier and thriving community. (In English): Notwithstanding the points and clarifications above, I support the Motion.
Mr Dennis Tan Lip Fong (Hougang)2236 words
[+10 sentences]Mr Speaker, according to the Healthier SG White Paper, all residents will be encouraged to enrol with a family doctor or a family physician, who, I quote from the White Paper, "will serve as the point of contact to holistically manage the residents' health", focusing on providing holistic care, prevention and to improve chronic care. Each family doctor will develop an appropriate health plan for each enrolled resident and would also administer the appropriate health screenings and vaccinations. Mr Speaker, I agree with the intent and merits of having a specific family doctor to holistically manage each resident's health. Needless to say, any doctor would be familiar with his or her regular patients over time. I believe there are already many Singaporeans who have the habit of seeing the same GP over a long period of time each time they fall ill or need prescription and appreciate the benefits of a GP who is familiar with their medical history over time. I have known my current family GP since I was in secondary school. The proposed requirement of a family physician having to develop an appropriate health plan for each enrolled resident and having an annual check-in with each enrolled resident, to find out how the resident is doing in terms of his health or how he or she is adhering to his or her health plan should be a significant departure beyond the current common practice of only seeing the doctor when we do not feel well or when we require prescriptions. I agree with these proposals, but the devil is, of course, in the details. The health plans, screenings and annual check-ins will, hopefully, provide a sufficiently regular opportunity for the doctor to be able to help us to pick up any signs of any health issue earlier before it manifests into something serious or chronic. That said, it is important that such health plans are appropriately developed for residents of different age groups and dealing with prevention of a range of diseases and health conditions. Beyond the mentioned first three chronic illnesses, may I ask the Minister to elaborate more on the 12 care protocols and the time it is expected to take for the care protocols to be fully rolled out beyond the first year of Healthier SG?[+5 sentences] The White Paper also mentioned that mental health and end of life will subsequently be covered. I hope that mental health will certainly not be at the end of the queue, but some priority be given for its earlier introduction. The White Paper itself gave a "special mention" of mental health at page 52. The family physician will, certainly, be ideally positioned to help residents with regular checks on their mental health and, importantly, early detection of any problem. May I ask whether the Inter-Agency Taskforce on Mental Health and Well-Being has been specifically tasked to integrate the new plans under Healthier SG? Will the task force consider how the family physician's role in managing the mental health of their residents can be enhanced?[+8 sentences] Will the task force help to integrate the family physician's new role alongside other resources and stakeholders which are already part of the task force's efforts to date? Mr Speaker, in order for the proposed programme under Healthier SG to work, it will also require the cooperation of all enrolled residents, to be able to adopt the right attitude in adhering to the health plan developed for them and to be actively concerned for their health, and physical and mental well-being. Everyone must be willing and able to accord it priority alongside other demands of their everyday life and treating the plans and the appointments with the family doctor seriously and taking full advantage of them. In the hustle and bustle of modern living, I am not sure everyone may be able to do so. I do hope MOH will have an appropriate public education campaign not just to encourage enrolment, but to encourage enrolled residents to take this programme seriously and be diligent in adhering to the health plans and recommendations and advice of their family doctors, and to make full use of what is provided under the programme. Mr Speaker, I also believe that for this programme to work to the best benefit of most Singaporeans or residents, we need to ensure that as many people will enrol under this programme. I am aware that many Singaporeans currently visit GPs or clinics which are on the panel of their employers' corporate medical insurance plans. These GPs are often not their usual family GPs. When employees change employment or if their employers change their insurers, the GPs or clinics may also change. I would like to ask how does MOH intend to harmonise this situation with its proposed programme under Healthier SG to have more people stick to one regular family doctor?[+3 sentences] Would MOH also engage different stakeholders, including both the medical practitioners and the insurance industry, to see how corporate medical insurance plans can be tweaked to enhance the Healthier SG objective of having more people stay with one family physician? There are also many people who have regularly gone to see GPs in polyclinics, ostensibly for reasons of cost and subsidy. Can MOH give an indication of the size of this group of Singaporeans? Besides MOH's plans to make available more prescribed drugs under CHAS subsidy in GP clinics, how will MOH ensure that the cost of consultations and prescriptions with the family physician will not discourage Singaporeans from switching to Healthier SG?[+20 sentences] Following the introduction of Healthier SG, how does MOH see the role of GPs in polyclinics with respect to primary care and would MOH be reviewing the role of GPs in polyclinics? The Healthier SG also proposes to allow for a change of family doctor once each year. While I understand there may be a need for some flexibility, for example, when a resident changes his or her place of residence or even changes his employment, allowing changes of doctors within a short period of time may not be conducive for the greater goal of Healthier SG to get more people to have one family doctor to manage their health. Mr Speaker, the White Paper also mentioned that the number of eldercare centres (ECs) will be expanded from 119 to 220 by 2025 and that under Healthier SG, the offerings for eldercare centres will be expanded as follows: (a) eldercare centres will serve as a community connector for seniors to help them follow through with the lifestyle interventions as recommended by family doctors; (b) eldercare centres will offer community-based monitoring of vital signs, such as blood pressure in between their visits to the family doctor, following care protocol requirements to be worked out under Healthier SG; (c) eldercare centres will also help to roll out health screenings and other healthcare initiatives. I welcome the above, but I do see that this must come with additional manpower as well as IT resources. I would like to ask the Minister whether and how will MOH help with the provision of additional manpower, IT, training and other necessary resources and support for both the eldercare centres as well as the family physicians' practices. More assistance may be required by both stakeholders in managing the additional responsibilities as well as ensuring that all interventions, screenings and other measures recommended by the family physicians are well coordinated. Mr Speaker, I do appreciate what the eldercare centres, the senior activity centres and, indeed, the day care centres in Hougang Single Member Constituency (SMC) are doing to take care of the seniors under their charge. It is not an easy task for the eldercare or senior activity centres to reach out to all seniors within their designated cluster and try to ensure that the seniors are in good shape and that help can be given if required. The response of our seniors may vary between individuals. While many are happy to know of the support they can reach out to and many also get involved in activities in eldercare centres and welcome being connected to such centres, some seniors may not be open when eldercare centres try reaching out to them. Some may not want to keep in touch with their eldercare centres. Some keep to themselves and may not socialise with others. Some of these seniors live by themselves and may not have family members at hand to keep an eye on them in their homes. I am concerned that for this group of people, the family doctors under Healthier SG may also experience difficulty in reaching out to them or ensuring their committed participation. I hope MOH can study how outreach efforts can be improved to such seniors so that all can actually benefit from these programmes under Healthier SG and, most of all, their health and well-being can be enhanced. Mr Speaker, the Healthier SG White Paper is silent on dental care. While I understand the White Paper may focus on chronic care management and prevention of chronic disease, dental health is important. Good dental and oral health can also enhance our overall health and prevent complications to other areas of our health, including prevention of certain chronic or other diseases. Moreover, there is some overlap in similar lifestyle factors causing problems to dental/oral health and to other aspects of our health, for example, consumption of sugary products. In my view, a similarly structured programme akin to Healthier SG may also help to promote better dental and oral health. I would, therefore, like to know whether in the future, if MOH will also look at extending Healthier SG to the coverage of dental and oral healthcare.[+4 sentences] Still on the topic of dental health, recently, a resident provided some feedback to me about the cost of dental treatments not covered by MediSave. Payments through MediSave can only be made for treatments where surgeries are involved. Dental clinic treatments like tooth extraction, root canal treatments and affixing of crowns, while not necessarily regarded as under the category of surgery, can be relatively expensive to many people. For retirees, the outlay in cash for dental treatments can be a burden, especially if they have recurring issues. While there are subsidies available for limited categories of CHAS and other card holders, my resident wishes that the Government can consider making MediSave available for at least some of the treatments and/or consider increasing the extent of CHAS subsidies currently available for these treatments, for example, for orange CHAS card holders and even beyond.[+3 sentences] If need be, the Government can look into including more measures to deter possible abuses by minority practitioners. Mr Speaker, before I end, I would like to touch briefly on the issue of resourcing. Under Healthier SG, family doctors have new responsibilities towards the care of residents enrolled under them, regardless of age. While they will be paid a fee per enrolled resident, if the patient numbers do not reduce for any family doctor, what is the expectation of MOH on the effect of the additional work or additional patient loading brought about by Healthier SG?[+5 sentences] And how are the doctors expected to cope with the additional work and responsibilities? Mr Speaker, in Mandarin, please. (In Mandarin): Mr Speaker, I support the recommendations in the Healthier SG White Paper that every Singaporean chooses a designated family doctor to provide medical services and manage their overall health. To implement Healthier SG smoothly, we must ensure that the participation of the majority of Singaporeans and that participants have a positive attitude towards the health plan set for them. In addition, I hope that the mental health aspect mentioned in the White Paper will be given priority and included into Healthier SG as soon as possible. The White Paper also plans to increase the number of existing eldercare centres from 119 to 220 by 2025.[+12 sentences] These centres will take on more responsibilities and services and work closely with GPs. I hope that the Government will provide more manpower, technology training and other resources for the various parties to support this new model of cooperation. At present, apart from ensuring the health of the elderly and providing them with assistance, eldercare centres also need to reach out to and communicate with the elderly in the area in different ways. This is a meaningful but challenging task. Many seniors are glad to learn that the centres are able to provide the necessary assistance and are happy to participate in the activities organised by the centres. However, there are still some elderly folks who choose not to contact the centres or participate in activities organised by them. This trend will pose some challenges to the Healthier SG programme. For example, how GPs can effectively engage and persuade this group of seniors, especially those living alone, to participate in the programme is an issue to look at. I hope that MOH will look into improving outreach to this group of seniors so that all Singaporeans can benefit from Healthier SG. Mr Speaker, although oral health is not currently covered under the Healthier SG White Paper, dental and oral care has implications for the overall health of an individual, such as helping us avoid other chronic health conditions. I hope that oral health will also be included in Healthier SG. (In English): Mr Speaker, notwithstanding the concerns I raised, I support the Motion.
Mr Speaker3 words
[+1 sentence]Ms Mariam Jafaar.
Ms Mariam Jaafar (Sembawang)2887 words
[+2 sentences]Mr Speaker, I declare that I am a Managing Director and partner of a management consulting firm that does work in the healthcare space. The rising cost of healthcare is a threat to our Government budgets and to our economy. It is a growing financial and emotional burden on our families. It has already been cited as the reason why we have to do the unpopular choice and raise GST, despite the political cost.[+14 sentences] It is, in a word, unsustainable for Singapore. It is unsustainable for Singaporeans like my Woodlands resident, Mr Z, whose wife suffers from diabetes. Mr Z comes to my Meet-the-People Sessions (MPS). He has problems – how to cover the cash co-pay for her next hospital visit, how to pay for the bags and other consumables that are not paid by MediSave, how he is going to push her in her wheelchair to the NKF centre for her dialysis treatments, these days, often in the rain, when the growing arthritis in his bones sends waves of pain up his legs and back. It is for my resident, Ms N, who has worked hard to build her career. But one illness to her aunt who lives here on a Long-Term Visit Pass (LTVP), has wiped out a huge chunk of Ms N's savings, and continues to take a chunk out of her take-home pay every month. It is why my resident, Mr T, refuses to go for check-ups, let alone screening. "If they find something, I do not have the money for treatment. So, better do not know", as Minister Ong said. It was exactly what Mr T said. Sir, we have a healthcare system that is admired. We are living longer. And, at this point, I want to react to the comment by the Member Ms He Ting Ru who stated that we are living longer but not healthier and that MOH tends to look at life expectancy rather than more healthy indicators. For this speech, I did look at that data. And she may want to know for the specific datapoint on health adjusted life expectancy (HALE), MOH has actually tried doing that and it has been increasing year-on-year. And based on the global finding, our HALE at 73.9% in 2019 is the highest in the world.[+5 sentences] So, I just wanted to give the credit to MOH that our hospitals do a great job at treating the sick. But could we have done more to avoid people getting sick in the first place? Could we have done more in taking more decisive, holistic actions on preventive care, on a national focus on population health, that permeates everything we do in our daily lives, from the food we eat, the exercise we do or do not do, the amount of screen time we allow our kids that might have helped us prevent the rise of chronic diseases – diseases like diabetes, hypertension and lipid disorders? So, for these reasons, Mr Speaker, I say that Heathier SG is not just a good idea. It is necessary and overdue. Too much has been spent on acute care, too little on prevention.[+23 sentences] More people are getting sick and living with chronic illness. They are getting sick earlier in their lives and will require medical care for a long time. Add to that an ageing population and rising costs and we have no choice but to make this work. HPB has worked hard to promote healthy living, but HPB cannot do this alone. It is time we recognise and ensure that incentives, norms, practices, data analytics and policies must be aligned to the behaviours we want to drive across the system. Not only behaviours of the doctors, nurses, hospital administrators, everyone in the healthcare delivery system, but also of the community, of patients and currently healthy citizens, to take charge of our own health. There are many things to like in the Healthier SG White Paper – mobilising GPs, removing co-pay, free vaccinations, cheaper drugs at the GP, social prescriptions, leveraging community assets and solutions. Colleagues have talked about it today. I would like to focus on three enablers to making Healthier SG happen – healthcare financing, IT and manpower as identified in the White Paper. But before I go into the enablers, I would like to frame them in the context of what it is that we are trying to achieve. How do we frame the objectives? The ultimate objectives must be better health outcomes, at lower cost. And indeed, this is the objective of healthcare reforms around the world, towards a model commonly known as value-based healthcare. But when we look at the key performance indicators (KPIs) for Healthier SG, many of the KPIs, especially in the near term, are process indicators, things like enrolment rates, screening rates, vaccination rates and health plan completion rates, while health outcomes like disease prevalence and control, mortality, re-admission rates, frailty, start to figure only later. Mr Speaker, there is a whole body of knowledge that has emerged in the field of value-based healthcare around health outcomes measurement, such as the US' Centers For Medicare and Medicaid Services and its Meaningful Measures initiative, as well as the International Consortium for Health Outcomes Measurement and its range of condition-specific standard sets of outcomes, for different age groups and different demographics, including clinical and patient-reported outcomes. Patient-reported outcomes includes measures of quality of life, for example. Do they feel pain, their ability to perform activities in daily living, sense of control, their moods, loneliness? So, why all this effort? Quite simply, it is because without measurement and transparency of outcomes, we would not know whether what we are doing and paying for is having an impact and how much. Doctors and clusters would not have the data they need to make better decisions and drive innovation, teamwork and best practice sharing. We need outcomes that are measurable, effective and standardised across clusters. It takes time to identify, find ways to measure, and to show the value to everyone in the care delivery chain so it is not simply administrative overhead. This is not something we can leave to the clusters. I repeat, not something we can leave to the clusters.[+1 sentence] MOH leadership is needed. So, I call on MOH to consider including, as another pillar of Healthier SG, a drive to accelerate the identification, measurement and transparency of health outcomes.[+5 sentences] It is very true that there is a big risk in a transformation as fundamental and complex as Healthier SG to expect too much too soon. But the evidence from successful value-based healthcare systems has shown that meaningful health outcomes can, in fact, be achieved sooner, but for defined patient segments, particularly at the intersection between primary care and the secondary and tertiary space, such as at the point of discharge from hospital. For example, a general nutrition education takes a long time to payback. But Oak Street Health, a relatively young and innovative US primary care provider, found that making sure elderly patients with diabetes are eating properly when they are first discharged from hospital is very rapid payback in terms of lower re-admission rates. Another example, in Sweden, the Stockholm County Council launched a value-based payment programme for hip and knee replacement in 2009, led to a rapid shift of care from acute care hospitals to cheaper specialty clinics. In the first two years, complications decreased by 18%, re-operations by 23%, and revisions by 19%, cost per patient declined 14% in terms of resources used by providers and 20% in terms of money paid out by the Council.[+4 sentences] Finally, the Lumos programme, an initiative to integrate healthcare data in Sydney, Australia, developed a model that shows the high value impact that can be obtained through early detection in primary care specifically. When a patient is diagnosed with diabetes early in primary care, and has regular GP visits forthwith, their diabetes journey is much more likely to be managed over time in the community setting. In contrast, when the diagnosis is done later and in a hospital setting, and he does not engage much with primary care, this could result in poorer management of diabetes and increased re-admissions. But here is the good news. The Lumos data also suggests a GP visit within one week of discharge of an unplanned re-admission can substantially reduce the risk of an unplanned hospitalisation in the five to 12 weeks following discharge.[+14 sentences] This is data that we can act upon and do something about. The common thread in each of these examples is "think big but start small" – focus on a specific population group and patient segment, for example, people over 60 with diabetes and identify a subset of outcomes for that patient segment, and set the system to work to track and improve those outcomes and make this visible. And I stress to focus first on managing and tracking and doing something with it. I am a little bit more ambivalent about the suggestion by the Member Mr Gerald Giam to put a target on every KPI, especially with some of these KPIs, as the Member Ms Denise Phua said, it is very easy to achieve them, can set some perverse incentives. What is important is to identify the right KPIs, measure them and actually use them to make our system better. So, I urge MOH to consider a real push to measure health outcomes from the beginning. And with this lens of focusing on outcomes, I turn now to what it is going to take to make Healthier SG work. First, healthcare financing, an area that will undergo significant reforms in Healthier SG, with a move towards capitation funding. The drawbacks of our current model of a fee for service are clear. It motivates doctors to take on more and more patients, even if they do not have time, to order that extra MRI, even if it is not necessary, to prescribe the most expensive drug instead of a generic that does the job. It feeds off a very human trait – love, the love that makes us willing to try anything, spend anything, if we believe it might keep our loved ones alive. And trust me, I know how that feels. But, Mr Speaker, more expensive care is not necessarily better care. More treatment is not better care. This is why healthcare systems around the world are implementing payment reforms, with mixed results. There are different forms – pay for performance, bundled payments, capitation and they can be used in combination, but the fundamental logic is the same – pay for quality and value rather than volume.[+2 sentences] Capitation, in particular, gives healthcare providers a powerful incentive to manage total systems costs. Most capitation systems are geared to encourage providers to focus on prevention and early detection and intervention. One successful example is CMS Medicare Advantage in the US, where Medicare pays private insurers a fixed risk-adjusted payment for the total cost of care for a patient.[+12 sentences] Then, it is up to the insurer and its provider partners to figure out the best way to invest that money to provide the care. Insurers, such as Humana, have built their own or partnered provider networks to help them create more value-based models. Oak Street Health, which I mentioned earlier, is one such Humana partner. Oak Street clinicians are given the autonomy to do whatever drives best outcomes for the patient. Working in multidisciplinary teams of GPs, nurses, specialists, nutritionists, they take input from the patient and caregiver, and also consider the patient's social determinants of health, such as food security and social support. This holistic approach often drives new insights and innovation. So, if the patient needs a surgery to be healthy, they will make the referral. If he needs food delivered to him to make sure he eats healthy, that is what they do. Or if it takes a house visit to make sure that the home does not have hazards – a stray rug or slippery tiles that could cause him to trip and fall, that is what they do. Or if they think the most meaningful thing is to have someone put their arm around him to be comfortable with his life situation, that is what they do – and they are achieving good outcomes. Another example is Kaiser Permanente, also in the US, where transparency about outcomes and costs encourages the clinical teams to avoid low-value care and right-site care within its integrated network of hospitals and primary care providers. A system of incentives encourages clinicians to work together and share best practices and always driving continuous improvement. These successful models point to a few prerequisites for capitation to be truly value-based. It needs to be organised around defined patient groups and population segments, adjusted for risk, and linked to quality thresholds or improvement in health outcomes. Otherwise, capitation could create incentives for "cherry-picking" of healthier patients or for limiting access to required care or what we call "rationing" behaviour. To that end, can the Minister clarify the capitation model envisioned under Healthier SG, including how will the payments be risk adjusted based on patient profiles in the cluster?[+29 sentences] Will there be bonus payments for achieving better health outcomes? How will health outcomes be shared across the delivery value chain to encourage people to work together? How much autonomy will be given to the clusters and clinical teams to do what they believe is right to deliver better care, informed by care protocols and outcomes? Can there be participation payments for tracking and reporting health outcomes? How will adjustments be made at the backend when someone uses healthcare services outside his or her own cluster? Second, healthcare IT. The enhanced National Health Electronic Records system under Healthier SG is much needed. We should not need to tell every new doctor or specialist we see about our medical history or our prescriptions or to have to repeat expensive tests and x-rays or to repeat information needed by our medical social worker at every hospital you or your child goes to. Digitising and automating processes, leveraging mobile apps like MyHealthHub and Healthy 365, all these make sense, though implementation is non-trivial, as some colleagues have raised. The hon Member Tan Wu Meng has made the point that digital solutions must be easy to use and reliable. I absolutely agree. To change behaviour though, doctors and patients alike must be excited and willing to use these tools. Here is where the lens of outcomes pushes us to go even further and, that is, data – clinical data, pharmacy data, health screening data, health app data, cost data, but also data about the individual and how he likes to be engaged. Can we use all that data and analytics to identify risky individuals for whom we can have the right conversations and make the right targeted interventions in order to make a meaningful impact? Can we engage patients and physicians, not only with apps and technology and tools but with data – data that tells them where they stand in comparison to others and advises them with personally relevant information of actions that they can take, including, of course, working with community partners? I think the role that data and analytics can play in driving outcomes for Healthier SG is incredibly interesting and I would suggest doubling down on the capabilities to do this. Last but not least, healthcare manpower. I have spoken a number of times in this Parliament on the adequacy of healthcare manpower, including the shortage of nurses and the need for healthcare manpower transformation in preparation for a future that is much more focused on value-based care and prevention. For Healthier SG to work, we not only need more nurses, we need enough good family doctors, nurses, allied health professionals, pharmacists and care coordinators. They must be comfortable dealing with a wider range of complex conditions, working with data and technology, working in multidisciplinary teams, including specialists, and new ways to engage patients. We need everyone in the healthcare delivery system to be rewired around prevention and putting care in the right place. This will not come naturally. Today, they are not trained in that way, they are not compensated in that way, and let us face it, their intellectual respect – our intellectual respect – is not for prevention. Our intellectual respect is for the surgeon who pulls off a complicated surgery. So, we need to respect family doctors a lot more. If Healthier SG is to succeed, we have got to get this rewiring right. I believe that, for most clinicians, the language of health outcomes is an inspiring and powerful one versus administrative tasks. It can underpin the enormous change management effort that will be required. Mr Speaker, MOH has implemented a series of individual reforms in recent years. Healthier SG is a fundamental and comprehensive transformation that will require institutional commitment to work things out, considerable investment and new organisational and people capabilities and ways of working.[+3 sentences] They say, "health is wealth". To put our healthcare system now on a more sustainable footing and to get a healthier Singapore and Singaporeans – for Mr Z, Ms N, Mr T and millions of other Singaporeans like him – we cannot fail. I support the Motion.
Mr Speaker45 words
[+5 sentences]Order. I propose to take a healthy break now. I suspend the Sitting and will take the Chair at 5.40 pm. Sitting accordingly suspended at 5.21 pm until 5.40 pm. Sitting resumed at 5.40 pm.
Mdm Deputy Speaker3 words
[+1 sentence]Mr Gerald Giam
Mr Gerald Giam Yean Song80 words
[+4 sentences]Thank you, Mdm Deputy Speaker. I just want to make a clarification to Ms Mariam Jaafar. She mentioned that she was concerned about setting targets to accompany the KPIs because she mentioned that the hospitals could game the system. I just want to clarify if that is what she said, because the KPIs that I mentioned were all KPIs that were mentioned in the White Paper. So, which are the KPIs is she not concerned that the hospitals will game?
Mdm Deputy Speaker2 words
[+1 sentence]Ms Mariam.
Ms Mariam Jaafar98 words
[+1 sentence]Thank you. I think I am just making a general point that we have seen in multiple studies, that sometimes target-setting too early when you do not actually have a good base behind it can create a lot of perverse target-setting. I am not saying that hospitals will do it, not saying that doctors will do it, but I do not think we need to take that risk and instead focus on the measurement, identifying the right ones in the first place, measuring, and then also making sure that we keep doing better and better in those KPIs.
Mdm Deputy Speaker3 words
[+1 sentence]Mr Gerald Giam.
Mr Gerald Giam Yean Song45 words
[+1 sentence]So, is Ms Mariam Jaafar saying that we should not set targets right now even though we have the KPIs, or is she suggesting that there is a certain time frame later on that we should set the targets and so when will that be?
Mdm Deputy Speaker3 words
[+1 sentence]Ms Mariam Jaafar.
Ms Mariam Jaafar100 words
[+1 sentence]I think we would need to look at different KPIs. Some KPIs, maybe you can set the target. I believe we need to walk before we run. This is a very major transformation and like I said, we should scrutinise the KPIs on the page first to make sure that those are the right ones that we want to measure.[+1 sentence] I cannot say when the right time is to measure it, but I expect that will come in future once we have more data, I think it is important to do this based on a good fight, based on data.
Mdm Deputy Speaker4 words
[+1 sentence]Dr Lim Wee Kiak.
Dr Lim Wee Kiak (Sembawang)3075 words
[+5 sentences]Thank you, Mdm Deputy Speaker. First, let me declare my interest as a member of the medical profession – I am a practising ophthalmologist in the private sector. I would like to also commend and congratulate Minister Ong Ye Kung and the team over at MOH for a very bold and forward-looking Healthier SG White Paper. You know it is a good paper when many, many Members suddenly rise to the occasion and start to claim credit for it. So, everybody would quote their own previous Adjournment Motion, COS debate and so on. At this juncture, I think I would like to join them as well.[+1 sentence] Let me claim credit for putting forward the suggestion that there must be an adult immunisation schedule. This paper itself will transform our health care system into one that is preventive.[+21 sentences] It is a paradigm shift. A paradigm shift because most of us, most of the patients, only when they are ill, will they see a doctor. If you are not ill, you should not see a doctor at all. Most of the doctors will only see patients when they are ill. If the patients are well, they do not see the patients. So, it is very, very different. I am not sure if we should even call them patients in the first place because now, they are not ill at all. So, it is a complete paradigm shift. Maybe clinics will have to change their name, they should not be called clinics, they should be called wellness centres, because they are there for wellness, they are not there for the sick. In the transition, that is the difficulty. To have a paradigm shift, you have to change the mindset of both patients, as well as the GPs, as well as the population. I think that is the enormous task that MOH have now, ahead of them. First, let me just congratulate MOH for taking this very bold step, one small step ahead, but it is bold step for the nation. I totally agree with the White Paper and support the White Paper. All those proposed initiatives are commendable, but there are many areas of concerns, like my Parliamentary colleagues have raised. The details are always in the execution and the problems are always there. I would like to focus my speech on two areas – the "One Resident, One Doctor" scheme and how this will potentially affect the patient, as well as the GPs. Like many of my Parliamentary colleagues, I do have my family doctor, Dr Tan in the Nee Soon Clinic that looked after me and my family when I was young. I am very grateful for that. That one GP clinic looked after my entire extended family – my grandmother, grandfather – he was the one who came and signed the death certificate for my grandfather, and for my grandmother as well. So, I think we are quite familiar with the relationship of one good GP to a family and what a good family physician can do. The current White Paper now dictates that it should be one family doctor to one resident.[+10 sentences] I think it is a good idea. But our current GP practices now are no longer like those which were in Nee Soon village. They are no longer solo practices. Most of them are in group practices now. In fact, they are big group practices whereby doctors always change. So, you may not see the same doctors all the time. If the scheme now is to be attached to the clinic, then does it defeat the purpose of this White Paper, in the sense that you do not build a relationship between the doctor and patient, but it is just between the clinic and the patient. So, I am not sure how that changes the paradigm. It is very similar to the current polyclinic system now, whereby my residents always complain that when they go to the polyclinic, they see different doctors all the time. The only thing that held everything together is good medical records. When you have good medical records, then it makes a big difference. So, I think the key thing now is your IT.[+13 sentences] It is to make sure that the medical records are seamless so that patients do not need to repeat everything, doctors do not need to look through a lot of other records in order to find out how to manage this particular patient or resident. In established healthcare systems in developed countries like the UK and Switzerland, access to healthcare starts from a regular GP or family doctor. When doctors have a good long-term working relationship with their patients, they can harness the power of these relationships to solve problems beyond what may be too complex for other healthcare professionals, such as those pertaining to social and lifestyle challenges as well. As a doctor with regular patients, I can certainly attest to the effectiveness of such working relationships where both parties have mutual respect, trust and confidence, which is the most important. As I mentioned earlier on, many GPs are now in group practices. GPs rotate themselves between clinics. If patients are enrolled with a particular doctor, they may find it very difficult to reach this doctor at the preferred location on certain days or certain times. Under such circumstances, of course, the patients would be attached to the clinics instead. If the enrolment is based on the clinic and patients see different doctors, then the question, of course, is what is the value of the doctor-patient relationship? Some patients would prefer doctors who are not in their health cluster – not within their area of residence. I think the Minister has mentioned that they can switch GPs. If the patient can switch GPs, can they also switch cluster? That is the next question. Can the Minister also help clarify whether GPs in a particular health cluster can refer patients to specialists in other clusters, especially for existing patients who have been seeing a doctor at a particular hospital for a long time?[+51 sentences] This is important as patients may want to exercise more choice over their preferred specialists. The reverse is also true, in the sense that with specialists, can they refer patients now to GPs or polyclinics within their health cluster for step-down care? If the patient requests to go to their preferred GP, will this cross-referral and transfer of medical history be conducted seamlessly? Will cross clustering further complicate funding of the programmes as it is funded by clustering? Then, there are the patients who go to their company's medical group to utilise their company's medical benefits. Employees these days are spending fewer years working with the same company. This means that it would be very difficult to forge the long-term relationship that we hope to achieve through this "One Resident, One Doctor" scheme if they are switching doctors every few years under the company's scheme. How does the Government plan to counter this? The enrolment of one-to-one GP will still allow patients to use their CHAS card at other GP clinics and this does not allow for "stickiness" to one GP and patients will still go GP-hopping. This is the feedback that I got from my GP colleagues. Of course, GPs are GPs. There will be GPs that are very popular. I am afraid that when this enrolment starts, the very popular GPs will be all fully booked out. Just like the good schools, MOH may have to start a balloting system for patients to book their favourite GPs. Last of all, can GPs choose their patients? Are they allowed to reject patients who choose them in the first place? If that is the case, then, yes – by right, GP groups and GPs can cherry-pick. They can choose patients who are well, who do not need so much care, who are much more cooperative, compared to those who are not so cooperative. As for the age of entry, disease prevention, especially for chronic diseases, is the focus of the White Paper. I was wondering why the Ministry choose 60 and above as the entry age for the programme. In fact, 60 and above is where chronic diseases start. At 60 and above, like what my Parliamentary colleague Sharael Taha just mentioned, one out of 10 will be having early dementia. It is a bit too late. If you want to prevent dementia, you should encourage them to start walking at 40 years old. If you walk 4,000 steps a day, it reduces your risk by 20%. If you walk 10,000 steps a day, it halves your risks straightaway. In that case, you do not need to build so many expensive dementia management centres if you start the programme early. So, the question is – of course, ideally – that the implementation age should be 40 years old and younger – not older. The earlier you start, the easier it is to manage chronic diseases. In fact, we are here not to manage chronic diseases, but trying to prevent chronic diseases. By the time you hit 60, you are actually managing chronic diseases. So, there is a difference there. The essence of the White Paper is to prevent disease from forming. Of course, we also want to make sure that chronic diseases are well managed, they do not progress to become more serious in the first place. Last of all, is encouraging participation. Free medical checkups and vaccinations are, undoubtedly, attractive for boosting participation, yet there will be residents who are unconvinced. Even for our free COVID-19 vaccination programme, which it comes to their mind, there are people who will refuse the vaccination. There are also regular functional medical screenings via Project Silver Screen that is held in the heartlands, free for seniors over 60. Not everybody will sign up. I have older folks who do take care of their health through good lifestyle habits like regular exercise and eating healthily but there is an aversion when it comes to asking them to go for medical screenings or seeing a doctor, especially when they are not feeling unwell. Preventive healthcare does require commitment on the patients' part. It is unlike a simple medical consultation where patients see the doctor because they have symptoms. After they have their symptoms seen, they get treated, they go home with a medical prescription and that is the end of the transaction, whereas preventive healthcare is a long-term journey. The concept itself is relatively recent. What else can you do, as a Government now, to encourage the active participation of the population in preventive healthcare because it is really a big paradigm shift for all our residents. A big part of it is funding. I shall talk a little bit on remuneration for GPs. This, I must, first, not take credit for myself. I must credit my GP colleagues who have emailed me when I asked them for their feedback on the Healthier SG White Paper. The first thing they asked me was, "How is the funding model?" Many GPs are concerned about the remuneration model as they believe that the new scheme will add considerably more workload for them. MOH has announced that there will be an annual service fee for each enrolled resident, which will vary according to the risk profile, scope of care as well as progress made. The fees are based on the patient's progress rather than service, which I think could be challenging to measure objectively.[+7 sentences] I think the argument on what KPIs to set, how to measure, has already started in this House. A younger patient who is more receptive to advice will naturally make more progress than an older patient with more chronic health problems and who may be more resistant to changing their lifestyle. Can the Ministry provide a clearer outline on how GPs will be remunerated? While I believe that most doctors want to make a difference to their patients' lives. However, if they feel that they are not compensated reasonably for their time and effort, some will choose not to participate in this particular scheme. In short, my concerns are how do we empower GPs and how do we make sure that GPs do not cherry-pick at the end of the day? That is the tough part, the tough balance that you have to make. In terms of drug pricing – drug pricing to be made comparable to polyclinics needs to be handled carefully as GPs do earn from the sale of proprietary drugs. The uneven rollout of drug pricing by January 2024 may lead to residents preferring to be seen in polyclinics instead of GPs.[+2 sentences] That is one feedback that I got from most of the GPs. I also want to voice the concerns from my GP colleagues about the IT-enabler for GPs. The incentive for GPs may not be worth the extra time and effort because, in July 2023 – that is, next year – the solo GP and his clinical assistant must do an enormous amount of work.[+6 sentences] While clusters can help him and his patients to connect to the social and community partners, he still has to see patients in an efficient and timely manner and ensure outcome indicators as well. This can be a daunting task for many GPs. They will not receive payment for their work right away, it may be a year later. So, we need to walk this journey with the GPs and scope this launch very carefully. The next topic I want to talk about will be the participation from the healthcare clusters. I note that the three healthcare clusters will be involved in keeping the resident population healthy and will be step up as regional health managers. Can the Ministry share what are the specific KPIs for the health clusters and how will these KPIs be tracked? I would also like to raise the concern that small GP groups as well as independent GPs may find themselves at a disadvantage, compared to the big groups which have clinics spanning all three clusters, because their market will be very limited.[+13 sentences] Last of all, is preventing GP burnout. I echo some of my Parliamentary colleagues here. In the UK's National Health Service (NHS) system, GPs form the bedrock of their entire healthcare system. The healthcare journey for every patient starts with the GP first. In recent years, GP practices across the UK face significant and growing strains with the declining number of GPs, rising demand and struggling to recruit and trying to retain staff as well. This translates into longer waiting times and poorer service for patients. According to data from the British Medical Association (BMA), the overall number of GP partners has been on the decline in recent years. Since 2017, the number of GPs working full-time hours or more in GP practice-based settings has been steadily decreasing. More GPs choose to work part-time as they have better control of their hours and workload, to improve work-life balance and reduce stress and burnout. Besides loathing the heavy workload and long hours, NHS GPs have expressed their unhappiness with how their contributions and abilities have been undervalued, compared to specialists. They also face increasing abuse from patients as well. We must learn from these countries with similar models and recognise the benefits but see how we can avoid the pitfalls. For the shift in our healthcare policy to be successful, we need adequate GPs to be working regular and reasonable hours to minimise burnout and to ensure that all our patients will be able to receive timely and adequate care. How will MOH monitor the situation to ensure that GPs are well-equipped to deal with increasing workload?[+28 sentences] Will there be a support channel for both patients and GPs to share feedback? This is not to encourage patients to complain, but for MOH to seek meaningful feedback and to provide necessary support if the clinics are facing difficulties coping. The last thing we want is for the national care standards to drop and patients to be left in the lurch. Will MOH now require GPs enrolled under this scheme to operate a certain number of hours on specific days or specific times of the day? There are clinics that are open only half a day on certain days of the week. Many do not operate on weekends and public holidays. What will happen to patients who require medical care when their GP clinic is closed? What is the contingency plan if the GP is away for an extended period of time, be it for professional or personal reasons? Are enrolled clinics required to have more than one GP? Would they have to hire a standby and inform MOH if they will be away? Will there be a backup – a first-line GP and a second-line GP? Instead of appointing one, you have to appoint two, which means that one is on standby. To get a clearer picture on the GPs' interest in the "One Resident, One Doctor" scheme, we need more statistics. Currently, how many GPs are practising on a part-time basis? These GPs may not be able to accept major cases or cases requiring commitment for long-term follow-up. How many GPs are participating in the Primary Care Network? What percentage of GPs nationwide does this constitute? In conclusion, Mdm Deputy Speaker, good health is our personal capital asset. Responsibility for health should be a collaborative effort among individuals and the society that we live in. We all have to look after our health. At the same time, many may not be well-versed in healthcare matters and would greatly benefit from having a healthcare professional by their side to walk them through this healthcare journey. We cannot put this plan into execution without strong support from our GPs. During the pandemic, widespread burnout caused an exodus of healthcare staff around the world. Singapore experienced our highest turnover rate of healthcare workers over the past two years. Yet, even before that, healthcare workers have voiced their discontentment with long, inflexible working hours, and the abuse and disrespect they faced from patients. The pandemic has pushed the stress faced by healthcare workers to a breaking point. As we recover, we must ensure that Singapore continues to be a safe, conducive and inviting place for all our healthcare workers, including our GPs. With that, Mdm Deputy Speaker, I support the White Paper.
Mdm Deputy Speaker4 words
[+1 sentence]Dr Tan Yia Swam.
Dr Tan Yia Swam (Nominated Member)1528 words
[+17 sentences]Mdm Deputy Speaker, as President of the Singapore Medical Association (SMA), I have been involved in some prior discussions on Healthier SG. MOH has been actively engaging the College of Family Physicians and the SMA; and is aware that doctors broadly support this move. We support the shift in emphasis from treating disease to prevention and to strongly support the individual's health in primacy care via the family doctor and community support. I speak now to raise specific concerns and hope that these will be considered as we embark together on Healthier SG. I would like to remind everyone, that we must consider the whole healthcare ecosystem, and not strictly segregate primary versus specialist care, or restructured versus private sectors when problem solving. First, some context and background. I am a general surgeon who has worked in several restructured hospitals, before stepping out to private practice as a breast surgeon three years ago. And, as Dr Lim pointed out about wellness, I am registered as "Breast Friend Surgery and Wellness" because I advocate strongly for prevention of breast cancer. During an administrative briefing many years ago, I once saw patients described as "clients" and doctors are called "service providers". I was saddened and devastated. That is when I decided – I will do what I can to reclaim back the doctor-patient relationship, for all of us. It is demeaning to think of healthcare purely as a business, or a transaction of payment for services rendered. Those of us who have enjoyed good doctor-patient relationships – and I have been on both sides – understand the world of difference it makes. Having a good family doctor provides that strong anchor – to look after you and your family, and in turn, refer you to the necessary and relevant specialists for additional care. In real life, the difficulties and limitations of logistics, insurance panel restrictions and personal preferences will affect the flow of care. I have spoken on the problems with the Integrated Shield plans previously and I am glad to report that there has been some progress made. What other broad challenges exist now for healthcare workers? Three things: one, IT support; two, manpower; and three, the elephant in the room, respect for healthcare workers.[+17 sentences] Let me elaborate. The newspapers have reported on the national downtime affecting electronic healthcare systems in restructured clusters and this House has had updates from MOH on investigations. As SMA President, I received feedback on the struggles that healthcare workers face on the ground. Complaints and angry patients aside, what we are more worried about is the potential lapses of care, as back-up manual paperwork is done during downtime, and then healthcare workers have to stay back to load the relevant information back into the electronic system. Duplicate documentation – can you imagine how many man-hours are wasted, rather than focusing on actual patient care? As much as we understand the need to make things electronic, most healthcare workers are wary and cautious of the roll-out of the National Electronic Health Record (NEHR). I thank Minister Ong for acknowledging our concerns and recognising the need for good IT support and adequate monetary reimbursements. May I also suggest that we need legislative support, in the event of unexpected complications in trying to implement the changes, for example, in the cybersecurity of electronic health systems, be it the clinic's own records or the national system? I also propose that there should be education and encouragement for patients to take ownership of their own health records in HealthHub and to actively share relevant information with their attending doctor. Why is this mindset important? I, personally, would like some of my medical information to be private. Just, as an example, if I had a previous miscarriage and abortion, mental health issues, I would not like every healthcare worker to know about them. I will choose to inform my attending doctor on what I feel is relevant, or, if they ask, I will question, is this information going to make a difference to my current condition? I value confidentiality and privacy. In conjunction with Healthier SG, let us remember to educate individuals on the importance of personal care and responsibility. Next, manpower issues may not be solved just by hiring more healthcare workers. It is not just the number of staff but the experience of each staff. Losing one nurse with 10 years of experience and intensive care unit (ICU) training, can she be replaced by five new nurses?[+12 sentences] Look to the retention of staff – for senior, trained doctors to stay in public sectors; for experienced nurses and allied health to want to stay in Singapore. It is good that there are more training and new hires for Singaporeans and for foreigners, but how do we actually retain them? Exit interviews should be taken seriously to evaluate systemic problems or work culture differences. For my own exit interview some years back, the schedule was changed a few times and eventually, it was a new HR staff who met me to take back the staff pass and sign some papers as a formality. I hope MOH continues to engage all stakeholders on a regular basis and take our considered feedback. The Tripartite Committee looking in the welfare of our junior doctors is a positive step. How about other groups? Why are the foreign nurses, who have worked and trained here for years moving on to work in other countries? Is it purely about matching the salary, or struggles with setting up a family and their childcare needs? What are the subsidies available for foreign staff in the childcare centres? I take note that certain kinds of leave are eligible only if the child is a Singaporean Citizen. How may we help them to find a home and be willing to be here long term? Would it be possible to consider offering permanent resident (PR) status for the healthcare worker after one to two years of working here and maybe even extending PR status to the immediate family after a longer period of work, let us say, five years?[+1 sentence] I do not know. Specialists have raised concerns about the capitation model in particular, will there be funding for complex cases, such as transplants or if a routine case runs into complications?[+1 sentence] The feedback from senior specialists in restructured hospitals is that, should there be a decrease in the number of complex cases, it will affect the training of our younger specialists. In the long run, we worry that the quality of care will be affected adversely as well as our standing as a leading medical health hub.[+1 sentence] Finally, I address the elephant in the room – respect for healthcare workers. After the hurrah of healthcare heroes during COVID-19, we now struggle with a backload of "business as usual" cases, long waiting times and general unhappiness.[+9 sentences] Perhaps, the average layperson does not quite understand how complex the healthcare system is. In having team-based care, with nurses and allied health taking on so much of the healthcare needs, it should be recognised, by having the patients know that these are all professionals, who are trained to deliver specific interventions and health outcomes. As an example, I perceive that sometimes, patients do not understand the importance of physiotherapy after surgery and neglect to keep the range of movements, resulting in a frozen limb, and then, wrongly blaming the doctor for bad surgery. For patients who come to the hospital for the first time ever with end-stage organ failure; I am deeply saddened. Why the years of neglect? Was it a lack of awareness or lack of resources? How about the role and responsibility of the immediate family in reminding the elderly loved one to go for regular check-ups, advise compliance with medications and to take active steps to modify this. On the one hand, we see some patients who have chosen not to know anything about their own bodies. On the other hand, we also see some people who Google non-stop and take bits of information with inadequate context, even to the extent of arguing with healthcare professionals about what is correct medical care. I wonder, do people argue with lawyers or bankers this much in legal or financial matters?[+1 sentence] What is the right balance? I always believe that education is key: good basic health education and understanding of how our body system works, how the body gets ill – is essential towards keeping oneself healthy.[+5 sentences] Establishing a good doctor-patient relationship and having mutual trust in each other gives much better patient outcomes and satisfaction. The rise of badly-written Search Engine Optimisation articles is severely detrimental to the doctor-patient relationship. So many articles share half-truths and myths, even fear mongering. As a council doctor of the SMA, I will continue to advocate for this public education and allowing doctors to do our work well, with adequate support. Each and every one of us here has to play our part well, in taking responsibility for our own health. In the launch of Healthier SG, I look forward to the shift of care to a community-based care and truly embody "prevention is better than cure".
Mdm Deputy Speaker3 words
[+1 sentence]Ms Hazel Poa.
Ms Hazel Poa (Non-Constituency Member)704 words
[+4 sentences]Mdm Deputy Speaker, I welcome the plans outlined in the White Paper to bring about healthier Singaporeans. I have a number of questions on the funding model and manpower requirements, which I hope the Minister can provide answers to. Firstly, on the funding model for healthcare. I welcome the change in funding model to incentivise efforts towards preventive and early intervention measures and better health outcomes. Since we are paying the GPs and regional health managers on a capita basis, and learning from the SportsHub experience, will there be provisions for clawback of fees paid or termination for non-performance?[+7 sentences] What are the KPIs for family doctors? I note from the White Paper that MOH is still in the process of working out the KPIs for the healthcare clusters. I would like to request for these to be presented to Parliament once they have been worked out, as they will be of much interest not only to the Members here, but also to members of the public. Apart from KPIs based on the performance of the healthcare clusters at the regional level, I hope to also see KPIs based on outcomes at the national level as well for the regional clusters. This will provide incentives for the regional clusters to cooperate with one another for a better outcome at the national level. After all, the outcome at the national level is of greater importance to us and the KPIs should reflect that. Apart from KPIs for the healthcare organisations, the performance appraisal and reward system of key personnel should also be revealed for the same reasons. For the service fees that the Government will be paying to GPs and healthcare clusters, will there be any difference between foreigners and locals?[+2 sentences] Would there be any financial reasons for GPs or healthcare clusters to lean more towards one group? Next, I have some questions on the manpower requirements. What are the number of doctors, nurses, and other healthcare professionals now and projected in the next decade?[+20 sentences] How does MOH intend to reach those numbers? Would it be via an increase in enrolment in relevant courses at our universities, polytechnics and other training centres? If so, what is the planned enrolment for these courses in the next decade? How many is expected to be via recruitment from outside Singapore? And does MOH plan to change the terms and conditions of these healthcare professionals to attract and retain them? I also have some questions on chronic diseases. The White Paper showed that the rate of diabetes has fallen slightly, while that for obesity has risen slightly. However, the rate of high blood pressure and high blood cholesterol has risen sharply. Unbalanced diet and low level of physical activity were cited as reasons. These two reasons would, however, cause rises in all four categories. And since the magnitude of change is so different, could there be other contributing factors apart from diet and exercise? For example, would stress levels and poor work life balance be contributing factors? Can MOH also provide more details on what ways is our diet unbalanced? The White Paper also mentioned that the prevalence of chronic diseases have risen across many age groups including the young. Can MOH provide the prevalence rate with breakdown by age? Lastly, I have a couple of suggestions for the Minister to consider. I have raised this before and I will raise it again. MediSave can currently be used for hospitalisation and limited outpatient treatment. I have heard anecdotes of how some people chose inpatient treatment for something that can be treated as an outpatient and at a lower cost, because the former can be paid via MediSave while the latter require cash outlay. Therefore, demand is skewed towards the more expensive inpatient treatment due to MediSave rules. In line with the efforts outlined in the White Paper to move our healthcare more towards preventive and primary healthcare, will MOH consider allowing MediSave to be used for all outpatient treatment?[+3 sentences] Secondly, healthier food tends to be more expensive than unhealthy food. Can we find ways to make healthy food less expensive compared to unhealthy food? One option to consider is a tax on unhealthy food that goes towards subsidising healthy ones.
Mdm Deputy Speaker3 words
[+1 sentence]Dr Wan Rizal.
Dr Wan Rizal (Jalan Besar)1501 words
[+7 sentences]Mdm Deputy Speaker, I declare that I am an academic staff focusing on health and wellness at an Institute of Higher Learning (IHL). I welcome the announcement of the Healthier SG White Paper. The push toward preventive health is an area that I have advocated throughout my career, from being a Physical Educator and now, through research and programme design. I am supportive of the plans laid out by the Ministry, which have been on the agenda for many years. And now, with the fundamentals in place, we are taking this necessary step to improve our healthcare further. Madam, despite my support for the Healthier SG White Paper, I do have some concerns that I would like to put forth. Firstly, different constituencies have different demographics that may require specific considerations and attention. For example, as a whole, in my constituency at Kolam Ayer and Jalan Besar GRC, there are higher proportions of elderly residents and notably, there may be fewer GP clinics in the vicinity too. Therefore, concerning resources, both in terms of quantity and quality, will there be enough GPs and community partners that can support our elderly?[+8 sentences] Secondly, for the elderly who are less mobile or immobile, regular visits to the doctor may be challenging. How does MOH intend to engage and support them? During the COVID-19 pandemic, I was encouraged by the efforts on the ground to visit the elderly who are less mobile to provide vaccinations for them. I hope that similar efforts may be made to engage and support them. Thirdly, the elderly may take a longer consultation time. How does this impact the GPs daily workload and operations? And collectively, how will this impact the quality of support for the elderly? My fourth point revolves around the caregivers who selflessly tend to the elderly. Would it be possible to allow the caregivers to be enrolled with the elderly in their charge?[+4 sentences] This would allow the doctor to plan a more holistic and inclusive approach for both of them. Finally, with regards to the enhancement and usage of digital tools, our elderly have come a long way in getting themselves digitally ready. Nevertheless, some are concerned with how fast technology and apps have evolved. Moreover, the thought of being scammed, too, may hinder their usage of digital support. How, then, does the Ministry plan to address these concerns?[+1 sentence] Madam, throughout my stint in Parliament, I have continually raised the importance of mental health and how we should treat mental health just like physical health. Thus, I would like to ask the Ministry: how does mental health fit in the Healthier SG initiative?[+5 sentences] This would be more pertinent when Healthier SG is rolled out to the younger generation, who are more open to mental health issues and understand the importance of mental well-being. Nevertheless, the elderly are not spared too. Issues like dementia or depression due to social isolation remain pertinent issues. Therefore, concerns like whether there would be enough mental health trained GPs and, if so, how would these GPs engage and manage consultation time, bearing in mind that consultation times may differ in complexity, require deeper attention and may take a longer time. I believe Healthier SG is an opportunity to address the issues that I have raised previously related to accessibility and screening. GPs now would naturally increase the nodes for accessibility, and I hope health screening can also include aspects of mental health.[+34 sentences] Madam, through Healthier SG, collaborations and partnerships are increasingly emphasised. However, I was unable to find the roles of IHLs. Practice-based research efforts are expanding and courses that provide lifelong learning regarding public health have grown. IHLs play an important role within the public health system. To educate and train; conduct basic and applied research in disciplines pertinent to public health; and engage in the community and professional service. Of course, IHLs are not the only institutions that provides education, research, and service. However, it would be useful to tap on IHLs as additional resources. Madam, in Malay, please. (In Malay): In my English speech just now, I touched on several matters that I hope the Government can clarify. This includes the matter of our seniors. In Jalan Besar GRC, for instance, where many of its residents are senior citizens, I am concerned about their health. And I hope that they will make full use of the Healthier SG initiative. I hope that MOH can provide some clarification on the issue of resources, both in terms of doctors and community partners, who are able to support our seniors. I hope that the quantity and quality of these resources will not be affected. Second, for senior citizens who are less mobile, frequent visits to doctors may prove to be challenging. So, how does MOH intend to engage and support them? During the COVID-19 pandemic, I was grateful that many of our seniors, who have difficulty getting around, could be visited by doctors and get vaccinated. I hope that the same effort can be made to support them. Third, consultations for senior citizens may require a longer time. Therefore, I am concerned about the impact on the quality of support for our seniors. Fourth is about the caregivers of the elderly who have worked wholeheartedly and tirelessly. I hope they are allowed to register the elderly under their care. This will enable doctors to prepare a more holistic and inclusive health plan for both of them. My final point is related to the use of digital devices. Our seniors have gone a long way in preparing themselves digitally. However, some are worried about the rapid advancement of technology and applications that continue to evolve. In addition, many are also anxious and afraid of online scams. So, how does MOH plan to address their concerns? Finally, I have frequently highlighted in Parliament about mental health issues and how mental health is just as important as physical health. I hope that the Minister can elaborate on the role of mental health in the Healthier SG initiative. (In English): Madam, please allow me to end by sharing a personal anecdote. Last December, I had a health scare and I conceded that at 43 years old, I just could not catch up with my children. I consulted a doctor friend and after analysing the results, he assured me that I was just too exhausted but highlighted that it is time I put my sports science knowledge into practice. So, I started the New Year with a simple goal of being more active, having a healthier lifestyle. To shift my BMI category from overweight to something more acceptable and lowering my body fat percentage from 25% to 20%. This means shedding about 10 kilogrammes off my deceivingly "okay-looking" frame. I am glad to share that I have met the objectives, but there are a few lessons learnt.[+19 sentences] The first lesson is looking okay or feeling okay, does not mean one is healthy. Thus, the importance of screening cannot be underestimated. It not only gives me a peace of mind knowing the results of my screening, but nudged me towards preventive health too. My initial commitment to physical exercise and increased physical activity then manifested into other aspects of health. For example, I became more conscious of nutrition, cutting down on salt and sugar and eating more vegetables. I also began to be conscious of my overall well-being, like cutting down on screen time and making sure I have enough sleep. So, lesson number two is health is not just about physical health. A holistic, balanced, sustainable approach to self-care, based on the numerous dimensions of health and wellness, is important – like mental, social and spiritual health. Notably, the people around me became the catalyst and motivation. Family members, friends, colleagues and even my grassroots leaders, were more receptive to my healthier lifestyle. For example, simple things like a healthier food spread, more family activities at the park and shorter meetings in the evenings, makes a lot of difference to our health. These allow me to maintain my newfound healthy habits and encourage others to pick up healthier habits too. So, lesson number three – it is always better together. I hope that MOH and community partners like PA plan activities for all the communities – activities that revolve around families. Studies have shown the elderly who stay connected to the family and participate in regular recreational physical activities benefit from a longer life expectancy, better immune system and better mental health. Madam, preventive health is a commitment that each of us must make, but it is often easier said than done. In this regard, an individual's commitment and the whole community must move towards a healthy lifestyle and make preventive health happen. The Government alone cannot make it happen. However, I do hope that the plans laid in place will nudge and ease Singaporeans to control and begin a healthier lifestyle. Notwithstanding my concerns shared earlier, I support the Motion.
Mdm Deputy Speaker3 words
[+1 sentence]Ms Janet Ang.
Ms Janet Ang (Nominated Member)1811 words
[+6 sentences]Mdm Deputy Speaker, thank you for the opportunity to participate in this debate on the Healthier SG White Paper. "For a nation to truly prosper, its citizens must have good health. Those who enjoy good physical and mental health, report high levels of well-being. An effective health infrastructure is critical for sustaining per capita income. Poor health keeps people from fulfilling their potential." That was a quote by Baroness Philippa Stroud, CEO of Legatum Institute, a thinktank in London. Legatum Institute ranked Singapore number two in the world for the Health Pillar in their Legatum Prosperity Index (LPI) 2021.[+1 sentence] According to the World Health Organization (WHO), a well-functioning healthcare system requires a steady financing mechanism, a properly trained and adequately paid workforce, well-maintained facilities and access to reliable information to base decisions on. The WHO's global study assesses healthcare systems around the world and Singapore was ranked sixth in the world, and the highest rank for countries outside of Europe.[+28 sentences] And, as reflected in Figure 1 in the White Paper, Singapore has been able to achieve good health outcomes, improving our healthcare system, without incurring substantially higher levels of healthcare expenditure. It is not by chance that Singapore has been able to come out of the COVID-19 pandemic with relatively low deaths. How we have emerged from COVID-19 reflects the resilience of our healthcare system, of our institutions and most of all, of our Government and our people. Kudos especially to the generations of healthcare professionals and policy-makers who have strategically enabled us to more than survive COVID-19, and to emerge from COVID-19 stronger together. The Healthier SG White Paper, which is being debated in the House today, is timely. Singapore is faced with a rapidly ageing population, and we can expect, therefore, an increase in the proportion of people living with diabetes, hypertension and other chronic diseases. As the saying goes, "Prevention is always better than cure." We need to shift our emphasis from reactively caring for those who fall seriously ill, to proactively preventing individuals from falling ill. Therefore, health screening, a healthy lifestyle and education are the key pillars to disease prevention. We got to add to that discipline. At the same time, we need to sharpen our focus on the value of care, recognising that there is a cost to care. Dr Brent James, a renowned clinician and Doctor of Medicine who was the Chief Quality Officer for over 30 years at Intermountain Healthcare and a senior advisor with Health Catalyst as well as co-author of a book, "To Err is Human", suggests that Value of Care = divided by cost. Prevention and going upstream has been proven to be the best way to improve clinical outcome. The community also plays a part in the reshaping of our healthcare model toward one that involves every resident and not just when they become a patient. Allow me to share two initiatives where I personally witnessed the community in action, and the impact on the health and well-being of the seniors as well as the volunteers. GoodLife! Makan at Block 52 Marine Terrace is a programme by Caritas' Montfort Care Family Service Centre (FSC). Seniors in the neighbourhood are encouraged to come together at the GoodLife! Makan community kitchen to prepare, cook and share their meals with one another, and more importantly to listen to one another's stories and to learn and support each other. SHARE A POT® is another community initiative which brings seniors together around a pot of hot nutritious soup for them to enjoy, and also to rally each other to grow stronger and live well with broth and brawn. During COVID-19, SHARE A POT® went online and did its part to help seniors to stay connected. These kinds of initiatives can become a part of the Healthier SG community partnership. I applaud Healthier SG for the comprehensive holistic approach that it has taken. There is a lot to be done but we will need the whole of Singapore to be committed to act for a healthier Singapore. Continued dialogue with all stakeholders to clarify issues and collaborate on solutions as we take this forward will be imperative. For the rest of my speech, I will cover three areas. First, going upstream with resident and family physician relationship. For example, at Intermountain, they incentivise the Primary Care Network to keep people out of hospitals as much as possible. For their diabetic population, they invested additional 4% of their budget in this group and achieved a decrease in hospital admits by 22% and a decrease of 21% for other avoidable visits and admissions, resulting in overall improvement in value of care and reducing overall costs over time.[+9 sentences] So, prevention is certainly better than cure. Healthier SG is enlisting the primary care providers to play the central role in this healthcare model. This will cement the place of family medicine in delivering holistic and coordinated healthcare to all patients, reduce doctor and clinic hopping and have the potential to ultimately improve rationalisation of specialist care by public hospitals. Everyone I have spoken with agrees that this is certainly a step in the right direction, but cautions that as in all things, the devil is in the details. How to implement and to implement it right from the start is the big question. Here are some of the questions which we hope MOH can clarify. While it is good for a patient to come under a fixed doctor or clinic, it may not always translate in practice. For example, patients seen at polyclinics often do not get to see the same doctor at every visit. Likewise, some GP groups employ locum doctors. Can MOH clarify if the intended enrolment is with a GP practice/clinic or is it with a named doctor?[+6 sentences] Can a resident be enrolled with more than one GP so that there is a second opinion or a back-up doctor in case the enrolled doctor is on vacation or at a conference? How does the enrolment work for the family paediatrician, the family dental surgeon, the eye doctor and others? By the way, will health screening include regular eye screening and dental screening? What happens to the residents who do not enrol? How will it work for residents with company provided or insurance provided panel of doctors? Can the employees consider the GP clinics of the healthcare partners as their enrolled GP? Phased approach is the pragmatic way to implement. I am above 60, and so am in the category – but after listening to hon Members speak about it, I do hope that MOH can consider enrolling the students in Institutes of Higher Learning (IHLs) and the National Service (NS) groups as well as reduce the starting age to 40, because usually it is the 40-something who will bring the 70-something to the doctor.[+16 sentences] So, I think it is good also for research – comparing the different groups, how they adopt and enrol themselves into such a programme. Next, the plan to use technology to help implement this programme is laudable and should be explored. I love the idea of using the HealthHub app as a digital reminder to patients. To close the loop, there can be digital reminders in-built into the electronic medical record system, which prompts the doctor to check on the progress of the healthcare plan and ensure timely implementation. To take it one step further, appointments with relevant care team members can also be considered to be implemented online. Therefore, the IT system, the health communications network and the National Electronic Health Records system are critical for the successful implementation of this initiative. MOH has done very well as it is in this space but will need to continue to invest as more still needs to be done to ensure system up-time, efficient sharing and update of the patient's health records while ensuring data is secure and personal data duly protected. There will also be a need for trained doctors, nurses and staff to engage, educate and support the patients in the enrolment and transition journey. What help and support will MOH provide to help the GPs and clinics transition to the level of digital that will enable them to perform their role in this healthcare model? According to Dr David M Eddy, the father of evidence-based medicine, it is now well studied and clear that "complexity of modern medicine exceeds the capacity of the unaided expert mind. Solo reliance on the craft of medicine is scientifically untenable." It has been found that the best way forward is to develop evidence-based best practice protocol, blend it into clinical workflow, embed data systems to track protocol variations and strongly advocate that clinicians apply the protocol but subject the protocol to continuous improvement based on patient need, and thereby improving the protocol in a continuous loop applying Deming's Lean Six Sigma principles. Clinicians globally have found this approach to improve clinical quality and drive better clinical outcomes over time. I read from the White Paper that our Singapore medical and clinical professionals are exploring such best practice methodologies and I applaud it. Let me speak briefly for the digital naive, the vulnerable elders and the foreigners. In spite of the best efforts of the Infocomm Media Development Authority (IMDA), GovTech and their volunteers, there is still a large group of seniors who may not be digitally savvy. How will MOH onboard this segment of citizens who are digitally naive and who are likely to be from the lower-income households?[+4 sentences] Will we consider similar initiative like they did in Japan where the neighbourhood postman becomes the point of contact for this group of vulnerable seniors? For vulnerable elders, will home care and support for end-of-life be part of this programme? End-of-life care is expensive and underdeveloped. We will need to enable the caregivers and the elderly themselves to transition with dignity and with comfort. Lastly, considering that we do have a sizeable number of people in our community who are permenant residents (PRs) and employment pass holders or work permit holders, how will Healthier SG apply to them?[+2 sentences] In summary, the initiative is an excellent one. In the long run, it would lead to Singaporeans leading healthier and more productive lives. At the same time, there is opportunity for Singapore to create an innovative model of value-based care based on strong population health expertise with a robust digital health platform, an extensive telehealth network and a compassionate and engaged community.[+4 sentences] We all need to play our part. Let me close with some advice from my mother-in-law, Mrs Lily Cheah, who is 99 years old, going on 100. Whenever she is asked, "What is your secret, Auntie Lily, for a long and healthy, happy life?", Mom's answer is "Use it or you'll lose it." Mdm Deputy Speaker, I support the Motion.
Building a Healthier SG›Motions17 turns · 9,289w
· 65 highlighted
motion-1970
Mdm Deputy Speaker4 words
[+1 sentence]Mr Xie Yao Quan.
Mr Xie Yao Quan (Jurong)2458 words
[+1 sentence]Madam, in 2020, I said in my maiden speech in this House, during the thick of COVID-19, that while we worked on the immediate task at that time of flattening the epidemic curve, we also needed to keep our sight squarely on our longer-term health care challenges and bend our long-term healthcare cost curve. Today, we are debating a new health and healthcare strategy for Singapore, laid out in the White Paper on Healthier SG.[+2 sentences] The last time MOH published a White Paper was 30 years ago. That paper was on affordable health care and it was a landmark paper that went on to define the development of our healthcare system over the last 30 years. Thirty years on, we have this White Paper on Healthier SG. And I believe it will be no less of a landmark paper, providing an additional strategy – a strategy reboot – for a vastly different population with very different needs and against the backdrop of a Government healthcare budget that has increased many times in the last 10 years.[+20 sentences] This White Paper shows how urgent and important our challenge of bending the healthcare cost curve is. I stand in support of the Motion. I had two key considerations in mind as I prepared this speech. First, because the challenge before us is so important and so urgent, we must take a thorough and critical look at every piece of the Healthier SG strategy and leave no stone unturned. In this regard, I will make quite a number of points in my speech. But second, I will focus only on the strategy – and the key strategic pieces – and set aside for now questions that are of a more operational nature, even if there are a number of these. With this preamble, let me lay out my views on the White Paper on Healthier SG. First, Healthier SG must be inclusive because it goes to the heart of our social compact, and our social compact must, in turn, be for all Singaporeans. On this point, I have three key questions. How do we ensure Healthier SG is inclusive socio-economically? We know the lower-income segment has poorer health outcomes and a lower propensity for health-seeking behaviours for various reasons. Therefore, I wished the White Paper had included specific mention of how we plan to support our lower-income segment through additional, differentiated measures to remove the particular barriers to health-seeking behaviours that this segment faces. For example, because travelling distance may be an especially salient barrier for this segment, do we need to be particularly deliberate in ensuring proximity of family doctors in both GP clinics and polyclinics to our rental communities? How can we improve seemingly basic things like nutrition, sleep and smoking cessation through targeted interventions for this segment because these things may not be basic for them? How can we help this segment find time and cognitive bandwidth to exercise, when time and cognitive bandwidth may be particularly scarce for this group? Because the social needs of this segment are especially high, how can we be particularly deliberate in enabling GPs to work with community partners to address such social needs? How can we better bring Social Service Offices and social service agencies into the framework of healthcare clusters and Primary Care Networks so that we strengthen and tighten the nexus between social services and health for the low income? Who will have primary responsibility to pull all the assets together to wrap around the enrolled person? I wish the White Paper had provided some insights to these questions. The second question that I have is how do we ensure Healthier SG is inclusive digitally? The Healthy 365 app will be the "digital front door" for citizens to enrol with a family doctor and Healthy 365 will also be the "digital front door" for capturing individual behaviour, for tracking progress and for generating healthpoints in exchange for rewards.[+6 sentences] But we know that a number of seniors have dropped out of exercise groups when these groups went onto Healthy 365 for the sign-up and bidding of slots. They dropped out because they did not know how to do this on Healthy 365. Seniors have also given lots of feedback about polyclinics and their recent shift towards more and more of an appointment-based system in lieu of walk-ins. Seniors wonder how they go about booking polyclinic appointments online or on mobile? If they call the hotline, what number should they call? How long do they have to wait for their calls to be answered? A "digital front door" in Healthier SG can well become a "digital gate" for some and we have to avoid that.[+14 sentences] The White Paper further mentions HealthHub as the second "digital front door" for every individual's health action plan. But each of the three healthcare clusters also has its own app – its own "digital front door". So, put together, these could add convenience to users but they may also confuse them. The point is: while digital is essential and we must have digital channels, we have to also preserve traditional touchpoints. In other words, we must provide optionality in the key touchpoints of Healthier SG. Optionality by providing both traditional and digital options rather than substituting the traditional with the digital. We need optionality as a core design principle of key Healthier SG touchpoints. The third question I have is, how do we ensure Healthier SG is Inclusive for All Healthcare Professionals? I did a word count. The word "doctor" was mentioned more than 160 times in the White Paper, unsurprisingly. Compared to "nurse" and "nursing", which were mentioned 22 times, "pharmacist" was mentioned six times and "allied health", seven times. So, the doctor appears overwhelmingly to be the centre of gravity in the Healthier SG strategy, but what about the roles of a nurse, a pharmacist and an allied health professional? Is there room for more equal roles, more co-leadership to shape preventive care in the community? Because, let us pin the flag squarely on the mast. The focus of Healthier SG is chronic diseases. Prevent chronic disease onset in the first instance and if disease is inevitable, manage these diseases well.[+17 sentences] So, it is not complex medicine per se, but medicine that is person-centred, relationship-driven and certainly high-value. And in this respect, nurses are very good at titrating medication and at engaging, motivating and cajoling. These are key activities in preventing chronic diseases and in managing chronic diseases, that nurses can be very good at. And in comparison, what is more exclusive to doctors is the gestalt to diagnose diseases and to provide prognoses of disease trajectories. So, I wish we had a fuller articulation of the vision for nurses, pharmacists and allied health professionals, including medical social workers, in the overall Healthier SG strategy – all practicing at the top of their respective licenses in the community, alongside doctors, to prevent and manage chronic diseases across our population. And I think we also need a mindset shift in our population, from a doctor-centric view to one that respects all healthcare professionals including nurses, pharmacists and allied health professionals, and what they can do. In summary, my first broad point: our Healthier SG strategy needs to be inclusive socio-economically, inclusive digitally and inclusive for all healthcare professionals. My second broad point is that manpower planning will be key in Healthier SG. The most natural question in this regard is how many family doctors, nurses and so on, would we need to fully realise the strategy, but I prefer to leave this to MOH's COS debate next year. I think that would be the best time to discuss manpower numbers. Today, I would like to raise some other points about manpower planning. First, for the public healthcare sector, we need stability to become a key principle in manpower planning. Family doctors and physicians in our public polyclinics will take on a significant portion of the Healthier SG workload even as we enable GPs to step up and to do more. So, within the polyclinics, I would like to ask what happens to enrolment arrangements when family doctors and physicians within these polyclinics move, get rotated or cross-deployed, as they routinely do. Do patients move with the doctors? Fundamentally, are Singaporeans going to be enrolled to a polyclinic or to a particular doctor within the polyclinic? May I boldly suggest that we need less rotation and more stability in our manpower planning for all polyclinics across all three healthcare clusters in order for Healthier SG to work as it should? On a related note, may I suggest even more boldly, that clinical manpower recruitment, posting and deployment in general across our three healthcare clusters, should be centralised at the Ministry level going forward?[+16 sentences] Currently, the healthcare clusters have principal responsibility for this strategic manpower function. Taking this responsibility off the clusters and moving it to the Ministry level will ensure a coherent manpower planning strategy nationwide in support of national desired outcomes, and as importantly, this would free up strategic bandwidth within the clusters for them to step up to their very important new roles and responsibilities as regional health managers under Healthier SG. Besides clinical manpower planning, we would need equally robust manpower planning for our cybersecurity and healthcare IT talent. As the White Paper noted and many Members have noted, IT is a critical enabler and quite often a pain point. But the competition for tech talent has never been more intense and will probably intensify further. So, how does the Ministry plan to manage the competition and secure the healthcare IT and cybersecurity talent it needs to deliver on Healthier SG? We need to get this right, because this is about securing public trust in the protection of their healthcare data, and it is also about securing the trust of professional users in the usability and inter-operability of our healthcare IT systems. In summary, my second broad point about manpower planning for Healthier SG: we need this to enhance clinical manpower stability in polyclinics, we need to free up strategic bandwidth for healthcare clusters and we need to secure critical IT talent. My third broad point is: let us remember to integrate downstream even as we look to integrate upstream. It is timely and apt that Healthier SG emphasises upstream interventions, primary care, preventive care, collaboration between GPs and community partners to promote health. All this is good, but we also need to pay an equal amount of attention to integrating much more downstream. In other words, strengthening the integration between GPs and specialists that are based largely in our hospitals. GPs have spoken of the need to become more equal partners in care, vis-à-vis their specialist counterparts. GPs want to feel that after a referral is made to a specialist in a hospital, there is tight two-way communication and the loop is closed, and GPs do not feel like they are losing their patients to the system, and in the system. Of course, details about such integration between GPs and specialists ought to be worked out by the healthcare clusters but I wished the White Paper had made a stronger mention of our larger, strategic intent in this regard. For Healthier SG to really tackle chronic diseases across our population, we need to integrate much more, both upstream and downstream, across the health and healthcare value chain and address all archetypes, including those with more advanced diseases and requiring more specialised care. My fourth broad point: on healthcare financing, our reforms can go further to truly drive integration. Ideally, capitation funding to GPs should flow through the healthcare clusters rather than from MOH, as is currently proposed in the White Paper. Capitation funding to GPs through the clusters will drive fuller integrations between GPs and the clusters as regional health managers. We should aspire to – as many Members have mentioned – the UK model for example, where GPs can eventually refer patients for direct admission to a hospital within a healthcare cluster, without the need to go through an Emergency Department, for clinically appropriate cases.[+9 sentences] I hope as we progress in this multi-year Healthier SG journey, we will keep pushing the boundaries on healthcare financing as a key lever to drive integration and what is currently described in the White Paper will not be become our eventual end-state. My last broad point on Healthier SG: in certain aspects of the strategy, let us avoid optimising at the margins, only to blunt the tip of the spear. What do I mean? The Motion before us today has only three limbs and community-based programmes are one of the limbs. In fact, the White Paper also emphasised that, "good health is sustained through everyday choices and habits, which take place outside healthcare facilities" – outside the clinic. So, community-based, health-promoting programmes are a centre of gravity of Healthier SG. These programmes in the community are what I would call "the tip of our Healthier SG spear" and as Minister mentioned in his opening speech, they occupy that space and the time between the visits to the clinic, to the GP, so they are really important. They are the tip of our spear and we must keep it sharp. Keeping it sharp means amongst other things, ensuring that there is adequate funding to this part of the strategy, and as importantly, we need to rethink how we measure effectiveness and efficiency of such funding. For example, exercise groups by HPB had emerged with a vengeance since we opened up and residents have really welcomed this. But recently, there has been concerns amongst residents that some of the exercise groups by HPB could be cut or consolidated away because they are not hitting and maintaining a certain attendance rate.[+4 sentences] If the purpose of these exercise groups is simply community programming, then I would agree with this approach because we need to be prudent. But if such community exercise programmes are so important in Healthier SG, if these programmes are the tip of our Healthier SG spear, then we need a different approach. We need to have K-pop classes available in the mornings and evenings on weekdays and on weekends. We need to have Zumba and Stretch Band and HIIT classes equally available, mornings or evenings, weekdays or weekends. We need each and every local community to be abuzz and completely teeming with community exercise groups and health promoting activities catering to the entire range of needs and lifestyles within the community. This will really bring Healthier SG alive in the community and send a strong signal to residents that we want them on board, even if this may mean some redundancy or unused capacity at the margins.
Mdm Deputy Speaker9 words
[+1 sentence]Mr Xie, you have one minute to round up.
Mr Xie Yao Quan143 words
[+3 sentences]Indeed, we should welcome such redundancy and it could serve as a useful buffer. If we focus instead on optimising capacity and funding efficiency at the margins for these programmes, we will blunt the larger intended purpose of the programmes under the Healthier SG strategy. I will make one last point about the community and that is eating and food choices in the community. Member Ms Hazel Poa suggested taxing unhealthy food to subsidise healthy food. And I would just like to ask her for clarifications about her specific ideas for taxing unhealthy food and in the larger spirit of Healthier SG, having heard the essence of the strategy, whether she feels that, an intervention like taxing unhealthy food would cohere with the overall spirit of the strategy and is still a good idea.[+2 sentences] Madam, let me conclude. In the White Paper —
Mdm Deputy Speaker4 words
[+1 sentence]You have two seconds.
Mr Xie Yao Quan127 words
— one family doctor was quoted as describing Healthier SG as "our great leap forward for primary care and preventive care for chronic conditions." But a "great leap forward" may not end up in success. So, I prefer to see Healthier SG as a "moonshot" for SG Healthcare. And when JF Kennedy resolved to send a man to the Moon, he said, "We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard." Indeed, Healthier SG entails hard work ahead for us in this decade, very hard work.[+1 sentence] But this is precisely why we must do it, and we will do it together to secure a better and healthier future for all Singaporeans.
Mdm Deputy Speaker3 words
[+1 sentence]Mr Abdul Samad.
Mr Abdul Samad (Nominated Member)1299 words
[+7 sentences]Mdm Deputy Speaker, as a union leader and representative of fellow workers, I rise in support of this Motion to drive towards Healthier Singapore. This Motion clearly emphasises the need for and the importance of living healthily to start at a young age. This will then pave the way for healthy daily living and mobility as we grow old to enjoy the fruits of our hard work during our early age. Furthermore, unions also want to ensure that our fellow workers can continue working beyond the retirement age, knowing that one of the criteria is about the medical condition of the worker. My speech today will cover the role of unions in strongly focusing on preventive care and building strong partnerships with community partners to support our fellow workers who are taking care of their own health and wellness. Madam, I am not sure how many in this House or members of the public know the complete suite of benefits our unions provide in supporting our fellow workers. While many may be aware of the workplace grievances handled and social benefits provided by our NTUC social enterprises and affiliated merchants, unions do so much more than that. Of the many cases that unions handle, only about 10% are on workplace grievances.[+13 sentences] Hence, we need to provide unique, value-added services to the remaining 90% of our members, one of which is to provide support and subsidies for our members in terms of health and wellness. Unions continuously innovate to serve our members better because, for the unions, it is "Members First, Workers Always". Allow me to enlighten the House on the three different ways that our unions and our leaders have supported members and workers in the preventive healthcare journey. This role is not new to the unions. Minimally, we encourage our management partners to provide regular complimentary health screening for our members and workers. Regular health screening is critical to identify any symptoms of sickness that each worker has, and they could then be provided with the necessary early intervention measures before the sickness worsens. While providing these complimentary health screenings looks simple, mobilising and encouraging workers to take part is never an easy task. There were times when some management partners wanted to discontinue this, due to the low take-up rates, but our union leaders rejected strongly and worked with management partners, to maximise outreach efforts to increase and optimise participation. Allow me to share some examples of two unions that have gone beyond what their management partners do for their workers. First, is the Union of Security Employees, in short, USE, which has set up a healthcare advisory booth provided by the HPB at their customer service centre for any member to walk in and request for assistance. These members take the opportunity to know and understand health advisories while waiting for their turn to be called up. Another example is one of mine, the Union of Power and Gas Employees, in short, UPAGE. We started this movement many years ago with one of our management partners. Initially, our members were offered $50 if they chose not to take any medical leave for the year. We have replaced that with an annual health screening worth close to $150.[+2 sentences] We are happy to share that most of our represented companies today provide basic complimentary health screening for our workers either at their workplace or at a designated healthcare or medical centre to provide that flexibility for the workers. In addition to this, UPAGE started to provide additional subsidy since 2018 to encourage our members to go for additional testing during their health screening. This subsidy ranges from $50 to $100 per member, depending on the cost of additional tests that our members would like to take. We are pleased to share that we have supported more than 2,200 members with a total subsidy of more than $150,000 as of today and we intend to reach out to more members.[+8 sentences] We are only able to do this because of our close partners' strong support and generosity for workers in the power sector. Please note that this subsidy applies to UPAGE members only, not for all. With so many support measures and subsidy provisions, I always believe that the union membership fee would be beneficial to all, if not many. Hence, I would call on the Ministry to acknowledge and work together with the Labour Movement and our affiliated unions as one of your community partners to reach out, engage and encourage our fellow workers to strive for a healthy lifestyle. This will then align with the Government's vision of Healthier SG. At this juncture, I would like to put forward four requests to the Ministry. First, can the Ministry provide a guide on the kind of medical checks that everyone should prioritise for their own well-being at different age groups? Next, can the Ministry provide more designated centres for our fellow Singaporeans to do their health screening? Can the Ministry also allow an individual to use their MediSave for additional medical checks that they want to do for their own well-being?[+16 sentences] Finally, can the Ministry provide an enhanced infographic that not only states the risk of poor health but one that instils the importance of starting a healthy lifestyle at a very young age? Madam, I will speak in Malay. (In Malay): This Motion, that calls us to strive towards a healthier society, is the right move. It will help us to achieve a healthier life compared to a situation where we have to suffer in pain, regardless of whether we are young or old. Among the challenges that our society faces are diabetes and being overweight, just like me, which can lead to various other diseases. However, this must be changed from early on. We must gradually change our eating habits that always crave for sugary drinks and fatty food, so that we will choose less sugary drinks and healthier food, as well as consume lesser portions. I have personally witnessed family members, relatives and friends who had to live in pain at a young age, as early as their thirties, suffering from various diseases, such as diabetes, high blood pressure and so on. There is an Arabian proverb which says that every disease has its cure except death, but that does not mean that we should let ourselves go until we get sick, and then we start to get medication. It is certainly very challenging to change our unhealthy habits into healthy ones. However, we must accept that this change is meant for our own good. We also do not want to trouble our children when we get old, whereby, they need to take care of their sick parents and have difficulty leading their own lives. Let our old age be full of healthy activities, such as playing with our grandchildren and taking care of them, being able to walk to the mosque and so on. All these can be achieved by ensuring that we lead a healthy life from a young age. It is true that death can happen at any age, but a healthy and active body and mind will be more beneficial for us. Let us not leave our twilight years to chance, but instead, we ensure that we remain healthy for ourselves and for our loved ones. (In English): Madam, many of us would acknowledge that good health is the real wealth. It is one where we can enjoy benefits of our hard work, instead of sacrificing our savings and wealth to pay for our medical costs. Let us work together to eat healthier food and adopt a healthy lifestyle so that we can all achieve our mission towards a Healthier SG.[+1 sentence] In conclusion, I support this Motion.
Mdm Deputy Speaker5 words
[+1 sentence]Mr Edward Chia Bing Hui.
Mr Edward Chia Bing Hui (Holland-Bukit Timah)1275 words
[+4 sentences]Mdm Deputy Speaker, the Healthier SG White Paper is timely and critical for all Singaporeans today and augurs well for our long-term sustainability. The White Paper has set a bold direction and has completely redesigned the way we deliver healthcare – from one that is reactively caring to one that is proactively preventive. This is a sea change. As we are more user-led in solutions, we will be better able to identify patterns and similarities where solutions can be scaled up. Prioritising those above 55 is crucial, given that about one in four Singaporeans will be 65 years old and older in 2030.[+11 sentences] This White Paper shows our ability to turn a potential adversity of the silver tsunami into a possible silver lining. We cater to our seniors first and eventually scale this to a nationwide system for those above 40. In time, I hope this would be scaled up to all Singaporeans. Most importantly, Singaporeans now know that this Government will co-design a preventive health plan with them. This partnership will require every Singaporean to play their part in co-solutioning. I rise in support of the White Paper on Healthier SG. Gathered ground sentiments largely welcome this initiative. Many are pleased with the preventive measures in place. To enhance this White Paper, some came forward to share their opinions, which will be categorised into two main sections. First, I will share concerns from the perspective of the individual Singaporean, following which, I will touch on ecosystem partnerships that are required to scale up Healthier SG. I will now touch on the ground sentiment from residents I have interacted with. With regard to the national enrollment programme, it was stated that Singaporeans will be allowed up to four changes in the initial enrollment period but it was unclear how long the enrollment period would be.[+2 sentences] Furthermore, would there be a need for Singaporeans to indicate a reason for wanting to switch clinics? Given the increasing levels of tech literacy, Singaporeans are also turning to virtual doctor appointments and companies are offering such services as part of their medical benefits. Would the Government consider this group of GPs in terms of medication subsidy and capitation funding?[+18 sentences] Whether it is changing GPs or being able to access virtual clinician services, it will be very important for this programme to allow Singaporeans to make choices at key life stages. Indeed, while the GP would be the critical first touchpoint in this relationship, it would be ideal for individual Singaporeans to have a fitness coach who can journey with him or her on a regular basis. A little exercise goes a long way and the new Singapore National Physical Activity Guidelines launched by national bodies Sport Singapore and the Health Promotion Board rationalise official guidance towards healthy activity. Having access to fitness coaches would allow for a deeper collaboration between MOH with SportsSG, HPB and People's Association, especially with the vast range of community fitness centres that the Government has invested in for Singaporeans over the years. By understanding that every Singaporean will need a fitness coach or ambassador or advisor nearer to where he or she lives to execute this preventive health plan, we keep our communities close to our Singaporeans. Much like the relationship between a resident and a GP is a personal one that takes into account individual preferences, so will the relationship be with a fitness coach. To provide Singaporeans with greater choices, would MOH look into collaborating with private fitness service providers? As these service providers are all across the island in different fitness centres and gyms, they are well-placed to provide community care. MOH could also consider engaging self-employed persons (SEPs) with domain expertise as Healthier SG ambassadors and health coaches. Such approaches will, in turn, encourage diversity of offerings to cater to different individuals and tap on expertise and knowledge in the private sector. It would be a missed opportunity if we do not harness the choice private sector and self-employed individuals provide to Singaporeans. This will keep Healthier SG relevant to our citizens' preferences and also enable new innovative services like digital clinician services to participate. At the systems level, designing this programme to have high inter-operability with innovative delivery models will enable Healthier SG to tap on the private sector's ability to discover leaner and effective models of preventive healthcare. This will ensure longer-term success, especially with the backdrop of manpower constraints and rising costs. Next, I will touch on the ecosystem partnerships that are required to scale up Healthier SG. As shared, employers are providing employees with medical care plans. Healthier SG's proactive, preventive approach needs to harmonise with employers. The strong support of the Singapore Business Federation and the Singapore National Employers Federation will be needed to help companies to remodel corporate health plans with this new approach. One question for clarification will be how the Ministry intends to work with employers in assisting their employees to enrol in family doctor national enrolment programmes.[+3 sentences] Many Singaporeans rely on the provision of medical benefits from their employers and are restricted to a fixed panel of doctors. Also, in some cases, such services are provided by corporatised clinics where doctors are less rooted to a specific clinic or location. Another added complication is when an employer changes healthcare providers or when an employee moves to a new company. While Singaporeans can choose to see the panel doctors for episodic care despite enrolling in the national programme, it derails from the core idea of keeping to one primary care doctor, limiting the true benefit of having a dedicated family doctor.[+4 sentences] The area of interest of Singaporeans will be the co-payment or full payment by their employers under their existing employment contracts. Employers need to embrace Healthier SG so that every Singaporean feels assured that this is in line with their personal healthcare journey. This is all part of an evolving workplace environment and, as such, MOM needs to work very closely with MOH for this initiative. Another key ecosystem partner in the provision of healthcare is insurers. MOH and the monetary Authority of Singapore (MAS) should encourage the Life Insurance Association to find sustainable ways to integrate this to an individual's MediSave-related policies.[+1 sentence] Such preventive efforts need to be rewarded and if our insurance actuaries can understand the percentage of population making serious efforts to live better, their calculations of risks need to take this into consideration. For example, those with committed healthier plans should not be paying as much when premiums increase with age.[+3 sentences] Such co-related pricing will make our Integrated Plans relevant and useful. This would provide another incentive for individuals to take charge of their preventive health plan. Mdm Deputy Speaker, the business model enabling the provision of healthcare services is still largely based on reactive care. As we take the bold step to shift the model to one of preventive care, we will need to engage various aspects of society, including employers and insurers, to recalibrate various cost calculations and incentives.[+4 sentences] Mdm Deputy Speaker, I have touched on two main sections in my speech. First, on the micro level, let us place individual Singaporeans first in this journey by providing virtual doctors and fitness coaches by tapping on the private sector for more options. Second, at the macro level, let us engage employers and insurers in recalibrating benefits, costs and incentivise them to better align with our model. The easier we make this to follow, the more we can guide Singaporeans to a society where we can all keep costs sustainable, maintain a comfortable standard of living and, most importantly, age well in the decades to come.
Mdm Deputy Speaker4 words
[+1 sentence]Ms Ng Ling Ling.
Ms Ng Ling Ling (Ang Mo Kio)1880 words
[+17 sentences]Mdm Deputy Speaker, I would like to first declare my role as an independent consultant in healthcare transformation projects. Madam, I give apples to Jalan Kayu residents at every house visit from the start of this year. This gives me an opportunity to share with them about healthy living, a key theme that I promote in Jalan Kayu besides sustainability and intergenerational bonding. An apple a day keeps the doctor away – this 19th century proverb sounds simple, but it is not always easy to follow. In my COS speech in March, I spoke about my concern for the increased prevalence of chronic diseases, such as high blood pressure, high blood sugar and high cholesterol in our population, not just amongst our seniors but also in some of our younger people. I recognise that our national Budget for healthcare will inevitably have to increase in order to create better health and quality of life outcomes for our people. But I also suggested to manage the workload on our healthcare professionals by empowering Singaporeans to take more ownership of our own health and participate whenever possible with our healthcare professionals on our treatment or health plans. I thus read the Healthier SG White Paper with great delight, that we are, indeed, embarking as a nation towards a much healthier way of living, with stronger emphasis on preventive care, building relationships and trust with our family doctors to maintain our health, supported by each of our own community, right in our neighbourhood. This is a transformative healthcare policy, in my view. It will also require a transformative mindset from our people to fully reap the fruit of this healthcare policy breakthrough. But we can take heart that we will have our neighbours to walk the journey ahead with us together. For my Jalan Kayu residents, you have your Member of Parliament who will walk this journey with you. All good policies can only be as good as how well they are implemented. That is when the tyres hit the road, so to speak. I will focus my speech on clarifications with MOH on three implementation considerations. One, awareness of subsidised preventive health screening; two, enhance community partnership and participatory approach to collective health; and three, enabling seniors through simplifying healthcare technology. Firstly, I would like to know how MOH will be tracking and reporting the usage of the enhanced subsidies provided under Healthier SG to encourage Singaporeans to adopt more preventive health behaviours. The White Paper outlined MOH's plan to fully subsidise nationally recommended vaccinations and screenings as well as an onboarding health consultation with their chosen family doctors upon enrolment.[+1 sentence] I would like to clarify what types of vaccinations and screenings will be fully subsidised. Are they those that are under the existing Screen for Life programme or will there be more added under Healthier SG? What is the participation rate for Screen for Life for Singaporeans above 50 years old currently?[+13 sentences] And what improvement does MOH aim to achieve under Healthier SG? From my Meet-the-People (MPS) experience, whenever I asked my residents in need about their awareness of Screen for Life programme, I will usually draw a blank look. For the handful who may be aware, they would admit to me their fears of finding out illnesses that will cost them more to treat and affect their jobs. I believe for preventive health behaviours to improve significantly in Singapore, MOH must invest more in creating the right awareness and assurance of benefits of preventive health screening and a follow-through care that Singaporeans can expect. This should be done in more mass media and vernacular languages, including even some dialects, to correct the misinformation that screenings will lead to more problems. Secondly, I would like to propose strengthening the community participatory approach so that our busy family doctors, whether they are practising in the GP clinics or polyclinics, would know and have quick ways of connecting with their community, sports and social service counterparts when they see patients that need support beyond medical treatments. The White Paper proposed to rally a group of community care partners to support residents in leading healthier lives. The White Paper mentioned the People's Association (PA), SportsSG and Agency for Integrated Care (AIC)'s Silver Generation Office (SGO) to help organise healthy living programmes for residents. It also mentioned plans to tap on the eldercare centres to serve as the community care connectors for seniors, to help them follow through the recommended lifestyle interventions prescribed by their family doctors. Although I am fully supportive of this approach after speaking with a few GPs in my Jalan Kayu constituency since the release of the White Paper, I noted their concerns on the bandwidth to activate such community partnership to care for their patients who are my residents. There were also questions on seniors who are living in the private estates, such as those who are living in the Seletar Hills East and Jalan Kayu private estates where some of my older residents live. The existing eldercare centres are usually located nearer to rental blocks of each constituency. I would like to ask how MOH will also support the social prescriptions by family doctors for the senior residents living further from eldercare centres, including those living in the private estates. Lastly, I understand that enrolment will start next June, beginning with our older residents aged 60 and above first.[+5 sentences] This is good as we should always prioritise the health of our seniors first, given their higher risk of developing health challenges. The White Paper proposed the HealthHub app and Healthy 365 app as the digital front doors of Healthier SG to encourage and nudge residents to adopt healthier lifestyles. I understand that the HealthHub app will have a digitally enabled health plan where residents can access and check their health outcomes. This will be complemented by the Healthy 365 app which allows tracking of physical activities and diets, as well as supports their access to community activities. Like fellow hon Member Dr Tan Wu Meng, several studies that were published between 2020 and 2021 shared that there is lower interest in adopting mobile health applications and digital health services amongst seniors despite the convenience that it presented during the COVID-19 lockdown. Thus, I would like to clarify with MOH on the current adoption rates for these two apps by the senior population above 60 years old. And if the take-up rates have been low, similar to my fellow hon Member, Ms Denise Phua, I would like to ask how MOH intends to help our seniors utilise these two apps after they have enrolled with their family doctors under Healthier SG.[+14 sentences] Mdm Deputy Speaker, please allow me to say some words in Mandarin. (In Mandarin): Prevention is better than cure. Not only does this phrase demonstrates our understanding of preventive care, but it is also the core concept of the Healthier SG White Paper. Through preventive care, we can help every Singaporean improve their health and quality of life. In our ageing society, preventive care can also reduce the cost and burden on the healthcare system and individuals. If you want everyone to be healthier, we must empower them. Therefore, I strongly support the initiatives put forward in the White Paper. At the same time, I would like to make three suggestions to the implementation of Healthier SG to help residents better accept preventive care measures to improve their health. Firstly, I hope that MOH will provide more public education and information on benefits of preventive screening to encourage residents to undergo screening. MOH currently has the Screen for Life programme which covers chronic illnesses and some common cancers, for example, colorectal cancer. I hope that MOH will further strengthen public education under Healthier SG, and even use Malay, Tamil or even dialects to reach out so that more Singaporeans, especially the seniors, will understand the benefits of preventive health checks. Secondly, I also hope that MOH will work with the GPs and the community partners to empower residents to complete their own health plans, using more of the Community Participatory Approach. In the community, we should also have the regional health system to help identify common illnesses in each local constituency through the coordination of the three regional healthcare clusters, and work with Government agencies such as the People's Association and SGOs, as well as the residents, to organise healthy activities that benefit the residents. In this way, residents will be able to take ownership of their own health, making it easier for them to accept preventive care. This will also help to strengthen the Healthier SG ecosystem.[+1 sentence] Finally, I hope that MOH will be able to improve the HealthHub and Healthy 365 mobile apps to make them more accessible for the seniors under Healthier SG. I also hope that MOH will work with IMDA to promote HealthHub and Healthy365 apps through the IMDA's Senior Go-Digital Scheme and teach the seniors how to use these two apps and introduce their main functions.[+6 sentences] I hope that when the seniors experience the benefits of using these apps, they will help promote Healthier SG through word of mouth. (In English): In closing, I would like to speak up for a group of healthcare professionals who have become my friends in my four-and-a-half years of involvement in the healthcare sector. They are the family doctors working both in GP clinics and public polyclinics. They are a group of highly intelligent, motivated and committed healers in our community. The falling ill of one family doctor in a busy polyclinic can mean the rest taking up a much higher patient load for the day, sacrificing lunchtime or even any breaks in that day. I hope that MOH will continually invest in helping them reduce unnecessary administrative workload. To the Minister for Health Mr Ong Ye Kung, I agree that administrative work that is required for claims is very necessary, but I think we should study some of the areas in which we can maybe reduce for the professionals. This can include doing away with the need for issuing medical certificates (MCs) for mild acute illnesses, like coughs and colds, which my fellow hon Member Ms Mariam Jaafar has raised earlier in the Parliamentary speech she made. While this will require the support of the Ministry of Defense (MINDEF), the Ministry of Education (MOE) and MOM, countries like the United Kingdom that have practised doing away with MCs for absence from school and work due to common colds and coughs have not seen students or employees abusing such a move. Also, more use of telehealth, that can augment and take away some of the family doctors' repetitive tasks, should continue to be invested in and subsidised by MOH.[+4 sentences] There is no doubt that Healthier SG will take time – I think at least a decade – before we can see a healthier population coming to fruition. Nevertheless, as a strong advocate of healthy living and active ageing, I commend MOH for taking this bold step towards reshaping Singapore's population health. With the collective and united efforts of all Singaporeans, we will get there. Notwithstanding my considerations raised, I strongly support the White Paper on Healthier SG.
Mr Speaker3 words
[+1 sentence]Ms Joan Pereira.
Ms Joan Pereira (Tanjong Pagar)684 words
[+4 sentences]Mr Speaker, Sir, I support the Healthier SG initiatives and look forward to the expected benefits as this new healthcare model nudges Singaporeans to focus more on active self-care. All of us as individuals need to consciously take steps on a daily basis to minimise the risks of illnesses and diseases, with care and guidance from our doctors and their teams of support professionals. Many of the things we can do are quite achievable, though not always easy for some of us, such as taking the necessary medications on time, watching our diets and exercising. Following up with doctors familiar with our health histories regularly will help to introduce some discipline into our lives, as we have to be accountable to them too. One of my concerns is regarding the funding model that will be partly based on health outcomes. The White Paper states that service fee payments for family doctors will be partially based on "the progress made in terms of preventive care or chronic diseases management".[+4 sentences] While I understand the intent of this clause, the reality is that there will be some patients who have difficulties being compliant and it is not reasonable to expect the doctors to control their patients. I would like to know how the Ministry will help such patients. Will there be situations where doctors may choose not to continue with the management of very challenging patients? Another question is regarding the additional administrative and IT set-up and maintenance requirements necessary for this scheme. The White Paper states that in the initial phase, the Ministry will provide a one-off IT support grant.[+5 sentences] Going forward, inputting data and maintaining the IT system in a clinic will need more manpower and IT knowledge, particularly to ensure a high level of cybersecurity. While MOH has stated that it will support the GPs in this aspect, what will happen if a patient's preferred GP chooses not to join the network due to the clinic's constraints? Yes, patients can select another doctor but it is not so easy, especially when a strong relationship has been built and, more importantly, the doctor's medicine works well for the patients. This would then mean that patients have to doctor hop before finding the right one that suits them. Some residents are also concerned that more costs for the GPs will be involved and they worry as a result, the medical costs will be higher for residents who see GPs under this Healthier SG initiative. How would the Ministry ensure that costs will be kept in check? I applaud the decision to narrow the difference in drug subsidies across polyclinics and private clinics through a combination of enhanced drug subsidies and drug price limits.[+11 sentences] However, there may be some non-generic drugs which will continue to be priced above the limits. Will patients be given a choice to opt for such drugs via personal top-ups and MOH to provide greater subsidies because these drugs work well for them? Last, I would like to ask about the role of TCMPs in the Healthier SG model. TCMPs have been playing a significant role in helping residents, particularly the elderly, to better manage their health over the long term. Traditional Chinese Medicine (TCM) methods often emphasise holistic care and can be complementary to our current system. If the Ministry is concerned about the standard and consistent TCM healthcare delivery, how about setting up a system similar to our present Western medical framework and ensure its integration into our healthcare system? Sir, in Mandarin. (In Mandarin): Last, I would like to ask about the role of Traditional Chinese Medicine Practitioners (TCMPs) in the Healthier SG model. TCMPs have been playing a significant role in helping residents, particularly the elderly, to better manage their health over the long term. TCM methods often emphasise holistic care and can be complementary to our current system. If the Ministry is concerned about the standard and consistency of TCM healthcare delivery, how about setting up a system, similar to our present western medical framework, and ensure its integration into our healthcare system?
Mr Speaker3 words
[+1 sentence]Ms Hany Soh.
Ms Hany Soh (Marsiling-Yew Tee)1387 words
[+8 sentences]Mr Speaker, I speak in support of this Motion. I concur that prevention is undoubtedly better than cure, not only because the former can be easier and more affordable as compared to the latter but also because individuals and their loved ones can minimise the risk of experiencing a lower quality of life that comes with chronic diseases. It is well understood that prevention of chronic diseases is achieved by addressing risk factors before falling sick whether through healthy living, better dieting or exercising regularly. Although doing so seems simple and straightforward, these actions are easier said than done. Many of us are used to long working hours, a sedentary work life, late nights and, for better or worse, various cuisines within easy reach whether day or night – all of which contributes to a less than healthy lifestyle. With that said, it is possible to return to good healthy habits, but it will take some time, effort and some encouragement. Similar to the Singapore Green Plan, I view the Government's initiations of Healthier SG as a whole-of-nation movement which seeks to rally bold and collective actions, to transform our healthcare system and to encourage all Singaporeans to come together and take steps towards better health. The funding support from the Government and community partners will come in vital to kickstart this project and steer it towards the right direction. Similar to the concept of SG Eco Fund, I hope that the Ministry can consider setting up a SG healthy fund to support projects that champion healthy living and involve the community. A steering committee can be set up comprising representatives from the 3P sectors, retired grassroots advisors, sports athletes as well as healthy lifestyle experts to manage this fund and monitor the progress of such projects.[+4 sentences] In addition, this committee, with extensive community experience and networks from its members, can also provide useful guidance for healthy lifestyle clubs, thus further advancing the objectives of Healthier SG. One example of how such funds can be utilised would be to encourage GPs to organise community outreach events to foster lasting relationships between residents and their family doctors. The GPs can be the first line of support for many Singaporeans living in our heartlands. Many of these neighbourhood GPs have served the community for years or even decades and earned the trust and reputation of being the resident experts in all health-related matters. As such, to foster more of such GP-patient relationships, with trust being built up and utilised to deliver the message from Healthier SG, one suggestion would be to consider providing funding support for GPs to conduct health awareness talks for the community, educating our residents about the benefits of preserving one's health with good habits. Additional funding support can also be considered to encourage organising the follow-ups on the health awareness talks, such as one-time complimentary health screening and consultation sessions for attendees at their neighbourhood GP.[+19 sentences] Other funding support can go towards encouraging more community organisations to set up healthy lifestyle interest groups and for its champions to form strong, sustainable partnerships with the community to promote healthy lifestyle activities. Over the years, in my capacity as a community volunteer and subsequently as advisor, I have witnessed many inspiring examples of how healthy living has been promoted among residents through health awareness and wellness programmes initiated by the grassroots, such as the Northwest CDC's qigong, dance fit and brisk walking clubs. The provisions for support for these interest groups and their events will empower them to further enrich the lives of many of my residents in Woodgrove by providing a wider range of healthy activities to choose from. In addition to that, allocating funding support for passionate and committed healthy lifestyle champions, such as instructors and coordinators would also help grant a renewed sense of purpose for retirees looking to making a positive effect. These individuals are more than just active participants in their programmes of choice. They also serve as the glue within their own communities. Through them, I have seen many friendships forged among the members and their trainers. Even outside training, they will gather to organise potluck sessions, sharing healthy cooking tips. In Woodgrove, our active dance fit club members often help to bring more joy to events organised by the Residents' Committees, such as by choreographing a dance performance with them donned in special handsewn costumes. Mr Speaker, while there is much we can do to ensure that Healthier SG can further encourage more Singaporeans to lead a healthier lifestyle, we should also capitalise on its ability to provide additional benefits outside of its main scope of objectives. Picking up healthy living tips and sports can be interesting and enable the creation of more family bonding opportunities. One such example is the Woodgrove Badminton Clinic, which was jointly organised by our Woodgrove Community Sports Club and the Singapore Badminton Association, with support from Horlicks. During the event, apart from inviting our national team's shuttlers Crystal Wong and Jing Yujia to coach our little ones and their parents on badminton strokes, a health talk was also carried out by Horlicks, sharing tips on possible diets to follow before and after exercising. Next month, Woodgrove will also be collaborating with ActiveSG to organise a community sports day at the Woodland Stadium, encouraging families to participate in various sporting activities such as air badminton, table tennis, Zumba and K-cardio. In our Marsiling-Yew Tee GRC, the recent launch of the Healthy Living card game in Marsiling's "Living The Life Carnival" was also received positively by elderly residents and their families. In this game, players are supposed to collect cards depicting good health habits in order to win. Through playing the game, these cards will serve to inculcate players with these healthy living habits. Good health habits begin at a young age. As a community effort, Woodgrove is working on expanding the reach of this Healthy Living card game by encouraging our youngest residents to play with their families, hopefully inspiring them to a healthier lifestyle while promoting family bonding opportunities at the same time. For a start, the nine PCF Sparkletots centres across Woodgrove will be procuring additional sets of these playing cards and distributing them to all of our K2 students in 2023.[+4 sentences] One way to encourage healthier eating is to educate the public about new healthier alternatives. One good example of this would be the recent introduction of the lower sodium salt campaign. I believe that the public may find it useful to learn more about the science behind these healthier options from credible sources, such as HPB, so that they may be better informed about the food choices to make. Disseminating the information through mass media will be very helpful in this regard. Although we can achieve much by encouraging residents to pay more attention to their health, more help can be provided by influencing their dietary habits, such as reducing the cost of healthier food items, which have a reputation for being more expensive than the standard options.[+1 sentence] As such, in order to make the Healthier SG movement of success, there is a need to call for a mindset shift. Not just among the ordinary residents, but businesses that serve the community as a whole. This includes calling on fast food chains, film theatres and supermarkets, to just to name a few, to explore ways to incentivise offering of healthier options.[+4 sentences] In Mandarin please, Mr Speaker. (In Mandarin): Last month, Woodgrove division, in collaboration with Sian Chay Medical Institution, organised a free health talk, sharing with seniors tips on healthy living and post-recovery from COVID-19. Many participants shared with me that they prefer to see a TCM doctor first when they are not feeling well. The reasons vary, including cheaper consultation fees, for example, Sian Chay and Chung Hwa Medical Institution provide free or low-priced consultation and treatment. Generally, seniors tend to prefer opting for TCM to improve their vitality and address underlying root causes of health concerns in a holistic manner. I believe, we should look into combining Western and TCM medicine in terms of treatment as well as increasing awareness.[+2 sentences] To me, both Chinese and Western medicine offer benefits, integrating both would bring a win-win situation. In conclusion, I support the Healthier SG Motion.
Mr Speaker1 words
[+1 sentence]Leader.
Adjournment of Debate›Motions4 turns · 39w
· 0 highlighted
motion-1971
The Leader of the House (Ms Indranee Rajah)29 words
[+2 sentences]Mr Speaker, I beg to move that, "That the debate be now adjourned." . (proc text)]
Mr Speaker5 words
[+1 sentence]Resumption of debate, what day?
Ms Indranee Rajah2 words
[+1 sentence]Tomorrow, Sir.
Mr Speaker3 words
[+1 sentence]So be it.
Adjournment›Motions1 turns · 22w
· 0 highlighted
motion-1972
Speaker not recorded22 words
[+2 sentences]. (proc text)]
Affordability of Rising Public Housing Prices and Impact of Prices on Marriage and Fertility Rates›Oral Answers to Questions19 turns · 3,791w
· 22 highlighted
oral-answer-2899
Mr Yip Hon Weng64 words
asked the Minister for National Development (a) what measures are being taken to address the growing sentiment that Singapore property market is unaffordable for the masses; (b) how will the recent adjustments to manpower policies impact property prices; and (c) beyond existing cooling measures, what else will the Government do to ensure housing remains affordable for Singaporeans if housing market conditions do not improve.
Ms Hazel Poa28 words
asked the Minister for National Development whether the Ministry has conducted or will conduct studies on the impact of rising public housing prices on marriage and fertility rates.
The Minister for National Development (Mr Desmond Lee)58 words
[+2 sentences]Mr Speaker, Sir, Question No 2 on today's Order Paper on the issue of marriage and parenthood is also relevant to this question on public housing affordability. As such, may I request, Sir, that the answers to Question Nos 1 and 2 be provided first, and the supplementary questions from Members on both questions be taken together thereafter.
Mr Speaker2 words
[+1 sentence]Please proceed.
Mr Desmond Lee2030 words
[+17 sentences]Thank you, Sir. This reply will also respond to the Member's question for 3 October on affordability benchmarks for public housing. Sir, over the past two years, there has been strong, broad-based demand for housing, including in the Housing and Development Board (HDB) resale market. There are a number of reasons for this. First, we have seen more households forming as the echo-boomer generation – those who are in their 30s today – are getting married, especially with the easing of COVID-19 measures. Next, we also see societal trends shifting to smaller households, as young couples, singles, as well as adult children choose to buy their own homes instead of living together with their parents. These aspirations for more personal space may have been accentuated during the pandemic. Third, more homebuyers have also turned to the resale market because of longer waiting times for Build-To-Order (BTO) flats due to construction delays caused by the COVID-19 pandemic. Fourth, in the last two years, we have also seen more private property owners and existing HDB owners cashing out on their property and going into the HDB resale market. To be clear, foreigners are not allowed to buy HDB flats and would not have contributed to the increase in demand for public housing. They also account for a small proportion of overall private residential property demand. These demand factors, alongside the previous low interest rate environment that made it cheaper to service a home loan, have put upward pressure on HDB resale flat prices. Since the Government implemented a broad package of measures in December 2021, the HDB Resale Price Index has increased by 5.3% in the first half of this year. We understand the concerns about housing affordability and have, therefore, been carefully monitoring the housing market. We are committed to keeping public housing affordable and accessible, to meet the housing aspirations of Singaporeans and to help Singaporeans own their own homes. This is a key longstanding national priority and provides the basic foundation for us to raise our families, bring up our children and build strong communities. That is why we continue to build and sell new HDB flats at prices below the market as they come with significant subsidies. The average price for a new 4-room flat in a non-mature estate has remained relatively stable at $341,000 in 2019 and $348,000 in the first three quarters of this year.[+1 sentence] We have managed to keep prices relatively stable as market subsidies have been increased, to keep new flats affordable. Eligible first-timer buyers can also receive Enhanced CPF Housing Grants (EHG) of up to $80,000, with more help for lower-income buyers.[+7 sentences] For new flats in prime, central locations, we have introduced the Prime Location Public Housing (PLH) Model which provides additional subsidies on top of the substantial subsidies already provided for BTO flats. This is to keep flats in such locations affordable for a wider range of Singaporeans. The Member has asked if we should have affordability benchmarks and if these should consider families at the 30th percentile of income, instead of just median income. Sir, our affordability benchmarks do not only consider median incomes, as we provide a wide range of BTO flats for first-timer buyers with different housing needs and budgets. Take, for example, a first-timer household earning about $5,000, which is slightly less than the 30th percentile of resident household incomes. They may buy a 4-room flat in any of the three non-mature estate projects in the recent August 2022 BTO exercise, namely in Jurong East, Woodlands and Choa Chu Kang. These projects come with typical prices comparable to, or lower than, the average price of BTO flats in non-mature estates at about $348,000. After factoring in the $45,000 in grants they would receive, they will need to use about 23% of their monthly income for their housing loan, which means that they will be able to service their mortgages from their monthly Central Provident Fund (CPF) contributions with no cash outlay.[+13 sentences] This also works out to a home price-to-income ratio of around five for this family, which means that the price of their home is about five times their annual household income. For a first-timer couple who are both fresh tertiary graduates buying their first home, a typical combined starting salary would be about $6,500. They would receive $30,000 in grants and would only need to use 18% of their monthly income for their housing loan to afford the same new 4-room flats in any of the non-mature estate projects in the recent August 2022 BTO exercise, with typical prices comparable to or lower than $348,000. This works out to a home price-to-income ratio of around four for this family, and they would also be able to service their mortgage fully from their CPF contributions. As a broad comparison, the ratio of the median home price to the median household income in other comparable cities, such as London, Los Angeles and Sydney are much higher, at between eight and 15 times. In Hong Kong, it is more than 20 times. For resale flats, the Government provides significant housing grants of up to $160,000 to ensure that resale flats remain affordable for eligible first-timer families. We review our grants regularly to ensure that resale flats remain affordable. Generally, the mortgage servicing ratio (MSR), which is the proportion of monthly income used to service mortgage instalment payments, has remained below 25% for most new and resale first-timer flat buyers taking on an HDB loan. This is well below the international benchmark of between 30% and 35%. This means that most first-timer buyers can service their housing loans using their monthly CPF contributions, with little or no cash outlay. The Member also asked what the Government will do to ensure housing is affordable for Singaporeans in the wider Singapore property market. We have announced, on 30 September this year – measures to moderate demand in the HDB resale market to ensure that HDB flats continue to remain affordable, as well as measures to encourage prudent borrowing amidst the rising interest rate environment. First, we introduced a wait-out period of 15 months before private property owners are allowed to purchase a non-subsidised HDB resale flat.[+18 sentences] This measure aims to moderate demand and slow the momentum of price increases in the HDB resale market, by deferring demand from private property owners, so that HDB resale flats will continue to be an affordable option for first-time HDB flat buyers. We intend for this measure to be temporary and will review this, depending on overall demand and market changes. Previously, private residential property owners looking to buy a non-subsidised HDB resale flat do not have to serve a wait-out period, but they will need to sell their private properties within six months of the HDB flat purchase. In particular, the number of private property owners buying HDB resale flats has doubled in 2021 and the first three quarters of this year, as compared to 2019 and 2020. Overall, private property owners and former private property owners make up about one in 10 HDB resale flat buyers. Private residential property owners, generally, have more financial means to buy resale flats, as compared to first-time home buyers or existing HDB-owners. Some might not even need to take loans to complete their purchase. They, therefore, tend to pay higher amounts of cash-over-valuation (COV) when buying HDB resale flats. Having said that, we recognise that not all private residential property owners are in the same situation. Some seniors need to sell their private property and move to an HDB flat to strengthen their retirement adequacy. So, we are exempting seniors above the age of 55 who are moving from a private property to a 4-room or a smaller resale flat from the wait-out period. We also know that there are private residential property owners, whatever their age, who face genuine housing needs or who have to sell their homes because of extenuating circumstances, such as financial difficulties. They should approach HDB for assistance, and my colleagues will see how best to support them on a case-by-case basis. Next, we are also mindful of the challenges posed by the rising interest rate environment. From 2013 to 2021, we have had exceptionally low interest rates, especially from financial institutions. But market interest rates have risen over the last year, with further increases expected over the medium term. This will increase borrowing costs for those who are buying a home and also for those who are servicing existing home loans pegged to floating rates. Therefore, we have decided to move now to safeguard home buyers and ensure that they are able to service their long-term home loans. We have thus implemented the following measures to tighten the maximum amount that can be taken for home loans and ensure prudent borrowing. We have raised the medium-term rate floor used under the Total Debt Servicing Ratio (TDSR) and MSR frameworks to compute a borrower's maximum loan quantum for residential property loans granted by private financial institutions from 3.5% to 4% per annum.[+12 sentences] The actual rates that private financial institutions charge for home loans will, however, continue to be determined by them. Next, HDB will introduce an interest rate floor of 3% per annum to compute a borrower's maximum eligible housing loan amount. This is 1% below the Monetary Authority of Singapore (MAS) rate floor for private financial institutions. This will reduce the maximum loan quantum for home buyers taking HDB loans but will not increase the monthly instalment borrowers have to pay, as there is no change to the HDB concessionary interest rate of 2.6%. We have also lowered the Loan-to-Value (LTV) limit for HDB housing loans from 85% to 80%, so that home buyers borrow prudently in view of the uncertain economic outlook and rising interest rate environment. This is not expected to affect first-timer and lower-income flat buyers significantly, as they receive housing grants of up to $80,000 when buying a subsidised flat directly from HDB, or up to $160,000 when buying a resale flat, and can tap on their CPF savings to pay for the flat purchase. These measures are necessary as property loans are long-term commitments and often a household's largest liability. The higher floor rates ensure that today's borrowers take loans that reflect the likelihood of rising interest rates and avoid overstretching themselves. If we do not move now, households may run into housing difficulties when they find it harder to service their housing obligations. This is already happening in other countries where we see home owners defaulting on their mortgage payments and losing their homes. Beyond the cooling measures, we recognise that there is genuine demand from home buyers. We have, therefore, also increased supply in both public and private housing markets. For HDB, we have ramped up our BTO supply and are on track to launch 23,000 flats per year in 2022 and 2023, or a 35% increase from 2021.[+3 sentences] In November this year, we will launch more than 9,500 BTO flats. We are prepared to launch up to 100,000 flats in total from 2021 to 2025, if needed. We also endeavour to launch more projects with a shorter waiting time of less than three years where possible. The supply of private housing on the Confirmed List of the Government Land Sales (GLS) programme has also been increased by 75% from 2021 to 2022. We are prepared to increase supply further to meet the demand for private housing, if needed. The Government will intervene and do what is necessary, to ensure a stable property market and affordable public housing for Singaporeans.[+1 sentence] This has been our approach all along. We will do so decisively but also carefully, being cognisant of the uncertain global economic outlook and rising interest rates environment, which will affect home prices and contribute to uncertainty in our property market. We will continue to monitor the market closely and adjust our policies as necessary on both housing demand and supply, to ensure that prices move broadly in line with economic fundamentals.[+1 sentence] This Government is committed to the stability of the wider Singapore property market and to keeping public housing inclusive, affordable and accessible to Singaporeans.
The Second Minister for National Development (Ms Indranee Rajah)387 words
[+5 sentences]Mr Speaker, many different factors affect marriage and fertility rates. These include shifts in societal norms and attitudes towards marriage and parenthood over time, and temporal factors such as the restrictions and disruptions caused by COVID-19. While we have not conducted studies on the impact of housing prices on marriage and fertility rates, our regular surveys and engagements indicate that many couples continue to aspire to have their own home before they start a family. We recognise these aspirations and preferences, that is why public housing policies are designed to prioritise and support first-timer families to enable them to have their own home and start a family. For example, the vast majority of our BTO flat supply is set aside for first-timer families. The quota of 3-room and 4-room BTO flats in non-mature estates set aside for first-timer families, was increased to 85% and 95% respectively.[+3 sentences] For mature estates, we continue to set aside 95% of BTO flat supply for first-timer families. First-timer families also have more ballot chances than second-timer families, to improve their likelihood of securing a flat. In addition, the Government has put in place various grants and measures to help Singaporean couples own their first home. Eligible first-timer buyers who buy new flats can enjoy an enhanced CPF housing grant of up to $80,000, on top of the generous subsidies in new flat prices.[+4 sentences] Those who choose to buy a resale flat can enjoy housing grants of up to $160,000 dollars. In 2021, about 7,000 families received grants for their resale flat purchase. We recognise the concerns of couples looking for their first home to start a family. To meet the strong housing demand, we have ramped up the supply of new flats to 23,000 new flats per year in 2022 and 2023, or a 35% increase from 2021. We are well on track this year and home buyers can look forward to 9,500 flats being offered in the upcoming November BTO launch exercise. We are prepared to launch up to 100,000 new flats from 2021 to 2025.[+2 sentences] We also endeavour to launch more projects with a shorter waiting time of less than three years where possible. We continually review our policies, to ensure that Singaporeans continue to have access to affordable public housing and to support Singaporeans in owning their first home.
Mr Speaker4 words
[+1 sentence]Mr Yip Hon Weng.
Mr Yip Hon Weng (Yio Chu Kang)76 words
[+6 sentences]Thank you, Mr Speaker. I thank the Minister for National Development for his reply. Housing in Singapore should be primarily for occupation, rather than for speculation and investment. I have two supplementary questions in line with this train of thought. First, would the Government consider increasing property tax rates for non-owner-occupied properties? Second, would the Government consider higher Additional Buyer's Stamp Duty (ABSD) for those who buy more than one property in Singapore, especially for foreigners?
Mr Desmond Lee83 words
[+3 sentences]We, generally, do not discuss any impending or upcoming measures relating to the property market, in order not to cause people to read or misread signals. So, generally, all these ideas have been raised before, different ways in which we tax property, tax rental income, increase ABSD. We have to look at the housing market, look at what drives demand, look at whether it is in line with economic fundamentals and decide what necessary measures need to be taken and if so, when.
Mr Speaker4 words
[+1 sentence]Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim (Sengkang)98 words
[+4 sentences]Thank you, Speaker. Ministers Desmond Lee and Indranee Rajah both shared that the Government has taken active steps to increase the supply of public housing and I am sure this is well appreciated. I am wondering if they could elaborate on whether this will more than make up for the shortfall in inventory that resulted from halts to construction, as a result of the pandemic? And my second follow-up is, whether the Ministry has an estimate based on their models of when they expect house price increases to moderate after the application of the recently announced cooling measures.
Mr Desmond Lee283 words
[+9 sentences]Mr Speaker, Sir, I have to answer the first question in two parts. First, with regard to delays in construction, what the Member calls "shortfalls in inventory" due to construction delays arising from COVID-19, and then the ramp-up in housing supply. The construction delays impacted BTO launches that were set off prior to COVID-19. Their construction delays resulted in a lengthening of waiting times because of various factors, such as worker shortages, manpower shortages, material shortages, COVID-19 measures that stopped work during the circuit breaker and so on. HDB is working hard with contractors to make sure that the construction of those projects remain on track, while ensuring that the safety and the quality of those projects are not compromised. With regard to the broad-based demand that has arisen as a result of those factors which I mentioned earlier in my answer, that comes in the form of the 100,000 flats that we have committed to launch between 2021 and 2025, if demand is as such. In terms of what impact these set of measures – both macro-prudential measures targeting interest rate floors, as well as the demand management measures with regard to the 15-month wait out period – we intend for the first set to reduce the longer-term risk to home owners and home buyers who take loans. But for demand management, we expect it to have an impact in mitigating demand for resale flats. But, as my colleague, Deputy Prime Minister Lawrence Wong had said before, one can never fully predict what can happen in the property market and we will continue to keep a close eye on the property market after these measures and in the mid to longer term.
Mr Speaker3 words
[+1 sentence]Ms Denise Phua.
Ms Denise Phua Lay Peng (Jalan Besar)105 words
[+5 sentences]I thank the Ministers for the answers. I appreciate that both Ministers have mentioned that there will be a ramp-up amounting to 100,000 new flats, from 2021 till 2025. I think MND must have done some modelling in terms of demand and supply forecast. What is the meaning of these 100,000 new flats versus the demand that has been forecasted for each year, and how does that then meet or mitigate the challenges that we face in meeting the needs, especially, of first-time families and others? So, what does the 100,000 new flats mean versus the demand forecasts that, I am sure, MND has done?
Mr Desmond Lee126 words
[+3 sentences]We keep track of the demand for housing, both in terms of the application rates, but we also look at household formation rates – we look at marriage rates, we look at demographic trends. In terms of housing supply for BTO, we know that we have allocation of quota for different segments. For example, most recently, in the August BTO exercise, we ramped up the quota available to first-time flat buyers in non-mature estates, as my colleague, Minister Indranee Rajah said. The 100,000 flats, if the demand persists, will be able to meet much of this demand, but remember that HDB BTO flats are not the only source of housing.[+1 sentence] There is, of course, also the HDB resale market, as well as the private property market.
Mr Speaker4 words
[+1 sentence]Mr Leong Mun Wai.
Mr Leong Mun Wai (Non-Constituency Member)136 words
[+7 sentences]Thank you, Sir. I would like to ask the Minister two supplementary questions. One is, just now when the Minister was quoting the affordability statistics across countries, did he consistently use the comparison for public versus public housing, or did some of the data come from comparing our public housing to private housing in Hong Kong, for example? That is my first question. The second question is, I think the Ministers did not quite answer my colleague, Ms Hazel Poa's Parliamentary Question. There is a general feeling that the younger generation is quite seriously affected by the recent rise in the property market, especially over the last two years. So, are there any studies done to look at whether the younger generations are really affected and whether there are additional measures that the Ministry is considering?
Mr Desmond Lee74 words
[+5 sentences]Sir, I gave the home price to income (HPI) ratio as a broad comparison. Because, firstly, each country's property market is different. In many of the cities I have described, most of them do not have public sector housing the way we do, and certainly not covering 80% of Singaporean households. So, we are broadly comparing HPI for the Singapore property market, as well as for the cities concerned. So, these are broad comparisons.
Ms Indranee Rajah226 words
[+8 sentences]Mr Speaker, Sir, I think the Member just rose to suggest that I had not answered the question. We have recently discussed this. I have actually answered the question but let me just take the Member through it. The learned Member said that there is a general feeling that the younger generation are seriously affected, and whether there any studies done. The questions asked by Ms Hazel Poa was not about the younger generation. The question asked by Ms Hazel Poa was whether there were studies conducted on the impact of public housing prices on marriage and fertility rates. So, not the whole-of the younger generation, but for marriage and fertility rates. Let us just get the question correct first. Then, the second was, he had asked – because he said I had not answered – whether any studies are done. I had earlier said, while we have not conducted studies on the impact of housing prices on marriage and fertility rates, our regular surveys and engagements indicate that many couples continue to aspire to have their own home before they start a family. So, it means we have not conducted studies, but we have done regular surveys and engagements which give us the indications that we need.[+1 sentence] And the indication is that couples would like to have their own home before they start a family.
Extending Maximum Age of Vocational Driving Licences for Drivers Certified Medically Fit›Oral Answers to Questions5 turns · 665w
· 8 highlighted
oral-answer-2901
Ms Yeo Wan Ling71 words
[+1 sentence]asked the Minister for Transport (a) whether the Ministry will consider extending the maximum age of vocational licences for driving such as the Taxi Driver's Vocational Licence and the Private Hire Car Driver's Vocational Licence, should the driver be certified to be medically fit to drive a vehicle by a medical professional; and (b) if this is not possible, in what circumstances will the Ministry consider this on a case-by-case basis.
The Senior Minister of State for Transport (Dr Amy Khor Lean Suan) (for the Minister for Transport)237 words
The Land Transport Authority (LTA) recently commissioned the Singapore Medical Association (SMA) to conduct a study on a possible increase in the statutory age limit of 75 years old for holding a vocational licence (VL) to drive a public service vehicle.[+1 sentence] As taxi and private hire car (PHC) drivers spend a significant amount of time on the road and are responsible for the safety of commuters and other road users, it is important to ensure that they are fit to drive. Based on past accident statistics and SMA's medical assessment, SMA recommends not to increase the age limit for vocational licence holders beyond 75 years.[+1 sentence] SMA found the accident rate of older vocational drivers to be higher than that of younger vocational drivers. For instance, taxi and PHC drivers in the 70 to 74 age group were five to six times more likely to have had an accident, compared to taxi and PHC drivers aged below 60. Given safety concerns, LTA has assessed and considered SMA's recommendations and decided not to raise the maximum age limit for vocational licence holders for now. But older drivers aged 50 to 74 can continue to hold valid vocational licences if they undergo regular check-ups and meet the necessary medical requirements.[+1 sentence] LTA will continue to monitor the sector and review the statutory age limit periodically, to ensure an appropriate balance between safety and allowing older drivers to remain in their vocation.
Mr Speaker4 words
[+1 sentence]Ms Yeo Wan Ling.
Ms Yeo Wan Ling (Pasir Ris-Punggol)118 words
[+5 sentences]From the National Taxi Association members' data, the average age of our members has increased by about five years from 10 years ago. Our members have expressed their desire to continue driving past the age of 75 as they feel they are still in good health and have mental alertness. In addition, the past two COVID-19 years have been very tough on our drivers. And many of them have had their nest eggs wiped out, hence the appeal to continue driving past the retirement age. Should our drivers pass an annual medical examination, complete with eye and hearing test, will the LTA consider a restricted licence for a senior driver driving, for example, limited hours or limited routes?
Dr Amy Khor Lean Suan235 words
[+3 sentences]I thank the Member for her suggestions. Let me say that we appreciate and empathise with the request of the Member, as well as our taxi drivers and PHC drivers to remain in the vocation beyond the statutory age limit. But, as I have noted, we will continue to monitor the sector as we have been doing and we will review the statutory age limit periodically, making sure that we have a balance between safety as well as allowing the older drivers to remain in the vocation. In fact, we extended the statutory age limit for taxi drivers from 70 years to 73 years in 2006, and then again, from 73 years to 75 years in 2012.[+1 sentence] Taiwan is another jurisdiction that has got a statutory age limit on their taxi drivers and their current statutory age limit is 70 years – so we are already above their current age limit. In addition, as at August 2022, the number of VL holders aged over 70 remains a minority of between 1% and 5%.[+1 sentence] So, as I have said, we will continue to monitor and review this periodically. As regard to the Member's suggestions about time-restricted routes, as well as hours of operation, this is something we will carefully consider in our future review, taking note that there are challenges and implications in administrating, as well as in enforcing such limited, or time-bound and route-bound licence.
Appeals on Re-employment Disputes and Instances where Conciliation Failed and where Errant Employer is a Public Sector Employer›Oral Answers to Questions15 turns · 1,675w
· 11 highlighted
oral-answer-2902
Mr Gerald Giam Yean Song39 words
[+1 sentence]asked the Minister for Manpower (a) from 2016 to date, how many appeals on re-employment disputes has the Ministry received annually; (b) how many of these appeals are successful; and (c) what are the main reasons for unsuccessful appeals.
Ms Sylvia Lim72 words
[+1 sentence]asked the Minister for Manpower regarding re-employment disputes reported in 2016 to 2020 (a) how many notifications have been received by the Commissioner for Labour under section 8A of the Retirement and Re-employment Act (RRA); (b) of these cases, how many and what proportion are subsequently referred to the Minister for decision under section 8B of the RRA after conciliation failed; and (c) what proportion of cases are found to be substantiated.
Ms Sylvia Lim45 words
[+1 sentence]asked the Minister for Manpower regarding re-employment disputes reported in 2016 to 2020, of the cases where the employee succeeded in obtaining compensation under sections 8A and 8B of the Retirement and Re-employment Act, how many cases was the errant employer a public sector employer.
The Senior Minister of State for Manpower (Dr Koh Poh Koon) (for the Minister for Manpower)16 words
[+1 sentence]Mr Speaker, can I have your permission to take Question Nos 4 to 6 together, please?
Mr Speaker2 words
[+1 sentence]Yes, please.
Dr Koh Poh Koon230 words
[+1 sentence]Sir, the Ministry of Manpower (MOM) received about 80 re-employment disputes annually between 2016 and 2021. About 90% of the disputes were amicably resolved through the mediation process including instances where the employee subsequently withdrew his or her appeal.[+1 sentence] The remaining 10% were either escalated to the Minister for Manpower for a decision on unreasonable denial of re-employment, or to the Employment Claims Tribunals (ECT) for disputes over re-employment terms, or quantum of employment assistance payment. On average, about 10 cases a year are decided by the Minister or the ECT. Of these, 60%, or about six cases, were dismissed due to lack of merit, for example, the employee failed to meet the re-employment eligibility criteria due to unsatisfactory work performance or the employer was able to prove that there were no suitable vacancies for re-employment. The other 40%, or about four cases a year, were found to be substantiated and resulted in compensation to the employee from the employer.[+4 sentences] There was only one such case involving a public sector employer in 2018. To avoid disputes over re-employment, employers and employees should refer to the Retirement and Re-employment Act and the Tripartite Guidelines on the Re-employment of Older Employees. Employers should engage senior employees as early as possible to discuss possible re-employment arrangements. Senior employees should also be open to alternative jobs and reskilling opportunities to improve their long-term employability.
Mr Speaker3 words
[+1 sentence]Mr Gerald Giam.
Mr Gerald Giam Yean Song (Aljunied)186 words
[+7 sentences]Mr Speaker, some of my elderly residents have shared with me their experiences of being passed over for jobs for younger candidates, or not getting re-employed after reaching retirement age. Many are reluctant to even try looking for work because of their bad experiences with age discrimination. Age discrimination is in the workplace is rooted in ageism, which is an attitude of the heart. Can MOM embark on a more extensive and sustainable public education and engagement campaign to ingrain into the mindsets of everyone in Singapore, that age discrimination is morally, socially and legally unacceptable and, ultimately, hurts the ability of companies to attract and retain good workers? The Senior Minister of State mentioned some numbers – he said 80 cases have been adjudicated. The fact that there are so few cases being adjudicated points to either two things: one, there is very little age discrimination in Singapore, or two, older workers are not confident that the process will achieve their desired results. So, can the Ministry look into improving the reporting and appeals process, to better assist older workers who have experienced age discrimination?
Dr Koh Poh Koon474 words
[+21 sentences]Sir, I think the Ministry will continue to engage both employers and continue our public education to remind employees of their responsibilities and also to share the wider public as employees, what their rights are and what are the avenues for appeals or adjudication may be. That effort will be an ongoing one. It is not going to be something that we can do in a short period of time, because sometimes this messaging does take a while to percolate. And unfortunately, I think that sometimes until a person reaches a point where he or she faces that dilemma or the issue, some people may not be open to seek information or receive educational materials, when the thing comes. We are working actively through the unions who are representatives within the companies to also be a bit of a gatekeeper on how employers take care of the older workers within the company. This tripartite effort will continue to be played out over the many years to come. I would like to share with Mr Giam that in Singapore, our elder workers' labour force participation is actually not that bad. Let me just share a few numbers. The employment rate of residents aged between 55 and 64 has increased from 61.2% in the year 2011 to 69% in 2021. For those aged 65 to 69, it has also increased from 35.2% in 2011 to 49% in 2021. This is comparable to those of the top three Organisation for Economic Co-operation and Development (OECD) countries. So, while Mr Giam may have anecdotally encountered residents who do have grievances, or perhaps, are not aware of their rights and find that they have been disadvantaged, the fact is that over the last many years, the labour force participation rates in our older workforce has actually increased. So, it shows that more employers are prepared to employ older workers, and more older workers are also flexible enough and prepared to take on jobs and continue in the employment. But as it is, there will always be a few cases a year, who will find that they have either a mismatched expectation between the employment terms they seek or for which employers may still have misunderstanding about how they can better employ older workers. This is where our work will continue. There are many avenues in which workers can seek redress. One, of course, is through their union representative in their company. Two, the Tripartite Alliance for Dispute Management (TADM) is always there as a neutral party to receive any complaints from employees, or senior workers about the terms of disengagement, or any of the re-employment terms that they may feel is unfair. And finally, there is always MOM. We have an open email. They can write to us if they find that they are denied unjustifiably of re-employment opportunities.
Mr Speaker3 words
[+1 sentence]Ms Sylvia Lim.
Ms Sylvia Lim (Aljunied)120 words
[+7 sentences]Thank you, Speaker. Two supplementary questions for the Senior Minister of State. The first relates to cases that were decided by the Minister to be substantiated under section 8B of the Act. Am I right to assume that the compensation amount is usually a multiple of the employees' last drawn salary? And if that is the case, could the Ministry share with us: so far, what has been the range of the compensations ordered by the Minister, in terms of how many months? And the second supplementary question is, it was announced in 2021 that anti-discrimination legislation would be worked upon. Does he have any update for us on this and when we can expect it to come into force.
Dr Koh Poh Koon212 words
[+1 sentence]Sir, I thank the Member for the questions. In fact, for this Employment Assistant Payment (EAP), the amount has been something that has been determined and a tripartite consensus is in the guidelines.[+3 sentences] There is a fixed formula which is used; so, it is not something that we just pluck a number out of thin air. Let me just briefly say that for those who are aged 63 to less than 65.5 years old, the number of months of salary payable is 3.5 months and for those who are 65.5 years old to less than 68 years old, in the formula, it provides for two months of salary payable. But for each of these quantum, there is a certain minimum and maximum that is stipulated in the formula. If the Member is keen, she can look up the website where all the information is available. And as for updates, I think the Tripartite Committee is still looking at how we can translate the Tripartite Guidelines on Fair Employment Practices (TAFEP) into legislation.[+2 sentences] Right now, the discussion is ongoing. So, again, there are no immediate updates at this moment, but at a suitable juncture in time when the discussions are more final, we will provide an update to the Members of the House.
Mr Speaker3 words
[+1 sentence]Ms Sylvia Lim.
Ms Sylvia Lim59 words
[+4 sentences]Thank you, Sir. Just to clarify the Senior Minister of State's answer on the first question. In his answer, he mentioned the Employment Assistance Payment (EAP). But my concern was more about those cases where they were unreasonably denied re-employment, which is more a case of compensation. So, is he saying that the same formula applies to both scenarios?
Dr Koh Poh Koon211 words
[+1 sentence]Mr Speaker, let me add a supplement to what the Member is asking. I think in adjudicating some of the compensation quantums, the Minister for Manpower will objectively look at the facts of the case because each case is different.[+2 sentences] There are cases in which the employer may have to bear some responsibility, and there are cases in which also the employee himself or herself has got to bear part of the responsibility for, perhaps, not communicating, or not performing, or not indicating his or her interest to further the re-employment contract. So, in that sense, we take into account a myriad of factors: performance of the employee, years of service and including other aspects of the job scope, what were the terms of re-employment that were being offered, whether it was a fair description of the job that a person can meaningfully carry on. The health status of the employee also has to be looked into, because certain jobs will require a certain degree of medical fitness to continue. Therefore, it is not a one-size-fits-all type of calculation on the compensation amount.[+2 sentences] I hope that kind of gives the Member a sense of how we look at it in terms of the matrix. But the quantum would vary from case-to-case.
Levels of Proficiency of Seniors who Have Gone Through Seniors Go Digital Programme›Oral Answers to Questions11 turns · 1,627w
· 9 highlighted
oral-answer-2903
Mr Desmond Choo44 words
[+1 sentence]asked the Minister for Communications and Information (a) to date, how many seniors have been engaged through the Seniors Go Digital Programme; and (b) whether the Ministry has plans to enhance or put in place more programmes to specifically target online scams against seniors.
Mr Liang Eng Hwa65 words
[+1 sentence]asked the Minister for Communications and Information (a) whether those who participated in the Seniors Go Digital Programme are now more proficient in using digital devices in their daily lives, such as to access Singpass, online booking of polyclinic appointments and checking of account balances; and (b) beyond numbers, whether the focus of the Programme can be to improve digital usage by seniors going forward.
The Minister for Communications and Information (Mrs Josephine Teo)16 words
[+1 sentence]Mr Speaker, may I have your permission to take Question Nos 7 and 8 together, please?
Mr Speaker2 words
[+1 sentence]Please do.
Mrs Josephine Teo410 words
[+3 sentences]Thank you. The Ministry of Communications and Information (MCI) understands that going digital can be a daunting experience. This is one reason we established the SG Digital Office (SDO) in June 2020, to better support people who need help, such as seniors, hawkers and heartland merchants, with basic digital tools and skills. Under the Seniors Go Digital (SGD) programme, SDO's Digital Ambassadors (DAs) have engaged and trained over 190,000 seniors to date.[+3 sentences] The programme focuses on training and enabling seniors to use digital tools for their daily lives. These include using a smartphone to access Government services like Singpass and health services, and to communicate and transact online. The efforts have produced encouraging results. In a 2021 survey with seniors conducted one month after their engagement with the SDO, about nine in 10 seniors said they continued to apply the digital skills they learnt in their daily lives.[+1 sentence] Targeted programmes have also been implemented to strengthen seniors' ability to manage cyber threats. For instance, the Cyber Security Agency of Singapore (CSA) has a SG Cyber Safe Seniors Programme that raises awareness and drives adoption of cyber hygiene practices amongst seniors, and has engaged more than 45,000 seniors since its launch.[+1 sentence] The programmes I mentioned are regularly reviewed and updated to ensure their relevance. With online scams being a growing threat, a range of topics and tips for seniors to guard against online scams have been included.[+8 sentences] The Singapore Police Force (SPF) and National Crime Prevention Council (NCPC) have also rolled out broad-based and targeted public education efforts. These include the annual anti-scam public education campaign, "Spot the Signs. Stop the Crimes.", which builds awareness and vigilance amongst the general public on the tell-tale signs of scams. NCPC's Volunteer Crime Prevention Ambassadors also engage residents, including seniors, to share crime prevention tips. Complementing the Government's programmes, the Digital for Life (DfL) movement was launched in 2021 to galvanise the support of people, private and public (3P) sectors on ground-up initiatives to help Singaporeans gain confidence in going digital. For example, at the Majestic Smart Seniors Applied Centre, managed by RSVP Singapore, seniors learn to identify and avoid scams, and protect their digital identity through curated modules and webinars conducted in partnership with Google. The Government continuously reviews its anti-scam programmes and efforts to ensure they are updated and relevant. We will also continue to work with the community and industry to engage seniors, to help them stay safe and secure online.
Mr Speaker3 words
[+1 sentence]Mr Desmond Choo.
Mr Desmond Choo (Tampines)126 words
[+7 sentences]I thank the Minister for her reply. I have two supplementary questions. The Minister has mentioned that there are 190,000 seniors that were trained. This is quite an achievement since it started, because over the first year, it was only 100,000. Are there any specific targets that the Ministry has set for us to train as many seniors as we can? The second question is, there are three tiers of digital competency for the seniors, with scams being one of the largest threats to seniors, especially now that they are coming on board. Is there a need to enhance tier three of the competency, or to introduce a new tier of competency so that seniors are always protected as they come on board the digital training?
Mrs Josephine Teo334 words
[+18 sentences]Mr Speaker, we hope to avoid the tiers because it is very painful. But to your question, is there a target number? I would say the more the better. I think we are also very cognisant of the fact that seniors tend to take a longer time to become familiar with the digital domain and they would want to gain confidence a step at a time. So, we would not want to rush the seniors. We also do not want the seniors to feel that the only way they can have a meaningful life is to engage digitally. There are other things that are meaningful, but adding the digital dimension can help them to keep in touch with their friends through new means; to plug into opportunities for recreation, for understanding the world and to engage with society in a way that they could not have done so before. But it is important to note that we should let them take it at their own pace. Right now, we have organised some of the programmes according to tiers. Individuals can decide. I should also add that, in fact, once they gain confidence in going digital, some of the seniors are very savvy. They are so good that they can teach their friends how to become more effective. And then the question becomes: how are they able to learn new knowledge to teach their friends? In fact, through online resources, they are already able to become even more competent. So, that would be the approach that we take. It is also not just the programmes that matter. I think there are many touch points that seniors can come into contact with, and we do not want to assume that it is only the Government who can provide programmes that will work and be effective. Crowding in the partners is equally important, because it is also a question of building trust with the seniors, so that they are receptive to what is being shared with them.
Mr Speaker4 words
[+1 sentence]Mr Liang Eng Hwa.
Mr Liang Eng Hwa (Bukit Panjang)192 words
[+8 sentences]Thank you, Sir. Sir, I appreciate the extensive community outreach effort by the SG digital office, helping the seniors to be familiarised with the digital tools, and also the scam preventions. I would like to ask the Minister, in going forward, should the focus be more on practical applications, for example, the apps and functions that can help the seniors in their daily life. For example, how to use Singpass, calling a cab, ordering food, TeleConsult and so on. And if I may come back to my Parliamentary Question, on the polyclinic appointment bookings. With COVID-19 cases still high, the polyclinics are obviously very busy with high numbers of visits. Many of the seniors were told to book online and there are only limited walk-ins that you can book, but they are feeling helpless about how they can make a booking through the online platforms and how to go through the whole process – including using a Singpass, Singnet profiles and so on. Can I ask the Minister, if the digital office could also look at how to assist seniors to help them in some of these functions for their daily lives?
Mrs Josephine Teo431 words
[+1 sentence]Mr Speaker, I thank Mr Liang for his questions. If I could, perhaps, take a bit of time to just share with the Member and other colleagues an overview of the Seniors Go Digital programme curriculum.[+2 sentences] It is broken up into several modules. The first module is on connectivity and communication. And the applications are, for example, on smartphone features like how to use Wireless@SG, how to use WhatsApp, how to use Zoom. Then, there is another module specifically on access to Government Digital Services, TraceTogether, Singpass mobile.[+3 sentences] And yet another module on entertainment, MeLISTEN, MeWATCH and using NLB's Libby app. So, there is quite a range of things. In particular, there are several other features that would be of particular use to our seniors. For example, in the health module, the seniors are guided on how to use HealthHub and how to use Healthy 365.[+6 sentences] So, it is quite structured. But again, it all depends on the seniors' comfort level and what they find to be useful. I should just add that, inherent in Mr Liang's question is also a tension. There is a tension in wanting to help the seniors become more familiar with a range of digital applications and so nudging them in that direction to use digital services, as a motivation for them to learn about the tools and how to go digital. And on the other hand, recognising that some of these seniors will find this a very difficult task and they might actually feel very anxious. So, between the two, we have to find the right balance and try to move things forward. Our overall approach is to make the options available and to still make the non-digital avenues open.[+5 sentences] They may not be as convenient as the digital avenues, but it does not mean that seniors do not have the non-digital options available to them. The CDC vouchers is a very good example. Many seniors over time have learnt and gained confidence on how to use the digital vouchers, but there remains a group that far prefers to use the physical vouchers and those options still remain visible. In summary, we will continue to nudge forward, and we will continue to offer options for seniors who feel more confident and want to move to the next level of their digital engagement. But we will also want to be very mindful that some seniors are still not yet comfortable, and we want to offer them that sense of confidence that they are not being pushed in a direction that they do not wish to go.
Funding and Implementation Details for Beverage Container Return Scheme›Oral Answers to Questions12 turns · 2,074w
· 10 highlighted
oral-answer-2904
Mr Zhulkarnain Abdul Rahim65 words
[+1 sentence]asked the Minister for Sustainability and the Environment under the proposed beverage container return scheme (a) what are the types of pre-packaged beverage or container envisaged to be included; (b) what are the annual projected costs and expenditure to run the scheme; and (c) what are the Ministry's plans to utilise any excess deposit or fees which remain un-refunded because of beverage containers not returned.
Mr Ang Wei Neng66 words
asked the Minister for Sustainability and the Environment (a) what is the projected cost per annum for the new proposed beverage container return scheme; (b) whether NEA will consider setting up return points at hawker centres, food courts and canteens of significant size; and (c) how will NEA ensure that the non-profit administrator of the proposed scheme will operate the container return scheme efficiently and effectively.
Mr Liang Eng Hwa66 words
asked the Minister for Sustainability and the Environment with regard to the model in which the beverage container return scheme will be implemented (a) what is (i) the envisaged scale in its implementation and (ii) its projected initial and recurring costs under this model; and (b) whether the Ministry has considered other non-monetary related schemes to achieve the same outcome that is expected under this model.
The Senior Minister of State for Sustainability and the Environment (Dr Amy Khor Lean Suan) (for the Minister for Sustainability and the Environment)44 words
[+1 sentence]Mr Speaker, with your permission, may I take Question Nos 9 to 11 together, as well as replies to Parliamentary Questions by Mr Yip Hon Weng1 set for tomorrow's Sitting and by Mr Mohd Fahmi Aliman2 for a later Sitting on the same topic.
Mr Speaker2 words
[+1 sentence]Please proceed.
Dr Amy Khor Lean Suan1109 words
[+27 sentences]Thank you. The proposed beverage container return scheme aims to encourage good recycling practices, conserve resources and reduce waste and carbon emissions. This is in line with our Zero Waste Masterplan and contributes towards our climate ambition to achieve net-zero emissions by or around mid-century. The scheme, which was first proposed by the Citizens' Workgroup on #RecycleRight in 2019, will be the first phase of an Extended Producer Responsibility (EPR) approach to manage packaging waste. This Extended Producer Responsibility approach means that the scheme will be funded by producers of pre-packaged beverages. Under the EPR approach, beverage producers, such as manufacturers and importers, will be responsible for the collection and recycling of the products they put out on the market as well as funding the scheme. This is similar to the EPR scheme that was implemented for e-waste in 2021. Under the beverage container return scheme, a small refundable deposit will be applied when a consumer buys a pre-packaged beverage. I must emphasise that this is a refundable deposit. Consumers will get a full refund of their deposits when they return their empty beverage containers at designated return points. Compared to non-deposit-based recycling schemes, the refundable deposit will encourage a higher recycling rate and aggregate a stream of cleaner and higher quality recyclables that can be used to produce new products, thus enhancing the resource loop. Similar schemes in countries such as Norway, Sweden and Lithuania, have achieved return rates of 80% or higher. Producers typically appoint an operator to carry out their responsibilities under the scheme. Based on the experience of other countries, a not-for-profit, industry-led scheme operator is preferred. It will be able to tap on the industry's capabilities and resources, such as existing logistics channels to make use of backhaul trips to improve operational synergies. As the scheme is owned and run by the industry, it will have a strong incentive to operate the scheme efficiently and cost-effectively, to keep scheme costs low for all parties. In addition, the revenue from the sale of clean, high quality and high value recyclables, and any unclaimed deposits, will be utilised by the scheme operator to reduce the scheme costs. In Singapore, the eventual cost pass-through to consumers in beverage prices, if any, will likely be moderated by price competition among industry players. This is also the experience in other countries that have implemented similar schemes. To ensure that the scheme operator operates efficiently, cost effectively and fairly across multiple producers, the Government will exercise regulatory oversight over the scheme operator. The scheme operator will be licensed by NEA and be required to meet conditions set out by NEA, including a collection target. To develop the scheme framework for Singapore, my Ministry and NEA have conducted over two years of extensive engagements and consultations with stakeholders, including members of the public and over 250 beverage producers, retailers and waste management companies. We have taken into account their feedback and views in developing a proposed scheme framework, and we are currently conducting further public consultation via REACH. As public consultations are still ongoing, not all the details of the scheme have been finalised. We are proposing for the scheme to cover plastic bottles and metal cans as a start, as these have high material value, high consumption rates and are easy to collect and compact. We also propose to include all beverage types to reduce consumer confusion and maximise the number of containers that can be collected for recycling. The scheme would include containers from 150 millilitres to three litres, which can be accepted by typical reverse vending machines. With these proposed parameters, the scheme is estimated to cover more than one billion beverage containers in Singapore each year.[+2 sentences] In designing the scheme, we will make it easy for consumers to understand, to enable each of us to play our part in building a circular economy. We will need to have an extensive network of conveniently located return points to enable consumers to easily claim their deposit refunds. Based on a survey conducted with 1,000 households, supermarkets were among the most preferred return locations across all the age segments and are a major sales channel for prepackaged beverages. We have thus proposed that large supermarkets with a total floor area of more than 200 square metres be mandated to set up return points.[+8 sentences] This will cover about 400 large supermarkets. We also welcome operators of other premises, such as mall operators and smaller retailers, to voluntarily set up return points. Based on experiences overseas, this can increase footfall to stores. The scheme operator pays handling fees to return point operators, to reimburse the costs incurred. To build the return point network, NEA will work closely with the future scheme operator to identify and set up return points in suitable community and public spaces, such as Community Clubs, sports facilities and large, well-patronised hawker centres, to increase accessibility. Return point operators can choose manual over-the-counter return points or opt for automated reverse vending machines. At food and beverage (F&B) premises, such as hawker centres, food courts and canteens, operators and stallholders have the flexibility to decide whether to collect the deposit and pass the beverage containers to their patrons. There is a wide range of such premises, from casual settings to more formal settings, and each would have its own preference. For example, stallholders could serve the customer the beverage with its container and charge the deposit, in which case, the customers can take away the empty beverage containers and return them at designated return points to claim the refund on their deposit.[+6 sentences] Alternatively, stallholders could pour the beverage into a cup before serving, in which case, they do not need to charge the deposit as the customer does not receive the beverage container. In this case, the stallholder can collect the empty beverage containers and claim the refund of the deposits on the containers. We expect the former to apply in more casual settings, such as coffee shops and hawker centres, as the shop owners would typically have their customers pay the deposit and then take the beverage container. Operators of F&B premises, including hawker centres, food courts and canteens, could also consider setting up return points at their premises, where appropriate. NEA will work with the scheme operator to engage F&B premises operators, advise them on the scheme and prepare them for implementation. We will continue to engage stakeholders as we develop the scheme. The ongoing REACH consultation will be open until 14 October this year and we encourage and welcome all stakeholders and members of the public, as well as Members in this House, to give their feedback.
Mr Speaker4 words
[+1 sentence]Mr Zhulkarnain Abdul Rahim.
Mr Zhulkarnain Abdul Rahim (Chua Chu Kang)109 words
[+5 sentences]Mr Speaker, I thank the Senior Minister of State. My supplementary question is in relation to continuing cost-benefit analysis for this scheme. In 2001, Israel introduced a deposit refund law for glass and plastic containers smaller than 1.5 litres. A cost-benefit analysis in 2010 was done and it concluded that the law had a positive impact, with total benefits exceeding total cost by around 35%. In the same vein, can the Senior Minister of State and the Ministry also consider a similar cost-benefit analysis, and a regular reporting can be done on the effectiveness of the scheme, including possible recommendations of expansion of the scheme, if that is beneficial?
Dr Amy Khor Lean Suan97 words
[+2 sentences]I thank the Member for his question. I think it is, indeed, important that we do this. So, as I have noted, NEA has regulatory oversight over the scheme operator. So, it will require the scheme operator to regularly track as well as report on the scheme outcomes and related fees, for instance, the producer fees and the return targets. In fact, we will set a return target for the scheme operator, and we will work with the future scheme operator to evaluate the effectiveness of the scheme outcomes as well as further refinements to the scheme.
Mr Speaker4 words
[+1 sentence]Mr Ang Wei Neng.
Mr Ang Wei Neng (West Coast)98 words
[+4 sentences]I thank the Senior Minister of State for the comprehensive reply. I have two supplementary questions. Firstly, I would like to ask the Senior Minister of State, based on the experience of other countries that have implemented the same scheme, what are the challenges, especially the logistics challenges that these countries faced, as well as what is the estimated number of reverse vending machines and return points that are required if the scheme is implemented in full. Secondly, I would like the Senior Minister of State to confirm whether the deposit or the refund will attract any GST.
Dr Amy Khor Lean Suan410 words
[+14 sentences]I thank the Member for his questions, too. With regard to challenges, as I have alluded to, in order to facilitate return of the beverage containers, which is really the key objective of this scheme, that is, to nudge consumers' behaviour, nudge them to recycle the beverage containers, we will need to have an extensive network of return points to make it easily and conveniently accessible to the consumers, so that they can return and get back their deposit. For a start, we are mandating the large supermarkets above 200 square metres to have these return points because our survey and engagements with the public have shown that that is one of the most popular return point locations. Of course, it is also the single largest sales channel for prepackaged beverages. About a third of the total sales volume of prepackaged beverages is through the supermarkets and there will be about 400 of them, which is about two-thirds of the number of supermarkets that we have in Singapore. But beyond that, we will be looking at working with the future scheme operator and other stakeholders to have designated return points at other locations, publicly accessible locations, such as Community Centres, Residents' Networks (RNs), void decks, sports facilities, hawker centres which are well-patronised or even coffee shops. And, of course, some retailers, as is the experience in other countries do come forward to volunteer to have designated return points because that has been shown to increase footfall and, therefore, spending at the stores. So, we will implement this and then, monitor to see whether that is adequate and we can always refine this. I think that also answers the Member's question on return points, because this is one of the key issues. Of course, the other thing is to keep the scheme cost low and we are doing this by encouraging the producers to come together to form a not-for-profit industry-led scheme operator, which means that they can actually tap on their existing logistics as well as distribution networks. So, for instance, when they send new stocks, they can take back the used beverage containers. In addition to that, it is really a strong incentive since they are paying producers' fees to keep scheme costs low. Then, the sale of the high-quality, high value recyclables will help to offset some of the costs. With regard to GST, based on the intended scheme design, GST will not be chargeable on the deposit.
Net Loss for Central Weave BTO Development at Ang Mo Kio›Oral Answers to Questions2 turns · 411w
· 5 highlighted
oral-answer-2905
Mr Leong Mun Wai57 words
[+1 sentence]asked the Minister for National Development (a) what is HDB's net loss for the Central Weave BTO project at Ang Mo Kio; (b) what is the cost of land paid by HDB to SLA for this project; and (c) what is the net profit and loss position for the Government, including HDB and SLA, for this project.
The Minister for National Development (Mr Desmond Lee)354 words
[+1 sentence]Mr Speaker, Sir, the Housing and Development Board (HDB) will incur an estimated development loss of about $250 million for the Build-To-Order (BTO) project Central Weave @ AMK. If we consider the Central Provident Fund (CPF) housing grants that HDB will extend to eligible buyers, the loss will increase further by an estimated $20 million, to about $270 million. The estimated land cost for the project is about $500 million.[+9 sentences] This is determined independently by the Chief Valuer, using market valuation principles. Land forms part of the Past Reserves. Hence, when HDB uses the land for development, the money that HDB will need to pay for the land must be paid back into the Past Reserves, which are invested and grown for future generations and are protected. The Government cannot use proceeds from land sales as revenue for spending in the Budget. HDB does not price new flats based on cost. When pricing new flats, HDB first establishes their market value by considering the prices of comparable resale flats nearby as well as the individual attributes of the flats and prevailing market conditions. To derive the selling prices, HDB applies a significant subsidy to the assessed market values to ensure that new flats are affordable to those buying their first home. On top of this, HDB provides further grants, such as the Enhanced CPF Housing Grant, the Proximity Housing Grant and the Step-Up CPF Housing Grant, among others, to help specific demographic groups with their home ownership aspirations. HDB incurs a significant deficit every year, as the amount that it collects from the sale of flats is far less than the cost of its building programme and the housing grants it disburses each year. For the Financial Year (FY) 2021/2022, for example, HDB recorded a deficit of $3.85 billion for its Homeownership Programme. The average deficit incurred by HDB in the last three years from 2019 to 2021 was about $2.68 billion a year. So, claims that HDB profits from the development and sale of HDB flats are false.[+1 sentence] HDB will continue to ensure that public housing remains affordable and accessible for all Singaporeans.
Assessment of Mental Health and Well-being of Police and Auxiliary Police Officers Who Bear Arms›Oral Answers to Questions12 turns · 1,649w
· 10 highlighted
oral-answer-2906
Mr Zhulkarnain Abdul Rahim51 words
[+1 sentence]asked the Minister for Home Affairs whether there are precautionary measures taken on a continual basis to assess the state of mental health and well-being of Police and Auxiliary Police Officers who bear arms in the course of their duties, particularly those who have front-facing duties with members of the public.
Dr Shahira Abdullah73 words
[+1 sentence]asked the Minister for Home Affairs (a) from 2019 to date, how many Police officers have sought help from their unit for mental health challenges; (b) what is the process for Police Officers to seek help (i) within their unit and (ii) from other resources within SPF; and (c) what initiatives are in place to destigmatise help-seeking, given the fear of discrimination and unconscious biases relating to promotional prospects in a high-performing environment.
Dr Shahira Abdullah44 words
[+1 sentence]asked the Minister for Home Affairs (a) what support measures are given to Police officers to access external counselling service providers to alleviate stigma from seeking internal counselling support; and (b) whether such support extends to other first responders including paramedics and military staff.
The Minister of State for Home Affairs (Ms Sun Xueling) (for the Minister for Home Affairs)20 words
[+1 sentence]Mr Speaker, Sir, may I have your permission to answer Question Nos 13, 14 and 15 in today's Order Paper?
Mr Speaker2 words
[+1 sentence]Yes, please.
Ms Sun Xueling656 words
[+1 sentence]Mr Speaker, my response will cover the matters raised in the questions by Mr Zhulkarnain Abdul Rahim, Dr Shahira Abdullah and Mr Melvin Yong, who had asked similar questions yesterday, which we have given a written answer to. Between January 2018 and September 2022, 74 uniformed officers in the Home Team passed away while in service.[+2 sentences] The majority of these deaths were due to illnesses or natural causes. Eight deaths were ruled as suicide. The cause of death for three others, which had elements to suggest possible suicide, are pending coronial investigations.[+15 sentences] With regard to mental health, Home Team officers are provided with avenues of support from the time they join the Home Team. Resilience and stress management training is provided to all new officers. We provide training on detection of personal distress and this includes suicide prevention. Staff feedback is collected through regular staff engagement and pulse surveys, and the concerns raised include issues which officers may face in the workplace. Home Team supervisors are trained with the skills to identify and support officers who need help. This approach and culture have been built over several years. Across the Home Team departments, in-house psychological services are made available to officers, including first responders. Psychologists in the Home Team departments attend to the mental health needs of the officers. Peer support programmes, such as para-counsellors, have also been implemented in Home Team departments to provide care and support. For the Singapore Police Force (SPF), there is also a 24/7 helpline managed in-house by our psychologists and SPF senior para-counsellors. We have another external agency-administered 24/7 helpline which is available to all Home Team officers. The Home Team makes external counselling services available to all our officers, including frontline officers. The aim is to make it easier for them to access external help. This is confidential and anonymous, and we do not track who attends these services. The external counsellors will activate emergency services if they assess that there could be a threat of harm by the officers to themselves, or to others. The Police do not track the number of officers who have sought counselling or para-counselling assistance.[+1 sentence] Officers are not required to report their engagement of such assistance as the confidentiality of help-seeking is important to encourage officers with problems to come forward. Officers who seek help are not specifically disadvantaged in their career because they had sought help.[+9 sentences] They are assessed on their on-the-job performance and their promotion is based on merit and their potential to assume higher appointments. SPF psychologists try and demystify the myths and stigma of help-seeking during their regular mental health outreach to all Police officers. There is increased outreach every October, in line with World Mental Health Day, to build awareness of the importance of mental health and to encourage help-seeking. Where the bearing of firearms is concerned, all Police officers and Auxiliary Police Officers (APOs) undergo security vetting before employment. Medical and psychological assessments are conducted as part of the recruitment exercise for the SPF and for most of the Auxiliary Police Forces (APFs). Supervisors engage officers to check on their well-being. Officers are also encouraged to alert their supervisors if they think their peers may need help. If officers are assessed at any point to be unsuitable to carry firearms, they will not be issued with firearms and will be redeployed to other duties to allow them to settle down and recover from whatever strains they may be facing. We will continue to strengthen the support for the mental health and well-being of officers in the Home Team and the APFs but we will also require the help of family and friends, of officers in the Home Team and the APF as these family and friends may be in most frequent contact with the officers and are best able to detect changes in moods, in dispositions and be most sensitive to life events happening to these officers.
Mr Speaker4 words
[+1 sentence]Mr Zhulkarnain Abdul Rahim.
Mr Zhulkarnain Abdul Rahim145 words
[+8 sentences]Thank you, Sir. I thank the Minister of State for her answer. It is an important issue, given the recent tragic case. In a Washington Post article last year, in the US, law enforcement officers are 54% more likely to die by suicide than the average American and they are likely to die by suicide than in the line of duty. We do not want to be faced with a similar situation here in Singapore. Can the Ministry look into undertaking research and, maybe, coming up with a toolkit, together with other partners or agencies, to address this mental health issue among frontline first responders? It can cover various topics and the culture that the Minister of State mentioned as well. It will also be useful for APOs or other frontline or first responders who may not be familiar with current available help right now.
Ms Sun Xueling211 words
[+2 sentences]I thank the Member for his question and also his concern for Home Team officers as well as APFs. The situation in Singapore is different from what the Member has cited regarding the suicide rate of US law enforcement officers. Every suicide is one too many and I do not wish to trivialise the situation. But our statistics show that the suicide rate among the Ministry of Home Affairs (MHA) staff is about half that of the Singapore national average.[+1 sentence] I thank the Member for his suggestion on having toolkits and building the right culture to seek help and ensuring access to help channels for our officers. In my earlier reply, I had talked about the resilience training, which is conducted for ground officers across the Home Team departments. There are also simplified and easy to use toolkits which will help supervisors identify officers who are in distress.[+3 sentences] In addition, resources of support are shared regularly with officers through various channels. Regardless, this is ongoing, very important work to ensure that the mental health of our officers is well taken care of. We will continuously look at various means to encourage destigmatisation of mental health and to provide help channels which are useful to our officers should they require such support.
Mr Speaker3 words
[+1 sentence]Mr Murali Pillai.
Mr Murali Pillai177 words
[+8 sentences]Mr Speaker, Sir, I have two supplementary questions for the hon Minister of State. First, I join the hon Member Zhulkarnain Abdul Rahim in asking whether there has been any study to correlate the suicide cases with any stressors, for example, because of exposure to traumatic incidents, whether the reaction arises from post-traumatic kinds of stresses. Sorry, I am getting ahead of myself. Really, at the end of the day, if we were to identify the psychosocial factors that contribute to such suicides, I think we will be in a better position to prevent suicides in the first place. That is the thrust of my question. The second question is in relation to harnessing geo-positioning or geo-fencing technology with respect to APOs. I understand that they are being recruited from a wider background and many of them have static duties. So, I wonder whether technology can be harnessed such that if they leave their post and they are bearing arms, there could be some proactivity in managing such situations and, hopefully, prevent any untoward incidents as well.
Ms Sun Xueling263 words
[+1 sentence]I thank the Member for the two points that he has raised. On the first point, I had mentioned in my earlier reply that we do conduct surveys to collect staff feedback at regular junctures.[+6 sentences] We also have regular engagement exercises with our staff officers at various levels, sometimes on very large platforms and sometimes on much smaller platforms. For instance, for myself, I engage officers over breakfast – sometimes, 10 to 20 people – to hear the tensions they may be facing, the stresses they may be facing, to really get ground-up feedback to get a sense of what they are facing, whether or not it is in their personal lives or whether or not it is what they are facing in terms of their everyday work environment. It is through these engagements that we get a sense of what are some of the stressors that they may be facing. As I mentioned in my earlier reply, this is continuous, ongoing work. We will need the help of family and friends, because family and friends are often the most connected to these officers and they would know if there were any life-changing events that will throw them off course and lead them to choose a very unfortunate way out. So, this is continuous work in progress. On the second point the Member mentioned about geo-fencing, we can have a think about it, but I think we do have to balance the need for privacy as well as the needs of the job, but we thank the Member very much for that suggestion.
Safeguarding Singapore's National and Elite Athletes from Misuse of Drugs›Oral Answers to Questions9 turns · 1,202w
· 9 highlighted
oral-answer-2907
Dr Wan Rizal31 words
[+1 sentence]asked the Minister for Culture, Community and Youth (a) whether there are measures implemented to protect Singapore's carded athletes from the misuse of drugs; and (b) if so, what are they.
Mr Darryl David64 words
[+1 sentence]asked the Minister for Culture, Community and Youth (a) whether the Government or National Sports Associations (NSAs) have any programmes to educate national and elite athletes about the dangers and pitfalls of using recreational drugs and performance-enhancing drugs; and (b) whether the Government or NSAs have any programmes that regularly test their national and elite athletes for recreational drug use and performance-enhancing drug use.
The Senior Parliamentary Secretary to the Minister for Culture, Community and Youth (Mr Eric Chua) (for the Minister for Culture, Community and Youth)14 words
[+1 sentence]Mr Speaker, with your permission, may I take Question Nos 16 and 17 together?
Mr Speaker2 words
[+1 sentence]Yes, please.
Mr Eric Chua652 words
[+1 sentence]Thank you. The Government established Anti-Doping Singapore (ADS) as the national anti-doping authority in 2010.[+11 sentences] SportSG works with ADS and the broader sporting fraternity to ensure that sport in Singapore is free of doping and that our national athletes compete fairly and safely, and that they can be upheld as role models for Singapore and Singaporeans. At the national level, Singapore has a clear, well-established policy on drugs. In the context of sport, Singapore has a framework of rules and standards to keep sports in Singapore free of doping, including the use of both recreational drugs and performance-enhancing drugs. It aims to equip our national athletes with the information, tools and values for them to exercise sound judgement and choices when it comes to the use of drugs. There are two key strategies in which this is implemented: (a) through education and prevention; and (b) through detection and deterrence. Let me elaborate. One, education is a key preventive measure to discourage intentional or inadvertent doping, and this is done through various platforms. First, all National Sports Associations (NSAs) are expected to inform and educate their athletes and athlete support personnel on issues concerning sports doping under the framework. Second, ADS works with NSAs to plan, implement and monitor education programmes for athletes. These comprise regular updates on issues, such as the currency of prohibited substances and methods, the health consequences of doping, and the rights and responsibilities of athletes. ADS also reminds NSAs and their athletes on their anti-doping obligations at all pre-Major Games briefings. Third, it is mandatory for all national athletes to complete modules on the World Anti-Doping Agency's e-learning platform called the Anti-Doping Education and Learning (ADEL) Platform, to deepen their understanding of clean sports.[+1 sentence] To prevent inadvertent doping, ADS provides the "Check Drugs" function on its website to enable athletes and support personnel to check on the prohibited status of a particular drug or substance. The database contains more than 9,000 medications registered in Singapore and is updated monthly.[+6 sentences] For medications not on the database, athletes can and should check with a sports physician or with ADS directly. Two, on the detection and deterrence front, ADS oversees a robust doping testing regime. First, ADS develops and regularly reviews a test distribution plan for athletes, with higher testing frequencies for athletes assessed to be at higher risk of doping. Several factors are considered in determining the risk level of doping, such as the athlete's performance and the type of sports. ADS' testing regime covers both in-competition and out-of-competition tests. Second, ADS also relies on intelligence, such as whistle-blowing sources, to identify and investigate allegations of drug abuse, including following up to conduct tests on alleged offenders. Under the ADS, sanctions are imposed on athletes found to have violated anti-doping rules. These range from a few months to a lifetime ban, depending on the degree of fault, intention, type of substance used and aggravating circumstances.[+9 sentences] These sanctions are made public to send a deterrent signal to others. Other sanctions may also be imposed. For instance, SportSG could suspend the spexScholarship or other support offered to a carded athlete. The NSA may also suspend training support for the athlete or their selection for competitions. The Singapore National Olympic Council (SNOC) or the Singapore National Paralympic Council (SNPC) may also, separately, suspend the selection of the athlete for any Major Games for the appropriate period. Notwithstanding the range of sanctions that can be taken, it is also important to consider a rehabilitative approach to help the athlete not to offend again. The sporting community will work with the athletes to provide counselling and rehabilitative support they may need. The Government and the local sporting fraternity looks upon the misuse of drugs as a serious matter. SportSG, ADS and the fraternity will continue to work together to underscore the importance of complying with Singapore's laws on drugs and anti-doping rules at all times.
Mr Speaker3 words
[+1 sentence]Mr Darryl David.
Mr Darryl David (Ang Mo Kio)142 words
[+4 sentences]I would like to thank the Senior Parliamentary Secretary for his comprehensive reply both on education and also on deterrence. Just one supplementary question, Mr Speaker, on the aspect of education. I agree with the Senior Parliamentary Secretary that this is key as a preventive measure. Given that many of our national athletes or perhaps, many of our athletes, get competitive much earlier on – in school, perhaps – would ADS and SportSG consider working with the relevant authorities or the relevant Government agencies to go further upstream in terms of providing education to our younger competitive athletes who would, obviously, hopefully, become national athletes, seeing as to how the youths could be a bit more impressionable, to have these education programmes further upstream such that they are aware of the pitfalls of using recreational and performance-enhancing drugs in their athletic endeavours?
Mr Eric Chua235 words
[+4 sentences]Mr Speaker, I thank the Member Mr Darryl David for his question. I will make a broad point about what Mr Darryl David has mentioned. The pursuit of excellence in sport is not just limited to the technical aspects of it. I think this is consistent across sports, cultures and jurisdictions, if I may put it that way. In my recent visit to Europe, where I visited a few sporting centres of excellence – if I may call them that – in terms of football, I think the consistent message that has been sent is that they – these academies, these football clubs – they want to produce and create excellent footballers but, more than that, they also want to produce good individuals, individuals with good values. As much as the pursuit of sporting excellence is about fitness, technical competencies of each sport, it is very much also about values inculcation, the promulgation of values from one generation to the next. In that vein, coaching, as well as the role that coaches play, is a very important role that cannot be overstated in the sporting fraternity.[+1 sentence] That, I agree with Mr Darryl David. So, there can be a lot of scope for us – ADS, SportSG, SNOC and the different sporting bodies – to work together with the schools and MOE without even going into specifics and, definitely, I thank the Member for his suggestion.
Mr Speaker59 words
[+3 sentences]Order. End of Question Time. The Clerk will now proceed to read the Notice of Motion. [Pursuant to Standing Order No 22(3), written answers to questions not reached by the end of Question Time are reproduced in the Appendix, unless Members had asked for questions standing in their names to be postponed to a later Sitting day or withdrawn.]
Prevalence and Regulation of Cryptocurrency Transactions›Written Answers to Questions2 turns · 304w
· 0 highlighted
written-answer-11629
Mr Yip Hon Weng34 words
[+1 sentence]asked the Prime Minister (a) what is the prevalence of cryptocurrency transactions involving privacy coins and privacy wallets in Singapore; and (b) whether the Government regulates the use of privacy coins and cryptocurrency mixers.
Mr Tharman Shanmugaratnam (for the Prime Minister)270 words
[+12 sentences]Privacy coins1, privacy wallets2 or cryptocurrency mixers3 can be misused by criminals since they are all designed to hide the identity of persons behind cryptocurrency transactions. The Financial Action Taskforce (FATF) has issued guidance4 to the international community to treat transactions involving such anonymity features as highly risky. This means that regulated entities that undertake such transactions for their customers must take additional measures to mitigate the associated money laundering and terrorism financing (ML/TF) risks. Accordingly, the Monetary Authority of Singapore (MAS) requires digital payment token (DPT) service providers engaged in customer transactions involving such anonymity features to put in place stronger controls to address the higher risks they pose. In particular, they must assess the ML/TF risks posed by such tokens before dealing in them. MAS must be satisfied that they have taken adequate control measures to manage these risks5. MAS also requires DPT service providers to assess the purpose of their customers' use of privacy coins, privacy wallets or mixers and to undertake enhanced monitoring of their transactions6. Most licensed DPT service providers in Singapore do not offer privacy coins to their customers. There is, currently, no data on the use of privacy wallets and cryptocurrency mixers in Singapore, as both are essentially open-source and non-custodial protocols created by software developers and used to transact peer-to-peer. Nonetheless, MAS is closely monitoring the business activities of licensed DPT service providers. They are required to periodically report to MAS on DPTs they hold or transact in that they have assessed to be of higher risk. MAS will take appropriate supervisory actions against regulated entities that fall short of its standards.
Cryptocurrency Investment Companies Setting Up Operations and Measures in Place to Prevent Money Laundering and Fraud›Written Answers to Questions2 turns · 327w
· 0 highlighted
written-answer-11630
Mr Yip Hon Weng53 words
[+1 sentence]asked the Prime Minister in view of Singapore opening up to cryptocurrency in the last two years (a) whether there is an influx of businessmen interested in setting up cryptocurrency investment companies in Singapore; and (b) what are the safeguards to prevent money laundering operators and fraudsters from setting up such businesses here.
Mr Tharman Shanmugaratnam (for the Prime Minister)274 words
[+13 sentences]In Singapore, as in other jurisdictions, not all activities related to digital payment token (DPT) – referred to as cryptocurrencies – are regulated. A company that provides a service which involves buying, selling or facilitating the exchange of DPTs would be regulated under the Payment Services Act 2019 (PS Act). The Monetary Authority of Singapore (MAS) would not have information on the number of parties interested in setting up cryptocurrency investment companies in Singapore unless they apply for a licence from MAS. MAS' regulation under the PS Act focuses on money laundering, terrorism financing risks and technology risks. It administers a rigorous licensing process to ensure that we admit DPT service providers with strong governance structures and robust controls to address these risks. Many applicants have been turned away. Where MAS has reason to suspect that an applicant is involved in illicit activities, MAS will, besides rejecting the application, refer the matter to the Police for investigation. MAS also conducts surveillance to identify unlicensed firms that illegally provide DPT services or solicit customers in Singapore. It will instruct these entities to stop offering services to Singapore residents and refer them to the Police for investigation. MAS may also place them on its Investor Alert List to warn the public that these entities are not supervised by MAS. MAS also works closely with the Police to combat cryptocurrency scams. MAS and the Police have issued public advisories alerting consumers to guard against fraudulent websites soliciting cryptocurrency investments. When dealing with cryptocurrency firms, consumers should check if the entities are licensed or have been granted an exemption to hold a licence by referring to MAS' website.
HDB Homes with Mortgages Financed by Commercial Banks›Written Answers to Questions2 turns · 59w
· 0 highlighted
written-answer-11631
Mr Sitoh Yih Pin20 words
[+1 sentence]asked the Prime Minister what is the current percentage of HDB homes with mortgages that are financed by commercial banks.
Mr Tharman Shanmugaratnam (for the Prime Minister)39 words
[+2 sentences]As at the second half of 2022, 42% of all households who live in Housing and development Board (HDB) homes have outstanding mortgage loans. Of these, 63% were granted by HDB and the remaining 37% by financial institutions (FIs).
Prevalence of Practice of "Special Account (SA) Shielding" by CPF Members›Written Answers to Questions2 turns · 226w
· 0 highlighted
written-answer-11632
Mr Melvin Yong Yik Chye49 words
[+1 sentence]asked the Minister for Manpower (a) how prevalent is the practice of "Special Account (SA) shielding" by CPF members who shield their SA monies from flowing into the Retirement Account at age 55; and (b) whether the Ministry intends to review the current CPF policy to address this trend.
Dr Tan See Leng177 words
[+6 sentences]We are aware that some members invest their Special Account (SA) savings shortly before age 55 and liquidate it after age 55, to retain more Central Provident Fund (CPF) savings in their Special Account (SA). In 2021, about 2% of CPF members turning 55 invested their SA monies under the CPF Investment Scheme-Special Account (CPFIS-SA) within six months before they turned age 55 and liquidated their investments within six months after they turned age 55. Some of them may have done so to prevent their SA monies from flowing into the Retirement Account at age 55. We would like to reiterate to CPF members that the investment of SA monies comes with costs and investment risks – there are transaction fees involved and members may lose a portion of the amount invested. Financial advisers and insurance brokers who promote this practice without highlighting the costs and investment risks may be guilty of mis-selling and should be reported to the Monetary Authority of Singapore (MAS). We will continue to monitor this trend closely and take action if necessary.
Ongoing Review of Prevention of Corruption Act 1960›Written Answers to Questions2 turns · 430w
· 0 highlighted
written-answer-11633
Mr Murali Pillai32 words
[+1 sentence]asked the Prime Minister whether he can provide an update on the ongoing review of the Prevention of Corruption Act 1960 that was announced by the Corrupt Practices Investigation Bureau in 2018.
Mr Chan Chun Sing (for the Prime Minister)398 words
[+20 sentences]The Prevention of Corruption Act (PCA) is a key instrument in our fight against corruption. We must ensure that PCA remains effective to combat and deter corruption and that it enables us to fulfil our international obligations. The Corrupt Practices Investigation Bureau (CPIB), in close consultation with the Attorney-General's Chambers (AGC), has reviewed PCA in this spirit. We would like to thank Members of the House for their suggestions relating to the review, which included those relating to corporate liability for corruption offences. CPIB took these suggestions into consideration in the review. The review has concluded that PCA, as it stands, provides effective deterrence and adequately empowers CPIB to carry out its duties. There is, therefore, no need to amend or enhance the existing provisions. Besides providing for tough enforcement action against corrupt individuals, PCA offers sufficient basis for the prosecution of corporate bodies in Court if the facts of the case call for it. This extends to instances where corporate entities are found to be complicit in the corrupt conduct of their employees. CPIB has successfully taken corporate bodies to task in the past and will not hesitate to do so. The Corruption, Drug Trafficking and Other Serious Crimes (Confiscation of Benefits) Act complements PCA by enabling the disgorgement of benefits obtained by a corporate body through the giving of bribes. Our legislative framework is, therefore, sufficiently robust to ensure that errant corporate bodies will have to bear the full brunt of the law and will not be able to enjoy any ill-gotten gains through corrupt means. A robust anti-corruption framework goes beyond legislative instruments. The last Public Perception Survey conducted in 2020 cited strong political determination, along with effective anti-corruption law and heavy punishment, as the top three factors behind the low incidence of corruption in Singapore. Constant vigilance and a zero-tolerance attitude against corruption on the part of every Singaporean are also critical. The corruption situation in Singapore is firmly under control and we are well-regarded internationally for our anti-corruption efforts. However, there is no room for complacency as the corruption threat is persistent and ever evolving. CPIB understands this very well. It will spare no effort not just in carrying out its work without fear or favour, but also in improving its capabilities to stay ahead of the corrupt. We must continue to support CPIB and do our part to keep corruption at bay.
Complaints from Singaporeans About Being Replaced by Foreign Labour in Last Five Years›Written Answers to Questions2 turns · 148w
· 0 highlighted
written-answer-11634
Mr Leong Mun Wai46 words
[+1 sentence]asked the Minister for Manpower (a) for each of the last five years, what is the number of complaints received from Singaporeans about being replaced by foreign labour; and (b) what percentage of the total number of complaints received by the Ministry do such complaints make.
Dr Tan See Leng102 words
[+4 sentences]Between 2017 and 2021, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) received an average of about 180 complaints each year involving discrimination based on nationality, including complaints against job advertisements. Complaints by Singaporeans on being replaced by foreign workers would form a smaller subset of these complaints but TAFEP does not track case count on such a basis. Overall, complaints over nationality discrimination make up fewer than 5% of employment-related complaints, including complaints over salary arrears, filed by local employees. The Ministry of Manpower (MOM) takes every discrimination complaint seriously and will take appropriate enforcement actions against errant employers.
Appeals for Inclusion Under Silver Support Scheme in Last Three Years›Written Answers to Questions2 turns · 260w
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written-answer-11635
Ms Sylvia Lim56 words
[+1 sentence]asked the Minister for Manpower regarding successful appeals for inclusion under the Silver Support Scheme (SSS) in the last three years (a) what are the most common grounds for allowing the appeals; (b) whether the successful appeals include persons who qualify for SSS but who are not auto-included; and (c) if so, how were they omitted.
Dr Tan See Leng204 words
[+10 sentences]The Silver Support Scheme (SSS) provides quarterly cash supplements to seniors who had lower incomes during their working years and now have little or no family support in their retirement. Silver Support is designed such that seniors automatically qualify if they pass the annual eligibility assessment. This ensures that eligible seniors receive Silver Support without the need to apply, even if they were initially unaware of the scheme. It also allows us to provide support to eligible seniors more quickly. There is a small group of seniors who became eligible for Silver Support due to changes in their circumstances, but the changes came after the annual assessment was conducted. Seniors who inform the Central Provident Fund (CPF) Board of their updated circumstances will have their eligibility reassessed. Silver Generation Ambassadors also help to facilitate appeals from potentially eligible seniors whom they meet during house visits. In any case, their updated circumstances will be captured at the next annual assessment. Between 2019 and 2021, there was an average of 4,000 successful appeals for such cases each year, less than 2% of all Silver Support recipients. Changes in circumstances include moving to new residences, seniors' children moving out or household members experiencing a change in employment.
Minimum Experience and Qualification for Experienced Tech Professionals Applying for Five-Year Employment Pass›Written Answers to Questions2 turns · 140w
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written-answer-11636
Ms Hazel Poa31 words
[+1 sentence]asked the Minister for Manpower whether there will be any minimum experience requirements or minimum educational qualification requirements imposed on experienced tech professionals who are applying for the five-year Employment Pass.
Dr Tan See Leng109 words
[+4 sentences]We are still reviewing the occupations that will be eligible for the five-year Employment Pass (EP). There will be a salary requirement, as well as specific occupation-based checks, to ensure that candidates are suitably experienced and qualified for their respective roles. All candidates must earn a monthly salary of at least $10,5001 to proxy for professionals with mid-level experience. Similar to EP applications that rely on the Shortage Occupation List bonus to pass the Complementarity Assessment Framework (COMPASS), the Ministry of Manpower (MOM) will also conduct verification checks to ensure that the applicants have the specialised skills required to perform the stated role, which includes requesting for relevant qualifications.
Encouraging Transition Towards Household Services Scheme for Families with Foreign Domestic Worker›Written Answers to Questions2 turns · 202w
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written-answer-11637
Mr Louis Ng Kok Kwang31 words
[+1 sentence]asked the Minister for Manpower whether the Ministry is studying the possibility of encouraging the transition towards the Household Services Scheme for more families who currently have a foreign domestic worker.
Dr Tan See Leng171 words
[+8 sentences]Companies under the Household Services Scheme (HSS) deploy their workers to provide domestic services, such as home cleaning and laundry, to different households on a part-time basis. Since HSS became a permanent scheme in September 2021, interest from companies and households has grown sharply. The number of companies on the HSS increased by more than 75%, from 76 last year to 134 currently. Based on a market sensing poll, we estimate that HSS companies today serve more than 20,000 households, of which about 27% had formerly engaged migrant domestic workers (MDWs). While households with heavier domestic and caregiving needs may still need MDWs, households with lighter needs may enjoy cost savings by engaging HSS services on a part-time basis instead. As announced at the Committee of Supply (COS) 2022, the Ministry of Manpower (MOM) will be broadening the scope of HSS to include basic child-minding and elder-minding services. This will encourage more households to consider engaging HSS services, instead of hiring MDWs. We will share more details in the coming months.
Requests for Housing Assistance Received by HDB and Outcome›Written Answers to Questions2 turns · 235w
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written-answer-11638
Ms He Ting Ru55 words
[+1 sentence]asked the Minister for National Development (a) for each quarter in the last three years, how many cases for housing assistance have been received by HDB as broken down into requests for assistance on allocation of HDB units for (i) ownership and (ii) rental respectively; and (b) what is the success rate of these requests.
Mr Desmond Lee180 words
[+6 sentences]In view of the highly-subsidised nature of new public housing flats, Housing and Development Board (HDB) conducts public sales exercises, that is, Build-To-Order (BTO) and Sale of Balance Flats (SBF) exercises and open booking – for their sale so that all eligible home seekers can have a fair chance to apply for them. Similarly, to ensure fair allocation of highly-subsidised public rental flats to low-income households who have no other housing options, approved applicants will join a queue before they are invited to select a flat. Nevertheless, HDB recognises that some applicants may face extenuating circumstances and require special assistance to meet their urgent housing needs. From January 2020 to June 2022, HDB received about 22,600 and 6,800 requests for priority allocation of a new flat and public rental flat respectively. Each of these appeals was assessed on a case-by-case basis, taking into consideration factors, such as whether the applicants are facing extenuating circumstances and whether they have other suitable housing options available. The number of appeals received and approved in each year are shown in Tables 1 and 2.
Previously Owned Residential Properties Transacted by Agents With General and Exclusivity Agreement Clause Since 2019›Written Answers to Questions2 turns · 148w
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written-answer-11639
Dr Tan Wu Meng43 words
[+1 sentence]asked the Minister for National Development since 2019 annually, how many sales of previously owned residential properties were transacted by agents who had entered into (i) Prescribed Estate Agency Agreements in general and (ii) Prescribed Estate Agency Agreements with an exclusivity agreement clause.
Mr Desmond Lee105 words
[+5 sentences]An Estate Agency Agreement is a binding contract between the consumer and the property agency/agent for the performance of estate agency work. The agreement protects the interests of both parties by providing for contractual clarity in the property transaction. The Council for Estate Agencies (CEA) has provided eight standard template Estate Agency Agreements on a variety of residential transactions, and they are made available on CEA's website. We strongly encourage consumers and property agencies/agents to adopt these template agreements to protect the interests of both parties. As the use of these template agreements is not mandatory, CEA does not track its use by the industry.
Annual Sales of Previously Owned Residential Properties Since 2019›Written Answers to Questions2 turns · 71w
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written-answer-11640
Dr Tan Wu Meng41 words
[+1 sentence]asked the Minister for National Development (a) since 2019, how many sales of previously owned residential properties have taken place annually; and (b) of these, what proportion involved (i) HDB residences, (ii) first-time sellers and (iii) first-time sellers of HDB residences.
Mr Desmond Lee30 words
[+1 sentence]Information on the number of resale transactions and first-time sellers of Housing and Development Board (HDB) flats and private residential properties from 2019 to August 2022 is in Table 1.
Breakdown of Invoices Issued to Patients at Public Healthcare Institutions Since 2021›Written Answers to Questions2 turns · 116w
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written-answer-11641
Dr Tan Wu Meng71 words
[+1 sentence]asked the Minister for Health since 2021, for inpatients and outpatients respectively (a) how many billing invoices have been issued to patients at public healthcare institutions; and (b) what proportions are for care provided within the prior (i) 30 days, (ii) 31 to 60 days, (iii) 61 to 90 days, (iv) 91 to 120 days, (v) 121 to 180 days, (vi) 181 to 365 days and (vii) 366 or more days.
Mr Ong Ye Kung45 words
[+2 sentences]Between 1 January 2021 and 31 December 2021, around seven million invoices were issued to patients of public hospitals. Of these, approximately 6.7 million, or 96%, were issued within 30 days of the care episode and 6.8 million, or 98%, were issued within 90 days.
Tax Evasion Offences Detected and Adequacy of Deterrent Measures in Place›Written Answers to Questions2 turns · 270w
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written-answer-11642
Mr Zhulkarnain Abdul Rahim71 words
[+1 sentence]asked the Deputy Prime Minister and Minister for Finance (a) in each of the past three years, what is the number of tax evasion offences detected; (b) what are the steps and measures in place to detect and prevent such offences; (c) whether the current reward for whistleblowing or penalties are sufficient for deterrence; and (d) if not, whether the Ministry intends to review the reward and penalties in the future.
Mr Lawrence Wong199 words
[+9 sentences]From FY2019 to FY2021, the Inland Revenue Authority of Singapore (IRAS) investigated a total of 465 cases of tax evasion: 141 in FY2019; 192 in FY2020; and 132 in FY2021. IRAS proactively detects tax evasion cases through its combination of data analytics, intelligence gathering, tax audit and reporting by whistleblowers. Once identified, IRAS subject cases to rigorous audit and investigation to determine whether tax offences have been committed. Where IRAS has established that tax evasion offences have been committed, IRAS will not hesitate to initiate Court proceedings to prosecute the taxpayer and/or the abettors. Those found guilty of tax evasion may face a penalty of up to four times the amount of tax evaded, a fine not exceeding $50,000, and/or imprisonment of up to seven years. Whistleblowers are able to receive a reward of 15% of the tax recovered, capped at $100,000, if the information provided leads to a recovery of tax that would have otherwise been lost. In practice, most whistleblowers are not motivated by rewards. Most do not request, and thus do not receive, the reward for making tip-offs. Taken together, the penalties for non-compliance and rewards for whistleblowers have contributed to keeping tax evasion cases low.
Protecting Young People and Jobseekers from Overseas Job Scams and Human Trafficking Syndicates›Written Answers to Questions2 turns · 218w
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written-answer-11643
Mr Zhulkarnain Abdul Rahim66 words
[+1 sentence]asked the Minister for Home Affairs regarding reports in Southeast Asia of young people and jobseekers being lured into overseas job scams and human trafficking syndicates (a) what are the Ministry's steps to raise awareness of such scams and protect young Singaporeans based or travelling overseas for work; and (b) what roles will Singapore play in ASEAN to promote greater collaboration to tackle such syndicates together.
Mr K Shanmugam152 words
[+8 sentences]The best defence against all scam types, including overseas jobs scams, is a discerning public. Our annual anti-scam public education campaign, called "Spot the Signs. Stop the Crimes.", seeks to build awareness amongst the public on the tell-tale signs of scams and increase their vigilance. For job scams, these include online advertisements or unsolicited messages from unknown numbers which promise attractive salaries for seemingly easy work. The Police also work with schools and Institutes of Higher Learning (IHLs) to raise awareness amongst young people on scams. Singapore participates in various regional efforts to discuss cooperation on combating transnational crime, including scams and trafficking in persons. These include the ASEAN Senior Officials Meeting on Transnational Crime and its Working Group on trafficking in persons, as well as the ASEAN Ministerial Meeting on Transnational Crime. We will continue to work closely with other countries to address the threat of scams and trafficking in persons.
Enrolment in Nursing Programmes in ITE, Polytechnics and Universities in Past Five Years›Written Answers to Questions2 turns · 168w
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written-answer-11644
Mr Louis Ng Kok Kwang58 words
[+1 sentence]asked the Minister for Health for each year over the past five years (a) what is the number of students who enrolled into nursing programmes in the ITE, polytechnics and universities respectively; and (b) what is the number and percentage of nursing students who go on to practise nursing after graduation from the ITE, polytechnics and universities respectively.
Mr Ong Ye Kung110 words
[+5 sentences]The nursing intake numbers in the Institutes of Higher Learning (IHLs) have remained relatively stable between 2017 and 2021, after growing by around 20% in the five years before that. Each year, about 2,100 students are admitted into pre-registration nursing courses at the Institute of Technical Education (ITE), Nanyang Polytechnic (NYP), Ngee Ann Polytechnic and National University of Singapore (NUS) combined. Employment outcomes for nursing graduates have also been strong over the same period. Based on the annual Graduate Employment Survey (GES) conducted by the IHLs, 83% were in full-time permanent (FTP) employment within six months after graduation. Of those in FTP employment, nine in 10 were working as nurses.
Illegal Modifications to Motor Vehicle Involved in Tanjong Pagar Traffic Accident on 13 February 2021›Written Answers to Questions2 turns · 159w
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written-answer-11645
Mr Derrick Goh75 words
[+1 sentence]asked the Minister for Home Affairs in the case of the Tanjong Pagar traffic accident on 13 February 2021 (a) whether the change of the car's charge pipes from original to aftermarket parts is considered an illegal modification; and (b) given the extensive damage to the car that prevented a full mechanical inspection, whether there are efforts to trace the car's workshop to fully assess if there were other modifications that could have been illegal.
Mr K Shanmugam84 words
[+5 sentences]The replacement of the car's charge pipes from those originally installed by the manufacturer, to aftermarket charge pipes, was not considered an illegal modification under the Land Transport Authority (LTA)'s regulations. This is because aftermarket charge pipes do not affect a vehicle's safety. As part of the investigation for that fatal accident, the Traffic Police had sent the car for mechanical inspection. The inspection did not detect any illegal modifications done to the car. Agencies, therefore, did not take further action in this regard.
Consent for Couples with Minor Children Undergoing Divorce to List Them in Respective Applications for HDB Flat›Written Answers to Questions2 turns · 318w
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written-answer-11646
Mr Louis Ng Kok Kwang69 words
[+1 sentence]asked the Minister for Social and Family Development whether the Ministry will work with the Ministry of Law and the Ministry of National Development to consider requiring couples with minor children undergoing divorce to state in the matrimonial property plan whether there is consent to both parties listing minor children in their respective applications for an HDB flat and, if there is no consent, the reasons for withholding consent.
Mr Masagos Zulkifli B M M249 words
[+9 sentences]The matrimonial property plan is not the appropriate avenue to require divorcing parents to state whether they are giving consent for their children to be listed in prospective applications for a Housing and Development Board (HDB) flat. The key objective of the matrimonial property plan is to set out the parties' agreement or proposals as to the way in which matrimonial assets are to be divided. It is unlikely that parties will be able to plan for future HDB applications at the stage of filing the matrimonial property plan, as outcomes regarding the division of matrimonial assets have not yet been determined. We encourage couples with minor children undergoing divorce to work together on their arrangements concerning the care of their children. As each individual is only allowed to be listed in one HDB flat application, we require divorced parents who have shared care and control of their children, to come to an agreement before either party lists their child in a flat application. We recognise that there may be cases where parents are unable to reach an agreement despite their best efforts. In such cases, they can approach HDB to discuss their options. On a case-by-case basis, HDB is prepared to exercise flexibility by waiving the requirement for an ex-spouse's consent, in the interest of ensuring that the child has a stable housing arrangement. Parents who require further support may also approach the Strengthening Families Programme @ Family Service Centre (FAM@FSCs) or the Divorce Support Specialist Agencies (DSSAs).
Requiring Preschools to Set Aside Minimum Mandatory Rest Areas for Teachers and Staff›Written Answers to Questions2 turns · 221w
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written-answer-11647
Mr Zhulkarnain Abdul Rahim50 words
[+1 sentence]asked the Minister for Social and Family Development whether the Early Childhood Development Agency will consider requiring preschools to set aside a minimum mandatory area for teachers and staff to rest or conduct administrative work in a conducive environment, with appropriate furniture that are suitable for adults and office work.
Mr Masagos Zulkifli B M M171 words
[+8 sentences]The Early Childhood Development Agency (ECDA) requires every preschool to have an office area for staff and an area where staff may rest but does not prescribe the amount of space required. Operators have, generally, complied with this requirement. In 2021, ECDA released the findings of the Occupational Health and Safety Assessment (OHSA) for the early childhood sector. Among the OHSA recommendations to improve the well-being of educators was the provision of dedicated areas and adult-friendly furniture to work and rest. ECDA worked with the Association of Early Childhood and Training Services (ASSETS) to make ergonomic furniture available on a portal that preschool operators can purchase, with bulk discounts. Beyond adult-friendly furniture, OHSA also has other recommendations to improve educators' health and well-being. For example, preschools can better manage educators' workload and stress levels by adopting digital tools and signing them up for health and wellness programmes. ECDA will continue to encourage greater adoption of the OHSA recommendations in our preschools to improve the working environment and well-being of our educators.
Publishing Full National Education Curriculum Content for All Students›Written Answers to Questions2 turns · 119w
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Mr Gerald Giam Yean Song28 words
[+1 sentence]asked the Minister for Education whether the Ministry can publish the full National Education curriculum content for all levels of students and make it accessible to the public.
Mr Chan Chun Sing91 words
[+5 sentences]National Education (NE) is a key component of our Character and Citizenship Education (CCE) curriculum for students from primary to pre-university levels. NE is also delivered through other subjects, such as Social Studies and History; and reinforced through various learning experiences, such as the NE Commemorative Days, Values in Action and learning journeys to sites of national significance. The CCE syllabus documents for primary, secondary and pre-university levels are on the Ministry of Education (MOE) website: Primary: https://www.moe.gov.sg/primary/curriculum/syllabus. Secondary: https://www.moe.gov.sg/secondary/courses/express/electives#subjects. Pre-University: https://www.moe.gov.sg/post-secondary/a-level-curriculum-and-subject-syllabuses General information on National Education is available at: https://www.moe.gov.sg/education-in-sg/our-programmes/national-education.
Facilitating Greater Access to Reading Resources for Children and Adolescents from Lower-income Families›Written Answers to Questions2 turns · 252w
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written-answer-11649
Mr Gerald Giam Yean Song61 words
[+1 sentence]asked the Minister for Education (a) how do schools support children and adolescents, especially those from lower-income families, to facilitate greater access to reading resources, including free online reading resources provided by the National Library; and (b) whether students can be taught in school how to use National Library apps like NLB Mobile and Libby to access these free reading resources.
Mr Chan Chun Sing191 words
[+9 sentences]Schools provide a wide range of print and digital reading materials to cater to the different age groups and varied interests of students. The school library system is linked to the National Library Board's (NLB) catalogue, pointing students to curated e-books from NLB. Schools also work with NLB on reading programmes, such as kidsREAD, which provides younger students from lower-income families with books and taps on volunteers to read to them. For older students, the Ministry of Education (MOE) supports the habit of reading the news to cultivate their interest in current affairs. At the secondary level, MOE partners Ngee Ann Kongsi and SPH Media Trust to provide all students with access to Mother Tongue Language digital news resources. At the pre-university level, students have been given accounts to read The Straits Times online. Teachers guide students on how to select reading materials and how to access e-resources. Schools are also provided with the information and links on how to access NLB's reading apps. MOE will encourage schools to share these materials with their students to help them utilise the NLB Mobile and Libby reading apps to access more reading resources.
Inclusion of Emerging and Contemporary Policy Issues, Constitution and Workings of Parliamentary Democracy in National Education Syllabus›Written Answers to Questions2 turns · 229w
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Assoc Prof Jamus Jerome Lim42 words
[+1 sentence]asked the Minister for Education what efforts are currently in place to ensure that, as part of the National Education syllabus, students are apprised of (i) emerging and contemporary policy issues and (ii) Singapore's Constitution and the workings of Singapore's parliamentary democracy.
Mr Chan Chun Sing187 words
[+10 sentences]Students discuss contemporary issues in subjects like Social Studies, General Paper and Character and Citizenship Education (CCE). Through these subjects, they learn about Singapore's Constitution and the workings of Singapore's parliamentary democracy. In Social Studies, students inquire into contemporary issues by examining policies, the tradeoffs involved and their impact on society. For example, students explore Singapore's approach in managing sociocultural diversity and consider the role of citizens. In General Paper, teachers engage pre-University students in discussions on a broad range of societal issues, guiding them to consider different perspectives and to understand Singapore's context and position amidst global developments. As part of the refreshed CCE curriculum, secondary and pre-university teachers raise contemporary issues for their students' understanding and discussion. Examples include topics like the Russia-Ukraine conflict and racism. In Social Studies, students learn about Singapore's Constitution, the various organs of state and the decision-making process in a representative democracy. They explore the principles that shape governance in Singapore and consider the role of citizens. Through History at the pre-university level, students deepen their understanding of the establishment of Parliamentary democracy in Singapore and constitutional processes since Independence.
Utility of Maintaining Provisions in Chapter 9 of Penal Code 1871 Dealing with Corruption Involving Public Servants›Written Answers to Questions2 turns · 253w
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Mr Murali Pillai39 words
[+1 sentence]asked the Minister for Home Affairs whether there remains any utility in maintaining the provisions in Chapter 9 of the Penal Code 1871 dealing with corruption involving public servants after the enactment of the Prevention of Corruption Act 1960.
Mr K Shanmugam214 words
[+8 sentences]While the Prevention of Corruption Act 1960 (PCA) is the primary anti-corruption legislation in Singapore, it is complemented by other laws that deal with related forms of misconduct, such as the Corruption, Drug Trafficking and Other Serious Crimes (Confiscation of Benefits) Act 1992, the Penal Code 1871 and the Customs Act 1960. The offences under sections 161 to 165 of the Penal Code deal specifically with bribery and other forms of corrupt practices involving public servants. Compared to the offences in PCA, they are more targeted in scope towards tackling the various forms of bribery of, and the taking of bribes by, public servants. For example, section 165 makes it an offence for a public servant to accept anything of value, without payment or with inadequate payment, from any person with whom he is involved in an official capacity. Unlike in PCA, there is no need to further establish that this was an inducement or reward for the public servant to act in such a manner. Therefore, there is utility in retaining these Penal Code offences, which, together with the PCA and other related laws, provide a comprehensive set of legislative levers for corruption control. That said, there may be utility in siting these Penal Code offences in PCA. The Government will review this.
Outcome Since Introduction of Student-initiated Learning›Written Answers to Questions2 turns · 210w
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written-answer-11653
Ms Hazel Poa35 words
[+1 sentence]asked the Minister for Education since the introduction of Student-Initiated Learning (SIL) (a) how many schools have implemented SIL; (b) how has it been implemented; and (c) what has been the outcome of the implementation.
Mr Chan Chun Sing175 words
[+9 sentences]At the end of May 2022, more than eight in 10 Secondary schools and pre-University institutions have implemented Student-Initiated Learning (SIL) as part of regular Home-Based Learning (HBL) days. SIL is a component of HBL days where time is set aside for students to pursue their own interests and learn outside the curriculum. This is to encourage students to be more curious and self-directed in their learning. Schools have the flexibility to implement SIL in ways to better support their students' interests and needs. For example, some schools have facilitated the grouping of students with similar interests, so that they can explore their interests together. Some schools have provided students who needed more guidance with suggested activities or resources at the start and will reduce the scaffolds over time. Students have responded positively to SIL, pursuing interests such as learning foreign languages, learning to play musical instruments, programming, cooking or serving the community. Preliminary feedback indicates that SIL is valued by schools and students. We will evaluate the outcomes when the initiative is fully implemented.
Accidents Reported Involving Workers Transported in Back of Lorries and Other Vehicles›Written Answers to Questions2 turns · 102w
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Ms He Ting Ru42 words
[+1 sentence]asked the Minister for Home Affairs (a) for each quarter in the last year, how many accidents are reported involving workers being transported in the back of lorries and other vehicles; and (b) of these, how many involved casualties and deaths respectively.
Mr K Shanmugam60 words
[+3 sentences]The Traffic Police are only able to provide data on accidents involving passengers of lorries which resulted in casualties or deaths in a relevant accident. It does not track the occupation of the passengers, if they are workers or otherwise, or if they are specifically seated in the front or the rear of the lorry. Please see Table 1 below.
Derivation of Prices of Land Leases to Religious Organisations›Written Answers to Questions2 turns · 468w
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Ms Sylvia Lim24 words
[+1 sentence]asked the Minister for Law how are the prices of land leases issued and renewed to religious organisations, such as temples and churches, derived.
Mr K Shanmugam444 words
[+21 sentences]State land parcels, including those that are allocated for Place of Worship (PW) use, are required to be sold at fair market value (FMV). In general, they are sold through a competitive tender process where the highest acceptable bid becomes the land price for the specific site. A different approach is taken for mosque land. Land for mosques is directly alienated to Majlis Ugama Islam Singapura (MUIS) which centrally coordinates mosque development, at market price as determined by the Chief Valuer (CV). This would, generally, result in mosque land being less expensive, because there is no bidding. The proceeds from the disposal of state land, including land sold for PWs, go to the Past Reserves. This is because land is part of the Past Reserves, and land sales simply convert physical assets to financial assets. The sale proceeds of land cannot, therefore, be used as revenue for spending in the Budget. For lease renewals of PWs, the premium is also at current market price, as determined by the CV generally. In determining the current market price, the CV takes into consideration relevant transactions of PW land and makes necessary adjustments for attributes of the site, such as location and land area. In recent years, the PW land prices have risen because of competitive bidding by religious organisations. The Government cannot unilaterally adjust the price of land that is sold for PW use, as it is covered by the Reserves Protection Framework to dispose of land at FMV. Any change will require a change to the Reserves Protection Framework and the approval of the President. The Government has been in discussions with various religious organisations to consider how best to assist them in mitigating the price rises, which come from such bidding. At the same time, the Government has been doing a review of our PW land allocation and pricing framework, to see how the price rises can be mitigated. This was publicly disclosed and reported in the media in July this year in an article titled "Religious groups hope to pay less for leasehold land after policy review." Pending the conclusion of the review, the Government has also advised PWs, where the lease has come up for renewal, to consider taking up a short-term tenancy or Temporary Occupation Licence, so that once the review is completed, the PWs will get the benefit of the review. This has also been reported in the media. Thus far, 20 PWs have done this, while six PWs have decided, nevertheless, to proceed with a 30-year lease renewal at current market prices. Significant progress on the review has been made. Details will be released when the process is completed.
"Right to Repair" for Electronic Devices›Written Answers to Questions2 turns · 86w
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Mr Chua Kheng Wee Louis39 words
[+1 sentence]asked the Minister for Trade and Industry (a) whether the Government will consider legislation for "right to repair" for electronic devices to ensure that manufacturers provide practical means for owners to repair their devices; and (b) if not, why.
Mr Gan Kim Yong47 words
[+3 sentences]"Right-to-repair" is a nascent issue, and the aim and scope of such a policy differs across countries. Right-to-repair requirements may also affect the pricing of such electronic devices. The Government is monitoring the global discussions to help us assess if a similar legislation is suitable for Singapore.
Need for New Cruise and Ferry Infrastructure to Include Environmental Baseline Studies and Environmental Impact Assessment›Written Answers to Questions2 turns · 159w
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Mr Leon Perera57 words
[+1 sentence]asked the Minister for Trade and Industry (a) whether the Singapore Tourism Board's survey for Singapore's need for new cruise and ferry infrastructure will also include Environmental Baseline Studies and Environmental Impact Assessment to assess the environmental impact of new cruise infrastructure on our coastline; and (b) whether the final survey and report will be made public.
Mr Gan Kim Yong102 words
[+3 sentences]New developments near marine and coastal areas, including cruise and ferry infrastructure, undergo an in-depth consultation process with relevant technical agencies, such as the National Environment Agency (NEA), National Parks Board (NParks), Maritime and Port Authority of Singapore (MPA) and Singapore Food Agency (SFA) to discuss the scope of works, the possible environmental impact and mitigation measures. Where required, environmental studies, such as environmental impact assessments (EIAs), which, typically, include environmental baseline surveys and the development of mitigation measures, will be carried out. Such reports are, generally, made publicly available unless there are specific reasons to maintain confidentiality, such as security considerations.
Improvement in Peak-hour Car Travel Speeds Since Implementation of High ERP Rates Along CTE›Written Answers to Questions2 turns · 279w
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Ms Ng Ling Ling88 words
[+1 sentence]asked the Minister for Transport since the implementation of the higher ERP rates from 1 August 2022 along CTE (a) what is the improvement in car travel speeds from (i) 8 am to 9.30 am along southbound CTE before Braddell Road and the slip road into southbound PIE and (ii) 6 pm to 7.30 pm along northbound CTE before PIE; and (b) whether LTA has other plans to improve congestion along CTE, which is heavily used by residents in the Ang Mo Kio GRC, besides increasing ERP rates.
Mr S Iswaran191 words
[+7 sentences]In general, traffic speeds improve at timeslots and locations where electronic road pricing (ERP) rates are increased. From 1 August 2022, Land Transport Authority (LTA) increased ERP rates at 8 am to 8.30 am along southbound Central Expressway (CTE) after Braddell Road and the Pan-Island Expressway (PIE) slip road into southbound CTE, and from 7 pm to 7.30 pm along northbound CTE after PIE. After the rate increases, traffic speed at these time slots along these stretches of the CTE improved by an average of 13%. There are several upcoming infrastructural enhancements that will provide commuters with more choices. By the end of this year, Stage 3 of the Thomson-East Coast Line (TEL) will be opened and serve residents living along the TEL corridor, including Ang Mo Kio group representation constituency (GRC) residents in the vicinity of TEL stations, such as Lentor and Mayflower. These residents will have a faster and more direct train option to travel towards the city centre. And towards the end of this decade, the North-South Corridor (NSC) will directly connect the Northern region of Singapore to the city centre and relieve some demand on the CTE.
Expected Completion Date for Third Runway at Changi Airport and Impact on Passenger and Flight Handling Capacities›Written Answers to Questions2 turns · 65w
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written-answer-11659
Mr Chua Kheng Wee Louis32 words
[+1 sentence]asked the Minister for Transport what is the expected completion date for the third runway at Changi Airport and the impact on passenger capacity as well as flight handling capacity upon completion.
Mr S Iswaran33 words
[+2 sentences]Changi Airport will be operational with three runways by the latter half of this decade. This will increase Changi Airport's current flight handling capacity and the corresponding passenger capacity by more than one-third.
Enforcement Actions Against Vehicle Owners and Workshops Since Increase of Penalties for Illegal Vehicle Modifications›Written Answers to Questions2 turns · 262w
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Mr Derrick Goh73 words
[+1 sentence]asked the Minister for Transport (a) in the 12 months since the increased penalties for illegal vehicle modifications on 1 July 2021, what is the number of enforcement actions against vehicle owners and workshops; (b) how do the numbers compare with the 12 months prior to 1 July 2021; and (c) given the rise in motor vehicle traffic in 2022, whether there are more enforcement checks made against errant vehicle owners and workshops.
Mr S Iswaran189 words
[+9 sentences]Vehicle safety is a key concern, and over the years, Land Transport Authority (LTA) has stepped up efforts to deter illegal modifications. Specifically, one of the measures was to increase the composition sum for first-time offenders who conduct illegal exhaust modifications, which have the highest safety risks, from $500 to $1,000. Offenders of more egregious cases can be taken to Court, even if they are first-time offenders. With these enhanced penalties as a deterrent, there was a 10% decrease in the number of offences issued against individuals for illegal exhaust modifications, compared to the 12 months before. At the same time, LTA increased general enforcement efforts against all illegal modifications. Since July 2021, LTA has issued a total of 9,000 offences against individuals for all illegal modifications, which is an increase of 6%, compared to the previous 12 months. LTA also charged six workshops for illegally modifying vehicles, up from two workshops for the 12 months before. Illegal modifications can endanger all road users, including the driver. We urge all motorists to ensure that their planned vehicle modifications comply with LTA's guidelines, which are published on the OneMotoring website.
Compliance with Safety and Emission Requirements by Drivers of Foreign-registered Vehicles Entering Singapore›Written Answers to Questions2 turns · 247w
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Mr Leon Perera67 words
[+1 sentence]asked the Minister for Sustainability and the Environment (a) how and to what extent does the Government work with its Malaysian counterparts to highlight to drivers of foreign-registered vehicles entering Singapore that they must comply with safety and emission requirements, such as exhaust and noise emission standards under the Environmental Protection and Management (Vehicular Emissions) Regulations; and (b) what enforcement efforts are made to raise compliance rates.
Ms Grace Fu Hai Yien180 words
[+7 sentences]The Ministry of Sustainability and the Environment (MSE) and the National Environment Agency (NEA) have regular bilateral engagements with our Malaysian counterparts to exchange information on environmental issues of mutual interest, including the control of vehicular emissions and enforcement efforts in both countries. Notably, the Malaysia-Singapore Expert Group on Vehicular Emissions meet regularly to update each other on vehicular policies which will impact the other, well ahead of implementation. NEA also publicises vehicular policies impacting foreign motorists well ahead of implementation through media channels and posters placed at land entry checkpoints. Foreign vehicles entering Singapore are routinely screened at the land entry checkpoints to ensure that their emissions comply with the requirements under the Environmental Protection and Management (Vehicular Emissions) Regulations. LTA, NEA and the Traffic Police also conduct joint enforcement operations along our roads for violation of the emission standards and other vehicle-related offences. Drivers will be offered a composition sum on the spot if their vehicle fails the emissions test. Beyond the composition sum, foreign vehicles emitting excessive smoke can be turned back at the land entry checkpoints.
Pupil-Teacher Ratio for Primary and Secondary School Examinable Subjects›Written Answers to Questions2 turns · 186w
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written-answer-11662
Assoc Prof Jamus Jerome Lim42 words
[+1 sentence]asked the Minister for Education what is the current pupil-teacher ratio for (i) Primary and (ii) Secondary levels for examinable subjects, such as the languages, mathematics and science, and non-examinable or elective subjects, such as physical education, social studies and art/music respectively.
Mr Chan Chun Sing144 words
[+6 sentences]MOE adopts the Organisation for Economic Cooperation and Development (OECD)'s definition of the student-teacher ratio, or in the context, the pupil-teacher ratio (PTR), which is calculated by dividing the total student enrolment by the total number of teachers at a given level of education. Our PTR has improved over the last decade, from 19 in 2011 to 15 in 2021 at the primary level, and from 15 to 12 at the secondary level. Our PTRs are comparable to OECD averages and countries, such as Japan, Switzerland and Germany. The PTR is a measure of the overall investment and allocation of teacher resources in an education system. It is neither feasible nor meaningful to calculate the PTR by different subjects, as many teachers teach more than one subject. More importantly, we regard both examinable and non-examinable subjects as important elements of a broad-based holistic education.
Amount Owed for Medical Services Provided to Foreigners›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 232w
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Ms Mariam Jaafar56 words
[+1 sentence]asked the Minister for Health (a) what is the current amount owed for medical services by foreigners on Long Term Visit Pass (LTVP) holders who are part of Singaporean households; and (b) whether more can be done to help these Singaporean households that bear the cost of medical treatment for their foreign family members on LTVP.
Mr Ong Ye Kung176 words
[+8 sentences]Between 2017 and 2021, arrears by foreigners constituted less than 0.1% of the total bills issued by Public Healthcare Institutions (PHIs). This includes foreigners residing and working in Singapore, as well as some short-term visitors. The Ministry of Health (MOH) does not have data on arrears specifically for Long-Term Visit Pass (LTVP) holders. Government healthcare subsidies are, generally, accorded to Singapore Citizens (SCs) and Permanent Residents (PRs), in line with the broader Government policy of differentiating benefits by citizenship status. While LTVP holders are not eligible for medical subsidies, some may be covered by their sponsors' employee medical benefits or other private medical insurance plans. SCs and PRs may also tap on their MediSave to pay for the medical expenses incurred by their immediate family members, and this includes those who are LTVPs. LTVP holders who face difficulties affording their healthcare bills may approach the medical social workers at the public healthcare institutions to apply for assistance. PHIs may offer payment instalment plans or provide assistance using charity funds based on their medical social workers' assessment.
Updating Safety Standards for Construction and Infrastructure Projects in Light of Climate Change›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 160w
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Ms Mariam Jaafar30 words
[+1 sentence]asked the Minister for National Development (a) whether regulations and safety standards for construction and infrastructure projects are being updated in light of climate change; and (b) if so, how.
Mr Desmond Lee130 words
[+4 sentences]Under our building control regime, buildings must be designed and constructed according to relevant building standards. These include requirements to ensure the structural integrity of building works when exposed to extreme environmental conditions, such as high temperatures, intense rainfall and strong winds. The Building and Construction Authority (BCA) has assessed that our prevailing building standards are sufficiently robust to ensure the structural integrity of our buildings under the projected climatic conditions for Singapore, based on the Fifth Assessment Report (AR5) of the United Nations Intergovernmental Panel on Climate Change (IPCC). BCA will continue to review its requirements regularly to ensure that the relevant building standards are on par with international standards and account for the latest scientific evidence, including the updated climate projections under the IPCC's Sixth Assessment Report (AR6).
Projected Economic Benefit to Singapore from Recent FinTech Cooperation Agreement with India›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 501w
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Mr Desmond Choo79 words
[+1 sentence]asked the Prime Minister in light of the recently signed FinTech Cooperation Agreement with India's International Financial Services Centres Authority, (a) what steps will the Government be taking to facilitate the entry of India-based fintech companies into Singapore; (b) what is the projected economic benefit to Singapore's economy, in terms of local investments and job opportunities; and (c) whether and, if so, what other jurisdictions does the Government intend to invite to participate in the proposed Global Regulatory Sandbox.
Mr Tharman Shanmugaratnam (for the Prime Minister)422 words
[+17 sentences]The FinTech Cooperation Agreement signed between the Monetary Authority of Singapore (MAS) and India's International Financial Services Centres Authority (IFSCA) on 18 September 2022 aims to support experimentation and adoption of new financial products or services, and potentially enable cross-border testing with industry players in both jurisdictions. It does so by leveraging the regulatory sandboxes of both authorities. The agreement also provides for a broader global regulatory sandbox arrangement that caters to use cases which may involve other jurisdictions beyond Singapore and India. Such an arrangement, with India and any other jurisdiction in future, should enable faster time to market, particularly for products and solutions with cross-border applications. Under the agreement, a Singapore-based FinTech company interested in providing innovative financial services in India can reach out to MAS for referral to IFSCA. India-based FinTech companies can similarly benefit from this collaboration by reaching out to IFSCA for referral to MAS. The coordination between the two regulators allows the FinTech companies to apply for admission to the respective sandboxes, without the need to incorporate a business in the other jurisdiction before they are admitted to the sandbox. Similar to other applications to the local regulatory sandbox, MAS will assess any application under the agreement and perform the necessary due diligence on the FinTech company and its proposal. For successful applicants, MAS will work with the FinTech companies on agreed sandbox boundaries within which the companies can conduct market trials of their products or services. MAS may also require the FinTech companies to put in place safeguards to contain risks arising from possible failure of the product or service. If the sandbox experiment is successful, the FinTech company can exit the regulatory sandbox and offer the new product or service as a fully regulated financial services activity. To do so, they must fully comply with the relevant legal and regulatory requirements and obtain the relevant licences. The MAS FinTech regulatory sandbox has, in fact, helped FinTech companies and MAS better understand both the benefits and risks of new products and innovations. It has also enabled the sandbox companies to validate the market potential for their new products and services. We have seen some companies in Singapore emerging from the sandbox to become fast-growing startups. As I mentioned, the agreement also provides for the involvement of additional jurisdictions, as part of the global regulatory sandbox arrangement. This will depend on the specific target markets of sandbox use cases, and whether the relevant jurisdiction has a regulatory sandbox regime to facilitate testing of these use cases.
Coordination between Police and Banks when Scams are Reported›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 154w
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Mr Dennis Tan Lip Fong65 words
[+1 sentence]asked the Minister for Home Affairs for scam cases where it is reported that a phone number has been given for payment purposes via PayNow, whether the Police immediately reaches out to the banks in question to track the bank accounts used and stop further usage of PayNow for the relevant accounts immediately to prevent further acts of scam involving the same or other victims.
Mr K Shanmugam89 words
[+4 sentences]When investigating into reports on scams, Police will trace the flow of the funds and swiftly freeze bank accounts suspected to be involved in the scammers' operations. Frozen bank accounts will not be able to accept further transfers of money, including through PayNow. The swift freezing of bank accounts is done at the Anti-Scam Centre, where bank staff are co-located with Police. Since July 2022, six of the major banks in Singapore, namely, DBS, OCBC, UOB, Standard Chartered Bank, HSBC and CIMB have co-located their staff at the Centre.
Prosecution and Convictions under Organised Crimes Act›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 294w
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Mr Murali Pillai57 words
[+1 sentence]asked the Minister for Home Affairs (a) to date, how many persons have been convicted under the Organised Crimes Act; (b) how many organised crime prevention orders or Financial Reporting Orders have been issued; (c) what is the dollar value of benefits from organised crime activities confiscated; and (d) how many organised crime groups have been crippled.
Mr K Shanmugam237 words
[+11 sentences]The Organised Crime Act (OCA) was enacted in 2015 to strengthen the ability of our law enforcement agencies to deal with criminal syndicates. To date, the authorities have investigated 10 organised crime groups for offences involving remote gambling and public gaming, and those under the Computer Misuse Act (CMA), the Misuse of Drugs Act (MDA) and the Corruption, Drug Trafficking and Other Serious Crimes Act (CDSA). Forty persons have been convicted for offences under OCA so far. For the organised crime groups which we have investigated, we have seized or confiscated cash and crime proceeds related to the crimes, as well as other items related to unlawful gambling and drug offences. We do not track the total dollar value of the items seized. Under OCA, an Organised Crime Prevention Order (OCPO) may be granted by the Court to prevent, restrict or disrupt the activities of persons involved in organised crime groups. This imposes restrictions on a person's activities, such as the premises to which he may have access and how he may associate with others. OCA also empowers the Court to grant a Financial Reporting Order, which requires a person to furnish financial reports. To date, no OCPO or Financial Reporting Orders have been issued. OCA also provides for a Civil Confiscation Regime, which enables the civil confiscation of benefits from organised crime activities. To date, we have not used the levers under the Civil Confiscation Regime.
Property Agents who Failed to Take Due Diligence Measures for Anti-money Laundering-related Lapses in Breach of Estates Agents Act›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 218w
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Mr Gan Thiam Poh55 words
[+1 sentence]asked the Minister for National Development (a) in the past two years, how many property agents and developers have (i) failed to take due diligence measures for anti-money laundering related lapses and (ii) committed breaches under the Estate Agents Act; and (b) whether any purchase transactions had to be voided or aborted as a result.
Mr Desmond Lee163 words
[+7 sentences]Property agents are required to fulfil specific duties under the Estate Agents Act (EAA) to prevent money laundering and terrorism financing. These include performing due diligence checks on customers and reporting suspicious transactions to the Suspicious Transaction Reporting Office (STRO) of the Singapore Police Force. The Council for Estate Agencies (CEA) conducts regular inspections of property agencies and their agents on their compliance with the regulatory requirements. Those who fail to comply would have committed a breach under EAA and could be subjected to disciplinary action. Between September 2020 and September 2022, CEA has warned 27 property agents for not properly conducting the required due diligence checks on their customers. As a result, there have been no purchase transactions which had to be voided or aborted. The Government has also passed the Developers (Anti-Money Laundering and Terrorism Financing) Act and will impose new requirements on developers, such as carrying out customer due diligence checks on purchasers to detect money laundering and terrorism financing.
Making Public Renovation Permits Issued by HDB for Authorised Renovation Works›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 312w
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written-answer-na-11507
Mr Murali Pillai64 words
[+1 sentence]asked the Minister for National Development whether HDB can make public, through its portal or any other appropriate platform, of the renovation permits that it has issued for authorised renovation works at HDB flats so that residents of the affected blocks can make better plans on how to organise their day to avoid or minimise the disturbance arising from the renovation works on them.
Mr Desmond Lee248 words
[+7 sentences]Certain renovation works that may affect the structural integrity of the Housing and Development Board (HDB) block, such as the demolition of walls and hacking of flooring, require a renovation permit from HDB. Before carrying out such works, renovation contractors are required to inform the households within a radius of two flats of the unit being renovated, including the upper and lower floor neighbours, at least five days in advance to give the neighbours notice and time to make prior adjustments. Contractors are also required to put up the Notice of Renovation Works outside the flat being renovated during the renovation period, displaying the contact details of the renovation contractor, duration of the renovation and the dates of the hacking works. Since July 2021, residents have been able to log into the Municipal Services Office (MSO)'s OneService app, Home Renovation Notice, to find out details, including the start and end dates of units in their block which are undergoing renovation works where an HDB permit is required. With the app, residents can choose to receive alerts for upcoming flat renovation works approved by HDB in their blocks. Renovation works that do not affect the structural integrity of the HDB block, such as electrical and carpentry works, are not regulated by HDB. As these works may also generate some noise, HDB encourages the flat owners and their contractors to adopt measures to minimise the noise generated and to similarly keep their immediate neighbours informed of the works in advance.
Mental or Emotional Stress Cited as Reason for Leaving Education Service in Last Five Years›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 94w
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written-answer-na-11510
Mr Darryl David27 words
[+1 sentence]asked the Minister for Education in the last five years, how many educators have cited mental or emotional stress at the workplace for leaving the education service.
Mr Chan Chun Sing67 words
[+2 sentences]In the past five years, less than one in 20 of our teachers who had resigned cited job-related stress or workload as their reason for leaving service. The Ministry of Education (MOE) values our teachers and will continue to work with school leaders and stakeholders to support our teachers' well-being, so that they can, in turn, continue to give their best to the education of our students.
Proportion of Time that Teachers Allocate to Teaching versus Non-teaching Administrative Duties›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 489w
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written-answer-na-11512
Assoc Prof Jamus Jerome Lim56 words
[+1 sentence]asked the Minister for Education (a) what is the proportion of time that teachers allocate to teaching versus non-teaching administrative duties in a given week; and (b) what is the current budget that schools allocate towards hiring of administrators that assist teachers in areas of non-teaching administrative activities, such as on procurement, billings and reception work.
Mr Chan Chun Sing433 words
[+22 sentences]Our teachers play many roles in school. Beyond teaching specific subjects, they nurture the whole child. This includes developing socioemotional competencies, life skills, attitudes and values through learning experiences, such as camps, co-curricular activities and other student programmes. Our teachers also provide student guidance and work in partnership with parents to support students. For these reasons, it is difficult to demarcate teaching versus non-teaching duties and administrative duties. Based on our surveys, on average, less than 10% of the weekly work hours of our teachers are spent on general administrative work. Over the years, the Ministry of Education (MOE) has streamlined processes and used technology, where feasible, to reduce administrative work. For example, teachers now use Parents' Gateway, an IT platform, to obtain consent from, and to disseminate information to parents. To better support the work of our teachers, we have provided more administrative staff and certain types of allied educators to schools. Each school has, on average, eight to nine administrative staff today, which include the school administration manager, information and communications technology (ICT) manager, operations manager and administration executives, who assist teachers with general administrative matters, procurement and financial operations as well as logistics support. We have also given schools more flexibility to hire supplementary administrative manpower, who can be hired as adjunct or casual staff. This is about 33% to 50% more, compared to about six administrative staff per school about a decade ago. Schools are also given funding to hire external vendors to meet administrative needs and support student programmes. To help teachers better support students with greater needs, we have doubled the number of Special Educational Needs (SEN) Officers in the last decade. In 2015, we also introduced student welfare officers to work with at-risk students, which helps to reduce the load on teachers. We have also invested significantly over the last 10 years in teacher resourcing for schools. From 2011 to 2021, our pupil-teacher ratios have improved from 19 to 15 at the primary level and from 15 to 12 at the secondary level. We are now on par with average pupil-teacher ratios in Organisation for Economic Co-operation and Development (OECD) countries. Given the tight labour market, there are limits to how much we can expand the teaching force, without a trade-off in quality. MOE will continue to streamline work in schools and see how to manage the overall demands on our teachers' time. But we cannot do this alone. We need the support of all stakeholders, including parents and the community, which I have spoken about extensively in the Adjournment Motion on teachers' well-being last month.
Impact of Change in Primary 1 Registration Framework on Number and Proportion of Students Obtaining Places in Schools within One and Two Kilometres of Residence›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 288w
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Mr Chua Kheng Wee Louis80 words
[+1 sentence]asked the Minister for Education (a) for primary schools that required balloting in 2021 and 2022, since the changes to the Primary 1 Registration Framework, what is the change in number and proportion of students who have obtained a place in a primary school residing (i) within one kilometre and (ii) within two kilometres of their residential address; and (b) what is the Government's assessment of the effectiveness of the change in the registration framework in achieving its stated objectives.
Mr Chan Chun Sing208 words
[+8 sentences]Starting from the 2022 Primary 1 Registration Exercise, the Ministry of Education (MOE) has doubled the number of Phase 2C reserved places from 20 to 40, so that more children can be enrolled in a school near their homes. This is in the educational interest of the child and for the convenience of the family. The posting outcomes for this year's exercise are in line with this policy intent and we will continue to monitor the outcomes of future Primary 1 Registration Exercises closely. For primary schools that were oversubscribed in Phase 2A, 2B or 2C in both the 2021 and 2022 Primary 1 Registration Exercises, more students who reside nearer to these schools were admitted. Within one kilometre of these schools, about 1,300 more students were admitted in 2022 than in 2021. Within two kilometres of these schools, about 1,100 more students were admitted in 2022 compared to 2021. In terms of proportion, this translates to 7% more students who obtained a place within one kilometre, and 6% more students who obtained a place within two kilometres. About 98% of Primary 1 registrants were able to obtain a place in a primary school of their choice or within two kilometres of their residence in 2021 and 2022.
Foreign Students who Receive Tuition Fee Grants or Scholarships and Subsequently Become Singapore Citizens›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 186w
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written-answer-na-11516
Mr Leong Mun Wai44 words
[+1 sentence]asked the Minister for Education (a) to date, among the foreign students who receive tuition fee grants or scholarships at the secondary school level and university level respectively, how many have subsequently become Singapore citizens; and (b) how many have performed full-time National Service.
Mr Chan Chun Sing142 words
[+8 sentences]The decision to take up citizenship may occur from the time they are in school till much later in life. Our experience suggests that many do so progressively. As illustrated, among those who graduated from university from 2014 to 2016, around 75% of scholarship holders and 60% of tuition grant recipients became Permanent Residents within five years of graduation. Around 10% to 15% converted to Singapore citizenship within the same time. These figures include scholars who studied in our secondary schools, as the majority of them progressed to our autonomous universities. For those who eventually choose to leave Singapore, they continue to be part of our valuable global network, through the friendships and links forged during their studies. The Ministry of Education (MOE) does not track whether they perform National Service. National Service eligibility will be in accordance with our national policies.
Foreign Students Who Did Not Fully Serve Out Bonds after Receiving Tuition Fee Grants or Scholarships›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 111w
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written-answer-na-11517
Mr Leong Mun Wai52 words
[+1 sentence]asked the Minister for Education (a) how many foreign students did not fully serve out their bonds after receiving tuition fee grants or scholarships in each of the last 10 years; (b) how many are considered to have defaulted; and (c) how many are exempted from fulfilling the bond requirements without penalty.
Mr Chan Chun Sing59 words
[+3 sentences]The proportion of defaulters has been about 4% over the past decade. We have only approved exemptions for a very small number of cases, as they were unable to serve their bonds due to very serious medical conditions or death. The rest are serving or have served their bonds, and some have applied for deferment for their postgraduate studies.
Incidence of Pregnant Women Being Diagnosed with Gestational Diabetes›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 295w
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written-answer-na-11518
Ms He Ting Ru40 words
[+1 sentence]asked the Minister for Health (a) in each of the last five years, how many pregnant women are diagnosed as having gestational diabetes; and (b) what are the efforts to combat and lower the incidence and impact of gestational diabetes.
Mr Ong Ye Kung255 words
[+11 sentences]Based on data from public hospitals, the average number of pregnant women diagnosed with gestational diabetes in our public hospitals from 2017 to 2021 was approximately 2,950 each year. Women can lower their risks of gestational diabetes by achieving an optimal weight gain and adopting a healthy lifestyle before and during pregnancy. Pregnant women can access the Health Promotion Board (HPB)'s Parent Hub portal for resources on maintaining a healthy Body Mass Index (BMI) through exercising regularly and adopting a healthier diet. Gestational diabetes screening is offered to pregnant women between 24 and 28 weeks of gestation. Women with gestational diabetes will be closely monitored and managed with lifestyle interventions and may be referred to nurse counsellors for advice. Some may require medication or insulin injections for blood glucose control. It is estimated that four in 10 women with a history of gestational diabetes develop diabetes or pre-diabetes when measured four to six years after delivery. As such, between six and 12 weeks post-delivery, they will be screened for diabetes. If gestational diabetes has resolved, they will be recommended to continue lifestyle interventions and attend diabetes screening every one to three years. Post-delivery, women of any age with a history of gestational diabetes are eligible for subsidised diabetes screening under the existing Screen for Life (SFL) programme package. The Agency for Care Effectiveness (ACE) has recently updated the Appropriate Care Guide (ACG) in August 2022 on recommendations for screening, diagnosis and follow-up for gestational diabetes to provide the latest evidence-based guidance to support clinicians better.
Diabetes Cases Referred from Public Healthcare System to Private Doctors›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 135w
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written-answer-na-11519
Ms He Ting Ru40 words
[+1 sentence]asked the Minister for Health (a) in each of the last five years, how many diabetes cases are referred from the public healthcare system to private general practitioners; and (b) what impact is this having on caseloads for general practitioners.
Mr Ong Ye Kung95 words
[+4 sentences]Hospitals do not routinely track referrals to private general practitioners (GPs) by diagnosis. Nevertheless, since 2018, some private GPs have organised themselves into Primary Care Networks (PCNs) to provide more holistic and team-based care and take on patients previously attended to by hospitals. Based on available information from public acute hospitals, about 10% to 20% of diabetic patients seen in these hospitals are referred to primary care doctors between 2018 to 2021. With Healthier SG, more patients with chronic diseases, including diabetes, will be treated in GP clinics and we expect caseloads to continue increasing.
Key Causes of Recent Increase in Number of Patients Requiring Kidney Dialysis›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 343w
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Mr Yip Hon Weng68 words
[+1 sentence]asked the Minister for Health (a) what are the key causes of the recent increase in the number of patients requiring kidney dialysis; (b) what is the annual socioeconomic cost of dialysis in the past two years; (c) what are the targets that the Ministry has for eligible patients to take up peritoneal dialysis; and (d) how will the Government keep treatment accessible and affordable as demand grows.
Mr Ong Ye Kung275 words
[+13 sentences]Kidney dialysis is required for patients with End-Stage Renal Disease (ESRD), where their kidneys can no longer function adequately. The increase in the number of ESRD patients on dialysis is driven mainly by Singapore's ageing population and the prevalence of chronic diseases, particularly, diabetes and hypertension. The ESRD, or kidney failure imposes a heavy personal and social cost. It is also a significant burden for the healthcare system. The Ministry of Health (MOH) has not done an estimation of the socioeconomic costs. "Dialysis" is commonly understood to mean haemodialysis (HD). This is the more common mode of dialysis, but peritoneal dialysis (PD) has been shown to be more cost-effective and produces clinical outcomes comparable to HD and is done at home, providing convenience and independence for patients. Hence, MOH has adopted a PD-preferred strategy for medically suitable patients. MOH also provides higher subsidies for PD to encourage uptake and aims to raise the percentage of PD uptake amongst new dialysis patients from 19% now to 30% by 2025. In working towards this target, MOH works with stakeholders on a set of pre-dialysis counselling, training and educational materials to help patients to perform PD independently at home. In April this year, MOH launched the National PD Home Support Programme, which provides home visits and more targeted counselling and support to help patients and their loved ones to gain confidence to perform PD at home. MOH also provides means-tested subsidies to patients receiving HD and PD treatment, including those receiving PD home support. Patients can also use MediShield Life and MediSave for their dialysis treatment, and there is also charity assistance for those who face affordability concerns.
Assessment of Reports Linking COVID-19 Vaccines to Onset of Kidney Diseases in Patients with Renal Problems›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 129w
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written-answer-na-11523
Mr Yip Hon Weng63 words
[+1 sentence]asked the Minister for Health (a) whether there are incidences of severe kidney damage caused by COVID-19 which resulted in the need for dialysis; (b) whether the Ministry is aware of reports suggesting the possibility of links between COVID-19 vaccinations to the onset of kidney diseases in patients with renal problems; and (c) whether there are any related studies being done in Singapore.
Mr Ong Ye Kung66 words
[+4 sentences]Severe infections and illnesses, particularly those requiring intensive care, can result in acute kidney injury that necessitates dialysis. This has also been observed for COVID-19 patients who had become severely ill. Otherwise, COVID-19 has not been established to directly cause an increased risk of end-stage kidney disease requiring long-term dialysis. Likewise, there has been no established link, locally or internationally, between COVID-19 vaccines and kidney disease.
Ease of Application for Overseas Networks and Expertise Pass Compared with that for Personalised Employment Pass›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 189w
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written-answer-na-11528
Assoc Prof Jamus Jerome Lim61 words
[+1 sentence]asked the Minister for Manpower (a) for the purposes of signalling the desirability of Singapore as a base for top professionals, whether the application for the Overseas Networks and Expertise Pass is made relatively easier when compared to the existing Personalised Employment Pass; and (b) if so, whether there is any intent to fast-track permanent residency or citizenship for such individuals.
Dr Tan See Leng128 words
[+7 sentences]The Member would be aware that the criteria for the Overseas Networks and Expertise (ONE) Pass is set at a high bar. Compared to the Personalised Employment Pass (PEP), which the Member has cited, the ONE Pass criteria are harder to meet. Furthermore, there are some additional checks that the Ministry of Manpower (MOM) will need to carry out for the ONE Pass, in line with the criteria. For example, for overseas candidates, we will assess their company's market capitalisation and revenue based on verifiable sources. I had mentioned this in my Ministerial Statement in September. The Immigration and Checkpoints Authority (ICA) assesses applications for permanent residency (PR) and citizenship independently from work passes. The ONE Pass does not give its holders a fast-track to PR or citizenship.
Monitoring Fraudulent Claims in Workfare Income Supplement Scheme›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 297w
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written-answer-na-11529
Assoc Prof Jamus Jerome Lim71 words
[+1 sentence]asked the Minister for Manpower (a) whether the Ministry monitors for fraud in applications made under the Workfare Income Supplement (WIS) scheme; (b) if so, what is the rate of fraudulent WIS claims perpetrated by firms; and (c) if not, whether there are plans to independently audit WIS firms to ensure that WIS top-ups are not granted to "ghost" employees that may be friends and family members of the business owner.
Dr Tan See Leng226 words
[+10 sentences]The Workfare Income Supplement (WIS) scheme encourages lower-income Singaporeans to work and build up their Central Provident Fund (CPF) savings, by supplementing their income through cash payments and CPF contributions if they have a job and are working. Workers do not need to apply for the scheme. For employees, eligibility is assessed automatically based on the quantum of CPF contributions made by the employers for their employees. For self-employed persons, eligibility is assessed based on their net trade income declared to Inland Revenue Authority of Singapore (IRAS). The Ministry of Manpower (MOM) makes use of data analytics to identify and detect unusual patterns in hiring practices. Suspicious companies are flagged out for on-site inspection to ascertain whether the suspected phantom workers are employed by the company. Similarly, IRAS performs audits on the income declared by self-employed persons to detect irregularities in the income information reported. Where there is suggestion of fraudulent intent, MOM and CPF Board will surface these cases to the Singapore Police Force for further investigation. Over the last three years, the Singapore Police Force had found two cases related to WIS to be fraudulent and CPF Board has since recovered all the disbursed Workfare monies. MOM and CPF Board will continue to review our processes and step up our fraud detection capabilities to better identify risks and deter fraudulent cases related to Workfare.
Update on Study into Making CPF Contributions Mandatory for Platform Workers›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 168w
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written-answer-na-11530
Ms Hazel Poa22 words
[+1 sentence]asked the Minister for Manpower whether he can provide an update on the study into making CPF contributions mandatory for platform workers.
Dr Tan See Leng146 words
[+5 sentences]The Advisory Committee on Platform Workers has been engaging extensively over the past months with platform workers and companies on strengthening protection, including mandatory Central Provident Fund (CPF) contributions for platform workers. While more than half of platform workers who responded to our public consultation on CPF contributions felt that mandatory contributions are important for their retirement and housing needs, we note that some of them are concerned about the impact on take-home earnings. Although platform companies recognise the importance for platform workers to build up their CPF for retirement and housing needs, the companies have raised concerns that such a move will result in increase in business cost. Given the complexity of this issue, it is important for the Committee to discuss any proposal thoroughly with both workers and companies. The Committee remains on course to complete its work by the end of this year.
Complaints of Ageism in Workplace›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 296w
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written-answer-na-11531
Ms Hazel Poa15 words
[+1 sentence]asked the Minister for Manpower whether ageism in the workplace is increasingly becoming a problem.
Dr Tan See Leng281 words
[+16 sentences]Senior workers are, and will, continue to be an important part of our workforce, especially as our workforce ages. Employers recognise this. The employment rate of residents aged 55 to 64 has increased from 67.1% in 2017 to 69% in 2021. For those aged 65 to 69, it has increased from 41.7% to 49%. This is comparable to the average of the top three Organisation for Economic Co-operation and Development (OECD) countries. Our re-employment rate also remained high, with most employees continuing to work in the same job without any cuts to basic wage and benefits. The incidence of age discrimination has also fallen. Based on the Ministry of Manpower (MOM)'s Fair Employment Practices survey, the proportion of resident job applicants who experienced age discrimination during job search fell from 30.4% in 2018 to 18.9% in 2021. The proportion of resident employees who experienced discrimination during employment due to age is also relatively low, at 4.6% in 2021. Nonetheless, we are mindful that we must continue to work with our tripartite partners to tackle the issue of age-related discrimination. The Tripartite Alliance for Fair and Progressive Practices (TAFEP) undertakes various efforts to educate employers and promote fair employment practices, so as to cultivate the right workplace norms and values. In addition, the Tripartite Guidelines on Fair Employment Practices (TGFEP), requires employers to treat all employees and jobseekers, fairly and objectively. We take enforcement action against employers with discriminatory practices. Looking ahead, we will be enacting workplace fairness legislation. This will send a signal that there is no place for discrimination at the workplace. The legislation will broaden the range of measures and penalties available to address workplace discrimination, including age discrimination.
Locally-sourced Raw Materials in Food Grown under 30-by-30 Goal›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 120w
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written-answer-na-11533
Mr Dennis Tan Lip Fong40 words
[+1 sentence]asked the Minister for Sustainability and the Environment whether the "30 by 30" goal to produce 30% of our local nutritional needs domestically takes into account whether the food is grown based on locally-sourced raw materials, including feed and fertilisers.
Ms Grace Fu Hai Yien80 words
[+4 sentences]The agri-inputs required for the "30 by 30" goal, such as feed, fish fry, seeds and fertiliser, will need to be sourced both locally and overseas. Given Singapore's limited land and other resources, it will not be feasible or commercially viable to locally produce all agri-inputs required by our farms. For business continuity, our farms will need to ensure their agri-inputs come from diversified sources. Our farms also hold some buffer stock of their key agri-inputs for supply chain resilience.
Enforcement against Motorists for Exceeding Noise Emission Limits in Last Five Years›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 235w
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written-answer-na-11534
Mr Leon Perera75 words
[+1 sentence]asked the Minister for Sustainability and the Environment (a) in each of the last five years, how many enforcement actions have been taken against motorists for exceeding the noise emission limits; and (b) whether the Ministry will consider trialling the use of acoustic cameras to support enforcement during late-night and early-morning hours where traffic is light and offending motorists are likely to interrupt residents' sleep and they would more likely be detected by such cameras.
Ms Grace Fu Hai Yien160 words
[+6 sentences]Excessive vehicle noise can be caused by a variety of factors, including vehicle design, illegal modifications, poor maintenance and inconsiderate driver behaviour. The National Environment Agency (NEA) sets noise emission standards that new vehicles must adhere to upon registration, as well as in-use noise emission standards to ensure that vehicles plying the roads are regularly serviced, well-maintained and do not emit excessive noise. NEA carries out enforcement actions against vehicles that violate the noise emission standards based on feedback. In the past five years, enforcement actions were taken against 167 vehicles in 2017, 177 in 2018, eight in 2019, nine in 2020 and 76 in 2021. The use of acoustic cameras for monitoring and enforcement requires rigorous testing under local traffic conditions, as the cameras have limited ability in detecting noise violations from individual vehicles accurately and reliably. Nonetheless, NEA continues to explore acoustic cameras and other technologies with a view to trialling them to strengthen enforcement against noisy vehicles.
Tying Achievement of 2030 Nationally Determined Contribution and Climate Targets to Individual Ministry's KPIs and Senior Management Performance Bonuses›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 129w
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written-answer-na-11536
Mr Chua Kheng Wee Louis53 words
[+1 sentence]asked the Minister for Sustainability and the Environment following the review of Singapore's 2030 Nationally Determined Contribution (NDC) (a) whether the achievement of the NDC and climate targets will be tied to individual Ministry's KPIs and senior management performance bonuses; (b) if so, how is this implemented; and (c) if not, why not.
Ms Grace Fu Hai Yien76 words
[+3 sentences]The performance bonuses of senior management in the public sector are not tied to climate targets. Key Government outcomes, including our national greenhouse gas emissions, are reported annually in the Revenue and Expenditure Estimates, also known as the Budget Book, and progress is reported biennially in the Singapore Public Sector Outcomes Review (SPOR). The Inter-Ministerial Committee on Climate Change (IMCCC), chaired by Senior Minister Teo Chee Hean, also tracks the progress towards Singapore's national climate targets.
Measures to Further Reduce Number of Smoking Corners at Coffee Shops›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 158w
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written-answer-na-11538
Mr Louis Ng Kok Kwang50 words
[+1 sentence]asked the Minister for Sustainability and the Environment (a) for each year in the past five years, how many and what percentage of coffee shops do not have a smoking corner; and (b) what steps will the Ministry take to further reduce the number of smoking corners at coffee shops.
Ms Grace Fu Hai Yien108 words
[+6 sentences]The National Environment Agency (NEA) stopped accepting applications for new smoking corners in retail food establishments, including coffee shops, since June 2017. At that time, there were about 1,000 smoking corners, including at coffee shops. As of September 2022, the number of smoking corners has decreased to about 600. Currently, about 60% of coffee shops do not have smoking corners. Existing smoking corners in retail food establishments, such as coffee shops, will be phased out when the licences of the establishments are terminated or cancelled. This will result in a further decrease in the number of smoking corners in coffee shops and other retail food establishments over time.
Sufficiency of Measures and Staff Strength to Assist Consumers Subjected to Undue Pressure to Enter into Unfair Transactions›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 421w
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written-answer-na-11539
Mr Liang Eng Hwa71 words
[+1 sentence]asked the Minister for Trade and Industry (a) what is the current number of frontline personnel available at CASE, the Small Claims Tribunal and the Competition and Consumer Commission of Singapore to assist consumers who are subjected to undue pressure or influence to enter into unfair transactions, respectively; (b) whether there are sufficient deterrent measures against such errant businesses; and (c) whether the existing regulatory safeguards need to be further strengthened.
Mr Gan Kim Yong350 words
[+17 sentences]The Consumer Protection (Fair Trading) Act (CPFTA) prescribes a list of unfair practices that suppliers must not engage in. An example would be the act of exerting undue pressure or undue influence on the consumer to enter a transaction. Consumers who encounter such practices may seek redress by approaching the Consumers Association of Singapore (CASE) for assistance. CASE can represent a consumer to negotiate a settlement with an errant supplier or mediate between a consumer and an errant supplier. There are, currently, 11 frontline officers in CASE who assist consumers in dispute resolution. If negotiation or mediation fails, consumers have the option of filing a claim with the Small Claims Tribunal or seeking other forms of legal redress. The State Courts' Central Registry is available to help consumers who have filed their claims with the Small Claims Tribunal. Unrepresented consumers who need legal advice may approach the Community Justice Centre for assistance. For incidents of unfair practices, CASE may ask the supplier to enter into a Voluntary Compliance Agreement (VCA), which can include the undertaking not to engage in any unfair practices and to compensate the affected consumers. In egregious cases, CASE will refer errant suppliers to the Competition and Consumer Commission of Singapore (CCCS) for investigation under CPFTA. CCCS may then apply for a Court injunction to restrain the supplier from engaging in the unfair practice. The Courts may also make accompanying orders, which include requiring the supplier to notify consumers of the injunction order and to report to CCCS any change to its business, such as the setting up of new branches. In the last five years, CCCS had investigated five cases involving pressure sales tactics. These suppliers have since ceased their unfair practices, and either signed VCAs with CASE or provided undertakings to CCCS. The Ministry of Trade and Industry (MTI) and CCCS regularly review our consumer protection regime to ensure its relevance and adequate protection for consumers. Most businesses are responsible in their practices and seek to serve their customers well. We will continue to work with CASE and industry partners to protect and empower consumers.
Boosting In-bound Tourism Given Strong Singapore Dollar›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 294w
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written-answer-na-11541
Mr Darryl David41 words
[+1 sentence]asked the Minister for Trade and Industry in view of the recent strengthening of the Singapore dollar that is making it more expensive for foreigners to visit, what future plans does the Government have to further boost tourism inflows into Singapore.
Mr Gan Kim Yong253 words
[+12 sentences]Singapore's tourism industry is recovering well. In the first eight months of 2022, Singapore received three million visitor arrivals, nearly 20 times more, compared to the same period in 2021. When compared to nine key competitor cities, Singapore remains the top destination for both leisure and business travellers in the Singapore Tourism Board's (STB) Brand Health Survey of Singapore's top 15 markets. Singapore does not compete for international travellers based on cost alone. Our value proposition rests on the quality of our products, services, experiences, efficiency and connectivity to the region and the world. At the start of this year, STB outlined its strategy to grow the tourism industry called Tourism 203X (T203X). This is built on several key pillars. These include growing our position as the Global-Asia node for business tourism; injecting more "fun" into our events and experiences; becoming one of the world's most sustainable urban destinations; and becoming an urban wellness haven. STB is anchoring these activities through SingapoReimagine, its global marketing campaign to keep Singapore top-of-mind. The SingapoReimagine Marketing Programme (SMP) helps our tourism and lifestyle industries deliver innovative marketing campaigns in overseas markets to strengthen Singapore's appeal as a choice destination for business and leisure travel. STB will also continue to deepen its strategic partnerships with airlines, travel agents and financial institutions, which can help drive visitor arrivals and spend in Singapore. We will continue to strengthen Singapore's attractiveness as a travel destination and support our tourism industry to offer unique, quality experiences and products to the world.
Proportion of Household Consumers Buying Electricity from SP Services Since Exit of Other Electricity Market Retailers›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 101w
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written-answer-na-11542
Ms Sylvia Lim42 words
[+1 sentence]asked the Minister for Trade and Industry whether there has been any discernible change in the proportion of household consumers buying electricity from SP Services compared to other retailers, since the exit of several retailers from the open electricity market in 2021.
Mr Gan Kim Yong59 words
[+4 sentences]Between October and December 2021, six electricity retailers exited the open electricity market. Affected household consumers were transferred to SP Services. Some subsequently entered into new electricity plans with other retailers. As at end-August 2022, around 58% of household consumers were on SP Services' regulated tariff, compared to around 50% a year ago, before the global energy crisis started.
Impact of India's Rice Export Ban and Thailand and Vietnam's Plans to Raise Rice Export Prices›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 222w
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written-answer-na-11543
Mr Chua Kheng Wee Louis49 words
[+1 sentence]asked the Minister for Trade and Industry (a) what is the Government's assessment on the impact of India's rice export ban and plans by Thailand and Vietnam to raise export prices for rice; and (b) what measures are being considered to mitigate the impact on rice imports by Singapore.
Mr Gan Kim Yong173 words
[+8 sentences]The recent ban on rice exports by India applies to the category of broken rice, of which consumption in Singapore is low. Thus far, there have been no confirmed plans by Thailand and Vietnam on raising export prices for rice. Singapore has a multi-pronged strategy of import diversification and stockpiling to manage supply chain disruptions to rice imports. Under the Rice Stockpile Scheme (RSS), rice importers are required to hold a buffer inventory equivalent to twice their monthly imports. This helps to ensure an adequate supply of rice in the market. We review the inventory buffers regularly and stand ready to work closely with the industry if any adjustments are required. In addition, a strong Singapore dollar through the Monetary Authority of Singapore (MAS)' tightening of monetary policy will help to mitigate the impact of higher rice and other food import prices. The Government has also provided support packages to assist lower-income and vulnerable Singaporeans, such as the $1.5 billion support package announced by the Ministry of Finance (MOF) in June this year.
Economic Impact of Imposing Ban on Transporting Workers on Back of Lorries›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 198w
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written-answer-na-11545
Ms He Ting Ru67 words
[+1 sentence]asked the Minister for Transport (a) whether the Ministry has commissioned or commenced a study on the quantifiable economic effect on businesses and the economy generation if a ban is introduced against transporting workers in the back of lorries and other vehicles and to look into addressing practical and operational challenges associated with such a ban; and (b) if not, whether the Ministry will consider doing so.
Mr S Iswaran131 words
[+6 sentences]At the Committee of Supply (COS) debate this year, the Ministry of Transport (MOT) updated the House on the considerations and various proposals the Government was studying to improve the safety of transporting workers in lorries. Since then, agencies have been engaging various stakeholders, including to understand sector-specific needs. Rather than an academic study, this approach allows us to gain a better understanding of ground concerns and practical challenges so that any changes can be implemented smoothly to benefit all stakeholders. As announced earlier this year, the Government will be introducing several new measures to further improve the safety and welfare of workers on lorries. We will share more details soon this year. Meanwhile, I urge all employers to do their part to ensure the welfare and safety of their workers.
Key Performance Indicators for Road Opening Coordination Committee›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 92w
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written-answer-na-11546
Mr Leon Perera28 words
[+1 sentence]asked the Minister for Transport (a) what are the key performance indicators (KPIs) for the Road Opening Coordination Committee; and (b) whether such KPI data will be published.
Mr S Iswaran64 words
[+1 sentence]This question was addressed in the written reply issued for Question No 59 for Oral Answer for the 3 October 2022 Parliament sitting. [Please refer to "Monitoring Road Surfacing and Related Works to Ensure Safety and Comfortable Ride for Motorists", Official Report, 3 October 2022, Vol 95, Issue 70, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]
Relevance of Preferential Additional Registration Fee Scheme to Minimise Pollution from Older Vehicles›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 195w
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written-answer-na-11547
Mr Murali Pillai64 words
[+1 sentence]asked the Minister for Transport having regard to the Government's plans for an electric vehicle population under the Singapore Green Plan 2030 and environmental impact from mining lithium, whether the Government will consider reviewing the relevance of the Preferential Additional Registration Fee scheme which was introduced to keep the average age of cars in Singapore young, reduce breakdown rates and pollution from exhaust fumes.
Mr S Iswaran131 words
[+7 sentences]The Preferential Additional Registration Fee (PARF) scheme incentivises motorists to deregister their cars before 10 years of age. It serves to reduce the number of old cars, so that there will be fewer breakdowns on our roads and less traffic disamenities. Over time, newer cars have come with cleaner engines. So, PARF does help to reduce air pollution on our roads. The PARF scheme has worked well so far, keeping the average age of the car population relatively young at nine to 10 years. Most cars still use internal combustion engines, the PARF scheme remains relevant. As we move towards a predominantly electric car population, LTA will closely monitor and study how an electric car's age could affect its propensity to break down and review the relevance of the PARF scheme.
Trend of Fare Evasion by Private Hire Car Passengers›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 439w
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written-answer-na-11548
Mr Melvin Yong Yik Chye54 words
[+1 sentence]asked the Minister for Transport (a) in the past five years, how prevalent is fare evasion among private hire car passengers; (b) whether there has been a rising trend of fare evasion cases; and (c) how easy is it for private hire car drivers to report and seek redress for such cases from LTA.
Mr S Iswaran385 words
[+24 sentences]This response also addresses a related question filed by Mr Don Wee for a subsequent sitting. We take fare evasion cases for taxi and private hire car (PHC) services seriously. Passengers who do not pay their fares affect the livelihoods of taxi and PHC drivers. This is why we have an established process to assist drivers. Taxi and PHC drivers who encounter fare evasion have several ways to seek redress. First, drivers can report fare evasion to the taxi or PHC operators, who will attempt to recover the fares on behalf of their drivers. If the operators are not successful, cases can be referred to Land Transport Authority (LTA) for further investigation. Second, drivers can call the Police for assistance or drive passengers who refuse to pay to the nearest Police station. After lodging a Police report, drivers can refer the case directly to LTA for investigation. Drivers can also approach LTA directly. For the past five years from 2017 to 2021, for both taxi and PHC services, LTA investigated a total of 233, 269, 164, 104 and 96 cases of fare evasion respectively – a falling trend. For comparison, the total number of taxi and PHC trips is about 600,000 per day. That means that 0.00005% of all trips, or one in two million trips, have reported fare evasion. PHC cases are only included in this data from 30 October 2020, when the PHC regulatory framework commenced. No PHC cases were investigated in 2020 and 21 PHC cases were investigated in 2021. Cases of fare evasion vary in complexity. For example, where passengers cannot be identified, it will be challenging to track them down to recover the unpaid fares. Even so, from 2017 to 2021, fares were recovered from about six in 10 of all cases investigated. Non-payment of taxi and PHC fares is an offence under the Public Transport Council Act. A person guilty of non-payment can be fined up to $1,000. Repeat offenders can be fined up to $2,000 or jailed for up to six months, or both. From 2017 to 2021, a penalty was imposed in about one in 10 of all cases investigated. No penalties have been imposed for PHC cases thus far. Finally, let me reiterate that LTA stands ready to assist any drivers who come across fare evasion.
Evaluation of MRT Infrastructure Designs for Robustness in View of Climate Change›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 209w
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written-answer-na-11549
Dr Tan Wu Meng76 words
[+1 sentence]asked the Minister for Transport (a) whether MRT infrastructure designs have been evaluated for robustness in view of climate change; (b) if so, whether the scenarios considered go beyond the optimistic and median scenarios in terms of severity; and (c) to what extent do these evaluations and scenarios consider (i) rising sea levels in the case of underground stations and tunnels and (ii) soil changes and landslide risk in the case of above-ground stations and tracks.
Mr S Iswaran133 words
[+4 sentences]The design of our Mass Rapid Transit (MRT) infrastructure takes into consideration climate change scenarios, such as increases in sea levels, rainfall, ambient temperature and wind strength. These scenarios are based on findings from the Centre for Climate Research Singapore (CCRS)'s Second National Climate Change Study, which takes reference from the Fifth Assessment Report (AR5) of the United Nations' Intergovernmental Panel on Climate Change (IPCC). Our MRT infrastructure also conforms to the drainage and flood protection requirements set out in PUB's Code of Practice on Surface Water Drainage for all developments. In addition, LTA regularly reviews the design of existing infrastructure to ensure that they are on par with international standards and account for the latest scientific evidence on climate change and may implement additional mitigation measures to improve their resilience, if necessary.
Claims Filed and Successfully Resolved at Financial Dispute Resolution Centre in Past Three Years›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 120w
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written-answer-na-11553
Mr Gan Thiam Poh32 words
[+1 sentence]asked the Prime Minister (a) how many claims have been filed with the Financial Dispute Resolution Centre for the past three years; and (b) of which, how many have been successfully resolved.
Mr Tharman Shanmugaratnam (for the Prime Minister)88 words
[+4 sentences]For financial years 2020 to 2022, a total of 3,137 claims or around a thousand cases each year, were filed with and handled by the Financial Industry Disputes Resolution Centre Ltd (FIDReC). As of 23 September 2022, 2,922 or 93% of these claims had been resolved upon mediation or adjudication. The cases that remain unresolved are mainly more recent claims filed since March 2022. Based on FIDReC's data for its past three financial years1, about 89% of cases are resolved within six months and 97% within nine months.
Publication of Findings from Public Consultation on Singapore's Climate Ambition›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 158w
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written-answer-na-11554
Mr Dennis Tan Lip Fong42 words
[+1 sentence]asked the Prime Minister whether the findings of the Public Consultation on Singapore's Climate Ambition will be published in full, prior to any formal revision of Singapore's Long-Term Low Emissions Development Strategy and 2030 Nationally Determined Contribution, before the end of 2022.
Mr Teo Chee Hean (for the Prime Minister)116 words
[+4 sentences]The Public Consultation on Singapore's Climate Ambition is part of our effort to engage multiple stakeholders following the announcement in Budget 2022 that Singapore will be raising our climate ambition. The Public Consultation closed on 26 September 2022 and builds on the series of engagement sessions with businesses, non-governmental organisations, green groups and youths under the Singapore Green Plan 2030. We have received close to 500 responses from the Public Consultation. We are currently studying the feedback and will publish a summary report of the aggregated findings, prior to any formal revision of Singapore's Long-Term Low Emissions Development Strategy (LEDS) and 2030 Nationally Determined Contribution (NDC) to the United Nations Framework Convention on Climate Change (UNFCCC).
Unauthorised PayNow Transactions Reported and Funds Recovered›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 348w
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written-answer-na-11555
Dr Tan Wu Meng82 words
[+1 sentence]asked the Prime Minister (a) since 2020, how many reports are received by financial institutions or MAS regarding unauthorised PayNow transactions involving consumer banking accounts; (b) what proportion of the cases has the mechanism of unauthorised transaction been established; (c) how do such unauthorised transactions take place; (d) what is the total amount of the unauthorised fund transfers reported and recovered respectively; (e) what are the respective median amounts per affected consumer; and (f) what is being done to better protect consumers.
Mr Tharman Shanmugaratnam (for the Prime Minister)266 words
[+9 sentences]According to statistics from the Singapore Police Force (SPF), there were 477 cases of banking-related phishing scams involving PayNow transactions in 2021, with a median loss of $3,400. In the first half of 2022, the cases stood at 133, with a median loss of $1,200. These unauthorised transactions were perpetrated by scammers who had deceived bank customers into giving them their digital banking credentials. The recovery rate for this category of unauthorised transactions, through PayNow specifically, is not available. The two rounds of anti-scam measures announced by the Monetary Authority of Singapore (MAS) and the Association of Banks in Singapore (ABS) in January and June this year have strengthened safeguards against unauthorised banking transactions, including when such transactions are effected via PayNow. For instance, the default transaction limit set at $5,000 or lower and the default transaction notification threshold set at $100 or lower apply to PayNow transactions as well. Banks have also been adapting their anti-scam defences in response to new attack patterns, for instance, by temporarily lowering the PayNow limit to ward off attacks that may be directed at PayNow users. MAS continues to work closely with the industry to review and enhance the suite of anti-scam measures. Consumers need to stay vigilant and remember a few basic rules – one, do not provide your digital banking credentials to anyone under any circumstances; two, do not click on links purportedly sent by banks, as banks will not send you links in SMS or emails; three, use the banks' official mobile applications for your banking needs to minimise the risk of navigating to fraudulent websites.
Applying Lessons from How Employers Manage Operational Needs during Employees' Reservist Call-ups to Use of Parental and Childcare Leave›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 374w
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written-answer-na-11556
Mr Louis Ng Kok Kwang77 words
[+1 sentence]asked the Prime Minister (a) whether any study has been conducted on how employers balance their operational needs against reservist obligations of operationally-ready National Servicemen for up to 40 days per year; (b) if such studies have been conducted, whether the Ministry can study how such measures can be applied to parental and childcare leave; and (c) if such studies have not been conducted, whether the Ministry will consider conducting such studies and, if not, why not.
Ms Indranee Rajah (for the Prime Minister)297 words
[+10 sentences]National Service (NS) is key to Singapore's defence and security. In a survey by the Institute of Policy Studies commissioned by the Ministry of Defence (MINDEF) in 2013, 77% of employed National Servicemen (NSmen) said that their employers had adjusted their workload due to their NS commitments. In MINDEF's engagements with employers, employers also shared how they made arrangements for other employees to temporarily cover the work when their NSmen colleagues are called up for In-Camp Training (ICT). This is enabled by MINDEF and the Singapore Armed Forces (SAF) ensuring that NSmen are informed of their ICT call-ups at least three to six months in advance. Through our focus group discussions with parents as well as feedback from employers, we found that employers address their operational and business needs in similar ways when their employees take parental or childcare leave. For instance, for time-sensitive frontline roles, or if the leave is for an extended period as is the case for maternity leave, employers typically reallocate work to other employees, or hire temporary or part-time workers to fill the gap. For less time-sensitive roles or when the leave duration is relatively short – for instance, a couple of days of childcare leave, employees could have the flexibility to adjust work schedules as long as overall work deliverables and deadlines are met. We encourage parents to discuss their parental or childcare leave plans with their employers early, so that employers can plan for covering work arrangements if needed. Such workplace practices are examples of how employers can maintain operational resilience while supporting their employees in balancing their work and personal responsibilities, whether for NS commitments, or parental or childcare leave. We will continue to work closely with tripartite partners and employers to encourage the adoption of progressive workplace practices.
Trend for Occurrence of Landslide Incidents›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 557w
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written-answer-na-11621
Ms Mariam Jaafar43 words
[+1 sentence]asked the Minister for National Development (a) whether there has been an increase in landslide incidences in the past five years; (b) if so, what are the drivers behind the increase; and (c) what is being done to contain the number of incidents.
Mr Desmond Lee514 words
[+22 sentences]The scale and impact of landslides, which are movements of a mass of soil down a slope, vary greatly, depending on the amount of soil movement. There was an average of four landslide incidents reported to the Building and Construction Authority (BCA) per year between 2017 and 2019, and 21 per year in 2020 and 2021. These were all relatively minor cases involving the movement of shallow layers of soil and did not cause significant damage to infrastructure. Higher-than-normal rainfall was recorded in 2020 and 2021, which could be one factor that contributed to the higher number of incidents in these two years. As of end-September this year, there has been one landslide incident reported to BCA so far. This was the incident which occurred at the Clementi NorthArc Build-To-Order (BTO) construction site on 2 September 2022. This was caused by slope failure, which refers to the sudden collapse of a slope due to changes in soil strength or the destabilisation of the slope. BCA has inspected the surrounding buildings and found them to be structurally sound. The cause of this incident is, currently, being investigated. Soil movements may be triggered by various factors, such as heavy and prolonged rainfall, additional loads on the slope or changes to the slope profile due to construction work. Agencies that manage public land carry out regular inspections on slopes that may pose a risk to public safety and implement appropriate mitigation measures to stabilise the slopes as needed. Our agencies may also conduct inspections more frequently, such as on a weekly or monthly basis, during periods of intense wet weather. In addition, BCA requires all slopes that are formed or modified by building works to be assessed for risk of failure by a Qualified Person (QP) before construction commences. The QP is required to recommend slope protection measures to be put in place, such as earth retaining walls and stabilising structures, to ensure that the slope remains stable under adverse weather conditions, including extreme rainfall. The QP is also required to recommend measures to monitor the condition of the slope while works are ongoing. The frequency of monitoring may vary, depending on the complexity of the works. For example, slopes may be monitored twice a week for relatively shallow excavation works, and daily for works in close proximity to other buildings. As an additional precautionary measure following the slope failure incident on 2 September, BCA has reminded QPs and builders to inspect slopes on or adjacent to construction sites and to take additional measures to ensure that these slopes remain stable, as needed. BCA will conduct checks to ascertain that project parties have taken these measures. BCA also issues regular advisories to remind land and building owners to implement measures to manage the risk of landslides for their slopes. These include ensuring adequate drainage and proper maintenance of slope- and earth-retaining structures. BCA will review the cause of the recent slope failure incident after the investigations have been completed and assess if additional measures are required, to ensure the safety of slopes on or near construction sites.
Building a Healthier SG›Motions45 turns · 29,079w
· 180 highlighted
motion-1974recorded 2022-10-05
Speaker not recorded99 words
[+2 sentences], (proc text)] [(proc text) That this House endorses Paper Cmd 19 of 2022 on "White Paper on Healthier SG" as the basis to transform our healthcare system by (a) focusing strongly on preventive care; (b) fostering lasting relationships between residents and family doctors; and (c) building strong partnerships within the community, so as to support individuals taking care of their own health and wellness and strive towards our vision of long and healthy lives for Singaporeans. – . (proc text)]
Mr Deputy Speaker3 words
[+1 sentence]Ms Sylvia Lim.
Ms Sylvia Lim (Aljunied)1602 words
[+15 sentences]Mr Deputy Speaker, as Members of Parliament, it is not unusual at our Meet-the-People Sessions (MPS) to encounter residents with serious health or mobility issues. For them a short trip to the MPS is, itself, a difficult journey. Some of them are around my age. As I learn more about their circumstances, I often ask myself whether the quality of their lives might have been drastically better if they have had the correct interventions and advice at an earlier stage. I tend to see this particularly in residents of less means. On today's Motion on the Healthier SG White Paper, I wish to focus my speech on three areas: one, the potential of Healthier SG: two, clarifications around capitation funding; and three, to conclude with the importance of a whole-of-society buy-in. First, the potential of Healthier SG. A key thrust of the Healthier SG White Paper is that residents will be encouraged to enrol with a family doctor even when they are well so that they may benefit from advice regarding social interventions to adopt healthier lifestyles. It is envisaged that the doctor will take charge of the overall well-being of the resident for a period of time, rather than to treat the patient on an episodic basis. This holds much promise for a healthier nation overall. In moving the Motion yesterday, the Health Minister assessed that the returns of better health outcomes from Healthier SG would take maybe eight to 10 years before tangible results might be seen. However, on returns based on dollars and cents terms, there are encouraging experiences from overseas. Prevention strategies have been shown to make economic sense as they are substantially cost-saving. It is well-known that it is preferable for healthcare systems to aim to prevent ill health rather than to subsequently treat it from a financial standpoint. Five years ago, a systematic review was published, assessing the returns from investing in public health interventions such as promoting well-being and preventing ill health in society. From 52 studies of healthcare systems in high-income countries, it was found that the return on investment (ROI) of public health interventions was at the median of 14 to one, that, is, for every one dollar invested in public health, $14 will be subsequently returned to the wider health and social care economy.[+3 sentences] Although we do not yet know what returns Healthier SG might bring in dollars and cents, there is reason to be optimistic. From the healthcare system standpoint, it is vital that the focus of prevention ease the pressure on our acute facilities. Even as we debate today, residents experienced very busy A&E departments in public hospitals in the past months, with patients sometimes waiting more than a day at A&E before being allocated a ward bed. On this front, I note that in the White Paper, the Ministry has listed 22 indicators to assess Healthier SG by, including indicators of easing the load on acute facilities, such as reducing the avoidable Emergency Department attendance rate and reducing the admissions of the elderly for fall injuries.[+10 sentences] If achieved, these reductions will bring relief to patients and staff at acute facilities and contribute to better care for those most in need. That said, I have two further observations; first, to seek clarifications on the move to capitation funding and how healthcare outcomes will be safeguarded; and second, to conclude with the importance of a whole-of-society buy-in to the plan. First, on capitation funding. At Chapter 5 of the White Paper, it is stated that to fund Healthier SG, the Government intends to roll out capitation funding first to family doctors and then to the geographical healthcare clusters. There are scant details in the White Paper about how this will be implemented and the Minister yesterday did give a few more details. I would like to ask how the Government intends to ensure that the move to capitation funding does not undermine access to healthcare and the quality of healthcare. As stated in the White Paper, capitation funding will be a shift away from the current funding model based on services provided, commonly called fee for service or FFS models. The Ministry has pointed out that capitation funding is in place in healthcare systems in other countries, such as in Europe, New Zealand and the United States. Yesterday, the Minister pointed out that general practitioners (GPs) here are also not new to the concept. For Healthier SG, the Minister stated that besides the annual servicing fee paid to healthcare providers, there would still be separate subsidies for patients' medicines and screening. The Ministry's stated objective for adopting capitation funding is to, and I quote, "Create an inherent incentive for healthcare providers to focus on preventive care and right siting of patients." Put another way, healthcare providers who keep patients healthy and do not over service their patients will benefit under a system of capitation funding.[+3 sentences] Sir, if capitation funding means that patients can go to the doctor for consultations at minimal cost, this potentially will encourage poorer Singaporeans to consult doctors to work out health plans. If successfully implemented, it will go some way towards reducing healthcare inequality. At the same time, capitation funding has been the subject of research in many countries, particularly on whether such funding has led to healthcare providers to function as economic agents, that is, instead of focusing on the patient's best interest, healthcare providers look at the financial bottom-line and behave in certain ways which may not be in the patient's best interest. I am not saying this will happen for Healthier SG but we should be alive to the risk. There is evidence from several studies overseas that capitation funding models tended to result in patients receiving less treatment, that is, they went to the doctor less frequently and their treatments tended to cost less than compared with the FFS models.[+7 sentences] It is often not clear whether this was a result of capitation working well by cutting down unnecessary treatments and waste, or whether, on the other hand, patients were, in fact, underserved, that is, not getting adequate treatment. It also goes without saying that the level of funding is key. If capitation funding is pegged more generously, the quality of care would generally be better. Some studies focus on doctors' own assessments of whether the way they treated patients was different and under capitation funding compared to FFS models. There were indications that some physicians believed that funding had affected their choices of treatment. There has also been concern whether capitation funding would lead to healthcare providers cherry-picking their patients. In other words, with a fixed annual servicing fee, it might make economic sense to choose healthier patients rather than, for instance, older patients with health problems. Coming back to Healthier SG, I am pleased to note that the White Paper states that the capitation funding formula "will be tiered based on the health risk profile of each enrolled resident, scope of required care and the progress made in terms of preventive care for chronic disease management." Could the Ministry clarify what level of granularity will be used to tier the funding, for instance, will the funding be tiered based on the disease diagnosis and the stage of the disease progression? Yesterday, the Minister also touched on the overall finance and budget implications of Healthier SG. He said that the set-up cost over three to four years would be about $1 billion, while there would be recurrent cost of about $400 million a year, including the annual servicing fee for patients. Does this mean that the Ministry has already worked out the detailed capitation sums for each health risk profile, and when will this information be published?[+17 sentences] Sir, my final observation is that for Healthier SG to succeed, there needs to be a whole-of-society buy-in. Each of us needs to make adjustments to our daily lives. To illustrate the possible difficulties and inertia, please let me share a personal anecdote. Over the weekend. I met some friends for a meal. As they continued to order local favourites, such as char kway teow, fried Hokkien mee and others, I asked them whether they had heard about the Healthier SG plan which would be debated in Parliament this week. They gave me a quizzical look and, without blinking an eye, continued to order more of the same. Sir, this amplifies the monumental task ahead to get population buy-in for changes to deep-seated lifestyle habits. Besides having incentives to consult family doctor regularly, there will also be a need for a supportive infrastructure and to change mindsets. On infrastructure, the Government has built sporting facilities and beautiful park connectors for Singaporeans to exercise in. Besides that, healthier food needs to be affordably priced so that less privileged Singaporeans can afford to make healthy choices daily. Whatever the case, in the final analysis, changing people's deep-seated habits might be the most difficult of all. Sir, let me conclude. This Motion to focus on preventive care as a key thrust in healthcare should be supported. It holds the promise of meaningful and fulfilling lives for Singaporeans into old age. And, if implemented well, can help reduce healthcare inequality. It is likely to be money well-spent. At the same time, based on studies overseas, there may be risks associated with capitation funding.[+2 sentences] I hope the Ministry will clarify in due course how the funding model will be implemented so as to minimise any compromise on health outcomes. Finally, for Healthier SG to succeed, a whole-of-society effort towards healthier living, including changing some deep-seated mindsets and habits will be needed.
Mr Deputy Speaker4 words
[+1 sentence]Mr Gan Thiam Poh.
Mr Gan Thiam Poh (Ang Mo Kio)1029 words
[+3 sentences]Mr Deputy Speaker, in Mandarin. (In Mandarin): I thank MOH for further expanding the role that our clinics and family physicians can play in universal healthcare. Years ago, some of my Parliamentary colleagues and I proposed to the Government to allow residents to visit neighbourhood clinics instead of polyclinics, while benefiting from the lower outpatient service fees charged by polyclinics. The Government then launched the CHAS scheme, allowing residents to visit their own GP clinics at the price of polyclinic fees.[+20 sentences] Since its implementation, the plan has been welcomed by residents. I also shared feedback from residents at that time. In many cases, residents often perceive that their family doctors were more cordial, reliable and trustworthy. So, recoveries were quick after the visits. Sir, the recommendations of the White Paper are commendable. Residents do not need to go to the polyclinics to queue for outpatient services. They can easily go to the family doctors in their neighbourhoods for treatment and follow-up consultations, hence prevent the deterioration of chronic illnesses. At the same time, they can obtain early and proper treatment. In the last session of Parliament, I talked about "the best doctor", that is, prevention is still the best medicine. Therefore, this White Paper is the best form of medical practice. It is farsighted and looks to the future so that Singaporeans can age in place. I hope that under this scheme, residents will have more flexibility to change clinics or GP, if the GP has transferred to another clinic or has left. (In English): Deputy Speaker, Sir, I fully support the excellent proposals in the White Paper on Healthier SG. This preventive care model is yet another step in our journey to help Singaporeans achieve and maintain their best health and live more good years. The proposals in this White Paper will further strengthen the role of GPs in the national healthcare framework. It is a superior strategy and deserves our full support. I have always believed that our family doctors play an essential role in this endeavour. Residents find it comfortable to have family doctors with whom they are familiar with to look after their healthcare issues. I believe it can be technically done to have all GPs to have online access to patients' records. However, we must recognise that there is a need to balance patients' confidentiality and operational efficiency. In addition, I would like to ask the Ministry how will the balance be maintained between need and demand for certain medications.[+7 sentences] Some patients may ask for more than necessary, as generic medications are generally more economical. Will patients be given a choice between new and generic medications? Patients may still find it a burden regarding the choices of new medicines. I hope this plan can be expanded soon to allow residents to visit more than one GP at similarly subsidised rates for the management of diseases. Some GPs may be more experienced and skilled at managing certain diseases. This is because certain GPs may have individual competitive strengths or specialties. Thus, each patient may like to have a principal GP doctor in attendance and be assisted by such specialists upon referrals. Next, may I ask what would happen to the doctors or clinics in the case of uncooperative patients with problems adhering to their healthcare plans?[+4 sentences] I am concerned because the White Paper has stated that this new model will be outcome-based. I hope that the Ministry will not penalise the doctors in charge as these patients should be the ones responsible for their own health. Many GPs clinics, especially those in mature estates, are already overwhelmed with patients. For some popular clinics, the wait for the face-to-face onboarding health consultation may take days to weeks. If the enrolment for particular clinics is always too many for the doctors to cope, how will this be resolved?[+14 sentences] Another concern is regarding the use of Healthhub to choose preferred clinics and enroll in Healthier SG. Will assisted support on-site and via helplines be available at the clinic itself or at CCs? As many seniors are non-IT savvy and some may be illiterate, they will not be able to use the apps after enrolment to monitor their health progress. They may require simple printed materials to do manual recording. This means that the GPs will have to manually key in the progress reports into the available system to enable monitoring. This is additional work for GPs if they have many of such senior patients. For this group of seniors, they will not know how to use apps like Healthy 365, ActiveSG and OnePA to book and pay for activities. They may have to ask the doctors to teach them during their first consultations or even subsequent consultations and this will take up the doctors' time, which could be better used in treating patients. Another concern is about patients who are not enrolled into Healthier SG at GP clinics. The clinic assistant will have to remember to charge correct prices for patients under the Healthier SG and non-Healthier SG schemes. For the popular clinics, the clinic assistants may be overwhelmed, resulting in longer waits for all patients. For residents who do not have chronic diseases to follow up at the GPs, the face-to-face consultation after enrolment via Healthhub will probably be the first and only visit to the GPs under Healthier SG. I doubt anyone with no sickness would want to see a doctor regularly. If a healthy person sees the GP for their first health consultation under Healthier SG or subsequent follow up, will they be given a medical certificate (MC) or memo to excuse them from their work? Will all employers recognise such "excuse sheet", the same as during COVID-19, when employers must recognise ART-positive results as proof? For such residents, the doctor will advise them on appropriate preventive measures as part of their health plans, such as health screenings and vaccinations. The doctor may also make referrals to community programmes.[+3 sentences] I would like to ask if it is necessary for doctors to do social prescriptions for such patients? Will health coaches not be more suitable? With that, I support the Motion.
Mr Deputy Speaker5 words
[+1 sentence]Assoc Prof Jamus Jerome Lim.
Assoc Prof Jamus Jerome Lim (Sengkang)2774 words
[+23 sentences]Not long after I landed on US shores for my doctoral studies – a week after 11 September 2001, as it turned out – I had to confront the behemoth that was the US healthcare system. One of my earliest tasks on arrival was securing medical insurance. Because I was a graduate student, I was enrolled in a plan managed by the university. The amount was non-trivial, especially for a student confronting US dollar exchange rates. But in exchange, I was able to see the doctor at any time without paying any fee, including for routine illnesses, such as cough or fever, while also enjoying fully-paid dental and access to world-class hospital facilities and surgical procedures. I was only 25 then, of course, and like most pre-chronic-condition 25-year-olds, I thought I was physiologically invincible and I would never need a doctor. Still, the insurance plan was mandatory and so I reluctantly signed on. After spending a dozen years embedded in the US medical system, I have come to understand just how painfully convoluted the system was. The University of California healthcare plan, which I had previously been under, was, as it turns out, a relatively good one. In contrast, many plans are far less generous in their terms and costlier to boot. If one were to lose one's job, one would automatically lose one's health insurance – a painful double-whammy of being both unemployed and uninsured. In contrast to my free-of-charge visits to the university health centre, most insurance plans charge a co-pay per visit, which could amount to $30 or $40 – the amount that I would pay out-of-pocket for any doctor in Singapore, even without insurance. Why am I sharing this story? Because I used to think that the Singapore system – where we were assured of world-class medical care at a fraction of the cost – was an amazing healthcare policy success. Singapore managed to contain costs, all while generating impressive and still-improving health outcomes. We appeared to have cracked the code of healthcare financing. At the global level, our healthcare costs do remain admirable, prompting the New York Times to question in a fawning article as recently as 2017, "What Makes Singapore's Health Care So Cheap?" I had often attributed this miracle to a combination of Asian veneration of doctors as a calling, our scholarship-bond system that kept junior doctor salaries compressed for a half-decade out of medical school and the dominance of a largely single-payer, publicly-run, broadly universal healthcare system. But over the years hence, our model has begun to edge ever closer toward the mixed system that characterises the United States and I am not entirely certain that this has been a positive development. Mr Deputy Speaker, I contend that focusing solely on preventative care is an incomplete solution to limiting the demand for healthcare whose persistence has, indeed, been driving prices up. The solution our people face today must go beyond the Healthier SG initiatives, as laudable as they are. Healthcare costs are escalating, are doing so rapidly, and look to continue to do so in the future. Even without greater attention paid to prevention, we must not limit ourselves to outsourcing yet another initiative to the end user without simultaneously tackling issues inherent to the system. Singapore's healthcare financing is often described as resting on three key elements, MediSave, MediShield Life and MediFund, which, together with subsidies, characterise the idiosyncratic Singaporean model. But it is also worth noting that these three vaunted pillars of the system finance only a little more than 8% of total national healthcare expenditure.[+3 sentences] Including subsidies, this increases, but not by all that much. The upshot is that, beyond the 3Ms plus subsidies, we cover a significant amount of expenditures directly out of our own pockets and savings. But even though out-of-pocket expenditures, as a share of total health expenditures, have fallen, the absolute amount we have had to pay has steadily risen. Dollar spending on out-of-pocket expenditures, even after accounting for inflation, has almost doubled over the past two decades from $448 in 2000 to $821 in 2018.[+3 sentences] This eats into our real income gains. Over the period, increases in healthcare costs outstripped inflation at the rate of 2.3% per annum to 1.5%. Perhaps more worryingly, other independent sources peg much faster price increases in the future, between 7% and 10% per annum in more recent years. Every month, Singaporean families spend an average of $323, or 5.5% of their incomes, on health expenses, an increase from 4.9% just a decade ago.[+2 sentences] Such spending was as much as families set aside for education and more than communication, clothing, footwear and recreation. Moreover, this share has been growing for the least fortunate among us. While the highest quintile of income earners devotes 4.8% to healthcare expenditures, the burden on the lowest is more than one-and-a-half times greater at 7.8%.[+30 sentences] While dedicating a little bit more than 5% of each pay cheque to health is surely a wise investment, the concern is that this could continue rising. Spending a few hundred dollars monthly may still be manageable, but this becomes much harder to bear when the amount begins to approach $1,000 every month or more than $11,400 a year. Is this an impossible fantasy? I hope so, but it is worth noting that American households currently fork out an amount comparable annually and they used to pay our current share as recently as 15 years ago. The issues of how informational asymmetries are endemic in markets for healthcare and health financing are well understood by members of this House and I shall not regurgitate them here. The main takeaway is simply that we cannot expect healthcare markets to function in a similar manner to other markets, which necessitates some degree of Government intervention. One important corollary of this result is that while we may very much wish to harness market forces to contain price increases, we need to be very judicious in our application of such mechanisms because introductory economic principles may give rise to counterintuitive and perhaps even counterproductive outcomes. I will document several examples of such outcomes when I deal with potential solutions later in my speech. Another important corollary is that any policy that increases the distance between the patient and the payee may also lead to perverse outcomes because this distance separates agents – patients, in this case – from the cost implications of their choices. This could be on the part of healthcare providers – if doctors are primarily making treatment decisions, with little input from the patient – or from healthcare financiers, if health insurers are defining available options or covering all costs involved, with little feedback from the insured. While some gap is inevitable – I would have no idea how to choose between one treatment regimen versus another – but the more information we put in the hands of patients, the better. The suggestions I will detail also account for the importance of keeping this distance, as far as possible, to the minimum. Moreover, public healthcare often coexists with a vibrant private sector. As the pandemic has reminded us, public health is, in and of itself, a valuable public good. But the private market for healthcare often plays an important complementary role in the overall national healthcare system. In developing countries, the emergence of a parallel private system is what often prevents an outright collapse of overstretched public systems altogether. In advanced economies, the private system can plug gaps in care that the public system is unable to meet. Managing the COVID-19 pandemic would have been much more challenging in the absence of private healthcare. Nevertheless, while there is seldom an "optimal" division of the proportion of healthcare provided by the public versus the private sector, resource limitations in the former usually means that it tends to ration by time, either a longer wait before an operation in a public hospital is scheduled, or a shorter time spent with the doctor at the polyclinic. While the latter, the private system, controls demand by price, which is why one tends to pay for the privilege of speed and attention when seeing a private doctor. These differences are not problematic, per se, as long as we recognise that there are the essential trade-offs. However, we should never allow these trade-offs to become a synonym for quality. Indeed, many of my doctor friends, including those in private practice, suggest that complicated procedures could well be best performed at a public hospital in Singapore, because they are endowed with the latest technologies and tend to see a greater volume of complex cases and, hence, acquire familiarity and expertise in dealing with them. Sir, before I touch on some suggested refinements to the current system, I will stress this at the outset. Promoting competitive forces are often a positive and a means of containing costs. However, we want to exercise care when we apply regulation in service of promoting greater competition. For instance, price fixing or collusion is typically frowned upon, because this allows suppliers to coordinate on a price target, which would otherwise be unsustainable in the presence of genuine competition. But such prohibitions may only make sense when the competitive landscape itself is characterised by few players in possession of substantial market power. When there are many suppliers, coupled with free entry, firms are much more likely to compete on product differentiation rather than price. In this case, even when doctors can freely set prices, excess profits are no longer assured, at least in the long run. Prohibitions on price guidelines, in this case, may merely induce market participants to pursue greater differentiation through the inclusion of bells and whistles, which could paradoxically elevate their costs and in turn, prices charged. Hence, the decision by the Competition Commission of Singapore to prohibit price guidelines issued by Singapore Medical Association (SMA) may make sense insofar as we are looking at a market comprised of a small number of providers. But this hardly describes, in general, the physician market. It would seem to me that regulating the price schedule, per se, with the inclusion of a wide range of representatives, including academics and MOH-appointed doctors and medical professionals, as has been implemented by the MOH fee benchmark, would be better than allowing prices to be completely unmoored from any guidance whatsoever.[+1 sentence] What remains is to have all prices cross-referenced to these benchmarks, so that incentives to adopt them will remain compelling. One approach is to require all physicians post the multiplier of their charges, relative to the benchmark's median.[+3 sentences] Benchmark ranges should also not be to drift too wide. To prevent a proliferation of procedures, fee ranges should be posted just for the most common ailments, not surgical procedures, since the latter are often less relevant to the typical patient. These should be prominently displayed at all registration counters, not just in hospitals, but in clinics and medical centres as well. The upshot of such a move, as the Life Insurance Association (LIA) itself has allowed, is the possibility of removing healthcare provider panels.[+1 sentence] Such restrictions are inherently anti-competitive, since panel membership is restricted by definition. With prices no longer the main criteria for panel membership, non-panel doctors will face more pressures to rein in their charges.[+4 sentences] And as SMA has stressed, panels short-circuit the patient-doctor relationship. To contain cost escalation, insurers can simply agree to pay out amounts between the 40th and 60th percentile, leaving patients a choice. Those who wish to do so may top up any of the excess charges at their own expense. We should also be sensitive to how more players in an industry, especially in health insurance, need not automatically give rise to the most competitive prices. For instance, allowing the exclusion of pre-existing conditions effectively consigns most patients to their current insurer, once such conditions are developed and identified. But if we value the inherent natural justice in taking care of the chronically ill and believe that competition among insurance would work to contain the inevitable increases in premiums, then the Government can resolve the coordination problem by mandating the carrying over of pre-existing conditions, because any insurer would never want to be the first mover.[+11 sentences] Moreover, competition may also be the most effective at containing costs when there is simultaneously a dominant player, in this case, the Government, operating through MediShield Life, who takes on the role of the price setter. This requires MediShield Life to be even more proactive in negotiating and bargaining for lower prices for procedures and medications that it covers. After all, since the 3Ms account for less than a tenth of total healthcare spending, the value of these publicly mandated components of the healthcare system must rest in the ability of the public sector to either coordinate players, or signal the direction that the system should follow. Such negotiated pricing is common in single payer systems worldwide, including Canada, France, Germany, Norway, Sweden and the United Kingdom. Relatedly, MOH should also scrutinise the face value of public charges. There have been anecdotal reports that pre-subsidy prices of some public health providers are now significantly higher than their private sector equivalents. While I believe that the public sector still bills less than the private sector overall, it is important that the regulator keep an eye out for unwarranted public sector charges. After all, when the typical patient will only be concerned with his or her actual, unsubsidised fees, it falls. therefore, on MOH to police price escalation "on paper" since these are benchmarks for the private sector. The Fee Benchmarks Advisory Committee should expand its scope to not just examining the overall fee schedule, but also interrogate any persistent or accelerating divergence in public-private fees. Finally, we should also be cognisant of how actions by the Government, beyond MOH, may contribute to cost escalation. More than one doctor we spoke to stressed that the industry-wide need to raise prices was premised on increases in rental costs at private hospitals and that this elevated benchmark was, in turn, first set by the precedent of Mount Elizabeth Novena. The cost of the $2 billion facility was compounded by the record-setting $1.25 billion land sale on which it sits.[+16 sentences] Here, higher land sales costs have translated into higher medical charges. The need to adapt to rising costs, of course does not fall solely on the medical profession and medical facilities. Insurers often find it easy to pass along costs, which allows them to stack additional layers of paperwork to access insurance payouts. While I am not in favour of interfering with how private firms run their businesses, additional administrative burdens undeniably lead to fee bloat, while also adding distance between the patients and the treatment they receive. Here, the Government can leverage information technology to roll out a central insurance claims system. MediShield Life claims are already directly submitted by CPF at the moment. However, IP claims are still independently processed by the respective insurers, this adds unnecessary steps and increases administrative costs. There is currently an effort underway to develop an integrated claims platform across insurers. Since there is already, presumably, a common claims system for MediShield Life, MOH could enfold this proposed claims platform under the same umbrella, into an expanded, public-private partnership platform. Mr Deputy Speaker, I understand that the complexity of healthcare has made this speech more involved than usual. But my bottom line is simple, we allow the private system to grow, sans public sector leadership and strong regulatory guidelines, at our peril. My actionable takeaways are that we include greater cross-referencing of prices to benchmarks that are limited in range, that we allow insurers to pay out within this narrower range. And if we believe in the justice of covering pre-existing conditions, the Government should play a coordinating role in mandating such coverage. Government should be more proactive in bargaining for lower prices for procedures currently covered under MediShield Life, while also auditing excessive discrepancies between public-private fees. And as the price increases in other inputs, such as real estate, should be managed, since this can spill over into healthcare costs. I am sure we have all heard stories of how we have experienced long wait times for admission into our hospitals lately. Data released by MOH suggest that the median waiting time could have been almost 24 hours.[+3 sentences] The Ministry takes the question of wait times seriously, yet researchers from the Saw Swee Hock School of Public Health note that despite "measures to reduce waiting times… the problem and the concern persists." I will conclude, Mr Deputy Speaker. I see your trigger-happy finger —
Mr Deputy Speaker33 words
[+2 sentences]My finger is not trigger happy. I was just going to remind you that you have nearly breached your 20 minutes full complement, that is your right; so, could you wrap up, please?
Assoc Prof Jamus Jerome Lim39 words
[+1 sentence]Thank you. My fear is that such waits are but a foretaste of what an overstretched public health system, forced to operate alongside a parallel private system with only light regulation, could yield.[+1 sentence] That said, I support the Motion.
Mr Deputy Speaker4 words
[+1 sentence]Mr Yip Hon Weng.
Mr Yip Hon Weng (Yio Chu Kang)1612 words
[+6 sentences]Mr Deputy Speaker, Sir, I support this bold initiative to promote preventive healthcare. This White Paper has naturally gotten a lot of attention amongst my senior residents and GPs in Yio Chu Kang, which is a mature estate. Having spoken with them, I would like to raise feedback on several areas. First, Mr Deputy Speaker, Sir, I will discuss Healthier SG from my residents' point of view. My residents are generally happy with the Healthier SG benefits. Notwithstanding, there are a few concerns. First, can a patient, who has already enrolled with a family doctor, consult other GPs and still enjoy Healthier SG benefits?[+4 sentences] I would like to highlight. TCM treatments. Many patients also like to get a combination of Western and TCM treatments for their ailments. Some elderly patients prefer to get regular acupuncture treatments at registered TCM clinics for their aches and pains, rather than to rely on pain medication. Will the Government take this opportunity to review how we involve TCM practitioners in community preventive healthcare, especially, since acupuncture is also offered in our restructured hospitals?[+11 sentences] Second, how will compliance and success be measured? Measuring health is unlike exercise, where we can determine participation and progress through counting the number of steps taken, heart rate and so on. How does the GP and the wider healthcare system assess adherence and compliance? How do we measure the impact on the individual at the personal level? For patients who refuse to follow the prescribed health plan, how can we then determine whether the overall programme is effective, or even whether the GP is proficient? Having a good number of sign-ups is a favourable start. However, this does not necessarily guarantee in-depth participation. What is more important would be compliance to a single GP or the Primary Care Network (PCN). How do we discourage the practice of GP hopping? Will there be penalties for either the patient or GPs? Is this a key performance indicator and who is it directed to? Third, can we speed up the implementation of Healthier SG to residents under 60 years old?[+17 sentences] I believe we should be more ambitious, especially considering that chronic illnesses can start in the 40s. One way to do this is by allowing family members to enroll in the programme together with the senior. For example, if an individual is 60 years old and his wife is younger by a few years, can they both enrol at the same time? This ensures better compliance. They can motivate and accompany each other for consultations and screenings, and adhere with exercise plans. Mr Deputy Speaker, Sir, I now move on to what Healthier SG means for GPs. Our GPs have been very helpful with our efforts to build a dementia-friendly community in Yio Chu Kang. They shared with me some useful insights on Healthier SG. First, how adequately are our GPs trained in managing chronic diseases? A GP who wants to manage more complex health problems must begin their training from medical school. In big countries like Australia, there may only be one doctor serving one or even a few towns. The GPs there are trained through medical school and postgraduate courses, with the expectation that they will function as the only doctor in the town and would, therefore, be equipped as such, with skills spanning from common ailments to more complex chronic conditions. In Singapore, because of how accessible our tertiary healthcare institutions are, many of our GPs focus on common ailments and function as referrers for more complex and serious conditions. Second, how many GPs are enrolled in our PCNs? This may give some insight on GPs' willingness to participate in Healthier SG. Do we have the majority of GPs on board the PCN initiative? What more can we do to get their buy-in to provide effective care in the neighbourhood? Third, will the cost of ancillary services be subsidised by the Government so that it is on par with those provided by tertiary healthcare institutions?[+20 sentences] The Government has gone to great lengths to reassure us that the drug cost parity between prescriptions from GPs and polyclinics is reduced. Will this be done through restricting the brands of drugs brought in? What happens if a patient opts for "branded medication"? As drug sales constitute a large part of GPs' incomes, how will drug cost parity affect a GP's willingness to sell generic drugs? Does this also extend to the cost of ancillary services, such as blood tests, X-rays and other related services provided by GPs? The White Paper also mentions a team-based care approach. Will this be similar to the PCN where backend support for care coordination and other ancillary services are provided to the GP? Would GPs have to hire additional manpower or to pay for these services? Fourth, how many more staff are required to deal with the additional administrative workload and to handle social prescription? Under Healthier SG, we expect GPs to provide advice on lifestyle and dietary activities but such social prescriptions can involve a longer consultation session and probably over an extended duration of time. In the meantime, GPs still have other patients' ailments to tend to. Can the GP count on the care team to help out or will they have to hire additional staff if they are unable to manage? This is more so in solo practices and goes back to my previous point on getting more GPs to join PCNs. In tertiary healthcare institutions, typically, you would have a nutritionist speak to a patient on diet and then there will be other healthcare professionals and programmes to deal with smoking cessation, weight loss and so on. With many GPs still practicing solo, would they have the time and resources to do so? In Australia, GP visits are by appointments. This gives them adequate time to holistically review a patient's clinical and lifestyle needs, including making adjustments. In Singapore, it is, generally, a numbers game. The more patients a GP sees, the more money a GP makes. It would only be natural that the GP would want to earn more by seeing more patients. Fifth, will the annual fee for providing care for enrolled patients be extended beyond CDMP conditions?[+2 sentences] This could include frailty and mobility issues, which are common with old age. Delaying the onset of such problems is critical in preventive care and will greatly help to improve the quality of life. Sixth, I hope that under Healthier SG, GPs can be incentivised to start end-of-life care planning with their patients.[+5 sentences] This includes encouraging them to do Advanced Care Planning, or LPAs, at the opportune time. These conversations are best started by people like GPs who know the patient best and ideally understand the patient's family and social context. It is these meaningful conversations that may need to take place. It is not so much to "bend the cost curve", though it might, but it helps people prepare for the inevitable and for families to be at peace with their decisions. Lastly, Mr Deputy Speaker, Sir, I will now talk about the role of community care providers in Healthier SG. Can the Ministry clarify whether screenings under Healthier SG are primarily done by GPs or Eldercare Centres (ECs)?[+6 sentences] The White Paper mentions leveraging on physical spaces in ECs to conduct activities like health screening, early detection of dementia risk and other healthcare initiatives for seniors. Yet, GPs are also expected to conduct screenings. What is the envisioned eventual end state? Regular opportunistic screening systems may make screenings more widely accessible. However, they could be confusing and overlapping in intent, thus resulting in excess costs. In conclusion, Mr Deputy Speaker, Sir, Healthier SG is a paradigm shift. The Government's Population in Brief report was released last week.[+16 sentences] It shows that Singapore continues to grapple with long-term issues, such as low total fertility rate and the ageing population. The responsibility of caregiving for older family members will rest on fewer shoulders. If all of us can take better care of ourselves and be more independent in our silver years, we can help to reduce this caregiving responsibility for our loved ones. At the systems level, this means reduced fiscal funding on healthcare so that the money can be better used in other areas. But what matters most is for the individual. I recently spoke with Mdm C, a senior living alone in Yio Chu Kang. I often see her around in the neighbourhood. Most of the time, I see her at the weekly exercise class in the park or at the market after her exercise for her breakfast with her exercise kakis. I asked her what she thinks is a good life. She told me that, being in her 70s, she does not ask for much. She said as long as she can eat well, sleep early, exercise and meet up with her neighbours and her friends, she would have lived a fulfilling life. With the benefits of Healthier SG, such as having an assigned GP who knows her well and having a proper health plan to keep healthy, I am certain she will be active and can enjoy her silver years for many more years to come. The focus should rightly be on health and not on healthcare, and to stay healthy in the community for as long as possible and not in the hospital. As such, I would like to take this opportunity to encourage all eligible residents listening in to sign up with Healthier SG as soon as the opportunity avails. Let us all do our part to take responsibility for our own health and build a healthier Singapore. I support the Motion.
Mr Deputy Speaker4 words
[+1 sentence]Miss Cheng Li Hui.
Miss Cheng Li Hui (Tampines)1399 words
[+3 sentences]Mr Deputy Speaker, I stand in support of the Healthier SG White Paper. Sir, allowing our GPs to play a bigger role in our healthcare system is something close to my heart. In my Budget speech in 2016, I brought up coordinated care, about GPs playing a more prominent role in the overall well-being of our people. Eighty percent of our GPs are in the private sector and only 20% of them are in polyclinics and hospitals handling 80% of our population.[+28 sentences] I was told the ratio has improved since. I hope that with the focus on primary care, we can look forward to stronger GP-patient rapport. COVID-19 has showed us the importance of reducing our load on public healthcare institutions. Trust and rapport are implicit in healthcare. Often, this trust overlaps generations and is passed between family members. This trust transcends doctor and patient and goes into areas of digital privacy. In my 2016 speech, I mentioned I was surprised to see the GP in Australia pull out the x-ray and surgical records of the next patient from his computer and it really made me ponder on the importance of coordinated care. The availability of our healthcare records will empower our GPs to make informed care decisions for us. We need to trust our doctors with the data and that the systems that hold our healthcare records are safe from bad actors, hackers and lapses. In 2016, I also mentioned that isolation is one of the biggest problems for seniors. During the pandemic, due in part to the Seniors Go Digital programme, many seniors learnt to harness the power of technology and stay in touch with their loved ones. They were taught communication skills like video calls, connecting to WiFi and basic cybersecurity. These have helped thousands of seniors remain connected and engaged through the most difficult times of the pandemic. We should continue with the momentum to enrich their lives for them to stay connected, not isolated and yet not addicted. There is a small issue of addiction to gadgets which may aggravate isolation. Some of you know I am very close to my nephew. I am very conscious about children's gadget time. I am even more concerned about my senior residents' gadget time. Many of them have learnt to download movies and dramas and are hooked to them. My volunteers and PA staff work hard to create programmes to draw them out of their homes to have a healthy and active social life. Programmes must be targeted at pre-retirement age so that they will continue their active social life post-retirement. For the not so socially active seniors, I was heartened to read The Straits Times article on 28 September 2022 on retired timber worker Lim Thiam Teng who warmed up to volunteers and is now an advocate of care centres. Sir, I have spoken several times in this House on our Tampines East three-in-one centre. The auntie who started walking to the centre before she went blind so she could familiarise herself with the route. Her meals were provided for in our centre and she could listen to the news in the afternoon, amidst other activities. The auntie who no longer needed plasters after daily exercises at the centre. She also found someone there who loves singing Cantonese songs like her. Most recently, we had our youngest dementia client in her early fifties. We could feel the increasing need for more senior care centres. I am delighted to read that MOH has plans to increase these centres.[+29 sentences] These allow our elderly to age in place, with their family and in familiar surroundings. I remember my first referral as a new Member of Parliament. During our regular house visit, the auntie said the flat is occupied by her and her husband who had suffered a stroke. For the past seven years, she was his only and main caregiver. I asked her if she was okay and the tears just rolled. She said, "Okay. I am tired. I cannot even go to the market for too long." Her eyes brightened up when I explained the respite services at our day care centre. She was happy she could get a couple of days off to go and meet her friends and have a walk, just like she used to. I was reminded of its importance of care centres during the pandemic when a resident approached me at a Tampines East vaccination centre. She said, "My brother-in-law is in your centre. He has dementia. It was so hard for us when the centre was closed. The day before opening, we told him. He seemed to understand and was in a good mood and went to bed readily. The centre is a great help to our family." Often, our mild dementia patients, our clients, will call me "teacher" and say they will go back and tell their "parents" about their day. I am not sure if they would remember to but we go with the flow on good days and manage their bad days. I want to take the opportunity to thank all day care and nursing home staff for their contributions to the many families. It is not an easy job. It is a calling. Sir, I had mentioned senior day care centres allow our elderly to age in place. Recently, a dementia client was supposed to be discharged from our centre. Her daughter cried when she picked her up on her last day at the centre. They were supposed to check into a nursing home that weekend as her condition has deteriorated. However, she was back on Monday. It is hard for some to send their loved ones to a nursing home. They will try and manage with some help from the Government. With more understanding of how senior day care centres work, the lower cost involved, I believe more families will be willing to have their loved ones in day care rather than nursing homes when they are still able to handle. We need to get our GPs to come on board to be a coordinator of care for the elderly and the Primary Care Networks (PCN) under Healthier SG to play a bigger role in our elderly care centres. We can engage our neighbourhood doctors who know their clients well to educate or refer them to day care facilities.[+2 sentences] Our Tampines GP, Dr Leong, even contacted us when he had extra flu vaccines that had some months left to expiry for us to ask our staff and clients if they would like to take the flu jab for free and many did. So, while some families hire caregivers and have helpers to multitask with housework, children and seniors, it lacks the exercise and activity elements that senior activity centres or day care centres provide. How can we further attract, train, support and retain the staff of these centres to take on the expanded roles as envisaged by Healthier SG?[+9 sentences] Sir, In May 2016, the PAP Women's Wing made a trip to Hong Kong. One morning, we visited their senior day care centre. I decided to spend the day there and what struck me was the heart and effort the staff put in in caring for the elderly there. For instance, one staff tried to feed a resident using a spoon. She tried three times before she switched to tube feeding. She explained that she did that so that the resident would still retain her ability to swallow and not just rely on tube feeding, which will aggravate her decline in her physical state. When the day ended, their families picked them up in a trolley sort of wheelchair as they could not sit up straight. Some thoughts went through my mind such as – with this condition here, they will be in a nursing home or with a dedicated caregiver at home. Was it a lack of nursing home? What kind of training or qualifications are needed for some of the staff to manage clients with such chronic conditions? Will we see our daycare progressing to handle more chronic conditions? We will need a well-coordinated strategy that takes into account public health, sustainability, resilience, training, trust and our ageing population.[+2 sentences] Several of these topics are intertwined and the White Paper has done a good job in articulating these areas to address. Sir, I support the White Paper.
The Senior Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam)1469 words
[+14 sentences]Mr Deputy Speaker, Sir, we all want to be healthy, but with many competing demands in our hectic lives, it can be challenging for us to do so. This is why, as part of the Healthier SG strategy, it is important to build an ecosystem and rally the community as part of that ecosystem to facilitate healthy living, making it easier for us to make better, healthier choices. Today, I would like to address various Members' questions related to preventive health and encouraging healthy lifestyles in the community. Our efforts can be summarised with the acronym "HEALTH". "H" for harnessing existing health initiatives, "E" for enhanced suite of health programmes, "A" for active collaboration with community partners, "L" for looking out for caregivers, "T" for tracking health activities via technology, and the last "H" for health-related lifestyle nudges. Let me elaborate on each of these in turn. The first "H" is for harnessing existing health initiatives. Currently, there are a wide range of national initiatives to support us in adopting and prioritising healthy living. To promote physical activity, there are self-directed programmes such as the National Steps Challenge – where you can participate at your own pace anytime and anywhere – to virtual or on-ground MOVE IT leisure-time physical activity programmes for those who prefer guided exercise sessions. Good nutrition is also a key component of living healthily and we actively encourage Singaporeans to adopt a healthier diet, particularly by reducing sugar and salt consumption. Ms Hazel Poa and Ms Sylvia Lim had spoken about this earlier, in particular about improving affordability of healthier food choices. Ms Hazel Poa had gone so far as to suggest taxes on unhealthy food. Mr Xie Yao Quan had sought clarification from her yesterday during his speech so the specifics of her proposals are not clear. In any case, let me share about our ongoing initiatives. To reduce the intake of sugar, beverages sold in Singapore in prepacked form and from automatic beverage dispensers will be subject to new Nutri-Grade labelling requirements and advertising prohibitions from 30 December 2022. Similar measures for freshly prepared beverages will come into effect by end of 2023.[+1 sentence] Some of you may also have heard that we are working with retailers to introduce lower-sodium alternatives which are healthier than regular salt. In fact, supermarket chains FairPrice and Sheng Siong will start selling lower-sodium salt products starting from this week.[+6 sentences] In addition, HPB supports food manufacturers and suppliers to develop healthier products through the Healthier Ingredient Development Scheme (HIDS), and partners food and beverage establishments, including hawker centres and coffeeshops, to offer healthier meal options. HPB also works actively with supermarket chains to introduce more Healthier Choice Symbol (HCS) products to increase the variety of HCS house brand products which are typically more affordable than branded alternatives. MOH also has a multi-pronged strategy to reduce the prevalence of use of tobacco products. In his speech, Mr Sharael Taha highlighted the issue of vaping. To address the use of vaporisers, we are working with various partners to strengthen enforcement measures and public education efforts. We will step up enforcement at borders, social media platforms such as Telegram and public areas. MOH and MOE are also working together to address vaping in schools. These efforts will be complemented by the roll out of a vape-free campaign in 2023 targeted at youths and younger adults through popular digital platforms, to communicate that vaping is harmful and illegal.[+19 sentences] These are just some of the many initiatives we have and I am happy to note that they have impacted the lives of our residents. One such resident is 84-year-old Mr Louis Loh. Diagnosed with diabetes 10 years ago, Mr Loh remained largely sedentary. He only grew more motivated and began exercising regularly after joining National Steps Challenge Season 4 in 2018. Brisk-walking became his everyday routine and this enabled him to accumulate a daily average of 60 minutes of moderate-intensity physical activity. Keeping active has helped Mr Loh achieve a healthier body mass index (BMI) after losing about 10 kg in the last three years and his health conditions are now better managed and controlled. Mr Loh's improved health outcomes have encouraged him to keep to his walking regime even outside the Challenge. Today, he continues to track his daily physical activity for the benefit of his health. Another example is 63-year-old Madam Rahimah. When her family members were diagnosed with diabetes and hypertension, she realised the importance of having good health and decided to take steps towards a healthier lifestyle. To encourage healthier eating habits, Madam Rahimah cooks healthy meals at home and packs them for her children to bring to work. The HPB's Healthier Choice Symbol made it easier for her to choose healthier ingredients and the information on how to cook healthier meals have also been useful. She opts for wholegrains such as brown rice and brown rice bee hoon. When making desserts like "bubur kacang" for the family, she uses low fat milk instead of coconut milk. In her cooking, she uses healthier oil and includes more vegetables, as well as using healthier cooking methods such as grilling and stir-frying instead of deep frying. Besides eating healthily, Madam Rahimah also incorporates physical activity in her daily routine to stay active. Madam Rahimah has noticed a big difference in herself ever since she started to lead a healthier lifestyle. She is more energetic and does not feel tired easily. Mr Loh and Madam Rahimah took ownership of their health and harnessed existing health initiatives to improve their lifestyle. Through Healthier SG, your family doctor will support you in this journey, managing your health holistically and guiding you to develop a personal Health Plan.[+3 sentences] This includes not only recommended health screening and vaccinations, but also lifestyle adjustments. Your doctor can also recommend existing health-related activities and services in your community that will be suitable for you. Second, "E" refers to enhancing our existing suite of health programmes. Under Healthier SG, you will be able to easily identify programmes suitable for your health status and sign up for these programmes more conveniently through one app, Healthy 365.[+7 sentences] We will collate community partners' programmes and house these on the Healthy 365 app over time to cover the range from self-directed programmes to targeted weight management interventions for residents with well-controlled chronic disease and practical nutrition workshops on preparing a well-balanced healthy meal. Mr Xie Yao Quan called for a wider variety of community programmes so that every local community is abuzz with exercise groups and health-promoting activities, catering to different needs. We do want a vibrant and robust slate of programmes but not all programmes need to be HPB- or MOH-driven programmes. To optimise resources, we will have to channel resources towards programmes that are well-received and impactful. However, we encourage community partners to play a part in this. It is heartening therefore, to hear Ms Hany Soh share about the ground-up initiatives in her constituency. Ground partners can supplement existing health promotion efforts and programmes, and I would like to thank Ms Hany Soh for her ideas in this area. To encourage more residents to champion their interest groups and support Healthier SG, HPB provides our Healthy Singapore Fund for individuals or organisations to self-organise activities that meet their communities' needs.[+5 sentences] We hope these efforts will continue to bloom and add to the existing suite of offerings that residents can tap on to sustain healthy lifestyles. I would like to assure Mr Edward Chia that we will continually explore ways in which private sector partners can play a role under Healthier SG. For example, we will explore how a more comprehensive range of physical activities may be made available to residents across the island through collaborations with private partners such as physical activity providers. HPB's Healthy 365 app will be the lifestyle application that you can use to easily access lifestyle programmes offered by community partners near you. I agree with Dr Tan Wu Meng's and Ms Denise Phua's comment on the need to assist seniors or those who are not digitally savvy. For those who need help navigating the programmes, there will be support provided, such as through the Eldercare Centres and Community Centres.[+5 sentences] With these features in place, you will be able to easily access and select suitable programmes that support your health and lifestyle goals. Next is "A" for active collaboration with community partners. Over the years, we have worked closely with the community to extend our preventive health efforts. One example is the formation of the Malay Community Outreach Workgroup (MCO), which comprises of Malay community leaders with wide ranging experience, including PA MESRA, MUIS, Mendaki under the M3@Towns committees, and Muslim Health Professionals Association (MHPA). At this point, please allow me to say a few words in Malay.
Mr Deputy Speaker1639 words
[+3 sentences]Please do. (In Malay): We have been working closely with the mosques for several years, to encourage congregants to lead an active lifestyle through the JKJU programme (Look After Your Health, Look After Your Community). HPB will continue to expand the JKJU network by involving more organisations apart from the mosques to develop healthy lifestyle programmes and culturally-nuanced healthy lifestyle messages for the Malay community. Recently, we have also launched the "Saham Kesihatan" (Health Investment) initiative, a collaboration between HPB and community organisations, including M3@Towns, ActiveSG and the People's Association (PA).[+2 sentences] This initiative aims to encourage more Malay/Muslims to stay healthy through community-led interest groups. These groups can design their own local health programmes by leveraging on the various healthcare facilities and services provided by community bodies and Whole-of-Government organisations. The pilot "Saham Kesihatan" programme was launched in M3@Jurong and M3@Tampines.[+17 sentences] We hope to nurture at least one community-led interest group in every M3@Town. We will also continue to enhance existing programmes and support the Malay community with various health programmes, to encourage them to lead a healthy lifestyle. (In English): In her speech, Ms He Ting Ru touched on the gender health gap for women. The feminisation of ageing is a well-recognised phenomenon, where women face a greater risk and duration of loneliness as those who are married tend to live longer than their husbands. They also have greater financial insecurity than men and carry a greater budget of the challenges and stresses of caregiving. MOH is cognisant of these concerns. In fact, I chair a Women's Health Committee which comprises community partners championing for women's health issues. Together with our partners, we will continue to increase the awareness of women's health issues and promote healthier lifestyle practices amongst women. Sustained education efforts and support for women is important in addressing this long-term phenomenon. The efforts of the Committee will complement Healthier SG in supporting women in their preventive health journey so that they may live longer, healthier. I agree with Ms Ng Ling Ling's point on the importance of adopting a community participatory approach under Healthier SG and this is in line with our plans. Under Healthier SG, we and our healthcare clusters will continue to work closely with agencies to explore these suggestions and we look forward to the support of all our partners to achieve the vision of Healthier SG. Moving on, we have "L" which stands for looking out for caregivers. As we seek to empower fellow Singaporeans to stay healthy, we recognise that some of our seniors are already frail, living with dementia, or approaching end of life. These seniors and their caregivers also need our support. Second Minister for Health, Mr Masagos Zulkifli, will speak more about our commitment to enabling seniors to live and age well in the community. Over the years, we have enhanced our support for caregivers, with a range of initiatives under the Caregiver Support Action Plan and the White Paper on Women's Development. If you are a caregiver, there are a range of care options to help ease your burden, such as the Dementia Day Care and the Night Respite Care pilot to help caregivers of persons living with dementia, and home-based respite care for caregivers of those approaching the end of life. We will also provide more help to ease caregiving costs, with an enhanced Home Caregiving Grant in 2023.[+7 sentences] Ground-up community efforts can also let caregivers know that they are not alone in this journey. For example, peer support networks under the People's Association's WIN Caregivers Network and Project 3i empower caregivers to learn skills and receive social-emotional support. We recognise that caregivers also need even more support as their loved ones approach the end of life. Palliative care comes in here to provide not just physical, but also emotional, psychosocial, and spiritual support to patients and their families. I would like to encourage caregivers to join and benefit from these initiatives. In their speeches, Dr Wan Rizal and Ms Hany Soh touched on enabling caregivers to better support their loved ones. Currently, nominated caregivers can already conveniently access the health records and appointments of their loved ones in HealthHub. Next year, caregivers will also be able to use HealthHub to help their loved ones enrol to Healthier SG.[+7 sentences] I would also like to acknowledge Ms Janet Ang's point on leveraging digital technology to engage caregivers and we will continue to work with partners to engage caregivers through various channels, including digital channels. So far, I have covered how the Government and community can play a role in supporting our healthy living journey. For my last two points, I will cover how technology can be used to empower and motivate you to take charge of your own health journey. The letter "T" is for tracking of your health activities. In between visits to your family doctor under Heathier SG, you can access relevant, up-to-date advice via the Healthy 365 app and the HealthHub app on your personal devices. Healthy 365 enables easy tracking of different lifestyle behaviours such as physical activity, healthier food purchase and consumption. You will also be able to share your lifestyle data by showing the app to your family doctor, enabling the doctor to have a holistic view of your progress and discuss what lifestyle goals and programmes can help you. In addition to monitoring of physical activity, sleep and healthy food purchases, the Healthy 365 app will be enhanced with new features, such as diet logging. The diet logging tool will help you easily monitor and be aware of your daily caloric intake from food and drinks consumed, so that you can work towards achieving your daily recommended caloric intake. This tool will have a photo recognition function, that Minister described, so that we can simply take a picture of our meal, which could comprise of local food and drinks, such as chicken rice and kopi-o, for the app to estimate the caloric intake.[+10 sentences] There will also be ways to support those who are not digitally fluent, for example, by enabling patients’ caregivers or family to assist. Finally, the last “H” refers to health-related lifestyle nudges, personalised recommendations and rewards to sustain healthy behaviours. At the heart of Healthier SG is empowering residents to choose health for themselves while the system supports them. We know that lifestyle behavioural change is a long-term journey requiring both strong motivation and regular participation. While we may interact with our family doctors once every six to 12 months and participate in community activities a couple of times a week, personalised recommendations and nudges delivered via digital technology can be a constant support to help us stay engaged on our healthy journeys. We will enhance Healthy 365 to deliver more personalised nudges, such as through recommending suitable lifestyle activities, achievement of health goals and improving adoption of healthy lifestyle behaviours. Many private companies have been developing such technologies and some have built deep expertise in nudging health behaviour change. We will continue to explore collaborations with them to harness technology and insights to help us all take better ownership of our health. We have also made healthy living rewarding with HPB Healthpoints. You can earn Healthpoints under programmes, such as the National Steps Challenge. You will also receive Healthpoints after enrolling and completing the first consultation with your enrolled family doctor.[+13 sentences] We will continue to improve on this and encourage all of us as we choose better health. With Healthier SG, it will be easier for everyone to start and sustain healthy living. Let me share a fictional example of how your health journey can look like. Madam Anna, a 60-year-old resident in Jurong, meets her family doctor to discuss her health plan after getting her screening results. As Madam Anna is overweight and has high blood pressure and pre-diabetes, her family doctor recommends that she attends the “Live Well Age Well” programme to stay active and pick up nutrition tips to avert diabetes. Madam Anna can scroll through the Healthy 365 app to find the “Live Well Age Well” programme nearest to her friend, so that they can attend together. She is also automatically registered for the “National Steps Challenge” and “Eat Drink Shop Healthy Challenge” where her daily healthy lifestyle activities help her earn Healthpoints to exchange for vouchers. The Healthy 365 app will also remind her to clock more steps, complete more moderate to vigorous physical activity (MVPA) minutes and offer other suitable activities to add variety. During Madam Anna’s next half-yearly check in with her family doctor, she proudly shares that she has become more active and has reduced her caloric intake by using the Healthy 365 diet logging tool to monitor her meals. The family doctor notes that Madam Anna has lost two kilogrammes in the past six months. Her high blood pressure is also under control. If Madam Anna continues to sustain her healthy lifestyle and manage her chronic condition well, the family doctor may consider reducing her regular medication at her next health consult. Although Madam Anna is a fictional character, as demonstrated by Mr Loh and Madam Rahimah in my earlier example, it is possible to start and sustain a healthy lifestyle and Healthier SG would make it easier for you to do so. Enrolment for Healthier SG will start in the second half of 2023 for those aged 60 and above.[+4 sentences] In the meantime, you may download and explore HealthHub and Healthy 365 to access a wide range of preventive health resources and programmes. Healthy living starts with you and me. Thus, as the Government strengthens support for preventive health under Healthier SG, I would also like to urge all of us to make a conscious decision to invest in our health. Let us strive towards living healthier and better lives.
Mr Deputy Speaker4 words
[+1 sentence]Ms Tin Pei Ling.
Ms Tin Pei Ling (MacPherson)1097 words
[+2 sentences]Mr Deputy Speaker, in Mandarin, please. (In Mandarin): As the saying goes, "prevention is better than cure". This wise and well-known quote is apt to describe the Healthier SG White Paper. It also represents a major turning point in our public healthcare policy.[+14 sentences] Singapore's public healthcare system has always placed a greater emphasis on treatment. From the allocation of Government funds to services provided by civic organisations, there is a clear bias towards the treatment of patients. This is a passive model. Even in the eyes of the general public, to be a specialist is better than a general practitioner. This attitude inadvertently affects the choice of students when they choose their course of study, hence has an impact on our talent supply. It also affects the perception of the public with regard to public healthcare. Of course, when people are sick, we have to treat and take care of them. Like a parent, the Government should not only provide quality medical care for Singaporeans, but also give subsidies to reduce the financial burden from medical expenses. Against the backdrop of an ageing population, it is even more important for the Government to provide quality and affordable healthcare. However, when people fall ill in their twilight years, they may find it hard to enjoy life even if they own a mountain of wealth. Hence it is often said that health is wealth. Because if you are healthy, you will have the energy to travel around, play with your grandchildren, pursue unfulfilled dreams and scale new heights in life. In this way, seniors will not be counting down to the end of their lives, but will be anticipating every new day. Of course, from a long-term point of view, preventive public healthcare will only bring benefits. First, although we are a rapidly ageing population, the increase in public healthcare expenditure can be slowed down and the burden on future generations will also be lightened.[+20 sentences] Second, good health helps to improve our quality of life, and a good quality of life helps to improve our happiness index. Third, a healthy and strong population means a prosperous country. With good health, one need not fear about the future. Earlier, I heard Assoc Prof Jamus Lim's speech and I have some doubts. I would like to take this opportunity to seek clarifications from him. He talked about listing out consultation fees at private clinics. I believe benchmarking fees against market standards and listing out consultation fees at private clinics are already in practice. Is he looking for greater transparency or better consistency of consultation fees? Second, he talked about MediShield Life. From what I heard he seemed to suggest that more medical services be included in MediShield Life. Can he elaborate on what additional medical services he is thinking of? Today, we are debating the White Paper, does he expect that certain preventive care services be included in MediShield Life? If so, how will that affect the premiums of MediShield Life? How do we help Singaporeans deal with the increase in premiums? Can Assoc Prof Jamus Lim clarify on these points? My general feeling after listening to Assoc Prof Lim's speech is that he still plays a greater emphasis on treatment, but the Healthier SG White Paper is focusing on preventive care. I would like to seek his clarification. Does he also agree that the preventive medicine is better than curative medicine? In the long term, I feel that preventive care is a better option. Now, I would like to return to my original speech. To move Singapore's health focus from treatment to prevention is necessary. However, in my view, the key to realising the vision of the White Paper lies in getting the people's genuine buy in.[+14 sentences] Bai Juyi once said, "feel how other people would feel with your own body and heart". When we rollout Healthier SG, we must pay attention to both the body and mind. Policies play a facilitating role. At present, if we ask Singaporeans whether they should live healthy lives and take preventive care, the answer must be "yes". Ask if they support it, the answer will surely be "yes" as well. But how important is it to them? And whether they will translate it into action, the answers are not so clear. In fact, unless we are sick, we tend to have the mindset that "it will not be me". Health checks or healthy dietary habits are often not on the agenda. Hence, in the White Paper, it is right to emphasise the role of GPs in inculcating good habits among Singaporeans. Building on the existing CHAS network, I hope that all GPs will heed the call and join the Healthier SG initiative to benefit more Singaporeans. For these reasons, I support the Healthier SG White Paper. The White Paper's analysis is meticulous and the measures put forward are suitable. But I have two questions. First, as the existing recreational facilities, community partners and health activities in each estate are not uniform, how does the Government intend to work with various Government agencies and social organisations to ensure that each estate has a basic package with sufficient space and budget, customised according to the needs of the estate?[+6 sentences] For example, in some mature estates, there may be more elderly people living alone who are old, frail and financially disadvantaged. What they need is not just recreational activities, but also social and financial support. How can the Government ensure that every community, whether it is old or new, rich or poor, provides equal services? After all, one can get chronic illnesses regardless of one's status. But one's financial ability affects one's choice in life. Second, I am happy to see that the Government agrees with the importance of mental health. In the White Paper, care protocols are mentioned to enhance the consistency of GPs in the care of chronic illnesses.[+5 sentences] I hope that the Government will also step up its efforts in the mental health area. Singapore is a high stress environment and mental health cannot be ignored. During the pandemic, many older Singaporeans have become accustomed to staying at home or avoiding the crowds because they have lived at home for a long time. This inevitably aggravates the psychological challenges that they face. So, I think mental health is an issue that we have to deal with sooner rather than later. Can the Government introduce mental health care with the "three highs" care protocols? Overall, the intention of the Healthier SG White Paper is clear and should be supported.
Mr Deputy Speaker20 words
[+4 sentences]Assoc Prof Jamus Lim. I understand that it is a reply to the clarification asked of you. Yes. Please proceed.
Assoc Prof Jamus Jerome Lim309 words
[+6 sentences]Thank you, Mr Deputy Speaker. And thank you that I got a little more air time today. I will just quickly point out in response to the two specific questions that were raised by Ms Tin Pei Ling. The first was Ms Tin suggested that I was saying that more fees should be published, right? This is not, in fact, what I said. I appreciate that I spoke quickly. What I said was that we should publish more of a multiplier of existing charges. If anything, I think that we do not need to publish all the fees in doctors offices, per se. We should publish it as a matter of course in literature, but rather, we should allow the multiplier of fees to be published so that the consumer is aware of how much more or less expensive their doctor may be relative to the benchmark.[+2 sentences] The second point, Ms Tin mentioned about what I was suggesting be included into MediShield Life in terms of procedures that were not covered. Again, I think she may have misheard what I said. What I said instead was that MediShield Life should be a lot more proactive in negotiating for price setting. And that is important because MediShield Life is, in fact, one of the more prominent insurers in the existing market.[+3 sentences] Finally, I should clarify that while I did focus my speech indeed on elements of cost pricing from the supply side, I also explained why I did so. The reason is preventative care – which is, of course, the focus of this Motion – is insufficient if we wish to contain costs. We have to address the demand side, in terms of how much people are demanding medical care but also address concerns from the supply side, those insurers as well as medical providers that are providing said care.
Mr Deputy Speaker12 words
[+2 sentences]Ms Tin Pei Ling, is there a response? No. Mr Mark Chay.
Mr Mark Chay (Nominated Member)1428 words
[+7 sentences]Mr Deputy Speaker, on the onset, I would like to declare that I am the President of Singapore Swimming Association and a director of two private education institutions in the business of certifying and accrediting sports coaches and fitness professionals. Please allow me to congratulate the Health Minister as well as the team at MOH for this progressive strategy. The shift from being a reactive to a strategy that promotes preventive healthcare makes perfect sense. Quite frankly, it is high time that we make this move. I would like to address three matters related to the White Paper: on engaging with the sports, fitness and wellness community on education and certification and on leveraging digital technology. On engaging with the sports, fitness and wellness community, I am happy to see that the White Paper asserts that improving health goes beyond the doctor's visit and encourages residents to adopt a healthier lifestyle. This reinforces what sports and fitness practitioners have long believed. International Olympic Committee President Thomas Bach said that "sport and physical activity are the low-cost, high-impact tools for healthy bodies, healthy minds and resilient communities." The World Health Organization statistics show that one in four adults, and four out of five adolescents do not get enough physical activity. Globally, the estimated to cost US$54 billion in direct healthcare and another US$14 billion in lost productivity.[+5 sentences] This has a significant impact on populations, more so on economies like Singapore which depend heavily on its people. It is good to see that there are plans to activate community partners, such as SportSG and the People's Association (PA). It would be better to see more engagement with private sector entities that provide relevant and structured programmes. Some of these programmes are customised to the requirements of our seniors and persons with chronic diseases. Partnering such private sector entities would give SportSG and PA greater options and relevant programmes to communities that require specialised programming. What are MOH's plans to engage the sports, fitness and wellness community in its Healthier SG strategy?[+17 sentences] Sports has a large part to play in getting Singaporeans active. In the last National Sports Participation Survey (NSPS), swimming, walking and jogging are the only activities that consistently rank amongst the top five most participated activities across all age groups ranging 13 to over 60 years. Physical health and mental health ranked amongst the top motivations for participants in these activities. From my own experience, I can tell you ploughing up and down a swimming pool by yourself is not the most exciting nor the most social activity. But when you come together as a group, complete sets, set goals and throw in a little competitiveness, sports can be a fun and it can be sustainable. Which is why I believe National Sports Associations, private sports clubs and academies have a part to play in in the Healthier SG White Paper. Structured, competitive sports and games should not be limited to just a person's school years, but for life. I would like to quote a former Nominated Member of Parliament Dr Benedict Tan who delivered a speech here in Parliament in 2015 on 10 worrying trends in Singapore's sports culture. He said, "Our sports events can be more veteran-friendly. One is never too old to participate in sport and there is ample medical evidence to show that one can benefit from exercise, even if one starts late." I agree with Dr Tan and we can do more to design programmes which are "veteran-friendly", modifying games, adjust training intensity, make it fun, such that physical activity is a way of life. Physical activity promotes optimal health and is integral in the prevention and treatment of many medical conditions. Sport, activity, exercise is medicine. Which brings me to my second point on education and certification. In the Healthier SG White Paper, a doctor will be able to keep track of an individual's health conditions, detect health problems early, work with the individual on a care plan and refer the individual to suitable activities or programmes in the community. Knowledge of disease care is as important as knowledge of disease prevention. I would like to ask the Minister what are MOH's plans to provide opportunities for doctors as well as healthcare professionals, sports and fitness professionals, to attain relevant training with respect to prescribing exercise to special populations. One such course is Exercise is Medicine, which is a global health initiative managed by the American College of Sports Medicine.[+30 sentences] Exercise is Medicine strives to make physical activity assessment and promotion a standard in clinical care, connecting healthcare with evidence-based physical activity resources for people everywhere, for all abilities. Physicians and other healthcare providers should be encouraged to include physical activity when designing treatment plans and to refer patients to evidence-based exercise programmes and qualified exercise professionals. Training a young athlete for peak performance is different from training an adult in his or her 30s and 40s, and is different from training a senior with chronic disease. It may seem intuitive. However, many coaching and fitness certification courses do not address the physiological differences in depth. I would like to ask the Minister what strategies have been considered to roll out continuing education for professionals in this sector. Perhaps, such courses can be delivered through CoachSG and PA. Mr Deputy Speaker, I believe education does not stop when we leave school. In Primary school, we all went through health education. In Secondary school, we went through physical education. But what happens when we become adults? Should knowledge come from the family doctor? I would like to ask if educational programmes are planned to be rolled out to inform Singaporeans of health risks, prevention methods and physical maintenance in relation to an individual's age and condition. Such information can be bespoke based on data and information collected on wearable technology and pushed through an app. This brings me to my next point which is leveraging digital technology. As our population ages, a concern is mental and cognitive health. Dementia is a concern of mine. Perhaps, with wearable and mobile technology being more accessible, we can explore how gaming and virtual reality can help diseases such as dementia and Alzheimer's. Researchers at UC San Francisco described that an immersive game called Labryinth-VR, where players wear a head-mounted virtual reality display and navigate through "neighbourhoods" of increasing size and complexity and run errands. Players walk through a place and move their bodies as they navigate the game, gaining physical exercise that can increase cerebral blood flow associated with improvement in general cognitive performance. We live in an amazing time, where technology can bridge the physical and virtual worlds. During the pandemic when physical activity in groups was limited, we made do exercising from home. Technology played an important role in connecting our physical activity done at home to an online community. Many of us took part in virtual races and activities and where we logged distances walked, swum and cycled. I remember even doing a push-up challenge with Speaker to raise funds for the Community Chest. Platforms like Zwift enable us to compete in real-time in virtual reality, connecting with people from all over the world. I would like to ask if MOH has considered the applications of simulated and virtual sport to increase and track activity. Gamification creates a stickiness and technology connects and gathers data for us to make educated decisions on our health and physical performance. The potential to connect and activate is boundless. However, the strength of our strategy is only as strong as its weakest link. The White Paper must be able to connect with Singaporeans from different socio-economic backgrounds, or different physical and cognitive abilities. This includes persons with disabilities as well as those who are not technologically savvy. It would be reassuring to hear details on how the Minister has considered these vulnerable groups in MOH's plans.[+1 sentence] In conclusion, I would like to say that I am extremely proud of Singapore's healthcare system and our healthcare workers. I firmly believe that Healthier SG is a strategy which will support our healthcare workers, by placing a greater responsibility of an individual's health on the individual and also provide access to a wide network of support and expertise bolstered by a robust technology platform.[+4 sentences] Healthier SG is an ambitious strategy and by no means a simple matter. It requires an immense level of coordination from various organisations to make it a success. Together, we can look forward to greater quality of life in our senior years. I support this Motion.
Mr Deputy Speaker15 words
[+1 sentence]Ms Hazel Poa, I understand you have a clarification or want to respond to one.
Ms Hazel Poa (Non-Constituency Member)239 words
[+5 sentences]Thank you, Deputy Speaker. Yesterday, I understand that the hon Member Xie Yao Quan sought a couple of clarifications from me. First, with regards to my suggestion of tax on unhealthy food, he asked for specifics. And also, the second part is whether imposing such a tax adheres to the spirit of the White Paper. As to the specifics of the tax, one specific example would be the sugar tax that exists in many countries and cities, including places like UK, France, India, Thailand, Malaysia and in certain cities in USA, it is is quite common. And a few months ago, a research that was funded by the World Health Organization came up with a report that examined the effect of this tax on the countries or regions that have in place this sugar tax. And it was found that it decreased demand for sugared drinks by 15%.[+5 sentences] So, it has been proven to be effective. As to whether imposing this text adheres to the spirit of the White Paper, I do believe so. In fact, I do not see any contradiction. So, if the Member disagrees, perhaps, he can share why he feels that it does not. And, in same spirit, I would also like to ask the Member whether he thinks that our current tax on tobacco and liquor adheres to the spirit of the White Paper and does he think that they ought to be removed.
Mr Deputy Speaker27 words
[+2 sentences]I see Mr Xie Yao Quan and Minister Ong Ye Kung's hand. Minister Ong and then perhaps, Mr Xie can decide whether he wants to respond thereafter.
The Minister for Health (Mr Ong Ye Kung)271 words
[+7 sentences]I thank Ms Hazel Poa for her suggestion on the sugar tax. We have been very reluctant to look into a tax like that. The principle is not wrong – having a "sin" tax is the policy of this Government. When it is cigarettes, it is something that is harmful, we do tax it. Carbon, we tax it. We do tax sins. The question is sugar causes diabetes, should we tax sugar? The Member, Ms Hazel Poa, has suggested a sugar tax.[+9 sentences] I assume if you extend it further, you can also tax salt or oil, for example. We are reluctant to do this. First, it affects a lot of people. Sugar is commonly consumed by so many people and so, you will add cost. And also, we consider the equity of the tax. There is equity involved. Because sugar is found in fruit juices, sugarcane, the pearls in bubble tea. So, you start to make such comparison, it is not going to be so easy. Therefore, the implementation will be complicated. Which is why for MOH, we decided against it – notwithstanding other countries having imposed sugar tax.[+3 sentences] We use labelling and regulation. Senior Parliamentary Secretary Rahayu Mahzam talked about the Nutri-Grade labelling. Once we announced Nutri-Grade A to D, if you have high sugar content for canned beverages, you will be graded D, immediately, the beverage companies reformulated. As a result, today – I do not have the data with me – but we are achieving a reduction in sugar consumption as effectively as the UK with labelling and without a sugar tax.[+1 sentence] But thank you for that suggestion.
Mr Deputy Speaker3 words
[+1 sentence]Mr Melvin Yong.
Mr Melvin Yong Yik Chye (Radin Mas)1405 words
[+12 sentences]Thank you, Mr Deputy Speaker. I stand in support of the Motion, which seeks to empower individuals to take charge of our own health and wellness and help Singaporeans live longer and healthier lives. The strategies proposed within the White Paper on Building a Healthier SG provide significant steps in the right direction to provide better quality healthcare in a more affordable and convenient manner. In my speech, I will talk about how Healthier SG will benefit our workers who work hard, work long hours and more often than not, also work in stressful environments and offer suggestions on areas where we can and should do more. Let me start by talking about the healthcare challenges that our workers face and how employers can play their part to help foster a healthier workplace. During the NTUC's recent #EveryWorkerMatters Conversation, many workers raised concerns about the steady creep in healthcare costs. Concerns were understandably more pronounced among our mature workers, who are deeply worried about being able to afford treatments for their chronic illnesses such as diabetes, high blood pressure and high cholesterol. Employers too are affected by the rise in healthcare costs for their ageing workforce as they have to spend more for their employees' medical benefits. An unhealthy workforce also reduces workplace productivity. According to the United States' Centre for Disease Control and Prevention, some job roles can result in workers becoming more susceptible to chronic illnesses. For example, four out of the 10 most costly health conditions for US employers, which include chest pains, high blood pressure, diabetes and heart attack, could be attributed to work stress and physical inactivity caused by prolonged hours of sitting at the work desk. This relationship between certain job roles and chronic health conditions is unlikely to be unique to the United States. The Labour Movement is therefore heartened that Healthier SG will help to make healthcare more affordable through: one, subsidies on health screenings and vaccinations; two, waiver of the co-payment requirement when using MediSave for chronic care management; and three, introduction of the new Community Health Assist Scheme (CHAS) drug subsidy tier for a whitelist of chronic disease management drugs to ensure that medications for chronic illnesses are made affordable.[+5 sentences] Beyond general chronic illnesses that Singaporeans are susceptible to, we should also consider whether certain types of work predispose us to certain chronic illnesses. As I have alluded to earlier, spending long hours sitting in front of the computer or in a driver's seat, among many other repetitive job tasks, can result in various forms of chronic illnesses. Examples include arthritis, carpal tunnel syndrome and hypertension. What can we do about this? Mr Deputy Speaker, we spend most of our adult lives at work and research has shown a strong correlation between our work and overall well-being. Employers therefore must do their part to mitigate job-specific chronic illnesses faced by their workers. They can do so in three ways: one, design the work environment to prevent chronic illnesses from forming; two, provide structured health screenings at the workplace, targeting job-specific chronic illnesses; and three, provide healthier eating options within the workplace.[+8 sentences] Let me elaborate. First, employers must put in place a work environment that prevents job-specific chronic illnesses from forming and to adapt the workplace and work processes to help workers who are suffering from chronic illnesses, in particular, our mature workers. According to a 2017 Swedish study, which examined the challenges involved in encouraging an ageing workforce to continue working productively, the researchers found that workers with chronic conditions can continue to work meaningfully by changing tasks and having proper physical aids to assist them. However, the study also observed that these changes often come at the workers' initiative, rather than the employer proactively doing so. As our population and workforce ages, employers must be cognisant on how to adapt the work environment to help their workers remain productive. Sir, as we shift away from transactional and episodic care, employers should also shift away from requiring medical certificates and provide workers some sick leave without MC. This will reduce the need to visit the doctor just to get an MC and reduce medical bills too. While some employers are already doing this – for example, workers in our healthcare clusters are given up to three days of non-MC sick leave – I urge all employers to do the same. Second, all employers should work with their insurers and third-party administrators to include more Healthier SG clinics on their panels and offer structured health screenings and vaccinations for their workers.[+5 sentences] This benefit should also be provided to all workers, including those in the gig economy. The Labour Movement has been pushing for this as early detection and intervention can help prevent chronic illnesses and infection of diseases. For example, the National Taxi Association, the National Private Hire Vehicles Association and the NTUC's Freelancers and Self-Employed Unit have been working with the Health Promotion Board (HPB) to encourage gig economy workers to go for quarterly health screening and health coaching sessions, to get active and to stay in shape. Third, companies with staff canteens can promote healthier eating options. The canteens operated by the National Transport Workers' Union have been offering brown rice at subsidised rates, to encourage our public transport workers to take up this healthier option. Since the campaign started, more than 100,000 plates have been taken up by our public transport workers.[+4 sentences] Instead of a sugar tax, the canteens rolled out promotional discounted prices for our kopi o kosong and teh o kosong to encourage workers to cut down on their sugar intake. We are working with HPB next on a low salt campaign for our public transport workers. I hope that all companies with staff canteens can follow suit and nudge their workers towards a healthier diet. Mr Deputy Speaker, in addition to better physical health outcomes, today's debate would not be complete if we do not consider the need for better mental health outcomes too. According to a 2021 study by the Institute of Mental Health, the COVID-19 pandemic has led to a rise in mental health issues in Singapore.[+1 sentence] Our workers are feeling the stress acutely. A 2021 survey by software company Oracle found that nearly seven in 10 residents in Singapore said that 2021 was the most stressful year at work.[+3 sentences] More than half of respondents said that they were struggling with their workplace mental health. I therefore fully agree with the White Paper that taking a preventative approach in mental health is aligned with the objectives of Healthier SG and I note that the scope of Healthier SG will eventually widen and include other complex chronic conditions such as mental health conditions. I would just like to ask the Minister when that will be. Could we consider improving access to mental healthcare support to all Singaporeans by increasing the current psychiatrist-to-population ratio to 10 per 100,000 residents, similar to other countries such as the United States and Australia? We should also encourage Singaporeans to have a dedicated counsellor or psychologist, similar to how we are encouraging everyone to have a regular family doctor, to serve as their first point of contact for their mental health.[+8 sentences] The bottom line is that mental health conditions should be given the same priority as all other chronic illnesses and it is in everyone's interest – employers, workers and the Government – to ensure that we have a mentally healthy workforce. I hope that MOH and the Inter-agency Taskforce on Mental Health and Well-being can prioritise the roll-out of preventative mental healthcare for the next review of Healthier SG. Sir, to conclude, it is no secret that our health affects the way we work and our work affects our health. While the strategies outlined in the White Paper on Building a Healthier SG will help us achieve a higher quality, affordable and convenient healthcare ecosystem, we can all lean in and do more. I encourage employers to play their part in tackling job-specific chronic illnesses at the workplace and putting in place a structured healthy workplace programme for their workers. Workers too should also do their part to go for regular health screenings, partake in regular exercise and eat healthily so as to remain healthy, productive and employable. Lastly, I hope that the next review of Healthier SG will include a strong focus on preventative mental healthcare. With that, I support the Motion.
Mr Deputy Speaker49 words
[+5 sentences]Order. I propose to take a break now. I suspend the Sitting and will take the Chair at 3.25 pm. Sitting accordingly suspended at 2.57 pm until 3.25 pm. Sitting resumed at 3.25 pm.
Mr Deputy Speaker3 words
[+1 sentence]Minister Masagos Zulkifli.
The Second Minister for Health (Mr Masagos Zulkifli B M M)2296 words
[+1 sentence]Mr Deputy Speaker, we have reached a critical point in Singapore's demographic history. One in four citizens are expected to be aged 65 and above by 2030, up from one in six today. While our life expectancy is one of the highest in the world at 85 years, our health-adjusted life expectancy is 75 years.[+2 sentences] This means that on average, we spend about 10 years in ill health. Our chronic disease prevalence rate has also risen. The proportion of population with high blood pressure has increased, from 20% in 2010 to 32% in 2020, and 26% to 37% for high blood cholesterol.[+42 sentences] We want to reverse these trends and empower residents to lead active and healthy lives, surrounded by people whom they love and can support them in their journey towards better health. We must not let our health be determined by medical care alone, even if there are plentiful experts who can provide it. In fact, the way we live, work and play, and the environment we put ourselves in are as important, if not, more so. We are already familiar with keeping healthy. From young, Singaporeans participate in activities in schools, such as physical education (PE), and go on to participate in programmes and activities in their workplaces and in the community. During our engagements, residents have told us that they are better able to sustain healthy behaviours if it is social. Much like in school – among friends. For example, some find joy in going brisk walking with their friends. Others are motivated to stay healthy so that they do not burden their family members. One resident said "Exercise and sports, I do a lot of that. I play pickleball. If I am not playing games, I am going for walks with my friends." Another resident said "If a doctor recommends for me to do something, I would convince him that I rather do it with my friends." Like both residents, we are more motivated to exercise if our friends and family encourages us to do so or better yet, to do it with us. Healthier SG acknowledges the importance that we place on participating in activities we enjoy, with our loved ones and friends. In support of this, community partners will provide a range of lifestyle programmes and activities to attract different profiles, and bring them closer to residents' homes, especially for our seniors. Senior Parliamentary Secretary Rahayu Mahzam has touched on HPB's support for this. People's Association also has a wide array of health and wellness lifestyle activities, interest groups and courses catering to a broad range of preferences and interests. Those who prefer more structured support can start with Sport Singapore's network of Active Health Labs and Coaches. Active Health Labs will help residents get started and stay on their health regime. Residents will receive regular health and wellness coaching and advice on exercise customised to them, in order to meet health goals. This includes residents who are at risk of developing chronic conditions. Even before Healthier SG, we are and will continue to be inclusive in promoting health to all. Ms Denise Phua and Mr Mark Chay asked about MOH's plan for persons with disabilities. The Enabling Masterplan 2030, which was just published in August, sets out our approach to enable persons with disabilities to live healthier lives, supported by quality healthcare. Mr Gerald Giam asked about MOH's upstream efforts on child and maternal health. Child and maternal health is critical. We have already started on this, in parallel with planning for Healthier SG. The inter-agency Child and Maternal Health and Well-being Taskforce that I chair focuses on improving health outcomes for our women and children, starting from as early as the pre-conception stage and during pregnancy, to give every child a good start. Expecting and postpartum women can access educational information and resources on Parent Hub, which can be found on HealthHub. Ms Denise Phua also asked about upstream interventions. We will continue to inculcate healthy habits from young by making health more prominent in schools and preschools and have started a review with MOE and MSF on this so that we can better support the health and development of our children. I have heard your concern for care and outreach to seniors participating, including males. Ms Ng Ling Ling suggested to partner family doctor with community partners. These suggestions are important as we shape Healthier SG. We will need to ensure family doctors are plugged into relevant community level information so that they are familiar and can refer residents to these programmes. But more importantly, we hope their doctors can help them follow through on their health plans and show how these can achieve good health outcomes. Therefore, we will strengthen coordination and support across partners. First, Healthy 365 as the entry way for all residents to easily access lifestyle programmes offered by community partners. Ms Ng Ling Ling suggested making it easy for more seniors to use Healthy 365 and HealthHub. I would like to assure her and other Members that seniors who need help navigating the app and enrolment need not worry. Help is available at our community centres, eldercare centres or through our Silver Generation Ambassadors. Already, out of those 50 years old and above, 280,000 participate in National Steps Challenge on Healthy 365.[+18 sentences] There are also about 230,000 seniors above 55 who are using HealthHub. We will reach out to more seniors and ensure they will be able to easily navigate the apps and locate the information they want. Second, our healthcare clusters, as regional health managers, will step up. Ms Denise Phua and Mr Sharael Taha asked about the role of regional health managers. They will build relationships, coordinate activities and support across community partners and tailor programmes specific to the needs of the population in their regions. Over time, healthcare clusters will gain in-depth understanding of their residents’ needs. They will work with partners to strengthen the environmental and social support for our residents. The Agency for Integrated Care, a trusted partner of many community partners, will support this effort, integrating care across partners to better support residents. Mr Yip Hon Weng expressed concern that there may be duplicative efforts in screening by community partners and primary care. We understand the concern. Senior Minister of State Janil Puthucheary will be sharing the care protocols that will guide screening done by family doctors and their care team. In addition, our healthcare clusters will guide supporting initiatives in the community. Over time, we hope to minimise duplication and target population segments that need more help. These partnerships will make it easy for residents to live healthily in their day-to-day lives and help connect residents to relevant programmes and services. Mr Deputy Speaker, Sir, let me now elaborate on how we are supporting our seniors. We are committed to enabling seniors to age and live to their fullest potential in the community. The Ministerial Committee on Ageing (MCA) adopts a whole-of-society approach towards making Singapore a better community to age in. This is one instance of a whole-of-society approach in health which Member Sylvia Lim said we should have. In 2015, MCA launched the Action Plan for Successful Ageing, covering 70 initiatives across 12 areas.[+7 sentences] I am glad to share some key achievements from the Action Plan and the latest initiatives on how we have built communities of care around our seniors. Today, active ageing programmes exist in every neighbourhood. Our seniors have opportunities to learn new things and meet new people close to their homes. We provide targeted outreach to those who need it through the Silver Generation Office (SGO) and with intermediate and long-term care (ILTC) partners. Since April 2022, in their door-to-door preventive health visits to seniors, SGO looks out for seniors’ frailty status and level of social support. They will intensify outreach to seniors identified to have higher health and social risks so that they can be referred to the right services. Dr Wan Rizal will be glad to know that we have been enhancing our care infrastructure and capacity to support the growing needs of our population, helping seniors to age in community, including those that are less mobile or immobile. Between 2012 and 2020, we added around 6,000 day care places and 5,500 home care places to cater to seniors with a range of care needs.[+12 sentences] Transport is provided to seniors who need it. Healthier SG will extend to all seniors, including those who are lower-income earners. I appreciate Mr Xie Yao Quan for raising concerns about the lower-income in Healthier SG. Preventive care is not only for those who can afford personal trainers and coaches. With Healthier SG, we are making preventive care accessible to everyone. We are collaborating with GPs and polyclinics to help residents stay healthier. We are activating community partners to support them to live healthier lifestyles. Healthcare clusters have been working with SSAs and MSF’s social services offices (SSOs) in their regions to jointly address the health and social needs of the residents, particularly those from the lower-income households. For example, there are community nursing posts co-located with many SSAs and SSOs to make health services more accessible at these community touchpoints. With Healthier SG, we will facilitate partnership and shared care of individuals across health and social agencies. We will also work through PCNs to strengthen the collaborations with Healthier SG GPs. All hands must be on deck to enable our seniors to remain physically, cognitively and socially engaged, as well as maintain and improve their health. The MCA is refreshing the Action Plan for Successful Ageing.[+3 sentences] MCA ran a series of engagements with more than 5,000 residents. We found that many seniors continue to have aspirations even as they age, whether it is to volunteer in the community, care for their grandchildren or even start a business. We have concluded our recommendations and are finalising the report which will be launched early next year. The Action Plan Refresh will be anchored on Care, Contribution and Connectedness, or what we call the 3Cs.[+10 sentences] For the Care thrust, seniors will be supported through preventive health, active ageing programmes and care services. On Contribution, seniors will have opportunities to contribute their knowledge and expertise to the community by volunteering, continuous learning and employment. Through our Citizens’ Panel on Contribution, many seniors have told us that they also wish to contribute to society by mentoring our youths. I am heartened to see such enthusiasm. Finally, for Connectedness, seniors will age-in-community within an inclusive built environment while staying connected to their loved ones and society through digital platforms and support networks. As suggested by Ms Hany Soh and Mr Sharael Taha, we will increase opportunities for families to provide the support system to help our seniors live healthier lives, strengthening intergenerational relationships within the family. The Action Plan Refresh will focus on interventions in the community. The Infocomm Media Development Authority (IMDA) and SGO help seniors to be more confident in using technology to stay healthy. For example, our eldercare centres have been collaborating with IMDA to hold digital literacy workshops for seniors. The Seniors Go Digital programme also helps introduce use of Healthy 365 and HealthHub. MOH has been working closely with MND to develop new housing-cum-care options to support seniors to age in community. We launched our first Community Care Apartments –which are senior-friendly housing integrated with care services – in Bukit Batok last year. And we will be launching our second in Queenstown in the November 2022 BTO exercise.[+5 sentences] Housing monetisation options like the Lease Buyback Scheme are also available to support seniors to age in community while boosting their retirement savings. Eldercare Centres will be further strengthened as the key node for seniors. ECs will be the go-to points for all seniors’ health-social needs, including connecting them to social and lifestyle activities and monitoring simple vitals. I would like to thank Ms Ng Ling Ling for her suggestion of reaching out to seniors living in private estates. Today, ECs provide support for seniors from different ethnicities and backgrounds and many of them participate regularly in activities and programmes at ECs. When we double our ECs by 2025, we expect eight in 10 seniors to be able to access these activities near their homes.[+1 sentence] We welcome more stakeholders and community partners to come together in this endeavour to build a society that empowers seniors to contribute, be socially engaged and achieve their aspirations. All these efforts, together with Healthier SG’s emphasis on preventive care, lay a strong foundation for seniors to age in community, a major reform of our aged care ecosystem.[+11 sentences] Before I conclude, let me summarise my speech in Malay. (In Malay): Healthier SG aims to empower all of us to take care of our own health. Family doctors will work with residents to improve our health. But beyond healthcare, we acknowledge that social and environmental factors are also important. Under Healthier SG, community organisations will also be involved to provide various programmes close to homes to facilitate participation in programmes and activities to stay healthy. We will help seniors age in place and live to their fullest potential within the community. Ultimately, every individual must be responsible for their own health and therefore take active steps to stay healthy. Let us all make use of the resources available to live a healthier life and support one another to do the same. (In English): In closing, the shift to leveraging community support for better health is a significant move. Everyone – families, individuals, community partners and the Government – must and will do their part, I hope. Together, we can help one another sustain healthier lifestyles, live and age well and be a Healthier Singapore.
Ms Carrie Tan (Nee Soon)2066 words
[+36 sentences]I would like to thank the Minister for Health for the wonderful efforts to tackle our people's health challenges and also our nation's healthcare cost challenges using this upstream approach and also to thank Senior Parliamentary Secretary Rahayu Mahzam earlier for going into detail and describing the various technologies and apps – I think it is very creative to tap on Singapore's national love for food and taking pictures of food – and also considering support for caregivers, which is really important. Minister Masagos also spoke about many hands on deck. I believe that is the correct direction to go. I am very supportive of these initiatives in Healthier SG. I would like to expand on all these efforts a little bit more by highlighting some nuancing that I believe are quite important in the way we approach the community efforts for greater ownership of individuals. One, I am hearted to note that these efforts to reduce cost of healthcare amidst the ageing challenges is to mitigate institutional healthcare costs, which is by de-institutionalising care. I believe the Government is already embarking on this with various "Ageing in Place" efforts, like Minister Masagos has said. I personally think that the pilot for Queenstown's Health District pilot is very commendable. It is really good to see the concerted efforts by both MOH and MND to do so. To supplement the infrastructure design and development of care within the vicinity of people's homes, we also need to build up what we call the "soft infrastructure". As my hon colleague Denise Phua brought up yesterday, what is there in between GP visits to ensure that people follow their health plan that is recommended to them? What is there in our everyday? To that, I would like to propose that we harness and strengthen the community's capacity to be the peer influencers and peer enablers for each other. I would like to make two points in my speech – to involve other agencies in tandem with MOH and to expand our collective efforts towards greater health together. First of all, we need to harness our people, our citizens for mutual support to be influencers as well as facilitators. For the past two years since being a Member of Parliament at Nee Soon, I have worked closely with Yishun Health and gotten to know and see the very good efforts they created in neighbourhoods as part of their community health outreach efforts. I am very inspired by their approach and model towards health, which is to decouple it from sickness and to emphasise instead empowering the agency within the individual for wellness. They started initiatives like Share A Pot, which Nominated Member of Parliament Janet Ang mentioned yesterday. It is a programme that taps on seniors to gather together with other seniors. They are cooking and sharing bone broth together to strengthen their bones, to decrease their risk of frailty and risk of falls. The other notable project is called Repair Kakis, where a group of elderly uncles come together and they provide handyman services to their neighborhood. It was actually started by a gentleman who suffers from Parkinson's disease. The Yishun Health team discovered that he was an aircon serviceman before and he possesses the technical knowledge and mechanical knowledge to repair appliances. They encouraged him and he started this group. Before long, more uncles joined him. And now, weekly, they create a session where they welcome neighbours to bring their faulty home appliances for them to repair. I think what is really beautiful about this initiative was that it harnessed the strength of an individual, created a ripple effect and it built up this man's sense of dignity in being able to contribute to his community despite his medical condition. I think the self-esteem that he got and the wellness that he got from such an initiative and being a contributor really, really showed him to be a positive role model amongst his peers. I also heard from the Yishun Health team that amongst these groups, there were successful cases where elderly gentlemen saw a friend of theirs pass away due to lung cancer from having been a chronic smoker. That prompted them to decide that they would also want to quit smoking. In these examples, we see that it is actually the power of social relationships that worked wonders. Often, people do not need an expert to come and tell them what to do. People can make good choices for themselves when they are inspired by the stories and people amongst them. As much as I am very glad for the current plans by Healthier SG that focus on physical health, I would like to encourage MOH to work closely with other Ministries such as MSF because the social determinants of health are equally, if not even more important in upstream efforts. Our efforts may go to waste if we neglect this critical piece. As Woodlands Health Campus' Chief Operating Officer (COO) once shared with me a few years back in my then capacity as the executive director of Daughters of Tomorrow, many of the hospital's "frequent-flyer users" come from the lower-income segment. In fact, Woodlands Health Campus' utilisation trends show that 20% of patients use up to 80% of healthcare cost. Often, these are the people who will shun visiting the GP when they are sick because they cannot afford to pay the cash even after subsidies. They end up getting into A&E when their conditions get too severe.[+3 sentences] They also avoid seeing the doctor because they are in jobs that are daily paid. They work long hours or are mentally overloaded with too many chronic stresses to make healthy lifestyle choices. Under these circumstances, the mindset that they are often beset with is, "I cannot" or "It is too difficult". Yet, in the example of the Yishun Health community outreach teams' Wellness Kampung efforts, we see how peers can influence peers to see that, "If you can, maybe I can too." Such share and care activities harness the power of the community and the assets and strengths from amongst residents themselves to initiate activities that provide positive influence and share their own knowledge with one another.[+7 sentences] Such asset-based community development initiatives help to uplift wellbeing from lifting the self-esteem and social connection of people and contribute to their socio-emotional health – a key dimension as well as determinant of physical health. We can scale up such efforts by involving and enhancing the capabilities of PA to do similar. People may ask, "What is the difference? We already have so many grassroots activities, interest group activities, brisk walking" and so on. I would like to highlight that there is a distinct nuance here because to date, PA has developed itself and it is very strong as an organiser and often seen as a service provider of these activities, both recreational and social. But we are looking at in the A-B-C-D model is to enable residents to initiate and own the programmes themselves, thereby increasing their sense of ownership and their personal sense of agency. Minister Ong mentioned that the community plays a big part in this plan. Specifically, I call for MOH to lead and to help fund a dedicated community health team within PA to train specifically personnel in asset-based community development in collaboration with Yishun Health's community outreach team as well as other community partners who are well-versed and familiar with the A-B-C-D model.[+5 sentences] I think this would help effect a very important transformational mindset shift from our people being at the receiving end of services to them being the enablers for change in the community and within themselves. My next point: how can we better distribute care in the system so that it is not concentrated in formal settings, which are costly to provide? The good news is I believe we leverage the very good momentum that the COVID-19 pandemic has provided, where we see that in many parts of Singapore, neighbours are already helping neighbours, whether it is buying food, helping to fetch groceries when their neighbours are in quarantine and so on. These acts of kindness and helping and care are already happening sporadically in a rather organic manner. The question is – how can we be more intentional about it and grow such mutual support and care within the community more systematically? In Nee Soon, I am now piloting an experiment with Yishun Health to explore tapping on neighbours to help so that the hospital can readily discharge patients who are ready to be discharged but may not have people at home to care for them.[+10 sentences] With the team there, they have created a list of care tasks and micro-errands that do not require medical expertise for people to help with. We are enrolling volunteers from the community to step up so that discharged elderly from the hospital can be adequately cared for and caregivers can have more support and more respite. As we worked on this pilot, along the way, I met other initiatives in the form of social enterprises and ground-up groups that are doing the same or attempting to do the same. Initiatives like SG Assist by amazing Singaporeans like Adrian Tan and Greg Tan as well as Denise Tay and Michelle Lau, who founded KampungKakis. They are doing great work to excavate and pull together the human power for mutual support and caregiving in the community. We need to grow the efforts of these leaders and champions for community care. These are social entrepreneurs with hearts that care and a commitment to pledge their careers to creating solutions for society. We should support, harness their strengths and invest in them. I would like to ask the Government to enable their growth by incentivising impact investors and philanthropists to invest in such initiatives to help scale up their work and impact to reach more of Singapore. I have some specific suggestions to support social enterprises to provide capability building in community care so that we can help to accelerate the de-institutionalisation of health and healthcare. One, it is possible to look into expanding the Community Capability Trust with specific funding injections from MOH to invest in social enterprises that provide such capability building services for the community.[+1 sentence] We can do this for as long as before they show any positive monetary returns or profits. This is really to help them during their startup stage. We can also consider providing Government tax deduction benefits to impact investors who invest in early stage social enterprises that provide similar services in the same way that it incentivises donations to Institutions of Public Character (IPCs) because after all, if more people can be harnessed and built in their capability to care in the neighbourhoods, then we all can hopefully pay less taxes because of institutional healthcare costs.[+13 sentences] Ground-up initiatives have closer experience on the ground. Often, their interventions and services are designed with personal experience of founders or beneficiaries. They can plug the last mile service gap much better than Government agencies can. In summary, I would like to wrap up my speech to emphasis this point that aligns with the Ministry's intention for Healthier SG, which is that as individuals, we can do more to own and to take charge of our health. To do this, we need to harness the capacities, strengths and assets of individuals amongst residents. We need to invest in and grow the capacity of leaders amongst our citizens. In so doing, we can truly bring the power of the community together and build up our citizens' agency and health by facilitating their initiative and their pioneering spirit through mutual sharing and caring activities that they start. There is a Chinese saying, "百花齐放" – a hundred flowers bloom. I hope the Government can seriously consider these proposals to nurture and fertilise the flowers to bloom in this community health and community care space. And so, I urge MOH to set up a dedicated work group that includes MSF and MCCY to help drive Healthier SG because the social determinants of health are key if we wish to see the outcomes we want. Hopefully, we can create, through these collective efforts, a virtuous cycle driven by the will and initiatives of our people. The more we care and share, the healthier we get. I support the White Paper.
Mr Deputy Speaker4 words
[+1 sentence]Mr Ang Wei Neng.
Mr Ang Wei Neng (West Coast)1469 words
[+11 sentences]Mr Deputy Speaker, it is timely that Singapore is going to shift away from illness-based hospital care to a more sustainable way of patient-centred preventive care. This a good move but there will be challenges during the implementation stage. The general practitioners or GPs are critical to the success of Healthier SG. After the release of the Healthier SG White Paper, I managed to communicate with a few GPs, including GPs who are practising in the Nanyang division. In general, the GPs are very supportive of Healthier SG. While some GPs operate in residential areas and in clearly family clinics, others practise at the workplace. Those GPS who practise at the workplace are concerned that some residents or many residents would not appoint them as the primary family doctor, especially those residents above 60 years old, who are not working. How would MOH address this perceived inequality? On the other hand, some popular GPs may be overwhelmed if too many patients want them to be their primary family doctor and they have to turn people away. Minister Ong alluded to this in his opening speech. For Singaporeans, securing a family doctor should not be a competition. As such, I would like to ask what is maximum number of patients each family doctor can accept? What is the set of criteria which doctors can use to decide whether to accept or reject existing and new patients under Healthier SG?[+2 sentences] For instance, would they take into account factors like whether the patient had visited the clinic before, or how far away the patient lives from the clinic, or on a first-come-first-served basis? What exactly are the factors they would have to take into account and is that a priority? Meanwhile, one GP, who is an owner-doctor running his own clinic has requested me to ask if it is compulsory for all family doctors to join the Primary Care Network (PCN).[+1 sentence] Such GPs also have questions on the need to be qualified as a family physician. Referring to page 42 of the Healthier SG White Paper, it states that each GP clinic must have at least one family doctor to be registered as a family physician within seven years of the launch of Healthier SG.[+35 sentences] Thus, I would like to ask, does it mean that the family clinic with only doctor, the sole doctor would have to be qualified as a family physician? If so, this may have profound implications for family clinics run by solo doctors. If GPs are to oversee the end-to-end journey of caring for a patient, it would be helpful if they can work with partners to deliver this care. According to an article from the Harvard Medical School, such GPs, who are also called primary care physicians, work in teams to keep patients at the centre of all diagnostic and treatment activities. These teams often comprise medical assistants, nurses, pharmacists and social workers. Likewise, in the Netherlands where the GP is the central figure in Dutch primary care, GPs employ salaried nurses and primary care psychologists, who can even provide mental health services. The typical practice size is approximately 2,200 patients per full-time working GP and over 95% of the citizens are registered with one GP that they have chosen. Chronic care management is coordinated through care groups, which are mostly GP networks. These care groups coordinate care from multiple service providers for certain chronic diseases, such as diabetes and cardiovascular conditions. Would MOH envisage the formation of such GP networks in Singapore? If so, would such networks be coordinated by the respective three health clusters? Outside of the clinic, there are many touch points and community engagement opportunities with members of the public. I heard from Minister Masagos that the healthcare cluster will coordinate with community partners and GPs to provide healthy activities for the residents. And to this end, as a Member of Parliament taking care of the Nanyang Division of West Coast GRC, I would be happy to leverage on my community partners to work with the healthcare clusters and the GPs in Nanyang to provide healthy lifestyle activities for the residents. As with any change, it would take time for residents to embrace Healthier SG. Preventive care requires more commitment from people to live more healthily, commit to advice from their doctors and spend time on regular health screenings. Many Nanyang residents I met and have spoken to after the release of the Healthier SG White Paper are very supportive of Healthier SG but they have also raised some concerns. Let me continue in Mandarin. (In Mandarin): Many residents in Nanyang support Healthyier SG, but they also have some questions. Let me share an example. Mdm Tan, who is in her sixties, has been seeing a doctor at the Teo clinic near her home since young. She has just changed her job, and the clinic is not on the company's list of designated clinics. Hence, Mdm Tan cannot claim medical fees from the company for the cost of seeing the doctor at the Teo Clinic. Mdm Tan was glad to hear about Healthier SG, and wanted to appoint Dr Teo from the Teo clinic as her designated doctor, so that she could receive free vaccinations and highly subsidised pills for the "three highs". For a common cold, Mdm Tan still needs to go to company-designated clinics. This situation is just like what the White Paper has described on page 24. If Mdm Tan has a choice, she would prefer to go to the Teo Clinic which she is familiar with whenever she falls ill, just like what the White Paper has recommended. I hope MOH can solve this dilemma. Another important aspect of Healthier SG is to encourage Singaporeans to take part in more activities that are good for their health, such as Zumba, brisk walking in parks and gardening. To date, most of these activities are only attractive to women. Many men prefer to drink in coffee shops, eat and chitchat for a long time. It seems that we need to mobilise our men and entice them to move from drinking tables to table tennis and from eating to growing vegetables. While this is not MOH's strength, it is an important factor in Healthier SG. I hope the Minister will think about it and invest more in this area. (In English): Next, I would like to touch on another very important topic, which is the funding. Minister Ong had indicated that it would cost about $1 billion over the next three to four years for IT support and other one-off costs to bring the GPs on board Healthier SG. At the same time, the recurring cost of running Healthier SG will amount to $400 million a year, including the service fee for the GPs.[+10 sentences] As mentioned earlier, healthy activities for the residents as coordinated by the respective health clusters are a very important component of Healthier SG. I would like to ask Minister Ong, how much of the $400 million budget will be allocated for organising healthy activities and nudging residents to engage in such activities? Earlier, I heard from Senior Parliamentary Secretary Rahayu Mahzam that they will make Healthy 365 as a very key component of the entire Healthier SG. But we know that there are many other apps that are very popular with the residents. For example, there is LumiHealth. So, how would Healthy 365 interface with those apps that are very popular right now, like LumiHealth, so that they can be more coordinated and benefit more residents? Ultimately, we can take inspiration from what is being done in other countries for preventive healthcare. A research study of primary care physicians in 10 countries including Australia, Norway, United Kingdom and Switzerland showed how patients that are managed by one primary care physician are able to view information from their medical records, and can even e-mail their doctors. While this could prove quite onerous for our GPs, it would certainly go a long way in building trust between patients and their doctors. In conclusion, I would like to quote an advice by Dr Chuang Wei Ping, an elected member of the Singapore Medical Council and a popular GP in the Nanyang division. Dr Chuang said, “People want to live a fuller live, rather than a longer life.” “People want to live a fuller live, rather than a longer life.” Currently, Singaporeans' life expectancy is close to 85 years but they spend more than 10 years in ill health. With Healthier SG, we hope to reduce the number of years spent in ill health.[+2 sentences] This is possible if all Singaporeans, all GPs, all Government officials and all community partners are ready to make Healthier SG as a priority for a better Singapore. I support the Motion.
Mr Deputy Speaker3 words
[+1 sentence]Mr Pritam Singh.
Mr Pritam Singh (Aljunied)1893 words
[+6 sentences]Sir, the Workers' Party Members of Parliament have raised points which cover the main prongs of the Healthier SG White Paper. These include concerns on capitation funding, manpower issues across the healthcare landscape and the future evolution of the family medicine ecosystem as envisaged, amongst other points. The upcoming changes to the healthcare system underwritten by the White Paper are significant, and in the main, the Workers' Party supports the Government's strategic shift towards preventive healthcare, important aspects of which were pre-emptively raised by Workers' Party Member of Parliament Leon Pereira in his Adjournment Motion on reviewing strategies towards preventive healthcare in February this year. My contribution to this Motion will be short and it covers an important but sometimes understated stakeholder in the public health care ecosystem, and that stakeholder are the Traditional Chinese Medicine (TCM) practitioners and others who are practitioners of alternative or complementary medicine. In the course of the debate, I have heard hon Members Ms Joan Pereira, Ms Hany Soh and Mr Yip Hon Weng also speak on TCM and how it interfaces with the Healthier SG White Paper. In my speech today, I will make three suggestions to bridge TCM and complementary or alternative medicine as important community partners of a healthier SG. In July this year, I asked the Minister for Health in a written Parliamentary Question how TCM practitioners would be integrated into the Ministry's Healthier SG plans. Minister Ong replied and I quote: "Traditional Chinese Medicine practitioners are important stakeholders, especially given their emphasis on holistic and long-term care. However, unlike Western doctors, Traditional Chinese Medicine practitioners are not tightly regulated by MOH. The standard of care delivery varies widely and we will therefore not be able to take the same approach as we have taken for Western doctors." This reply is nonetheless not inconsistent with the Minister's public comments in December 2021 where Minister was quoted as recognising the benefits of TCM in fighting chronic diseases.[+22 sentences] In fact, successive health Ministers have raised hopes of alternative approaches to healthcare like TCM, which complement and integrate Western medicine. Some almost 30 years ago, in 1995, the Health Ministry accepted the recommendations of the Committee on Traditional Chinese Medicine and moved to begin regulating TCM. Globally, under the Beijing Declaration adopted by the World Health Organization (WHO) in November 2008, Traditional Chinese Medicine was recognised as having an important role in the improvement of public health. Acupuncture has in fact, been scientifically proven through trials recognised by WHO to be an effective treatment for more than 20 diseases and disorders. Today, TCM practitioners in Singapore are governed by the Traditional Chinese Medicine Practitioners Act and physicians are expected to abide by the ethical code and ethical guidelines for TCM practitioners issued by the TCM Practitioners Board which also comes under MOH. In 2019, legislative changes were made to further professionalise the TCM industry. These included the introduction of continuing professional education and raising the maximum fines on errant practitioners from $10,000 to $50,000. This hike in fines brought the TCM Practitioners Board's disciplinary powers in line with those in the dental, pharmaceutical and allied healthcare boards. Sir, TCM and other alternative treatments such as ayurveda and other alternative therapies have a long tradition of acceptance in various Asian cultures. Singapore is no different with non-Chinese Singaporeans resorting to TCM and alternative medicine as well. To this end, some TCM products have even been halal certified. In fact, as early as 2005, MOH allowed licensed hospitals and nursing homes to have full service TCM clinics, including acupuncture, tuina and herbal medicine services to be co-located on their premises on the condition that the TCM clinic was clearly distinct from conventional medical services. In 2018, an acupuncturist at Khoo Teck Phuat Hospital was quoted in the newspapers as saying that around 40% of her patients who sought acupuncture were non-Chinese and under the age of 25. The Government, for its part, has previously allocated $3 million for the TCM Clinical Research Grant from fiscal years 2013 to 2018 to support research into chronic diseases. A further $10 million in research and development grants was also announced in 2017 as part of efforts to modernise the industry. Then Senior Minister for Health, Mr Chee Hong Tat, was quoted as saying: "After you come out of hospital, how do you help a person to get back as quickly as possible to good health? I think things like therapeutic massage actually play a very useful role." On 29 December 2020, in a significant move, MOH announced that it was extending means-tested subsidies and MediSave coverage under a pilot arrangement to support acupuncture for lower back pain and neck pain at specialist outpatient clinics in public healthcare institutions. The pilot did not cover acupuncture used to treat other pain indications and other forms of traditional complementary and alternative medicine offered at public healthcare institutions. However, the Ministry stated that it would review the expansion of the pilot to other settings in the longer term, taking into account learnings and data from this pilot. Healthier SG may well provide the opportune platform and impetus to expand this pilot. Suggestion one – extending use of MediSave to more procedures and allow TCM practitioners who offer them. To this end, Sir, my first suggestion is for the Government to consider extending the use of MediSave for more TCM procedures and alternative therapies that have a proven role in the management of one's general health and, more pertinently, in the prevention of chronic diseases. This expansion should also see the inclusion of certified TCM practitioners who can be allowed to offer such approved procedures in their TCM clinics outside public healthcare institutions.[+4 sentences] In order to prevent abuse, a fixed and audited list of procedures and caps to limit the fees that can be charged for such procedures ought to be considered. Additional subsidies can also be extended to Pioneer and Merdeka card holders for these procedures, many of whom resort to TCM as an important source of primary care. Suggestion two – consider alternative and complementary medicine to lower costs. Second, MOH should look into the cost of alternative medicine that substantively produces the same clinical outcomes as medicines and drugs disbursed by our public healthcare institutions. For example, Fybogel, which is commonly dispensed for constipation, can cost around $20 on the shelf without subsidies, whereas psyllium husk, which confers similar, if not identical, benefits, can be purchased from Little India and even NTUC supermarkets at under $3.[+5 sentences] In 2015, the then Head of the Traditional and Complementary Medicine Branch of the Primary and Community Care Division at MOH confirmed and I quote, "MOH constantly reviews the regulations and policies on TCM, taking into consideration the scientific advancements and rising standards of TCM." In similar vein and with a view to better manage costs, a review of commonly prescribed medicine which substantially produces the same clinical outcomes as complementary medicine should be undertaken on a longer-term basis. It would be useful to understand if the Ministry or a relevant body like the Health Sciences Authority currently carries out such comparisons of clinical outcomes between Western and alternative medicine with the view to lower overall healthcare costs. Separately, I suspect more than a few in this House would have encountered cervical episodes for which traction and other specific thoracic mobility stretches are commonly prescribed through physiotherapy. Similarly, TCM also advances traction and certain stretching and mobility exercises as rehabilitative procedures. In this light, would the Ministry consider whether there is scope for such rehabilitation or physiotherapy to be undertaken at TCM clinics by TCM practitioners?[+12 sentences] Such rehabilitation is not usually just more affordable than physiotherapy sessions at many private and public healthcare facilities, but the convenience of having such options for Singaporeans within one's neighbourhood and perhaps right under one's block can ensure that patients complete their rehabilitation and live healthier and more mobile lives. Suggestion three – leverage on TCM practitioners to achieve Healthier SG. Mr Deputy Speaker, late last year, a Straits Times article reported that the Government's feedback channel, REACH, discovered that many seniors were reluctant to get their COVID-19 vaccines due to and I quote, "advice from their doctors, mostly traditional Chinese medicine (TCM) practitioners who are unsure of what advice to give". In response to this, MOH arranged to meet all TCM practitioners to explain why vaccination was critical. Sir, while TCM and other alternative therapies have not been covered in any substantive detail in the White Paper, it is clear that TCM practitioners do not have a small footprint in the mindshare of Singaporeans when it comes to our health, particularly in the heartlands. Like Healthier SG, prevention of long-term diseases is a core belief of TCM and complementary medicine. And this does not start in one's senior years. Their treatment philosophy places an acute focus on prevention before a disease arises. They advance the view that one's lifestyle is intimately related to health, which can be improved through effective mental health management, rest, a good diet and interventions based on a person's specific physical conditions, amongst others. By watching such indicators, one is well on his or her way to good health, regardless which economic strata of society one belongs to. Indeed, the White Paper lists a number of community partners, such as AIC, Sport Singapore, the People's Association (PA) and the National Parks Board (NPB), that will empower residents to chart their own journey towards healthy and active lives. In our journey to live more healthy lives, I would suggest that we should not underestimate the wide reach of the local sinsehs in our neighbourhoods. MOH should tap on them to help share healthy living tips and preventive healthcare strategies, not just to our seniors. And MOH should not rule out subsidising TCM practitioners in this endeavour, subject to their contributions towards objective criteria under Healthier SG.[+9 sentences] Such an approach would also be consistent with the aim of successive Ministers of Health who had hoped to integrate Western medicine and TCM and alternative medicine as far as practicable, even as both branches of medicine operate in different cultural and professional milieus. While progress in this regard appears to have been fitful so far, Healthier SG provides a new-found opportunity for TCM and alternative medicine to play a more active role in the primary healthcare space and in preventive healthcare. In conclusion, Sir, just like family doctors, many Singaporeans have been going to the same TCM practitioners for decades. For some, the reasons behind this may well be behavioural, peace of mind and more comfort dealing with a TCM practitioner. The Government is on record to say that TCM practitioners are an important stakeholder in Healthier SG. The Ministry should consider concrete plans and strategies to include them in the country's strategic shift towards preventive healthcare as Healthier SG is fleshed out and operationalised in the months and years ahead. The Ministry will not be starting from ground zero. With decades of regulatory experience and periodic reviews of the TCM landscape undertaken by the TCM Practitioners Board, a dedicated effort must be undertaken, driven by the Ministry to draw on the treasure trove of alternative and complementary medicine that has been relied on by generations of Singaporeans for their well-being. This is an opportunity that should not be missed.
Mr Deputy Speaker15 words
I was going to call Mr Henry Kwek.[+1 sentence] But Minister Ong, you have a clarification?
Mr Ong Ye Kung48 words
[+1 sentence]I thank the Leader of the Opposition. I am glad that he read my Parliamentary answer on TCM and also my December 2021 speech on TCM. I just wonder, last month, I gave two more speeches about TCM and Healthier SG.[+1 sentence] I just wonder whether he is aware.
Mr Pritam Singh4 words
[+2 sentences]Yes. On 11 September?
Mr Ong Ye Kung29 words
[+6 sentences]You are. Thank you very much. And 18 September. A few Members have raised this issue. I will give a fuller response later in my closing speech. Thank you.
Mr Deputy Speaker3 words
[+1 sentence]Mr Henry Kwek.
Mr Kwek Hian Chuan Henry (Kebun Baru)1470 words
[+9 sentences]Mr Deputy Speaker, loneliness can wither away even the bravest souls – a spouse passes on, siblings disappear, children distancing themselves. These can be devastating to our seniors. Some never even had close family members or friends to begin with. For them, their final years can be harsh. Many of them decide that in the absence of love, health is meaningless. They decide to fade away. Yes, loneliness can kill, sometimes, in the most undignified way. But I have seen it with my own eyes that it need not be so. It need not be so. A few years ago, Dementia Singapore and my volunteers set up a self-funded eldercare centre from scratch within Block 115 in Ang Mo Kio.[+28 sentences] The centre combines health and social care for the most vulnerable seniors living in that block of rental flats, most of whom are frail and without familial support. We took over four units of HDB studio apartments and we did up the void deck. We got doctors and nurses from TTSH to review the health status of every senior under our care and to come up with a personal health plan. By health plan, it means more than just doing monitoring their vitals or ensuring medical compliance. It also includes social prescription, getting them to join in regular exercises and activities, getting them to eat healthy meals together and getting them to join in the kampung downstairs. These social prescriptions were delivered by a few staff and seniors were given micro-jobs. We also have the assistance of community partners and volunteers from all walks of life. The results were dramatic. Let me just talk about just two seniors, although we have seen impact in almost all the seniors under our care. Both have consented for me to share their stories, but I will still mention them using pseudonyms. One, Uncle Paul, who is in the 80s. He has a heart that is functioning less than a quarter of what it needs to be. He was frequently admitted to the hospital, taking medicine was a chore because he felt hopeless about life. But when he felt the love and support of our volunteers, he decided to fight on. With proper medications and regular reviews, his health has improved. Today, even though he continues to be frail, he is energetic and cheerful. Two, Uncle Ong. Uncle Ong is a single, retired construction worker in his late 70s. He has always been independent, never troubling others for help and he never joined our activities. He developed chronic conditions and did not take medicine regularly. He relied extensively on alternative medicine. One day, Uncle Ong injured his toes and it turned gangrene soon after. The gangrene spread upwards towards the shank and he had an amputation just below his knees. He was depressed and in great pain. Our volunteers prepared special meals for him which we brought to him daily. Initially, Uncle Ong was uncomfortable to be "served" and "cared" for by several volunteers. But, over time, he accepted the services supported. And now, he complies with his medication and goes for reviews. He has learnt to come to terms with his disability.[+2 sentences] He even participates at social events now. His chronic conditions are also under control. Now, given what we have seen, my volunteers and I are, of course, thrilled when we heard that under Healthier SG, MOH will set up many more eldercare centres that integrate community programmes with health.[+12 sentences] There are many more such seniors beyond our rental blocks – in our HDB estates, in our private estates. And more importantly, I have seen first-hand how the various aspects of Healthier SG can come together – personal healthcare plans, social prescription, healthcare workers working hand-in-glove with our community partners and local volunteers. I have also seen our frail seniors, having received support and concern, take personal responsibility of their health. Healthier SG is, indeed, the decisive shift that our healthcare system needs. But preventive health is better than curative health or rehabilitation. I believe the future of preventive health can be found in the science of longevity medicine which Minister Ong Ye Kung mentioned at the end of his opening speech. Over the last few decades, researchers have made tremendous progress in understanding the science of ageing. There is now ample evidence on how affordable preventive interventions can slow down ageing and increase our health span, which is the proportion of our lives that we spend in good health. It is now clear that a person can be much healthier than what his age suggests, with the right lifestyle and clinical intervention. Lifestyle intervention can include things we already know very well, such as intermittent fasting or exercises. But what is more interesting are clinical interventions – potential new supplements, existing drugs repositioned for healthy longevity and new drugs over time. And it is more and more possible to measure one's biological age through a series of biomarker tests, so that we can see the progress or the regression of our health span more clearly so that we can take better responsibility for our own health. Last month, I was delighted to attend and join in a panel at Singapore's first longevity research conference where Deputy Prime Minister Heng Swee Keat launched NUHS' Centre for Healthy Longevity. Yes, I understand the science is still developing, but it will be wonderful if MOH can sketch out what our emerging plan is because healthy longevity can have a profound impact because Singapore can be the first country to systematically translate longevity research into practical intervention for all.[+9 sentences] Brilliant plans, bold plans require brilliant execution. I would now like to make a few brief points about the implementation of Healthier SG. Firstly, MOH must decisively break down the silos of information that exists today. I also concur with member Dr Tan Wu Meng that we must build a world- class healthcare IT system. Our family doctors must have access to quality medical history pulled from all different healthcare institutes. They need prompt and relevant information to create meaningful health plans that Singaporeans trust. Secondly, our Government needs to do more to encourage all Singaporeans to exercise more and eat less sugar and salt. While we have done much, much more can be done. It would be helpful to hear concrete plans from MOH. Thirdly, I hope that our healthcare leaders boldly invest resources and imagination in preventive health, even though our natural instincts are to spend the most to care for the sick.[+4 sentences] I certainly hope it is true for the National Healthcare Group, which serves Kebun Baru and which sees many seniors, perhaps even more than other regions. However, I can understand why MOH wants to use population size as the basis for funding our healthcare clusters. The more time we spend debating on what is the precise level of funding, the more time we lose in pivoting towards preventive care. Because being roughly correct today, is better than being precisely correct after the ship has sailed. But I do hope that MOH can keep close tabs to ensure that all regional health systems spend enough on preventive care. And that over time, MOH can refine the funding model to factor in differing age distribution, social economic status across different healthcare clusters.[+5 sentences] And that MOH can also help clusters scale up particularly innovative efforts. Mr Deputy Speaker, to conclude, as a member of PAP Seniors Group, Healthier SG is a necessary reform, a bold reform of our healthcare system. It deserves our full support, even though there are many challenges ahead, even though it will take a decade for us to see real dividends. My volunteers and I are also deeply committed to making Healthier SG work for Kebun Baru. We feel this way because we understand the possibilities. In fact, we have started creating our Kebun Baru local action plan for healthy longevity, that we hope to partner with NHG on.[+4 sentences] We will grow as many exercise and wellness groups as we can and build bridges between them and NHG. We will create a single service directory on how to care for our seniors and we will share it with all our local partners including family doctors. We will join Ang Mo Kio GRC’s efforts to set up a dedicated helpline to serve the seniors. We will improve our existing local efforts on dementia, palliative care, assisted living and we will build up support groups for stroke and cancer. We will reach out to the Centre for Healthy Longevity, so that our residents can benefit from longevity interventions as soon as possible. And lastly, we will power some of these local efforts with micro-jobs for our healthy seniors.[+1 sentence] With that, Mr Deputy Speaker I stand in full support of the White Paper.
Mr Deputy Speaker6 words
[+1 sentence]Senior Minister of State Janil Puthucheary.
The Senior Minister of State for Health (Dr Janil Puthucheary)3169 words
[+6 sentences]Mr Deputy Speaker, Sir, the Healthier SG strategy focuses on GPs and residents, as we encourage them to develop closer, longstanding relationships to better enable preventive care. Family doctors, General Practitioners (GPs) will play an important role. MOH is supporting GPs to help them on board to Healthier SG. We have consulted GPs extensively about this and I thank them for their time and valuable feedback. GPs are supportive of Healthier SG and agree with the focus on health, not illness. They have raised some concerns and suggestions on how this will be implemented. Several Members of this House have also raised similar concerns and provided suggestions.[+1 sentence] GPs require support for their enhanced role. We have worked with primary care teams to develop 12 care protocols. These will provide clarity and consistent processes for the GPs and the clusters who will support them. The protocols are on providing screening and vaccination, and managing common chronic conditions like diabetes, hypertension and lipid disorders. This will be a multi-year effort and we will continue to develop more care protocols, such as for mental and dental health.[+39 sentences] Mr Xie Yao Quan suggested we strengthen the integration between GPs and the healthcare clusters. Our clusters will work closely with the Primary Care Networks (PCNs) to do this, developing clinical programmes for shared care. Ms Janet Ang and Mr Ang Wei Neng asked about the enrolment process. Enrolment is tagged to the clinic, to enable service delivery even when a specific doctor is away or unavailable. After enrolment, residents can still visit other clinics if needed. Residents can also choose to change their enrolled clinic. For example, if your doctor leaves the clinic to join another group, you have the option to switch and enrol with your doctor's new clinic. Others may prefer the convenience of staying with the same clinic in the same location. Ms Ang also asked if three generations could enroll to the same doctor as well. This is ideal. But for now, we have to consider the capacity of GPs for the enrolment process, especially early in the roll out of Healthier SG. And we will consider this approach that Ms Ang described as we open up to other age groups. Ms Denise Phua and Mr Gerald Giam also asked about enrolment to polyclinics. They will assign enrolled patients to a regular care team, so that there is one team looking after the resident for continuity of care. Ms Joan Pereira asked if enrolled patients can use branded drugs at their own cost. They can. However, the enhanced CHAS chronic drug subsidies will not apply. The enhanced subsidy tier applies to a targeted list of clinically effective and cost-effective chronic drugs, which will be reviewed regularly. For drugs outside of this list, the current CHAS subsidies will still apply. MOH will announce more details next year, including standard safeguards and reviews to guard against excessive purchases as raised by Mr Gan Thiam Poh. GPs have questions about their remuneration, the design of the annual service fee, will they be penalised if patients refuse to adhere to their health plan and would some GPs be incentivised to cherry-pick patients. They are also concerned about the impact on their business when drug prices are made more comparable with those at the polyclinics. These points were also raised by Dr Lim Wee Kiak and Mr Gan Thiam Poh. Let me first explain how the annual service fee will work. There will be a base rate that will differ for enrolled patients with and without chronic conditions. This is regardless of whether the enrollees, the residents, are compliant with the health plans. On top of this base rate, additional payouts will be provided upon the completion of critical care components recommended in the GPs' care protocols and the residents' Health Plan. For example, have patients with diabetes gone for their annual eye and foot screening? So, at the start, doctors will be paid not on the basis of whether the blood pressure or the blood sugar levels have come down, but whether the patient has engaged with the interventions that will help bring down the blood pressure and the blood sugar levels – at the start. GPs have shared that educating and encouraging Singaporeans to turn up for screening requires dedicated time and effort, and the design of the service fee addresses this and minimises the impact of cherry-picking. This new annual service fee is on top of the existing Government subsidies and the patient revenue that GPs already receive for services rendered. GPs can also expect more revenue from these patients with the increased uptake of recommended preventive care services which will be fully subsidised. And more comparable drug prices will help patients, who may have otherwise visited polyclinics, to see their GPs instead. Taken together, all of these means that GPs will be fairly remunerated for the care that they deliver under Healthier SG. Ms Denise Phua highlighted the plight of busy GPs. We hope this set of changes will also help them gradually evolve from a volume-driven model to one with more opportunities to connect with and empower their residents for health. To Ms Hazel Poa and Mr Gerald Giam's comments on MediSave, we have limits on the use of MediSave to ensure Singaporeans have sufficient savings to meet their various healthcare needs throughout their lifetime. We will continue to review the adequacy of each Medisave limit. MOH also reviews the list of conditions on the Chronic Disease Management Programme (CDMP) regularly and has recently expanded the list to include three new conditions such as gout, allergic rhinitis and chronic hepatitis B, bringing the total to 23 conditions. To Mr Xie Yao Quan and Ms He Ting Ru's questions on personnel and overseas Singaporeans who are healthcare workers, we are actively growing our pool of family physicians to meet our target of 3,500 by 2030.[+7 sentences] The annual intake for family medicine has been increasing and we will continue to review the training numbers. MOH has been working with the Family Medicine Training Advisory Committee and the College of Family Physicians Singapore on expanding the number of training places. We are also increasing exposure to family medicine in the undergraduate curriculum and have incorporated preventive care in all clinical modules. We conduct regular recruitment and retention efforts to reach out to overseas Singaporean medical students studying in medical schools recognised by us. We provide them with details on applying for jobs in Singapore and offer them Pre-Employment Grants to help with their school fees, in return for being bonded to work in our public sector healthcare institutions. We also offer, as appropriate, housemanship training positions or more senior jobs. Our aim is to facilitate as many of them as possible to return home. Overall, about 200 overseas trained Singaporean doctors come back every year.[+15 sentences] Mr Edward Chia asked about telehealth providers. Telehealth will be an important enabler. In line with this, we will also consider how remote providers, without standard in-person clinic facilities, can be included. We will share more on how GPs can leverage telemedicine to offer regular check-ins for their residents under Healthier SG in future. Let me also address Mr Ang Wei Neng and Ms Denise Phua's queries about doctors on company panels. We need to ensure that as many GPs as possible who are on employer panels join Healthier SG. The Singapore National Employers Federation (SNEF) and NTUC, employers and union leaders agree that they will need to get more of their panel GPs to join the Healthier SG programme. What does this mean for an employee? If most panel clinics are on Healthier SG, the employee can benefit from Healthier SG benefits and employer medical benefits when they enrol with a Healthier SG provider that is on their employer's panel. If and when they change employers or retire, they can stay with the same clinic and continue to enjoy the Healthier SG benefits. These Healthier SG benefits will build on top of the employer medical benefits. Regardless of the coverage of the employer medical benefits, employees on Healthier SG will receive a free consultation on their health plan and will be encouraged to complete the free nationally recommended screening and vaccinations. With effective preventive health, some employers may see savings in employer medical benefits. SNEF has been urged to plough back these savings into other health and wellness programmes to enhance the health of employees and SNEF is supportive. Mr Ang Wei Neng asked about the family physician requirements and how it will impact solo clinics. The intent is for all participating clinics to have at least one family physician per clinic.[+11 sentences] There is a seven-year runway to achieve this. PCNs support clinics in their network to achieve the requirements for Healthier SG and AIC can also provide support to clinics. We will find ways to facilitate the participation of solo GPs in Healthier SG. Dr Tan Wu Meng and Ms Joan Pereira raised concerns about the administrative burden of data submission and whether the IT systems would adequately support the work of GPs. Many GPs we engaged also highlighted the importance of IT and that the systems need to be improved. We will work closely with GPs and their IT vendors, this work has already started with GPs and their IT vendors, to support the enhancement of IT systems, to simplify administrative processes, improve data flows and sharing – all while ensuring data security. The indicators that will need to be submitted for outcome tracking and remuneration have been streamlined, taking reference from existing clinical indicators that doctors would routinely document and track, in their own records, to deliver good care. We want GPs to use a Clinic Management System (CMS) that supports their daily operations well and connects to all the key public health IT systems. And this then, will save them time on administration so that they can focus on the patients. We are working closely with the commercial CMS vendors to improve their products and strengthen their backend services. Some GPs today continue to use pen and paper services, we will provide them an interim web portal, for them or their staff to enter the essential information while they adopt a CMS and we have given them some time to do so. We know that it is not easy for GPs to upgrade to an IT system that is Healthier SG compatible, and they will have one year from the launch of Healthier SG to adjust. We will also provide a one-off IT support grant to support this transition.[+11 sentences] MOH and AIC will continue to support GPs in this process. We want them to come on board Healthier SG. Our plans will require a close collaboration among family doctors, the healthcare clusters and a wide range of service providers. However, the use of IT and record-sharing differs widely, hindering coordination and communication across partners today. Going forward, to deliver Healthier SG, we must transform how we communicate and share data for more holistic, integrated and coordinated care. Ms Mariam Jaafar and Dr Tan Yia Swam spoke about this. One key tool will be the National Electronic Health Record (NEHR). NEHR will capture summaries of patient medical records in one platform. Those healthcare workers who need it to support the clinical care that they are delivering, such as family doctors, will be able to draw from, and contribute to, a common platform. We have put in place controls to restrict the access to sensitive health information to selected user groups only. There are also additional authentication processes for the sensitive health information and we audit the access to this set of information. We will continue to implement safeguards to balance patients' need for privacy and to ensure that the correct healthcare providers are able to access critical information necessary to provide care to patients. We will introduce new legislation, the Health Information Bill, in 2023. This Bill will facilitate the proper collection, use and sharing of health data among healthcare providers in a safe and secure manner.[+1 sentence] This includes our healthcare clusters who will serve our residents as regional health managers. Only authorised personnel will be allowed to access the data, which will be limited to what is necessary for their work.[+18 sentences] MOH will be seeking feedback on the Bill later this year and we look forward to hearing your views. Ms Mariam also highlighted the importance of data analytics. Data-driven intervention is indeed our intent. We will continue to work with clusters and partners to share data and deploy such capabilities to help our residents. It is important therefore that we set up the NEHR, with the safeguards and obligations spelled out in the proposed Health Information Bill. We are strengthening the IT platforms, the services and the connections across all the partners: family doctors and healthcare clusters. I thank the many IT teams, public and private, who are collaborating on this. It is with their help that we will improve the flow of data, impact health outcomes and optimise the user experience for residents and our healthcare providers. I am glad that Mr Xie Yao Quan has also highlighted the importance of having sufficient IT and cybersecurity talent. While we have built up expertise, a key challenge remains to attract and retain skilled IT professionals in a competitive market. We will continue to remunerate competitively. We also hope that healthcare IT colleagues see the contribution they make and the fulfilling career they can have in transforming our system, caring for our society. Ms Ng Ling Ling suggested that more comprehensive health screening is needed as we move towards preventive health and Mr Abdul Samad further suggested more MediSave utilisation for this. We take guidance from the recommendations of the Screening Test Review Committee. This guidance is based on scientific evidence to ensure that screening tests are safe, effective and suitable for population level screening, means it applies to everyone across the population. We need to strike a balance, to balance the practice good preventive care, but consider what the test involves, without going overboard. In some cases, some of the tests, some of the screening tools, are better applied to targeted population. It may be better for some cases to take a calculated, risk-based approach, to offer tests that are effective and easy to administer to high-risk groups. One example is what we are doing for those aged 50 and above, such as with the 2-day Faecal Immunochemical Test (FIT) which is for colorectal cancer.[+21 sentences] So, there are some tests which the science suggests we should apply it to the entire population and there are some tests which the science suggests we should apply to targeted population. We will continue to review emerging scientific evidence on these screening tests as well as the effectiveness of our financing models. Fundamentally, access will not be denied to those who need it. Ms Janet Ang asked about regular eye and dental screening. These are important, we must look after our teeth and have our eyes checked, and most of us do so. The screening processes and tools are less appropriate as a mass exercise for all under the population approach for Healthier SG and again, are more suitable as targeted effort for certain groups of Singaporeans. Healthier SG is a multi-year effort, we will continue to review and include other necessary care protocols in future. Meanwhile, to reassure Members of the House, regular oral health and eye screening programmes are already easily and readily available as a routine service in many settings, and we will continue to offer these. For example, Project Silver Screen conducts check-ups for seniors at community locations for age-related decline in vision, oral health and hearing, so that they do not have to visit a clinic or hospital, and so that timely interventions can be provided. Likewise, we would like to assure Mr Dennis Tan that there are already similar preventive dental health programmes in place. To Mr Abdul Samad's comment, there are nationally recommended health screening tests widely available at CHAS GP clinics, polyclinics and participating community providers. In future, Singaporeans should go to their enrolled clinic to enjoy free screening. Finally, let me address mental health and well-being, a topic important to many we engaged during our public consultation. Several members such as Ms Tin Pei Ling, Ms He Ting Ru, Dr Wan Rizal, Mr Melvin Yong and Mr Dennis Tan have also raised this. Good health is also about good mental health. The current planned interventions under the first phase of Healthier SG will support mental well-being. People have asked when will we start to look at mental well-being? Yesterday – actually, years ago! The interventions we already planned under Healthier SG, starting with our initial emphasis on eating well and regular exercise, will have a positive effect on mental health. But allow me to also highlight what we have put in place over the last few years to promote mental health and well-being, even before Healthier SG. To raise mental health awareness, we have developed MindSG, a trusted online resource portal that provides comprehensive and current information on mental health. To improve access to community mental health services, we developed Community Outreach Teams (CREST).[+1 sentence] We have the redeveloped Alexandra Hospital coming up, which will provide psychiatric services. The National Addictions Management Service at IMH will be extended to other hospitals, including Changi General Hospital and National University Hospital, to make the services more accessible.[+1 sentence] We have been working closely with AIC and GP partners to have more GPs provide mental health support. As of March 2022, there were over 390 GP partners trained to care for persons with mental health conditions in the community. We have convened the Interagency Taskforce on Mental Health & Well-being with members from over 30 organisations.[+13 sentences] The task force has reviewed our mental health needs and identified four focus areas. First, to strengthen services and family support for parents and youths. Second, to provide and improve access to quality and affordable mental health care by integrating health and social services. Third, to provide employment support for persons with mental health conditions. And four, to improve mental health literacy among the citizens and create an inclusive society for persons with mental health conditions. We have completed our public consultation on the issue of Mental Health Strategy in August. Members of the public and key stakeholders have shared their feedback, and we are now refining the recommendations. The task force will share its findings soon. Mr Deputy Speaker, Sir, a Healthier Singapore requires a whole-of- society approach. We need the support of all healthcare professionals, the healthcare clusters, community partners and many more. We need to, and will, put in place systemic enablers for this challenging set of reform to succeed. Ultimately all of us need to also play our part in taking some responsibility for own health and change our behaviours. By working together, we can improve health for all of us.
Mr Deputy Speaker2 words
[+1 sentence]Deputy Leader.
Building a Healthier SG›Motions27 turns · 9,004w
· 52 highlighted
motion-1976recorded 2022-10-05
Mr Deputy Speaker18 words
[+2 sentences]Minister Ong Ye Kung. Mr Gerald Giam, I will take clarifications at the end of the Debate, please.
The Minister for Health (Mr Ong Ye Kung)6516 words
[+61 sentences]Thank you, the speech is slightly long. Mr Deputy Speaker, Sir, I thank the Members for all their questions and my MOH colleagues for answering the bulk of them. In closing, I will address the few remaining issues and then, I will then take a step back and share the broader perspective of the challenge that we are facing concerning healthcare. Let me start with TCM, as raised by several Members and Leader of the Opposition, Mr Yip Hon Weng, Ms Hany Soh, Ms Joan Pereira. Maybe I will start with – we seem to have this mood here where we talk about who made what speeches in the past. Let me give my version. I came into MOH about a year and a half ago, what struck me was the tremendous amount of groundwork that was done by my predecessor in laying a preventive health infrastructure, the IT system, the three clusters and all the medical protocols. So, I walked into a workplan seminar. As the new Health Minister, I had to speak to the senior doctors and management. At the workplan seminar, it was very daunting. I discussed with three very learned persons, our three Director of Medical Services (DMS), Prof Kenneth Mak, Prof Benjamin Ong and Prof Tan Chorh Chuan. I had in-depth discussion with them, discussed what was the next phase of healthcare and I think we zoomed in on preventive care. The good thing is, so much groundwork has been laid. On 23 May 2021, I think, I made my first speech in MOH. We talked about two topics. One was COVID-19 – Living with COVID-19 and second was preventive care, that was when Healthier SG, was first talked about. But really, thank you to the several Ministers before me and the whole team who laid so much groundwork. Then then we had COVID-19 closures and all that. We did not have many events until December. I thank Mr Pritam Singh for reminding me. I got invited in December to an event by the TCM community and that is why I spoke to them, with the indication that if we focus on preventive care, I think it is an impetus that we can make a breakthrough and feature TCM in preventive care. And that was how the thinking first started. And my last two speeches about TCM, I made quite a few TCM speeches, they are all in Chinese. The coverage has been uneven, so it is good that I have this opportunity now to explain it in English. The two speeches I last made was quite recent, Mr Patrick Tay was there, in one of the events in September last month. In summary, this was what I have been telling the TCM community and what we have been doing. One, MOH has always recognised the tremendous value of TCM and the benefits they have brought to the community. I specifically always mention, during COVID-19 – and the Leader of the Opposition mentioned this as well – I personally wrote to our TCM clinicians to say: "Please advise your patients to take the vaccines." They were a great help and really helped us moved the needle in getting heartlanders to take the vaccine. But, I also explained, we must recognise that Western medicines and TCM, they evolve very differently throughout history. They are two separate systems, complete systems with their own disciplines and their own know-how. They may intersect at some point, they may overlap, but you cannot make one to be like the other. It is not possible. They are two complete holistic systems. Take for example, you ask a western doctor, "how do you balance the five elements of a human body to keep him healthy?" Most western doctors would profess they would not know. We have doctors in the House, I do not think you would profess that you know. If you ask a TCM doctor, "This patient need a life-saving, urgent operation, can you replace it with herbal medication?" They would say "No, go for the operation." Most TCM practitioners I know, would say that too. I think they respect each other's space, their strengths and their disciplines. When it comes to regulation, there is a fundamental difference as well. Western medicine is a lot about research, clinical evidence, efficacy, safety. You get the data, then, the drug, the treatment can be approved. It is tightly regulated and by law. TCM is passed down from generations, great-great-great-great grandfather took that and passed down to great-great-great grandfather. Culturally, traditionally, they trust that herbal medicine. And you ask for clinical evidence? They do not have. You want to go for MediSave? Today's rules mean it must be a medicine, it must be certified by HSA with clinical data. For TCM, that is hard to come by. What TCM is very strong in is preventive care. More than 2,000 years ago there was already the saying: 养生三法：“饮食有节、起居有常、不妄作劳.” Very hard to translate, but let me try. Even the literal translation does not capture the full meaning. It means there are three key aspects to health: you eat not just in moderation, but 饮食有节 means you eat what your body requires, you go according to the seasons. 起居有常 means you have a healthy daily routine that follows the rhythm of the day, the month and the year probably, and not to over-exert your body, heart and mind. So, in the area of preventive health, that is where I think Western medicine and TCM share a common understanding. You would notice in my opening speech, I have a symmetry, where I talk about preventive care and how the other side also has been emphasising on it. Both disciplines believe that early management of risk factors and disease can stave off problems and complications later on in life. Therefore, I believe, when we focus on preventive care under Healthier SG, we hope TCM can play a role. While we work that out, in the mean time, we encourage TCM practitioners to continue to do what you are good at, advise the patients to take care of their health, pick up good habits, live healthily and take care of their health holistically. But like I said in my Parliamentary reply, TCM is self-regulated, with varying standards of practice. So, over the last year, MOH and the TCM community have established two workgroups. They work on issues such as enhancing TCM clinical training and improving career development. And once completed, this can be a basis to explore how to involve TCM in support of Healthier SG.[+1 sentence] But I do not think, as one Member suggested, I do not think we should impose the regulation of Western medicine on TCM. I think self-regulation for something that is traditional and cultural, would be more appropriate.[+1 sentence] But we need to strengthen that self-regulation. We have recently also finalised the succession plan of the Chairman of the TCM Board.[+2 sentences] This is MOH's partner in the TCM community. Mrs Yu-Foo Yee Shoon has been Chairman for I think at least three terms or more, a lot of contributions. The incoming Chairman will be Dr Teo Ho Pin, another familiar colleague of ours.[+17 sentences] He has taken up the Chairmanship with gusto. I have had several discussions with him. He understands the big shoes he has to fill, MOH's position and thinking, especially in the context of Healthier SG, and I think he understands his task as the TCM Board Chairman. Once we can feature TCM in Healthier SG, then the suggestions that the Leader of the Opposition has put forth, I think will be considered. And there will be a certain natural forward movement in our policy thinking. I just have one last thing before I move to another topic. Mr Pritam Singh mentioned psyllium and fybogel. I think it is the same thing. It is not that one is Western medicine and one is TCM, one is funded and one is not – I am not wrong. There are doctors in the House, please correct me. I think it is the same thing. Psyllium is the seed for fibre supplements, fybogel is essentially psyllium with a brand, called Fybogel. Both are not medicine, both are dietary supplements, fibre supplements. But like all things sold in the polyclinic, including the gauze used to dress your wounds, they will all be subsidised, including supplements. But there are doctors in the House; so, please correct if I am wrong. Let me move to the next topic, crowded GPs, raised by several Members. Dr Tan Wu Meng, Mr Yip Hon Weng, Mr Ang Wei Neng, all expressed concerns that if GPs become very popular, residents can get squeezed out by the huge demand. I tried to explain some of this in my opening speech that we will try our best to manage this. We will ask GPs to set a limit on number of residents they can enrol.[+22 sentences] How many will depend on the clinic and the doctor's own judgement, how many more can he take. So, it will differ from clinic to clinic. We are also implementing enrolment in phases; we will prompt residents to enrol with their usual GPs, the dropdown list, your most frequented GP will be first; and we will encourage residents to enrol early and not wait. I take comfort that we are discussing this because we are worried the demand will be overwhelming. It is in a way, a good problem. It is better than if the feedback comes back as, "We think nobody will enrol". That would be a bigger problem. But if GPs are to over time accept enrolment from the entire population and help keep them healthy, they have got to shift out of some current load. And I am glad that a couple of Members have given a good suggestion. Mr Melvin Yong suggested for employers not to insist on workers producing medical certificates (MCs) whenever they are sick. Many common ailments like cough and cold can be managed with more rest, drinking more water and perhaps some off-the-shelf, over the counter medication, including TCM medication. Ironically, the disease where this is most practised now is COVID-19. But if we insist we want to see a GP, we queue up and see the family doctor in order to get an MC – today, a lot of people practice that – but actually it is not the best use of the doctor’s precious time and resources. Many employers already do not insist on MCs for COVID-19. Mr Melvin Yong mentioned that our healthcare clusters today accept up to three days of sick leave without the need to produce an MC; the Civil Service grants officers up to two days for mild conditions like cough and cold. I hope this can become a prevalent practice. Let me talk about drug prices. Mr Gerald Giam asked a series of questions about our effort to substantively remove difference in drug prices, between GP clinics and polyclinics for residents enroled in Healthier SG. As I said in my opening speech, the basis of subsidy for polyclinics and for CHAS in GP clinics are different. The former, which is polyclinic, takes into account age. But for CHAS in GP clinics, a major factor for consideration is income. So, we cannot remove the differences up to the last cent and for the higher-income households, the difference may well remain in dollars. But parity of drug prices is an important concern, told to us by many residents when we did our consultation. And we will try our best to make sure there is drug price parity, especially for the lower income.[+41 sentences] Let me move on to the next subject which is delivering outcomes and KPIs. A number of Members talked about KPIs and outcomes and there was an exchange between Mr Gerald Giam and Ms Mariam Jaafar yesterday. Of course, we have to measure outcomes and set targets. That is why we listed short-, medium-, long-term KPIs in the White Paper. The work has just begun. Healthier SG is a dynamic multi-year transformation exercise. There will be twists, turns and uncertainties along the way. MOH is having extensive discussions with clinicians and other stakeholders to set out the technical definitions and our approach to data sharing and measuring these outcomes. And from there, we will establish the baselines of various indicators and then, determine what targets we want to achieve and by when. While it is important to measure outcomes and targets, those who have run organisations before will know that this is not straightforward. I used to be involved in workers' training, so I interacted a lot with HR practitioners. And HR practitioners always lament – and this is not just for Singapore, it is the whole world. They always lament employees are over-managed but under led. The unions always say that. Because if you are manager and you are in the middle of a big change management exercise, you will likely instinctively say, what are the targets, let us measure the targets, whatever gets measured, gets done. That is what the manager always says. Ms Hazel Poa went further to say, let us measure the targets achieved by the GPs. And if they do not achieve, clawback the service fee. But as Dr Tan Yia Swam cautioned, it is important for GPs and MOH to work together, for GPs to feel that they are integral part of this change. And I agree with Dr Tan. Ms Mariam Jaafar, my colleague from Sembawang, and an experienced management consultant, immediately raised a red flag. I think she has seen enough organisational changes to notice the danger of blindly chasing KPIs and targets. Because I talked about what the manager would do. But what will a leader do? A leader that is driving the change will have a different starting point. He or she, the starting point is, bring everyone on board, make sure everyone understands and buys into the mission in objective. Then, we jointly set KPIs and targets and then do our best to achieve them in the right spirit. If we do not do that, then we are not leading. We are only managing. And if in our zeal to over-manage, we penalise people for not meeting targets in the middle of a big change, that is when people become cynical and they lose heart, and then you get perverse outcomes like what Dr Lim Wee Kiak said. Imagine if we really say to the doctors, "If you do not meet your KPI, we will claw back your service fee". Then, it is very simple for the doctors. Number one, either I do not join Healthier SG; or two, I join, but I cherry-pick the healthy residents. So, the way we look at KPIs, always, you are able to differentiate the leaders from the managers. Since we are on the topic of outcomes, I want to respond to Ms Mariam Jaafar. She is not here today, she has to fly off for work. But she had a very thoughtful and insightful explanation of value-based care and I think it is worth responding to her. She cited several good international practices. I want to assure the House that our hospitals have already been implementing value-based healthcare through many such initiatives too. We just did not feature them in the White Paper under Healthier SG. There are many examples. One, all the community measures taken to help resuscitate out-of-hospital cardiac arrests by making defibrillators available in the community, training members of the public to perform CPR, alerting them through apps, that there is a cardiac arrest nearby. And so far, the survival rate of out-of-hospital cardiac arrest has improved by 10 times – 2% to 22% over the years.[+1 sentence] Changi General Hospital has set up a post-acute myocardial infarction clinic to support patients in their post-heart surgery recovery. The idea is to review the patient's condition early within two weeks. This has resulted in a reduction of the 30-day re-admission rate from 14.3% to 9.6%.[+6 sentences] There are many such examples and I hope Ms Mariam Jaafar and the House will be comforted that our clinicians are always thinking of better ways to deliver better clinical outcomes. Let me now comment about capitation. A few Members have raised the issue of capitation. I agree with Members on the benefits of capitation funding, but we are doing it step-by-step and carefully. I explained how we are doing it at the GP level during my opening speech by extending them a standard base fee per enrolled resident. So, it is loosely a capitation payment. At the healthcare cluster level, we have changed the basis of calculating their budgets to be capitation-based.[+6 sentences] They still get the same budget, except that the basis of calculation has moved away from based on workload to capitation – the population that they are taking care of. So, they receive fixed capitated budgets for residents of different age bands. For the very young, they have to do a lot more work, at a higher capitation rate. Young adults will have the lowest capitation rates and as you get older, as you need to pay more attention to their healthcare, capitation rate goes up again. So, age bands are a reasonable proxy for both workload as well as health risks. Ms Sylvia Lim asked whether we can publish the rate. For now, I think it is better we keep this as internal parameters within MOH.[+16 sentences] In any case, the annual reports and financial statements of the clusters are available, if you get them from ACRA. Clusters, in turn, will cascade down Healthier SG key performance indicators (KPIs) to all their institutions and partners. But they will not yet capitate the budgets of hospitals, polyclinics or community hospitals. So, below the clusters, healthcare institutions will still be funded the same way for now. But capitation funding is a direction we want to move towards. It is a big change and we will have to study and plan each move carefully, making sure every institution, every partner is ready before we do so. When it happens, it must be accompanied by a significant granting of autonomy so that healthcare institutions can make the right-siting decisions properly. I will give Members an example. Let us take a palliative care hospice, for example. Today, we fund them through workload – same formula – but we can capitate their budget. So, a palliative care provider can receive a standard based fee for each palliative patient they take care of and then they decide which services are in the best interest of each patient, whether they should go to inpatient hospice care, home care or day care. They do not have to worry about separate funding for separate services under separate settings. That is where we have a lot of potential. Let me now move on to the next important topic, which is manpower. Several Members – Dr Tan Wu Meng, Dr Tan Yia Swam, Ms Mariam Jaafar, Mr Dennis Tan and Ms He Ting Ru – raised concerns about manpower and I appreciate that. It is a major challenge. The key challenge is to have sufficient nurses, allied health professionals and support care staff to operate hospitals, clinics and also eldercare centres. These few groups number about 58,000 now and MOH estimates that this will need to grow to 82,000 in 2030 – 58,000 to 82,000 from now to 2030.[+14 sentences] We will broaden training for our healthcare workers – nurses, allied health professionals and pharmacists – so that they can take on the crucial roles alongside doctors in preventive care. For example, nurses in the community will be trained in lifestyle coaching to empower residents to make good choices according to their care needs. Undergraduate allied health courses comprise specific modules on population health, health promotion and chronic disease management. Mr Mark Chay suggested some useful training for doctors on physical fitness. I think we will follow up with discussions with him on how we can improve or broaden the range of courses that doctors can go to for their continuous training. Our community pharmacists are now able to provide smoking cessation and weight management services and there are plans to train them in influenza vaccination. But first, there must be enough people to train. There is, again, a certain narrative going around – some Members alluded to this narrative – that hospital staff are leaving because they are overworked, attrition rate is at a record high, people are avoiding the healthcare sector and that we must do campaigns, reduce workload and raise salaries to attract more people. That is the common narrative now going around. There are some elements of truth in this narrative, such as there is, indeed, a manpower crunch and hospital staff have been working very hard, especially during the pandemic. But the rest is less than fully factual. They propagate some negative energy and may not help us tackle the actual problems. Take the attractiveness of the healthcare sector. Are young people really avoiding the sector? Ten years ago, ITE, Polytechnics and Universities in Singapore took in about 1,500 nursing students a year. Now, this has gone up to 2,100 and we are trying to increase it further to 2,300 in the next couple of years.[+13 sentences] Our education institutions receive many more applications than there are places. At this number, we are attracting 4% of the student cohort into nursing. If we maintain that number while cohort sizes shrink, the percentage will drift up to maybe 5% of each cohort. That means that for every 20 local students you see in a class, one will be trained to become a nurse and they are applying. So, healthcare has a very fair share of the local talent pool, considering there are so many sectors vying for local talent. On attrition rate – is it really at a record high? If we look at local nurses, the normal annual attrition rate every year is about 6.4%, which is not high by any industry standard. In 2020, when the pandemic struck, it went down to 5.4% because many of our nurses who were planning to retire or resign, in the face of the pandemic, decided to stay and fight. In 2021, there was a slight rebound to 7.4%. In 2022, this year, so far, the numbers have reverted to that of normal years. There was no mass exodus of local nurses. These are the numbers. Nurses have remained dedicated and steadfast and bravely stood their ground in the face of the pandemic. What has gone up is the attrition of foreign nurses – from about 8.9% in normal years to 14.8% in 2021.[+33 sentences] This is where there is record high attrition, at least, over past few years. We know the main reason, and Dr Tan Yia Swam talked about it, which is that the pandemic has increased the demand for nurses all over the world and our foreign nurses are being poached by other countries. They go to New Zealand, Australia, the UK, UAE. So, if we want to tackle the manpower crunch in healthcare, the starting point is to hold on to our foreign nurses in the face of heightened international competition. Only then can we reduce the workload for all nurses, which many Members have called for. But we must be clear where our starting point is. Remember, healthcare is one sector that is directly affected by our demographic changes. An expanding aged population needs more healthcare and more healthcare manpower. A shrinking young population limits the number of new local talents that we can bring into healthcare. Therefore, if we are honest with ourselves, we know the numbers simply will not add up if we just rely on local nurses or local manpower, no matter how hard we try to expand the local pipeline. Therefore, if we want to take care of our seniors and the sick, if we want to reduce the workload of healthcare workers or at least make it more manageable, we must expect foreign healthcare workers to play a bigger role in the coming years. This is especially so in areas where there is a more severe manpower crunch, such as aged care or palliative care. The great majority of our nursing workforce will still be locals but the number and role of foreign nurses will need to grow. MOH is, therefore, securing various pipelines of good foreign healthcare workers from different source countries to bring them here and further train and develop them. Some may leave us after a few years but we will try to keep the majority, especially those who have become an integral part of our care teams. Dr Tan Yia Swam suggested granting the good performers PR and MOH is supportive of this. ICA always assesses PR applications holistically, including taking into account the economic and social contribution of the applicants. So, when it comes to evaluating applications from foreign healthcare workers, ICA will certainly consider the important contributions of healthcare workers and MOH's support for the applicants. At this juncture, Mr Deputy Speaker, I would like to say a few words to our healthcare workers through you. I believe the great majority of Singaporeans respect and appreciate our healthcare workers. We have seen the outpouring of public support in the recent past for the sacrifices made by frontliners as they steadfastly battled the COVID-19 pandemic. However, many of our healthcare workers have also experienced abuse by patients and family members who lashed out at them because hospitals and clinics are high-stress environments. I hope that our healthcare workers will look past a small minority that show disrespect and have faith that the great majority salute you, which includes everyone in MOH. I believe I speak for every one, every Member of this House, that we, too, respect them and their work, whether they are men or women, young or old, locals or foreigners. Abuse against healthcare workers cannot and should not go unaddressed. We hope to raise public awareness on abusive behaviour that should be stopped and equip healthcare workers to better handle such situations. Mr Deputy Speaker, Sir, ultimately, we need to squarely tackle the challenge before us, which is that our society is ageing fast. It is a worldwide trend. By 2030, the old will outnumber the young in the world – the first time in recorded human history. East Asia, in particular, is ageing faster than any other region in the world due to declining fertility and people living longer lives. Within East Asia, the countries ageing the fastest are Japan, South Korea and Singapore. We are called the "advanced agers". Members have heard this statistic many times. By 2030, one in four Singaporeans or thereabouts will be 65 and above, up from one in six today.[+1 sentence] But it is not just a statistic. The number translates into real impact on our lives and we have yet to feel the full brunt of it. For companies, you will face a shortage of workers, requiring you to move into automation, adopt less manpower-intensive business models while using foreign workers judiciously.[+11 sentences] For schools, shrinking student intakes, which is why MOE has to merge schools and some of us find our alma maters gone. Within communities, we have to make sure estates are now barrier-free. At traffic light junctions, the green man will have to appear longer because people take longer to cross the road. If you are a driver, you will have to slow down in the HDB estates and we already have silver zones. For families, more and more couples will find that they have to take care of two sets of aged parents, in addition to their own children. In the healthcare sector, we see rising disease burden and escalating demand for hospitals, clinics, doctors, nurses, budget and so on. Most importantly, the seniors themselves, as they see more of them, they will be asking, "How do I live purposefully and healthily, with dignity, in my old age?" Mr Henry Kwek, Ms Tin Pei Ling, Miss Cheng Li Hui and Ms Carrie Tan raised these concerns and, importantly, they warned us of the danger of isolation of seniors and the importance of social contacts for seniors. Ageing is a major topic. Its impact spans across various sectors. Today, let me just address the implications on healthcare. Our basic premise must be this – ageing may be an inexorable trend but a rapid escalation of disease burden and suffering need not be a given.[+30 sentences] We can manage this, provided we stay healthy. Many of us, myself included, are guilty of being caught in the old mould where life stages are determined by age – five years old, go preschool; 12 years old, take PSLE; 20-plus, graduate; by then, roughly, you should find a boyfriend or girlfriend and apply for BTO; late 20s, get married; 50s, beware of onset of chronic illness; 60-plus, retire; beyond 80, you may start to become frail. The age markers remain relevant and can continue to guide us in understanding life stages, key events and risks throughout our lives. But we need not be strait-jacketed by them, especially when it comes to health and ageing. For example, there is no reason why 50s has to be the onset of chronic illnesses. We can stay healthy and not have chronic illnesses in our 50s. There is no reason why once you cross 65, you go into the wrong side of the dependency ratio. There is also no reason that why being in our 80s must be associated with frailty. We can delay it as long as you can, well into your 80s or 90s. Policy planners will continue to monitor the statistics based on age, but as individuals, we can choose to differ from these widely accepted assumptions. And the Government can make policy changes and reform our systems to help individuals achieve that. To do so, we need to recognise now that the healthcare system is not one system, but three interconnected systems, working together to deliver good outcomes. The first system is the acute care system. This is what typically comes to mind when we think of the healthcare system. It comprises hospitals, specialist clinics, emergency departments – the places that treat us and cure us when we are very sick. We are expanding this system, building more acute and community hospitals in the coming years. The second system, less known, is the public health system. One important part of the public health system is the control of infectious diseases. And we can see these systems springing to rigorous action during the pandemic. The other important part of the public health system is the one that improves the health of our population. This comprises the policies and processes for preventive care, including the network of family doctors, their long-lasting relationships with residents, the practice of regular health screening, the culture of good lifestyle habits, all of which keep a people healthy. This is the system that we are now building and strengthening through Healthier SG. We have seen how the two systems complement each other during COVID-19. The public health system strengthened the surveillance of the virus, got people to adopt good hygiene habits, received vaccinations, stayed home if unwell. The acute care system took care of those who got infected and experienced more severe symptoms. But still, the two systems are not enough. In an ageing society like ours, the third system is equally critical and that is the aged care system. This is the support system for the large segment of people who are advancing in age. And this system is not only about nursing homes. The nursing homes, they serve an important purpose, which is to care for seniors who are very frail and unable to live independently, whose families cannot support them. But nursing homes are not and cannot be the mainstream solution to ageing. We are building nursing homes very quickly, from 16,200 beds now, to 31,000 beds in 2030.[+20 sentences] I am sure we need them as our population ages, but the projected pace of expansion is worrying. In our Asian culture, we value caring for our seniors at home. Our seniors also prefer to age in a familiar environment and we should not lose this. As a society, we must guard against the assumption that seniors will always become sick and frail, and unable to take care of themselves. This is quite a risky mindset because it will exacerbate our challenge. Because over time, society will, perhaps unintentionally, push more older people to become isolated – which many Members have warned us of. Our instincts backfire from time to time. We would have come across such stories. Let us say, a senior went marketing in a wet market and then he fell. The family may, to protect him, tell him, "Do not go out anymore, we will hire a domestic helper to watch after you." Or a senior cooks forgot to switch off the stove, and fortunately, it was discovered early. The family may tell her, "Do not cook anymore, we order in for you, every meal." We might do all these out of concern for our loved ones, but in so doing, we deprive them of physical activity, a sense of agency, a sense of dignity. We want to protect them, but we unintentionally expose them to an even greater risk of isolation and loneliness. That is when the spirit wears out, the body gives way. If that mindset becomes entrenched, then over time, seniors become a problem to be contained, put aside in nursing homes – out-of-sight, out-of-mind. It is like a room in your house, where you put all your problems and you do not want to see. One day, that room will burst. We must support as many seniors as possible to continue to live in the community, independently or with some help, contributing to the best of their ability, able to choose their own activities, having a full social life with friends and family. I visited Block 115 that Mr Henry Kwek talked about. It is not run on a big budget, a lot of passionate volunteers, we all know who got involved, but it is doing such heavy lifting and making such a huge difference to the seniors living in that block. I came across this piece of research, which estimated that the health impact of loneliness for a senior is equivalent to smoking 15 cigarettes a day. We estimate that today, 97% of our seniors above 65 can either live independently or with some help in the community.[+7 sentences] We must maintain or improve that share and not inadvertently give them the equivalent of 15 cigarettes a day, and weaken their health and ability to live independently. For the large majority of seniors, what they need most is social care, more than healthcare. The way to deliver that is to enable ageing in communities. We will need a range of solutions to anchor ageing in communities. These include building more Community Care Apartments that Second Minister Masagos Zulkifli talked about, on releasing land for private assisted-living facilities. But the greatest asset for managing ageing is actually right before us – and that is our HDB estates. Most estates already have ample shared spaces for interaction and activities, you got your void deck, your coffeeshop, your supermarket, your RC centre, our Eldercare Centre, your community clubs. We did not specifically build them as infrastructure to support ageing, but they are extremely valuable in our ageing society. And that is why MOH is rapidly expanding our network of Eldercare Centres to activate these existing spaces and create more shared spaces and social networks for seniors.[+5 sentences] We are working closely with AIC to provide training opportunities for our centres to take on an expanded role under Healthier SG. As a social worker told me, a very effective initiative is to simply bring the seniors to that shared space to cook and enjoy a meal together and once they eat together, they socialise, they start doing different kinds of activities together. There is no risk of forgetting to switch off your stove and we will definitely improve the way the Eldercare Centres work. As suggested by Ms Janet Ang, for those who are in their last lap of their health journey, we are expanding palliative care, especially at home, to allow our loved ones to pass on as comfortably and with as much dignity as possible. This is the wish of most seniors and we should try our best to fulfil it. Ageing in communities will be the next major area of change and reform in healthcare that we need to work on.[+12 sentences] When all three systems – acute care system, public health system, aged care system – work together synergistically, healthcare happens everywhere and not just in medical facilities. So, I thank Dr Tan Wu Meng for sharing the story of Ah Ma, and pointing out that the healthcare subsidy should not be tied to services being delivered in brick-and-mortar facilities. This will naturally have to be reviewed as we shift our paradigm. Mr Deputy Speaker, Sir, let me conclude. Some countries may place a stronger emphasis on just one of the three systems or organise them in a way that they end up working in silo. For example, Japan, as a super-ageing society, has a great focus on aged and institutional care. The US acute care system is state-driven, but public health is driven at the federal level. In Singapore, we take an integrated approach. Acute care, public health, aged care, all come under MOH. The Minister for Health, is also the Minister in-charge of ageing issues and chairs a multi-Ministry task force going beyond healthcare. And this is an important advantage for us. MOH is in a position to develop a cogent and comprehensive plan, muster resources to transform and fire up all three systems, to deliver health outcomes for our people. Healthier SG is a key effort to activate and reform the public health system, empower individuals to choose health and lay the foundation for the aged care system I spoke about.[+2 sentences] We need all stakeholders – doctors, community partners, healthcare clusters, employers, residents – to join us in this effort, to shape a healthier Singapore. We do this for ourselves, we do this for each other. All societies, at some point, will have to confront population ageing. It is an urgent and stern test, and some societies end up with bankrupted healthcare systems or let healthcare cripple their society and economy.[+1 sentence] We are determined to overcome this test. We have the resources, ability, organisation and determination to do this. I seek the support of this House and of the people of Singapore to endorse this Healthier SG effort as the basis to transform our healthcare system, so as to strive towards the vision of long and healthy lives for Singaporeans.
Mr Deputy Speaker44 words
[+5 sentences]We have had a healthy debate over two days. Members deserve a chance to seek clarifications. This will also allow MOH's officeholders to further explain MOH's priorities. In the interest of time, Members are invited to ask short clarifications, please. Dr Tan Wu Meng.
Dr Tan Wu Meng (Jurong)277 words
[+5 sentences]Mr Deputy Speaker, I thank the Minister for Health for his support and statement, supporting our healthcare workers across Singapore, who continue keeping Singapore patients safe and looked after, even as the COVID-19 pandemic winds down and the BAU load continues apace. I also want to thank Minister for recognising the challenge that my Clementi resident, Ah Ma, went through, the family had asked me to tell her story and I am glad that the difficulties she and her family went through, have been recognised and will be looked at by MOH. I have a clarification to ask about how we support residents and patients who are in the frail stage of their health. These are residents who may have a number of medical conditions, who are not quite so ill that they may need to be admitted or have to go to a care home, but not quite in the pink of health. And they often have many medical conditions, with many, many follow-ups. In a Parliamentary Question earlier this year that I asked, and which I raised in Committee of Supply, there are Singaporeans today who may have 20 or even 30 outpatient visits in a single year, each of these visits poses challenges for the caregivers, especially caregivers who may be daily rated and cannot get time-off from their employer. As part of Healthier SG and strengthening coordination of care, can the Ministry also help look at ways to reduce the number of visits, by giving care providers, doctors and healthcare workers additional time and bandwidth, to help further coordinate and streamline the care for such patients who face frailty and many medical issues?
Mr Ong Ye Kung207 words
[+12 sentences]Thank you. We will try our best to streamline the procedures, but without belaboring what I have just said in my closing speech, frailty, we may see it as a permanent condition but they can improve. And if you ask Mr Henry Kwek, in his Block 115, people have improved. They saw seniors who could not walk, you create that common space in that block. First step, make sure they stick to their medication; take their medication; gradually, they improve; then, give them better food, social connections with nutrition and confidence interacting with people; they actually become better, even though they are in their 80s. I think Mr Henry Kwek can tell more of that story. But we see it. It can happen. We see in Kampung Wellness that Ms Carrie Tan spoke about. A different shape but similar effort. So, without belabouring the point, I think there is a lot of potential we can do for the current generation of aged, ageing in community's social care, including healthcare, can improve their health and push back frailty as long as possible. For the younger group, Healthier SG – postpone frailty as long as we can, make sure our healthy life is as long as our biological life.
Mr Deputy Speaker3 words
[+1 sentence]Mr Pritam Singh.
Mr Pritam Singh141 words
[+7 sentences]Thank you, Mr Deputy Speaker. Just a minor point to clarify the query the Minister raised about the particular product I was referring to, psyllium husk. I think Minister will understand why I had some trouble when I identify the name it is marketed under because the box says, Telephone Brand (Sat-Isabgol) Psyllium Husk. And so this product is produced in Gujarat, that means, as the Minister said, substantively the same product as Fybogel. And Fybogel, as we know, is commonly prescribed especially after invasive surgical procedures where individuals may suffer from constipation. The point I was making really is in parallel with the point the Minister made about the intersection between Western medicine and alternative medicine. And if we can extract savings from that intersection, I think this will be consistent with watching the fiscal umbers on healthcare going forward.
Mr Deputy Speaker4 words
[+1 sentence]Ms Ng Ling Ling.
Ms Ng Ling Ling (Ang Mo Kio)147 words
[+3 sentences]Thank you, Deputy Speaker. I want to thank all the officeholders for Health for the very, very helpful responses to all the speeches that had been made. And you will see that the members in the Government Parliamentary Committee (GPC) for Health, we have all spoken up because it is a really important initiative for the population health of Singapore. I have one clarification for the Minister for Health.[+1 sentence] I would like to ask, of the $1 billion start-up funds that the Minister mentioned and potentially, $400 million recurrent funds, to support this whole initiative, how will it be broadly, allocated to the stakeholders in this whole ecosystem that need to make this work, especially for the GPs that we know have to do a lot of the heavy lifting, as well as the residents who have to feel the incentive to take ownership of their health?
Mr Ong Ye Kung174 words
I do not have the numbers with me but of the $1 billion, slightly over $1 billion, there is a chunk for the central IT system, there is a chunk to upgrade the capabilities and IT capabilities of GPs, there is a chunk to upgrade or build up capabilities within the clusters in order to be regional health managers, there is a chunk to do a one-time ramp up of social activities.[+1 sentence] We are also thinking during enrolment, there could be some incentives – so, there is another chunk there. So, they all add up to over $1 billion . But what the Member did not ask is also, in terms of recurrent, I did mention recurrent expenses of about $400 million a year.[+2 sentences] That recurrent amount, about half will go to GPs as their service fee, the capitated service fee, for looking after enrolled patients, and another half will be the additional subsidies for residents, including healthpoints, health screening and so on, which will be free. So, it is about 50-50 for recurrent.
Mr Deputy Speaker4 words
[+1 sentence]Dr Tan Yia Swam.
Dr Tan Yia Swam (Nominated Member)152 words
[+11 sentences]Thank you for the opportunity. Mr Deputy Speaker and the House, I would like to thank Minister Ong for acknowledging the contributions of healthcare workers, especially in the past two years. Three big points. One is that my own term here as a Nominated Member of Parliament is limited and will come to an end pretty much soon. I hope that all of you will continue to engage with healthcare workers on the ground, not just doctors to reflect our view. Doctors have always felt that we cannot be a union and sometimes, we are marginalised. As it is, there are 15,000 doctors in Singapore. There are even more nurses around and someone needs to help represent healthcare workers as we forge forward for Healthier SG. Final point. Oh no. I am so nervous that I have lost my train of thought. I will email Minister Ong separately about my final point.
Mr Deputy Speaker19 words
[+1 sentence]But you have the opportunity to ask it if you can think of it in the next five minutes.
Dr Tan Yia Swam3 words
[+1 sentence]I remember now.
Mr Deputy Speaker3 words
[+1 sentence]Okay, go ahead.
Dr Tan Yia Swam53 words
[+3 sentences]I am so sorry. About the KPIs, one big thing is that, as MOH and various committees talk about KPIs, please remember to involve doctors in the conversation and not be chasing economics – which is more economically viable. Let doctors advise you on what we think are feasible, medical and clinical KPIs.
Mr Ong Ye Kung87 words
[+5 sentences]On the second issue, that is natural. For MOH, we always err on the side of over-consulting especially our medical experts. On representing healthcare workers in the Chamber, I think we have NTUC here and they will always champion workers and especially nurses and healthcare workers. We had Ms K Thanaletchimi as Nominated Member of Parliament before. But even we do not have a healthcare worker as a Nominated Member of Parliament, be rest assured NTUC is there and the Minister for Health will be here too.
Mr Deputy Speaker3 words
[+1 sentence]Mr Gerald Giam.
Mr Gerald Giam Yean Song (Aljunied)266 words
[+7 sentences]I thank the Minister and Senior Minister of State for responding to my proposals and questions. I would like to seek clarifications from both of them. First, for the Minister, I would like to clarify that KPIs and targets are not synonymous. The White Paper already lists many good KPIs. I am just asking MOH to take the next step to set targets for each KPI so that all stakeholders can work together towards achieving those targets. The best practice in performance management is actually to jointly set KPIs and targets with stakeholders – including doctors of course – and then review them regularly and make adjustments if the conditions change. So, they are not set in stone. But I also do not think that we should start out such a major initiative without any target set.[+1 sentence] Secondly, for the Senior Minister of State, can I clarify with the Senior Minister of State that under the Healthier SG initiative, residents can choose to enrol with polyclinics instead of with GP clinics? And lastly, the Healthier SG White Paper said that MOH will waive the requirement for residents to co-pay part of their bills in cash. Can I clarify that patients will be able to use MediSave to make that co-payment? And will that still be subject to the annual withdrawal limit?[+2 sentences] Because if this is so, then patients will more likely hit their annual withdrawal limit and thereafter, have to co-pay in cash. So, even if MOH cannot remove the annual withdrawal limit now, can it consider increasing it to, let us say $1,000 a year?
Mr Ong Ye Kung39 words
[+3 sentences]I will take the first question and then Senior Minister of State Janil will take the next two. I thank the Member for the clarification about KPIs and targets. I think we are now essentially on the same page.
Dr Janil Puthucheary27 words
[+2 sentences]I thank Mr Gerald Giam for his questions. Yes, they can enrol with polyclinics and we will continue to review the issue of the annual withdrawal limits.
Mr Deputy Speaker21 words
[+2 sentences]I see last two hands. We will have Ms Hazel Poa and then, we will conclude with Mr Liang Eng Hwa.
Ms Hazel Poa (Non-Constituency Member)73 words
[+3 sentences]Thank you, Deputy Speaker, I just want to make sure that I understood the Minister correctly. When he said that there will be no KPIs for family doctors and no clawback, because that would mean that essentially, if I recall correctly, the amount of money that will be paying in service fee is $400 million a year. Does that mean that we will be paying this $400 million a year, with no accountability?
Mr Ong Ye Kung261 words
Ms Hazel Poa asked a question but she is actually making a statement. She is saying that Healthier SG, $400 million to spend, as I just answered, $400 million is, first, to subsidise residents for health screening, health points and all that.[+10 sentences] The other half is a service fee to GPs to help us take care of population. And I think she just made a statement to say this is not a good spend of money and if you want it to be spent well, give KPIs and targets to the GPs, and if they do not meet, claw back the fees. This is not what we should do. In a major effort like this, we want to bring in the GPs to be part of this. Of course, there will be KPIs with targets and we collectively work together to achieve it. At the GP level, they will have certain targets as well. But I do not think we want to treat them like vendors and contractors where if you missed out on a certain KPI, we claw back the fee. They care about the health of the population as much as we do, maybe more than Members in the Chamber. Treat them as part of the team, together in the right spirit, we will look at how well we are doing together by reviewing the targets and adjust along the way to achieve good health for Singaporean. A billion-dollar set-up, $400 million, if we can keep the population healthy, is money well-spent, even though the Member may think otherwise.
Mr Deputy Speaker4 words
[+1 sentence]Mr Liang Eng Hwa.
Mr Liang Eng Hwa (Bukit Panjang)168 words
[+8 sentences]Thank you, Mr Deputy Speaker. Sir, I am really happy that the Minister mentioned about the Elderly Centres, and the plan to build more in the community. I agree fully there is a real need for that. But the problem is, like in many of the estates, like my constituency Bukit Panjang, we are running out of void deck spaces to build such centres. And we need to reserve some of these void deck spaces for other activities like funeral wakes and so on which is also a reality of ageing. So, can I ask the Minister whether would MOH be open to allowing standalone centres, those outside the void decks, which understandably will cost more to build? But there are some spaces that can actually allow such facility to be built. And specifically, my question is whether MOH will fund this this facility that is outside the void deck centres which may cost a bit more but, because of the space constraint, we have to do that.
Mr Ong Ye Kung290 words
[+15 sentences]It sounds like a specific Bukit Panjang issue which we can discuss. We always do not say no right at the outset. Let us look at the circumstances. But the larger point is this. We also tend to look at the problem and then we want to solve the problem and the first thing is, we need real estate. As I mentioned earlier, if we want to enable ageing in communities, look at what assets is already right in front of us. And visiting Block 115 in Ang Mo Kio is a bit sobering but it is so inspiring too. They are using their void deck spaces. They took back four units or HDB helped take back four units on the second floor. And in that four units, there is a medical centre, there is a therapy centre, there is a place for them to have activities. And so, you create the space. Look around our communities, HDB estates are brilliantly built with lots of shared places. We just need to activate them. So, while we will look at the Member's proposal, let us not close our minds to also the assets that is already right in front of us. [(proc text) That this House endorses Paper Cmd 19 of 2022 on "White Paper on Healthier SG" as the basis to transform our healthcare system by (a) focusing strongly on preventive care; (b) fostering lasting relationships between residents and family doctors; and (c) building strong partnerships within the community, so as to support individuals taking care of their own health and wellness and strive towards our vision of long and healthy lives for Singaporeans. (proc text)]