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Building a Healthier SG›Motions34 turns · 29,555w
· 172 highlighted
motion-1968recorded 2022-10-04
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.
Mdm Deputy Speaker2 words
[+1 sentence]Deputy Leader.
Building a Healthier SG›Motions17 turns · 9,289w
· 65 highlighted
motion-1970recorded 2022-10-04
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.
Senior Employability: Meaningful Employment and its Value for Businesses and Singapore›Matter Raised On Adjournment Motion4 turns · 3,980w
· 26 highlighted
matter-adj-1978
The Leader of the House (Ms Indranee Rajah)14 words
[+2 sentences]Mr Speaker, Sir, I beg to move, "That Parliament do now adjourn." Question proposed.
Ms Jessica Tan Soon Neo (East Coast)2438 words
[+1 sentence]Thank you, Mr Deputy Speaker. By 2030, one in four Singaporeans will be aged 65 and above. Based on the United Nations' report on the world's population ageing in 2019, Singapore will be amongst the top 10 aged countries in the world in 2050 and the second highest country with the largest percentage point increase in the share of older persons in the world. Life expectancy, as we all discussed earlier, of Singaporeans is going up, and in 2020, it is 83.93 years with healthy life expectancy at 73.7 years for males and 75.2 years for females.[+8 sentences] With longer life expectancy and healthier life, a senior can continue to work productively and lead a meaningful life for longer. While longevity touches many aspects of how we live, work and play, I am advocating the need for a concerted focus on work and senior employability. Enhancing the employability of seniors aged 55 and above is not a new topic in Singapore. There are a myriad of re-employment, retirement and retention policies, financial support and grants to employ seniors, programmes to redesign work, to hire and support seniors who want to continue to work. The Motion today is to share the voices from surveys and focus group discussions on senior employment and to make recommendations to enable meaningful employment of seniors and the value of the pool of talent for businesses and Singapore. To understand senior employability, as part of the PAP Seniors Group's effort to reach out and hear the voices of seniors employed and unemployed, we conducted online surveys and focus group discussions with seniors. This enabled us to learn more about what matters to seniors in their working lives, the opportunities and challenges they face. In October 2021, PAP Seniors Group started our engagement with seniors aged 50 and above through an online survey. Nine hundred and thirty-four seniors of diverse profiles responded to the survey.[+23 sentences] To gather further insights, we engaged 200 seniors, including the survey respondents who were willing to participate in Focus Group Discussions (FGDs) to have deeper conversations and dialogues. In addition, we conducted a literature review on senior employability both locally and globally. We examined the matter from the perspectives of seniors and various stakeholders, such as employers and younger workers who work with seniors. Contrary to the popular belief that one would retire, not work and "enjoy" life; seniors we engaged with shared that they want to continue to work as well as to do work that tapped on their capability. The primary motivation is the sense of satisfaction derived from the contributions made at work, amongst others, of course, more realistically, economic and some sociological motivations. The survey results corroborated with the qualitative responses of seniors who participated in our focus group discussions. We also conducted online surveys with the younger workers and employers to hear and examine the matter from their perspectives. In August this year, together with the support of Singapore Human Resources Institute (SHRI) and in partnership with Professor John Wong and the team from NUS and NUHS working on the Singapore Health District @ Queenstown, I joined a dialogue with human resource professionals and decision makers from different companies to understand their experience in hiring and managing seniors in the workforce. The inputs we gathered from online surveys and FGDs with seniors, employers, younger workers and HR professionals have informed the recommendations I am putting forward on senior employability. The seniors, employers, HR professionals and younger employees we engaged, acknowledge the value of the many policies and programmes available today, that promote support and advance the hiring, training and retention of seniors in the workforce. However, all stakeholders agreed that more needs to be done to address challenges faced and to promote active employment of seniors for more meaningful and happier employment. It is not just the number of seniors being employed but the quality of the jobs and the work experience of seniors as well as seniors being able to fulfill the requirements of available jobs. Ageism and the continued need to learn new things or skills to stay relevant amid the dynamic macro environment were two key challenges and experiences shared by seniors in the survey and FGDs. Feedback from employers, younger workers and HR professionals highlighted the value of the experience, knowledge and expertise of older workers and the diversity with a multi-generational workforce. However again, all stakeholders, including seniors themselves, shared challenges of managing or working in a multi-generational workforce. In the FGDs with seniors, participants shared their experiences with ageism, with many citing difficulties in getting the opportunity for interviews for the multiple jobs applications made. In our discussion with HR professionals, they did share that often business leaders may not consider workers above 50yrs for certain roles as they are seen as having not enough "runway". While citing these examples, seniors and HR professionals acknowledged that it is often unconscious bias and not a deliberate attempt to discriminate. From both the surveys and FGDs, seniors shared that they worry about not being able to continue to work after the retirement and re-employment age. In Singapore, the Retirement and Re-Employment Act (RRA) protects employees from being dismissed because of age. When they reach the retirement age, which is currently 63, the company will have to re-employ them until they reach the re-employment age, which is currently 68. In the FGD with HR professionals, they highlighted that while the intent is to protect older workers, the RRA is a double-edge sword, leading to an unconscious bias against selecting seniors for roles. As a company considers hiring someone who is senior and has little "runway" to retirement, they may see it as a risk to hire a person if he/she turns out not be a good fit for the role, as the company will be required to offer re-employment for the person when he/she reaches retirement age. In the OECD report on Promoting an Age-Inclusive Workforce 2020, it was reported that across OECD, the hiring rate for older workers aged 55 to 64 is half that for younger workers, and the challenges in recruitment posed barriers for older workers.[+4 sentences] From the employer FGD and the online survey with younger workers, a significant proportion of participants highlighted the need for seniors to learn new skills, especially digital skills. Employers also indicated that seniors may not have the motivation or interest to attend training due to lack of relevance of the training content, or not understanding the language used to deliver training, not being able to follow the pace of training, or not having the time. And this finding corresponds to the responses by seniors. The employers also indicated that there is a shortage of manpower to send employees away for training. From the survey with younger workers, the findings showed a paradox, where a high proportion of respondents, which is 94%, which caught me by surprise as well, acknowledged the advantages of working with older colleagues and yet, a relatively high number of respondents, 78%, faced challenges working with older colleagues.[+5 sentences] I will not give you details of some of the responses they gave. These responses translate to the general sentiment that it is beneficial to work alongside older colleagues, but at the same time, one needs to recognise there are challenges in a multi-generational workforce. These challenges are attributed to the differences between people in terms of beliefs, mindset, values, disposition and working styles. I have summarised and shared what we have heard on senior employability from seniors and other stakeholders. While we acknowledge and recognise the value of policies and programmes available today that promote, support and advance the hiring, training and retention of seniors in the workforce, the challenges need to be addressed. My recommendations touch on two areas: one, structural change required in how we learn and organise work; two, the need to better support a multi-generational workforce.[+3 sentences] We are facing structural economic and social shifts. We have an ageing population, longevity, healthier life expectancy, declining birth rates, technological advances and disruptions. The traditional one-directional and linear progression of distinct life stages of education, work and retirement and how they affect meaningful employment need to be seen through new lenses. Minister Ong Ye Kung touched on this point about life stages determining the different points in terms of health and I think we need to also look at it in terms of work. We need structural change to policies around learning, employment models, work processes, HR practices, career planning to enable seniors to have more meaningful employment and for employers and Singapore to effectively tap the potential of this segment and growing pool of talent.[+34 sentences] As people live longer and healthier, we continue to learn, we can be productive and we have a desire to contribute in different ways. This implies that many of us will continue to work as we age. This means that we will progress through our life stages in a non-linear way, where there are different pathways. Just as we allow for different pathways of our young in formal education, perhaps we need to re-think of how we structure this for seniors in the workforce to enable continuous learning and work. Individuals and employers know the value of continuous learning, the challenge is making time, making time to substantially invest in it. Hence, the vicious cycle of talent gaps and skills relevancy affecting both businesses and individuals. Structural intervention is required. For example, to allow a period of perhaps, maybe a few months for work related learning every few years. Then we will really build skills. Today, there is already significant subsidies and funds available for training and development. What is required is to make learning as systemic for workers and not just seniors in the workplace as it is for young in formal education. Making it systemic does not mean that it is a one size fits all. Individuals will want to make different choices, choices that will work for them. There should be multiple routes connecting the roles, opportunities and commitments of individuals throughout their adult lives. This will mean that people may transition in and out of life stages, work and learning often. We need to understand and support individuals to learn, work and age well throughout their lives. People need to be able to access learning formal and informal and acquire knowledge in ways that fit their life stages and their abilities. An area emphasised by HR professionals in our FGD is the need for functional, technical and cognitive skills to support senior learners prepare and deal with career transitions. We need to recognise that senior learners may face a combination of structural, physical and emotional challenges in learning. Delivery methods should address the various needs and challenges for positive learning experience and outcomes. As people live and work longer, work and employment models need to be organised differently to allow greater flexibility for career, parenting, caregiving and personal obligations throughout the different stages of one's life. This is especially important for seniors. Let me touch on multi-generational workforce. Employers, younger workers and HR professionals we engaged, value the experience of the knowledge, experience and expertise of older workers as well as the diversity of a multi-generational workforce. Opportunities for mentoring and reverse mentoring were also highlighted. But as I mentioned earlier, the challenges were also highlighted. With longevity, an ageing population, technological disruptions and flexible work arrangements, people are working longer. It is not just a matter of young versus old employees but multi-generational, four or five generations. Many organisations – I do not think we realise this – in many organisations today, there are multi-generations already there. Therefore, the needs of employees do differ between the different generations: the baby boomers, the Gen X, the Millennials, the Gen Z and now, the Generation Alphas. Factors such as one's tenure with the organisation, job type, job level add further complexity to this. Each generation has its preferences, working styles, its strengths, influenced by the world we grew up in, our work experiences and our life stage. Generational differences can lead to communication and difficulty of working together between different age groups in an organisation. Organisations must give attention to acknowledge and understand the challenges and put the right programmes, tools and processes to support and respect the needs of employees of all ages. A World Economic Forum, AARP and the OECD study found that investing in a multi-generational workforce actually increases GDP per capita by almost 19% in three decades. The key learnings that were released by OECD revealed that the multi-generational workforces increased productivity, leads to better retention of experiences and know-how, increases resilience and better access to multi-skilled teams and other benefits.[+3 sentences] Age diversity in the workplace means varied experiences and points of view, which can become a source of innovation, if we are able to harness the strengths and varied experiences of all workers. This will not only foster a culture of creative thinking, innovation, better decision making and progress for all but also address the ageism and unconscious biases. A multi-generational workforce can also provide a platform for sharing of knowledge through mentoring and reverse mentoring amongst the different generations. We must do more in Singapore to understand and provide the environment to harness the strength of a multi-generational workforce. I do hope that MOM will agree with me on the benefits of a multi-generational workforce and will help put in place the right reforms in our system to make meaningful policies that will support this environment. I want to say that the Forward Singapore Movement provides an opportunity and an important platform for all stakeholders young and old, individuals, employers, Government, unions, educational and training institutions, trade associations and industry bodies to come together to chart the way forward for meaningful employment of seniors.[+5 sentences] My recommendation on structural change is broad as I am advocating a rethink of work and learning in the workforce, as people are living longer and healthier lives and are working longer. This change is not trivial. It will require all stakeholders to come together and take action to make the change if we are to tap the value of work of seniors and a multi-generational workforce in Singapore. What we do now will affect not only our seniors but our young of today, as they will be seniors of the future. I think that the Government will play a very important role to put in the reforms in our system to make this change possible and to help galvanise this change, to allow us to make meaningful senior employability possible.
Mr Deputy Speaker6 words
[+1 sentence]Minister of State Gan Siow Huang.
The Minister of State for Manpower (Ms Gan Siow Huang)1522 words
[+5 sentences]Mr Deputy Speaker, I thank the hon Member Jessica Tan for sharing her insights on this very important subject of senior employability and also sharing her findings from the PAP Seniors Group, their surveys as well as their focus group discussions. Indeed, as our seniors lead longer and healthier lives, we need to collectively shift our mindset as a society. It is important to see this as a golden opportunity to tap on the accumulated human capital of our seniors. The Government has long placed a strong emphasis on improving the employability of our senior workers and we have made good progress. Employment rates for senior workers have continued to rise, even during the pandemic. From 2019 to 2021, the employment rate for those aged 55 to 64 increased from 67.6% to 69% while those aged 65 to 69 increased from 41.7% to 49.0%.[+3 sentences] This is comparable to top OECD countries and reflect the fact that our senior workers are valued by employers in Singapore. Perhaps another reality is that we have a tight labour market in Singapore and an ageing workforce, so companies that are progressive and forward looking know that they must tap on the growing pool of senior workers if they want to meet their needs for manpower and talent in the long run. It is heartening to hear that seniors themselves want to continue to work. Together with our tripartite partners, we have put in place a roadmap to support that. We have raised the retirement and re-employment age to 63 and 68 respectively from 1 July this year. Our goal is to increase it to 65 and 70 respectively by 2030.[+12 sentences] This will support more senior workers who wish to continue working to do so. Even as we work towards this goal, we are mindful that there must be sufficient flexibility to avoid unintended consequences. Under the retirement and re-employment framework, the onus is placed on businesses to re-employ senior workers but there is some flexibility to adjust re-employment terms so that businesses can provide employment opportunities to our senior workers while remaining competitive. If an employer is unable to identify a suitable position to re-employ the senior worker in, he can provide an Employment Assistance Payment in lieu of re-employment as a last resort. This is to help the worker tide over while he or she seeks alternative employment. These flexibilities are the outcome of close discussions between tripartite partners and seek to mitigate the concerns on whether re-employment policies may inadvertently disincentivise the hiring of senior workers. We will continue to study international best practices and ensure that our retirement and re-employment framework stays robust and relevant for Singapore. Beyond just employment, I agree with Ms Jessica Tan that we should also make sure that senior workers are employed in meaningful roles. The key to this is reskilling and upskilling our senior workers so that they continue to remain relevant as the economy evolves. Ms Jessica Tan raised an important point that with improving longevity and more frequent economic change, our career paths may no longer be so linear as before but rather, we may need to be prepared for a few career changes throughout our working lives. Senior workers, in particular, may wish to or even find themselves needing to transition into new roles or getting into new growth sectors. For seniors who are currently out of the workforce and require assistance in job search, Workforce Singapore and NTUC's e2i provide career matching services. We have put in place a skills upgrading ecosystem to support career switches through the SkillsFuture Mid-Career Support Package and, more recently, SkillsFuture Career Transition Programme. We also provide enhanced salary and training support of up to 90% through reskilling programmes such as career conversion programmes which support employers to upskill their new hires, including senior employees, to take on enhanced job roles such as in digital fields, where we know there are lots of exciting development.[+16 sentences] There is a career conversion programme, for example, for in-house digital communication professionals, which equips individuals with digital marketing skills to take on in-demand job functions such as brand development. In addition, there are volunteer career advisors, some of them senior workers themselves, who provide their peers with sector- and occupation-specific career advice and mentoring and connect them to relevant Government programmes and services. To complement these moves, we provide structural support through schemes such as the SkillsFuture Enterprise Credit, which encourages employers to invest in the training and capability building of their employees. Ms Jessica Tan has raised several other pertinent points that can support the upskilling of senior workers. We will definitely take her feedback into consideration as we continually look into how we can refine our training ecosystem. In particular, we are studying how we can support Singaporean mid-career workers in enhancing their skills more substantially during the later stages of their working lives. Ms Jessica Tan has also suggested that there must be a culture of continuous learning at the workplace. I fully agree. Indeed, this is critical not just for senior workers but also for other workers. While the Government can and will continue to provide the necessary resources and support, employers must also see the value of adopting a "plug-train-play" approach rather than a "plug-and-play" approach. This is why we have been working with companies to provide quality training to their employees at the workplace. We have expanded the reach of the National Centre of Excellence for Workplace Learning (NACE) to uplift the workplace learning capabilities of companies, especially SMEs. To date, more than 1,700 companies have benefited from the programmes offered by NACE. I agree with Ms Jessica Tan that we must continue promoting different pathways for workers to progress. There is no one-size-fits-all-solution. Different businesses will have different needs and so do different senior workers. A ground-up approach is thus needed where employers take ownership and conduct regular and structured career conversations with their senior workers. This is one of the key aspects that the NTUC's Company Training Committees (CTCs) seek to do – bringing together the employers, HR and employee representatives to identify gaps and opportunities and align the training plans for its workforce to its business transformation roadmap.[+15 sentences] MOM has also worked with the Singapore National Employers Federation to develop a structured career planning resource guide. I encourage more employers to utilise this guide and take a more deliberate approach in workforce planning. As our population ages, multi-generational workplaces will increasingly be the norm. As Ms Jessica Tan has pointed out, a multi-generational workforce allows us to harness the experience and expertise of senior workers which can contribute to better productivity. As the saying goes, "姜还是老的辣". The older, the wiser. Senior workers bring a different value-add and complement the younger workerforce as they often have more experience and knowledge of the trade. We all have a role to play in creating effective multi-generational workplaces. Senior workers themselves play an important role in shaping perceptions. It may not be easy but they should be open to job role changes and picking up new skills to keep pace with technological advancements and also changes in the ways of working. The Government will always support our senior workers on this journey. Employers should adopt age-friendly workplace practices such as job redesign to make tasks and workplace environments more age-friendly, providing flexible work arrangements and practising fair employment practices. Business leaders and HR have an important role to play in shaping a company culture that is age-friendly. The tripartite partners have taken steps to nurture age-friendly work practices. The Tripartite Alliance for Fair and Progressive Practices, or TAFEP in short, runs complimentary workshops to guide employers on putting fair employment practices into place. I encourage employers to approach TAFEP to find out more. I would also like to encourage more employers to adopt the Tripartite Standard on Age-friendly Workplace Practices, which specifies a set of good age management practices and recognises progressive employers that implement them.[+3 sentences] Several Members in this House today and in the past have expressed concerns with ageism affecting job opportunities and career progression for senior workers. The Government does not tolerate age discrimination. I would like to reiterate that all employers are expected to abide by the Tripartite Guidelines on Fair Employment Practices (TGFEP). As announced last year, a Tripartite Committee is looking into enacting workplace fairness legislation. This will broaden the range of measures and penalties available to address workplace discrimination, including age discrimination.[+5 sentences] Mr Deputy Speaker, as a society, we must collectively rethink our attitudes towards ageing and see it as a boon, not a bane. The Government will continue to provide the fullest support to enable our seniors to have longer careers and contribute meaningfully in multi-generational workplaces. But we cannot do this alone. We need a strong ecosystem of employers, unions, training institutions and, most of all, employees, young and old, to play a part to enable Singaporeans to harness the benefits of longevity. Adjourned accordingly at 6.27 pm.
Building a Healthier SG›Motions45 turns · 29,079w
· 180 highlighted
motion-1974
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.
Time Limit for Minister's Speech›Motions2 turns · 134w
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The Deputy Leader of the House (Mr Zaqy Mohamad)47 words
[+1 sentence]Mr Deputy Speaker, may I seek your consent and the general assent of Members present to move that the proceedings on the item under discussion be exempted from the provisions of Standing Order 48(8) to remove the time limit in respect of Minister Ong Ye Kung's speech?
Mr Deputy Speaker87 words
[+3 sentences]I give my consent. Does the Deputy Leader of the House have the general assent of the Members present to so move? . (proc text)]
Building a Healthier SG›Motions27 turns · 9,004w
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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)]
Adjournment›Motions1 turns · 23w
· 0 highlighted
motion-1977
Speaker not recorded23 words
[+2 sentences]. (proc text)]
Working with Family Offices to Deepen Investments in Local Companies›Oral Answers to Questions5 turns · 1,006w
· 8 highlighted
oral-answer-2908
Mr Desmond Choo25 words
[+1 sentence]asked the Prime Minister whether and, if so, how has the Ministry been working with family offices in Singapore to deepen investments in local companies.
The Minister of State for Trade and Industry (Mr Alvin Tan) (on behalf of the Prime Minister)230 words
[+1 sentence]Sir, our Government agencies are working to encourage family offices to invest in local companies in a number of ways. First, single family offices (SFOs) applying for tax incentive schemes have been required since April this year to allocate at least 10% or S$10million of their assets, whichever is lower, to local investments. Local investments may include: one, equities listed on Singapore exchanges; two, private equity investments in unlisted Singapore-incorporated companies; or three, qualifying debt securities. Second, MAS and Enterprise Singapore have set up a number of platforms to connect local companies to potential investors, including family offices.[+2 sentences] These include "Deal Fridays", FinTech Investor sessions, and the Singapore Week of Innovation and Technology (SWITCH), which we will be organising from 25-28 October, this month. We are also encouraging match-ups during the annual Singapore FinTech Festival, which will also be organised very shortly, from 2-4 November. Third, MAS and EDB have supported the Wealth Management Institute’s Global-Asia Family Office Circle, which aims to encourage family offices here to make co-investments in companies as well as develop strategies in areas such as philanthropy and sustainable investments.[+2 sentences] At the same time, we must recognise that family offices come to Singapore to access investment and philanthropic opportunities in the broader Asian region. This adds to Singapore’s status as a dynamic as well as purposeful financial centre, supporting growth and opportunity in our neighbouring countries.
Mr Deputy Speaker3 words
[+1 sentence]Mr Desmond Choo.
Mr Desmond Choo (Tampines)63 words
[+5 sentences]Deputy Speaker, I would like to thank the Minister of State for his reply. I have a couple of clarifications. The first is, how have and will local companies and the local workforce benefit from family offices? Second, where do these family offices generally come from? That is, which country or which industry were they operating in before they set up in Singapore?
Mr Alvin Tan685 words
[+11 sentences]Mr Deputy Speaker, I thank the Member for his supplementary questions. The SFOs generate employment in Singapore in a couple of ways. The first is by directly employing advisers and investment professionals; and also, to generate indirect employment when they work, for example, with external finance, tax and legal professionals, and also fund administrators, for example, custodians, on investment management, wealth planning and also operational matters. So, a wide aspect in both direct as well as indirect employment. SFOs also expand the pool of patient capital for Singapore-based startups and business ventures, as well as Singapore-based funds that invest in such companies. Investee companies may also benefit from the strategic guidance offered by the principals of these family offices, many of whom themselves are owners of successful businesses. Some families also use their SFOs or related entities to manage their investments and contributions towards social and philanthropic activities or causes in Singapore. With regard to the second supplementary question on where the SFOs originate from, the SFO community in Singapore is diverse, it is international. They come from a variety of regions, including Europe, the US as well as Asia. And families who are keen to set up a satellite presence here in Singapore, do so because of our favourable business environment, connectivity to the region which allow for them to use Singapore as a base to explore investment opportunities beyond Singapore to the region. I will also just share a little bit about what we are doing to attract these family offices, as related to that supplementary question. The Member may know that in 2019, MAS and EDB jointly set up the Family Office Development Team or FODT to coordinate a whole-of-Government effort to ensure Singapore remains a really relevant and attractive location for family offices.[+1 sentence] This development team has three focus areas. The first focus area is to enhance and widen the operating environment to broaden the suite of asset vehicles, such as variable capital companies (VCCs), that are available to these family offices.[+1 sentence] Second is to develop the capabilities and to build essential skillsets among our service providers, both local as well as foreign, and our professionals. For example, MAS and the Institute of Banking and Finance launched these skill maps for family office advisers, including those at banks and tax or legal firms; and also, for entry level professionals employed in family offices; and also, then, management level executives who head and also run these offices.[+3 sentences] We also do training for advisers. For example, the Wealth Management Institute and the SMU Business Families Institute have launched a series of training programmes for family office advisers, professionals and principals that are then accredited against these skill maps. So, if there are many individuals or professionals who are interested in entering this space or to deepen your capabilities, you can also take reference to these skill maps to better equip yourselves with the necessary skillsets to enter this industry. MAS has available co-funding schemes in place to offset the training fees for professionals attending these courses that have been accredited against these skill maps.[+4 sentences] Finally, we are also facilitating this community building amongst family offices such as supporting the setting up of the Global Asia Family Office Circle to galvanise and to encourage like-minded family offices towards common areas of interest, such as ESG, philanthropy enterprise financing and to create opportunities for collaboration amongst many other co-investments. The final point is that we have, as a posture, consistently welcomed a variety of financial and other capital investments into Singapore. We have welcomed individual companies that can contribute to Singapore's growth, create good jobs, regardless of where they are and regardless of their country of origin where they come from. So, we need to remain open, we need to remain connected to global investors to strengthen Singapore's value proposition to Asia and to be a key Asian node for high growth tech investment and tech companies to base here, to grow their patient capital, and then to grow and be a base for new and exciting industries, and ultimately, create good jobs for Singaporeans.
Review of Salary and Benefits for Educators and Staff in Mainstream Schools, Preschools and Special Education Schools›Oral Answers to Questions11 turns · 1,531w
· 9 highlighted
oral-answer-2909
Ms Denise Phua Lay Peng47 words
[+1 sentence]asked the Minister for Education when and how are salary scale and benefit reviews conducted and recommended for (i) educators from mainstream schools, preschools and special education schools and (ii) other staff such as education psychologists, job coach therapists and school leaders serving in these education institutions.
The Minister for Education (Mr Chan Chun Sing)362 words
[+4 sentences]Mr Deputy Speaker, Sir, MOE periodically reviews the salaries of officers in MOE schemes of service and, in consultation with the Public Service Division, considers making appropriate adjustments to ensure that their overall salary packages remain market competitive. Salary adjustments take into consideration the size of the salary gaps compared to market benchmarks. Generally, larger adjustments are made when the gap with the market benchmarks is wider. This is in line with the principle that Civil Service salaries should keep pace with but not lead the market. MOE recently announced salary adjustments for all eligible Education Officers (EOs), Allied Educators (AEDs) and MOE Kindergarten Educators (MKEs), which took effect on 1 October 2022.[+1 sentence] These adjustments also apply to MOE staff seconded to other agencies. ECDA is separately conducting a salary review for Early Childhood educators in government-supported preschools to ensure that their salaries are commensurate with their contributions and professional skills. The salary review is expected to be completed by end 2022 and ECDA will work with government-supported operators to implement the changes from 2023 onwards.[+6 sentences] Special Education (SPED) schools are run by Social Service Agencies (SSAs). While SPED schools receive full funding, SSAs retain substantial autonomy in HR practices, including how they compensate SPED school staff. Nevertheless, MOE, in our role in overseeing the SPED sector, works closely with and supports the SSAs to ensure that salaries for SPED teachers remain competitive through periodic compensation reviews. In 2018, salaries were reviewed together with the National Council of Social Service. In 2020, salaries were again reviewed with the introduction of the Journeys of Excellence Package. This Journeys package contains several complementary initiatives to raise the quality and professionalism of the SPED teaching profession by strengthening their competencies, expertise and career progression. Additional funding is provided for manpower costs in two tranches – the first has been implemented in 2021 and the second is planned for 2024.[+3 sentences] MOE will continue to work with SSAs so that our SPED teachers have good career progression and updated salary guidelines. For non-teaching SPED school staff such as psychologists, the SSAs take reference from the NCSS sector salary guidelines for different professions. The guidelines are updated annually.
Mr Deputy Speaker3 words
[+1 sentence]Ms Denise Phua.
Ms Denise Phua Lay Peng (Jalan Besar)296 words
[+12 sentences]I thank the Minister for his comprehensive reply. Let me declare that I am a volunteer at several people sector charities and helping out in special schools as well. Recently, when the announcement for MOE teachers or Education Officers was made, it created quite a bit of ripple amongst the special education sector and also in the rest of the people sector where organisations take in students who graduate from the special schools. When announcements, such as this, are made unilaterally, it does affect the others. Sometimes, the approach or the methodology by which these compensation reviews are made, are either not known or perhaps could be missed out when the original announcements were made. I think it is always good and would MOE consider that when it makes announcements of such nature, especially in terms of compensation, that it be not announced unilaterally and that mention be made of the rest of the sector who are also serving the children, the young people or the older people of Singapore in education? So, that is one, that announcements will also make some mention of the rest of the service providers. Number two, I would like MOE to consider and communicate to the SSAs – either special schools or disability organisations – the philosophy by which their salaries are computed or decided upon. Because for some of the positions – such as the educators, psychologists, therapists and so forth – both sectors, the people and public sectors, are recruiting from the same pool. The competitiveness is quite important because you want to serve such persons throughout their lifespan. So, the philosophy is quite important because they could be recruiting from the same pool. So, I would appreciate that MOE would consider some of what I have shared.
Mr Chan Chun Sing177 words
[+8 sentences]Mr Deputy Speaker, Sir, to the first comment by Ms Denise Phua, yes, indeed, Public Service Division and MOE, as part of the wider service, regularly review the salary scales for different professions. I would say that, in general, we do this progressively, systematically and continuously. The reason that we do not announce everything at one go is because we do the work in stages. But every time we announce a change in one particular profession, we will certainly take into account the other professions to make sure that the relativities are maintained, both within the sector and also beyond the sector, with other professions. On the second comment, we will continue to share our methodologies of how this is done in the public sector with the people sector. The methodology of how we compute the salaries and the remuneration packages – all this is not a secret. We do it openly and there is an open methodology of how we do it. We will be very happy to share this with the rest of the SSAs.
Mr Deputy Speaker4 words
[+1 sentence]Mr Leong Mun Wai.
Mr Leong Mun Wai (Non-Constituency Member)155 words
[+8 sentences]Thank you, Sir. It is important that in every sector in the economy, we must allocate some of our top talents. So, even in preschools and SPED schools, are we allocating our top talents? For example, is the Public Service Commission (PSC) offering scholarships to allow some of our top talents to be trained in those areas so that, in the future, they can lead the sectors? Secondly, in the long run, we must also ensure that every sector has a fair salary structure. For example, we cannot assume that the preschool teachers are of a lower level than the teachers in the Junior Colleges. So, in the long run, we must align the competencies, we must make sure that we recognise the competency level in every of these sectors and remunerate them accordingly. We have heard a lot of stories that overseas, there are Masters and PhD holders becoming teachers of preschools, for example.
Mr Deputy Speaker14 words
[+1 sentence]Sorry, Mr Leong Mun Wai, are you asking a question or are you —
Mr Leong Mun Wai30 words
[+1 sentence]Sir, I am asking the question whether there are plans in the future that will ensure that these remuneration packages for preschools and special education areas will continue to improve.
Mr Christopher de Souza4 words
[+1 sentence]Minister Chan Chun Sing.
Mr Chan Chun Sing439 words
[+1 sentence]Mr Deputy Speaker, Sir, to Mr Leong's first comment, yes, indeed, first of all, we try to get a fair share of talent into the Public Service. Within the Public Service, we will spread the talent across different agencies and different professional areas to make sure that all sectors have a fair share of talent.[+2 sentences] So, that we have done. Specific to Mr Leong Mun Wai's question, Mr Leong might want to know or may already know that actually when I was in the Ministry of Social and Family Development, we have a talent development scheme working with the SSAs. In fact, one of the schemes that we started many years ago was the Sun Ray Scheme where we develop top talent or capable people and rotate them across agencies to give them exposure beyond the agencies because my personal belief is that we do not develop people within each agency alone in a stovepipe.[+7 sentences] Our aim is to make sure that they get a broader exposure so that the good ideas can spread around faster and the whole sector itself can benefit. So, we have been doing that and we will continue to do that. On Mr Leong Mun Wai's second point about the salary structure, indeed, that is also what we have always been doing to make sure that every sector is compensated competitively. Of course, we do not take compensation as the only reason to help people stay in the sector. It is also about career development, their route of advancement, the working environment and so forth. But I would just like to raise one nuanced point. I think we should be very careful about remunerating people based on credentials. In fact, in the whole economy, we are encouraging people to remunerate people based on their skills, capabilities and not just based on their credentials.[+3 sentences] So, whether educators have Masters, PhD or basic degree or diploma, I think we need to look at them, but we also need to look beyond that and look at the kind of skillsets that people have and the kind of contributions that people have made. I would not say that just because someone has a Masters, therefore, they will obviously be paid more than someone who might be very experienced in the sector itself. We look at it holistically. We look at some of the prior training that our people have, the contributions that they are making in the sector and the kind of experiences that they have. I think these are all the factors that will help us to make a remuneration package that is both fair and competitive.
Progress on Framework for Equitable Sharing of Losses Between Scam Victims and Financial Institutions›Oral Answers to Questions11 turns · 1,639w
· 10 highlighted
oral-answer-2910
Mr Saktiandi Supaat74 words
[+1 sentence]asked the Prime Minister (a) whether the Government can provide updates on (i) the progress of the framework for the equitable sharing of losses suffered by scam victims and (ii) the work of the Payments Council in reviewing the practices that the financial industry can put in place to better protect consumers from scams; and (b) what are current and upcoming efforts of Project Frontier and the Inter-Ministry Committee on Scams on combating scams.
The Minister of State for Trade and Industry (Mr Alvin Tan) (for the Prime Minister)291 words
MAS is working with the industry to finalise a framework for the equitable sharing of losses resulting from scams. The Payments Council has proposed a draft set of responsibilities relevant to financial institutions and consumers.[+5 sentences] MAS is finalising the framework, in coordination with other Government agencies. It is taking us longer than expected to design a fair and effective framework that ensures shared responsibility across the ecosystem as well as incentives for each party to be vigilant against scams. MAS aims to seek public comments on the framework as soon as possible. At the broader level, the Inter-Ministry Committee on Scams (IMCS), chaired by the Ministry of Home Affairs, also partners the financial institutions closely. This includes Project FRONTIER, as mentioned by the Member, where the Police have established processes with financial institutions to swiftly freeze bank accounts suspected of being used in scams, in order to mitigate victims’ losses and disrupt scammers’ operations. From January to June 2022, the Police froze more than 7,800 accounts and recovered more than S$80 million worth of scam proceeds.[+1 sentence] The IMCS has also strengthened enforcement against perpetrators. Since the formation of the Singapore Police Force’s Anti-Scam Command in March this year, more than 4,300 scammers and money mules who were involved in more than 12,000 scam cases involving S$101 million were either arrested or called up for investigation.[+4 sentences] Other than enforcement actions, the IMCS has expanded its public education campaign, called "Spot the Signs. Stop the Crimes", to build public awareness and vigilance on how to spot scams. For instance, it has shared materials advising the public to not share personal details, such as log-in credentials and one-time-passwords, with unverified parties. IMCS will continue to work with all stakeholders to deepen its public outreach.
Mr Deputy Speaker3 words
[+1 sentence]Mr Saktiandi Supaat.
Mr Saktiandi Supaat (Bishan-Toa Payoh)181 words
[+8 sentences]Mr Deputy Speaker, I thank the Minister of State for the answers. I have two supplementary questions. One is in relation to the loss-sharing framework that the Minister of State shared. I have residents who came up to me to highlight about some of their loss-sharing issues. I was wondering whether the Minister of State can share how fast this can be rolled out because it has a direct impact on residents in monetary terms. Two, in relation to the knowledge of contact information for scams, I have a few residents who came up to me experiencing a scam in process while they are literally speaking to a scammer, called 999 but was informed that that is not the number to call. So, I was wondering whether more can be done via Project FRONTIER to ensure that there is some coordination between the Police and the banks to handle such situations. So, I hope the Minister of State can share a bit more on that front in terms of coordination and whether Project FRONTIER can, together with IMCS, actually enhance that.
Mr Alvin Tan460 words
[+1 sentence]Mr Deputy Speaker, I thank Mr Saktiandi Supaat for the supplementary questions. With regard to the loss-sharing framework, I think the major principle is for us to find a good platform in which to design a fair and effective framework such that many of the different parties have a shared responsibility, all aspects of it. It is taking us longer than expected because to put in all of the key aspects in place requires us to make sure where the shared responsibility lies equitably across all of the different stakeholders.[+14 sentences] But we continue to work on this at a very urgent pace. We understand that this is urgent work and what we are trying to do is to make sure that this loss-sharing and accountability approach incorporates as well as involves all key parties in the ecosystem and every single aspect of this. Every stakeholder has to be vigilant in their own right against scams, both institutions as well as individuals. That is why, in my original answer, I said that it was important for all of us to also conduct public outreach and also for the financial institutions and authorities to play their part. What we are trying to achieve is, as I mentioned, a fair as well as effective framework so that there is shared responsibility across the ecosystem. With regard to the Member's residents, this is something that is very important for us to bear in mind. If members of the public face this issue, they should notify their banks immediately, if they suspect that they are victims of scams. Many of the financial institutions, in fact, the major retail banks, have made it easier for the public to report scams by either having dedicated hotline numbers or making it the first few options on their phone banking menu. So, members of the public are encouraged to obtain such hotline numbers from the official sources, such as at the back of the ATM cards and to also save the numbers on their mobile phones. In addition, members of the public can also file a Police report either online or in person if they have lost money to scams. They can call the anti-scam hotline at 1800 722 6688 for advice. This is managed by both the National Crime Prevention Council (NCPC) and also the latest ScamShield app that is available now on both android as well as IOS can also be used to report suspicious scam messages. But, in concert, all of these are also a work in progress. We also encourage members of the public to give us feedback and also the financial institutions as well as the retail banks on how to tighten this further as we continue to fight as an ecosystem against scams.
Mr Deputy Speaker4 words
[+1 sentence]Dr Tan Wu Meng.
Dr Tan Wu Meng (Jurong)98 words
[+5 sentences]I thank the Minister of State for his answer. I have raised PQs on this topic before. I have two supplementary questions. Firstly, does MAS track the response time from notification to a Government agency or the bank till the time the illegal transfer is interrupted in cases where residents discover an illegal transfer in progress? Secondly, for this equitable risk-sharing framework, will the agencies continue to consider the point I raised previously, that is, the idea that there can be a continuum between an unforced error and a forced error, depending on the sophistication of the scammer?
Mr Alvin Tan141 words
[+1 sentence]I thank Dr Tan Wu Meng for his supplementary questions. Maybe I will share about the second question first with regard to the equitable risk-sharing framework on the continuum between the error as well as the unforced error. These are issues or steps that we are taking proactively within consultation. MAS, with regard to the other agencies, are looking into this equitable sharing framework and will take into account both this broad continuum because the instance where a scam is being perpetrated, as well as the discovery, these are all quite critical in terms of finding the perpetrator, in terms of making sure that there is recovery as well.[+1 sentence] So, we will factor those into our discussions. On the first question, at this point in time, we do not track those data.[+1 sentence] But we will take into account the Member's feedback.
Mr Deputy Speaker18 words
[+2 sentences]I will allow one last supplementary question because we need to move on to dengue. Ms Denise Phua.
Ms Denise Phua Lay Peng (Jalan Besar)156 words
[+8 sentences]Thank you, Mr Deputy Speaker. Two supplementary questions for the Minister of State. Firstly, does MAS require the banks or the financial institutions to notify their customers should there be regular and/or big sums of withdrawals or money movements from their accounts? I know some banks do it, some banks do not, but I wonder if there is actually a regulation, practice or policy regarding this. Secondly, I know that MAS is working very hard on the framework and so forth to ensure loss-sharing and recourse like that. But I wonder what the interim recourse is for the scam victims. I have a resident, for example, who lost his life savings of almost a quarter million dollars and he did the right thing – make a Police report, wrote to the authorities, wrote to the banks and so forth, but still extremely distraught and distressed. So, I wonder what is the recourse for victims like this.
Mr Alvin Tan213 words
[+8 sentences]I thank the Member for her questions. I think many of our residents have also shared with regard to the scams and one of the issues with regard to banks as well as the scams is on individual responsibility as well. But we also make sure that we have constant updates with the Police and will also inform customers on how to report to the Police. I know that this issue with regard to scams is a rather new one because of the online as well as technology. But what we are trying to do with both the loss-sharing framework as well as the public outreach to individuals and also to encourage the banks to have good processes in place will be very important for us to manage this issue in a fair and equitable way. But that notwithstanding, we want to encourage all members of the public to, first, be extremely vigilant. If you see any of these funds being transferred outside, that is, unusual transactions, please inform your banks immediately. We, on the MAS front, are coordinating very closely with the Police as well as the financial institutions to tighten these processes and this consultation will come in due time so that we can tighten these processes and combat scams together.
Reports of Insect or Mosquito Bites in Project Wolbachia Areas›Oral Answers to Questions8 turns · 782w
· 9 highlighted
oral-answer-2911
Ms Yeo Wan Ling60 words
[+1 sentence]asked the Minister for Sustainability and the Environment (a) whether there has been an increasing number of feedback received on insect or mosquito bites in areas where Project Wolbachia was introduced despite that these male Wolbachia-Aedes mosquitoes do not bite; and (b) whether the Ministry will provide resources to residents or neighbourhoods experiencing such a situation to address these feedback.
The Senior Parliamentary Secretary to the Minister for Sustainability and the Environment (Mr Baey Yam Keng) (for the Minister for Sustainability and the Environment)248 words
[+1 sentence]Sir, at the start of Wolbachia-Aedes releases in new areas, NEA typically receives an increased number of feedback relating to mosquitoes. While the male mosquitoes released do not bite, their increased presence can be noticeable to residents. The increase in feedback is however temporary as residents become accustomed to the programme. NEA's data shows that after a few months of releases, the population of the wild-type Aedes aegypti mosquito falls to very low levels, decreasing by up to 98%. Bites from these mosquitoes are correspondingly significantly reduced. This is evident in the reduction of dengue cases by up to 70% observed in study sites with at least one year of releases. However, as Wolbachia-Aedes technology does not affect other species of mosquitoes, residents may still experience some bites from such mosquitoes.[+6 sentences] NEA regularly engages residents on Project Wolbachia at the study sites. These communication and outreach activities are done prior to releases and include door-to-door distribution of publicity materials, display of posters and banners at high footfall areas and sharing of information via traditional and social media platforms. NEA also engages establishments such as childcare centres and schools within the release sites. Source reduction remains the key strategy to control the populations of all types of mosquitoes. NEA will continue to work with the community and other stakeholders in carrying out mosquito control measures, including the regular practice of the Mozzie Wipeout B-L-O-C-K steps. Residents can also take the "Spray, Apply, Wear (S-A-W)" actions to prevent mosquito bites.
Mr Deputy Speaker4 words
[+1 sentence]Ms Yeo Wan Ling.
Ms Yeo Wan Ling (Pasir Ris-Punggol)116 words
[+4 sentences]Thank you. The NEA started Project Wolbachia in Punggol and some residents have given feedback on the increased number of bites, and according to even one of the residents, leading to skin sensitivity and rashes. One preschool administrator, who was unaware of the start of the project, had reported that the school suddenly saw swarms of mosquitoes, thereby leading to some degree of fear and alarm with the children. Will NEA, besides traditional sources of media banners and all that, consider also having ground walkabouts and educational talks directly to homes and community areas such as malls, schools and coffee shops to promote and perhaps to assuage the initial alarm on the rollout of Project Wolbachia?
Mr Baey Yam Keng133 words
[+1 sentence]Mr Deputy Speaker, as mentioned in the reply, prior to release, NEA does engage the community. Specific to the Punggol site, prior to release on 30 August, there was door-to-door distribution of letters to residents and establishments at HDB blocks, display of banners, posters at lift lobbies, to inform residents of the release schedule as well as emails to schools, childcare centres and condominiums. We take the Member's feedback that, on top of these channels, we should explore more targeted, direct engagement, including door-to-door, so that this will increase the community's awareness, understanding, buy-in and support of the Project Wolbachia.[+2 sentences] This is important so that we can reduce the number of dengue infections and potentially, fatalities. We thank the Member for her suggestion and NEA will work closely with her on such outreach.
Mr Deputy Speaker3 words
[+1 sentence]Mr Louis Chua.
Mr Chua Kheng Wee Louis (Sengkang)153 words
[+6 sentences]Thank you, Mr Deputy Speaker. Like Member Ms Yeo Wan Ling, I also received similar feedback from some residents on the increasing prevalence of mosquitoes, which I presumed is due to the release of these male Wolbachia mosquitoes. My supplementary question is on how much the Ministry believes in the importance of support from all MPs in the community engagement efforts. And I ask this because I received an email from NEA earlier in March, in terms of support for the publicity of Project Wolbachia, in terms of the engagement of residents. But while I attended such an online zoom session in March, I thought it was also important to gain a firsthand understanding, hence requested to actually participate in some of these study sites and release activities. But I only learnt last week that these community engagement efforts are conducted only through People's Association (PA) and I was not able to participate.
Mr Baey Yam Keng65 words
NEA works with the community and grassroots to carry out these outreach programmes, as with all the various Government initiatives.[+2 sentences] In addition to that, particularly for Project Wolbachia, we work directly with the various Town Councils on operational issues, and the Town Councils also maintain the general cleanliness of the estate and to reduce mosquito breeding grounds. We will continue to work on both fronts.
High Incidence of Anxiety, Depression and Other Mental Disorders Among People Exposed to Second-hand Smoke›Oral Answers to Questions8 turns · 723w
· 7 highlighted
oral-answer-2912
Mr Louis Ng Kok Kwang69 words
[+1 sentence]asked the Minister for Sustainability and the Environment (a) whether the Ministry is aware of and has reviewed studies conducted by other countries which have found that people exposed to second-hand smoke are more likely to be suffering from depression, anxiety, stress, Attention Deficit Hyperactivity Disorder and dementia; and (b) if so, whether the Ministry will review policies on tackling second-hand smoke at homes in light of these studies.
The Senior Minister of State for Sustainability and the Environment (Dr Amy Khor Lean Suan) (for the Minister for Sustainability and the Environment)99 words
MOH regularly reviews the evidence surrounding tobacco control policy and is continually enhancing its efforts to further reduce the prevalence of smoking in Singapore, through public education, provision of smoking cessation services, legislation and taxation. As previously explained in this House, NEA is constantly looking out for reasonable and practical solutions to further strengthen our efforts to address the harms of second-hand tobacco smoke.[+1 sentence] Smokers should also exercise social responsibility, by refraining from lighting up in places where the second-hand tobacco smoke can affect those around them, including their families and loved ones, in order to protect their health.
Mr Deputy Speaker3 words
[+1 sentence]Mr Louis Ng.
Mr Louis Ng Kok Kwang (Nee Soon)107 words
[+6 sentences]Thank you, Sir. I thank the Senior Minister of State for all her replies on second-hand smoke over the years. But, could I just ask whether there is a threshold we need to reach before we will look into reviewing our policies and legislation? Is there perhaps a certain number of deaths or number of people who are affected by this before we would change? I ask this because we already know that it does cause death, it does cause physical harm to our health and now we realise, even our mental health. So, what more will it take before we are willing to amend our policies?
Dr Amy Khor Lean Suan272 words
[+4 sentences]Firstly, let me say that, whilst there is evidence of a link between second-hand tobacco smoke and mental health condition, such as depression, anxiety, Attention Deficit Hyperactivity Disorder and so on, the evidence is currently inconclusive as to whether the second-hand smoke exposure directly causes these mental health condition or is simply associated with these mental health conditions. That means, it is a sign that it is an environment that contributes to these mental health conditions, just to explain your earlier query. But notwithstanding this, let me assure the Member that we are as concerned about the harmful effects of second-hand tobacco smoke on non-smokers. And in fact, that is the reason why over the decades, we have put in tremendous effort and resources to reducing the prevalence of smoking, through various efforts as I have said, whether it is education, provision of cessation services, legislation, taxation as well as constantly looking out for reasonable and practical solutions to further strengthen these efforts to address the issue of second-hand tobacco smoke. For instance, this month, 1 October 2022, we have further extended the smoking prohibited areas to additional public gardens and parks, as well as ABC water sites and 10 recreational beaches, including that in Sentosa. Which means that as of now, some 50,000 places, they are banned – where smoking is prohibited.[+1 sentence] So, we will continue as I have said, to look at how we can strengthen our efforts. Both MOH, HPB, NEA and the various stakeholders, we will consistently look at the evidence as well as the solutions available and will not hesitate to adjust or review this where appropriate.
Mr Deputy Speaker8 words
[+1 sentence]A short supplementary question, please, Mr Louis Ng.
Mr Louis Ng Kok Kwang92 words
[+5 sentences]A short one. If I could ask the Senior Minister of State, we are doing so much to protect people from second-hand smoke in the public areas, could we apply similar efforts to protecting them at their own homes. It seems strange that when they are out there. they are all protected, but then when they reach home, they keep smelling second-hand smoke. Two, I am in touch with the researcher. So, if we can provide some conclusive evidence that it is linked to mental health, will MSE then amend our policies?
Dr Amy Khor Lean Suan73 words
Again, as I have said, we are concerned about the harmful effects of second-hand tobacco smoke, notwithstanding whether it leads to depression and so on, because we know that second-hand tobacco smoke also increases the risk of cancer.[+1 sentence] So, there is no doubt that we are as concerned. Regarding second-hand tobacco smoke in homes, I think I have reiterated my answers many times.[+1 sentence] I do not think I need to repeat them again.
Ratio of Bicycle Parking Lots Per MRT Station›Oral Answers to Questions8 turns · 586w
· 8 highlighted
oral-answer-2913
Mr Chua Kheng Wee Louis58 words
[+1 sentence]asked the Minister for Transport (a) what is the current ratio of bicycle parking lots per MRT station; (b) what will this ratio be by 2025, when 3,000 more bicycle parking lots are provided; and (c) what is the Ministry’s target ratio and number of lots expected by 2040, as part of the Land Transport Master Plan 2040.
The Senior Parliamentary Secretary to the Minister for Transport (Mr Baey Yam Keng) (for the Minister for Transport)138 words
[+1 sentence]Mr Deputy Speaker, currently, there are about 27,000 bicycle parking lots across 127 MRT stations and Integrated Transport Hubs. In general, we do not look at a single fixed or target ratio for bicycle parking lots per MRT station. The number of lots ranges for different stations due to the different levels of demand near these transport nodes. Based on this assessed demand, LTA aims to provide sufficient parking capacity plus a built-in buffer, to address the trends of cyclist behaviour and needs in different parts of Singapore.[+2 sentences] Given the limited space in MRT stations, LTA also works with developments in the vicinity, such as shopping malls, to provide more bicycle parking. In line with our broad push for active mobility, LTA will continue to monitor areas with growing demand and build more bicycle parking lots over time.
Mr Deputy Speaker3 words
[+1 sentence]Mr Louis Chua.
Mr Chua Kheng Wee Louis (Sengkang)27 words
[+3 sentences]Thank you, Mr Deputy Speaker. Just two quick supplementary question. The first is, if the Ministry can share with us the utilisation rates of these bicycle lots.
Mr Deputy Speaker33 words
[+2 sentences]I am afraid, Mr Chua, Senior Parliamentary Secretary Baey Yam Keng is seated quite far away and is straining to hear you. Could I invite you to just speak up a little please?
Mr Chua Kheng Wee Louis69 words
[+3 sentences]Sorry. The first is in regard to the utilisation rates of these bicycles lots across the different transit stations. And the second is, I understand that under the Land Transport Master Plan 2040 (LTMP), we do have targets for a 20-minute town and 45-minutes city, so whether or not we could set certain targets as to the number of lots in order to support these ambitions under the LTMP.
Mr Deputy Speaker4 words
[+1 sentence]Senior Parliamentary Secretary Baey.
Mr Baey Yam Keng254 words
[+3 sentences]Thank you, Mr Deputy Speaker. Yes, LTA does track the utilisation of the bicycle lots at MRT stations. We do it annually. In particular for Mr Louis Chua's area, based on a survey in 2022, the bicycle parking at Sengkang and Buangkok MRT stations has utilisation rates of about 65% and 77% respectively.[+3 sentences] However, these numbers have fluctuated over the past few years, given the COVID-19 situation may have affected daily commutes. Yes, as part of our LTMP target, we do hope to provide public transport accessibility for our public. The first and last mile journeys are important and we do hope that more people can take to walking or cycling to reach these nodes. LTA has published broad planning parameters for MRT stations under the Walking and Cycling Design Guide, which will be applied for new MRT stations.[+1 sentence] These were developed considering factors such as MRT ridership, the number of dwelling units served and existing data and surveys. So, whether that station is a first mile or last mile station, whether it is near to, for example, foreign workers dormitories, the range of parking lot provisions will have a certain spectrum. So, for example, the range for first mile station is between 250 and 800; it is quite a big range depending on each locality. LTA will continue to monitor the usage and to promote active mobility, so the provision for such infrastructure such as bicycle parking lots is critical and we will continue to work towards our vision of a car-lite Society.
Successful Implementation of Age Verification for Joining Social Media Platforms›Oral Answers to Questions5 turns · 674w
· 9 highlighted
oral-answer-2914
Mr Melvin Yong Yik Chye61 words
[+1 sentence]asked the Minister for Communications and Information (a) whether the Ministry is considering a minimum age limit for children to join social media platforms, to mitigate the potential harm that social media sites can cause on young children; and (b) whether the Ministry has studied any overseas jurisdictions that have successfully implemented age verification for the use of social media platforms.
The Senior Minister of State for Communications and Information (Dr Janil Puthucheary) (for the Minister for Communications and Information)300 words
[+1 sentence]Sir, currently, most major social media services require users to be at least 13 years old to register for an account. Users have to declare their birth date at the point of registration. As false declarations may be made, some social media services have made efforts to develop technologies, including a combination of Artificial Intelligence (AI), machine learning and facial recognition algorithms for proactive detection and the removal of accounts held by underage users, or acting on user reports against such accounts by suspending them. Age verification, to a high degree of certainty, is technically difficult and the technology continues to evolve.[+2 sentences] There are concerns over data protection, especially regarding children's data. Balancing data protection concerns with effective and reliable age verification methods is challenging and global standards have not yet been set. MCI has frequent engagements with our international counterparts on issues related to online safety, especially for young users. We will be introducing measures, including a proposed Code of Practice for Online Safety. The Code will require social media services with significant reach, or impact, to put in place systems and processes to mitigate exposure to harmful content for users in Singapore, with additional safeguards for young users. We will continue to monitor global developments as well as consult extensively, including on the issue of age verification, as we consider additional measures where viable and appropriate.[+2 sentences] We also encourage parents to take an active role in engaging and guiding their children on the appropriate age to use social media. Parents may tap on useful resources, such as those produced by the Media Literacy Council that promote safe and responsible online behaviour, including a "Social Media Guide: What is the right age for my child?" which provides tips for parents on when to let their child use social media.
Mr Deputy Speaker3 words
[+1 sentence]Mr Melvin Yong.
Mr Melvin Yong Yik Chye (Radin Mas)115 words
[+5 sentences]Sir, I thank Senior Minister of State Dr Janil Puthucheary for his reply. I have one supplementary question. I think as the Senior Minister of State has pointed out, parents are the first influencers for our children and can significantly affect the way their children's attitudes towards all these social media platforms form. Sir, I would like to ask if IMDA can explore creating parents' specific social media literacy programmes to train them on how to help their child navigate the various social media platforms. I am certain this will help parents, equip them with the necessary knowledge, skills and tools to mitigate any potential harm that these social media may pose to our children.
Dr Janil Puthucheary195 words
[+4 sentences]Sir, I thank Mr Melvin Yong for his question and for his suggestion, which is a good one. We are doing such things. There is a broader question of how to support parents and help them be that right guide, the right set of first influencers for their children. There are a few things that we are doing. The first is a requirement that Internet service providers are required when they offer residential services, to offer residential and mobile Internet filtering services to help parents ensure that children have safe access to the Internet, with several initiatives to provide resources and support to parents – I described one in my original answer.[+3 sentences] NLB also organises "S.U.R.E. Celebrates Media and Information Literacy" events in October. This provides Singaporeans with skills, how to be discerning when using online information sources and it also includes programmes targeting children, such as the "S.U.R.E. for School". MOE also works with parents – and not just with the children – to provide online resources, parenting kits and articles to give them the skills, knowledge and tools to be able to help guide their children and better manage their children's online habits.
Aligning Schedules at Institutes of Higher Learning with Pre-employment Programmes and School Holidays›Oral Answers to Questions8 turns · 887w
· 13 highlighted
oral-answer-2915
Dr Wan Rizal27 words
[+1 sentence]asked the Minister for Education whether the Ministry has plans to review polytechnic semester breaks so that they are aligned with the primary and secondary school holidays.
Dr Wan Rizal32 words
[+1 sentence]asked the Minister for Education whether the Ministry has plans to align the semestral schedules of the Pre-Employment Training programme and Continuing Education and Training programme in the Institutes of Higher Learning.
The Minister for Education (Mr Chan Chun Sing)17 words
[+1 sentence]Mr Deputy Speaker, Sir, may I have your permission to take Question Nos 8 and 9 together?
Mr Deputy Speaker2 words
[+1 sentence]Please do.
Mr Chan Chun Sing154 words
[+2 sentences]Mr Deputy Speaker, Sir, the academic calendars of the Institutes of Higher Learning (IHLs) are planned to support students' learning experiences. This includes ensuring sufficient time for both curriculum coverage and student life during term time. The Polytechnic calendar also takes into consideration when students enroll into their courses. There are currently no plans to align the Polytechnic academic calendars with Primary and Secondary schools.[+1 sentence] There are, however, overlaps between the term breaks of our schools and Polytechnics. The academic schedules in IHLs for Continuing Education and Training (CET) programmes leading to full qualifications, such as part-time diploma and degree programmes, are broadly aligned with Pre-Employment Training (PET) programmes. Short modular courses and Workforce Skills Qualifications, however, are designed with a more flexible programme schedule and do not necessarily align with the academic calendars for the longer programmes.[+1 sentence] This better meets the needs of adult learners, who have to juggle both work and learning.
Mr Deputy Speaker3 words
[+1 sentence]Dr Wan Rizal.
Dr Wan Rizal (Jalan Besar)293 words
[+12 sentences]Thank you, Mr Deputy Speaker. I would like the Minister for the reply. Foremost, I would like to declare that I am an academic staff at Republic Polytechnic. Sir, my concern is really for the academic staff, as well as the students from both PET and CET programmes. In December, for example, PET students undergo an exam period, that is, in December, they have the first two weeks of exams, followed by two weeks of supposed break. However, they are given graded assignments also, which means that throughout December, they are supposed to finish an assignment before they come back in January. Which means, probably, that they will not spend their December holidays. This means that they will spend less time with their family and catch-up with the younger siblings, if they have these. For CET students, the December period, especially for the part-time diplomas, that actually transcends throughout. For example, in December, their lessons are throughout December. And this means that, for us to encourage them to do a part-time diploma and have a work-life balance, this means sacrificing their December holidays, and in the spirit of celebrating families, I think that this is something that we are missing. The staff, they have to do the markings in December, which means they are usually affected. Or if they are teaching CET students like I do, we do not get the December holidays as a whole. So, will the Ministry consider removal of mid semestral assessments, both in terms of exams as well as these graded assignments within the December period? Second, would the Ministry consider blocking off the December holidays completely to allow staff and students to recuperate and consolidate at the very least and, of course, spend time with their families?
Mr Chan Chun Sing359 words
[+2 sentences]Mr Deputy Speaker, Sir, I think we share the Member's concern for family time. But I should perhaps lay down the following considerations on how we determine when we should go for breaks for different parts of our society. I think different parts of our society will have different needs, be it Primary schools, Preschools, Secondary schools, post-Secondary schools, Universities and adult learners. It may also not necessarily be the best idea for all of us to say that all of them should take their breaks together and align it as such.[+4 sentences] Because I do believe that different parts of our society do have different requirements and it is quite difficult for us to, therefore, have one model that fits everything. I am quite sure that even if we do align it, there will be other challenges as well. Second, I think we have to consider the different learning needs of different segments of our population. For example, when we should have the term breaks for our IHLs is not just about what they learn in school. One of the very critical parts of the learning environment for our IHLs has to do with their internship opportunities. And in fact, in more recent times, I have also urged our IHLs to move away from what we rigidly think of as term time and break time, because that may not be necessarily the best way for us to fit the internship opportunities into the working environment that is required by the participating companies.[+2 sentences] Companies would like to have interns according to their business needs, rather than just the academic calendars. So, we need to take in to account all these differing needs. All the more so for adult learners in the continuing education and training programmes, that they would have different needs, different courses would have different internship opportunities and we have to take all this into account. So, it would not be very possible nor very wise for us to work on the premise of one single consideration and, therefore, try to align all our school calendars from preschool, all the way to IHLs, according to only one consideration.
Universal Concept for HDB Flats Built before 2006›Oral Answers to Questions5 turns · 614w
· 5 highlighted
oral-answer-2916
Ms Jessica Tan Soon Neo67 words
[+1 sentence]asked the Minister for National Development since HDB has applied the Universal Design (UD) concept for flats built from 2006 to make them functional, accessible and safe (a) whether it is feasible to incorporate the UD concept for flats built before 2006 to better support seniors and those with mobility challenges living in these older flats; and (b) if so, whether there are plans to do so.
The Minister of State for National Development (Assoc Prof Dr Muhammad Faishal Ibrahim) (for the Minister of National Development)193 words
[+1 sentence]Mr Deputy Speaker, universal design (UD) and barrier-free design principles have been incorporated into all new HDB developments since 2006. For older blocks, UD and barrier-free design features based on the prevailing Code of Accessibility in the Built Environment are incorporated, where feasible, when the blocks undergo upgrading. We have also introduced the Lift Upgrading Programme (LUP) to provide direct lift access to HDB residents by adding new lifts and lift shafts to eligible blocks, where feasible. At the precinct level, the Neighbourhood Renewal Programme (NRP) provides and upgrades features catered to seniors and those with mobility challenges, including ramps, resting points, elderly fitness corners in three-generation playgrounds, as well as wheelchair and elderly-friendly planters in community gardens. To enhance the safety and mobility of seniors in their homes, residents can also choose to install grab bars in their bathrooms or toilets, as well as ramps within their flats and at the main entrance, under the Home Improvement Programme (HIP) and Enhancement for Active Seniors (EASE) programme.[+1 sentence] HDB will continue to anticipate future needs and develop initiatives to create an environment that is user-friendly to all, including seniors and those with mobility challenges.
Mr Deputy Speaker3 words
[+1 sentence]Ms Jessica Tan.
Ms Jessica Tan Soon Neo (East Coast)264 words
[+11 sentences]I thank the Minister of State for his answers. I do have two supplementary questions. One is with regard to the design and accessibility outside of the flats, especially the older flats. There has been quite a bit of improvements with NRP and the various upgrading, but in terms of some of the older blocks, especially for example, those in Simei, where there is a level issue in the void decks because of the scupper drains. They do serve a purpose, but going forward, and with the advance in design and all that, is HDB looking at how to address the unevenness caused by the scupper drains, because the pathways are quite narrow for blocks of flats that were built during this time. My second supplementary question is within the flats themselves. Yes, the EASE programme has served the needs of our residents, in terms of helping with mobility and with the grab bars and the ramps, but is HDB looking at enhancing the EASE programme with regard to ramps or any other features? Because with the ageing population and those with mobility struggles, I think there is more that can be done around EASE and also, with regards to the width of the doorway entrances of flats. Because I visited many of my residents and I have noticed that the doorways are really quite narrow. Even if you have EASE and the right ramps, if the wheelchairs cannot go into the toilets or the bedrooms with ease, then it still does not serve the purpose. So, I hope HDB will look at this.
Assoc Prof Dr Muhammad Faishal Ibrahim87 words
[+3 sentences]Sir, I thank the Member for the supplementary questions. For the first supplementary question, I take note of her feedback and we will take it back to the Ministry. In regard to the second question, yes, the EASE programme is popular. In fact, we are currently reviewing the EASE programme to explore the provision of additional items to further enhance the safety and mobility of our seniors within their flats, taking into consideration the changing demographic profile of the ageing population, as well as anticipating future needs.
Sharing of Counselling Information when Primary School Students Transition to Secondary School and Beyond›Oral Answers to Questions8 turns · 446w
· 8 highlighted
oral-answer-2917
Mr Darryl David41 words
[+1 sentence]asked the Minister for Education (a) whether the number of Primary school students requiring counselling for mental health issues have risen in the last five years; and (b) how are such students managed as they transition into Secondary school and beyond.
The Minister of State for Education (Ms Gan Siow Huang) (for the Minister for Education)99 words
[+1 sentence]Mr Deputy Speaker, the number of Primary school students being referred to school counsellors for mental health-related issues was stable between 2017 and 2021. Some of these students may require counselling support even after they graduate from Primary schools. The school counsellors facilitate this by engaging parents to discuss how the counselling support can be extended in the child's new school. With the parents' consent, information such as the strategies to support the child and his challenges will be shared with the receiving school. Such information will be managed sensitively and will only be shared on a need-to-know basis.
Mr Deputy Speaker3 words
[+1 sentence]Mr Darryl David.
Mr Darryl David (Ang Mo Kio)127 words
[+6 sentences]I would like to thank the Minister of State for her reply. Just one supplementary question, Mr Deputy Speaker. I think the Minister of State mentioned that such information will be sensitively managed and shared on a need-to-know basis. Could the Minister of State further explain, with regard to even sharing the information beyond MOE, for example, in the future with other Government agencies, how is that information managed and accessed? For example, if a male student should need to get mental support, mental healthcare, throughout his scholastic journey, and when he enlists in the Army, would MINDEF have accessibility to that kind of information, which is typically I am assuming, held by MOE. Could the Minister of State please provide some clarity on issues like that?
Ms Gan Siow Huang97 words
[+2 sentences]I thank the Member for a very good question. We are very concerned about the continuity of mental health care and support for our young people. The Member might also be aware that the inter-agency task force for mental health and well-being has been stood up. MOE is plugged into this task force and we are discussing, in great depth, on how we can provide continuous care as well as to do so in a manner that respects the need for medical confidentiality and also that respects the wishes of the individuals as well as their parents.
Mr Deputy Speaker3 words
[+1 sentence]Mr Pritam Singh.
Mr Pritam Singh (Aljunied)41 words
[+4 sentences]Thank you, Mr Deputy Speaker. Just a quick question for the Minister of State. She mentioned earlier that the number has been stable. Can I just enquire from the Minister of State what is that number, particularly, for the last year?
Ms Gan Siow Huang35 words
The number of students that require mental health support in our Primary school has been stable for the last five years. In particular, in the last year, the number was about 16 per 1,000 students.
In-house Programmes in MOE Kindergartens for Special Needs Children›Oral Answers to Questions11 turns · 1,114w
· 11 highlighted
oral-answer-2918
Ms Yeo Wan Ling43 words
[+1 sentence]asked the Minister for Education (a) whether MOE Kindergartens (MK) have in-house programmes for special needs children; (b) whether these programmes prepare their special needs students for mainstream Primary schools; and (c) how many special needs children are in the MK system currently.
The Minister of State for Education (Ms Gan Siow Huang) (for the Minister for Education)271 words
[+4 sentences]Mr Deputy Speaker, currently, 8% of children enrolled in MOE Kindergartens (MKs), numbering around 600 Kindergarten One and Two children, are reported to have developmental needs that require support. Not all these children have a formal diagnosis. Some were identified by our Kindergarten educators, who are equipped with basic awareness and strategies to support diverse learners in the classroom. The type of support would vary depending on the needs of each child. MKs tap on sector-wide Early Intervention (EI) provisions, such as the Development Support - Learning Support (DS-LS) and Development Support Plus (DS-Plus) programmes, to support these children.[+5 sentences] Under these programmes, professionals such as Learning Support Educators and therapists provide intervention for identified children once or twice a week. This includes language and literacy support for children with learning needs and psychological support for children with behavioural needs. MOE also provides Assistive Technology such as Frequency Modulation systems for children with hearing loss. Some children who require medium to high levels of Early Intervention support also attend the Early Intervention Programme for Infants and Children, EIPIC in short, outside of MKs to ensure that their developmental needs are met. MOE Educational Psychologists work with our MKs to identify the needs of the children and design in-class strategies to support them. While the majority of children with developmental needs will progress to mainstream Primary schools, MOE Educational Psychologists will also make recommendations to Special Education (SPED) for the small proportion of children better supported in a SPED school.[+1 sentence] MKs also work closely with parents to support their child and prepare them for transition beyond preschool, whether in mainstream or SPED schools.
Mr Deputy Speaker4 words
[+1 sentence]Ms Yeo Wan Ling.
Ms Yeo Wan Ling (Pasir Ris-Punggol)134 words
[+5 sentences]I thank the Minister of State. I note from appeals from my residents, more families are asking for preschool placements for their special needs children and are being put on a waitlist or a special assessment before the child can be considered for school enrolment. I understand for experts in the field, that is also important for intervention to take place at a young age for certain special needs conditions before former school begins. Given that the MK system was put in place to prepare preschool children for formal education, would the Minister's assessment, be that the current spaces and in-school resources available for children with special needs, be sufficient for the Special Needs community? Also, are our preschool sufficiently resource, especially with trained teaching staff and in-house therapist to handle such student loads?
Ms Gan Siow Huang157 words
MKs are part of the wider ecosystem of preschools for children, especially those with special needs. And in our MKs, the MK Educators are offered baseline training by MOE Educational Psychologists within the first two years of service to gain awareness of developmental needs and strategies to support these diverse learners in the classroom.[+4 sentences] They would also have undergone training by the NIEC or the National Institute of Early Childhood Development or other training institutes on the skills required to identify and support children with developmental needs. Our MK Educators are supported by a Case Management Team set up in each MK to coordinate identification and support for children with developmental needs. The MK Case Management Team includes personnel, who receive more in-depth training including school Special Educational Needs Officers and our MK Special Educational Needs Coordinators. Our MKs are also supported by MOE Educational Psychologists, who provide consultation on identification, referrals and advice on in-class strategies.
Mr Deputy Speaker3 words
[+1 sentence]Ms Denise Phua.
Ms Denise Phua Lay Peng (Jalan Besar)149 words
[+7 sentences]I understand that children with special needs sometimes attend, not just their daily kindergartens, whether MOE or the anchor operators – like PCF, My First Skool and others. That is usually daily. But some of them also, because of their need, they attend the EIPIC programme, some specialised classes, and that is like once or twice a week. So, it is a combination of both. I was recently told by some residents that the policy is such that if they receive EIPIC, which is early intervention support, then if they go to the kindergartens, which are also funded by MOE, then they would not receive support in the preschools. So, my question to the Minister of State is, is that true? And if that is true, could we consider looking into support for these children, so that they can receive an effective intervention and support on a daily basis?
Ms Gan Siow Huang64 words
[+1 sentence]I thank the Member for the supplementary question. We want the best support for children with special needs, whether they are in MKs or in the EIPIC centres or the early intervention centres that Member Denise Phua mentioned. And we will work together with the early intervention centres to make sure the programmes and support given to the special needs children will be complementary.
Mr Deputy Speaker12 words
[+1 sentence]Ms Yeo Wan Ling, keep it to a short supplementary question, please.
Ms Yeo Wan Ling61 words
[+3 sentences]Would the Ministry also be looking at the number of people on the waitlist? Has it increased for special needs people wanting to enter the MK system over the last five years, for instance? And also, at the same time, would there also be numbers that you monitor in terms of the number of special needs people within the MK system?
Ms Gan Siow Huang216 words
[+3 sentences]As I have mentioned earlier on, MKs are part of the ecosystem of preschools in Singapore. Besides MKs, there are other preschools managed under MSF that cater to the needs of students, whether they hare normal or special needs. So, I think it is important that we do not just look at the MKs by themselves, but look at how as a system as a whole, we can meet the needs and demands of the students. Offhand I do not know the waitlist for special needs children who want to go to the MKs. But, as I mentioned earlier on, all MKs have specially trained teachers and are supported by a group of professionals to help students with special needs. And also, we know that among special needs students, there is actually a very wide spectrum. Those that are of very mild conditions; most of them are able to get the support that they need from the MKs. And those who are deemed to have moderate and more severe conditions, their care and support will then be supplemented by the other centres that the students will go to once or twice a week.[+1 sentence] So, I think it is important that we look at this issue more holistically and not just look at the MOE system alone.
Indicators Used to Measure Impact of Productivity Grants on SMEs›Oral Answers to Questions6 turns · 467w
· 9 highlighted
oral-answer-2919
Speaker not recorded74 words
[+1 sentence]The following question stood in the name of Mr Leon Perera – 13 To ask the Minister for Trade and Industry (a) what are the indicators used by the Government to measure the impact of grants such as the Productivity Solutions Grant on the firm-level productivity of SMEs and micro-SMEs that have taken up such grants; and (b) whether the Ministry can publish all grant KPIs and outcomes in yearly reports in aggregate terms.
Assoc Prof Jamus Jerome Lim (Sengkang)3 words
[+1 sentence]Question No 13.
The Minister of State for Trade and Industry (Ms Low Yen Ling) (for the Minister for Trade and Industry)113 words
[+2 sentences]Mr Deputy Speaker, Enterprise Singapore publishes indicators such as committed value-add and projected skilled jobs creation in its annual Year-in-Review that measure the economic impact of grant projects undertaken by enterprises. In addition, the Government also conducts regular studies on the impact of its grant schemes. For example, an impact analysis for the Market Readiness Assistance grant was published in the Economic Survey of Singapore Third Quarter 2021. In another study in 2020, Enterprise Singapore sampled 129 companies on the impact of the Productivity Solutions Grant (PSG) and found that more than 80% of these projects had achieved various forms of productivity gains in terms of cost savings, time savings and revenue gains.
Mr Deputy Speaker4 words
[+1 sentence]Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim82 words
[+4 sentences]Just a quick follow-up to the reply by the Minister of State. Is it possible that the studies that she cited be provided on a more disaggregated basis? As she mentioned that is published in Economic Survey of Singapore and I am just wondering whether the underlying background papers could be made available? I ask this in part because it is interesting to understand to the extent to which these grants could causally be attributed to improving the productivity of these firms.
Ms Low Yen Ling191 words
[+2 sentences]I want to thank the Member Assoc Prof Jamus Lim for his supplementary questions. Allow me to recap for the other Members as well. Productivity Solutions Grant (PSG) was introduced in 2018 to support our enterprises in their transformation journey and they are aligned to the Industry Transformation Map (ITMs) to support our enterprises to adopt IT solutions, equipment or consultancy services that are pre-scoped by the industry's leading agency.[+2 sentences] It could be BCA for construction, NEA and so on. So, let me elaborate on the reach and also the uptake of the scheme for PSG. Between FY2019 and FY2021, over the three years, more than 116,100 applications were received. Nearly 95% of the complete submissions were approved. When I cited the impact study earlier, we are looking at the data and certainly, in due course, we will share more details. Suffice to say, the top three sectors are retail, food and beverage, and construction. We are heartened that the companies in these three sectors are really taking up PSG to raise the productivity gains. I want to assure him that we will certainly share more details from the impact studies.
Addressing Access Issues with Digitalisation of Lasting Power of Attorney-making Process›Oral Answers to Questions8 turns · 671w
· 9 highlighted
oral-answer-2920
Mr Yip Hon Weng86 words
[+1 sentence]asked the Minister for Social and Family Development with the impending digitalisation of the Lasting Power of Attorney (LPA) process (a) whether the related website and apps will be available in the four national languages for users who are less familiar with the English language; (b) whether smart technology will be leveraged on to provide relevant recommendations, fill up forms and skip irrelevant features based on the users’ profile; and (c)whether residents will get access to training and assistance with registering their LPA through the system.
The Minister for Social and Family Development (Mr Masagos Zulkifli B M M)153 words
[+1 sentence]Mr Speaker, the online form for a Lasting Power of Attorney (LPA) application and step-by-step instructional videos will be available in the four official languages. If fields in the form are already known to the Government, the system will pre-fill them with the user's consent. Users will only be prompted to fill fields relevant to the scope of powers and appointment under their LPA applications.[+1 sentence] For example, if a user indicates his intent to appoint only one donee, the online form will not have a field on how multiple donees should act. Key legal terms will be explained in simple language.[+1 sentence] These features will make the LPA-making process quicker and more convenient. Apart from designing the system to be user friendly, we have prepared instructional videos and quick reference guides for donors, donees and certificate issuers. Members of the public may also approach Citizen Connect Centres and ServiceSG Centres located island-wide for assistance.
Mr Deputy Speaker4 words
[+1 sentence]Mr Yip Hon Weng.
Mr Yip Hon Weng (Yio Chu Kang)50 words
[+4 sentences]I thank the Minister for his reply. I have two supplementary questions. Will the digitalised LPA be made available in NEHR to facilitate ease of use by clinicians? Second, how does the Ministry intend to improve LPA awareness and better outreach to seniors with the digitalisation of the LPA processes?
Mr Masagos Zulkifli B M M120 words
Currently, the certificate issuer must be a registered lawyer, accredited doctor or psychiatrist.[+4 sentences] I think we want to confine this to these three groups of people, because to determine whether the donor and donee should be qualified for the LPA is a very important legal process. We will keep it to that for now, and then in the future when there are needs to do so, we will expand. For the second question, certainly, we will do as much as we can to reach out to our seniors. We have a good system of outreaching with them, either through the Silver Generation Ambassadors (SGA), AIC if they are visiting them, or even PA when they come to our contact points.
Mr Deputy Speaker4 words
[+1 sentence]Mr Seah Kian Peng.
Mr Seah Kian Peng (Marine Parade)102 words
[+7 sentences]Just a quick supplementary question to the Minister. I think the importance of LPA is obvious and certainly more so for the seniors, the elderly. My supplementary question to Minister is whether, currently, is he able to let us know how many of us have already done our LPAs? Whatever the number is, I think it is not enough. So, my question is, how can we accelerate this and bring this to a much higher level? And it should really start at a much younger age, where possible. And maybe at certain appropriate milestones, we can incorporate this to increase the adoption.
Mr Masagos Zulkifli B M M152 words
[+1 sentence]I usually will ask the Member to file a Parliamentary Question for that, but I happen to have the number here. The total number as of end June 2022 is around 152,000.[+2 sentences] I think the number is still small and I agree with the Member that we should encourage our friends, even ourselves, to take up the LPA. Do not take it for granted until the last minute, when there are things that you need to get someone to handle your legal affairs, your personal affairs and that someone is not authorised to do so. It is important for us to help ourselves, especially, and those that we love to make sure the LPA is signed. And we have many certificate issuers who are willing to come forward and there is already a waiver for those who are coming to get an LPA, for Singapore Citizens, up to, I think, March 2023.
Registration for Overseas Entities who wish to Buy, Sell or Transfer Properties in Singapore as Anti-money Laundering Measure›Oral Answers to Questions5 turns · 392w
· 8 highlighted
oral-answer-2921
Mr Murali Pillai61 words
asked the Minister for Law whether the Ministry will require overseas entities wanting to buy, sell or transfer properties in Singapore to register with the Accounting and Corporate Regulatory Authority and disclose the beneficial owners and principal officers of the entities along the lines of what has been introduced in United Kingdom in August 2022 as a measure against money laundering.
The Senior Parliamentary Secretary to the Minister for Law (Ms Rahayu Mahzam) (for the Minister for Law)245 words
[+1 sentence]Mr Deputy Speaker, the Member has asked if there should be a requirement for overseas entities to register with the Accounting and Corporate Regulatory Authority (ACRA) before they can transact in property in Singapore. I understand that ACRA has implemented a register of registrable controllers for companies, foreign companies and limited liability partnerships (LLPs). Such entities are required to file information on their registrable controllers, that is, beneficial owners, centrally with ACRA.[+1 sentence] This serves to make the ownership and control of such entities more transparent and thus reduce opportunities for the misuse of such entities for illicit purposes. Foreign entities that carry on or intend to carry on business in Singapore are already required to be registered with ACRA and would be subject to existing requirements to file information on their beneficial owner with ACRA. Currently, in line with the anti-money laundering and countering the financing of terrorism standards set by the Financial Action Task Force, professionals involved in the buying, selling and transfer of real estate, such as real estate agents and lawyers, are required to address the money laundering and terrorism financing risks. They have to assess their money laundering and terrorism financing risks, conduct customer due diligence including the identification of their customers’ beneficial owners, and where the risks of a customer are high, take enhanced measures such as source of funds checks. Agencies are assessing whether a measure like the UK’s Register of Overseas Entities would be useful in our context.
Mr Deputy Speaker3 words
[+1 sentence]Mr Murali Pillai.
Mr Murali Pillai (Bukit Batok)57 words
[+2 sentences]I thank the hon Senior Parliamentary Secretary for her answer. My supplementary question is as follows: whether MinLaw would be intending to make the information on beneficial ownership of shell companies which owns properties, accessible by public as well as financial institutions and professionals who act as gatekeepers, so they can do their customer due diligence better.
Ms Rahayu Mahzam26 words
[+1 sentence]I note the underlying concerns in relation to the Member's suggestion. Let us take this back and consider whether this is something feasible in our context.
Low Take-up Rate for Climate-Friendly Households Programme›Oral Answers to Questions12 turns · 416w
· 9 highlighted
oral-answer-2922
Speaker not recorded71 words
[+1 sentence]The following question stood in the name of Mr Leon Perera – 16 To ask the Minister for Sustainability and the Environment (a) whether the Ministry will consider increasing the value of the $150 Climate-Friendly Households Programme e-voucher for energy-efficient refrigerators given the significantly higher cost of a three-tick refrigerator; and (b) whether the Ministry will consider covering more aspects of residents’ emission-emitting activities, such as through offering vouchers for bicycles.
Mr Leon Perera40 words
[+1 sentence]asked the Minister for Sustainability and the Environment in view of the low take-up rate of the Climate-Friendly Households Programme, whether the Ministry has surveyed eligible households and conducted outreach to better understand the reasons for the low take-up rate.
Assoc Prof Jamus Jerome Lim (Sengkang)4 words
[+1 sentence]Question No 16, please.
The Senior Parliamentary Secretary to the Minister for Sustainability and the Environment (Mr Baey Yam Keng) (for the Minister for Sustainability and the Environment)15 words
[+1 sentence]Mr Deputy Speaker, may I give a combined answer to Question Nos 16 and 17?
Mr Deputy Speaker2 words
[+1 sentence]Please do.
Mr Baey Yam Keng124 words
The Climate-Friendly Households Programme aims to encourage 1-, 2- and 3-room HDB households to make the switch to resource-efficient and climate-friendly appliances – refrigerators, LED lighting and shower fittings.[+1 sentence] In this way, the HDB households can also enjoy savings in utilities costs. From NEA’s earlier market survey on refrigerators, a $150 voucher amount was sufficient to defray the average incremental cost of energy efficient models. To improve the programme take-up rate, NEA and PUB have been working with community partners to conduct outreach activities to residents. Posters on the Programme have also been displayed at Community Clubs and digital display panels at some HDB blocks. We will continue to monitor the take-up rate of the vouchers and review the Programme at an appropriate juncture.
Mr Deputy Speaker4 words
[+1 sentence]Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim32 words
[+2 sentences]If I could just follow up. Part (b) of the question was about whether other activities might be considered to be covered by this and I do not think that was answered.
Mr Baey Yam Keng11 words
[+2 sentences]Could I clarify? Are you looking to other appliances or activities?
Assoc Prof Jamus Jerome Lim12 words
[+1 sentence]The actual Parliamentary Question mentioned the possibility of offering vouchers for bicycles.
Mr Baey Yam Keng94 words
The current programme is designed to help low-income HDB households to make the switch to more energy-efficient appliances while saving costs. This current phase of programme will end on 31 December 2023. NEA and PUB are currently conducting a review of the programme and will look at whether we could extend the programme to cover more appliances. Ultimately, we are looking at electrical appliances, so whether the likes of bicycles can be covered, yes, it is an energy zero device for mobility, but we will look at it and announce further details when ready.
Mr Deputy Speaker7 words
[+2 sentences]No further supplementary questions? Mr Murali Pillai.
Review to Ensure Continued Relevance of GCE “A" Level Curriculum for Singapore Schools›Oral Answers to Questions7 turns · 906w
· 10 highlighted
oral-answer-2923
Mr Murali Pillai66 words
[+1 sentence]asked the Minister for Education having regard to the trend of students taking the International Baccalaureate instead of the GCE “A” levels, the continued popularity of Polytechnics amongst students eligible for Junior Colleges (JCs) and overseas universities offering places to students who complete pre-university foundation courses, whether there will be a review to ensure the continued relevance of the GCE "A" Level curriculum at MOE schools.
Mr Deputy Speaker11 words
[+2 sentences]Question No 18 has been asked. Dr Maliki, are you answering?
The Second Minister for Education (Dr Mohamad Maliki Bin Osman) (for the Minister for Education)157 words
[+1 sentence]Yes, I am answering. The GCE “A” Level programme, International Baccalaureate Diploma Programme (IBDP) and Polytechnic diploma programmes are different pathways that offer choice and opportunities for students of different interests and profiles. MOE regularly reviews the GCE “A” Level curriculum to ensure its continued relevance.[+1 sentence] For example, Project Work and the contrasting subject requirement were introduced to promote collaborative problem solving and broaden learning. In addition, we are also in the midst of reviewing the overall curriculum and assessment demand across the general education system to identify ways to further strengthen the development of 21st Century Competencies in our students.[+2 sentences] These reviews ensure that our GCE “A” Level curriculum continues to provide our students with the essential knowledge, skills and dispositions to articulate smoothly to the next stage of learning, and to thrive at work and in life. The pre-university institutions have therefore remained a popular pathway among students eligible for the GCE “A” Level programme.
Mr Deputy Speaker3 words
[+1 sentence]Mr Murali Pillai.
Mr Murali Pillai (Bukit Batok)115 words
[+6 sentences]Thank you, Sir. May I ask the hon Minister whether he can look into having better pathways for GCE “A” Level students who have passed the exams, but cannot get into universities. Perhaps there could be foundation courses run by local universities, so they can later on apply to universities. Or for example, there could be transferred credits, so they can go to Polytechnics. The second supplementary question is in relation to GCE "A" Level students who fail their exams. Can MOE consider offering exams in June, so they do not have to wait the entire year, and hopefully they can then move on and consider the next step without loss of too much time?
Dr Mohamad Maliki Bin Osman500 words
[+4 sentences]Sir, I thank the Member for his two questions. The first question is on pathways for GCE “A” Level students who have finished their GCE “A” Levels, but may not have made it to universities. Of course, we know that students who do the GCE “A” Level programme set their sights to go to university but some do not make it. What we try to do now is to offer different pathways. Some of them do decide to subsequently go into the Polytechnics and when the Polytechnics admit these students, they get some advanced standings. Some of the students who are admitted with their GCE “A” Level qualifications go straight to the second year. It really depends on the credentials that the GCE “A” Level students come in with. We are also looking at how we can develop this whole concept of micro-credentialing with our Universities. For example, SIT has started with conceptualising micro-credentialing, in which students will take modules at different points in time, during their career.[+7 sentences] The broader concept we are introducing to our students is that you do not necessarily have to see the university as your immediate end point after your GCE “A” Levels. Even those who qualify immediately do not necessarily have to go directly to the universities. We do encourage them to have a taste of the work and industry so that they have a better idea if that is indeed the field that they want to get into. So, we are working on different pathways to provide better opportunities for young people to look at skills as the more critical impetus to their future careers and therefore, when deciding on going into a particular industry, understand what kind of skills are relevant and take courses in relation to that, and then accumulate the micro-credentials, to possibly lead to a degree qualification. On the second supplementary question, GCE “A” Level students who do not make it to universities. As I mentioned earlier, as and when they are able to go onto other pathways, they are welcome to do so. On whether you can do GCE “A” Levels in June, it might be a bit tougher, because currently the GCE “A” Levels curriculum is also done together with Cambridge. So, the June papers tend to focus more on the languages. We can look into that possibility, but, really, it is also dependent on the number of students that we want to make it available to.[+2 sentences] We do not want a situation where just because we make it available in June, then the ones who are supposed to do it in December want to cram everything in June, and therefore, increase the level of stress, which already is very high for our JC students. So, you cannot be doing it just for a group of students who did not do it very well the previous year, because it does require a lot of effort and resources to develop examination papers just for this group of students.
Mr Deputy Speaker54 words
[+4 sentences]Order. End of Question Time. The Clerk will now proceed to read the Order of the Day. [Pursuant to Standing Order No 22(3), Written Answers to Question Nos 19-33 and 35-38 on the Order Paper are reproduced in the Appendix. The remaining Questions have been postponed to a later Sitting of Parliament or withdrawn.]
Noise Nuisance or Disturbance Complaints Lodged with Police in Last Three Years›Written Answers to Questions2 turns · 85w
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written-answer-11687
Ms He Ting Ru60 words
[+1 sentence]asked the Minister for Home Affairs (a) for each of the last three years, how many complaints about noise nuisance or disturbance in (i) common areas of housing estates (ii) coffee shops or hawker centres and (iii) public entertainment venues are lodged with the Singapore Police Force respectively; and (b) of these, how many are about disturbances before 10.30 pm.
Mr K Shanmugam25 words
[+2 sentences]The Police do not track the number of complaints about noise-related nuisance or disturbances. The majority of these cases do not have criminal offences disclosed.
Outcome of Cases Filed with Protection from Harassment Court Since Its Operationalisation›Written Answers to Questions2 turns · 248w
· 0 highlighted
written-answer-11688
Ms He Ting Ru83 words
[+1 sentence]asked the Minister for Law since the operationalisation of the Protection from Harassment Court (PHC) on 1 June 2021 (a) how many cases are filed with the PHC, broken down into criminal complaints and civil remedies respectively; (b) of the civil cases filed with PHC, how many are successful in obtaining (i) protection orders (ii) mandatory treatment orders and (iii) monetary compensation/damages; and (c) out of the cases filed with criminal complaints, how many are referred to the Public Prosecutor for further action.
Mr K Shanmugam165 words
[+6 sentences]From the operationalisation of the Protection from Harassment Court (PHC) on 1 June 2021 to 30 June 2022, there have been 650 applications for civil remedies (that is, protection orders, orders relating to false statements and damages) filed with the PHC. Of these 650 applications, the PHC has granted 173 protection orders and awarded damages in nine cases, as at 30 June 2022. Complaints for alleged Protection from Harassment Act (POHA) offences are filed by way of a Magistrate's Complaint in the Magistrate's Court, not the PHC. There have been 626 Magistrate's Complaints filed for alleged POHA offences from 1 June 2021 to 30 June 2022. The Magistrate does not refer Magistrate's Complaints to the Public Prosecutor, but may direct the Police to conduct investigations into the complaint, who may thereafter refer the matter to the Public Prosecutor. Information on the number of Magistrate's Complaints filed for alleged POHA offences which were subsequently referred to the Public Prosecutor for further action is not readily available.
Cases Filed with Protection from Harassment Court›Written Answers to Questions2 turns · 67w
· 0 highlighted
written-answer-11689
Ms He Ting Ru42 words
[+1 sentence]asked the Minister for Law to date, what is the number of cases filed with the Protection from Harassment Court broken down into (i) sexual harassment (ii) workplace harassment (iii) cyberbullying (iv) doxxing and (v) harassment by debt collectors, moneylenders, or creditors.
Mr K Shanmugam25 words
[+1 sentence]Statistics on the breakdown of harassment cases filed with the Protection from Harassment Court from 1 June 2021 to 30 June 2022, is as follows:
Protection and Expedited Protection Orders Granted under Protection from Harassment Act 2014›Written Answers to Questions2 turns · 157w
· 0 highlighted
written-answer-11690
Ms He Ting Ru83 words
[+1 sentence]asked the Minister for Law (a) in each of the past five years, how many Protection Orders (PO) or Expedited Protection Orders (EPO) have been granted under the Protection From Harassment Act 2014; (b) how many orders of committal (for matters before 1 April 2022) or committal orders (for matters on or after 1 April 2022) have been requested; and (c) how many cases of alleged breaches of PO or EPO have been referred to the Public Prosecutor for further investigation and action.
Mr K Shanmugam74 words
[+2 sentences]Statistics on the number of Protection Orders (PO) or Expedited Protection Orders (EPO) granted in the past five years are as follows: In respect of alleged breaches of PO or EPO, there were two applications filed seeking committal orders as of 30 June 2022. Information on the number of cases of alleged breaches of PO or EPO which have been referred to the Public Prosecutor for further investigation and action is not readily available.
Participation of Autonomous University Undergraduates in In-person International Exposure Opportunities in Last Five Years›Written Answers to Questions2 turns · 126w
· 0 highlighted
written-answer-11691
Mr Chua Kheng Wee Louis42 words
[+1 sentence]asked the Minister for Education for local undergraduates at the Autonomous Universities, what is the proportion of students who have participated in in-person international exposure opportunities such as student exchange programmes and overseas internships in each year over the last five years.
Mr Chan Chun Sing84 words
[+4 sentences]The Autonomous Universities (AUs) provide opportunities for undergraduates to gain in-person overseas exposure through exchanges, internships, entrepreneurial attachments and short-term immersion programmes. From Academic Year (AY) 2017 to 2019, an average of around 20% of local undergraduates in the AUs participated in an in-person overseas exposure programme annually. In-person overseas programmes were mostly halted in AY2020 and AY2021 due to the COVID-19 pandemic. With the easing of international border restrictions, the AUs are resuming overseas programmes, taking into consideration prevailing travel advisories and guidelines.
Median and Mean Number of Primary and Secondary School Students in Classes Headed by Form Teachers›Written Answers to Questions2 turns · 173w
· 0 highlighted
written-answer-11692
Mr Leon Perera35 words
[+1 sentence]asked the Minister for Education for Primary and Secondary schools, what is the current median and mean number of students in a class as defined by the grouping of students headed by a form teacher.
Mr Chan Chun Sing138 words
[+5 sentences]In 2021, the mean form class size in both Primary and Secondary schools was 33. The median form class size in Primary and Secondary schools were 32 and 36 respectively. MOE adopts a needs-based resourcing approach, where additional resources are provided to schools which have more students with specific learning needs, so that the teaching for such students could be done in smaller groups based on learning needs or programme considerations. Some examples include the Learning Support Programme for lower Primary students which are conducted in pull-out classes of eight to 10, as well as the School-based Dyslexia Remediation programme conducted in classes of four to six students. Adopting a targeted and flexible approach in having some of the teaching to be done in smaller teaching classes would ensure prudent use of our limited financial and manpower resources.
Assessing Sufficiency of Financial Support for Those Deemed Medically Unfit for Employment›Written Answers to Questions2 turns · 153w
· 0 highlighted
written-answer-11693
Mr Chua Kheng Wee Louis45 words
[+1 sentence]asked the Minister for Social and Family Development whether there are any ongoing reviews to assess whether the current level of financial support is sufficient for those who are deemed medically unfit for employment but are well enough to perform most Activities of Daily Living.
Mr Masagos Zulkifli B M M108 words
[+4 sentences]MSF regularly reviews the scope and coverage of ComCare assistance schemes to ensure that support provided is adequate. MSF has already announced recently, the increase in the amount of assistance for low-income households on the ComCare Long-Term Assistance (LTA) and Short-to-Medium-Term Assistance (SMTA) schemes from 1 August 2022. It is unclear from the Member's question why a household with a person medically unfit for employment would have a different expenditure need from a household where the person is medically fit but nevertheless unemployed. If the issue is about specific medical expenditure, these are taken into account when the household's application is assessed by the Social Service Offices (SSOs).
Annual Leave Taken by Nurses in Restructured Hospitals in Past Five Years›Written Answers to Questions2 turns · 76w
· 0 highlighted
written-answer-11694
Mr Louis Ng Kok Kwang49 words
[+1 sentence]asked the Minister for Health (a) for each year in the past five years, what are the mean and median number of days of annual leave that nurses in restructured hospitals have taken; and (b) if this information is not available, whether the Ministry will start collecting this data.
Mr Ong Ye Kung27 words
[+1 sentence]The mean and median number of days of annual leave taken by nurses in the restructured hospitals between 2018 and 2021 is shown in the table below:
Streamlining and Enhancing Palliative Care Process across Healthcare Continuum›Written Answers to Questions2 turns · 235w
· 0 highlighted
written-answer-11695
Mr Yip Hon Weng88 words
[+1 sentence]asked the Minister for Health (a) what are the Ministry's plans to streamline and enhance the palliative care process across the healthcare continuum; (b) how will the Ministry facilitate closer partnership between Health Promotion Board, Agency for Integrated Care, the Singapore Hospice Council and other organisations with expertise on hospice and palliative care to enhance the local palliative care landscape; and (c) how will hospital discharge processes be simplified with the goal of making it easier for patients to be in their preferred environment in their final moments.
Mr Ong Ye Kung147 words
[+7 sentences]To enhance the palliative care process, MOH works with healthcare providers on protocols for the early identification of patients with palliative care needs. Patients can then receive care in the appropriate setting (for example, at home, in a day hospice, an inpatient hospice or a nursing home) and transfer between these settings as required. To support this, we are building both capacity and capabilities in all the various settings. This includes bringing palliative care into nursing homes. MOH also works closely with Agency for Integrated Care, Singapore Hospice Council, and the Health Promotion Board to raise awareness of end-of-life (EOL) issues through the national Advance Care Planning programme, sharing EOL caregiving resources and public communications and engagement efforts, such as events and roadshows. MOH is reviewing how to further improve hospital discharge processes for palliative care at home. This includes increasing support and respite services for caregivers.
Increasing Claim Limit of MediShield Life for Couples Experiencing Serious Pregnancy Complications›Written Answers to Questions2 turns · 89w
· 0 highlighted
written-answer-11696
Mr Leon Perera32 words
[+1 sentence]asked the Minister for Health whether the Ministry will consider increasing the claim limit of MediShield Life for couples who experience serious pregnancy complications given that the last review was in 2019.
Mr Ong Ye Kung57 words
[+3 sentences]MediShield Life limits for inpatient treatment of serious pregnancy and delivery-related complications are pegged to the prevailing normal and intensive care unit ward daily limits of $800 and $2,200 respectively. These limits were last reviewed and increased on 1 March 2021. MOH will continue to review the claim limits regularly to ensure that they provide adequate coverage.
Targets for Resident and GP Enrollments and Health Screenings for Healthier SG Programme›Written Answers to Questions2 turns · 159w
· 0 highlighted
written-answer-11697
Mr Gerald Giam Yean Song74 words
[+1 sentence]asked the Minister for Health in view of the short-term outcome indicators published in the White Paper on Healthier SG, what are the Ministry's targets within the next three years for (i) resident enrolment rate (ii) proportion of general practitioner clinics offering enrolment (iii) screening rates for chronic diseases and cancer (iv) proportion of diabetes mellitus patients with appropriate screening done and (v) proportion of residents who are actively using the Health 365 app.
Mr Ong Ye Kung85 words
[+4 sentences]We are setting targets under Healthier SG to ensure that the short-, medium- and long-term outcomes can be achieved. They need to be done in the right spirit, bearing in mind that this is an act of enterprise and a dynamic and multi-year transformation effort with a certain amount of uncertainty. Right now, we are focusing on designing the scheme right, rolling it out and stabilising operations. We will then monitor the key performance indicators and disclose them to the public from time to time.
Targeted versus Medium-term Outcome Indicators of Healthier SG Programme›Written Answers to Questions2 turns · 288w
· 0 highlighted
written-answer-11698
Mr Gerald Giam Yean Song89 words
[+1 sentence]asked the Minister for Health in view of the medium-term outcome indicators published in the Healthier SG White Paper (a) what is the current (i) obesity rate (ii) avoidable emergency department attendance rate (iii) 365-day re-admission rate (iv) average bed-days per capita and (v) admission rate of fall-associated injury among elderly; (b) what is the current proportion of (i) diabetes mellitus (ii) dyslipidemia and (iii) hypertension patients with optimal control; and (c) what are the targets for all the above within 10 years of the launch of Healthier SG.
Mr Ong Ye Kung199 words
[+5 sentences]Based on the most recent 2019/20 National Population Health Survey results: (a) Crude prevalence of obesity was 10.5%; (b) 38% of adults with known diabetes had good control of their glucose levels; (c) 35.7% of adults with known hypertension had good control of their blood pressure levels; and (d) For hyperlipidaemia, the recommended LDL-cholesterol target levels varied based on the individual's risk status of developing future coronary events and was not captured. Based on the pre-COVID period of 2017 to 2019: (a) The average hospital admission rate for avoidable emergency department attendance was 44.8%; (b) The average hospital admission rate of falls and fall-associated injury among the elderly was 44.6%; (c) The average 365-day readmission rate due to all causes was 33%. The technical specifications for this indicator are still under review by MOH and clusters, to better align with the objectives of Healthier SG; and (d) The indicator of average bed-days per capita is under review. MOH is focusing on designing the Healthier SG scheme right, rolling it out and stabilising operations. We will then set targets, taking into account the current baselines, monitor the key performance indicators and disclose them to the public from time to time.
Plans to Build More Complexes with Integrated Inter-generational Care Facilities›Written Answers to Questions2 turns · 256w
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written-answer-11699
Mr Yip Hon Weng50 words
[+1 sentence]asked the Minister for National Development whether there are plans to build more complexes with integrated inter-generational care facilities like eldercare and childcare in the community to facilitate cross-generation bonding and make it more convenient for sandwiched generations to have their children and parents cared for in the same place.
Mr Desmond Lee206 words
[+6 sentences]HDB works closely with the relevant Ministries and Government agencies, such as MOH, the Early Childhood Development Agency (ECDA), MSF and the People's Association (PA), to plan and provide Social Communal Facilities (SCFs), including childcare and eldercare facilities, in new public housing developments. To provide opportunities for intergenerational bonding and greater convenience for our residents to meet the care needs of both the young and old, HDB co-locates the childcare and eldercare facilities where possible, such as in the multi-storey carparks or standalone community facilities buildings of new Build-To-Order (BTO) developments. Together with the various agencies, HDB and URA also explore co-locating various SCFs and other facilities within a single complex. One such example is Kampung Admiralty, which integrates housing for the elderly with an Active Ageing Hub and childcare centre, as well as other healthcare, commercial and community facilities. We will continue to explore such co-location opportunities, taking into consideration the local context and needs, availability of a suitable location, and the timelines and funding availabilities of the various co-locating agencies. Going forward, as part of HDB's recently launched "Designing For Life" roadmap, more childcare and eldercare facilities will also be located close to precinct facilities like three-generation playgrounds to facilitate inter-generational bonding and interaction.
Participation Rate in Enhanced Revitalisation of Shops Scheme in HDB Estates›Written Answers to Questions2 turns · 250w
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written-answer-11700
Mr Murali Pillai56 words
[+1 sentence]asked the Minister for National Development (a) in the past three years, how many shops in HDB housing estates have opted for the enhanced Revitalisation of Shops (ROS) scheme to upgrade the common property fronting their shops; and (b) what steps can be taken to boost the number of shops participating in the enhanced ROS scheme.
Mr Desmond Lee194 words
[+7 sentences]The last batch of Revitalisation of Shops (ROS) sites announced in 2016 comprised 13 town and neighbourhood centres that applied for co-funding for upgrading of common areas, of which five eventually proceeded with upgrading. The upgrading works for these five sites, comprising around 270 shops, were progressively completed between 2019 and 2021. Since then, we have not announced any new ROS batch as HDB is reviewing the scheme. As part of this review, we conducted Focus Group Discussions with key stakeholders like Merchants' Associations and shop owners over 2021 to 2022 to gather feedback on how the ROS scheme can be improved. The feedback from these sessions has been useful in shaping some of the enhancements that we are considering for the scheme, which could translate to higher participation from shops. For instance, some participants had shared that the current ROS requirement to obtain 100% support from benefiting shop owners means that upgrading works cannot proceed if a small number of shop owners oppose the upgrading, even if the majority are in support. We are currently firming up the details of the ROS enhancements and will be sharing more details in the coming months.
Assistance for Shops and Retail Outlets in HDB Estates to Boost Vibrancy and Competitiveness›Written Answers to Questions2 turns · 522w
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written-answer-11701
Mr Murali Pillai37 words
[+1 sentence]asked the Minister for National Development what steps are being considered to assist shops and retail outlets in HDB housing estates to boost their vibrancy and competitiveness and address the general drop in patronage at these locations.
Mr Desmond Lee485 words
[+18 sentences]HDB shops not only provide residents with convenient access to essential goods and services, but also serve as a social node for residents to mingle and enhance the vibrancy of HDB communities. HDB shops are well-patronised by our residents and overall vacancy rate for HDB shops remains low. Nevertheless, our heartland shops do face challenges given changing consumer habits and preferences, and most recently, the COVID-19 pandemic. Given the important role the heartland shops play in our HDB estates, the Government has put in place various short- and medium-term measures to tide them through difficult periods and to help them transform for the future. In the past one to two years, the Heartland Digitalisation and Revitalisation Committee (HDRC), co-chaired by Senior Minister of State Sim Ann and Minister of State Low Yen Ling, supported heartland merchants in advancing their digitalisation efforts and growing their revenue streams. The HDRC worked with agencies to introduce initiatives such as Heartlands Go Digital to accelerate the adoption of digital solutions and Visual Merchandising to improve heartland shopfront aesthetics to attract customers. Events were also organised to attract footfall. For example, the three-month long Heartlands Festival, which commenced in November 2021, resulted in 20% more footfall in participating precincts and up to 30% more revenue among some shops. Support packages such as rental waivers for our HDB merchants and Community Development Council (CDC) vouchers were also given out to Singaporean households to use at participating hawkers and heartland merchants. Beyond the business impact of the COVID-19 pandemic, however, there is a need to undertake deeper measures to help our shops remain competitive and relevant to customers and the community. Firstly, under the Revitalisation of Shops scheme (ROS), HDB provides co-funding to help retailers upgrade their shopping environment or carry out promotional events to attract crowds. HDB is currently reviewing how it can further improve this scheme, to enhance its attractiveness and increase the take up rates. More details will be announced in the coming months. Secondly, as announced during Committee of Supply 2022, HDB partnered Enterprise Singapore (EnterpriseSG) to launch Our Heartlands 2025 programme. Over the next four years, up to $50 million will be set aside to support heartland shops, (i) continuing to deepen digitalisation and manpower capabilities; (ii) enhancing liveliness of shopfronts and supporting events to draw footfall; and (iii) upgrading capabilities of Trades Associations and Chambers to better support heartland shops. Finally, HDB has also partnered with EnterpriseSG and the Prime Minister's Office to undertake the Heartlands Shops Study, which is a study on the social and economic value of heartland shops for various stakeholders such as residents, business owners and merchant associations. Over 2,800 stakeholders were engaged through the study to gather feedback and ideas on how to increase vibrancy, inclusiveness and heritage in our heartland shops. We will reference the views and study new measures to further enhance the vibrancy and relevance of heartland shops.
Qualifying Criteria for Merchants’ Enrollment in CDC Vouchers Scheme›Written Answers to Questions2 turns · 218w
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written-answer-11702
Ms He Ting Ru57 words
[+1 sentence]asked the Minister for Culture, Community and Youth (a) what are the qualifying criteria for merchants to be enrolled under the Community Development Council Vouchers scheme; (b) whether an update can be provided on the number of merchants enrolled in the scheme; and (c) how many applications by merchants to be added in the scheme are unsuccessful.
Mr Edwin Tong Chun Fai161 words
[+6 sentences]The CDC Vouchers Scheme aims to support Singaporeans in their daily expenses as well as help heartland merchants and hawkers in their businesses. Heartland merchants in trades involving daily necessities and services (such as F&B, minimarts, household retail and salons/barbers) and hawkers would generally be eligible to be enrolled onto the Scheme. Heartland merchants or hawkers who are interested to be enrolled onto the Scheme, can register with the CDCs at the website: vouchers.cdc.gov.sg or through their respective Merchants' Associations, Hawkers' Associations, or Business Advisers at SME Centres@CDC. The CDC Ambassadors will then visit the merchants and hawkers in the heartlands to make an assessment and enrol them. Since the launch of the CDC Vouchers Scheme in December 2021, more than 18,000 participating heartland merchants and hawkers have been enrolled onto the Scheme. The CDCs will continue to reach out to a broad cross section of heartland merchants and hawkers so that more businesses can benefit from the CDC Vouchers Scheme.
Assistance from Corrupt Practices Investigation Bureau in Cases Involving Employment Kickbacks›Written Answers to Questions2 turns · 146w
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written-answer-11703
Mr Louis Ng Kok Kwang43 words
[+1 sentence]asked the Minister for Manpower (a) whether the Ministry obtains assistance from the Corrupt Practices Investigation Bureau when investigating cases involving kickbacks from workers for employment; (b) if not, why not; and (c) whether the Ministry intends to do so in the future.
Dr Tan See Leng103 words
[+4 sentences]MOM investigates offences under the Employment of Foreign Manpower Act (EFMA) such as employment kickbacks and takes appropriate enforcement action against errant parties. Enhancements to the EFMA in 2012 (for instance the establishment of employment kickbacks as a standalone contravention) allow MOM to more effectively enforce against such offences. There are existing processes for MOM to work with other agencies or to obtain necessary information if required during investigation into employment kickbacks offences. Should offences under the purview of other agencies be uncovered during MOM’s investigations, MOM will alert the relevant law enforcement agency, including CPIB, so that it can be looked into.
Profile of Local Workers in Cleaning, Security and Landscape Sectors›Written Answers to Questions2 turns · 104w
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written-answer-11704
Mr Leong Mun Wai49 words
[+1 sentence]asked the Minister for Manpower whether he can provide a breakdown of the number of local workers in the cleaning, security, and landscape sectors respectively, in terms of age groups of (i) below 40 years old (ii) between 40 to 63 years old and (iii) above 63 years old.
Dr Tan See Leng55 words
[+2 sentences]In 2021, there were approximately 20,000 full-time resident cleaners, 17,000 full-time resident security officers and 1,900 full-time resident landscape maintenance employees in the cleaning, security and landscape sectors respectively. Table 1 breaks down the number of full-time resident cleaners, security officers and landscape maintenance employees in the cleaning, security and landscape sectors by age group.
Fires at Waste Recycling Collection Sites and Installation of Fire Suppressant Equipment to Minimise Such Fires›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 259w
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written-answer-na-11504
Ms Poh Li San67 words
[+1 sentence]asked the Minister for Home Affairs (a) how many fires have occurred in waste recycling collection sites in 2021 and thus far in 2022; (b) whether the facilities are required to install fire suppressant equipment in view of the flammable nature of recyclable waste such as paper and plastic; and (c) what measures does NEA impose on waste recycling companies to reduce the incidence of industrial fires.
Mr K Shanmugam192 words
[+10 sentences]In 2021, there were 11 fires in general waste disposal facilities, which include waste recycling facilities. Of these 11 fires, six involved waste materials. From 1 January to 17 September 2022, there have been 12 fires in general waste disposal facilities, nine of which involved waste materials. The Fire Code requires buildings containing waste recycling facilities to install appropriate fire protection systems. The type of system required depends on the size of the waste recycling facility. Building plans incorporating the appropriate fire protection systems need to be submitted and approved by the Singapore Civil Defence Force (SCDF). SCDF collaborates with the Waste Management and Recycling Association of Singapore to organise dialogues and seminars to raise awareness about fire safety in the waste management industry. These sessions help to build rapport between SCDF and members of the industry, and serve as a platform to share good practices and lessons learned from incidents and near misses. NEA is also working with SCDF on a joint circular and a set of best practices covering measures to minimise fire risks in waste recycling facilities. It is targeted to be sent out to the industry by end-2022.
Key Lessons from Trial of Battery Swapping for Electric Motorcycles›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 235w
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written-answer-na-11550
Mr Saktiandi Supaat73 words
[+1 sentence]asked the Minister for Transport with regard to the two trial sandboxes for battery swapping for electric motorcycles (a) what are the takeaways from the experience of Taiwan especially in relation to the risk of lithium-ion-battery fires; (b) whether the number of electric motorcycles will increase from the current number of 26 during the 12-month trial period; and (c) whether battery-swapping electric motorcycles are expected to be used predominantly for commercial point-to-point services.
Mr S Iswaran162 words
[+8 sentences]Electric motorcycles with swappable batteries have been used for both commercial point-to-point services and private purposes in Taiwan. We are only aware of one isolated fire incident in relation to such swapping solutions in Taiwan. However, given the importance of public safety, LTA has chosen to pilot battery-swapping solutions through limited deployment in regulatory sandboxes, in the first instance. This will allow us to understand and test the technology in our local context and adapt our regulations accordingly, before allowing any wider deployment for public use. Both the current sandboxes are limited to a combined deployment of 26 electric motorcycles – 20 for Gogoro and six for MO Batteries. Sandbox participants who wish to expand the sandbox must apply to LTA. LTA will consider the progress and safety record of the sandbox in assessing any such applications. When battery swapping has been established as a safe charging mode, we can expect to see such electric motorcycles for both commercial and private use.
Tracking Level of Usage of Rental Electric Vehicles at HDB and URA Car Parks›Written Answers to Questions for Oral Answer Not Answered by End of Question Time1 turns · 28w
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Mr S Iswaran28 words
[+1 sentence]The Land Transport Authority (LTA) does not currently track the utilisation of rental vehicles, including electric vehicles, whether they are available for lease at public carparks or otherwise.
Consulting with Senior Residents on Locations for Pedestrian Crossings›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 414w
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Ms Ng Ling Ling87 words
[+1 sentence]asked the Minister for Transport in view of the higher proportion of seniors involved in road traffic accidents (a) whether the Ministry can explain LTA’s planning norms for safe road crossing; (b) what are the criteria used to determine whether an overhead bridge with lifts or an underpass will be built despite their higher costs; and (c) whether LTA has or will adopt a design approach of co-creating with senior residents on where natural crossings need to be set up, especially in estates with more senior residents.
Mr S Iswaran327 words
[+14 sentences]The safety of pedestrians is key when the Land Transport Authority (LTA) plans town infrastructure with the relevant agencies. Local roads with high pedestrian footfall are provided with signalised pedestrian crossings or zebra crossings as a default. In determining the locations of these crossings, LTA ensures that they are not so far apart as to inconvenience pedestrians and not so close that motorists do not have time to slow down and react. For roads that are wider and have higher speed limits, grade-separated pedestrian crossings such as pedestrian overhead bridges or underpasses are provided. In particular, to provide barrier free crossings, LTA has retrofitted 77 pedestrian overhead bridges with lifts near places such as healthcare institutions which tend to serve seniors, with another 30 to be retrofitted with lifts over the next three years. Moving forward, all new pedestrian overhead bridges constructed by LTA will be barrier free. Furthermore, LTA has implemented various initiatives for seniors in areas with high senior population or located near places frequented by them. For instance, to provide seniors with additional time to cross the road, LTA has implemented 1,008 Green Man + pedestrian crossings. LTA has also worked with the community including the seniors, to implement Silver Zones. So far, LTA has installed 26 Silver Zones and will be installing 24 more Silver Zones by 2025. These Silver Zones are specially designed to enhance road safety for seniors, with reduced speed limits, narrower and meandering lanes, more prominent road markings, raised crossings and speed humps. Together, these measures make roads safer for crossing in those areas and have effectively reduced the accident rate among senior pedestrians by about 80%. Beyond Silver Zones, where there is local community support, LTA is also repurposing roads, to allow for wider footpaths and free up more space for better accessibility by pedestrians. One recent example of this is the widening of footpaths along Havelock Road and the building of a ramp for easier barrier-free access.
Increasing Number of Schools Offering Staggered Work Hours for Teachers›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 200w
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Mr Louis Ng Kok Kwang55 words
[+1 sentence]asked the Minister for Education (a) whether the Ministry will consider mandating all MOE schools to offer staggered working hours for teachers instead of allowing this to be at their discretion; and (b) if not, why and what steps will the Ministry take to increase the number of schools offering staggered working hours for teachers.
Mr Chan Chun Sing145 words
[+5 sentences]As schools have different operating contexts, the Ministry of Education (MOE) gives School Leaders the autonomy to implement staggered working hours while maintaining duty of care for students and ensuring that educational outcomes are not compromised. Rather than mandating that all schools offer staggered working hours, schools offer different forms of flexible work arrangements for staff. These include allowing staff to (a) work part-time, (b) take time-off to attend to urgent personal/family needs, (c) work from home when they have no in-person classes or other duties requiring their presence in school, or (d) attend virtual meetings at their preferred venue. Staff who require flexibility in their work arrangements can discuss with their supervisor how best to meet the needs of both the school and the staff. MOE will continue to share good practices and work with School Leaders to support the well-being of our teachers.
Academic and Non-academic Staff Employed by Institutes of Higher Learning on Employment and S Passes›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 125w
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Mr Leong Mun Wai53 words
[+1 sentence]asked the Minister for Education (a) what is the number of academic and non-academic staff employed by Institutes of Higher Learning who are on Employment Passes and S Passes respectively; (b) what is the number of employees on S Passes who are PhD holders, if any; and (c) what roles do they hold.
Mr Chan Chun Sing72 words
[+3 sentences]Our Institutes of Higher Learning (IHLs) recruit staff based on merit. In 2021, Employment Pass and S Pass holders made up around 11% and 4% respectively, as a proportion of all academic and non-academic staff in the Autonomous Universities, Polytechnics and Institute of Technical Education. Around 2% of staff in the IHLs were S Pass holders with PhD qualifications, who contribute mainly in junior research-related roles and are classified as non-academic staff.
Registered and Enrolled Nurses for Nurse-to-patient Ratios in General Wards and in Intensive Care Units›Written Answers to Questions for Oral Answer Not Answered by End of Question Time1 turns · 95w
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Mr Ong Ye Kung95 words
[+3 sentences]As shared with the Member previously, the typical nurse-to-bed ratio for general wards in the public acute hospitals is one nurse for every four or five beds. In the Intensive Care Units (ICU), the ratio is typically one nurse for each ICU patient and may be higher, such as two nurses for more complex ICU cases. The average skills mix proportion of nurses for these ratios is around 80% registered nurses and 20% enrolled nurses – the exact distribution will depend on the hospital’s clinical and operational needs, patient acuity and type of specialty settings.
Codes of Practice for Healthcare Institutions Offering Novel Therapies›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 264w
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Mr Yip Hon Weng54 words
[+1 sentence]asked the Minister for Health in view of the recent case of a patient undergoing liver transplant shortly after cancer surgery (a) whether there are codes of practice for healthcare institutions presenting novel therapies; and (b) how long does a patient have to proceed with treatment after a novel therapy before being pronounced cancer-free.
Mr Ong Ye Kung210 words
[+8 sentences]Public healthcare institutions abide by MOH regulatory and services planning frameworks for the provision of clinical services. Medical practitioners are also bound by the Singapore Medical Council Ethical Code and Ethical Guidelines which stipulated that patients should be treated according to generally accepted methods, based on a balance of available evidence and accepted best practices. Hence, any proposed novel innovative therapies will have to be assessed, balancing the available evidence for safety, efficacy and ethics, against accepted best practices. There must be professional consensus on the use of such novel therapies for the particular clinical situation should be sought from independent external experts and Clinical Ethics Committee, where appropriate. Untested treatments that are not accepted as standard of care should only be offered under the strict context of research or clinical trial. These are subjected to MOH and HSA regulations and approval by institution’s ethics review committee and with informed consent from patients. The term “remission” and “no evidence of disease” are commonly used to describe a clinical state where no evidence of cancer is currently detected in the body. Regardless of treatment type, patients will need to continue regular follow-up to screen for possible relapse, the frequency of which is based on clinical assessment and guidelines for specific cancers.
Impact of Healthier SG on MediSave Withdrawal Limits for Chronic Disease Management›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 81w
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written-answer-na-11669
Mr Gerald Giam Yean Song22 words
[+1 sentence]asked the Minister for Health whether the annual MediSave withdrawal limits for chronic disease management will be completely lifted under Healthier SG.
Mr Ong Ye Kung59 words
[+3 sentences]The withdrawal limit for MediSave continues to be relevant and will be in place, to ensure adequacy in healthcare savings through life. In 2021, about nine in 10 of all patients who withdrew MediSave under the Chronic Disease Management Programme did not reach their annual limits. The Ministry will continue to monitor MediSave utilisation and review withdrawal limits regularly.
Switching Outpatient Treatment from Polyclinics to Enrolled Private Family Doctors Given Healthier SG›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 92w
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written-answer-na-11670
Mr Gerald Giam Yean Song33 words
[+1 sentence]asked the Minister for Health whether residents who have been seeking outpatient medical treatment at polyclinics will be expected to switch to seeking treatment from their enrolled private family doctors under Healthier SG.
Mr Ong Ye Kung59 words
[+3 sentences]Singaporeans can continue to choose to seek care at any location, even after they have enrolled with a clinic under Healthier SG. They may also choose to enrol with a GP clinic or a polyclinic. For continuity of care, we encourage Singaporeans who enrol with a clinic to return to their enrolled clinic for care as much as possible.
Difference between Polyclinics and Private Family Doctors' Charges for Outpatient Consultations and Medications›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 177w
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written-answer-na-11671
Mr Gerald Giam Yean Song42 words
[+1 sentence]asked the Minister for Health whether patients’ costs for (i) outpatient consultations and (ii) drugs at their enrolled family doctor under Healthier SG will be the same as that charged at polyclinics, without any deliberate increases in polyclinic charges to achieve parity.
Mr Ong Ye Kung135 words
[+6 sentences]As explained in the White Paper on Healthier SG, MOH will make drug prices for a whitelist of common chronic drugs at participating general practitioner (GP) clinics more comparable to those at polyclinics, through a combination of enhanced drug subsidies and drug price limits. However, we will not be able to equalise patients’ costs across GPs and polyclinics down to the last dollar for all components of care, such as consultations and investigations. This is due to differences in costs and operating considerations between polyclinics and GP clinics. The Member’s last question is somewhat puzzling. We are giving additional subsidies to remove the differences in patients’ costs between polyclinics and GPs. The reason for any polyclinic fee adjustments has been to reflect changes in underlying costs, such as the salary costs of our healthcare workers.
Amending Small Claims Tribunal Act 1984 to Offer Cost-effective Civil Measures to Recover Misdirected Funds from Electronic Transfers›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 236w
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written-answer-na-11673
Mr Murali Pillai46 words
[+1 sentence]asked the Minister for Law having regard to the current adoption rate of electronic fund transfers and cases involving payments to erroneous accounts, whether the Ministry will consider amending the Small Claims Tribunal Act 1984 to provide cost-effective and quick civil measures to recover misdirected funds.
Mr K Shanmugam190 words
[+9 sentences]If a person has made an electronic fund transfer in error, he should inform the unintended recipient or his bank of the mistake and request for the funds to be returned. The Monetary Authority of Singapore (MAS) has issued guidelines on this issue. Under these guidelines, the sender’s bank should help to engage the recipient’s bank to inform the unintended recipient, so that a refund can be initiated. This framework helps parties resolve erroneous payments without the need to commence legal proceedings. If the recipient refuses to return funds that have been transferred in error, the sender should make a police report. It is an offence under the Penal Code for the recipient to retain or use the funds when he has been informed that it was transferred in error. It is also possible for the sender to bring a civil claim against the unintended recipient. Such a claim must, depending on its value, be filed with the Magistrates’ Court, District Courts, or the General Division of the High Court. I thank the Member for his suggestion, which we will study in future reviews of the Small Claims Tribunals Act.
Unemployment Rate for Singapore Citizens and PRs with Postgraduate Degrees›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 82w
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Mr Leong Mun Wai26 words
[+1 sentence]asked the Minister for Manpower what is the current average unemployment rate for Singapore Citizens and Permanent Residents whose highest attained qualification is a postgraduate degree.
Dr Tan See Leng56 words
[+3 sentences]The annual average unemployment rate for residents whose highest qualification attained is a postgraduate degree was 2.6% in 2021. This is lower than the average unemployment rates for degree holders and all residents, which were 3.2% and 3.5% respectively in 2021. This question was previously addressed in the combined Parliamentary Question reply on 3 October 2022.
Materiality of Letter of Consent for Spouses of Overseas Networks & Expertise Pass Holders›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 128w
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written-answer-na-11675
Ms Hazel Poa35 words
[+1 sentence]asked the Minister for Manpower (a) which agencies have provided feedback on the materiality of the letter of consent for spouses of Overseas Networks and Expertise Pass holders; and (b) when was the feedback given.
Dr Tan See Leng93 words
[+3 sentences]The Ministry of Manpower (MOM) and economic agencies received feedback from a number of trade associations and chambers including the Singapore International Chamber of Commerce, and the American, British, European and French Chambers of Commerce. The feedback stated that having the Letter of Consent provided assurance to foreign professionals that their spouses would be able to work in Singapore and this was critical to their relocation decision. The feedback was given following the announcement in March 2021 during MOM’s Committee of Supply debate on the regularisation of work arrangements of Dependant’s Pass holders.
Measures to Protect the Young and Elderly from Monkey Invasions of Urban Environment›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 416w
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written-answer-na-11676
Dr Tan Wu Meng61 words
[+1 sentence]asked the Minister for National Development (a) whether in planning of responses to monkeys in the urban environment, NParks has considered the proximity of monkey invasions to residents' homes, nursing homes and places of care for the elderly, preschool and childcare facilities; and (b) what measures are available to assist residents, especially children, who may be attacked or injured by monkeys.
Mr Desmond Lee355 words
[+18 sentences]We adopt a community- and science-based approach to managing the monkey population in Singapore. As part of these efforts, NParks closely monitors the geographical distribution of monkey-related feedback, taking into consideration their proximity to places such as residential homes, nursing homes and childcare facilities. NParks also conducts research to better understand the population trends and distribution of monkeys and uses the findings from these studies to inform its measures to manage the monkey population. For example, at monkey hotspots, NParks carries out habitat modification by replacing or harvesting fruit trees. This reduces the availability of food for monkeys. In addition, NParks works closely with other public agencies, grassroots organisations and Town Councils to engage the community on proper refuse management and to deter illegal wildlife feeding. Through such efforts, we work with residents to mitigate the presence of wildlife in their estates. NParks also partners the Long-tailed Macaque Working Group, which includes stakeholders such as academic experts and members of the nature community, to jointly develop and implement measures for monkey management. This includes monkey guarding, which NParks carries out in partnership with residents and other volunteers, to deter troops of monkeys from approaching residential areas. In areas where individual monkeys display more intrusive or aggressive behaviour, NParks intervenes more strongly to protect public safety. This includes trapping and translocating such monkeys away from residential areas. In the longer term, NParks is also looking at population control measures such as sterilisation. Should NParks receive feedback on a monkey-related attack or injury, we will also assist the affected individual where we can. NParks will continue to partner key stakeholders on its public engagement and outreach programmes. These include talks at preschools and childcare facilities near hotspots, engagement sessions in neighbourhoods and public webinars. Through these science-based programmes, residents can learn how to recognise the different facial expressions of monkeys, better understand their behaviour and respond to them safely. All of us have a part to play in minimising wildlife intrusions and keeping our community safe. We can do this by refraining from feeding wildlife, keeping our residential areas clean and appreciating wildlife from a safe distance.
Redundancy Capacity at Mandai Crematorium to Hedge against Downtime›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 100w
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written-answer-na-11680
Dr Tan Wu Meng21 words
[+1 sentence]asked the Minister for Sustainability and the Environment whether there is redundancy capacity at Mandai Crematorium to hedge against crematorium downtime.
Ms Grace Fu Hai Yien79 words
[+5 sentences]The Mandai Crematorium managed by NEA has sufficient capacity to meet current cremation demand. This includes buffer capacity to allow for regular maintenance of cremators and to accommodate fluctuations in daily cremation demand. Intermittent higher demand can also be met by extending operation hours to increase the number of cremation slots at Mandai Crematorium. A second crematorium being constructed at Mandai is scheduled to be completed by 2024. This will further enhance our long-term capacity to meet projected demand.
Proportion of Natural Gas Used for Electricity Generation Derived from Piped Natural Gas versus Shipped Liquefied Natural Gas›Written Answers to Questions for Oral Answer Not Answered by End of Question Time1 turns · 220w
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Mr Gan Kim Yong220 words
[+11 sentences]Domestically, around 95% of our electricity is generated using natural gas. For 2021, around two-thirds of our natural gas is imported as term Piped Natural Gas (PNG), while the remaining one-third is imported as term Liquefied Natural Gas (LNG). Our electricity generation companies also use spot LNG to supplement their long-term contracts. Between January and August 2022, prices of PNG and LNG provided through term contracts have risen by around 21% and 38% respectively. Spot LNG prices have increased by 113%. The year-on-year increase, from August 2021 before the energy crunch started to August 2022, is 20% and 50% for PNG and LNG provided under long term contracts respectively, and 224% for spot LNG. As Singapore imports most of our energy supply for electricity production, the increase in global energy prices over the past year will flow through into our prices. Countries around the world are struggling with rising energy prices, especially as winter approaches. I know that many Singaporeans are also concerned about whether something similar might happen to us. Our approach has always been to right-price electricity and provide targeted assistance, such as GST Voucher - U-Save rebates to consumers, especially to the vulnerable and low-income ones. The Energy Market Authority is also prepared to introduce more emergency measures to forestall extreme volatility in electricity prices if necessary.
Expected Full Completion and Capacity of Changi Airport's Terminal 5›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 232w
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written-answer-na-11683
Mr Chua Kheng Wee Louis38 words
[+1 sentence]asked the Minister for Transport (a) whether there are still provisions for the passenger handling capacity of Changi Airport's Terminal 5 to reach 70 million passengers a year; and (b) when is full completion of Terminal 5 expected.
Mr S Iswaran194 words
[+7 sentences]Pre-COVID-19, we had planned for Changi Airport Terminal 5 (T5) to have a handling capacity of about 50 million passengers per annum (mppa) in its initial phase, with the provision to increase to up to 70 mppa in the longer term. Due to the impact of COVID-19 on air travel, we had paused the T5 development for two years. We have since assessed that the long-term prospects for air travel remain strong, especially in the Asia Pacific region, underpinned by rapid economic growth and a fast-growing middle class in Southeast Asia and South Asia. We have resumed work on T5, which is expected to be operational around the mid-2030s. Similar to pre-COVID-19, we are currently planning for T5 to have a handling capacity of about 50 mppa, with the design flexibility to be built in two phases, in line with traffic growth. We also retain the option to increase the capacity of T5 to up to 70 mppa in the longer term. Ultimately, we want to ensure that we have the infrastructural capacity to ride on the long-term growth of air travel and strengthen Changi Airport’s position as a regional and global air hub.
Reports of Fare Evasions by Passengers of Taxis and Private Hire Vehicles›Written Answers to Questions for Oral Answer Not Answered by End of Question Time2 turns · 136w
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written-answer-na-11685
Mr Don Wee77 words
[+1 sentence]asked the Minister for Transport (a) whether the Ministry has data on how often fare evasions by passengers of taxi and private hire vehicles are reported to their respective companies and LTA; (b) if so, what is the data; (c) what is the proportion of cases of successful fare recovery; and (d) what measures, which should include improving the fare evasion reporting procedures to LTA, are in place to enhance assistance to drivers to recover their fares.
Mr S Iswaran59 words
[+1 sentence]This question was addressed in the written reply issued for Question No 42 for oral answer for the 4 October 2022 Parliament Sitting. [Please refer to "Trend of Fare Evasion by Private Hire Car Passengers", Official Report, 4 October 2022, Vol 95, Issue 70, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]