Amy Khor Lean Suan
Singapore
“Sir, NEA does conduct inspections of these premises from time to time. For this particular premises, they actually did six inspections since 2021.”
“The Land Transport Authority (LTA) conducts enforcement actions against drivers who are found to have provided illegal car-pooling services. An individual who provides an illegal car-pooling service may face a fine of up to $3,000, up to six months' imprisonment, or both.”
“We will also provide the first 500 private heavy vehicle chargers co-funding of up to 50% of the charger installation cost, capped at $30,000 per charger. These measures will narrow the lifecycle cost gap between an electric and internal combustion engine heavy vehicle and spur adoption of electric heavy vehicles.”
“With regard to the extension of the lower speed limit to school zones for full day, we will work with the relevant agencies on the enhanced enforcements.”
“They will provide a certain amount of protection to the pedestrians because, as I have said, the bollards will absorb the impact of the collision from the vehicles. So, there is a protection. But ultimately, of course, road safety really depends on a multitude of factors, including road user behaviour.”
“The bollards installed at pedestrian crossings by the Land Transport Authority (LTA) are not of the K4, K8 or K12 standards stated by the Member. Bollards of these standards are typically security bollards. They are installed to protect critical infrastructure or at high security areas, such as Changi Airport, to be unyielding.”
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“As I have said, I think what we want to do is to adopt a holistic approach and to tackle this upstream. So, by bringing forward the mandatory reporting of packaging waste and waste reduction plans, we are working on addressing the issue of excessive consumption of disposables, not just plastics, but all kinds of disposables. Currently, we do not plan to implement a charge on single-use plastics. But we will continue to monitor the effectiveness of various policies that are implemented overseas.”
“Certainly, this is something that we ought to consider.”
“As I have noted, we will not hesitate to implement legislation and policies where they are appropriate. So, we are bringing forward our mandatory packaging waste reporting and waste reduction plans, including for plastics, by a year.”
“In fact, a city like San Francisco, for instance, is now imposing a charge not just on single-use plastic bags, but all kinds of disposable bags, paper as well as plastics. We are monitoring this closely to see the effectiveness of the policy. Having said that, what is important is, we need to look at our local context, to adopt a rational and discerning approach to design policies suited to our unique needs and circumstances. In Singapore, for instance, the Singapore Environment Council (SEC) study, the recent survey, has shown that two-thirds of the respondents who take single-use plastic bags from supermarkets say that they use these bags to bag and dispose their garbage. In fact, many of us stay in high-rise apartments and we use plastic bags to bag and dispose of our garbage. It has taken us many years from the 1970s to get Singaporeans to do this. It is a key way for hygienic disposal of waste. Therefore, we cannot take this for granted. We need to carefully consider how imposing a mandatory charge on single-use plastics will impact on such behaviour. Secondly, we have proactive measures in place to tackle the harmful effects of plastics in the oceans and landfills, which are actually the subject of discussion by many other countries and internationally. We have a safe and efficient waste management and disposal system. All our plastic bags that are disposed properly will be incinerated. They do not go directly into the landfill. Even for those that may get into our waterways, we have measures in place – litter traps, for instance, and flotsam removal craft – to retrieve these bags before they go into the sea. Notwithstanding this, we recognise that plastic waste is a key waste stream.”
“On the first question relating to giving incentives to companies, as I have alluded to, we do provide support to companies that have initiatives to promote recycling, reduce the use of single use plastics and waste minimisation projects. So, an example would be the 3R Fund, which I have talked about that was launched in 2009. It is a co-funding scheme for companies. Since then, we have disbursed about $1.36 million for such projects and have diverted 11,000 tonnes of waste from the incineration plants. There are also other incentives to acknowledge companies who have put in effort to reduce packaging waste. There is the Singapore Packaging Agreement Award that we give out. This year, we have awarded Australian Fruit Juice (S) Pte Ltd because they have put in effort to reduce their packaging waste like reducing the packaging material for their 2-litre bottles. We also have the 3R awards for hotels and shopping malls to recognise their achievements. And there are other funds like the Call for Ideas Fund and the 3P Partnership Fund. We will continue to see and look into ways to support companies which promote waste minimisation and help us in our efforts to achieve a Zero Waste vision. Regarding the second question about plastic bag charge, as I have said earlier, the NEA lifecycle assessment study has shown that different types of disposables, whether it is single-use plastics or other types of bags, have an impact and cost on the environment, even biodegradable bags, because you need lots of water for production, for instance, or there will be forest destruction and greenhouse gas emissions in the process. What we are really looking at is how we can do this in a holistic manner.”
“For example, Kentucky Fried Chicken (KFC) has stopped providing plastic lids and straws for dine-in. Startups like UnPackt are also promoting packaging-free shopping by requiring customers to bring their own reusable containers for groceries. To support R&D in waste reduction, recycling and the recovery of valuable fractions, NEA has embarked on the Closing the Waste Loop Initiative. The Initiative encourages collaboration between institutes of higher learning, research institutes and private sector partners to develop technologies and solutions to tackle challenges in waste management. As part of the Initiative, NEA has solicited and is evaluating research proposals on the sustainable design of plastic materials, reducing the use of plastic materials and packaging, making plastics more reusable and easier to recycle, and recovering value from waste plastics. Ultimately, the issue of marine plastic litter and excessive use of single-use plastics will require everyone to play his or her part. This can be done by properly disposing of waste into litter bins and using reusable bags and containers, instead of disposables. Individuals can find information on other ways to reduce and reuse on our NEA website and the myENV mobile app.”
“Regarding single-use plastics, a recent NEA life-cycle assessment study found that available alternatives to plastics, including biodegradable bags, also have an environmental impact. For example, they consume water during production or they result in forest destruction. Substituting plastics with these alternatives is not likely to improve the environmental outcome. This is especially so in Singapore where we incinerate our waste instead of landfilling it. Our approach, thus, is focused on reducing the use of single-use plastics and packaging. To encourage businesses to minimise their contribution to plastic waste, my Ministry recently announced that the implementation of mandatory reporting of packaging data and packaging reduction plans will be brought forward by one year, to 2020. This will include single-use plastic packaging. We are also studying the feasibility of implementing an Extended Producer Responsibility framework for certain single-use packaging and plastics. We have already taken the lead by disallowing the use of disposables in our new hawker centres for dine-ins. NEA provides funding support to organisations with initiatives to reduce the use of single-use disposables or promote plastic recycling. These include the 3R Fund, 3P Partnership Fund or the Call for Ideas Fund. For instance, Zero Waste SG received funding for their Bring-Your-Own Campaign in 2017, where they partnered retailers to encourage consumers to use reusable containers, bottles and bags through educational tips, resources and incentives. We will continue to engage, educate and support businesses and the public in reducing the use of single-use plastics. The private sector has also taken steps to discourage the excessive consumption of single-use plastics.”
“Thank you. My Ministry takes the issue of marine plastic pollution seriously, and measures are in place to prevent marine pollution from land-based sources. For example, we have strict anti-littering measures and dispose of all general waste at our waste-to-energy plants. Any litter that enters our waterways is removed using litter traps and flotsam removal craft before it reaches the sea. Beach and underwater clean-ups are also conducted. However, tackling marine plastic pollution will require international and regional cooperation because of its transboundary nature. There has been positive momentum. The United Nations Sustainable Development Goal 14 emphasises the conservation and sustainable use of the oceans, seas and marine resources. Singapore actively participates in regional and global discussions to address marine litter and microplastics. Singapore also contributes to international capacity building efforts under the Singapore Cooperation Programme. Last October, the National Environment Agency (NEA) organised a joint Third Country Training Programme with Norway on waste management and reduction of marine litter for government officials from our region. Our only landfill at Semakau will run out of space by 2035 based on our current waste disposal trends. Waste, including single-use plastics, are already incinerated where possible as this reduces the volume of waste by up to 90%. To prolong the lifespan of Semakau Landfill, my Ministry has been developing measures that address the entire waste value chain and across different waste streams by encouraging businesses and producers to reduce waste and recycle, engaging and partnering the public and private sector and supporting research and development (R&D).”
“Yes, I think for top-ups, there are already some tax incentives, but it is accrued to the recipients. But we note the Member's point.”
“As I said earlier in my speech, yes, we could have designed it based on equal premiums but, as I have noted, I think we feel that, on balance, it is more prudent to do gender differentiation because of the concern about adverse selection and the unsustainability of the scheme. But we will continue to explore ways to look at how we can help women who face difficulties. We appreciate this fact. Regarding the missed opportunity, I do not think so. Besides having equal premiums, the fact is that family members, men, spouse or any loved ones, could already help the women with their premium payments by topping up their MediSave or using their MediSave to pay. So, in fact, it is a very good opportunity to promote strong family values and support through the scheme.”
“We note the issue about women having less savings, MediSave and so on. We think that it is prudent to determine the premiums correctly and then look at different ways to help the women. First of all, our means-tested premium subsidies actually already provide a higher quantum of subsidies for women because it is based on a percentage of premiums payable. In addition, at the end of the day, anyone who is not able to pay for their premiums if they opt in to CareShield Life or they are in the mandatory cohort, the Government will assist with Additional Premium Support. So, no one would lose coverage because of financial difficulties. In addition to that, of course, actually, for women, because they are more likely to become severely disabled as a result of longer lifespan, it means that, as I said earlier, those who claim are likely to claim for a longer period, too. In MediShield Life, for instance, women actually pay premiums, on average, for a longer period because they have a longer lifespan. Of course, then they are covered over their longer lifespan. Regarding the other point, sorry, what was it that the Member was asking me? Can the Member remind me again?”
“Indeed, as I have said, it is not an easy decision to make for the ESRC and, obviously, for us. So, when we made our decision, it must be on the principle that the scheme will be sustainable in the long term. I think that it is very important to ensure that the scheme is sustainable. So, let me explain. At the start of the scheme – when we implement it – CareShield Life is mandatory for future cohorts, but for existing cohorts, based on the various reasons that I have provided, the decision was that it will not be mandatory, but we would want to encourage as many as possible to come on the scheme. So, at the start of the scheme in 2020, for instance, in the first few years, the existing cohort is definitely much larger than the mandatory cohort. There is a potential for up to two million policyholders to be in the CareShield Life scheme for the existing cohort whereas, for the mandatory cohort, for the first 11 batches, the estimate is about 600,000. So, if we do not determine the premiums on an actuarially correct basis, what it means is that there is likely to be some adverse selection. Currently, ElderShield premiums are already gender-differentiated. So, the men actually pay less than women for the same age group and income level. And if we equalise the CareShield Life premiums, they would know that they are paying more than what is actuarially determined. So, some may feel that they would not want to join the scheme and there would be dropouts. In addition, private insurers may also offer lower premiums for men based on gender differentiation, and that would mean that more would opt out of the CareShield Life scheme and, at the end of the day, it could be unsustainable. So, I think what we want to do is to make sure that it is actuarially correctly determined.”
“This ensures cognitively impaired policyholders with higher care needs will more consistently qualify for claims. Mr Deputy Speaker, to conclude, let me affirm the Government’s commitment to invest in a strong aged-care system anchored by home and community care as well as communities of care supported by fellow Singaporeans. CareShield Life, MediSave withdrawals for long-term care and ElderFund complement our efforts to build an inclusive and caring home for all of us as we age. Mr Deputy Speaker, I support the Motion.”
“I want to, first, clarify that those with cognitive impairments and are unable to perform three or more ADLs are already able to benefit from ElderShield today. Under today’s assessment framework, assessors are already supposed to take into account how cognitive impairments impact the policyholder’s ability to perform the ADLs. Many policyholders with severe dementia are already able to make ElderShield claims today. One policyholder who benefited from ElderShield is 77-year-old Mdm Leong. Mdm Leong has late-stage dementia which impacts her ability to perform ADLs independently. Although Mdm Leong is physically able to eat and walk, she is unable to recall the way to specific places, such as the toilet, or express her needs. Mdm Leong has been able to receive ElderShield payouts for the last two years, which have helped the family with the costs of medicine. Nevertheless, the Committee heard feedback that it is not clear how ElderShield assessors should take into account the impact of an individual’s cognitive impairment on his ability to physically perform the ADLs. This can lead to inconsistent claim outcomes for ElderShield policyholders with cognitive impairments. We, therefore, accept the Committee’s recommendations to improve the disability assessment framework to provide clear guidance for disability assessors to consider policyholders’ ability to initiate a task, plan and, finally, complete an ADL effectively and safely. For instance, in the current assessment framework, the assessor may only evaluate solely whether a policyholder with severe dementia can execute the physical actions, such as threading their arms through sleeves. With the improvement to the assessment framework, assessors may also evaluate their ability to do so without being prompted to.”
“The Committee had put in a lot of effort to understand the current ElderShield claims process and developed a good set of recommendations to improve the claims process. Under CareShield Life, policyholders and their caregivers can expect a claims process that is easier to navigate. Today, in order to be assessed for ElderShield claims, policyholders will need to see an appointed ElderShield assessor, who will complete the ElderShield disability assessment for them. There are currently 127 assessors, 13 of whom can provide home assessments. For CareShield Life, we will not require policyholders to arrange for a separate disability assessment, if an equivalent disability assessment had already been done for them by their doctor, therapist or nurse in the course of receiving care in a health or long-term care setting. For those who need a separate disability assessment, we will expand the pool of assessors beyond doctors to include occupational therapists, physiotherapists and nurses. This will make it more convenient to go for an assessment. Ms K Thanaletchimi suggested the assessment fee be waived for the cognitively impaired. The Government will waive the first assessment fee for all policyholders, regardless of whether the claim is successful, so that the fee does not deter eligible policyholders, especially the lower-income, from making a claim. Subsequent assessment fees will be reimbursed if the claim is successful. Ms Joan Pereira’s suggestion for proper communication to policyholders who make a recovery is also well-noted, and we will certainly follow through on it. Ms K Thanaletchimi and Mr Murali Pillai asked how we can help seniors who are cognitively impaired, for instance, with dementia, benefit from CareShield Life.”
“The Government also currently provides subsidies of up to 80% for home and community care services. This is also why we designed the two new enhancements that Minister Gan announced – MediSave withdrawals for long-term care and ElderFund – to also pay out in cash. Mr Saktiandi Supaat asked what safeguards will be put in place to ensure cash payouts will be spent on the care of severely disabled individuals, especially those suffering from dementia. We recognise that severely disabled individuals may be more susceptible to exploitation, especially if they lose mental capacity. We will design the three schemes’ claims processes carefully, and put in place checks and audits to ensure that payouts are used for the care needs of the claimant. We will do this in a way that does not inconvenience the claimant or his caregivers. It is also useful for all of us to make a Lasting Power of Attorney (LPA) early and choose our donee carefully, as Ms K Thanaletchimi pointed out. We should appoint someone we trust to act in our best interests should we lose the capacity to make decisions. Finally, CareShield Life will provide a better claims experience. As at end of 2017, 15,600 policyholders have made ElderShield claims and benefited from the scheme. Some of these policyholders and their families or care providers have provided feedback that the current ElderShield claims process is confusing. Mr Melvin Yong asked how we will ensure that severely disabled policyholders and their caregivers navigate the claims process more easily. We wholeheartedly support the recommendations by the Committee to improve the claims process for CareShield Life.”
“Some will ask why this is a different approach from MediShield Life. MediShield Life premiums are payable for as long as a policyholder lives. While women may make more claims since they live longer, they would also have paid more years of MediShield Life premiums compared to men. On the other hand, CareShield Life premiums are only paid until the age of 67, although policyholders are covered for the rest of their lives. Second, CareShield Life provides flexibility to age in place. In enhancing our long-term care financing system, it is also important to bear in mind that Singaporeans have different needs and preferences for their long-term care, and the majority prefer to age at home and in the community. Similar to ElderShield, the Committee had recommended CareShield Life to provide cash payouts instead of using CareShield Life to reimburse the use of specific long-term care services. We support the Committee’s recommendation. Let me explain. Reimbursement of specific long-term care services may, at first glance, provide more reassurance to claimants and their caregivers, as the reimbursements would be pegged to the costs of the services. However, cash payouts will provide claimants and their caregivers more flexibility to decide on care arrangements appropriate to their needs and do not limit care to certain long-term care services in order to be eligible for claim. This design also recognises that long-term care needs might extend beyond medical needs and will better support policyholders who choose informal care at home or in the community instead of formal care services. Cash payouts also support our overall efforts to go Beyond Hospital To Community, to support care in the community and allow more seniors to be cared for at home.”
“The Government accepts the Committee’s recommendations, though I must assure this House that the Ministry, not just myself, but my other colleagues, similarly had great difficulty in coming to this decision. It was not an easy decision. Some may ask why should we differentiate premiums between men and women if we say CareShield Life is an inclusive scheme? While we have designed CareShield Life to be inclusive, on balance, it is also important for the scheme to be equitable and sustainable and avoid adverse selection. To that end, premiums must be actuarially sound. The Government will address the issue of affordability directly. In line with the progressive design of our healthcare financing system, the Government's premium subsidies for CareShield Life are means-tested, with the quantum of support based on a percentage of premiums. This also means lower- and middle-income females will receive larger dollar quantum of Government subsidies, compared to the men in their age cohort with the same income levels. And in line with our effort to promote strong family values, care and support, immediate family members, such as their spouse, can also help pay for their premiums with their MediSave, or top-up their MediSave with cash to help them pay for the premiums. The Government will also provide Additional Premium Support for those with less financial means, so that no one will lose coverage due to financial difficulties. Overall, this design will support the sustainability of CareShield Life, while ensuring that premiums remain affordable for all Singaporeans, regardless of gender. We will continue to explore how to give more help to women who face difficulties but, on balance, it is more prudent to keep the scheme actuarially correct and fair.”
“At the older ages, when disability is likely to take place, women are also more likely to remain in disability for a longer time than men and, hence, will draw on CareShield Life payouts for a longer period should they become severely disabled. Based on a longitudinal survey of older Singaporeans in 2009 and 2011 to 2012, researchers estimated women aged 60 are expected to spend 7.8 years requiring assistance with any of the ADLs by the end of their lives, compared to 2.6 years for men aged 60. Other countries, like the US, found similar gender-differentiated disability trends. In a longitudinal study of US men and women between 1982 and 2011, researchers estimated women aged 65 in 2011 are expected to spend about six years requiring assistance with ADLs by the end of their lives, compared to about three-and-a-half years for men aged 65 in 2011. Two-thirds of long-term insurance claims benefits paid out in 2012 went towards females. It is, of course, possible to have a scheme where men and women pay the same premiums. The Committee did consider that women have less savings on average and could, therefore, be better supported by the men. However, on balance, the Committee decided that applying gender-differentiated premiums for CareShield Life would more accurately reflect the differences in risk between men and women and result in a more actuarially fair and sustainable scheme. While CareShield Life is compulsory for future cohorts, it must be noted that it is not compulsory for existing cohorts. So, there will be adverse selection. Hence, it is better to be actuarially fair and correct. The Committee emphasised, however, the need to provide premium support for lower-income and middle-income policyholders.”
“Mr Saktiandi Supaat asked whether the payout amounts for these new initiatives are enough. I would like to clarify that these initiatives are designed to complement other existing Government subsidies and funding schemes, such as the Seniors’ Mobility and Enabling Fund and PG Disability Assistance Scheme (PioneerDAS), as well as our other safety nets, including MediFund and ComCare, to help Singaporeans afford their long-term care costs. They should not be seen in isolation. Nevertheless, Ms Thanaletchimi, Mr Saktiandi Supaat and Ms Tin Pei Ling should rest assured that the Government will continue to review our financing policies to keep healthcare and long-term care affordable for all Singaporeans. Many members, like Dr Chia Shi-Lu, Ms Sylvia Lim, Assoc Prof Daniel Goh, Mr Melvin Yong and Ms Tin Pei Ling, have also asked why CareShield Life premiums have to be gender differentiated. The ESRC had debated this topic extensively and it was not an easy decision to make. Women live longer than men and are, therefore, more likely to spend more years in severe disability, as all of us are more likely to become severely disabled at the older ages. Let me share some statistics. In 2017, the average life expectancy at birth for women is 85.2 years, as compared to 80.7 years for men. Minister Gan had earlier shared that one in two Singaporeans at the age of 65 are expected to become severely disabled by the end of their lives. Breaking this down by gender, using the same statistics, three in five healthy women at age 65 are expected to become severely disabled by the end of their lives, compared to two in five healthy men at age 65.”
“These incentives will help to shoulder a significant part of the costs of including those in the existing cohorts with pre-existing medical conditions or mild disabilities. This is on top of the premium subsidies we are providing to lower- and middle-income policyholders. After the first two years, underwriting will be tightened such that those in the existing cohorts assessed to be unable to do any of the ADLs will not be able to join to minimise adverse selection and moral hazard so that the scheme remains sustainable and fair for all policyholders. For ElderShield policyholders who do not wish to join CareShield Life, they will continue to be protected by their current ElderShield policies. Dr Lily Neo and Ms K Thanaletchimi asked how would those who are already severely disabled in the existing cohorts be helped, if they are unable to join CareShield Life? Mr Zainal Sapari and Er Dr Lee Bee Wah also asked for the actuarial considerations and premium impact, if we were to include those with pre-existing severe disabilities in the existing cohorts from CareShield Life. The proportion of Singaporeans who are severely disabled at the older ages is much higher – about 7% of Singaporeans aged 65 and above today are severely disabled, compared to less than 0.1% of Singaporeans aged between 30 and 40. Including the severely disabled from existing cohorts in CareShield Life would significantly increase premiums by about 30% for the rest of policyholders in these cohorts. The Government will support Singaporeans from existing cohorts who are already severely disabled and unable to join CareShield Life through other measures, including MediSave and ElderFund. These are initiatives that Minister Gan spoke about earlier.”
“This means that CareShield Life premiums are heavily prefunded. Older Singaporeans from the existing cohorts would, therefore, need to pay significantly higher annual premiums under CareShield Life, as they would have fewer years to spread out their premiums needed to support the benefits under CareShield Life. Some Singaporeans in existing cohorts have also previously made decisions about their ElderShield coverage when they were auto-enrolled at age 40, as Mr Png Eng Huat had also shared earlier. When ElderShield was launched in 2002, 38% of Singaporeans who were auto-enrolled opted out. While the opt-out rate has dropped to 5% in 2017, about one in four people in the existing cohorts have opted out of ElderShield. Others may also have made plans for their long-term care needs. As of 2017, about one-third of ElderShield policyholders have bought ElderShield Supplements from the ElderShield insurers. Taking into account these considerations, the Committee recommended that it would not be practical to make CareShield Life mandatory for these individuals. However, the scheme should remain open for them to join, if they are not already severely disabled. I want to assure Members that CareShield Life will still be an inclusive scheme for existing cohorts. Ms Chia Yong Yong asked about the treatment for Singaporeans in existing cohorts who want to join CareShield Life. Singaporeans in existing cohorts can join the scheme as long as they are not severely disabled or able to perform at least three ADLs, even if they have medical conditions, such as diabetes or hypertension. This is consistent with our inclusive vision for CareShield Life. The Government will provide participation incentives to encourage existing cohorts to join CareShield Life within the first two years.”
“The premium amount is less than the first monthly CareShield Life payout they will receive. An individual who will benefit is 36-year-old Mr Mohamed Hasan, who has cerebral palsy and is physically unable to perform all ADLs. As he will be part of the future cohorts to be enrolled in 2020, he will be able to receive CareShield Life payouts from 2020 for as long as he remains severely disabled. Mr Gan Thiam Poh and Mr Ang Wei Neng asked how many Singaporeans in the future cohorts have severe disability. The prevalence of severe disability at younger ages is low. Only a very small proportion, less than 0.1%, of the future cohorts aged 30 to 40 may already be severely disabled when they first join CareShield Life. The Government will inject $100 million into the CareShield Life insurance fund to cover a significant portion of the costs of including Singaporeans in the future cohorts with pre-existing disabilities. The remainder of the costs will be socialised across all CareShield Life policyholders in the future cohorts, with everyone playing our part to support fellow Singaporeans in need. This is in line with our vision of an inclusive and caring society. During public consultations, the ESRC also found support for this among Singaporeans. Ms K Thanaletchimi and Mr Zainal Sapari asked why CareShield Life is not universal and mandatory for Singaporeans from existing cohorts, since CareShield Life provides better protection and greater assurance than ElderShield. The Committee had considered this during their review, and decided this was not feasible, given the nature of CareShield Life as a prefunded insurance scheme. Unlike MediShield Life where premiums are paid for life, CareShield Life premiums are paid till age 67 even though it provides lifetime coverage.”
“These plans typically only provide coverage during one's working years, up to age 60 to 70, as they are meant to insure against loss of income. This means that in our old age, when we are most likely to become severely disabled and need long-term care, we will no longer be covered by these plans. On the other hand, CareShield Life will provide coverage for life. There are different views among Members about what age should Singaporeans be enrolled into CareShield Life. Mr Gan Thiam Poh suggested 21, Mr Ang Wei Neng suggested 40. The ESRC likewise received a range of suggestions. We agree with their recommendation to start at 30, and we understand that this was an age that many youths engaged by the Committee felt would be reasonable. At 30, most feel that they would have started working and managed to build up some savings in their MediSave. Starting at 30 instead of 40 also means they have more years to spread their premium payments, which makes their annual premiums more manageable. The Government will provide means-tested premium subsidies and transitional subsidies to ensure that premiums are affordable, particularly for the lower-income. We will also provide Additional Premium Support for those who are unable to afford their premiums even after subsidies, so that no one loses coverage due to financial difficulties. Including those with pre-existing disabilities in future cohorts in our national long-term care insurance scheme is part of our collective responsibility and is fundamental to our inclusive and caring society. Individuals in future cohorts with any pre-existing disabilities will only need to pay the first-year premium to join CareShield Life, and, thereafter, will be able to benefit from the payouts, as long as they remain severely disabled.”
“The ESRC made many good recommendations, and I am optimistic that these enhancements will provide better protection and assurance for Singaporeans to age actively and well in the community. Let me speak on three key aspects of the new scheme. First, the new CareShield Life will be an inclusive scheme. For future cohorts, CareShield Life is not just an insurance scheme, but will be an important part of our social safety net. It will provide universal coverage for all future cohorts of Singaporeans born in 1980 or later, regardless of financial, health or disability status. This means that all Singaporeans in these cohorts will have basic protection for their long-term care should they become severely disabled. Mr Gan Thiam Poh, Ms Jessica Tan, Mr Saktiandi Supaat, Mr Ang Wei Neng have asked why CareShield Life is not optional for future cohorts, given that some young Singaporeans might already have bought their own policies. Including all future cohorts allows us to maximise the size of the risk pool, which keeps premiums affordable and the scheme sustainable. If the scheme is optional, those with pre-existing disabilities cannot be covered, as healthy Singaporeans would be more likely to opt out of the scheme. Over time, the risk-pool would worsen and the scheme would become unsustainable. Other vulnerable groups like the low-income may also drop out of the scheme because of an inability to pay. As CareShield Life provides payouts in cash, they would not duplicate existing policies that Singaporeans may already have purchased. There is also a misperception that private disability insurance products, such as total and permanent disability plans or disability income replacement plans, provide similar coverage to CareShield Life.”
“We are building communities of care through the Community Networks for Seniors (CNS) programme to help seniors age well in the community through preventive health and active ageing programmes and the integration of social and healthcare support for frail seniors with complex health and social needs. With the new Silver Generation Office (SGO) under AIC, MOH can better serve our seniors’ needs in a holistic manner, with support from over 3,000 Silver Generation Ambassadors. Mr Gan Thiam Poh suggested recruiting Ambassadors to explain the enhancements to residents. We will definitely leverage SGO’s outreach capabilities to reach out to seniors, explain how these new enhancements help support their long-term care needs and direct them to relevant financial assistance. Residents will find the Ambassadors a familiar face as they had also helped many seniors understand the PG Package, MedShield Life and many other assistance schemes. Fourth, the Government will continue to support the needs of Singaporeans with ageing-related cognitive conditions and their caregivers under the Community Mental Health Masterplan. For instance, we have established six Dementia Friendly Communities to increase the awareness of dementia in these communities so that persons with dementia and their families feel included and supported to continue living at home. We aim to have 15 such Communities by 2021. While we continue to improve our service capacity and quality and grow community networks to better support our elderly, we must also ensure that Singaporeans plan ahead and are able to financially cope with their long-term care needs. Minister Gan has outlined our long-term care financing philosophy and the role that insurance plays, together with family and Government support.”
“Mr Deputy Speaker, to support the needs of our ageing population, we need to approach the issue comprehensively. Besides financing, we should also invest in aged care service capacity, enhance care quality, and build communities of care and a strong social support system. In particular, Dr Lily Neo and Mr Ang Wei Neng asked how the Government is improving the long-term care infrastructure to help severely disabled seniors age and receive good home care. Let me elaborate on some of these efforts. First, we have grown our aged care capacity significantly. We are on track to achieve 10,000 home care places and 6,200 day centre places by 2020. For seniors who may need institutional care, we have added 1,200 community hospital beds and 5,300 nursing home beds since 2011. We have also grown our healthcare workforce by about 36% since 2011. We will continue to expand the range of home and community care options and pilot new models of care, such as the Integrated Home and Day Care (IHDC) packages rolled out in 2016, which help to provide frail seniors with home and day care services that cater to their unique needs. In fact, by 2020, we hope to provide 90% of seniors with access to an eldercare centre within a one-kilometre radius from their homes. Second, we will also invest in improving service quality. We have progressively raised care standards, such as introducing the Enhanced Nursing Home Standards (ENHS) to ensure residents receive safe and good care. We have also introduced developmental service guidelines as a reference for home and centre-based providers to work towards delivering good quality care for our seniors. Third, we are integrating social and healthcare support to better meet the needs of our elderly in their communities.”
“As The Economist article highlights, the "caring economy" disproportionately affects women because they make up the majority of caregivers, which also negatively impacts gender parity. FWAs, such as flexi work hours, work from home arrangements, or part-time work would better allow caregivers to remain in the workforce. Besides providing funding support and the Tripartite Standard on FWAs, moving forward, we could, adopting a tripartite approach and help companies who may not have the know-how to implement FWAs to do so. Over the years, we have been increasing support for caregivers, such as expanding day care and home care capacity, providing caregiver training grant and training, respite care and elder sitter service for dementia patients. Nonetheless, as our population ages and caregiving needs increase, we must look at more ways to better support caregivers. Mr Speaker, Sir, we have made some progress, but we must press on in creating and sustaining an inclusive workplace, so that work opportunities are maximised for everyone who are able and willing to work; and that no Singaporean, young or old, woman or man, is left behind. Policymakers can continue to roll out initiatives to foster and support such an environment but creating a truly inclusive workplace would require individuals and companies – shareholder, management and staff – changing within themselves in terms of mindsets and prejudices and changing their corporate culture. Sir, with this I support the Motion. 2.24 pm”
“Today, more than 100 wards across the public healthcare institutions have adopted FWAs for nurses, in the form of more flexible shift work hours. This helps them to avoid the binary option of either being employed or unemployed. To further scale up FWA adoption for nurses, the public healthcare institutions will progressively move to electronic rostering, or e-rostering, starting from the second half of 2018. This shift will help to support nurse managers in managing more complex shift rostering of staff and empower them to support FWAs in a bigger way. Globally, gender pay gap persists, including in Singapore, although we rank relatively well even among the Organization for Economic Cooperation and Development (OECD) countries, ahead of countries like Australia and the UK. A reason often attributed to this pay gap is men's greater share of senior jobs as more women drop out of the workforce due to family care-giving duties. An article in The Economist noted that men’s and women's salaries start diverging from the child-bearing years. This "motherhood penalty" is often followed by a "good daughter penalty" when elderly parents require care and daughters often prove more conscientious than sons. So, here, I am tempted to note that the men just do not get it! Quoting figures from the UK's Office of National Statistics, the median pay gap is only 2% among full-time workers in their 30s yet jumps to 14% in their 40s and 16% in their 50s. As our population ages, a so called "caring economy" is emerging. The need to provide care to the elderly can have a significant impact on the workforce. Working caregivers must often take time off or leave the workforce altogether.”
“The course commences in July this year, with an estimated inaugural cohort of about 40 mid-career trainees. We are also working with WSG and e2i on programmes to facilitate employment and transition of mature workers, especially professionals, managers, executives and technicians (PMETs) who may be displaced due to restructuring in other industries, into suitable roles in the healthcare sector. Older workers as a segment of the workforce do not represent a monolithic group. They are of differing ages, educational backgrounds and circumstances. While some work simply because they want to remain gainfully employed, others, like Minister Ng Chee Meng said yesterday, need to work as they have expenses, mortgages and dependents relying on them. Hence, I support Minister Ng's idea of forming a new Tripartite Committee to take a closer and perhaps more granular look at ways to support mature workers to continue working if they choose to. Secondly, we must step up flexible work arrangements to cater to Singaporeans with different needs, especially women. Singaporeans in different life segments and at different life stages have varying needs in their careers. Those starting a family or looking after their elderly parents or grandchildren may be looking to balance their work with family commitments. Many women ask for this support in flexible work arrangements (FWAs) and actually the men too. Adopting FWAs will help us better cater to the needs of our healthcare workforce at different life stages, and retain them in the workforce, especially our women and older workers, for a win-win. For instance, we have piloted FWAs for nurses, who are the largest staff group in the public healthcare sector. We have engaged nurses, and we know that this is important for many of them.”
“We are also automating some labour-intensive care activities such as lifting and transferring of patients using mobile hoists and bed transporters. This will reduce the strain on older workers and allow them to continue in their roles. For those who wish to take on part-time or smaller, bite-sized roles, we have also been working with our partners to increase the number of micro-jobs. For example, several of our public hospitals have created Basic Care Assistant (BCA) positions, where locals with no prior healthcare experience are trained to provide care in areas such as feeding and patient transfer in the wards on a part-time basis. For mature workers looking to switch careers, we provide multiple pathways and training to facilitate picking up of new skills to join us in our care transformation journey. In 2017, we supported about 150 mid-career locals through healthcare conversion programmes, such as the Professional Conversion Programmes (PCPs) and the Senior Management Associate Scheme (SMAS), to help individuals acquire skills and take on good jobs in healthcare in a variety of roles such as Nursing, Allied Health and Administration. And this is triple the number compared to three years ago. We enhanced the PCP for nursing by providing employers with more funding to support the training of mid-career nurses. Earlier this year, MOH together with the National University of Singapore (NUS) and Workforce Singapore (WSG) also introduced a new degree-level PCP-Registered Nurses (PCP-RN) to attract more mid-career Singaporeans into the nursing profession. This PCP will complement the current PCP-RN diploma programme at Nanyang Polytechnic and provide an additional pathway for mid-career conversion into nursing.”
“The good news is that our healthy life expectancy is also increasing, with people staying healthier for longer, and there is also an opportunity to better leverage the abilities of those over 60, by adjusting workplace policies and redefining what “retirement” means. Seizing opportunities arising from productive longevity is, therefore, crucial to Singapore’s success as a nation and it is a key priority. Extending working life and promoting senior entrepreneurship are increasingly perceived as economic drivers. Fostering both can enable older people to leverage their institutional knowledge, wisdom and insights to continue contributing positively to the community and economy. For existing healthcare workers who wish to continue in their current roles, we facilitate their re-employment through strategies such as job re-design, training and re-employment facilitation workshops. Today, nine in 10 staff at retirement age are re-employed. The public healthcare sector raised the re-employment age for staff before legislation kicked in, from 65 to 67 since July 2016. In the case of nurses, who form the bulk of the healthcare workforce and where we most need manpower, we have also seen an increase in the number of nurses working past the retirement age. In 2017, over 1,400 retired nurses aged above 62 were working, compared to 1,200 in 2015, and 20% percent of them are working part-time. This flexibility supports older nurses so that they can continue to contribute at a pace that they are comfortable with. Our public healthcare institutions have also implemented workplace initiatives such as elder-friendly features like placing a magnifying glass on medication carts, and larger fonts for signages.”
“This way, they can age positively. While some seniors will want to retire to spend time with their grandchildren and hobbies, some will find purpose in continuing their current roles, and others may wish to take smaller, bite-size roles. Some mature workers are also in transition between careers and welcome opportunities in the care sector. We will need to cater to their different wants to keep them integrated in society while playing a meaningful role. Mr Francis Tan of UOB recently pointed out that this year, 2018, is the first year in our history when the share of the population that is 65 years old and above will match that of those younger than 15 years old. Globally, the trend is also accelerating elsewhere. The World Economic Forum points out that by 2020, the global population of those over 60 years of age will reach one billion. By 2050, it is expected to reach two billion. This trend, combined with a general decline in birth rates, is leading to a situation where the world’s old will outnumber the young. This is not just a statistical quirk, but a demographic result of great significance. The consequence of ageing is well documented. Oxford Economics and Haver Analytics posit that there will be sharp deceleration and, indeed, negative labour supply growth, and Singapore could be among the worst hit in terms of its impact on economic growth. However, in Singapore, as Minister Chan Chun Sing said on Monday, we should not let challenges define us. Instead, we should see ageing as an opportunity to do things differently, or as Mr Ravi Menon, Managing Director of the Monetary Authority of Singapore, puts it, “Demographics is not destiny”.”
“Sir, the President spoke eloquently of five thrusts for the Government moving into the future, one of which was to forge a caring and inclusive society, leaving no Singaporean behind. Two approaches to achieve this are: first, tackling inequality by providing the right support to those who need it, such as in skills training and employment; and second, rolling out policies for the growing elderly population, such as helping older workers stay employed. I speak in support of this with special focus on older workers and, especially, baby boomers, and women at the workplace. Let me first declare that I belong to the baby-boomer generation and am, therefore, happily classified as an elderly, plus I am a woman. One barometer of an inclusive society is having an inclusive workplace. This means helping different groups of Singaporeans who are able and willing to work, to stay employed and find fulfilment, even as circumstances change. An inclusive workplace is not an automatic nor easy outcome. But there are concrete ways the Government and our partners can work towards in order to create and sustain it, such as being inclusive in helping mature workers and being inclusive in creating flexible work arrangements, which is especially helpful for women. Indeed, these are precisely the outcomes that the Ministry of Health (MOH) is working towards, together with our healthcare institutions, for a diverse healthcare workforce, as we expect to increase our healthcare manpower by a further 9,000 between 2017 and 2019 to staff new and expanding facilities in our public healthcare and aged care settings. We need to help our mature workers, including the baby boomers who are now entering the retirement phase of their lives, by keeping them active and connected to society.”
“With regard to dual chutes, HDB's study in 2012 showed that blocks with dual chutes system, that means, one for waste and one for recyclables, actually contribute up to three times more recyclables than the blocks without those chutes. Because of this, HDB has implemented the dual chutes system for all the BTO flats launched from 2014, and we are requiring private non-landed residential developments above four storeys to also have this dual chute system from 1 April. The Member is right that if you throw recyclables into the chute, depending on where they land, glass bottles, for instance, might be broken. But this will not affect the recovery of the other commingled recyclables at MRF. Actually, even for glass pieces, particularly for the larger pieces, they can be recovered for recycling.”
“I thank the Member for her supplementary questions. Regarding the commingled recycling bin, our approach to encouraging recycling by households is to try and make it as convenient as possible for them to recycle and, of course, to raise awareness about recycling. The blue commingled recycling bin is placed at every HDB block and provided to every private landed residential home. That is really for ease of access. First of all, they do not need to invest extra effort and time in segregating the different recyclables. They also do not need to make space at home for the different recyclables because they can just deposit the recyclables in the blue bins anytime. These recyclables will be taken to the materials recovery facility (MRF) where the recyclables will be segregated and brought to the relevant recycling plants for processing. Regarding the contamination of recyclables that the Member alluded to for the blue commingled recycling bin, yes, there is contamination of recyclables if they deposit food waste or non-recyclables in the bin. The contamination rate is about 40% on average. In this area, what we want to do is to appeal to the public to be gracious and not deposit the non-recyclables in the bins, particularly if it is food waste. When it contaminates the recyclables, you waste people's effort in wanting to do their part for the environment. What we will also do is to work with stakeholders on the ground, for instance, the Town Councils, to make sure that there are sufficient waste bins around. We are also looking into putting up more prominent labels on the blue recycling bins to tell them "no food and liquid waste” in the recycling bins, and we hope that Singaporeans will be more gracious.”
“I thank the Member for her supplementary questions. Indeed, I think this is a very important issue, in particular, due to our ageing population. The uptake of counselling services is not specifically tracked because it is delivered as part of palliative care. Upon admission into palliative care services, the patients and the family members will be made aware of the counselling services available as part of the holistic assessment in recognition of the patients' and the families' needs. This would include their physical, psychosocial as well as their pastoral needs. For instance, at St Joseph's Home, counselling actually begins at the point of referral of a patient and the family members into palliative care. The multidisciplinary team, which comprises the consultants, nurses as well as social care staff will engage the patient as well as the family members in conversations on advance care planning, EOL preferences, coping with grief and so on. Counselling usually happens as a natural conversation and is a work-in-progress in that sense. It is an ongoing process as part of palliative care. In terms of promoting the awareness about EOL issues and palliative care services, MOH continues to work with SHC as well as various community partners and providers. For instance, we work with SHC on a community engagement programme. We have a three-year partnership with them from 2017 to 2019 on this community engagement programme to raise awareness among the public about palliative care services as well as EOL issues. We will continue to do so and extend this outreach in terms of raising awareness and also, improving the quality of EOL care and extend this to psychosocial support. That will include supportive counselling of patients and their family members.”
“Palliative care providers have multidisciplinary care teams that support patients on palliative care services and their family members. These teams comprise staff with experience in counselling, such as medical social workers, counsellors or pastoral care staff. The care teams will keep in close touch with family members, assess their needs and provide the necessary support for the patient and the family. This includes support to help family members cope with caregiving and grief management, as well as bereavement care after the patient's passing. Care teams may also link up families with other support organisations and resources. The Ministry of Health (MOH) has been working with community partners to promote public awareness about palliative care and End-of-Life (EOL) conversations. For example, in conjunction with World Hospice and Palliative Care Day, the Singapore Hospice Council (SHC) held an inaugural community engagement event in October last year to raise public awareness on the topic. We will continue to work with our community partners on such public outreach and education efforts.”
“Sir, the answer is that we will continue to review and make sure that the pay remains competitive.”
“For the non-practising nurses, in fact, we have enhanced our Return-to-Nursing programme. What we have done is to change this into a Place-and-Train programme, so that the nurses who are coming back will be placed first before they go for training, refresher course. So, they will be paid a salary instead of an allowance. Over the last two years, we have been able to get about 25 non-practising nurses back into practice in the community care sector. We are doing as much as we can to encourage the non-practising nurses to come back into the sector, particularly in the community care sector. For new entrants, staff nurses, diploma and graduate nurses, basically, our public healthcare institutions are paying our nurses or healthcare professionals on a performance basis, not just based on qualifications. But for new entrants, that is, people who have very little or no working experience, academic qualifications will be used as a basis. For degree graduates, they have gone through at least six years of post-secondary education. When they join the profession, they are paid at the Staff Nurse Grade I level, simply because they have gone through a longer period of training and they would have attained deeper skills to kick off, as well as the fact that when they are employed, they would likely be assuming a wider breadth or scope of duties. For diploma graduates, their post-secondary education is around three years. They will be able to start work after that and they would then have the same opportunities as the graduate nurses to progress in their career. In fact, after they join, both diploma and degree graduates will be assessed based on their performance, as well as any additional specialised skills that they would have gotten in the in-service training.”
“For gestational diabetes (GDM), MOH announced last year that we will undertake routine screening and make it available for all pregnant women under the care of the public hospitals with maternity services. Since the introduction of this policy in March last year, over 12,000 pregnant women have been screened at our three public healthcare institutions – KK Women’s and Children’s Hospital (KKH), SGH and NUH. About one in five pregnant women screened over the past year was found to have GDM. So, MOH has been reviewing relevant considerations pertaining to the management of GDM and longer-term post-delivery management. We will be issuing an appropriate care guide later this year to better support primary care doctors who are involved in the care of women with GDM post-delivery.”
“I want to thank Dr Lily Neo for her question and let me apologise that I was not able to reply to the cut due to lack of time for my other colleagues. So, let me just give a reply. First of all, indeed, as Dr Lily Neo had said, early detection facilitates prompt treatment and, in fact, it is key to improving the health outcomes of women diagnosed with breast cancer. I am pleased to say that the percentage of early stage breast cancer diagnosed has actually increased from 70.9% in the period 2003 to 2007, to 72.4% in the period from 2012 to 2016. In addition, there was a significant increase in a five-year observed survival of breast cancer patients from 66% in the period 2003 to 2007, to 71% in 2012 to 2016. I think this is likely due to improvements in treatment, as Dr Lily Neo had alluded to. As regards access to breast cancer screening, HPB's Screen for Life currently offers subsidised screening programme at participating polyclinics to women aged 50 and above, and close to 43,300 women have benefited from this programme last year. In addition, HPB collaborates with partners like Singapore Cancer Society, as well as Breast Cancer Foundation. These partners provide full sponsorship of screening programmes for lower-income women, such as CHAS cardholders, so that they do not even have to pay $50 to get screening. This year, to increase the number of women screened, HPB will work with the National Healthcare Group Diagnostics, as well as the community partners and healthcare institutions to bring the Mammobus, the mobile mammogram service, closer to the target population, to 12 additional sites. All of us, indeed, have a part to play in ensuring that people around us, our loved ones, do go for their mammogram screening.”
“In terms of support for caregivers, over the years, we have implemented quite a lot of support for caregivers. For dementia, as I have said earlier in my speech, we are introducing a Dementia Friends mobile app. This is to complement the range of services that we provide to help the caregivers. The mobile app is really to help caregivers in terms of providing resources, as well as push notifications. For instance, if their loved ones get lost, Dementia Friends is just like the Singapore Civil Defence Force's (SCDF's) First Responder mobile app. You can receive push notifications and try to help to find the loved ones. But there are other services that we provide, the Eldersit Programme, for instance. The Eldersitter can actually look after the loved one at home, whilst the caregiver takes her rest or needs to do other work. We have got Weekend Centre-based Respite Care, long-term Nursing Home Respite Care for seven to 30 days and so on; as well as Caregivers Training Grant to help caregivers get training through AIC programmes, for instance, to be better able to care for their loved ones. So, there is a range of services that we provide, including the Singapore Silver Line, Singapore Silver Pages webpage where caregivers can also access resources, services, referrals and information. The other question is on palliative care. For palliative care, we have been expanding the number of in-patient palliative care beds, for instance, as well as home palliative care services, increasing the capacity. I have just said that there is the Seniors’ Mobility and Enabling Fund (SMF), where we are now also providing a subsidy through SMF for home palliative care, in terms of consumables.”
“Well, for nurses, under the National Nursing Taskforce, we have reviewed the salaries of nurses in 2014 and 2015, twice, between 3% and 10% increase each year and we introduced a special nurse payment bonus at the end of the year. We will continue to monitor and review their pay to make sure that they remain competitive. But in addition to that, of course, we also continue to look at their professional development and career progression to make sure that it would be an attractive profession to recruit and to retain nurses. In fact, one of the things we have also done is to have an assistant nurse clinician role added in so that there will be more of them who can get promoted at an earlier stage. With regard to doctors, yes, indeed, we regularly monitor the demand and supply of doctors, taking into account demographics as well as disease trends. As I have noted, we will have a local training pipeline of 500 by this year. We do offer pre-employment training grants to Singaporeans who are graduates from recognised overseas universities and we will have to take the total number into account, even as we monitor demand and supply.”
“Medical experts from our healthcare institutions note that foetal viability below 24 weeks remains low, while neurodevelopmental disabilities are very high among premature babies who survive. This is also supported by international studies and professional bodies. Only 1% of all abortions in 2017 were performed between 22 and 24 gestational weeks, of which, more than half of these were due to foetal anomalies and other medical reasons. MOH will continue to monitor and review this issue as new evidence emerges. Chairman, to conclude, let me affirm MOH's commitment to build communities of care for seniors across Singapore so that they benefit from preventive health and affordable, quality healthcare that is person-centric. Together with a capable workforce, we can meet the needs of our ageing population in a sustainable way, enabling our seniors to age gracefully in place and with peace of mind.”
“Let me illustrate with an example of 77-year-old Mr Tan. Diagnosed with prostate cancer in July last year, he was referred to a home palliative care team upon discharge. With the introduction of collaborative prescribing rights, Mr Tan’s palliative care nurse can assess his condition and issue the prescription for antibiotics, for example, saving his caregiver an additional trip just to collect the prescription. We recognise the need to also upskill our allied health workforce, as highlighted by Mr Christopher de Souza. MOH and our public healthcare institutions have established various initiatives and grants to support the training and development of our allied health professionals (AHPs). These include skills attachments, postgraduate qualifications, and fellowships in clinical, education and management-related areas. We have been supporting the development of close to 250 AHPs annually. Our therapy support staff are an equally important group who work alongside therapists to provide rehabilitation care to patients. As a further boost to their training and development, the Institute of Technical Education (ITE) will be rolling out a new Work-Learn Technical Diploma in Rehabilitation Care in April 2018. The new apprenticeship-based diploma, where a majority of the training is conducted in partnership with the employers, allows newly hired and in-service therapy assistants to take on larger roles to provide rehabilitation care to seniors, and progression in their careers as senior therapy assistants. Mr Alex Yam asked whether MOH will be reviewing the abortion time limit. This upper gestational limit of 24 weeks for abortions is based on scientific evidence of foetal viability outside the womb.”
“06 but 1.2, which is actually comparable to the pay ratio in Australia, as quoted by Assoc Prof Daniel Goh Pei Siong. However, as workforce demographics and income profiles vary across countries, benchmarking purely based on pay ratios is not meaningful. Over the years, we have reviewed the salaries of nurses, which have increased in tandem with their expanding roles and responsibilities. Beyond pay, we have also enhanced professional development and career advancement opportunities for our nurses. Through these efforts, we are encouraged that our nursing intakes have increased by 30% over the past five years and the proportion of males in nursing has also risen from 8% to 10% during the same period. I am personally inspired by the experience of Dr Pauline Tan. Currently CEO of Yishun Community Hospital, Pauline started out as an enrolled nurse at the age of 18, and actively pursued training opportunities to upgrade her skills and knowledge. Over the years, she has made invaluable contributions in various roles within the healthcare sector. Pauline is testament to the capabilities and potential of our nurses and the many career progression pathways available. As we deepen the skills and capabilities of our nurses and other healthcare professionals, we can also enhance their scope of practice to support the implementation of more person-centred care models. Today, all prescriptions drafted by nurses and pharmacists require a doctor's counter-signature. Moving forward, we will revise our rules and put in safeguards to allow experienced and qualified nurses and pharmacists in the public healthcare sector to legally prescribe medicines through collaborative prescribing, under the supervision of doctors, so as to increase patients' access to quality care.”
“Given the dynamic healthcare landscape, our nurses will have to continue to learn and deepen their skills on the job. MOH, together with the Singapore Nursing Board, will engage the nursing leadership to look into a stronger system of skills recognition so that nurses who are trained by any accredited healthcare institution, can have their skills recognised for portability across the healthcare sector. This may mean that a stronger national skills credentialing capability will have to be built. Third, we want to nurture and build up stronger institutions for nursing education. As a start, we will be working with NUS Nursing to strengthen the nexus of its curriculum with practice, by forming a new advisory council comprising key nursing leaders from both the acute and community care sectors. In the future, we envisage new national centres of excellence in specific areas of specialised nursing education that will train practising nurses across the various healthcare clusters in specific skills, such as geriatric care. Taken together, we hope to build a first-class nursing education system that can empower our nurses with deep skills and give them the confidence to be at the forefront of driving care transformation. During last week's Budget Debate, Assoc Prof Daniel Goh Pei Siong called for an increase in the salaries of our local nurses, citing a lag when benchmarked against the pay ratios in other countries. Let me highlight that the basis of the health local income statistics he quoted are not comparable. The median monthly income for full-time employed residents had included employer's Central Provident Fund (CPF) contributions, but the amount cited for registered nurses had not. If we exclude employer's CPF contributions for both, the local ratio is, in fact, not 1.”
“As Senior Minister of State Lam Pin Min mentioned in Parliament on 1 March, we already have existing structures in place to promote collaboration among sectoral bodies, AIC and MOH, and will continue to strengthen existing partnerships as well as build new ones. MOH will be investing in developing a more robust Continuing Education and Training (CET) system, which is skills-based and industry-focused, for our nursing profession to complement pre-employment training in a few ways. First, we want to develop a more comprehensive and coordinated system of upgrading to higher qualifications. We will collaborate with our Institutes of Higher Learning (IHLs) and healthcare institutions to design skills-based, modularised and stackable courses for our nurses that can add up, over time, to higher qualifications. Both the Nanyang Polytechnic and Ngee Ann Polytechnic have introduced part-time skills deepening programmes, such as the Specialist Diplomas in nursing gerontology, community gerontology and clinical education. As of end 2017, about 90 nurses have enrolled in the three specialist diploma courses. 6.00 pm Later this year, NUS Nursing will introduce a new part-time and modular graduate diploma in Community Health Nursing to equip nurses with the clinical skills to manage population health needs in the community, including clinical decision-making and chronic disease management. The new programme will allow nurses greater flexibility in pursuing part-time study while continuing to work. They can obtain a graduate certificate upon completion of each module that will "stack up" towards a graduate diploma. Second, we want to build a more robust system of in-employment training across the acute as well as ILTC sectors.”
“To attract more mid-career Singaporeans into the nursing profession, I announced last month that NUS Nursing will launch a two-year Bachelor of Science (Nursing) Programme later this year under the PCP for Registered Nurses (PCP-RN) and will complement the existing PCP-RN at Nanyang Polytechnic. I agree with Ms Joan Pereira and Ms Thanaletchimi that the silver workforce is an important resource and can be an engine for national development. Today, more than nine in 10 public sector healthcare professionals who reach the age of 62 are re-employed, and we will do more to attract seniors without prior healthcare experience into the sector. In going beyond hospital to community, we have also accelerated recruitment efforts over the past year to place more than 1,000 Singaporeans with some 29 aged care service providers in the community. This includes over 40 professionals who made a career switch to the community care sector in 2017 under the Senior Management Associate Scheme. Mr Henry Kwek and Ms Thanaletchimi asked about our plans to develop the healthcare workforce as we grow the sector. Ms Tin Pei Ling also asked for an update on the training and career pathways for nurses. MOH has been working closely with SkillsFuture Singapore (SSG) to develop a Skills Framework for nurses, allied health professionals as well as support care staff to facilitate a national recognition of skills in the healthcare industry and development of career progression pathways as well as remuneration frameworks. This is targeted to be developed by the end of this year, and we will be engaging employers and the healthcare union on its adoption. I note that Ms Thanaletchimi has also called for the formation of an Association for the ILTC sector.”