Chia Shi-Lu
Singapore
“Chairman, I wish to thank all Members who have taken part in this debate and, of course, Minister Gan, Senior Ministers of State Amy Khor and Dr Lam Pin Min and Mr Edwin Tong and also Senior Parliamentary Secretary Amrin Amin, together with all the staff at MOH for their replies and the work they have put in for the healthcare system for…”
“Nonetheless, I believe that a united society will be a key piece to this puzzle, and I look forward to the Ministry of Health's stewardship in this regard. May we all live long, live well and grow old together as one people. Thank you, and I beg to move. [(proc text) Question proposed.”
“Mr Chairman, high usage of air-conditioning and refrigerators contributes to global warming, and none more so than in Singapore where we love our climate control and air-conditioning. But as a responsible member of the global community, we should do our best to reduce our carbon footprint.”
“Management of E-waste Last cut. With the introduction of the Resource Sustainability Act last year, the EPR scheme will commence and a PRS operator I alluded to earlier will be appointed to collect and ensure proper disposal of electrical and electronic consumer products.”
“I thank the Minister for the update. I just have two clarifications about the Disease Outbreak Response System Condition (DORSCON) level – the acronym of the year, so far! First, some clarification about how this DORSCON is arrived at. Is it by independent committee that makes this decision and recommends to the Minister?”
“I just want to echo and express my thanks to Minister Gan Kim Yong for his statement of thanks and support for healthcare workers. Two short but slightly technical questions, I apologise. The first, the Minister touched about it earlier.”
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“Second, with regard to section 31 − I know that Senior Minister of State Desmond Lee may have talked about it earlier − could I just confirm that Town Council staff and/or members of the MA will be barred from sitting on the Town Council Committee? Finally, can the Ministry share some details of the proposed Code of Governance to encourage best practices? I support the Bill.”
“I think we can suggest it in certain circumstances, but I do not think that is the way most governments work, because the whole thing becomes very unwieldy. I also think we should give credit to the rule of law in Singapore and to our civil servants who perform their roles without fear or favour. If we keep on playing the persecution card and say that the cards are always stacked against us, there is no end to this argument and it is very hard for our nation to progress. That is why, in my opinion, MND is probably the best body in this particular case to step in when necessary, when Town Councils are in need of help. I would like to move on to seek some clarity on the provisions for Town Councils which may be facing insolvency or have, perhaps, become insolvent. I understand that MND adheres to the principle that Town Councils should remain autonomous entities, but that should not preclude them from some protections as, ultimately, it will be the residents who bear the consequences. For instance, municipalities in countries like Germany and Canada cannot become bankrupt, as their public debts are implicitly guaranteed by the state. Could I ask that perhaps some considerations should be given to the fact that Town Councils could also be afforded some protections against claims? For instance, limits can be imposed on certain of its liabilities. I would also like to seek three further clarifications from the Minister. First, on the amendment of section 38 regarding the timely submission of audited accounts, in the event that the Town Council is in default and unable to produce the audited accounts and a fine is imposed, is this fine to be paid from the Town Council's coffers, or by the Committee or the Chairman of the Town Council?”
“All of these town councils do have some form of audit and, many times, the audits do show this inexorable deterioration in their finances, but nothing can be done in most of these cases because the government of the day of that country did not have the ability to step in and correct the cause when it had to be done. And so, it is here that I disagree with the WP position that we should just remain with the current state of affairs and rely on the AGO because that was the system that we had in the past. Audits and surveillance are really no substitutes for regulation or the proper intervention, when needed. Here, I take an example from a field that I am very familiar with. As a doctor working in a hospital, we have audits and we have heard that in other countries, for example, in the UK, when audits show deficiencies in care − which have led to problems of loss of life, to mobility for the patients − many of these cases, because there was no direct regulatory intervention, it took a long time before the audit results would go to the proper people so that the proper steps could be done. So, I think that this is the same situation here. There should be, in addition to an audit system or surveillance system, the proper regulation and also the intervention must be there to come in when needed, in this particular case, to safeguard the welfare and the benefits of the residents. The next question, of course, is: should MND not be the regulator? Well, if MND should not be the regulator, then who else should it be? I think it is a fallacious argument to always try to set up a new committee, which is supposedly independent, every time we need regulation.”
“Mdm Speaker, I rise in support of the amendment to the Town Council Act and declare my interest as the Vice Chairman of the Tanjong Pagar Town Council. The Town Council, as we all know, is the key instrument through which the elected MP for that constituency is able to directly influence the living environment of his constituents, and the performance and integrity of the Town Council serves as a bellwether of the Member's fidelity to his or her residents. I feel that this municipal role of a sitting Member should not change, as the separation of the municipal and legislative roles will dilute the relationship between an MP and his constituents or could even result in unproductive conflicts. Nonetheless, it has to be acknowledged, as many Members have done, that the Town Council is primarily a custodian of the properties within the Town, but also has heavy responsibilities regarding the immediate day-to-day upkeep of the precincts and also the long-term maintenance and rejuvenation of the Town, a key case in point being the need to plan for the replacement of lifts. Unlike the management of private housing projects, the Town Council has to factor in future large infrastructure investments into their operational considerations. Over the past decade, if we look around us, there has been an increasing number of municipal councils around the world which have become insolvent, often, we must say, from factors beyond their direct control, for example, pension obligations, reductions in their traditional tax bases or even large lawsuits. One of the reasons is also that in many of these countries, there is a lack of regulatory oversight and also of intervention.”
“Madam, I would like to thank all colleagues who have participated in today's COS debate and, certainly, a healthy dose of appreciation to Minister Gan Kim Yong, Senior Minister Amy Khor, Minister of State Dr Lam Pin Min and Minister of State Chee Hong Tat, as well as the entire staff of MOH for illuminating the debate with their replies. We may not know what the future brings but, certainly, on this basis, the future of healthcare in Singapore seems secure. Madam, I beg to leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $9,200,108,100 for Head O ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $1,534,789,500 for Head O ordered to stand part of the Development Estimates. (proc text)]”
“Madam, just some quick clarifications. First, the Minister mentioned that the reorganisation of the clusters is to enable us to pursue care transformation and, I quote, "more effectively and decisively". We note that the RHSes have also been in existence for a few years. So, could I just ask: what are some of the achievements of the RHSes when they were around? The second clarification is for Senior Minister of State Amy Khor. Yesterday was International Women's Day. I just wanted a quick question about whether the Senior Minister of State could say something about initiatives to improve the health of women and what more is being planned in terms of women healthcare. For Minister of State Chee, on productivity, we have been talking a lot about aged care. I was just wondering if there has been maybe equal at least, even additional emphasis, on productivity in the aged care sector and how the Ministry is encouraging manpower effectiveness in this sector, given that we can expect a lot more demand for manpower in the future. And for Minister of State Lam, yes, last year, he mentioned about the one-doctor-one-patient initiative in the context of primary care. I was wondering what has the progress been on that particular front?”
“Would the Ministry share how we can train and recruit these talents and keep them in this competitive global market? Manpower Development”
“Madam, with a rapidly ageing population, the demands on our healthcare system will increase correspondingly. MOH has projected that 30,000 additional healthcare workers will be needed by 2020, many of whom will be providing direct caregiving services. So far, it has been an uphill task attracting more Singaporeans to such caregiving jobs and also the attrition rate, particularly in the public sector, has been higher than desired. Has the Ministry identified the main reasons for these problems and what measures does it have to overcome these challenges? In addition, for foreigners recruited to help fill the manpower shortage, what measures does MOH have to ensure that they are sufficiently trained in our local system and our local culture so that they can deliver the desired quality of care? I would also like to know if we are on track to train and recruit enough doctors and nurses for geriatric medicine and gerontology and how we can build a strong Singaporean Core for this group of specialists. The confluence of information technology (IT), artificial intelligence (AI) and robotics will have a significant impact on healthcare. Today, we are already deploying autonomous transporters, such as automated guided vehicles (AGV) and clean fix robots, in our healthcare institutions. These and robotic-assisted beds and many other smart applications and machines will play an increasingly vital role in our hospitals and clinics. I have no doubt that they will lead to higher quality services and gains in productivity. However, this would mean that we need a strong team of competent technical professionals to service, maintain and upgrade these sophisticated networks and machinery.”
“Each visit will require her to collect medications from the pharmacist as well. To get to the specialist outpatient clinic or polyclinic, her daughter and son need to take turns off work, or her domestic helper will assist when they are overseas. She will take a taxi usually but, a few times, she has had to have a non-emergency ambulance to send her to the facility which, of course, costs her more. Care coordination is the deliberate organisation of patient care activities to facilitate appropriate delivery of services. It will help our patients negotiate the system efficiently and effectively and, of course, it will also save them time. There is a need to address the potential gaps in meeting patients' interrelated medical, social, educational, as well as support services needs. Too many transitions that exist today can, indeed, be confusing and time-consuming, especially for our seniors, and we are going to see more of them in the coming years. Care coordination has been identified as the key strategy by the US Institute of Medicine to increase effectiveness and safety. How can we streamline and coordinate, as well as integrate these various types of services so that someone like as Mdm A can be in one place and all the disciplines can see her there, more along the lines of perhaps a medical mall, but not at private sector costing. 12.00 pm Cost of Medicine and Vaccines”
“Madam, MOH announced a reorganisation of the healthcare system from six regional groups into three clusters in January this year. The intention is to better optimise resources and provide more comprehensive and patient-centred care services. Each cluster will provide the full range of acute hospital care, primary care and community care and also include a medical school. However, a number of my patients and residents have expressed concern that if their preferred polyclinic and Government hospital are not within the same clusters, they will encounter problems after the regrouping is completed in 2018. I had reassured them that under the National Electronic Health Record (NEHR) system, our hospitals, specialist outpatient clinics and polyclinics have access to their medical records. In fact, they can also access them through the HealthHub system. So, it is quite seamless and they will not be adversely affected. However, this explanation was not fully satisfactory for them as some of them could not understand the necessity of the regrouping in the first place. Would the Ministry share in greater detail about the new healthcare system regrouping and, ultimately, how Singaporeans will benefit from this reorganisation? In what ways will the new system be more suitable for our future healthcare needs? Care Coordination and Strengthening Assoc Prof Fatimah Lateef (Marine Parade): Chairman, Mdm A is 70 years old. She has complicated diabetes and has to follow up with her diabetologist for sugar control; her podiatrist for her long-term foot ulcer; an ophthalmologist for her diabetes which has affected her eyes; and her worsening kidney function requires her to see a renal physician. Some of her appointments are six-monthly and others are two- to three-monthly.”
“The US has its Precision Medicine Initiative, Europe has its European Alliance for Personalised Medicine, and China announced a massive investment in Personalised Medicine as part of its 13th Five-year Plan. However, this brave new world of medical therapy will have to be carefully navigated, and regulators will need to keep up. Traditional systems of healthcare delivery will change, such as what defines a hospital, and can treatment only come from the more traditional medical institutions? How do we make sense of the barrage of new technology and treatments and curate them properly for the benefit of our citizens? I have previously asked for a more robust framework for evaluating healthcare therapies, as there are many cautionary tales if one just looks around. The sad stories of dubious therapies like alkaline water treatment, spectacular failures like that of the flawed or perhaps even fraudulent blood testing technology of Theranos are but some examples. I would like to request an update on the health technology assessment framework. I think it bears repeating that we should rationalise and not ration healthcare. It has also announced that MOH is reviewing the Private Hospitals and Medical Clinics Act (PHMCA). What is the progress of this review and how will updating this Act better safeguard the welfare of our patients? In conclusion, Madam, the real answer to future-proofing healthcare in Singapore is simply to be future-ready. This means that we have to invest prudently and sustainably in the present and have a pragmatic roadmap for the future. [(proc text) Question proposed. (proc text)]”
“In our 2013 Paper on Healthcare Affordability, we opined that "with the integration of social care and healthcare under one Ministry, the Government Parliamentary Committee (GPC) for Health recommends that the current ElderShield payout be revised. Meant for severely disabled elderly Singaporeans, the current ElderShield payout is insufficient for Singaporeans to even cover nursing home fees. Its coverage should, therefore, be strengthened to make it more relevant." The GPC for Health has been concerned about this issue for some time now, and we will be presenting our comments and suggestions to the ElderShield Review Committee in due course. I would like to ask MOH if the timeline for the review remains on track. Finally, we are privileged to live in an era which has seen rapid and breathtaking advances in medical and healthcare technology. The disruptive effects of these advances will lead to new paradigms of healthcare delivery, and Singapore should be ready to embrace these shifts as they could lead to significant improvements in our well-being and can also be an impetus for economic development. In this generation, it is quite probable that medical care will become highly personalised, such that the care patients receive becomes more targeted, more efficient, safer and, ultimately, more affordable. Personalised healthcare, also known as precision medicine, holds great promise for the future of healthcare. Precision medicine refers to the ability to "tailor therapies to a patient's individual needs by examining their individual characteristics". Many countries are actively developing their capabilities here.”
“The emphasis on healthy eating is particularly laudable, since studies have shown that children who learn to eat healthily tend to continue to do so in their adult lives and are likely to pass on such habits to their children. This would surely be a significant pre-emptive strike in our continuing battle against diabetes and other chronic diseases. I believe that the Ministry could go even further by perhaps looking at legislation and enshrining such good practices in the requisite laws, such as what the United States (US) has done with the Healthy Hunger-Free Kids Act, which also addresses another issue, which is, to ensure that no child should start the school day without having a healthy breakfast. I would like to ask if MOH or perhaps the Ministry of Education (MOE) has any data on the percentage of our school children who do not regularly have breakfast before the school day begins. I also commend the announced focus on safeguarding sleep for our children. How does the Ministry intend to help parents and caregivers achieve the sleep goals for their children? Next, I would like to recognise the steady investment the Ministry has made over the years in intermediate and long-term care (ILTC) and end-of-life care, both in terms of manpower and infrastructure. Nonetheless, there remain concerns about how such care will be financed as the current MediSave, MediShield Life and MediFund (3M) framework does not adequately address this area of care. I am happy that the Government has recognised the urgency for a thorough review and enhancement of the ElderShield programme.”
“I certainly am not suggesting that we consider rationing healthcare to encourage more judicious use of medical care, although I do note with consternation that there are countries, both developed and developing, which are actually seriously exploring various ways of rationing healthcare to their population as costs have ballooned out of control. But we have to act now to rein in healthcare spending and channel resources to policies which have a proven impact on the health status of Singaporeans. My point is that we should rationalise, but not ration. I was encouraged that MOH had earlier announced three key shifts in healthcare (a) moving beyond the hospital to the community; (b) beyond quality to value; and (c) beyond healthcare to health. These are critical to the sustainability and future-proofing of our healthcare system, and I would like to ask what the Ministry has done to begin these shifts. Over the past few years, we have made great progress in providing quality, affordable and accessible medical care, but the challenges to the health of Singaporeans remain formidable. Smoking prevalence continues to be stubbornly sticky, many of us still feel helpless when trying to eat healthily and exercise often, and trying to maintain an optimal work-life balance remains a struggle for many. I applaud the recent announcement of the NurtureSG programme, which encapsulates many suggestions that healthcare professionals have been advocating. I would like to ask the Ministry if it can update this House on how it intends to see this programme through and what resources will be made available to ensure that this programme succeeds.”
“That is why many studies have shown an inconstant correlation between healthcare spending and the overall health status of a country, since healthcare spending primarily captures the magnitude of expenditure on medical care, rather than the sum of efforts directed towards health maintenance. I hope that MOH will be able to provide an update to this House as to what progress has been made in encouraging Singaporeans to keep active and live healthily. We still pride ourselves on being able to support a world-class medical care system and achieve world-class health standards, but it is increasingly becoming a stretch to declare that we can do so at a modest price. True, healthcare expenditure remains a small percentage of our gross domestic product (GDP) compared to what many other developed countries spend. But I note that, this year, the healthcare budget is close to S$10.7 billion, which is about an eighth of our operating Budget for 2017, and this is almost a 10% increase from last year's Budget. Just a few years ago, then Finance Minister Deputy Prime Minister Tharman announced that we can expect healthcare spending to jump to $12 billion by 2020, and it certainly seems that we may be reaching this target earlier rather than later. 11.45 am One of the big issues that has dominated this year's Budget is concerning the rise in the price of water. Healthcare, like water, is a necessity and it is a public good. But it, too, has resource limitations. One of the measures that has been suggested to impress on the public the importance and true cost of water is to reintroduce rationing exercises.”
“Madam, I beg to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100". I would like to begin with a quote from George Burns − he may probably not be the best person to begin this debate with because he is well-known for being always seen with a cigar hanging out of his mouth − but he once quipped that, "I look to the future because that's where I'm going to spend the rest of my life". In other words, we reap what we sow, and the lifestyle decisions we make have a significant impact on our health in later life. We cannot choose our parents and so our genetic make-up is predetermined, but we can certainly choose how we live our lives. Likewise, as a nation, decisions we now make regarding our healthcare framework will have deep and far-reaching consequences on the healthcare landscape of the future. In Singapore we should take some credit for always keeping a constant eye on the future. We have all heard about SkillsFuture and other forward-looking policies, and healthcare is no exception. Since my earliest speeches about health and healthcare in this House during the Budget Debates, the Ministry of Health (MOH) has progressed its Healthcare Masterplan, first to 2020, then beyond 2020, and now onto 2030. It is great that we are planning for the future, but in order to future-proof the health of our citizens, we need to pay close attention to the present. Shaping lifestyle decisions, ensuring a clean living environment and further improving socioeconomic conditions through inclusive growth remain arguably the most powerful means of influencing the health of our country.”
“Thank you. Just a quick clarification for the Senior Minister of State. With regard to waste collection, the PWCS is a very good system. I was just wondering about the existing households and estates now and the state of all the bin centres. Are there measures that we can do to improve the situation for the existing households?”
“Madam, I think we all agree that there is much room for improvement of waste collection in Singapore. In HDB estates under my care, I frequently see cleaners manually hauling refuse to the bin centres from the chutes. I also get complaints from residents on the odour and pests when these activities are not done properly or when the bin centres are not properly secured. How does the Ministry plan to improve waste collection in our housing estates and hawker centres? And will the Ministry act to upgrade the older bin centres in some of our estates? I would also like to suggest that we improve the way that waste is disposed of in the first place. For example, food waste is the primary culprit for causing odour and attracting pests. The Eco-Wiz's EcoDigester breaks down food to produce water that can be reused for cleaning or landscaping. This system, as I understand it, is already installed at around 30 hotels, restaurants and schools and at the Ang Mo Kio market. Each digester can process about one tonne of waste per day. Can this system be studied further and, perhaps, be installed at each precinct so that we can involve residents to dispose of their food waste in an environmentally-friendly way and also generate some water along the way?”
“Thank you, Mdm Chairman. I think many of my comments echo the previous Members'. For the first time in 17 years, our water price will increase, with the first 15% in July this year and another 15% in July next year. Many residents that I have spoken with understand and do support the rationale for this increase, considering the enormous sums of money that we have to continue spending on our water infrastructure in order to achieve water self-sufficiency in the long term. However, many of them have made suggestions. First, is it possible to perhaps stagger the increase even further, perhaps, say, 10% over three years, instead of 15% over two years? Another question is: what are the Ministry's plans to mitigate future increases in the price of water down the road? It has also been reassuring to hear over the last few days in this House, the help which lower and middle income families will get to manage this increase. After subsidies, households in 1-room and 2-room flats will hardly see any increase in their bills, and 75% of our HDB households can expect less than a $12 increment in their bills per month. Nonetheless, I am still concerned about some financially vulnerable households which may still be coping or struggling with utilities arrears, despite the subsidies. How will the Ministry assist this group of low-income households cope? Hawker Centre”
“Other than the informational function, the roadside air quality index will serve an educational purpose and as a progress tracking instrument in our fight against this specific pollution. Vehicular emission control is the ultimate solution to this problem. But even as we make progress on this front, would the Ministry work with the relevant agencies to promote technological and design innovations to mitigate the effects of curbside pollution on bus commuters? Recently, the experimental next-generation bus stop in Jurong made the news. Equipped with a swing, rooftop garden, artwork, library books and broadcast screens, the bus stop makes waiting productive and may even encourage more waiting. But this is actually a dangerous proposition given curbside pollution. I hope such experimental bus stops would also test technologies and designs to mitigate curbside pollution. Enforcement against Noisy Motorbikes”
“I understand that SUTD has recently submitted its report on alternative technologies to the Ministry. Diesel emissions are an area of concern. In 2016, some major cities around the world have taken actions to curb diesel vehicles which are known to emit higher levels of Particulate Matter (PM) and Nitrogen Oxides (NOx). For example, to improve air quality, Paris, Mexico City, Madrid and Athens have recently announced that they will ban the use of all diesel vehicles by 2025. I hope our Government will consider incentives, such as road tax exemptions and other rebates, for petrol-electric hybrid commercial vehicles or, even better, perhaps to follow in the footsteps of the above countries. May I know how MEWR's study is progressing and what are the likely findings and recommendations that they will make? Curbing Roadside Pollution Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Madam, in September 2016, a research scientist from the Singapore-MIT Alliance for Research and Technology (Smart) found that commuters who wait at bus stops could suffer more from the pollution of the toxic ultrafine particles emitted by vehicles. His research showed that a two-way bus journey five days a week could lead to a commuter inhaling about 3.5 times more tiny pollutant particles than at ambient level. The Singapore Air Quality Data, provided by the NEA, only measures up to PM2.5. However, the particles found in vehicle emissions are 100 times smaller and thus are not currently captured in our air quality indices. Also, in many cities around the world, curbside pollution along main trunk routes is included in air quality indices. We should develop our own roadside index as part of our slew of air quality indices.”
“Madam, the Ministry announced air quality targets under the Sustainable Singapore Blueprint in 2015. Unfortunately, we are not on track to achieve our air quality targets by 2020. For the last two years, we have not been able to meet our targets for pollutants, such as fine particulate matter (PM2.5), particulate matter (PM10) and ozone. I would like to request an update from the Ministry on its plans to achieve these targets. For pollutants that are carried here by the winds from neighbouring countries, what is the progress of our collaborations with these nations to cut down on activities which produce haze? On to the carbon tax. The carbon tax will affect between 30 and 40 direct emitters, such as power stations, should it start in 2019. How much improvement in air quality resulting from this tax does the Ministry expect and will the reduction be in time for us to reach the 2020 deadline? Will the Ministry consider giving much more attractive rebates for cars which emit less pollutants to convince more buyers to switch to these cars while increasing the surcharges for more polluting vehicles? Lastly, I hope the Ministry will look at measures to improve the quality of air in our estates by restricting indiscriminate burning for religious offerings and installing more accessible burners to encourage responsible usage. Can the Ministry also commission studies to improve the design of these burners? Diesel Emissions Next cut, please. At last year's COS, the Ministry announced that it would undertake a study on diesel vehicles. Commercial vehicles, such as vans and lorries, are mostly diesel-driven and account for nearly 60% of our total pollution from vehicles although they make up only about 30% of vehicles on the roads.”
“Mr Chairman, Singapore and Indonesia have enjoyed good relations for many years and share strong trade and cultural links, despite having some inevitable differences in various areas over the years. Singapore has been among the top three foreign investors in Indonesia and tourism between the two countries remains strong. In November last year, as earlier noted, four wide-ranging MOUs were signed on the sidelines of Prime Minister Lee Hsien Loong's Leaders' Retreat with President Joko Widodo. I note that Singapore and Indonesia will be commemorating their 50th anniversary of diplomatic relations this year. I would like to seek the Minister's views on the state of bilateral relations. Furthermore, I would like to ask if there are plans for a Golden Jubilee celebration with Indonesia. Future of ASEAN”
“Question No 7, please. The Minister for Culture, Community and Youth (Ms Grace Fu Hai Yien) (for the Minister for National Development): Since the Municipal Services Office (MSO) was set up in October 2014, there has been an improvement in the delivery of municipal services. The average time taken to respond to cases involving multiple agencies has been reduced by nine days, from 21 days in October 2014, when MSO was set up, to 12 days in June 2016. The proportion of cases which required referrals to multiple agencies has also dropped from 13% to 9% in the same period. This reflected an improvement in work processes and better understanding of the partners' area of responsibility. These improvements were made possible through the efforts of MSO and the partner agencies. Some of the specific work initiatives included the introduction of OneService App which allowed feedback to be given without knowing or identifying the agency responsible for the problem and the appointment of lead agencies to deal with groups of municipal issues. For example, public greenery maintenance has been centralised under the National Parks Board (NParks) since June 2015; the Land Transport Authority (LTA) has been appointed as the First Responder for feedback on maintenance of connectivity-related infrastructure since June this year. The Agri-Food and Veterinary Authority of Singapore (AVA) has also been appointed the First Responder for animal issues since 2012. Members of public can contact AVA for all animal-related issues, including feedback on the presence of a python in a monsoon drain. AVA will coordinate efforts with the relevant agencies, including external partners such as animal welfare groups, to resolve the problem and be the lead agency to reply to the feedback provider.”
“Mdm Chair, I would like to thank all Members who have contributed to the lively and considered debate. I am certain the feedback and suggestions will be useful as we work to strengthen our healthcare system. On behalf of Members, I would like to thank the tireless staff of MOH and, of course, Minister Gan, Senior Minister of State Amy Khor, Minister of State Lam Pin Min and Minister of State Chee Hong Tat for their meticulous replies and clarifications. I would be very happy to proffer them all a cup of teh-O kosong or kopi-O kosong for all their efforts! So, Mdm Chair, I beg leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $9,202,218,100 for Head O ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $1,797,678,900 for Head O ordered to stand part of the Development Estimates. (proc text)]”
“Yes. Could I just ask if there are any more concrete steps that we can take to, perhaps modulate the cost of private healthcare?”
“Mdm Chair, I have three clarifications. The first concerns the Health Products Act. As I understand it, it now regulates medical devices and cosmetic products and I also understand there have been some public consultations on this about whether it is possible to transfer the control of other pharmaceutical products under this Act. Could I ask the Minister for an update on the status of this transfer and whether it is likely that we will see an amendment to the Act in the near future? The second clarification concerns this threat of infectious diseases, and it is directed to Minister of State Dr Lam Pin Min. In view of the potential cost of an epidemic, should it occur, do we have provision for a fund to deal with the cost of tackling the epidemic and also the resultant economic cost? 3.15 pm If we look at the US, for instance, they set up a fund to combat Ebola. Now that the threat has passed, they are porting some money over to combat the threat of Zika and expanding on that fund. So, I am just wondering whether we have a provision for a fund to tackle such public health crises. The final clarification is with regard to my cut on transparency. I thank the Minister of State for his answer.”
“Labelling should be in line with WHO guidelines of cutting free-sugar consumption to less than 10% of daily calorie intake. This can be rolled out in phases, starting with canned and packet drinks. For example, a can of Coca Cola contains added sugar amounting to 80% of the current WHO guidelines and should be labelled red. Health warnings that read "Drinking beverages with excessive added sugar contributes to obesity, diabetes and tooth decay" should be attached to drinks that are labelled red. Studies to track whether labelling has resulted in consumers making better choices should be conducted to improve the labelling and gauge its success before we even consider a sugar tax. ElderShield”
“Sugar is arguably as significant a threat to public health as alcohol or tobacco, if not more. My rudimentary understanding of military strategy informs me that a key to winning a battle is to cut off the supply lines to the enemy and as we have just declared war on diabetes, I think such a move is tantamount to cutting the supply lines to the enemy, which is diabetes. Finally, I would also like to suggest that healthy food, such as fresh fruits and vegetables, be made cheaper through targeted subsidies. By making healthier food cheaper than unhealthy food, hopefully, our people would start to change their eating habits. Sugar Content Labelling Assoc Prof Daniel Goh Pei Siong: Mdm Chair, the harmful effect of excessive sugar consumption has led to Britain recently introducing a sugar tax. Singapore, like the UK, is experiencing an ageing population and the prevalence of obesity and heart disease. There are also local characteristics to the problem as Asians are at a higher risk of developing Type 2 diabetes. In fact, over 10% of adult Singaporeans are currently diabetic and it is the second highest proportion in the developed world. It will, therefore, appear that we should seriously consider a sugar tax. However, the effectiveness of the sugar tax is questionable, at least in Singapore, as it will likely turn out to be a requisite tax on vulnerable Singaporeans. We should focus instead on empowering Singaporeans towards making healthier choices and adjustments to their lifestyle. I request the Government to consider mandating the labelling of free-sugar content in processed foods where the calories and percentage of daily intake of free-sugar need to be prominently displayed on food packaging. The sugar content should also be colour-coded with green, amber and red.”
“Mdm Chair, according to a recent study that was published in the Lancet, which is a very well-respected medical journal, there are more than 640 million obese people globally. The threat of severe obesity noted in this paper was considered too severe to be tackled with medications or by exercise alone. The study recommended taxing foods that are high in sugar or that are highly processed. WHO has also recently come out in support of such a move. The level of obesity, as we have just heard, is also rising in Singapore. Our adult obesity rate increased from 6.9% in 2004 to 10.8% in 2010. It is probably higher today. Obesity increases the risk of diabetes, heart disease, stroke, joint problems, high blood pressure, high cholesterol and certain types of cancer. Not only does obesity have a negative impact on personal well-being; it is costly to the nation. We have to spend more money on obesity-related healthcare. And an unhealthy workforce is also likely to be less efficient, affecting our economic productivity. We should certainly not sugar-coat this problem. Hence, I would like to renew a call I first made in 2011 that the Ministry consider implementing increased taxation on unhealthy foodstuffs, such as those containing excessive fat or sugar, to discourage their consumption. Other nations have imposed taxes on sugared beverages and on food which is high in saturated fats. I understand that such general taxes will raise prices and may disproportionality affect Singaporeans with lower incomes who spend a greater part of their income on food. Unfortunately, unhealthy, processed food is often cheaper and more affordable. But just as taxes on alcohol and tobacco have nudged people into reducing their consumption, taxes on unhealthy food should be effective as well.”
“Transparency in Healthcare Delivery Madam, I am glad that, over the years, the Ministry has been actively pursuing greater transparency with regard to issues related to healthcare and healthcare delivery. Results of quality-of-care reviews, patient satisfaction surveys, average costs of hospitalisation for common procedures are readily available, and patients can now access their personal health information online. I would like to ask what further steps the Ministry is taking to allow even better transparency across the whole chain of healthcare delivery. Can this added transparency be harnessed to improve healthcare delivery, in terms of efficiency, quality and also cost containment? Healthcare costs are on the rise. Does MOH have any plans to enhance transparency of healthcare fees or to introduce fee guidelines to help contain healthcare inflation? MediShield Life now provides comprehensive and universal hospitalisation coverage, but about two-thirds of Singaporeans still have integrated insurance plans (IPs) that cover them for medical services by private healthcare providers. Many are concerned about the cost of private healthcare and also of IP premiums, notwithstanding the recently announced Standard B1 plans that aim to provide a reasonable benchmark for IPs. What is the Government doing to manage rising charges in the private healthcare sector?”
“Yes, Mdm Chair. While we are understandably concerned about the impact of chronic diseases on the population, such as diabetes, which we have been hearing about, we must remain vigilant to the continued threat of infectious diseases, in particular, new and emerging ones. Our experience with severe acute respiratory syndrome (SARS) at the turn of the millennium has shown us the devastating impact of a previously unrecognised infectious disease and the immense human, social and economic cost. More than a decade later, the world continues to be besieged by the threat of emerging infectious pathogens: bird flu, swine flu, Middle East respiratory syndrome (MERS), Ebola and, more recently, the Zika virus. MERS remains a threat in the Middle East and had a devastating though fortunately limited outbreak in South Korea last year. Ebola cut through entire populations in West Africa and infected close to 30,000 people worldwide and claimed over 11,000 lives worldwide. Now, we face the spectre of Zika, which is not fatal but behaves in a far more sinister fashion, affecting unborn babies and potentially condemning them to a lifetime of mental disability. I commend the Ministry on how it has increased our preparedness to deal with such threats since the SARS epidemic, and Singapore has thus far been spared similar crises, through a combination of vigilance, border controls and perhaps through a measure of good fortune. I would like to ask the Ministry to provide an update on its plans to protect Singapore from the threat of infectious diseases, such as the new and emerging ones which I have just mentioned, and also persistent ones like dengue and resurgent ones like tuberculosis.”
“Mdm Chair, I am glad with the clear intent in the 2020 Masterplan to strengthen the ILTC sector and, like many of the Members here, I would like to ask what measures the Ministry is considering to address the expanded manpower needs as this sector is particularly labour-intensive. We all know that our nurses play an essential role in the ILTC sector and the National Nursing Taskforce's recommendations for the future of the nursing profession have already been accepted by the Ministry. Would the Ministry share details about how it will provide our nurses with more career advancement opportunities, greater authority and autonomy, and implement flexible and part-time work arrangements? What can be done to improve their work conditions and remuneration? In addition, what will the Ministry do to protect our nurses from abuse from patients and their family members? This comes about because there was a worrying report in the Annals of the Academy of Medicine that estimated that about seven in 10 of our healthcare workers have suffered from such abuse. Manpower Challenges in ILTC Sector”
“Just as this year's Budget has been expansionary in the service of economic transformation, our healthcare policies have likewise been inclusive and expansionary over the past decade to meet changing and increasing healthcare demands. But even as we increase national spending on healthcare, we should be mindful that the spending should be prudent and sustainable and that the relationship between healthcare spending and health outcomes is not always linear, as many countries have found to their detriment. I am concerned about the strain on the public purse and whether future generations can sustain such spending. I would like to renew my call that the Government continue to rigorously assess new policies and new treatments for value based on clear outcomes. What else is the Ministry doing to ensure sustainability of our healthcare system as we hit from SG51 towards SG100? I beg to move. [(proc text) Question proposed. (proc text)] Waiting Time in Polyclinics”
“If this is not feasible, can Page: 127 we assist patients with disabilities, seniors and their caregivers with transport arrangements or subsidies from their homes to the various healthcare institutions? 7.45 pm My ward of Queenstown is already what would be classified as a super-aged community, the definition of which is that over one in five residents are over 65 years of age. A significant number live alone, or with a partner or spouse who is dependent on them. A recent article in The Straits Times noted that there were 41,200 households made up of residents aged 65 or older who live alone and that this number was expected to rise to 83,000 by 2030. In Queenstown, for example, we have several initiatives to meet this challenge. We have a home monitoring trial; we have a community guardian network; we also have things like a charitable free funeral service for those who pass on alone without kin. Can I ask if the Ministry has plans to manage this demographic challenge? My final concern lies in a slightly sensitive topic, but one which we should discuss as a community. Despite being ranked as one of the healthiest countries in the world and one of the best places to be born in, Singapore was only ranked 12th in the Quality of Death Index released by the Economist Intelligence Unit last year. This is a wake-up call that we should pay greater attention to improving end-of-life care. What plans does the Ministry have to improve palliative services and end-of-life care for Singaporeans? I would like to conclude on a cautionary fiscal note since this is after all a Budget debate.”
“In a rapidly ageing society like ours, we need to bolster measures to ensure that our seniors remain healthy and active and are able to age gracefully and to do so in the community where they have lived most of their lives. Medical care in Singapore is among the best in the world but, often, even with the best and most dedicated treatments, patients are left with residual disabilities. What is broken can sometimes not be made whole and the sick cannot always be made well again. For seniors, the ravages of age alone can lead to increasing dependence. I welcome the moves made by the Ministry to expand the capacity and capability of our Intermediate and Long-term Care sector under the Healthcare Masterplan and am encouraged by the principles that have been embodied in the Action Plan for Successful Ageing. I would also like to ask the Ministry if they are looking at new models of assisted living in the community, apart from the more traditional avenues like nursing homes and day care centres. The reason I ask this is both from personal experience and also from interactions with my residents and patients. It is, sometimes, a difficult choice to make. Some loved ones may need extra help in their daily activities, but to consign them to a nursing home may take away too much of their liberty and many scientific and medical articles have shown that such restriction of liberties may actually do more harm for the individual than good. I would also like to ask how we can better support community caregivers. Last year, it was announced that we were working on a home and community care plan, to facilitate ageing-in-place. How does the Ministry intend to ensure that our seniors receive holistic and seamless care? Are there plans to utilise technology for care delivery?”
“Similarly, patients with chronic diseases who adhere to their treatment programmes and clinical pathways could receive extra credit for their medical expenses. I would like to ask what else the Ministry can do to promote good health and prevent disease in our society. Can the Ministry provide an update on the Healthy Living Masterplan? What is being done for young Singaporeans to cultivate healthy living habits? For the elderly, I am heartened by the announcement of the setting up of Community Health Networks for Seniors and I hope the Ministry can shed more light on this initiative. I am a strong believer in the one-patient-one-family doctor concept, as the formation of a strong patient-doctor bond provides a singularly effective and efficient way to good health for life. The Ministry has enunciated this principle in years past and I would like to hear from the Ministry what progress has been made on this front. I also appreciate the various health screening programmes that have been implemented over the years, with many at little or no cost to the individual. For instance, community health screening activities are held regularly in my constituency of Queenstown, as they are all over Singapore, but concerns have been raised on how we can ensure that screen-positive patients do follow up on their follow-ups. Has the Ministry been looking at ways in which the transition from community health screening to follow-up in clinics can be made more seamless and accessible? Second, a strong healthcare system also needs to look after those who have undergone treatment but continue to have residual incapacity.”
“How does one go about convincing people to continue making the right lifestyle choices, day after day, over one's lifetime? The lure of just that one more cigarette, that extra helping of char kway teow, that one extra can of soda, that extra piece of cake, is often just too difficult to resist. Similarly, making the decision to eat more fruits and vegetables, to exercise more, always seems just that one day away. Two worrying reports have recently surfaced: the first is that obesity rates in Singapore are rising and, in particular, amongst our children; the second, unsurprisingly given the first report, is that Singapore has the second highest prevalence of diabetes amongst developed nations. This is certainly not something which Singapore would like to be on the leader board! The WHO has also reported that, globally, there is a frightening rise in the incidence of diabetes. Last year, during the Budget Debate, I remarked that much can be done to nudge Singaporeans to take greater ownership of their health. Anti-tobacco measures should be stepped up even further and, while some may argue that unhealthy behaviours should be penalised, by the same token, healthy choices can be incentivised. I will speak later on how we can encourage healthy eating through fiscal levers. Foods that are available in schools, for instance, could be more closely regulated to help stem the menace of childhood obesity. Page: 126 Singaporeans who participate regularly in approved wellness programmes or can demonstrate that they adhere to a healthy lifestyle with regular exercise, for instance, could receive tax rebates or pay discounted rates at public healthcare institutions.”
“Mr Chairman, Sir, I beg to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100." Sir, I would like to declare my interests, both as a medical doctor practising in a restructured hospital, as well as the Advisor to a facility providing day care for seniors and people with disabilities. It is a well-known aphorism that a chain is only as strong as its weakest link and, by the same token, a healthcare system is only as strong as its least amenable portions. The past few years have been marked by a remarkable remaking of the foundations of our medical system – the Pioneer Generation Package, MediShield Life, a rejuvenated and expanded CHAS programme, increased flexibility of MediSave usage and increased subsidies across the board for all manner of medical services. In fact, many of the concerns that were raised in a White Paper drafted by the Government Parliamentary Committee for Health some years ago and, indeed, raised by many Members of this House, both past and present, have been addressed, to varying degrees, by these bold initiatives. But it may surprise many that most of these measures benefit the outliers rather than the majority, as those who are manifestly sick represent the tip of the disease iceberg, the apex of the healthcare pyramid. A truly comprehensive and robust healthcare system must look beyond treating the sick and look beyond medical treatment alone. First, we have to focus on preventing disease and reducing the disease burden. I have previously remarked that the key to a healthy society is that, in the long run, it depends less on how well you treat sick people, but more on how you keep people from falling sick. Managing the healthy is probably one of the biggest challenges facing healthcare workers.”
“Mdm Chair, I have just two clarifications for the Senior Minister of State. The first is concerning food wastage. I appreciate her answer regarding food recycling. But my second point was how do we reduce the wastage of food, perhaps by redistributing the food? I suggested things like incentivising retailers to maybe sell them at a discount or maybe to distribute excess food to charities or similar VWOs. That is the first. The second was, could I have some idea of the efficacy of the Corrective Work Order programme? I note 1,100 were repeat offenders. Could I find out, of these 1,100, how many actually Page: 73 went into a second repeat? What was the recidivism rate of these CWO offenders?”
“Why is the current "Clean and Green" initiative not achieving its desired outcomes? How do we educate Singaporeans to have the right hygiene awareness? I would like to ask the Minister what is the progress of the Community Volunteer Programme and whether Corrective Work Order is effective in punishing the litterbugs? Rodent and Pest Control Last cut, in English. Mdm Chair, many estates are, unfortunately, witnessing increasing rodent populations, which are becoming recalcitrant to vermin control measures. Rats are very intelligent and there is evidence that they could learn to avoid traps and even poison. Recently, there have been several reports of rodent infestation in our heartland estates. In my constituency of Queenstown, despite the concerted efforts of our Town Council, the rodent population seems to be increasing. Improper disposal of food, improper food storage, littering, leftover food from the feeding of strays, all these provide rats with sources of food, allowing the rats to breed and multiply quickly. In the Ministry's reply to my Parliamentary Question last year, I note that NEA implements an integrated rodent surveillance and vector control programme and that from January 2014 to November 2014, over 35,000 rodent burrows were detected and treated. I also understand that NEA has brought back the Rat Attack programme that is administered in partnership with the Town Page: 55 Councils. Can the Ministry provide an update on further measures to counter this distressing problem and if it could better assist the respective Town Councils in their efforts to control the rodent population?”
“Mdm Chair, waste not, want not. Food is a defining part of our identity as Singaporeans. But unfortunately, as a nation, a great deal of food wastage occurs daily. In 2014, Singapore produced 788,600 tonnes of food waste, which means that each person discarded about 146 kilogrammes of food over the course of a year. Food waste in Singapore has increased by 48% in the past 10 years. Would the Ministry update us on its plans and public education programmes to reduce food wastage? What can be done to encourage diners to order less and our hawker centres and restaurants to give customers the option of choosing smaller portions? How do we improve our much beloved buffets, which will also help to reduce both wastage and our waist lines? How can we also incentivise retailers to reduce food wastage, perhaps by selling food near their expiry dates at a discount and donating their unsold food to the needy? Keeping Singapore Clean (In Mandarin): [Please refer to Vernacular Speech.] As exercise is the key to health, hygiene is the assurance of health. If you want to live a healthy life, a clean environment is a prerequisite. Regrettably, in recent years, our cleanliness has not been as good as before. Littering cases have been on the rise every year. This will not only affect the image of our country, but also lead to diseases. Some say Singapore is no longer a clean city but a cleaned city. We all know that cleaning itself cannot ensure environmental hygiene. Protecting our environment is the responsibility of each one of us. This is a pressing issue. I would like to ask the Minister: what is the effectiveness of our public engagement measures? Can we run the "Keep Singapore Clean" Campaign again, like before?”
“The Ang Mo Kio and Tiong Bahru markets together produce an estimated 1,800 tonnes of food waste a year but the markets occupy a central place in the town centres and NEA could extend the pilot projects to a wider catchment area to cover nearby private coffee shops, food courts and grocery stores. This makes food waste recycling readily accessible at town centres. In fact, NEA could also experiment with getting the surrounding HDB households to bring down their food waste to the recycling centres. This will gauge the readiness of households to adopt food waste recycling and allow NEA to test different methods to get households to recycle their food waste correctly and cleanly. Second, NEA should begin simultaneous pilot projects to encourage food waste recycling at clusters of F&B joints, such as those in shophouse rows or shopping malls across the city. This may present more challenges than hawker centres due to diverse stakeholders and configuration of space. Therefore, the pilot should start earlier. There is more time to evaluate and test the recycling methods. Recycling”
“Mdm Chair, electronic and electrical waste, also known as e-waste, contains small amounts of hazardous substance, which may pose health concerns if not properly disposed of. Substances, such as mercury or cadmium, found in e-waste could also cause long-term environment pollution and degradation. However, e-waste also contains useful Page: 53 materials, such as rubber, plastics, glass, gold and lithium, which can be recycled. Sixty million kilogrammes of e-waste are produced every year, of which only a small portion is collected by community e-waste recycling programmes. I understand that NEA is looking into the option of having a national system to collect, recycle and handle e-waste. In view of the growing e-waste volume in this iDevice generation, I would like to seek an update on the Ministry's plans to ensure the safe recycling and disposal of electronic and electrical waste. Food Waste Recycling Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Mdm Chair, NEA reported that in 2014, less than 13% of food waste was recycled and over 680,000 tonnes had to be incinerated. This number is only going to grow with our increasing population and given the prosperity of the population and the Singaporean culture of eating out. Recently, NEA announced the launch of a two-year onsite food waste recycling pilot at two hawker centres in Ang Mo Kio and Tiong Bahru. This is a good move. But for an urgent problem, it is insufficient. I have two suggestions to accelerate food waste recycling. First, food waste recycling in hawker centres is a low-hanging fruit as NEA is in charge of the space. However, hawker centres do not seem to account for large amounts of food waste.”
“I understand that the Ministry is already studying this and I call upon the Ministry to expedite this move. Australia was the first jurisdiction to have done so and the impact thus far has been encouraging and several other countries have also indicated that similar legislation is in progress. There is strong opposition to such legislation from tobacco companies and some of them are even bringing lawsuits against governments, but I think this is just another indication that standard packaging would further reduce smoking initiation and accelerate smoking cessation. Dr Lisa Henriksen from the Stanford Prevention Research Centre of Stanford University recently wrote of the retail environment as a barometer of progress towards the endgame for tobacco control. And I strongly believe that this amendment to the TCASA is an important step towards safeguarding the health of our society and it is an important step towards a tobacco-free generation and so I warmly support it.”
“The evidence was clear: children and adolescents who were exposed to point-of-sale tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those who were less frequently exposed. And this study concluded that "legislation banning tobacco point-of-sale promotion will effectively reduce smoking amongst young people." I think it is reassuring that this amendment to the TCASA will spell the end of the Tobacco Power Wall in Singapore and also tighten regulations pertaining to online advertising and marketing and also close loopholes regarding imitation tobacco products. I have two further issues to raise, which I hope the Ministry will be able to consider. First, it is with regard to the minimum age at which persons can use or purchase tobacco products. I think this has also been brought up by some of the hon Members who have spoken before me. I also feel that 18 is still too young and would like to call for it to be raised to at least 21 years of age. There is good evidence that such a move will further reduce smoking initiation rates and there appears to be broad support from the public for such a move, as indicated by the findings of the recent public consultations for this amendment. The World Health Organization has also stated, based on prevailing evidence, that people who do not begin smoking before the age of 21 are unlikely to become chronic smokers. Second, since we are already banning point-of-sale displays, I feel that it would just be an incremental but still significant move if we were to continue with our plans to introduce plain packaging for tobacco products.”
“When we go for a meal in a shopping mall, in a supermarket queue waiting to pay for our purchases, or at the petrol kiosk waiting to pay for our petrol, we end up purchasing things that we did not actually think we were going to purchase that were just available and attractively displayed at the counter. This phenomenon is not new. This phenomenon of impulse buying is well recognised by retailers and has been exploited by most retailers, including cigarette companies. A study conducted a few years ago by researchers at Johns Hopkins found that, in the US, as much as 11.2% of cigarette buyers were impulse buyers and the most likely impulse buyers were the young between 18 and 24 years old and also those who were occasional smokers and, finally, those who were trying to quit. And close to a third of respondents confirmed that point-of-sale displays made quitting harder for them. Besides Singapore, a few other countries have instituted point-of-sale display bans. Iceland was the first to do so, followed by several other countries – Thailand, Ireland, Norway, Finland, Canada and Australia. And Singapore will be the next on the list. Studies conducted in some of these countries since the ban have clearly demonstrated a marked reduction in consumer exposure to tobacco products, as well as a significant reduction in impulse buying. A review of 20 scientific studies have also overwhelmingly confirmed the association between point-of-sale displays and smoking promotion and susceptibility. A recent meta-analysis, which is a study that reviews the evidence provided by other well-regarded studies, was published in January this year and it looked specifically at the relationship between point-of-sale displays and smoking rates and susceptibility in the young and adolescents.”
“Mdm Speaker, together with other Members of this House, I rise in support of this amendment to the Act. I think we are all aware of the health risks to smokers and those exposed to smoke. Smoking is a significant contributor to disease burden. Many of us have spoken and expressed concern about the increasing healthcare expenditure by the Government. By the simple act of eliminating smoking, this would have a significant impact on reducing healthcare utilisation and also healthcare expenditure in many countries, including our own. Singapore has made much progress in controlling smoking rates and now boasts one of the lowest smoking rates in the world. But more can be done and there are areas of concern. The rate of reduction of smoking rates is plateauing and the rate of smoking amongst the young is still stubbornly high. Most smokers also pick up the habit in their youth and smoking cessation remains a challenge to most smokers. So, I feel that this amendment is both timely and forward-looking. With the strict regulation and restriction of tobacco-related products in many countries, tobacco companies have been focusing their marketing efforts at the points of sale. And many studies have demonstrated the effectiveness of such a strategy in enticing new smokers and also making it harder for smokers to quit. At the same time, instituting a point-of-sale display ban has been shown to be effective in both reducing smoking initiation and also helping smoking cessation. I think many of us have experienced this.”
“Lastly, in line with our aim to be a Smart Nation, I hope that the Government will increase funding for the research and development of health and mobility aids and monitoring devices such as variables and robotics and even drones to help out our elderly. To accelerate our development in this area, we should look into partnering foreign leading firms and institutions in this industry. Japan is one of the leaders in this field and exoskeletons like those developed by Cyberdyne and interactive personal robots, such as Pepper, which was launched by SoftBank recently, provide us with an endearing view of the future. Much has been said about the future of us but literally, the future of us is ourselves in old age. And to answer this call, I would ask that we, all of us, work together to help our senior citizens remain healthy and socially connected within the community, to give them and their family better assurances in their golden years and provide options for them to age within the community.”
“My medical colleagues have recently called upon the MOH to reconsider building subsidised single and twin rooms in nursing homes, as research has shown that residents with dementia in nursing homes with individual rooms have less anxiety, irritability and aggression, and also sleep better. And so, they have called for a move towards providing more individualised care for the elderly in nursing homes and also to allow them to retain some degree of independence. Not only is this good for the elderly, but it may also reduce the need for manpower in the long run, as earlier stated. And so, perhaps a mix of both single and multiple bed setups can be considered for future subsidised nursing homes, so that we can explore both paradigms. Second, we should have an ongoing public education campaign to sensitise our young and middle-aged to the need to plan ahead. This means putting aside some savings for old age, not to over-commit in terms of property purchase and not to opt-out of ElderShield. And if they do buy a larger flat, to consider downgrading after their children move out, for ease of upkeep and to release cash for post-retirement needs. I have seen the recent advertisements on our television channels highlighting this issue, and I think this is a good start. Third, we can consider a bigger role for insurance in long-term care financing, just as we enhanced MediShield. As there are plans to review ElderShield, I urge MOH to be comprehensive in this exercise and address the most important elements – the role of individuals in saving, the role of the family in supporting them and the role of the community and Government in sharing of the risks.”