Gan Kim Yong
Singapore
“Consumer complaints relating to the secondary resale market for tickets to major events and concerts have generally remained low. Nonetheless, to protect the public from scams on secondary ticket resale platforms, the Police have imposed Code of Practice requirements under the Online Criminal Harms Act to require designated online service…”
“Singapore does not condone the use of forced labour. We criminalise forced labour in Singapore under various laws. Relevant Government Ministries and agencies, such as the Ministry of Manpower, Ministry of Home Affairs and Singapore Police Force, play their part in investigating complaints of suspected breaches in domestic laws that relat…”
“The Association of Banks in Singapore (ABS) discontinued the PayNow nickname feature as scammers had been exploiting the use of nicknames to impersonate legitimate entities and trusted individuals.”
“As of end-2025, around 6,900 private residential buildings have registered their solar installations with SP Group for the export of excess solar-generated electricity to the grid. The installed solar capacity of these residential buildings is 115.3 megawatt-peak (MWp), or around 5.5% of all current installed solar capacity in Singapore.”
“The one-year pilot extension of liquor trading hours has seen strong interest from businesses. As of 31 May 2026, the Police have approved 88 applications for the extension of liquor trading hours from public entertainment outlets in these areas.”
“The Government does not make projections of domestic or regional demand for renewable diesel or sustainable aviation fuel. Demand depends on commercial considerations, evolving market conditions and regulatory developments across different jurisdictions.”
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“The Ministry of Health (MOH), consults the Expert Committee on Immunisation and takes into account criteria, such as the disease burden in Singapore, the need for herd immunity as protection against outbreaks of potentially serious diseases, and the clinical and cost-effectiveness of the vaccine, when including vaccines in the national schedules and school-based vaccination programmes. The aim is to prevent diseases with significant public health burden, by encouraging high vaccination take-up rates. The school-based human papillomavirus (HPV) vaccination programme for female students aims to prevent cervical cancer, which is caused by HPV. Cervical cancer is the 10th most common cancer and 8th most common cause of cancer death among females in Singapore. We have assessed that HPV vaccination for females is a cost-effective strategy for preventing cervical cancer. While HPV vaccination also confers protection against genital warts as well as other cancers, such as anal cancer, which are applicable to males, males are not at risk for cervical cancer. Genital warts are a much less serious problem compared to cervical cancer, and the incidence of anal cancer is much lower than cervical cancer in Singapore. HPV vaccination for males is, therefore, not part of the Committee’s current recommendations. MOH will continue to monitor the situation and will review our policy on HPV vaccination for males as and when new developments and evidence emerge on its clinical and cost-effectiveness.”
“Earlier this year, results from the first randomised controlled trial comparing e-cigarettes and Nicotine Replacement Therapy (NRT) was published. The study involved about 900 smokers with good motivation to quit. When combined with counselling, 18% of the smokers in the e-cigarette group quit smoking at 12 months post-intervention, compared to 10% of smokers from the NRT group. However, in the e-cigarette group, 80% of those who quit smoking continued to use e-cigarettes 12 months later. This means that, overall, less than 4% of those in the e-cigarette group quit tobacco product use and their nicotine addiction totally. As there are concerns about the potential harmful effects of long-term use of e-cigarettes, this raises the question of whether they would have been better off quitting using other methods. In addition, more than 30% of those in the e-cigarette group who failed to quit ended up using both cigarettes and e-cigarettes. This leaves them worse off than before, as a recent large study has shown that dual users of cigarettes and e-cigarettes are exposed to more toxins than persons who only smoke cigarettes. For smokers who wish to quit, there are already approved smoking cessation aids in Singapore which are safe and effective. Smoking cessation counselling, NRT and medications to treat nicotine dependence have all been shown to be effective in helping smokers to quit. There is also the Health Promotion Board's Quitline for smokers to get more information and support for their quit journey. We will continue to monitor the evidence pertaining to the safety and efficacy of e-cigarettes as a smoking cessation product. Like all therapeutic products for smoking cessation, the onus is on the e-cigarette manufacturer to provide evidence of safety and efficacy.”
“The Ministry of Health (MOH) has banned Electronic Nicotine Delivery Systems, including e-cigarettes for several reasons. First, e-cigarettes are harmful to health. Their vapour contains toxic cancer-causing substances, as well as nicotine, which is highly addictive and has harmful effects on foetuses and brain development in adolescents. Second, experience in other countries shows that there is a danger of e-cigarettes becoming entrenched in Singapore if we lift the ban. For example, an estimated 2.8 million adults in Great Britain used e-cigarettes in 2016, representing a four-fold increase from 700,000 users in 2012. In England, among 11- to 15-year-olds, one in 16 were current e-cigarette users in 2016, a 50% increase from 2014. Third, e-cigarettes can be a gateway or "starter product" which hooks youths on nicotine and leads them to cigarette use later. A systematic review of nine studies involving more than 17,000 youths in the United States found that e-cigarette users were three times more likely to become cigarette smokers, compared to non-users. Another study among more than 19,000 Canadian youths, showed that e-cigarette users were twice as likely to go on to smoke cigarettes regularly. Other studies in England, Scotland and Poland similarly support this "gateway effect". Nevertheless, we are open to companies registering a specific e-cigarette product under the Health Products Act as a therapeutic product for smoking cessation, if they are able to provide sufficient evidence that the product they are registering is safe and effective. The current evidence on the role of e-cigarettes in aiding smoking cessation remains limited and mixed.”
“Indeed, that is the case and, therefore, even within the current curriculum of our medical training, ethical practices are part of the syllabus our medical students have to go through. At the same time, we are also strengthening our ethical practice and guidelines, as mentioned in my speech, to provide greater guidance to the practitioners. As Members would appreciate, the medical landscape changes over time, evolves over time, new procedures, new treatment will evolve and doctors and patients have to decide whether they are appropriate or not. Therefore, the guidelines have to change over time as well. That is why it is an ongoing process. As I mentioned in my speech, we are looking into how we can provide greater guidance to both practising doctors as well as patients so that both sides will have a better understanding of what is acceptable practice.”
“As I have mentioned in my speech, we have set up a committee on sentencing guidelines, and the committee will then develop a set of guidelines to help guide DTs in meting out their sentences. For the two specific cases, we have asked SMC to lodge an appeal to the Court of Appeal, and because the cases are still being heard, I will refrain from commenting specifically on the two cases.”
“Yes, in fact, the SMC, when they receive a complaint, they will also look at the nature of the complaint. Some of the complaints have certain elements of urgency and they will deal with them more urgently. And if the Member has a specific case in mind, do let me know. We can take it up and see whether we could expedite the case if it is of an urgent nature.”
“The current cases under the DT must continue, otherwise there will be further undue delay. However, SMC and MOH will look into how we can provide greater support to the DT and the process and to streamline wherever possible so that the process will be smoother and the judgement and the decision of the DTs will be more considered.”
“Patients must trust their doctors and be able to rely on them to look after their interests and well-being. Our doctors, in turn, need to be able to practise in an environment where they have clear guidance and are not burdened with the uncertainties and vagaries of unwarranted sanctions or litigation. We have quite a lot of work to do to achieve this, but we are confident that we can do so. We will work through the initiatives described earlier to build a better healthcare system for all.”
“Sir, as I said earlier, the Court of Appeal has also made some suggestions in the civil suit against CGH on the responsibilities of radiologists and institutions. The Court of Appeal’s central concern in that case was to ensure that radiological reports with adverse findings are followed up with appropriate speed and care. This ensures patients’ safety, and we agree entirely with that. The question, however, is how best to achieve this. Arising from that decision, healthcare professionals and institutions have told us that they need clarity on the level of responsibility that radiologists bear. They also need clarity as to whether radiological reports with adverse findings should be returned to the doctors or teams who had ordered them, or should they be routed to another specialist department for follow-up. The position hitherto has been that radiologists are not expected to bear any primary care responsibility when there are adverse reports, and that such reports should be routed back to the doctor(s) who ordered the tests. That has worked well for us, and my Ministry believes that this is probably the best approach. We will consider the position carefully. My Ministry will also study the existing legislation, with a view to setting out in legislation what should be the legal and ethical responsibilities of the doctors involved and the institutions, and how reports with adverse findings should be routed. That should give greater clarity to the community. Sir, to conclude, the medical community that we wish to have is built on the mutual trust and respect of the patients and the public. Doctors are expected to uphold the highest possible standards of professional and safe medical practice where patients' interests are always at the core.”
“It will also consider whether legislation will be necessary in order to achieve these objectives and to set out the test to be applied. We should, however, remember that the relationship between the doctor and patient is not only unique in each case, but also dynamic. It will evolve over time and change with each diagnosis and advice given. It is, therefore, not possible nor desirable to be overly prescriptive in such guidance. There must always be sufficient flexibility in any test or guidance which we formulate so that, ultimately, patient interests are best served. Doctors know that patient welfare must be paramount. Second, to provide additional practice guidance to the community, MOH intends to issue legally binding clinical practice guidance in specific areas. We aim to give healthcare professionals more certainty on aligning their practices with the rest of the healthcare community and on discharging their ethical and legal obligations to their patients. For example, on the issue of informed consent, the guidance would explain what nature of information would be considered to be relevant and material to patients. Such guidance will not be confined to the issue of informed consent. For example, guidance can also be issued on how healthcare institutions and professionals should handle requests for assistance from patients’ next-of-kin and, in particular, verify the identities of the next-of-kin, a question raised by Dr Chia Shi-Lu and Dr Lim Wee Kiak. The approach will be balanced, protecting patients' interests and welfare, yet being fair to doctors. There should also be consideration for practical issues, such as what to do in emergency situations. MOH will engage the medical community and public before issuing the guidance.”
“Fearing that they might be called out should a complication occur, doctors are likely to overwhelm patients with voluminous information on multiple unlikely risks, protecting themselves legally but confusing patients. This would be highly detrimental to Singapore's healthcare system and will damage the trust between doctors and their patients. We should guard against turning into the kind of society where doctors care more about not being sued or disciplined by the professional body than about the patients' well-being. This is a well-travelled road elsewhere with very predictable consequences. The United States is a prime example of a healthcare system where large sums are awarded for medical negligence, a significant fraction of healthcare costs goes towards medical indemnity insurance, and patients and society as a whole end up bearing these costs. We will address this and provide clarity and guidance in two ways. First, the workgroup that is reviewing the SMC Disciplinary Processes will also review and study the legal and practical applications of taking informed consent. They will evaluate the local practice in different settings as well as study the practices in other jurisdictions. The workgroup will also consult widely on this and seek views from the medical community as well as the public. It will make recommendations to the Government on every aspect of informed consent and give guidance to the medical profession on what, where and how in taking informed consent. The intent is to address the needs of the patients while providing the medical community with clear practical guidelines so that doctors do not have to second guess what is needed in each case.”
“This is the process by which doctors provide patients with relevant and material information about the recommended course of treatment, potential risks of the treatment and possible alternatives, to enable the patient to make an informed decision with regard to his care options. The law on informed consent has, for a long time, been based on the well-known Bolam test, which has been consistently affirmed in Singapore, including by the Court of Appeal in the case of Gunapathy in 2002. This landmark decision set out the standard clearly. Over the years, the test was clear and well understood by the medical profession. In 2017, the Court of Appeal departed from its earlier decision of Gunapathy and applied a modified version of the test formulated in the United Kingdom case in Montgomery versus Lanarkshire Health Board. The court has ruled that a doctor, in taking proper informed consent, has to provide such information as that particular patient objectively requires. The feedback from the medical profession is that doctors are not sure as to how to apply the new legal test in practice settings. There are uncertainty and concern among doctors as to exactly what information would be considered to be relevant and material from the patient's perspective, and when and how consent needs to be taken. The recent case where Dr Lim Lian Arn was fined $100,000 for failing to take informed consent for a procedure has brought this issue to the fore. In the current climate of uncertainty, there is a real risk that medical practitioners will adopt defensive medicine. There is evidence that this is already happening.”
“We have to do a thorough review of the existing structure and process, and consider what is the best way in which complaints against doctors should be dealt with, which will minimise the current problems. We must seek to achieve clearer and more consistent outcomes faster, and which both the public and the medical community will have confidence in. I have appointed a workgroup comprising doctors, legal professionals and other persons with relevant expertise to completely review the SMC's complaints and disciplinary processes. The workgroup is co-led by Assoc Prof Ng Wai Hoe, Medical Director of National Neuroscience Institute and Deputy Chairman, Medical Board at SingHealth, and Ms Kuah Boon Theng, a Senior Counsel, who specialises in medico-legal cases. The workgroup has a broad mandate to review the entire process and make recommendations to my Ministry. They will consult widely. A series of engagement sessions have already been planned. The first few townhalls were conducted last week with SingHealth on Thursday and Gleneagles on Friday, and another session is planned with NUHS this week. These consultations will continue as we want to canvass as many views as possible. The workgroup’s recommendations are expected by the end of the year. In addition to the workgroup, MOH had also set up a Sentencing Guidelines committee to set out principles and guidance for sentences, to ensure greater consistency and fairness in the sentences meted out by the DTs. This committee has started its work and is expected to also report by the end of the year. Let me now address the issue of informed consent.”
“Whilst SMC has been making efforts to clear cases faster, the overall process generally takes too long, and some cases experience prolonged delays that are egregious and wholly unacceptable. Second, SMC has faced challenges in engaging doctors to serve on the Complaints and Disciplinary Committees, or as experts. This is partly due to the small community of senior practitioners and partly due to the difficulty in securing the commitment of experienced practitioners to serve, because of the heavy time commitment and opportunity cost incurred. I am most grateful to the doctors who have served on our CCs and DTs. We will have to improve and strengthen the system to better support them as they carry out their duties. Third, despite the guidance in SMC's Ethical Code and Ethical Guidelines (ECEG), there is wide variance in interpreting standards of care. Whilst the Guidelines cannot cater for all scenarios, we need greater clarity on the application of the standards in specific situations, such as the communication of medical information to patients’ family members and the taking of informed consent. Fourth, there is the issue of consistency and fairness of sentences meted out. Some sentences are not commensurate with the circumstances of the case. Despite their best efforts, some DTs are too lax, whilst others are too draconian and the SMC has had to appeal to the Court against the sentences meted out in these cases. The two recent DT cases, for instance, involve unexpectedly high fines. But there have also been cases where DTs imposed sentences that were too low, and the SMC has had to appeal to the High Court to increase these sentences. My Ministry will review the SMC disciplinary process.”
“The SMC Council members do not sit on the DT, so that the DT can act independently of the SMC. Annually, the SMC receives an average of 170 complaints. Most are resolved at the CC stage with about 8% being referred to DTs. This system is built on self-regulation. As professionals, doctors have to make care decisions in the best interests of their patients. More often than not, they have to rely on their professional judgement. Therefore, what is appropriate in each case is determined by their peers, taking into account what is acceptable practice. It is important to maintain the confidence of both the doctors and the public in this system. Both must have full confidence in the transparency and fairness of the process and outcomes. However, the recent cases which I described earlier have cast doubts on this. We have to address these concerns directly, make the necessary changes and give appropriate guidance so that there are greater clarity and consistency. I will now outline some of the main problems which have arisen in the operation of the current system. First, serious delays in the disciplinary process. Delays are unfair to the complainant who would be looking for closure. It is also unfair to the doctor, as it may prejudice the doctor's defence, affect his practice and livelihood, and cause unnecessary anxiety. It currently takes too long for a case to be heard. It takes up to two years and occasionally longer for the CC to reach a conclusion and, if a DT is convened, up to another two years to conclude the case, and occasionally even longer. If there is an appeal by either party to the Court of Three Judges, further time will be taken up.”
“Four specific concerns arise from these cases: one, what constitutes proper informed consent; two, whether radiological reports with adverse findings should be returned to the doctors or teams who had ordered them, or should they be routed to another specialist department for follow-up; three, whether the convictions and sentences are fair and reasonable, and reflect practice realities on the ground; and four, how to remedy the weaknesses of the SMC DT disciplinary process. We share all of these concerns. My Ministry will address them decisively, while always putting patient safety and welfare first. We have to act decisively because these concerns, if unresolved, will, over time, engender the practice of defensive medicine. This will not only affect doctors, but ultimately compromise the quality of medical care, raising medical costs and harming patient welfare. I will set out a broad overview of these issues and then outline the initiatives to address them. Let me, first, briefly describe the current SMC disciplinary process. The SMC is a Statutory Board and a self-regulating body, made up of both elected and appointed medical professionals. Its primary objective is to protect the welfare and safety of patients by regulating the professional and ethical practice of registered medical practitioners and by upholding high standards in the medical profession. When a patient makes a complaint, a Complaints Committee (CC), drawn from a panel of 100 senior doctors and 50 laypersons, reviews the complaint and decides on the appropriate further actions. When needed, the SMC will appoint a DT to hear the case. Both CCs and DTs are made up predominantly of doctors, aided by specialists who provide expert opinions, as well as legal professionals and laypersons, as appropriate.”
“MOH has asked SMC to consider an appeal and SMC has done so. The two DT decisions, as well as the uncertainty surrounding the current law on doctors' obligations, risk undermining the confidence of both the public and the medical profession. We must, and will, deal with the issues that have arisen to restore and ensure confidence. The Court of Appeal’s decision in the civil suit concerned a case of negligence against CGH for delaying the diagnosis of a patient’s cancer. I am saddened to learn that the patient Ms Noor Azlin Abdul Rahman has just passed away this morning. Let me offer my deepest condolences to the family. My thoughts are with them. The hospital will extend our support to the family. The Court of Appeal's decision has been interpreted by the medical profession to mean that, in the majority of cases, radiologists are well placed to decide which specialist or hospital department should follow up on a radiological report with an adverse finding. This is different from the current general practice, which is to return the radiological and test reports to the doctor and team who had seen the patient, ordered the investigations and had the continuing obligation to care for the patient. Radiologists are understandably worried that they do not have the same care relationship with patients and are not in a position to decide which department or specialist is most appropriate for the continuing care of the patient. Our lawyers have told us that the medical profession may not have interpreted the Court of Appeal's decision correctly. Nevertheless, we must deal with the medical profession’s concerns and clarify the position.”
“Mr Speaker, thank you for allowing me to speak to make a Statement on Protecting Patients' Interests and Supporting the Medical Community. Sir, both the medical community and the public have raised serious concerns regarding two recent decisions of the Singapore Medical Council's (SMC's) Disciplinary Tribunals (DT), as well as a decision of the Court of Appeal in a civil suit against Changi General Hospital (CGH). Members have asked various questions on these cases, which I will address in this Statement. Let me briefly outline these cases. The first decision was in respect of an orthopaedic surgeon, Dr Lim Lian Arn, who was alleged to have failed to obtain informed consent from his patient before performing a procedure, and was fined $100,000, the maximum fine permitted under the Medical Registration Act. SMC has taken steps to appeal the DT's decision. The Court will review this case and evaluate the decision of the DT, including the appropriateness of the fine. The second decision concerned a psychiatrist, Dr Soo Shuenn Chiang, who was alleged to have failed to take appropriate steps to verify the identity of his patient's family member before releasing a memorandum containing her sensitive medical information to the family member. He was fined $50,000. SMC has taken steps to pursue an appeal against the DT's decision in this case as well. On appeal, the Court will review the surrounding facts, including the circumstances in which the memorandum was procured and obtained by a family member. As both these cases are still before the Courts, I shall refrain from referring to them in detail. It will, however, be clear to Members that the Ministry of Health (MOH) is also deeply concerned with the decisions in both cases.”
“Mr Speaker, as I would be making a Ministerial Statement later on this subject, may I have your permission to take both Question Nos 1 and 2 during my Ministerial Statement?”
“As the home and community care sector grows over time, we will need to continually improve the quality and standards of home and day care services. Healthcare professionals working in the sector, such as doctors, nurses and therapists, are already subject to licensing by their respective professional bodies. They are held to strict professional standards in areas, such as code of conduct, practice standards and competencies. In 2015, the Ministry of Health (MOH), in consultation with the sector, also introduced developmental service guidelines for home and day care providers covering areas, such as care delivery, staff training and staff qualifications. MOH will review the need for more formal regulation of the home and day care sector. We have provided for the future regulation of home and day care services within the scope of the upcoming Healthcare Services Act. The specific timing, phasing and regulatory approach will need to be studied carefully as the sector is still nascent and evolving.”
“The Assisted Reproduction Programme (ARP) insurance scheme provides protection against unexpected cost of neonatal care incurred by babies conceived via in-vitro fertilisation (IVF), in the event that specialised care is required. It provides a cash benefit of $150 or $300 per day, if the baby is admitted to a Special Care Nursery or a Neonatal Intensive Care Unit respectively. Since 1994, couples are required to purchase ARP insurance when they enrol for IVF, as MediShield did not previously cover neonatal conditions. With the introduction of MediShield Life, it now provides universal coverage for all Singapore Citizens from birth. It provides coverage of up to $700 per day of normal ward hospitalisation and $1,200 per day of Intensive Care Unit hospitalisation. The MediSave Grant for Newborns, introduced since 2012, can also be used to offset hospitalisation costs, up to the MediSave withdrawal limits of $450 per day. We will also be extending MediShield Life coverage to serious pregnancy or delivery complications, which will take effect from 1 April 2019. The Ministry of Health has, therefore, decided to remove the requirement for couples to purchase ARP insurance before undergoing IVF, effective 1 April 2019. Insurers may continue to offer ARP insurance or similar products, if they assess that there is sufficient demand. Couples who wish to have additional coverage beyond MediShield Life and MediSave can still purchase ARP insurance or other maternity insurance plans in the private insurance market to meet their needs.”
“The Ministry of Health (MOH) partners voluntary welfare organisations (VWOs) as well as private and public sector service providers in delivering long-term care (LTC) services for Singaporeans. To estimate the costs of providing different LTC services, MOH works with the service providers to conduct regular costing exercises. The costs are determined based on service requirements set out for each care service. The average of the costs across the LTC provided by different service providers, the "Norm Cost" is then used as a reference to determine the funding for the services. As care models, cost structures and productivity vary across service providers, some could have costs that are higher than the norm cost, while others could have costs that are lower. MOH provides means-tested subsidies of up to 80% for LTC services. Singaporeans who require additional help after the subsidies can apply for financial assistance, such as MediFund. Some VWOs provide additional assistance to their clients through charity dollars raised. Some may also choose to provide additional facilities and services using their charity funds. To support VWOs in their fundraising efforts and encourage Singaporeans to give generously, the Government funded Community Silver Trust provides dollar-for-dollar matching for donations raised in the LTC sector.”
“Sir, the value-driven care initiative started in 2017, as I explained in my speech. We appointed a national VBH workgroup. This workgroup already comprised representatives from the various public healthcare institutions, so it is already quite broad-based. To date, we have initiated a total of 17 conditions under value-driven care, and we want to expand this over time. But we need to do it very carefully because, as the Member pointed out, we need a buy-in from both service providers as well as patients so that they are on this journey of value-driven care. We will continue to press on with this effort. But it is already broad-based, involving most of our public healthcare institutions and they have a plan to gradually expand these conditions to more conditions. But we would prefer to focus on these 17 for the time being to make sure that they are done well so that the same methodology, the same model, can then be replicated. If we rush into it, it may create more problems and difficulties. So, we would prefer to focus on these 17, do it well and develop a dashboard so that we can get everybody on board and try to improve and optimise the care outcome and cost effectiveness. Later on, we can replicate it to other conditions.”
“Lastly, having done some of these optimisations, we also want the agency to think out of the box to see whether they can have new innovative ways of managing the supply chain. For example, if you allow your imagination to run wild a little bit, you can think about whether we can deliver medication to the patients rather than having to collect it from the pharmacy. So, if you do a national kind of distribution network, that may be possible. Today, many of us purchase through e-commerce and they deliver to your house quite regularly. But, of course, delivering medication is quite different from delivering your food items and sundries and so on. It is more stringent. We will have to study it very carefully. But aggregating the supply chain and logistics function will allow us to think out of the box and develop new models of distribution which will, in the long term, benefit our patients.”
“Sir, on the quality information of our healthcare institutions, I will take on the suggestion and will take a look and see what kind of quality information we can put up to help patients make informed decisions. It is a useful suggestion. I want to thank the Member for that suggestion. Secondly, on ALPS, ALPS stands for the Agency for Logistics and Procurement Services. It is quite a mouthful. But it is an important initiative that we have introduced. The idea is to bring together the supply chain functions of all our clusters so that we can achieve economies of scale, aggregate demand and so on. 4.45 pm The first step is to better understand the procurement practices of the different clusters and see whether we can harmonise them, first, to achieve economies of scale by aggregating the purchases of the various clusters, and then we have a higher leverage with our suppliers so that we can negotiate for better pricing. Secondly, we are also looking at whether we can take the next step of standardising some of the products, instead of each one having their own prescribed specific products for the cluster, and whether we can find common products that we can further aggregate the demand so that we can optimise the supplies. Beyond that, the agency is also looking into how we can reorganise our distribution network, our logistics arrangement, our entire supply chain management so that we are able to optimise resources. For example, if you can imagine that you store your pharmaceuticals in one warehouse and deliver them to another hospital, and you have another warehouse deliver to the other hospital, actually we can just have one warehouse to deliver to both hospitals. So, there is opportunity for us to optimise.”
“We need to increase awareness of the resources that are available to caregivers, and more systematically match these caregivers to the help they require. 2.15 pm (In English): I have spoken about our progress, transformative initiatives that can change our care models, and MOH's focus areas for the next three to five years. But at the heart of our healthcare strategies is people – people like you and I. MOH and our healthcare providers can only do so much. For every "top-down" programme, we need many "ground-up" support and initiatives. Each of us must actively take charge of our health and come together as a community, or just as a group of friends, to support one another. This is why I find the example of "Team Strong Silvers" so inspiring. Team Strong Silvers is small, but mighty. It is a group of friends with a common interest in health and fitness who decided to form a senior citizens’ interest group in 2013. Just like its name suggests, the members build up their strength through calisthenic exercises. The team hopes to encourage more seniors to age actively, and to inspire younger generations to invest in their health from an earlier age. I am glad to see the team actively spreading the healthy lifestyle message via social media and even carrying out onsite fitness training sessions for other seniors. With more seniors like them, I am hopeful that we will add more years of healthy life to our growing life expectancy. And when we replace "I" with "We" and do it together, "Illness" can become "Wellness".”
“More than 2,000 Singaporeans die prematurely from smoking-related diseases each year, and the social cost of smoking in Singapore has been estimated to be at least $600 million annually. We will continue to work on reducing smoking rates. However, despite our best efforts to stay healthy, we may still fall ill and become frail as we age. Caregivers will need greater support as they will play a key role in caring for the sick and frail among us. With an ageing population and longer life expectancy, caregiving needs will rise, with family and informal caregivers playing an increasingly important role. Many will have to balance their work and family responsibilities. There is, therefore, greater urgency for the society to come together and collectively support our caregivers and ensure that adequate "hardware" and "heartware" are in place. Sir, allow me to share the story of Mr Tang in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] Mr Tang, who is 42 years old, heads the business development department of his company. In the past year or so, Mr Tang has been caring for his 81-year-old father with dementia, together with his mother, wife and siblings. While his mother is the main caregiver, the other family members also take turns to help care for his father. Although Mr Tang and his family faced challenges adapting to his father's behavioural changes, it was fortunate that his wife works in the healthcare sector, and the family was able to identify various avenues of support and help. Nonetheless, not all caregivers are equipped with such knowledge, or have other family members to share the caregiving burden. With our ageing population, caregiving needs will grow and we need to strengthen the support for our caregivers.”
“This is why we have MediShield Life and, soon, CareShield Life. We will continue to explore how we can further strengthen the role of insurance as we move forward. Lastly, individuals have the responsibility of saving for our own healthcare needs during our working years, including through MediSave, to meet our future needs when we grow old. We also have the responsibility to make well-informed decisions to choose appropriate healthcare services. But the most effective way to keep healthcare affordable is to stay healthy. The next challenge is, therefore, to take more decisive steps to encourage healthy living. Three years ago, I declared war on diabetes in this House. This is probably the only war that the Parliament has ever declared. We have made some progress but we do need to push harder. We held a Ministerial Conference on Diabetes last year and one of the key takeaways is that to tackle diabetes effectively, we need a coordinated effort by all stakeholders, not just MOH. In the year ahead, we will step up our efforts on several fronts, reducing diabetes-related amputations, empowering patients and healthcare professionals to better manage diabetes and minimise complications. In particular, we are also recommending the use of non-fasting screening test for diabetes to increase screening rates, and will make early screening more convenient for women with a history of gestational diabetes. My colleagues will elaborate more on these efforts later. Smoking is another area that we need to move more swiftly and strategically on. Tobacco use is the second-highest contributor to Singapore’s disease burden.”
“The MGP is our way of honouring the MG for their unique contributions in shaping the nation during our formative years. The Package is designed to support MG seniors in leading a healthy and active life as they age, and to provide assurance that they will be able to afford their care expenses. Senior Minister of State Amy Khor will share more details on MGP later. Senior Minister of State Edwin Tong will update on our proposed enhancements to CHAS so that all Singaporeans will have access to affordable quality primary care, especially for their chronic conditions. Healthcare providers and professionals, too, play an important role in keeping healthcare costs in check, through ensuring efficient operations and abiding by appropriate pricing and clinical practices. We had introduced fee benchmarks last year to provide all stakeholders with a useful reference on appropriate fee levels. We have also studied best practices and approaches on value-based healthcare in the US and elsewhere, which Mr Leon Perera asked about, and adapted it to our local context. It is also difficult for me to explain value-based healthcare in two minutes. So, I will try to be brief. Since 2017, MOH has appointed a National Value-based Healthcare (NVH) Workgroup to look into this. By comparing standardised clinical quality indicators and cost data across our public healthcare institutions, it will help our healthcare providers to identify best practices among them as well as identify opportunities to improve clinical outcomes in a cost-effective way. More work will need to be done and we are continuing to explore this. Insurance allows risks and resources to be shared across all members in the pool, helping patients to cope with large and unexpected healthcare costs.”
“There are strict controls to protect against unauthorised access. The NEHR system also does not allow users to download records onto workstations. As highlighted by Mr Christopher de Souza, having well-trained IT and cybersecurity specialists familiar with healthcare is key. MOH, with CSA’s support, is working to ensure that technical training for our cybersecurity specialists meets the industry's best practices and standards. Good cyber hygiene practices are regularly shared with all public healthcare staff. But we must assume that persistent attackers will not give up and they will eventually get through, despite the strongest protection. Therefore, the second level of safeguards is having proper detection and enforcement measures to pick up any breaches quickly and escalate to the appropriate level for prompt investigation and containment. All NEHR accesses are logged and subjected to monthly audits, using analytics to detect unusual usage patterns. The Integrated Health Information System plans to roll out a feature that will allow patients to view accesses made to their NEHR records so that they, too, can report any suspicious access. The third level is deterrence. We must take stern action against anyone who is responsible for data breaches, including our staff who have failed in their duties. This way, we can ensure a strong data protection system. Sir, our next challenge, as highlighted by many Members, is to keep healthcare affordable. As Mr Charles Chong pointed out, all stakeholders must work together to ensure that our healthcare system will be sustainable not just for our current needs but also for the needs of our future generations. As our Minister for Finance has announced in his Budget speech, we will be launching the MGP this year.”
“While efforts under Phase 1 will continue, MOHT and NUHS have commenced Phase 2, which aims to better integrate hospital care with community services required by patients living around Queentown. Dr Chia Shi-Lu will be very happy to know that this pilot will be in Queenstown. It is still early days, and these efforts will need to be fully developed and evaluated before scaling up. MOH will continue our care transformation efforts, in line with our strategy to move Beyond Hospital to Community, Beyond Quality to Value, and Beyond Healthcare to Health. However, there are a few key challenges ahead of us. First, we have to strengthen the robustness of our healthcare IT systems, including data privacy and security. As highlighted by Mr de Souza, IT and data play an important role in our care transformation journey as they help to better inform policy, ensure continuity of care, and allow innovative care models to evolve. The NEHR system, for example, is an important, large-scale national system designed to better support patient care. Assoc Prof Daniel Goh and Ms Sylvia Lim asked about the safeguards in place for NEHR to ensure patient confidentiality. Broadly, there are three levels of safeguards. The first is the protection against cyberattacks and unauthorised access. There are several lines of defences before the NEHR database, with intrusion detection at each line. Regular security audits are conducted, with the most recent penetration test done in October last year. In addition, there are ongoing robustness tests conducted by the Cyber Security Agency (CSA), the Government Technology Agency and an independent third-party PricewaterhouseCoopers. At the user level, the NEHR should only be used for direct patient care.”
“For example, several of our community care providers, such as All Saints Home, have introduced new sensor mats to monitor residents’ movements so as to prevent falls and to provide better care. To catalyse efforts on care transformation, we set up the MOH Office for Healthcare Transformation (MOHT) in 2018. MOHT has been working with partners to design innovative healthcare pilots, such as the new Integrated General Hospital (IGH) model piloted at Alexandra Hospital (AH). This model particularly benefits patients with multiple active conditions, who would typically be attended to by a few specialists during each admission. Under this new IGH model, one care team will look after each patient for better integrated care. Let me give Members an example of Mr Kang Swee Hiang. Mr Kang is an 81-year-old senior who lives alone and was recently admitted to AH for uncontrolled hypertension. He has a number of active medical conditions but was looked after by one care team, without transfers across wards and doctors. The care team found that Mr Kang's cataracts made it very difficult for him to take his medications and may increase future fall risks. The team then reduced the pills he had to take and counselled him on how to take them properly. He also underwent cataract surgery and received physiotherapy, too. They also engaged community partners to schedule befriending and home care services, and connected Mr Kang to the Social Service Office (SSO) for post-discharge assistance and support. AH is now working to consolidate his outpatient care under one principal doctor. About 4,000 patients have benefited from Phase 1 of the IGH model, which focuses primarily on inpatient care.”
“And this has helped to keep healthcare affordable, especially for needy Singaporeans. However, it is unsustainable for us to continue increasing our national healthcare expenditure at this current rate. And I agree with Prof Fatimah Lateef that our healthcare system has to transform the way it delivers care and we must continue to refine our way of funding healthcare services. As individuals, each of us must also take responsibility for our own health. Our healthcare institutions are doing their part to transform their healthcare models. Polyclinics, for example, have been experimenting with new ways to enhance chronic disease management. The National Healthcare Group Polyclinics have piloted a teamlet care model since 2015. By assigning patients with chronic diseases to the same team comprising family physicians, nurse care managers as well as care coordinators, there is better continuity of care. As a result, patient outcomes have improved, with more regular preventive health screenings done, and visits to the doctors and emergency departments reduced. SingHealth Polyclinics and National University Polyclinics are also rolling out team-based care models. Private GPs are our key partners in primary care, too. The Primary Care Network (PCN) started as a ground-up initiative by GPs from the Frontier Healthcare Group to share resources and improve chronic disease management. Senior Minister of State Lam Pin Min will share more about the progress of the PCN scheme. Similarly, we are working towards transforming care at the community level to better integrate social and healthcare services. Community care providers are also doing their part. Some of them are piloting innovative ways to enhance patient care and safety.”
“We have completed seven hospitals since 2010 which will add up to about 3,800 number of beds when fully opened. In 2018 itself, we opened the new Changi General Hospital Medical Centre, Sengkang General and Community Hospitals and, earlier this year, the new National University Centre for Oral Health Singapore commenced operations. We also injected a significant supply of aged care services, especially in home and community care, to encourage ageing in place. We have been training and recruiting healthcare professionals to meet our manpower demand. The number of registered doctors rose significantly, by 52% over the period from 2010 to 2018. Local medicine intake increased by some 60%, from about 300 to about 500 today. Together with Dentistry and Pharmacy, the total intake now exceeds 700 a year and contribute to a strong local pipeline, reducing our need for foreign-trained professionals. 2.00 pm Registered nurses have also increased significantly by 44%. While we had a record local nursing intake of over 2,100 students last year, we will still need more, especially in the critical community care sector. Senior Minister of State Amy Khor and Senior Parliamentary Secretary Amrin Amin will share more about opportunities for nursing and allied health professionals later. Our expenditure on healthcare has increased, too. Since 2010, Singapore’s national healthcare expenditure has almost doubled, from $11 billion to reach $21 billion in 2016. Government Health Expenditure increased even faster, by 2.4 times, from $3.9 billion to $9.3 billion. We have more than doubled the amount of direct Government subsidies given to Singaporeans from about $2.6 billion to $5.6 billion over the same period.”
“Dr Chia Shi-Lu asked for an update on our overall healthcare system. Let me begin by reviewing our overall state of health. Singapore's overall health outcomes are generally good. The Global Burden of Disease 2017 Study published in The Lancet ranked Singapore favourably as the country with the highest life expectancy. Our life expectancy at birth has risen from 83.2 years in 2010 to 84.8 years in 2017. Health Adjusted Life Expectancy at birth also increased from 72.9 years to 74.2 years over the same period. But these figures also show that we are living about 10 years of our lives in ill health. For every 10 years we live, we spend more than a year in illness. These findings are not surprising. The mortality rates due to cancer, stroke and heart diseases have reduced significantly by 16%, from 2010 to 2017. This was made possible in part due to the early prevention, better treatment and disease management, which have contributed to our increase in life expectancy. However, it is not time for us to celebrate yet. The recent Bloomberg report also reminds us that we need to keep up on our efforts. Data also shows that many of us are living with chronic illness. From 2010 to 2017, the prevalence rates of diabetes, hypertension and hyperlipidaemia among Singapore residents aged 18 to 69 have increased by 4%, 14% and 33% respectively. This is partly due to an older population, but we cannot blame everything on an ageing population because it is also partly due to unhealthy lifestyles and habits. If these chronic conditions are not managed well, more serious conditions may result further down the road. On capacity and accessibility, we have stepped up our building programmes.”
“Mr Chairman, I would like to thank the Members for their thoughtful comments. With your permission, may I share a slide at the end of my speech?”
“Based on latest available data in 2016, the Government's Healthcare Expenditure was $9.3 billion, of which about 80% and 20% were on recurrent cost and capital costs respectively. Government expenditure in long-term care was $830 million, of which about 70% and 30% were on recurrent and capital costs respectively.”
“The 2017 data will only be available later in 2019, as the data collection and compilation process spans across many Government and non-government data sources. Based on the latest available data in 2016, Singapore's National Health Expenditure on long-term care, including both formal care and informal caregiving, was about $1.3 billion. About two-thirds of this were borne by the Government, and the remaining one-third was paid by private financing sources, which include insurance, charities and individual out-of-pocket payments. Due to constraints in the data, we are unable to provide further breakdown of these sources.”
“Stress is the body's reaction to challenges. It is a normal part of life and helps us to meet the everyday demands of life. However, extreme or chronic stress can be detrimental to health if it overwhelms an individual's ability to cope. Chronic stress in childhood, such as adverse childhood experiences, has been linked with negative effects on brain development. This may put them at increased risk of developing mental disorders. In adults, chronic stress has been associated with impairment of various cognitive functions, such as memory and attention. While stress has been known to affect physical and emotional well-being, the physiological mechanisms through which this occurs remain unclear. Life satisfaction is influenced by many factors. An optimistic outlook, strong relationships and a supportive environment are factors that can help build resilience that allows an individual to better cope with stress.”
“We recently increased the MediSave withdrawal limit under the Chronic Disease Management Programme from $400 to $500 and lowered the minimum age for Flexi-MediSave from 65 to 60 in June 2018. This has allowed more Singaporeans to tap on more of their MediSave for outpatient treatments. The statistics for 2018 are not yet available. In 2016 and 2017, about 17% of Singaporeans aged 65 and above with chronic conditions and about 16% of those who used MediSave for outpatient diagnostic scans had fully utilised their respective MediSave limits. About 16% of Singaporeans 65 and above had fully utilised their Flexi-MediSave limit. Over the past two years, the Ministry of Health (MOH) received about 200 appeals each year from all age groups for outpatient MediSave use. All appeals are considered on a case-by-case basis and we take into consideration exceptional circumstances, such as whether more complex treatment is required due to unforeseen complications, or if the family is facing difficulties due to special social or financial circumstances. About half of the appeals were approved. MOH will continue to monitor the affordability of subsidised care, and regularly review the financing policies, including MediSave withdrawal limits. We will also continue to consider appeals for usage of MediSave above the withdrawal limits. Those who require further financial assistance could approach medical social workers at our public healthcare institutions.”
“The e-Learning Mental Health First Aid (Singapore) [MHFA(S)] was developed by Changi General Hospital (CGH) with funding from Temasek Foundation Cares to make mental health literacy more accessible through blended learning, that is, online learning with a half-day face-to-face practical session. As of November 2018, over 900 individuals from 26 organisations have attended this e-learning initiative. Of these, 94%, or more than 800, of the participants were certified by the MHFA(S) to have the knowledge to provide initial help to a person developing a mental health problem or in a mental health crisis until appropriate professional treatment is received or until the crisis resolves. The participants, who completed online and practical sessions, were mainly from Government agencies, social organisations, educational institutions, grassroots organisations and faith-based groups. While we do not have information regarding the activities of the trained participants, from informal feedback, CGH understands that their skills have been utilised to support their friends, co-workers and family members with mental health conditions.”
“From 2013 to 2017, the top three causes of death among Singapore residents aged 65 and above were cardiovascular diseases, cancer and pneumonia. During this period, between 3,000 and 3,750 elderly persons died from pneumonia each year. This made up about 25% of the total deaths among elderly persons.”
“These issues tend to vary from issue to issue, from case to case. As much as I would like to have a standard rule and say, "This is not my problem; I just follow the rules" — [(proc text) Hon Members indicated Senior Minister of State Dr Janil Puthucheary would give the reply. (proc text)]”
“Part of this is part of the Police investigation that is ongoing. Maybe I can just say that Brochez is not very consistent in his communication with all the relevant parties. So, it is very difficult to fathom what is his motive in sending these letters or demands. So far, we have not received any complaints or feedback on blackmails or threats from our patients or from any of our contacts. So, I probably should not go too much into the mechanism and the process because this is part of the Police investigation work that is ongoing.”
“I would need to be careful in answering this because the appeal is still in progress, but I can answer, probably, generally. Generally, doctors have to exercise discretion and they will have to exercise judgement, too. Under the ethical codes of conduct and guidelines, they will have to assess whether they do have a conflict of interest. If they feel that they have a conflict, they ought to make it known to the patient and to then step away from whatever procedure or treatment that they may be offering to them. But we cannot have a rule to say that you are not allowed to see everybody you know. Then, you have a problem, because doctors know many people. Therefore, eventually, it is the judgement of the doctor himself to assess whether by treating you, I do have a conflict of interest. But I must say that, in this particular case, it is not the conflict of interest, it is more than that. Brochez has been charged for cheating for fraud for specific reasons. So, it is not just a conflict of interest. In Brochez's case, and the case is over. It was fraud.”
“Patients can take civil action against MOH on breach of data or loss of data. But we encourage them to talk to us, and we will discuss with them what are the ways to help them and to support them in whichever way we can.”
“Let me first respond to Mr Seah Kian Peng's question on Data Analytics Group. We have about 50, but the number who are looking at the governance division, we have about six. So, we will need to expand the governance division. On Mr Png Eng Huat's question, even in 2012, there were data security governance policies at that time stipulated by the Government through the IMs and so on. NPHU is compliant with the requirements stipulated in the Government's data governance policies. For example, even at that time, you were only allowed to download data onto Government-issued computers. Therefore, you were not allowed to download data into your own computers. You were allowed to have portable storage devices at that time, because the encrypted storage devices were only a requirement in 2017, as a whole-of-Government policy, not MOH policy, but whole-of-Government. Therefore, we were in compliance. The nature of Ler's job requires him to constantly operate on the database and, therefore, he is allowed to download the registry into his computer. Unfortunately, he did not protect the data by using an unencrypted thumb drive. At that time, we did not have the encrypted thumb drive policy, so he used a normal thumb drive and he did not protect the thumb drive. If you are using the thumb drive, you need to transfer files from computer to another Government computer to work on it, you ought to protect the thumb drive. The policy stipulates that you must ensure that your access to the confidential official information must be with you all the time. You must ensure that you have possession of the information all the time. But he was believed to have failed to keep the thumb drive with him at all times and, had therefore, contravened the OSA, and that is why he is charged on that basis.”
“As I mentioned, we are now expanding the data governance division. We would need to look at the scope of the work and determine what is the size that we need. Currently, it is a very small unit and it is focusing on dealing with the policies, dealing with practices and reviewing MOH's governance practices on data security. But in order for them to do the audit function, to go down to the ground, to look at practices and to enforce practices, we would need to significantly enhance resources and these would include visiting and checking on the operations and practices on the ground to ensure compliance. Policies are as good as how much they are practised on the ground. Therefore, it is important for us to make sure that they practise what the policy requires. So, we will have to continue to enhance the size of the group. On the recruitment for staff handling sensitive information, we will take a look. But there is no foolproof system because integrity of the person has to be tested over time. The Chinese says, "路遥知马力，日久见人心". So, sometimes you do the best you can in assessing a person's character, but you will never know until you have worked with him over a period of time. We also have to be careful with unnecessary discrimination when you deal with a character assessment. Some of these may not be objective. Therefore, in recruitment and selecting people, we would need to take quite a holistic approach and make a holistic assessment on the suitability of the person.”
“This is something probably for the Ministry of Law to look into. But we will press for whatever is allowable under the law. But because Ler's case is still being appealed, I would not want to go into the case's specific details. We will wait for the Court and the law to take its process.”
“Sir, two points. First, on the risk of suicidal tendencies, I get feedback from my medical social workers who are working on calling the patients and they do tell me that in their calls, there were patients who were suicidal and they have to manage the case very delicately. They have to sense the distress the patients are facing, and they have to make a judgement how much to tell them, whether to stress them further, or to refer them for help. Often, when they come across a person who has a clear intention to do something drastic, they would refer them to the Institute of Mental Health, for example, who can manage them. Often, they would try to refer them to people whom they are familiar with, people who have been their support group, so that they are able to continue to support them. But these are very delicate issues, and I do not want to go into specific details for various reasons. On the issue of – what is Member's second question?”