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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“Volunteers play an important role in the public healthcare system. We have around 2,000 volunteers of all ages across the public healthcare institutions (PHIs) who contribute their time in areas ranging from cancer support, to organising recreational activities for patients, and providing care and pastoral services. These volunteers include ex-patients, members of the public, students and even staff, who do so out of their passion to serve. Our PHIs regularly review their volunteer management practices to incorporate new ideas where feasible and appropriate. Whilst the concept of time-banking is an interesting one, it is important to ensure that we do not inadvertently crowd out the intrinsic motivation of our volunteers to serve others. Our PHIs show recognition and appreciation for our volunteers through various initiatives, such as annual volunteer celebrations, training to develop leadership and patient interaction skills, and recognition awards. We will continue to study the landscape to explore how to further improve the recognition of the efforts of our volunteers and learn from best practices.”
“No vaccines produced by Changsheng Biotechnology had been approved for use in Singapore.”
“All Singaporeans, including expectant mothers, receive up to 80% subsidy for inpatient treatments in public hospitals, and up to 70% subsidy for subsidised treatments at specialist outpatient clinics. Over the past three years, about eight in 10 expectant mothers who received inpatient treatment for a pregnancy or delivery complication in B2/C Class wards had an out-of-pocket payment of less than $500, after subsidies and MediSave. Couples who face financial difficulties with their medical bills may approach medical social workers at our public hospitals for assistance, including tapping on MediFund. The Ministry of Health (MOH) recognises that some serious pregnancy complications could result in large bills. MOH is currently reviewing how MediShield Life can help to cover inpatient treatments for serious pregnancy and delivery complications. We will provide details when ready.”
“The causes of suicide are complex and multifaceted. An interaction of factors, such as family, social and mental health issues, may sometimes trigger suicidal behaviour. Individuals, the community and the Government can all play a part in identifying and caring for seniors who may exhibit signs of distress or require emotional support. We will continue to strengthen our interagency and multi-pronged efforts.”
“This complements the efforts of Senior Activity Centres that reach out to seniors in the community. Seniors living alone can also be referred to "Care Line", a pilot one-stop 24/7 hotline that provides tele-befriending services to those with medical or emotional conditions or facing difficulties in coping. Over 2,100 seniors have enrolled with Care Line to date. We plan to expand Care Line nationwide to reach out to more seniors across Singapore through partnerships with CNS and other community partners. Identifying At-risk Seniors. Third, we have established services and programmes to support seniors identified to be at higher risk of suicide. The Agency for Integrated Care’s (AIC’s) Community Resource, Engagement and Support Teams (CREST) programme reaches out to seniors at risk of dementia or depression and teaches them and their caregivers basic socio-emotional skills and coping strategies, including where to seek help if needed. Seniors with mild to moderate depression may be referred to counselling and therapy services. Family Service Centres (FSCs) also provide counselling and support services to families with seniors to help them with relationship problems, as well as financial and emotional difficulties. Crisis Interventions. Lastly, services are in place to support persons facing a crisis and who require urgent assistance. The Samaritans of Singapore (SOS) operates a 24-hour hotline to counsel persons in distress. Similarly, the Institute of Mental Health (IMH) operates a 24-hour Mental Health Helpline to assess and triage cases and activate home visit teams if necessary. For cases of attempted suicide, the Police may engage the next-of-kin to link them up with support or refer the individual to IMH for an assessment and treatment, if needed.”
“While the number of elderly suicides has increased in recent years along with our ageing population, the suicide death rates among our elderly have, in fact, declined over the past decade. The suicide rate among Singapore residents aged 60 and above fell from 22.4 per 100,000 residents in 2007 to 16.4 in 2017. However, each suicide is one too many. Government agencies and partners in the health and social sectors work together to prevent suicides by promoting upstream prevention, proactively reaching out to pre-empt social isolation and providing support to those at-risk. Prevention. First, in the area of prevention, it is important to build mental resilience in our population, increase awareness of the importance of good well-being and share information on available community resources for mental health support. For example, the National Council of Social Service recently launched a new Mental Health Public Education Campaign that aims to destigmatise mental health issues and encourage help-seeking behaviour. The Health Promotion Board (HPB) helps older adults learn more about mental well-being and resilience through the National Seniors' Health Programme in the community and at workplaces. Proactive Outreach and Support. Second, we need programmes to pre-empt social isolation, especially for seniors who live alone or have weak social support. For example, we are building communities of care through the Community Networks for Seniors (CNS), which will be progressively expanded to achieve nationwide coverage by 2020. CNS will connect seniors, identified by the Silver Generation Ambassadors, who are single or live alone to a befriender. To date, there are over 1,000 befrienders serving more than 3,200 seniors.”
“Our three public healthcare clusters – National University Health System (NUHS), National Healthcare Group (NHG) and Singapore Health Services (SingHealth) – are currently served by four different cleaning providers. All three clusters adopt an open process in selecting cleaning providers. Tenders are open to all cleaning companies, including those that are not currently contracted, and bidders can submit bids for consolidated contracts or sub-components of contracts. This arrangement enables smaller and newer vendors to participate in the tenders. Submitted tenders are evaluated for both price and quality, so as to ensure that the cleaning providers have the operational capabilities to meet our healthcare institutions' requirements in a cost-effective way.”
“The Community Health Assist Scheme (CHAS) was launched in 2012. Over the years, benefits and coverage of CHAS have been expanded and the number of CHAS cardholders has also increased. In 2017, a total of $154 million was disbursed to about 650,000 CHAS beneficiaries, equivalent to more than $200 subsidy per beneficiary, compared to $13 million disbursed in 2012 to 75,000 beneficiaries, equivalent to approximately $170 per beneficiary. The Ministry of Health plans to extend CHAS subsidies to all Singaporeans with chronic conditions, to enable more Singaporeans to benefit from subsidised chronic care at CHAS general practitioners. With this expansion, the projected total CHAS subsidies is expected to rise. The details are being worked out.”
“MediSave is intended to help Singaporeans save for their medical expenses, especially during old age, and its design takes into account significant Government subsidies for Singaporeans. The use of MediSave is, therefore, targeted at Singaporeans seeking subsidised care here. Nevertheless, the Ministry of Health understands that, on very rare occasions, some Singaporeans may find themselves in difficult situations due to medical emergencies when travelling overseas and require help with their medical costs incurred for such emergencies. We do exercise flexibility to allow the use of MediSave in such situations as an exception on appeal, especially for individuals normally resident in Singapore. We review such appeals carefully, taking into account the circumstance of each request on a case-by-case basis.”
“Having sufficient, good quality sleep is an important component of a healthy lifestyle. Insufficient or poor quality sleep can lead to impaired cognition and increased risk of health concerns, such as obesity, cardiovascular diseases and mental health issues. Insomnia, that is, difficulty sleeping and obstructive sleep apnoea (OSA) are the two most common sleep-related problems that Singaporeans seek medical help for. From 2012 to 2016, the number of patients diagnosed as having insomnia at polyclinics has been stable, averaging 5,100 persons per year. The number of admissions to public hospitals for OSA increased from 3,592 in 2012 to 4,685 in 2017. They could be due to varying factors, including increased awareness and more referrals. The Health Promotion Board (HPB) has various initiatives to raise awareness on the importance and benefits of adequate sleep, especially for the young. Efforts include incorporating messages in HPB's stress and psycho-emotional programmes for school children, and engaging parents through workshops to emphasise their role in inculcating good sleep habits in their children. HPB's HealthHub and a microsite also provide additional information on sleep and tips on good sleeping habits for adults and children. Our public hospitals hold regular forums to increase awareness about sleep disorders and their effects on health. The Ministry of Health and HPB will continue to encourage Singaporeans to adopt good sleep habits as part of a healthy lifestyle.”
“The 2015 to 2017 subsidised B2 and C ward hospitalisation statistics on Systemic Lupus Erythematosus, Spondyloarthritis and Psoriatic Arthritis are as shown in the following table. The Ministry of Health does not collect specific Specialist Outpatient Clinic data and primary care data for these three conditions.”
“To ensure inpatient treatment remains affordable, means-tested Government subsidies of up to 80% are available to all Singaporeans at our public healthcare institutions. In addition, all Singaporeans are covered by MediShield Life which protects them against large bills, and they can utilise MediSave for the co-payment portion of their hospitalisation costs. Currently, more than seven in 10 hospitalisations by Singaporeans aged 55 and above in the subsidised wards in B2 or C ward types do not require any cash payment, and more than eight in 10 paid less than $100 in cash. This means that with subsidies and MediShield Life, the MediSave claim limits are generally sufficient to cover the large majority of patients' hospitalisation bills. Where the patient's financial circumstances are more challenging, the Ministry of Health may also consider allowing more MediSave use on appeal. Singaporeans who require additional financial assistance can also approach medical social workers at our public healthcare institutions to apply for MediFund. We regularly review our MediSave withdrawal limits, in conjunction with subsidies and MediShield Life coverage, to ensure that good quality, basic inpatient care is affordable for all Singaporeans. Any changes to the MediSave withdrawal limits must take into account possible impact on Singaporeans' Central Provident Fund contribution rates and our MediSave adequacy in the longer term.”
“In addition to patient subsidies, the Ministry of Health also provides direct funding to subsidised long-term care (LTC) service providers to help them defray their operating costs, including manpower costs. Over $200 million of funding had been extended to 59 LTC service providers between 2012 and 2017 to raise the salaries of LTC staff. This has led to an average increase of local LTC workers' salaries by around 30% across participating providers over this period. We also support skills training, through scholarships and grants, productivity improvement and job redesign initiatives to raise the value of jobs alongside salary increases. We will continue with our efforts to improve career opportunities in the LTC sector and we will regularly review funding support for salaries of LTC staff to ensure that they are adequately recognised for their contributions.”
“CareShield Life is a national scheme and a key pillar of our social safety net. Singapore Citizens and residents covered under CareShield Life will have lifetime coverage and receive payouts for as long as they remain severely disabled.”
“CareShield Life will not be subject to the Insurance Act as it will be administered by the Government. However, the Government will ensure that CareShield Life is managed in line with relevant regulatory requirements that the Monetary Authority of Singapore sets for private insurance companies, including measures to ensure solvency. This is similar to how the MediShield Life scheme is managed today. To ensure the proper governance of premiums collected for CareShield Life, the Government intends to enact new legislation for CareShield Life in 2019. The new CareShield Life legislation will provide for the setting up of a CareShield Life Fund. All CareShield Life premiums collected, along with any investment returns from these premiums, will remain entirely within the Fund. The Fund will be used solely for the benefit of policyholders. It will be audited annually and the financial accounts made public to ensure that all the monies are accounted for. In addition, the Government also intends to legislate the setting up of an independent council to provide advice on the administration of the CareShield Life scheme. The Council will regularly review and recommend changes in premiums and payouts, in accordance with an actuarially sound adjustment framework. If claims are higher than projected, the Council could recommend raising premiums or slowing down payout increases. Conversely, if claims are lower than expected, the Council could recommend payout increases, slower premium increases, or to return surpluses to policyholders as premium rebates. This legislated arrangement will help safeguard the long-term sustainability of the Fund.”
“The Ministry of Health works with our partners to provide a range of services to support seniors who need care services. Currently, around 1,700 seniors receive Home Personal Care (HPC) services which assist them with Activities of Daily Living, for example, showering and feeding, light housekeeping, grocery shopping, elder-sitting as well as provide mind stimulating activities for them. Overall, there is no wait list across service providers. These services are usually charged on an hourly basis and the duration varies according to the care needs of the senior. HPC fees are around $23 per hour on average, before subsidies. For eligible seniors, subsidies of up to 80% are available. HPC providers also extend community and financial support to seniors who require further assistance. Nursing homes typically serve seniors who have higher care needs or are more frail, and it would not be meaningful to compare the cost of nursing home services directly with that of HPC services. Those who face financial difficulties can approach the Medical Social Workers for financial assistance, including tapping on MediFund.”
“In tandem with our support for skills upgrading and productivity improvement efforts, MOH has extended over $200 million to raise the salaries of LTC staff across 59 LTC service providers between 2012 and 2017. This has led to an average increase of local LTC workers’ salaries by around 30% across providers that tapped on our funding support over this period. Going forward, MOH is also working closely with SkillsFuture Singapore to develop a Healthcare Skills Framework which will articulate the roles, skills and competencies for each job role at different levels. Providers can use this framework as a reference to guide progression of staff in the healthcare industry, including the LTC sector. We will continue to work with LTC providers to improve career opportunities and regularly review salaries of LTC staff to ensure that they are adequately recognised for their contributions.”
“Based on data submitted last year by long-term care (LTC) providers receiving Government subvention, about four in 10 workers in the sector were locals. The proportion of locals varies across care settings within the LTC sector. Home and centre-based care settings have a higher proportion of locals than in residential care facilities, such as nursing homes, where workers have to do shift work and care for less ambulant clients. As the LTC sector grows and evolves, the Ministry of Health (MOH) and the Agency for Integrated Care (AIC) have stepped up our efforts to improve career prospects and salaries of LTC workers, as well as strengthened our support for skills development and productivity improvement. MOH works closely with AIC to provide scholarships and grants to make training opportunities more accessible to workers. For instance, training subsidies are provided to support workers' development in areas, such as clinical skills, leadership and people management through basic modular courses offered by AIC-appointed Learning Institutes. Service providers can also tap on the Community Care Manpower Development Award to sponsor staff for advanced formal training in nursing, physiotherapy, occupational therapy, speech therapy, social work and healthcare management. MOH has also been supporting the LTC sector in process improvements, adoption of technology and use of assistive equipment under the Healthcare Productivity Fund (HPF). These efforts aim to facilitate job redesign, increase worker productivity, improve career prospects of employees, as well as allow employers to raise their salaries.”
“The current recommended limit for regular alcohol consumption in Singapore is already two standard drinks a day for men and one standard drink a day for women as suggested by Dr Chia Shi-Lu. According to the latest National Population Health Survey, 2.3% of Singaporeans aged 18-69 exceeded the recommended limit in 2017. Although this was an increase from 1.4% in 2007, our alcohol consumption is still among the lowest in Asia1. Together with its partners, the Health Promotion Board's (HPB's) current strategy is focused on raising awareness on the harms of alcohol consumption and binge drinking among youths. HPB worked with the Ministry of Education (MOE) to include information on the harmful effects of alcohol in the school curriculum for all students at primary and secondary schools. Information on the effects of excessive alcohol consumption, particularly binge drinking, is embedded in the lifeskills programme and health-related activities for Institute of Technical Education (ITE) and polytechnic students, as well as National Servicemen. Similar information is also made available to members of the public on HPB's Healthhub website. HPB also collaborates with other agencies, such as the National Addictions Management Service and the Traffic Police, to include pertinent messages on sensible drinking in their campaigns. The Ministry of Health and HPB will continue to take into consideration evidence that is relevant and applicable to our local context when reviewing recommended limits and public education initiatives. We will also continue to closely monitor the trends of regular alcohol consumption and binge drinking in Singapore.”
“The Ministry of Health conducts regular reviews of subsidised primary care facilities in different geographical localities, including Braddell Heights and the surrounding areas. In doing so, we will take into account the existing subsidised capacity in Community Health Assist Scheme (CHAS) general practitioners (GPs) and polyclinics in the areas as well as the projected primary care demand. Meanwhile, residents within the Braddell Heights constituency can seek subsidised primary care at nearby polyclinics located in Toa Payoh, Hougang or Geylang, and nine CHAS GP clinics in the Braddell Heights area.”
“MOH has provided funding to providers to raise salaries, and this had led to an increase in local staff salaries by around 30% across providers which tapped on our funding support from 2012 to 2017. We agree that better recognition of the importance of care workers will help to encourage more Singaporeans to step forward to join this sector, and we will continue our efforts to reach out to the society at large.”
“The Ministry of Health (MOH) takes a developmental approach to ensure the provision of good quality home- and centre-based care services. In 2015, MOH, in consultation with the sector, introduced developmental service guidelines for home- and centre-based care providers covering areas, such as care delivery, staff training and staff qualifications. Separately, healthcare professionals in the sector, such as doctors, nurses and therapists, are subject to licensing by their respective professional bodies, and are held to strict professional standards in areas, such as code of conduct, practice standards and competencies. Eldercare centres receiving MOH funding are also required to pass service audits. To continually raise standards and improve quality of care, the Agency for Integrated Care (AIC) conducts regular capability-building programmes in areas, such as infection control and medication management, and holds sector forums to regularly share good practices. AIC also provides funding support to providers for staff development. MOH will review the need for more formal regulation, including licensing under the upcoming Healthcare Services Act. The Act is scheduled to be rolled out in 2020. As the sector is still nascent and evolving, we will adopt a risk-based approach and subject services with higher patient risks to higher levels of regulation, so as not to add excessive regulatory burden to providers, which could consequently raise the cost of care for seniors. We recognise the importance of building a strong Singaporean Core to support the growth of home- and centre-based services. In fact, locals comprise more than seven out of 10 of the workforce in the sector as at end 2017.”
“As of 2017, the average duration of claim by ElderShield claimants is 2.8 years. About one-third of claimants have claimed for the full duration of five and six years for ElderShield 300 and ElderShield 400 respectively. Hence, the average duration of disability will be higher than the average duration of claim of 2.8 years. The average life expectancy of Singaporeans who are severely disabled would likely increase in the future. Three in 10 severely disabled individuals are expected to remain in severe disability for 10 years or more. CareShield Life will provide payouts for as long as the policyholder remains severely disabled, which will provide Singaporeans greater assurance and better protection against their cost of long-term care.”
“Breast cancer is the most common cancer among females in Singapore, and the risk of developing the disease rises with age. The Health Promotion Board (HPB) works with healthcare providers and community partners on awareness and public education efforts on breast self-examinations. For example, HPB partners the Breast Cancer Foundation and the Singapore Cancer Society on outreach activities during the Breast Cancer Awareness Month in October each year. An information booklet on breast self-examination is also available at all polyclinics. These efforts benefit females of all ages, including students. Previous surveys have found that approximately 45% of women in Singapore performed regular breast self-examinations1. Because the risk of breast cancer rises with age, HPB puts added emphasis on females of working age and beyond, rather than students. For example, it recommends that from the age of 30, females should do regular breast self-examinations. It also has efforts to encourage women 50 years old and above to go for regular mammogram screening once every two years.”
“Based on available public hospital data, between 2008 and 2017, the average number of hospital admissions per year for alcohol-related conditions, including alcohol intoxication, was about 550 cases. Separately, over the same time period, we have not had any deaths reported where alcohol intoxication is the primary cause of death. In this same period, an average of 14 deaths per year were caused by longer-term effects of alcohol intake, including deaths from acute alcoholic hepatitis and advanced alcoholic cirrhosis.”
“Across all public hospitals, the readmission rates for patients aged 65 and older within 30 days after discharge showed a slight increase in the last five years, rising from 18.9% in 2013 to 19.5% in 2017, as our patients get older. After adjusting for patients’ age and severity of their conditions, readmission rates range between 11.6% and 11.8%. Our public hospitals have implemented various programmes to reduce readmissions. These include the Hospital-to-Home (H2H) programme which provide integrated care support to facilitate patients’ transition home via medication reconciliation, telephonic support, linkages with appropriate community-based services and caregiver training. To date, H2H has served more than 14,000 patients. The Ministry of Health (MOH) has also developed more community hospitals to provide sub-acute as well as rehabilitation care for acute hospital patients who require a longer period of recovery. This enhances the functions and confidence of the patients, thus reducing the risk of readmission. MOH and the public hospitals will continue to work with community and primary care providers to enhance the continuation of care for our patients in the community after their discharge from the hospitals.”
“The Ministry of Health has been encouraging collaborative research between researchers and practitioners in Traditional Chinese Medicine (TCM) and those from our healthcare institutions and institutes of higher learning. To support this, the Ministry established the TCM Research Grant in 2013. We have provided $8 million funding to date. Ten research projects were funded after the first two grant calls, and they are in various stages of progress. Examples of the collaborative projects include (a) a randomised controlled trial conducted by the Singapore Eye Research Institute and Singapore Chung Hwa Medical Institution on the use of acupuncture and herbal treatment in dry eyes; and (b) a study conducted by KK Women’s and Children’s Hospital and Singapore Thong Chai Medical Institution on the supportive role of TCM in the management of mild to moderate childhood asthma. The third grant call closed on 30 June 2018 and the proposals are being reviewed. TCM plays a complementary role in our healthcare system. Where evidence for efficacy and safety is demonstrated, like acupuncture for pain management and post-stroke rehabilitation, our public healthcare institutions have incorporated these into the care for patients. As more research evidence supporting its efficacy emerges, TCM can play a larger role. However, as we are still in the early stages of our research collaborations, we are unable to estimate the future costs of treatments integrating conventional western and traditional Chinese medicine. We will continue to monitor the progress and evaluate research evidence supporting not only its effectiveness but also its safety when TCM is used together with modern mainstream medicine.”
“The Advance Medical Directive (AMD) is a legal document that a person signs in advance, to direct the doctor treating him, not to employ extraordinary life-sustaining treatment to prolong his life, in the event that he suffers a terminal illness and is unable to exercise rational judgement at that time. Making an AMD is a personal, voluntary and optional decision. It represents a person’s considered and rational decision in advance. It is critical to maintain the principle that the decision on whether to accept or reject treatment should be considered carefully and made personally. Hence, we do not support an opt-out scheme for AMD. Where a person is unable to communicate his preference and has not made an AMD, decisions relating to the care should be made by the attending doctor, in close consultation with family members and caregivers, taking into consideration the best interest of the person, and any documented personal preferences.”
“Smartphone addiction is not a medical diagnosis under the international classifications, such as the World Health Organisation's International Classification of Diseases1 (ICD) and the Diagnostic and Statistical Manual of Mental Disorders2. Nevertheless, some children and teenagers do seek help in healthcare institutions for possible smartphone addiction and some of them have been diagnosed with impulse disorders3. Based on data from the Institute of Mental Health (IMH) and the Response, Early Intervention, Assessment in Community mental Health (REACH) teams, the number of young patients diagnosed with impulse disorders did not show any upward trend between 2013 and 2017. IMH reported an average of about 46 cases per year, and REACH teams reported an average of 14 cases per year. The figures, however, encompass various types of impulse disorders as there is no specific diagnosis for smartphone addiction. IMH's National Addictions Management Service (NAMS) has put in place measures on addictions related to the use of smartphones. These include education through outreach efforts at various schools and improving awareness amongst the general public on behavioural addictions through various media platforms, such as print and radio, as well as during the National Addictions Awareness Day. There are also intervention services for young children and teenagers who experience related problems, such as gaming addiction. NAMS provides assessment on the severity of the condition and offers treatment, such as counselling, to overcome such addictions. Beyond NAMS, there are also services available in the community provided by REACH, Community Health Assessment Teams (CHAT) and TOUCH Community Services.”
“The Foreign Domestic Worker Grant (FDWG) provides a monthly grant of $120 to help families employ an FDW to care for their loved ones who require permanent assistance with three or more Activities of Daily Living. As the grant is targeted at lower- and middle-income households, employers with household monthly income per person of $2,600 or lower will be eligible for the grant. Regardless of whether the FDW is employed by a family member living in a separate household, or the care recipient himself/herself, we consistently assess the means of the FDW employer's household in determining the eligibility for the grant. This allows us to take into account the needs of the employer who is directly responsible for paying the salary of the FDW. Nevertheless, we will also consider appeals from families who have extenuating circumstances and genuinely require financial aid.”
“Singaporeans can receive subsidised primary dental care at polyclinics as well as private dental clinics through the Community Health Assist Scheme (CHAS). There are currently more than 700 CHAS dental clinics and, together, they served a total of about 438,000 patient attendances in 2017. Ten of our polyclinics also offer subsidised primary care dental services. The median waiting time for new dental appointments at our polyclinics is about 4.5 months in 2017, compared to 5.8 months in 2013. Specifically on the Member's question about dental clinics at SingHealth polyclinics, there are three of them in the eastern region, serving about 31,000 patient attendances in 2017. They are Bedok Polyclinic, Punggol Polyclinic and Tampines Polyclinic. In planning for dental care capacity, The Ministry of Health takes into account both CHAS dental clinics and polyclinic dental capacity. Therefore, not every polyclinic will need to provide dental care services, if overall, there is adequate subsidised capacity to meet the dental care needs within a geographic location.”
“And even with Internet access, there are ways to protect against our core database system. For example, you could designate specific servers that they have access to and denied access to other servers that are not related. I do not want to go into too much detail because these also have implications on our security measures. Suffice to say that I do not want to pre-empt the outcome of the review. We give the Committee and the team time to look at the system and to review the implementation of ISS on the ground today. And from the experience of ISS, we can then make an informed assessment of which are the parts that should continue with ISS and which are the parts we should maybe refer to alternative solutions.”
“Sir, let me, first, respond to the second part of Assoc Prof Daniel Goh's question on which part of the system should be continued with ISS and which one should be exempted from ISS. It is still early days. I would not want to pre-empt the decision. IHiS, together with SingHealth and the clusters, are reviewing and we have also just implemented ISS. We really want to understand the impact on the ground and assess which are the parts that really can continue with the ISS and which are the portions of the healthcare system that actually ISS is not practical and could affect patient care in the long term. So, just to explain, today, whilst we have introduced ISS, there are a number of workaround solutions which the IHiS team has been working with our clusters on the ground to help our doctors and patients to ensure that the system will continue. But some of these workaround solutions are not sustainable in the long term because they are basically workarounds. And, therefore, we will have to look at whether there are practical, long-term solutions for some of these workarounds. In areas where it is not possible and there may be alternative safeguards that will be able to provide added protection but not necessarily ISS, those are the alternatives that we could consider. One example I mentioned earlier in my Statement was a virtual browser solution, together with Advanced Threat Protection measures. Taken together, they will provide significant protection without having to resort to ISS. I would imagine that in a healthcare system where care is quite closely linked to Internet access in some areas, for example, emergency departments and so on, it may be critical, and these are the areas which are more likely to be given certain rights for Internet access.”
“In the meantime, we also had to make sure that there were no further attacks on the system. As we mentioned earlier, as late as 19 July, there was still malicious activity in the data system. That is why we had to impose ISS on 19 July evening, so that on 20 July, when we disclosed to the public, we were quite confident that the system had been stabilised. At the same time, we have sufficient information to share with the public on how the incident happened, what were the data that were compromised, and who were the patients that were affected. All these require time to prepare. And it is important for us to ensure that our information given to the public is accurate as far as we are able to ascertain.”
“I will first clarify the second question. I think SingHealth, during the press conference, had also apologised, probably it was not carried in the media. But they did apologise to the patients for the incident as well as the inconvenience that has been created. Anyway, my apology is on behalf of the entire healthcare family. I take it that, ultimately, I will have to apologise to the patients who are affected. On the first question on the time between 10 July when we confirmed that it was a cyberattack and 20 July when we had a press conference and informed the public, I explained in my Statement that between 10 and 20 July, many things were happening and there were multiple streams of work that were carrying on at the same time. Our priority at that time was to ensure that our system was protected, our data would not be subject to further exfiltration. That took a while because, first, they had to trace back where the sources of attack came from, so that the Cyber Security staff would know where and how to protect the database. We also need to investigate to determine whether or not there were additional data that were compromised beyond what we already knew. So, the first stream of investigation was to focus on protecting the data. The second stream of work was on investigation of the incident to trace back to see how it started, so that we were confident that this was the only attack that we were experiencing. The third stream was to identify what were the data that were compromised and who were the patients that were affected, so that we could pave the way to inform them. Therefore, the third stream was very important as well. At the same time, SingHealth also started to prepare to inform the patients, and all these will require time.”
“Mr Speaker, Sir, as I explained in my speech, IHiS, together with CSA, has gone through our detailed access logs to ensure that the data has not been altered. But we understand that patients will still be anxious and want to know more about this incident, and how they can protect themselves, and what implication there is for them. I encourage them to contact SingHealth which will then follow up with more detailed explanation specifically to the affected patients. There is a hotline that they can call, and the number is 6326 5555. If they want to have more details, please contact SingHealth and our people, our hotline operators, are trained to answer their questions and to help them clarify any doubts or anxiety that they may have with regard to their medication information.”
“We look forward to its report and recommendations to further strengthen our resilience against cyberattacks. At the same time, we will be conducting a thorough review of the robustness of the cyber safeguards of our key IT systems. We will identify potential areas for improvement in cyber threat prevention, detection and response. To do this, we will bring in third-party experts to support us in this work where necessary. Finally, we will ensure that the lessons learnt and improvements needed are shared widely, across both the public and private healthcare systems. We must take this cyberattack seriously. While we have implemented additional cybersecurity measures, including the ISS, we must not be complacent and assume that we are now safe from cyberattacks. Instead, we must work on the assumption that the perpetrators will continue to try with increasingly sophisticated tools and techniques and may succeed in getting through. We must all remain vigilant, learn from this and continually strengthen our systems against evolving cybersecurity threats.”
“We will, therefore, put NEHR through a rigorous independent external review before we proceed with the mandatory contribution of electronic health records. We have engaged CSA and PricewaterhouseCoopers (PwC) Singapore as independent third parties to help identify any vulnerabilities and recommend measures to address them. We must assure ourselves, users and patients that the necessary safeguards are in place, before we proceed with wider implementation of NEHR. However, we should not reverse our direction in the use of technology in healthcare. Digitalisation, technology and use of data in healthcare have brought many benefits to our patients. We cannot return to the days of paper and pencil. IT systems have allowed us to greatly improve the safety and effectiveness of patient care. During an emergency where a patient is unconscious, access to his medical history in the NEHR helps doctors prescribe more effective medication and treatment in a timely manner. Data analytics help us to better understand disease patterns and plan ahead to meet our needs in the future. Automation improves productivity, reduces human errors and enables patients to receive better care. When patients receive care beyond the hospital, integration of IT systems allows easier referrals across settings and enables better team-based care, and more effective emergency response. These have to be matched with efforts to continually improve our ability to secure patients' data, and the increasing robustness of the systems to deal with a constantly evolving cybersecurity threat. Given the broader national cybersecurity implications, Minister Iswaran has appointed a Committee of Inquiry (COI) to look into this incident. We will extend our full support to the work of the Committee.”
“As a result of the security measures, some patients may experience a longer wait for consultations and in receiving their test results, as well as delays in checking their MediSave accounts or making their claims. The productivity and efficiency of our services may also be affected in some areas. We would like to thank our patients for their understanding as we work through these issues on the ground. Although I said ISS was a temporary measure, now that it has been implemented, we will study the impact of ISS on the ground and determine whether we can keep it as a permanent measure, at least for some parts of our healthcare system. We will need to develop longer-term mitigation solutions to overcome the operational issues if ISS were to stay. Sir, the cyberattack is unprecedented. Despite our security measures, the attackers had been very patient, very persistent and very resourceful. With advanced hacking tools, they eventually succeeded in gaining access to SingHealth’s IT system. We take this seriously as there is no reason to believe that they will not try again, with even more advanced tools. Therefore, we are reviewing the cybersecurity measures of our key IT projects and strengthening them where necessary. Members of Parliament have asked about the National Electronic Health Record (NEHR) system. The NEHR is a separate system that was not affected by this cyberattack. Due to the need for the system to interface with multiple external partners, NEHR is designed differently from the systems that were infiltrated. Nevertheless, we recognise that this is an important national system of significant scale, as it will eventually house key medical records for all patients.”
“Healthcare systems, such as Hong Kong’s Hospital Authority and Kaiser Permanante have not adopted full ISS. One possible approach we are studying and piloting is the virtual browser solution. This enables users to access the Internet more safely through a set of quarantined servers. This will reduce the number of potential attack points. The virtual browser solution will be complemented by the deployment of Advanced Threat Protection (ATP) measures, which will provide additional defence against advanced cyberattacks. The deployment of ATP had been initiated before this incident and is currently underway, expected to be completed by end of this month. Our ongoing pilot on virtual browser was scheduled to be completed by September this year. Nevertheless, given the urgency of the matter, we went ahead to implement ISS, albeit a temporary measure. To mitigate the challenges on the ground and allow the healthcare institutions to continue to operate safely, our engineers worked overnight and through the weekend to put in place temporary work-around solutions. The team continues to be on the ground to resolve the problems that have arisen as a result of ISS. Areas that have been affected include reading of diagnostic reports from laboratories, video consultation and assessment of suspected stroke patients at our emergency department. Waiting times for consultation may also be longer as doctors may need to access references on the Internet through a separate computer. There remain some issues not yet fully resolved, such as referrals to private sector partners, and submission and retrieval of results from screening systems. These do not compromise patient care and safety, but affect the efficiency of our healthcare system.”
“In view of continued malicious activity that we discovered, that we observed, I decided to temporarily impose ISS for all our public healthcare systems. ISS was implemented for SingHealth since 19 July, and the National University Health System (NUHS) and National Healthcare Group (NHG) have done so since 23 July. Imposing ISS will limit avenues for attackers to enter and exit the healthcare clusters’ IT systems. However, ISS has created some inconveniences as well as operational challenges for healthcare workers and patients. We have taken precautions to ensure patient care and safety are not affected. I would like to thank our healthcare workers and patients for their understanding and support. Could we have initiated ISS earlier? ISS is not a decision to be taken lightly. In fact, even before the incident, IHiS had been working with our clusters to study and assess the feasibility of ISS and the ways to mitigate the impact on patients and healthcare professionals. Internet access is an integral part of many of our healthcare institutions’ daily operations. They rely on the Internet to access other systems for the delivery of some healthcare services. These include receiving and reading reports from laboratories, referrals to our private sector partners, video consultation and tele-rehabilitation, as well as the payments and claims systems. We were also learning from the experiences of other countries’ healthcare IT systems and exploring alternative approaches to achieve similar protection as ISS, while minimising the impact on operations and patients. Many healthcare systems in other countries have also found it difficult to implement ISS for practical and operational considerations.”
“We face the constant challenge of striking the right balance between having stronger cybersecurity safeguards, while ensuring effective and safe patient care. To achieve this, we adopted a multi-layered approach to cybersecurity. First, prevention. Our systems are designed with defensive measures against illegal access. For example, there are multi-layer security defences in place, both at the perimeter guarding against threats on the Internet, as well as within the perimeter to protect against unauthorised access. Vulnerability scans and tests are conducted regularly. Independent IT security audits are also carried out, with the last such audit on the affected system carried out in the second half of 2017. Second, detection. We have monitoring tools and services to detect breaches. Our systems are also designed to provide extensive detailed activity logs for internal and external round-the-clock monitoring. Third, response. We have established operating and technical procedures and measures to contain the impact and neutralise the threat once a breach is discovered. In the event of a breach, we will also notify and work with CSA to contain and investigate the breach. Exercises are conducted regularly to ensure staff are familiar with the procedures. Beyond setting up a resilient system, we also need a culture of vigilance and cybersecurity awareness. This applies to our healthcare staff, as well as our IT staff. We should always adopt safe cyber practices, watch for suspicious emails and messages, and report them to our IT departments as soon as possible. Members of Parliament have also asked about Internet surfing separation (ISS).”
“IHiS staff combed through detailed access logs to confirm that the databases were not tampered with. Patient care has not been compromised and services were not disrupted during the period of the cyberattack. Despite the additional cybersecurity measures, we detected further malicious activity on our networks, but no further patient data were accessed or copied. We decided to effect Internet surfing separation for SingHealth on 19 July to minimise the risk of further intrusion and exfiltration. On 20 July, we assessed that the situation had been stabilised and informed the public of the cyberattack, even while investigations were ongoing. Between 20 and 23 July, SingHealth sent short message service (SMS) notifications to about two million patients who visited its healthcare institutions between 1 May 2015 and 4 July 2018, to inform them whether their personal information or medication information were affected. Let me just clarify that this includes patients who visited SingHealth during this period but whose data were not affected. SingHealth also set up an online data check through the SingHealth website and Health Buddy application and expanded its call centres to attend to queries from patients. Let me just clarify that this includes patients who visited SingHealth institutions during this period, but whose data was not affected. Many of our colleagues from the healthcare family were mobilised at short notice to help manage the situation and address patient concerns about the cyberattack. I would like to thank them for stepping up in this time of need. Patient well-being is our top priority. This includes safeguarding the confidentiality of patient data as well as ensuring safe and effective patient care.”
“This process took time as our hospital systems process millions of data queries daily. There will always be a number of unusual processes that need to be investigated and most of these turned out to be legitimate activities. Furthermore, the attacker was careful to remove its traces as it worked, making investigation harder. On 10 July, IHiS confirmed from its investigations that it was a cyberattack, and informed SingHealth, the Ministry of Health (MOH) and the Cyber Security Agency (CSA). Thereafter, several streams of tasks were carried out concurrently. An interagency team, comprising MOH, IHiS, SingHealth, the Ministry of Communications and Information (MCI) and CSA, worked closely together to contain the cyberattack and undertake measures to prevent further attacks. We implemented additional containment and monitoring measures, such as restricting user access, blocking additional connections, resetting security tokens, mandating password changes for users and heightened monitoring of IT systems across our public healthcare sector. At the same time, a separate team in IHiS supported SingHealth’s efforts to assess the extent of the data affected and identify the patients these data belong to, and to plan for patient engagement to inform them of the incident. The cyberattack has resulted in the personal particulars of one-and-a-half million SingHealth patients being accessed and copied. These included the name, National Registration Identity Card (NRIC) number, address, gender, race and date of birth. Of this, 160,000 had information on their outpatient dispensed medicines accessed. However, no phone numbers, passwords or credit card information were accessed. All records in SingHealth’s IT system remain intact and are unaltered.”
“Mr Speaker, thank you for allowing me to make a Statement on the recent cyberattack on SingHealth’s information technology (IT) system. Several Members of Parliament have also asked about the incident, and I will address their questions in my Statement. Sir, what we encountered was a sophisticated and unprecedented cyberattack. Personal particulars and outpatient dispensed medicines of SingHealth’s patients were accessed and copied. Let me once again apologise to our patients for this incident. Our healthcare family’s priorities are not just to provide good patient care, but also to safeguard the confidentiality of their data. This is a very serious cyberattack. The attacker accessed SingHealth’s system through an initial breach on a frontend workstation, circumvented the multi-layered security barriers by using advanced and sophisticated tools, and then gained access to privileged credentials to access the database. This is not the work of casual hackers or criminal gangs, but a sophisticated and resourceful attacker. Let me provide a quick recap of the incident based on what we know thus far. On 4 July 2018, data administrators of our Integrated Health Information Systems (IHiS) detected unusual activity on one of SingHealth’s IT databases. IHiS is the technology organisation that administers the IT systems for the public healthcare sector. The immediate priority of the team was to stop the unusual activity and block the connections to prevent further access. As a result, we prevented further loss of data and no further exfiltration has been detected since 4 July. Concurrently, the IHiS team immediately investigated the suspicious activity to determine its nature and whether it was malicious.”
“Mr Speaker, may I have your permission to also take Question Nos 13 to 19 subsequently in my Ministerial Statement.”
“HPB's communication and education efforts are part of a multi-pronged approach on tobacco control that includes legislation to control tobacco advertising and the minimum legal age for tobacco use, fiscal measures to reduce affordability and provision of smoking cessation support.”
“A 2016 study2 of awareness of the health risks of smoking found that 74% of Singaporeans surveyed were aware that smoking was associated with heart disease, 64% were aware of the association with stroke, 77% were aware that smoking was associated with mouth and throat cancer, and 82% were aware that smoking was associated with lung cancer. To raise awareness of the harms of smoking and to educate the next generation of Singaporeans, the Health Promotion Board (HPB) has several ongoing communication and education measures. One, systematic coverage of the harms of smoking in the school curriculum, supplemented by interactive programmes, such as skits, to help dispel common misconceptions about smoking and equip youths with techniques to refuse cigarette offers. Two, social media outreach to better engage young Singaporeans. Three, talks and seminars at workplaces and in the uniformed services to reinforce messages for adults. Four, HealthHub.sg to make information on harms of tobacco easily accessible online. Five, graphic health warnings on all tobacco products to remind both smokers and non-smokers of the harms of tobacco use. Graphic health warnings have been mandatory since 2003 and are refreshed every few years. Many smoking-related ailments, including heart disease, have been featured. This year, HPB will conduct a new public education campaign to encourage Singaporeans to live a tobacco-free lifestyle. The campaign will continue to emphasise the harms of addiction and tobacco use. The Ministry of Health has also recently conducted a public consultation on the introduction of standardised packaging of tobacco products in conjunction with enhanced graphic health warnings. We have received many submissions and are in the process of evaluating the responses received.”
“The starting salaries for graduates on Ministry of Health Holdings (MOHH) scholarships are standardised within a range across the public healthcare institutions. The public healthcare institutions will determine the exact starting salary for each MOHH scholar within the range, based on factors, such as their level of qualification and relevant working experience.”
“The current Accreditation Council for Graduate Medical Education (ACGME) International (ACGME-I) accredited medical postgraduate training system was introduced in Singapore in 2010 to bring about a more systematic and consistent training for medical specialists. Compared to the former apprenticeship training method, the system provides trainee doctors, who are called "residents", better defined training objectives and competencies, more structured curriculum and regular formative assessments. In 2014, the Ministry of Health (MOH) reviewed the training model and concluded that it was meeting our overall objectives. The review also identified areas for improvement, one of which was to contextualise the model to better suit our specific needs. MOH has been working on the recommended improvements and contextualisation. For example, to better prepare our medical specialists for our ageing population, we are providing our specialists with broader competencies for more holistic care delivery. From next year, doctors will start their specialist training after completing a generic postgraduate year one (PGY1) training. A mandatory geriatric medicine modular training programme has also been instituted as part of residency training for all non-Internal Medicine residents. We will continue to engage and take in the inputs of our stakeholders, including our healthcare institutions, medical community and ACGME-I, and make refinements to our training framework to better meet local needs.”