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 bulk of the PCP is standardised because they are based on the nursing modules or the specific Allied Health Professional modules. But in each of the PCP, it will also involve on-the-job training. On-the-job training would be catered more specifically to the institutions, in terms of their practices, team-based approach and so on. There are variations between institutions but the larger part of it is standardised.”
“Madam, the Healthcare Professional Conversion Programmes (PCPs) help mid-career Singaporeans to train and make a career switch to the healthcare sector. Today, we have PCPs for conversion to registered and enrolled nurses, physiotherapists and occupational therapists, diagnostic radiographers and dental surgery assistants. The Government provides significant funding for the course fees and allowances during the period of training. We have admitted more than 400 Singaporeans from non-healthcare sectors into the Healthcare Conversion Programmes since 2009. For the 223 enrolled between 2009 and 2011, 82% completed their training and were successfully placed into a healthcare job. Among those successfully placed, 92% remained in their jobs after the end of the minimum service period. Our public healthcare institutions also support suitable non-clinical healthcare staff to undergo skills conversion through the PCPs and similar programmes to take on clinical roles. For example, over the last three years, 54 training scholarships and sponsorships were provided for non-clinical in-service staff to convert into clinical roles as nurses and allied health professionals. We also provide upgrading opportunities for in-services nurses to take on higher end roles. More than 750 enrolled nurses entered our Polytechnic nursing programmes over the last three years to undergo skills training to become registered nurses.”
“We also expanded our nursing home and community facilities, by adding 3,400 nursing home beds and 5,600 home and centre-based care places. Fourth, we are systematically refreshing our housing estates, transport system and parks to make our city senior-friendly. All new public housing estates already have barrier-free designs. A $40 million Accessibility Fund has been established to incentivise owners of existing private sector buildings to improve accessibility. We have enhanced road safety for seniors and improved access to public transport. We are experimenting with "therapeutic gardens" and we welcome seniors to our parks to enjoy the sunshine, the greenery and nature, and to stay healthy and active. The Government will continue to plan ahead to ensure that infrastructure developments keep up with the needs of an ageing population. But preparing for the future involves not just infrastructure investments. We also need all citizens to work together to create inclusive workplaces and community to support our seniors.”
“Madam, we take a whole-of-Government approach in preparing ourselves in the face of an ageing population. Launched in 2015, the Action Plan for Successful Ageing outlines the national blueprint to help Singaporeans age well and age confidently, with strong family and community support. The Ministerial Committee on Ageing oversees and coordinates these efforts. First, to sustain our economic vitality and help Singaporeans adjust to the changing economy, the Government has been investing in continuing education and training (CET) infrastructure to help our older workers remain employable. Singaporeans can access heavily-funded CET programmes to upskill and reskill throughout their lifetime. There are also professional conversion programmes to support mid-career switches for PMETs. Many new initiatives have been introduced under SkillsFuture, such as skills-based modular courses. The Government also supports ageless workplaces through the WorkPro scheme which provides funding support for companies to redesign jobs for older workers. In addition, workplace health programmes have been put in place to keep mature workers healthy. Second, we are investing in infrastructure and programmes to cater to the social needs of seniors. HDB has provided more housing options for seniors, such as 2-room Flexi flats, and offered the Enhancement for Active Seniors (EASE) programme to make the home environment safe for our seniors. We are also setting up "Active Ageing Hubs", which are one-stop day centres for seniors which provide active ageing services for seniors. Third, we have been expanding our health and aged care infrastructure as outlined in Healthcare 2020. Since 2012, we have added 2,500 hospital beds.”
“The subsidy framework for healthcare services is guided by a set of policy principles, which include differentiation by citizenship status. As we had previously explained in this House, Singapore Citizens and Permanent Residents receive Government subsidies at public healthcare institutions, with citizens receiving a higher level of subsidies. To support Singaporeans with foreign spouses who are holders of Long-Term Visit Pass Plus (LTVP+), they are also eligible for healthcare subsidies for inpatient services. Long-Term Visit Pass (LTVP) holders do not enjoy subsidies. It is not meaningful to compute the incremental cost of extending healthcare subsidies to all LTVP holders, as it will involve assumptions on the number of LTVP holders, their healthcare needs and the extent of the subsidy to be granted when there is currently no plan to do so.”
“Besides promoting PD and expanding subsidised HD capacity, it is important that we strengthen upstream prevention of ESRD. MOH has recently announced new screening, detection and early intervention as well as more effective treatment efforts as part of the War on Diabetes.”
“The number of end-stage renal disease (ESRD) patients requiring dialysis has risen from 5,200 in 2012 to 6,400 in 2016. This is likely to increase further, due to the burden of diabetes and ageing population. Currently, 92% of dialysis patients are on haemodialysis (HD) while 8% are on peritoneal dialysis (PD). The Ministry of Health (MOH) provides subsidies for patients on PD as well as those receiving outpatient HD at 35 dialysis centres operated by the National Kidney Foundation (NKF), Kidney Dialysis Foundation (KDF) and People’s Dialysis Centre (PDC). At the national level, there are still available HD places, although there may be some geographical mismatch between demand and supply. Compared to HD, PD offers greater convenience and independence to patients as it can be administered at home by the patients themselves. PD also offers greater flexibility for patients as they are not restricted by the HD centres’ schedules4. Hence, MOH has embarked on initiatives to promote PD as an alternative dialysis modality to patients who are medically suitable. This is done in a few ways. First, MOH subsidises PD at higher levels to keep PD costs affordable for lower-income patients. Second, MOH is strengthening education programmes in public hospitals to raise patient awareness and acceptance of PD. Third, MOH has worked with NKF and public hospitals to develop and expand home support programmes for PD patients, where PD nurses will visit the patients to guide and assist them in carrying out PD at home. At the same time, HD capacity will be increased to serve an additional 1,300 subsidised patients by 2020. Four new HD centres will be opened later this year to serve an additional 500 subsidised patients.”
“The second area of focus is community, which is about strengthening community nursing. Community nurses will be equipped with nursing care competencies to meet patients’ needs by working with inter-professional teams at the primary, transitional, home, as well as long-term care settings. The third area of focus is competency, which is about developing broad-based nursing competencies and preparing nurses to practise team-based care across different settings. This work will be undertaken by a committee involving representatives from various professional groups in order to incorporate an inter-professional perspective in the review of the nursing education and training framework.”
“Inter-professional education and practice are integral to our education and training of nurses. For example, degree nursing students at the National University of Singapore have joint learning and training sessions with medical and pharmacy undergraduates on inter-professional communication and teamwork. They are also taught advance care planning with social work students. Nanyang Polytechnic organises an annual "Inter-professional Day" where students from health science disciplines, including nursing and social work, form teams to work on case scenarios and projects together. At our Institutes of Technical Education, students in nursing undergo simulations of team-based care comprising doctors and nurses. All nursing students will also experience team-based care during their clinical attachments in our public healthcare institutions. As part of continuing education and training efforts, doctors, nurses, pharmacists and allied health professionals in our public healthcare institutions will undergo joint training on areas, such as crisis management, patient safety and emergency resuscitation. In addition, the Ministry of Health has been sponsoring close to 50 in-employment nurses every year to undergo team-based skills training overseas. Going forward, the principles of inter-professional education and practice will be incorporated into the implementation of the three strategic areas of focus identified by the Future Nursing Career Review Committee. The first area of focus is care, which is about enabling nurses to focus more on patient care through job and process redesign. This will entail a streamlining of inter-professional and team-based processes to achieve better care and nursing productivity.”
“The Flexi-MediSave scheme was introduced in April 2015 to allow older Singaporeans to use up to $200 of MediSave each year to pay for their outpatient medical treatments at public sector Specialist Outpatient Clinics, polyclinics, and general practitioner clinics under the Community Health Assist Scheme. All Singaporeans aged 65 and older are eligible for this scheme and they do not need to submit applications for approval. In 2016, more than 260,000 Singaporeans, or about one in two Singaporeans aged 65 or older, have benefited from the Flexi-MediSave scheme.”
“HealthHub is a one-stop portal and mobile application developed by the Health Promotion Board (HPB). It provides a range of health-related content, e-services and incentives that encourage Singaporeans to stay healthy. It also enables Singaporeans to access some of their personal health information. As of end January 2017, more than 84,000 Singaporeans have downloaded the HealthHub application. The HealthHub portal has an average of 530,000 page views per month. A new Caregiver Access module was introduced in 2016 to allow authorised caregivers to access the medical appointments and records of those whom they are taking care of. This assists caregivers in keeping records and tracking appointments for their loved ones, who can decide on the level of access granted to the caregivers. In April 2017, HPB will introduce a new Personal Health Management module, known as the HealthHub Track. This provides users with digital tools, including action plans, to monitor and manage their health. HPB will also introduce personalised and localised content to support pregnant women in their pregnancy journey. In September 2017, HPB will introduce a new Diabetes Risk Assessment tool that helps adults, especially younger ones aged 18 to 39 years, to assess their risk for undiagnosed diabetes.”
“Since the National Electronic Health Record (NEHR) was introduced in 2013, usage has been on the increase. Today, more than 21,000 healthcare professionals, including doctors, nurses and pharmacists, from more than 1,000 healthcare providers have access to NEHR. In a typical month, more than 767,000 patient record searches are being made. The providers using NEHR come from different settings. For example, 56% of general practitioner clinics and 70% of the Intermediate and Long-Term Care providers have access to NEHR. In the past year, more care providers from the private sector, including specialist clinics, dental clinics and x-ray labs, have come on board. We will continue to encourage healthcare providers and professionals to adopt NEHR so as to bring more benefits to patients.”
“From July 2017, Government Ministries and Statutory Boards will conduct a three-year pilot to test the viability of providing an additional four weeks of unpaid infant care leave to their employees who wish to apply for such leave. The purpose of the pilot is to assess whether it is feasible to extend this arrangement to other organisations in future. As public healthcare institutions are separate from Government Ministries and Statutory Boards, they are not part of the pilot. We encourage our public healthcare institutions to discuss with the unions on the feasibility of having this arrangement for their employees.”
“With their diverse groups of employees, public healthcare institutions (PHIs) recognise the importance of building inclusive and harmonious workplaces. PHIs provide training to human resource staff and supervisors to work with employees from diverse backgrounds. Orientation programmes are organised for new employees which include modules on workplace culture and diversity. Social activities are also organised to encourage bonding amongst different groups of staff. Our institutions will continue to work with the union and employees to regularly obtain feedback on how we can work together to further improve workplace diversity practices.”
“Madam, let me give a quick answer. When we first set up the RHSes, they had a very clear mission, that is, to integrate care in the respective regions. The RHSes have since worked very hard to establish collaborations and partnerships with the regional service providers so that we can integrate care at the regional level and reach out to the population within the region. Over the last few years, they have done exactly that. This has also provided the impetus for the RHSes to be innovative, test out new models of care and provide the diversity needed for the healthcare system to evolve and to develop. Today, we are moving towards the three key shifts and this is why we are bringing the RHSes together so that they can leverage one another's strengths. One example is the Eastern Health Alliance. Over the last few years, they have spent a lot of effort and invested heavily in community engagement. They have worked very well with the nursing homes in the area. With the GPs, they have the GPFirst programme. They will bring this experience in engaging the community players to SingHealth when they eventually come together and merge with SingHeatlh. We are leveraging the experience and knowledge that they have developed to help the integrated clusters move forward in a decisive and effective manner.”
“We need to do so, but not only building them, but motivating Singaporeans to take charge of their health, to live their lives free of diabetes and, for those who already have diabetes, to provide them with support to help them to manage their conditions well. The three key shifts − beyond hospital to community, beyond quality to value and beyond healthcare to health − will define the future direction of health and healthcare in Singapore. They will lead us towards good, affordable and sustainable healthcare in the long term. All Singaporeans − you and me − want to have good health for themselves and for their family members. Therefore, let us work together as one healthcare system to bring better care, better health and better life to all Singaporeans.”
“One of the beneficiaries is Mdm Goh Soo Eng who was at risk of diabetes due to her elevated blood sugar level. Mdm Goh used to lead a sedentary lifestyle and had a sugar-heavy diet. This left her feeling sluggish and lethargic. Under the recommendation of her doctor, Mdm Goh joined HPB's Diabetes Prevention Programme and learnt to adopt healthy eating and exercise habits. Through these efforts, Mdm Goh has managed to keep her blood sugar level under control without the need for medication and is now an advocate for healthy living and diabetes prevention. She frequently encourages her friends to go for beverages with less or no sugar, and to choose healthier meal options. She also participates in the physical activities at Agape Village. Mdm Goh is a model soldier of the War on Diabetes. (In English): Madam, in my Mandarin speech, I shared the story of Mdm Goh who benefited from HPB's Diabetes Prevention Programme, which helped her manage her blood sugar level and prevent diabetes. Programmes like these are useful in helping pre-diabetics better manage their conditions through healthy eating and exercise habits. We hope to see many more take a step towards proactive disease management and prevent diabetes. Therefore, HPB will launch the "HealthHub Track" in April this year. This is a personal health management app in HealthHub which will provide users with digital tools to monitor and manage their health conditions more conveniently. The War on Diabetes will not be a quick battle and we must be prepared to keep up the momentum and go the distance. We need to fight the war on the ground one day at a time, one battle at a time, and even one person at a time. Winning the war is not about building more hospitals and clinics to take care of those who are already ill.”
“I look forward to more employers coming on board this War on Diabetes. After all, a healthy workforce is a prerequisite for a productive workforce. To fight this war, and to fight any war, we need soldiers. So, who are the soldiers? We are the soldiers. As individuals, we can play a part by being responsible for the choices that we make every day. Apart from staying active, it is also important that we watch our diet. A healthy diet is half a battle won, as we say. Many of us eat out regularly, and that is why MOH and the Health Promotion Board (HPB) have also been actively engaging our hawker centres, coffee shops and restaurants to offer healthier meals with lower calories and beverages with lower sugar. Like Minister Lim, I, too, share with my residents tips to combat diabetes. I encourage them to follow the three "R's" − Refrain, Reduce and Replace. When we decide what to eat, Refrain from unhealthy food, if you can. But I know it is difficult. If you cannot but have to eat, try to Reduce the amount of unhealthy food that you have to eat. If you cannot Refrain and cannot Reduce the amount, then please Replace with healthier alternatives. So, Refrain, Reduce and Replace. These are secrets to healthy living. Mdm Chairman, let me say a few words in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] For those who are at risk of developing diabetes, or who already have the disease, we need to help them manage their condition and prevent complications. Last year, we introduced diabetes roadshows, talks and screenings in the community, and reached more than 120,000 people. In addition, we also have HPB's Diabetes Prevention Programme which helps those with slightly elevated blood sugar levels reverse their risk for diabetes.”
“We have already established some 30 active ageing nodes in the three pilot CNS sites and engaged over 5,000 seniors, including those with diabetes or at risk of diabetes, in preventive health activities, such as health screening and monitoring, health talks and exercise sessions. We plan to expand CNS to the remaining precincts in the three participating Group Representation Constituencies (GRCs) of Tampines, Marine Parade and Chua Chu Kang by the end of 2017. Our aim is to bring CNS to more mature communities progressively so that we can make every community a place where our seniors can be cared for and supported by the community to age well in place. Advisors and Members of Parliament (MPs), too, can play an active part in helping to spread the message and keep their residents healthy. Minister Lim Swee Say, for example, has set up a diabetes taskforce in Bedok to raise awareness on diabetes. I visited one of his many Chit Chat sessions last week, where he personally shared about the War on Diabetes with about 50 residents. It is a lot of hard work, but there is no short cut. All of us have to play our part, in our own way, to reach out to our residents, to help them stay healthy. Not just in the community, at the workplaces, too. Seagate Technology International's Woodlands office is one such example. They regularly organise activities for their staff and participated in the National Steps ChallengeTM Season 2 Corporate Challenge. The office even organised an "intra-organisation challenge" to motivate their employees to clock more steps. Their efforts have paid off as I was told that all their participants have an average daily step count of more than 10,000 steps. Seagate Woodlands is also one of the top scorers for the Corporate Challenge!”
“Moving beyond hospital to community, and beyond quality to value, are about how we change and improve the way we deliver healthcare to our patients who are already ill. But what is perhaps even more important and critical is to nurture a healthy nation and a healthy people. This is why our third thrust is on moving beyond healthcare to health, focusing on early interventions and healthy lifestyle choices which will keep people in good health. This is easy to say but hard to do. We have several initiatives on this, which my colleagues will elaborate later. Mr Christopher de Souza and Mr Chen Show Mao have asked about the progress of our War on Diabetes. The National Diabetes Prevention and Care Taskforce was set up to drive the efforts on this war with three strategic focus areas, namely, healthy living and prevention; screening and follow-up; and disease management. These are underpinned by public education, data analytics and research as well as the mobilisation of stakeholders. The taskforce has engaged widely over the last six months and made useful recommendations even as their work continues. My colleagues will elaborate on these recommendations later on. I will focus on how we can win this war, by working together with communities, businesses, employers, workers and individuals, you and me. First, we need to mobilise the community. And we are doing so through initiatives, such as the Community Networks for Seniors (CNS) which we launched last year. We set up Community Health Posts under CNS to make services, such as health screening and monitoring, more accessible to residents living in our heartlands.”
“Senior Minister of State Amy Khor will speak on our plans to strengthen our community mental health capabilities. Minister of State Chee Hong Tat will share about our collaboration with our community partners. Another area of emphasis for us is to go beyond quality and offer patients value in healthcare provision. Advancements in medicine and healthcare technology offer new opportunities and potential for health and healthcare in Singapore. We want to keep abreast of such developments so that we can introduce new solutions that are clinically effective and cost-efficient and improve healthcare outcomes and quality of life. As pointed out by Dr Chia Shi-Lu, we must be mindful that newer does not always mean better. Some new drugs or treatments may not offer significant clinical advantage and, yet, come at a significantly higher cost. Generic drugs often offer similar outcomes as branded drugs, but at fraction of the cost. A good example would be the generic drugs for statins, used to manage high blood cholesterol, which usually cost less than half the price of the branded versions. Opting for generic drugs will help to reduce medication cost and we are working with our doctors to promote the use of generic drugs. The Agency for Care Effectiveness (ACE) was set up to evaluate the clinical and cost-effectiveness of new treatments. Through the work of ACE, we aim to identify treatments with good outcomes at affordable costs to guide our doctors and patients. ACE will be publishing their first set of Guidance in May this year. Minister of State Lam will also share how ACE's work on Appropriate Care Guides will play an important role in our war on diabetes.”
“We need to move beyond hospital to the community; move beyond quality to value; and move beyond healthcare to health. These three moves are critical in preparing us to meet our long-term healthcare needs in a sustainable manner. The first step is to better organise ourselves so that we can implement these three shifts more decisively and effectively. In January, we announced that we will be reorganising our healthcare system into three integrated clusters. With the reorganisation, the three integrated clusters will each have a broader range of healthcare services and facilities that will provide our patients with more seamless care. They can also tap on a larger pool of resources, including manpower and talent, both professional and managerial talent. The integrated clusters can also offer healthcare workers greater development and training opportunities, thereby raising the competency of our workers that will translate into better quality of care and, eventually, benefit our patients. Primary care will play an increasingly important role in our care transformation. This is why we are strengthening the primary care capabilities of each cluster. The National University Polyclinics (NUP) will be created under NUHS. With this move, each cluster will now have its own polyclinic group. This will enable the clusters to work in close collaboration with the GPs to augment our primary care sector and partner a wider range of community-based service providers, including VWOs, to anchor care firmly in the community, as pointed out by Ms Tin Pei Ling. Minister of State Lam Pin Min will share more about our plans in the primary care sector, including partnerships with the private GPs, through the Primary Care Networks scheme.”
“We will review from time to time. Finally, for needy Singaporeans who still have difficulties with healthcare costs after Government subsidies, MediShield Life coverage and MediSave, we have MediFund to help. Mr Low Thia Khiang asked about profit margins for our drugs in our hospitals and public healthcare institutions. I should take this opportunity to clarify that our public healthcare institutions are not-for-profit organisations. While the drug prices include a margin, this is to offset overheads and operation costs. Therefore, they are not profit margins; they are just margins to cover part of operation costs. In fact, last year, we provided a total of $4.3 billion of funding to our public healthcare institutions to support their operations to keep our healthcare costs low. To help patients with their medication costs, our public healthcare institutions like our Specialist Outpatient Clinics (SOCs) and our polyclinics provide subsidies of up to 75% for standard drugs, with Pioneers receiving a further 50% subsidy. In addition, the Medications Assistance Fund (MAF) is also available to help patients with selected high-cost non-standard drugs, if it is deemed necessary. Patients who still face difficulties despite all these subsidies can also apply for MediFund. With Government subsidies and the 3Ms, MediShield Life, MediFund and MediSave, Singaporeans have multiple layers of support for their healthcare needs. The system is constantly evolving and we will regularly review the adequacy of drug subsidies and the different schemes to ensure that medication remains affordable. 12.45 pm While we have made steady progress on Healthcare 2020, we need to plan for the long term. Last year, I outlined our plans to go beyond Healthcare 2020, encapsulated in the "3 Beyonds".”
“Larger bills, such as inpatient hospital bills and selected costly outpatient bills like chemotherapy and kidney dialysis, are covered by MediShield Life. Since its launch in late 2015, MediShield Life has provided Singaporeans and, especially the seniors, with better support and assurance. Over 500,000 claims were approved under MediShield Life in 2016, an increase of 47% compared to 2015. Claims by older Singaporeans aged above 65 increased even more, at 73% from 124,000 to 215,000 claims. This resulted in a 90% jump in the total amount of claims for seniors from $181 million to $343 million. Mr Murali Pillai asked about MediShield Life coverage for direct admissions to community hospitals. MediShield Life was designed primarily to provide coverage for large, acute hospital bills. As an extension of this coverage, MediShield Life covers community hospital stays for patients transferred from acute hospitals to community hospitals. Nonetheless, we note there could be some groups of patients who are suitable for direct admission to community hospitals without going through acute hospitals and might benefit from MediShield Life coverage. We will study this proposal carefully because it has impact on premiums as well. After subsidies and MediShield Life, the patient can use his MediSave savings to cover his share of the healthcare bills. Dr Lim Wee Kiak asked if the Flexi-MediSave limits could be raised. The Flexi-MediSave scheme was recently introduced in 2015 to allow older Singaporeans to use up to $200 a year to pay for outpatient medical treatment. So far, the majority of eligible patients have not fully utilised their Flexi-MediSave withdrawal limits. It is still early days, but it suggests that the claim limits are generally sufficient.”
“In addition to hospital developments, we have added seven new Family Medicine Clinics (FMCs) and seven Community Health Centres (CHCs) to support the primary care GPs in the community. We have also added 3,400 nursing home beds and 5,600 centre-based care and home care places since 2012. We will add another 4,200 beds and 4,700 places by 2020. But adding capacity alone is not a sustainable solution in the long term if we do nothing else. Our capacity growth must be coupled with efforts to transform our care model to leverage on strong primary and community care and keep our people healthy with better disease prevention and healthier lifestyle choices. To deliver quality services to our people, we need to grow and develop our healthcare manpower. The healthcare workforce has expanded by some 23,000 or 33% over the past five years. We need 9,000 more healthcare workers over the next three years, and there are many good career opportunities for Singaporean professionals, managers, executives and technicians (PMETs) in the healthcare sector. Given Singapore's limited labour pool, however, we cannot just grow the number but ensure that our healthcare workers are meaningfully and effectively deployed. Senior Minister of State Amy Khor will share more about MOH's efforts to build a strong, future-ready healthcare workforce. Several Members have asked about the affordability of healthcare. We have a multi-layer system of support to ensure that Singaporeans can afford the appropriate care that they need. Treatment and drugs that are clinically effective and cost-effective are subsidised. Means-tested Government subsidies at hospitals, Specialist Outpatient Clinics, CHAS clinics and nursing homes serve as the baseline support.”
“We, therefore, have a strong impetus to keep our Singaporeans healthy. Allow me to give an update on Healthcare 2020. Since 2012, we have opened Ng Teng Fong General Hospital (NTFGH), Changi General Hospital Integrated Building (CGH IB), Jurong Community Hospital (JCH) and Yishun Community Hospital (YCH). Together with the expansion of existing facilities, we have added a total of 2,500 hospital beds. Next year, Changi General Hospital will open its new Medical Centre, which will allow it to expand its specialist outpatient services. We also expect to open the Sengkang General and Community Hospitals by end-2018. The new National Centre for Infectious Diseases is also due to open progressively from end-2018. The construction of Outram Community Hospital is underway and it is scheduled to open by 2020. This is part of our overall plan to redevelop the Outram Campus, including the Singapore General Hospital, in a multi-phase process that will take us up to 20 years or more. Woodlands General Hospital and its co-located community hospital will break ground next month and they will be opened progressively from 2022. The National University Health System (NUHS) will take over the operations of Alexandra Hospital after the Sengkang team, which is currently in Alexandra Hospital, moves to the new Sengkang hospital in 2018. The 79-year-old Alexandra Campus is a unique site. The campus offers a unique opportunity as it has tremendous potential for redevelopment. I have, therefore, tasked NUHS to re-imagine healthcare for the future, taking the opportunity to design new and innovative care models that can better promote health and integrate care, and test them out at the Alexandra Campus.”
“Madam, we announced the Healthcare 2020 Master Plan in 2012 which outlined our plans to add capacity, improve affordability, as well as enhance care quality. Last year, we declared war here in this Chamber, War on Diabetes. I also highlighted three key shifts we need to make to prepare ourselves for the future beyond 2020. Today, I will give an update on the progress of Healthcare 2020, as requested by Dr Chia Shi-Lu. I will also give Members an update on the state of the War on Diabetes and outline our broad strategies to achieve the three key shifts beyond 2020. My colleagues will then elaborate on the specific efforts and the measures we intend to include. Madam, a report published in the Lancet medical journal last year placed Singapore in the top ranks for global health, alongside Iceland and Sweden. We have also made progress in managing and treating diseases which are leading causes of premature death for Singaporeans, such as ischaemic heart disease and stroke. Between 2000 and 2015, we have reduced the premature mortality rates for both diseases by half. However, there are some worrying trends. Our obesity prevalence rate has risen to 1.7 times, a 70% increase, from 1992 to 2013. Not 1.7%, but 1.7 times. What is even more worrying is that the obesity rate amongst younger Singaporeans aged 18 to 39 has grown at an even faster rate, doubling from 4.2% to 8.4% over the same period. This is worrying as obesity is a key driver contributing to the diabetes burden in Singapore. Based on our projections, one in three Singaporeans will develop diabetes in their lifetime. Obesity and diabetes are risk factors for heart disease and stroke. If we do not address these risk factors early, the progress on these two diseases will be eroded.”
“Madam, with your permission, may I display some slides during my speech?”
“As a result of our long-term tobacco control programme, smoking rates among those aged 18 to 69 have decreased from 18.3% in 1992 to 13.3% in 2013, based on National Health Survey data. However, over the past three years, smoking rates seemed to have stayed at about 13%. Of concern is also the relatively high smoking rate among our men where nearly one in four or 23.1% smoke. We need to do more. To discourage smoking, we have adopted a multi-pronged approach on tobacco control and public education. The Health Promotion Board (HPB) has expanded its outreach to help smokers to quit. The number of smokers who took part in HPB's smoking cessation programmes has more than doubled from about 6,000 in 2013 to about 15,000 in 2016. For youths, we focus on preventing initiation and helping young smokers to stop smoking. HPB works with educators and community organisations to promote smoke-free living among our youths. For example, smoking cessation training workshops are conducted for educators and youth workers to equip them with the skills and strategies to help youth smokers quit the habit. In addition, anti-tobacco messages are incorporated into the curriculum and Student Health Advisors are stationed in some schools to provide counselling to youth smokers. We need to sustain our efforts to discourage smoking. We are constantly studying various tobacco control initiatives and learning from the experiences of other countries and will consider adopting suitable measures here, including the possibility of increasing the minimum age for buying cigarettes.”
“We are also exploring new ways to deliver healthcare, such as through tele-health, where consultations can be performed via video to reduce physical clinic visits. Physiotherapists could prescribe rehabilitation exercises to patients at home and monitor their progress remotely using wearable sensors and analytics. To bring healthcare beyond hospitals into the community, we are scaling up our national tele-health platforms to more healthcare institutions and community care providers. In addition, public healthcare institutions are reviewing their workflow and processes. This includes redesigning job roles and upskilling healthcare staff to provide better care for patients. MOH will continue to work closely with our healthcare institutions to support productivity initiatives that enhance patient care and service quality and make our healthcare system more productive and sustainable.”
“As Singapore's population ages, we are faced with tighter labour constraints and a rising demand for healthcare services. Healthcare providers have to focus on productivity and improve operational efficiency to continue delivering quality care to patients. Productivity in healthcare is about increasing value to patients, for example, by doing more with the same amount of resources. One initiative under our Productivity Drive is to use automation and robotics as a workforce multiplier to reduce the amount of manual work and enable older employees to continue working for a longer period of time. Since 2012, the Ministry of Health (MOH) has supported healthcare providers to invest in productivity improvements. We have funded more than 200 projects so far, including those involving automation and robotics. Examples include the use of pneumatic tube systems for sending documents and specimens, and the automation of laboratory analysis processes. Hospitals are also using Automated Guided Vehicles to transport inventory items and deliver meals, and deploying automated cleaning robots, remote patient monitoring devices to improve their productivity. Another example is the Pharmacy Automation System, which allows medications to be picked more accurately and quickly. This has reduced pharmacy waiting times by up to 50% in KK Women's and Children's Hospital (KKH), National University Hospital and Tan Tock Seng Hospital. The Outpatient Pharmacy Automation System (OPAS) at KKH's Emergency Pharmacy was further developed to incorporate a new robotic bottle medication dispensing system that automatically loads, picks, and packs bottles. One year into implementation, OPAS has helped KKH to increase its pharmacy capacity by close to 30% with the same staff strength.”
“There were 290,000 Blue and 170,000 Orange Community Health Assistance Scheme (CHAS) cards issued in 2015, while 400,000 Blue and 240,000 Orange cards were issued in 2016.”
“A household’s eligibility for and level of subsidy under the Community Health Assist Scheme (CHAS) depends on their latest household income or property annual value, as well as household composition. To ensure that households receive the correct level of subsidies, households are requested to submit a renewal application form every two years so that we can verify and update their latest household information. The Ministry of Health (MOH) seeks to make the renewal process convenient for CHAS cardholders. Households would receive a reminder letter about three months before their CHAS cards are due to expire. For those who do not respond, another renewal reminder letter is sent about one month before their CHAS cards expire. The renewal application form is included with the reminder letters. The application form is prefilled based on our existing records, to make it simpler for households to update their household information. MOH also works with partners, such as the Agency for Integrated Care (AIC), to publicise information about the renewal process, as well as to reach out and provide any necessary assistance to individuals and households who may not be familiar with the renewal process. The CHAS application form is also available online, and at various locations, such as polyclinics, public hospitals and community centres. We will continue to review the CHAS renewal process from time to time to ensure that it is convenient to the public and enables them to receive appropriate levels of subsidy based on their latest circumstances.”
“Each cluster will serve a population of 1 million to 1.5 million Singapore residents. This is comparable to Hong Kong, which also has healthcare clusters serving populations of 0.5 million to 1.8 million each. Healthcare 2020 outlined our plan to expand capacity, improve quality and enhance the affordability of healthcare services. Even as we implement Healthcare 2020, we need to plan ahead further into the future. Last year, three key shifts to prepare for our healthcare needs beyond 2020 were announced beyond hospital to community, beyond quality to value and beyond healthcare to health. This transformation is necessary as our healthcare needs will grow in volume and complexity due to our ageing population and increased chronic disease burden. For this reason, we need to organise ourselves better so that we can implement the transformation more swiftly and decisively. The reorganisation will enable the integrated clusters to deliver more comprehensive and person-centreed healthcare services that are appropriate and closer to the patients. This will help to reduce the need to access specialist care and the accident and emergency department at the hospitals. The reorganisation will also facilitate scaling up of programmes and services to benefit more Singaporeans. In addition, the integrated clusters will be able to offer their employees a wider and deeper range of professional development opportunities, and a broader platform for cross-learning that will benefit staff and, ultimately, our patients.”
“Based on the Student Health Surveys which are conducted every three years, the prevalence of smoking among Secondary 1 to 4 students decreased from 8.6% in 2006 to 6.2% in 2009 but has remained at the same level in 2012. Although the rate fell to 2% based on the 2015 survey, there was a change in survey methodology, and we are studying the data to better understand if this had an impact. Based on national health surveys which are also conducted once every three years, smoking amongst women increased from 3.7% in 2007 to 4.2% in 2010 and decreased slightly to 3.8% in 2013. Smoking prevalence is determined by complex socio-demographic factors as well as the various tobacco control measures introduced in recent years. My Ministry will continue to monitor smoking prevalence in Singapore and further strengthen our tobacco control programme as part of a multipronged approach.”
“From 2012 to 2016, HSA convicted 37 offenders and SMC disciplined five doctors for inappropriate prescribing of codeine cough preparations.”
“Codeine is used as a medicine for the relief of cough and pain. As codeine can be addictive, the supply of medicines containing codeine is monitored and controlled in a few ways. First, the manufacture, import and supply of medicines, including codeine cough preparations, is regulated by the Health Sciences Authority (HSA). Under HSA's Health Products Act, doctors and pharmacists can only supply to an individual patient not more than 240 millilitres of codeine cough preparation on any one occasion. They cannot supply to the same patient within a period of four days. Any person who violates the law can be fined up to $50,000 and/or jailed for up to two years under the Health Products Act. Second, as the professional body which regulates the conduct of doctors, the Singapore Medical Council (SMC) acts on complaints of errant prescribing or dispensation of codeine cough preparations. The SMC Ethical Code and Ethical Guidelines also provide guidance for doctors to prescribe or dispense drugs with potential for dependence or addiction. Doctors who breach the Ministry of Health's (MOH) guidelines or the SMC Ethical Code and Ethical Guidelines may face disciplinary action and be liable for suspension of between three months and a year, fine and censure. Third, HSA regulates the wholesale distribution of codeine cough preparations, and works closely with various enforcement agencies, such as the Central Narcotics Bureau (CNB) and the Singapore Police Force (SPF) to curb the illegal diversion of such preparations into the illegal market. Finally, to help reduce the demand for such preparations by codeine abusers and addicts, HSA has stepped up public education on the harm caused by codeine abuse through public advisories and press releases.”
“The Ministry of Health (MOH) plans for nursing home capacity to meet projected demand based on a combination of factors, such as demographics and incidence of disability. We have increased our capacity from 9,400 beds in 2011 to 12,800 beds today and will develop more nursing homes to reach a total of 17,000 beds by 2020. This is expected to meet the demand for nursing homes in 2020. Beyond 2020, we will continue to add more nursing home capacity. However, the number of beds added will have to be constantly reviewed and calibrated as demand patterns change. We are also meeting seniors' care needs holistically in different ways. Even as we continue to build more nursing homes, we are also focusing on upstream efforts to keep Singaporeans healthy and growing our suite of home and community care services to help seniors age in place.”
“We have about 12,800 nursing home beds as at end-December 2016. Of these, about 11,000 beds are subsidised. Between 2012 and 2016, the Agency for Integrated Care (AIC) received an average of 3,400 applications for subsidised nursing home beds per year. The waiting time depends on several factors, such as care needs of patients, family preferences and available capacity. On average, successful applicants wait about four months for a subsidised nursing home bed. Very few nursing home residents are ambulant. This is because in assessing the needs of applicants, AIC generally prioritises nursing home placements for patients who require help and supervision in three or more activities of daily living, such as feeding and toileting and have weak family support. For seniors who are ambulant and can be supported in the community, AIC refers them for home-based and community services instead. We are strengthening these services to enable more seniors to age in place, rather than be cared for in a nursing home. In 2016, more than 6,000 seniors were placed in home care and/or day care.”
“It collects premiums while the policyholder is aged 40 to 65, and provides lifetime coverage from age 40, even after the policyholder reaches 65 and stops paying premiums. Hence, it is prudent for the total amount of premiums collected to exceed the amount of claims paid while our policyholders are still young, because the premiums collected are meant to provide coverage against future claims throughout the policyholder's lifetime. As explained earlier, the proportion of claims over premiums collected has been increasing since 2002 and we can expect this trend to continue as the profile of our policyholders gets older over time. If the insurers do not collect enough premiums today and set aside some amounts for future claims, there is a risk that ElderShield will not be able to provide adequate coverage for policyholders as our population ages. It is important for insurers to ensure that policyholders will not face this situation.”
“ElderShield is an insurance scheme that provides basic protection against the costs of long-term care arising from severe disability in old age. Premiums for policyholders are collected annually between age 40 and 65. Coverage starts at age 40 and the policyholder is covered for life. If a policyholder becomes severely disabled before age 65, he will no longer need to pay further premiums and will start to receive monthly ElderShield payouts. From 2002 to end-2015, about $2.6 billion have been collected in premiums and around $100 million have been paid out in claims. About $130 million in premium rebates have been given to policyholders so far, the first tranche in 2007 and another in 2012. The oldest ElderShield cohort that enrolled at age 40 in 2002 will be turning 55 this year. The current age profile of policyholders is relatively young but will get older over time. As older people are more likely to become severely disabled compared to younger people, ElderShield payouts are expected to increase when the profile of policyholders gets older. Indeed, the proportion of claims over premiums collected has been increasing since ElderShield started in 2002, and this trend will continue in the future. People who are not familiar with how ElderShield works may ask why the current amount of premiums collected is much higher than the amount of claims paid out so far. Some may even wrongly conclude that policyholders have been paying too much in premiums or that insurers have made excessive profits. Allow me to clarify the facts to address these misperceptions. There are insurance schemes that provide coverage for the year in which the policyholder pays his premiums and when the policyholder stops paying premiums, the coverage ends. ElderShield works differently.”
“The Bukit Panjang Polyclinic is being developed as part of a larger healthcare facility that also includes a nursing home and a senior care centre. Design of the polyclinic is in progress, and physical construction is scheduled to begin by early 2018. The polyclinic is targeted to begin operations by end 2020. Like other polyclinics, the new Bukit Panjang Polyclinic will provide a suite of services, including medical treatment for acute conditions, chronic disease management, women's and children's health services as well as radiological, laboratory and pharmacy services. We are also planning for dental services to be available at this new polyclinic.”
“Cerebos Pacific Limited, a manufacturing company, also offers family care leave on top of statutory leave. We will continue to review the need for legislating eldercare leave as our socio-economic circumstances evolve over time.”
“We recognise that caregiving is an important responsibility and is no easy feat, particularly for those who have to juggle between work and caregiving roles. The Ministry of Health has strengthened efforts to support caregivers by expanding the capacity of aged care services and the number of home and community care options. We have been studying the issue of legislating eldercare leave in consultation with unions and employers. On balance, we are not ready to legislate eldercare leave at this time, as we need to strike a balance between employers' concerns on business costs and manpower constraints, and the employability of caregivers, versus the need for additional leave provision for eldercare purposes. There are existing leave provisions that can be used for this purpose. According to the Ministry of Manpower’s (MOM) Comprehensive Labour Force Survey, some 176,200 females aged 25 to 54 were outside of the labour force in 2016, of which 10% were due to caregiving for family members or relatives. In relation to that, we encourage companies to provide more family-related leave benefits which can be used for different purposes, as well as flexible work arrangements. We track this provision, and the trends have been encouraging thus far; 67% of employees work in companies that offer at least one formal flexible work arrangement last year, up from 56% in 2011; and close to eight in 10 employers also provide unplanned time-off or ad hoc teleworking for their employees to attend to personal matters. Public service agencies currently already provide two days of parent care leave per year. Some private companies have also done so. OCBC offers two days of family care to employees who are not entitled to childcare leave.”
“The integrated clusters will be able to tap on a larger pool of manpower resources and talents. They will also be able to offer their employees a wider and deeper range of professional development opportunities and a broader platform for cross-learning that will benefit staff and our patients. We do not expect to incur significant financial cost for the reorganisation. The planned infrastructure and service developments are already included in our Healthcare 2020 Master Plan and the three key shifts I highlighted, and they are separately catered for in our healthcare budget. These will need to be implemented regardless of the reorganisation.”
“We announced in 2012 Healthcare 2020, which outlined our plan to expand capacity, improve quality and enhance the affordability of healthcare services. Even as we implement Healthcare 2020, we need to plan ahead further into the future. Last year, I announced three key shifts to prepare for our healthcare needs beyond 2020: beyond hospital to community, beyond quality to value, and beyond healthcare to health. This transformation is necessary as our healthcare needs will grow in volume and complexity due to our ageing population and increased chronic disease burden, among others. For this reason, we need to organise ourselves better so that we can implement the transformation more swiftly and decisively. The public healthcare system will be reorganised into three integrated clusters, each having a fuller range of facilities, capabilities, services and networks across different care settings. This will enable them to deliver more comprehensive and person-centred health promotion, disease prevention, curative and rehabilitative care for the population in their respective regions. Primary care will play an increasingly important role in our care transformation. After reorganisation, each cluster will have a group of polyclinics which, together with general practitioner partners and community partners, can anchor care more firmly in primary and community settings. Collectively, these changes will ultimately benefit Singaporeans by providing more appropriate care and bringing care closer to them. In addition to greater economies of scale, the reorganisation will also facilitate scaling up of programmes and services by the integrated clusters, and their collaborations with the private sector and community partners, across a wider region to benefit more Singaporeans.”
“The Government has several schemes to support households with seniors with caregiving needs. For example, the Agency for Integrated Care (AIC) administers the Caregiver's Training Grant (CTG), which has been in place since 2007. This provides caregivers, including foreign domestic workers (FDW), with up to $200 each year to attend suitable training courses on useful caregiving skills. To date, about 37,000 caregivers, including around 20,000 FDWs, have benefited from CTG. The FDW Grant (FDWG), which was introduced in 2012, supports lower- and middle-income families who need to hire an FDW to care for frail seniors and persons with moderate disabilities with a monthly grant of $120. Six thousand eight hundred households caring for seniors are currently receiving FDWG and all of them have either attended a CTG-approved course or have received training at the hospitals. Of these, 4,400 tapped on CTG for the training. The Basic Eldercare Course is one of the courses supported under CTG. It is a relatively new course that was started in late 2015. Since then, 167 FDWs have attended the course. Of these, 52 were employed by households also receiving FDWG. Leveraging on the Basic Eldercare Course, the Ministry of Health (MOH) and AIC started the Eldercarer FDW Scheme in November 2016. This enables households to employ FDWs who have been pretrained in eldercare prior to placements with the families. Over two months, about 30 FDWs have been trained under the scheme, of which 25 have been placed with families. MOH and AIC are working with employment agencies and healthcare and social service organisations to raise awareness of this new scheme so that we can serve more families with eldercare needs.”
“Pre-Implantation Genetic Screening (PGS) is a test for chromosomal abnormalities in embryos created through in vitro fertilisation (IVF), before the embryos are implanted into the uterus. The Ministry of Health recently approved a three-year pilot for PGS. This will commence at the National University Hospital in 2017. Under the pilot programme, patients who fulfil at least one of the following clinical criteria will be eligible: (a) aged 35 and above, regardless of prognosis; (b) two or more recurrent implantation failures, regardless of age; and (c) two or more recurrent pregnancy losses, regardless of age. In other words, women of any age can participate in the pilot if they have had two or more recurrent implantation failures or pregnancy losses. For those without recurrent implantation failures or pregnancy losses, the minimum age is set at 35. This is because literature evidence and overseas experience have shown that the chance of a baby born with chromosomal abnormalities for mothers aged 35 and above is significantly higher. Countries, such as the United Kingdom and Canada, have similarly recommended that PGS be made available to women aged 35 and above, regardless of prognosis.”
“For example, an ageing population and a higher rate of chronic diseases like diabetes and hypertension will increase the volume and complexity of healthcare services. We are investing in health promotion initiatives to help Singaporeans lead healthy and active lives. Another priority is to provide appropriate care for patients by moving healthcare services beyond hospitals into the community, and to improve productivity and efficiency in our healthcare institutions. MOH is also working with the professional bodies and industry players to enhance information transparency on fees and charges, and to discourage over-servicing by healthcare providers. All of these factors are important to develop a sustainable and affordable healthcare system that delivers quality care and outcomes for all Singaporeans.”
“Managed care companies (MCCs) and third-party administrators (TPAs) play a role in the healthcare system by providing information to patients and helping them with the administrative and claims processes. The Singapore Medical Council (SMC) is not prohibiting such services. The SMC's concern is with the charging practices adopted by some MCCs and TPAs, which compromise patient care and contribute to rising healthcare costs. For example, there are MCCs and TPAs which charge doctors referral fees of up to 25% of doctor’s fees. Their financial incentives are not aligned with the patient's interests as the decisions on referrals and care can be unduly influenced by the fee arrangements. In addition, the high referral fees will ultimately be borne by patients in the form of larger bill sizes or higher insurance premiums. This was why medical professionals and the insurance industry have highlighted their concerns with these charging practices to the Ministry of Health (MOH) and SMC. SMC has since revised their Ethical Code and Ethical Guidelines to state that doctors must not allow financial arrangements to lead to any compromise in the care of patients. Any charges which doctors pay to MCCs or TPAs should commensurate with the actual administrative work done by these intermediaries in processing the cases, rather than based primarily on the fees charged to patients. The SMC's position is supported by the Singapore Medical Association, Academy of Medicine Singapore and College of Family Physicians Singapore. A key priority for MOH is to keep our healthcare system sustainable for the longer term. There are many factors which can contribute to increases in healthcare costs.”