Janil Puthucheary
Singapore
“Sir, I thank Ms Lee for her two supplementary questions, which address what are our targets and what is it that we measure. Indeed, the issue of how we should think about recycling and waste disposal will be at the heart of our review of our Zero Waste Masterplan.”
“Another strategy that we are embarking on is the strengthening of the reuse of waste residue and treated toxic industrial waste before and after they are landfilled.”
“Sir, about half of our recycling material is exported. It is processed overseas. There are business arrangements between businesses here in Singapore and businesses in the region or overseas, to be able to handle the recycling of waste and recycling of material, whether domestic or non-domestic, already today.”
“Sir, I thank Ms Poh for her questions. Indeed, we do have to shift behaviours. The incentives and disincentives around recycling and waste disposal are an important part of it. We will consider her suggestion on looking at the fees.”
“The heat advisory that goes out is clearly defined. In my original answer, I explained what a heat wave was. There are clear definitions that we have been using in Singapore since 2016, if I recall. It was then last revised in 2023.”
“Sir, in the planning of schools, the Ministry of Education ensures that our students can access a primary school near their homes. Except for a small number, 15 of Special Assistance Plan schools, all primary schools offer the three official mother tongue languages.”
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“Sir, I thank Ms Tin for the question. We are still studying the matter. According to DeepSeek, there are hardware and software optimisations that have brought down the training and inference costs, and then by extension, this makes the compute greener because less energy is needed, a fraction of the compute. If it is true, and seeing as the company has made their model open source, there is indeed a possible positive development for advancing the efforts around resource efficient AI. However, there are counter claims that the actual compute cluster may have been much larger than reported and there may have been distillation of closed models. So, the facts around the matter are unclear, and we are still studying the matter to learn how best we can deploy compute power here in Singapore to advance our ambitions.”
“Based on tests with agencies, we have seen how Litmus can spot potential safety issues ahead of time, allowing us to act proactively. Essentially, this is AI testing as a service. Litmus provides a diagnosis of the AI risks, but we also need a solution, once those risks are detected. In the AI world, guardrails ensure that AI systems operate within ethical, legal and functional boundaries. We are building Sentinel, a platform that provides guardrails as a service for the Government's AI applications. Product teams can choose from a curated list of guardrails, including those from top AI developers and localised ones like LionGuard, and easily integrate these into their applications. Sentinel has been able to accurately identify attempts to infiltrate systems or trick AI models into producing inappropriate output. Litmus and Sentinel demonstrate how we want to develop Government Gen AI applications that are safe for use, including by members of the public. Sir, our digital infrastructure underpins key functions that citizens and businesses rely on. We have, therefore, actively invested in enhancing the security, resilience and future-readiness of our key digital infrastructure. We also continue to build capabilities in the public sector and embrace experimentation and innovation with AI to better serve Singaporeans. I am hopeful that this will build trust in our digital future as we continue on our Smart Nation journey.”
“We actively involve non-technical public officers in creating digital products. Last year, the Government Technology Agency of Singapore (GovTech) held its inaugural series of hackathons for public officers, called the LAUNCH! Programme. It gathered more than 600 ideas and birthed 26 innovative prototypes. For example, a team of two primary school teachers and a GovTech officer prototyped an AI tool to provide students with immediate customised feedback on their oral skills performance. We are also exploring how officers can innovate better and faster with AI. One of the prototypes from our recent Hack for Public Good hackathon was Spaceship, a tool to make prototyping less daunting for public officers. This tool, Spaceship, enables officers to use AI agents to build and deploy fully functional prototype applications, including LLM-based tools. They do this using just plain English. So, this is a tool for public officers, non-technical public officers to get from an idea to a workable app in minutes using just plain English. Sir, I tried out this prototype and I tried to have it code a portal that restricted the length of Members of Parliament's speeches. It put the appropriate filter into the spreadsheet, but I think that is the limit of the technology today. As we increase the use of AI in Government, it is critical to understand and mitigate the risks in AI applications. GovTech is building the capabilities to ensure that the Government's Gen AI applications go to market safely. We have Litmus, a tool for AI safety and security testing. We have curated a set of tests to ensure our AI applications are resistant to risks that mislead users or cause reputational harm. Litmus is built in partnership with IMDA's Moonshot and will be launched this year.”
“IMDA also launched the Energy Efficiency Grant for the data centre sector last December to support businesses' upgrades to more energy-efficient IT equipment. MDDI is further exploring ways to uplift data centre sustainability through regulations. We are studying other jurisdictions and are in early engagement with the industry to develop a framework for Singapore’s context. Sir, we have to lead by example, as a Digital Government. We must continue to build the capabilities for the public sector to create and experiment with AI and unlock citizen-centric solutions. We have made available, within the Public Service, access to best-in-class AI and large language model (LLM) tools. Pair Chat is a fast and secure Gen AI assistant used by more than half the Public Service today. Last year, we organised a whole-of-Government prompt engineering competition. This attracted over 1,040 officers. The fact that I can say this already makes us quite unusual in terms of how we do Digital Government – that we have a prompt engineering competition within Government and there were 1,040 public service officers who participated. The finalists were tasked to build an event publicity website within 10 minutes using large language model (LLM) tools. The winner of this competition was Muhammad Naim Bin Zahari, a firefighter with the Singapore Civil Defence Force (SCDF). At the time of the competition, he had just completed a 24-hour shift. In second place was Rachel Tiang, a finance officer at the Ministry of Manpower (MOM). Neither were in technical roles dealing with AI. Both of them and all the competitors were more than capable of building this functioning publicity website within 10 minutes using these AI and LLM-augmented tools.”
“There is a need for Government to manage access to information about individuals, as such information could be exploited in scam tactics. We are committed to ensure that data, including personal data, is managed carefully and responsibly. In the Government's provision of digital services involving data, agencies must assess the right balance between the benefits and risks in each use case, to achieve the dual objectives of service accessibility and data protection, in line with the guidelines and safeguards that MDDI has provided. Sir, our digital infrastructure must not only be secure and resilient but also position Singapore for the future. Last year, we announced that IMDA is investing up to $100 million to upgrade our Nationwide Broadband Network (NBN). This will enable broadband speeds up to 10 times faster than what most households have today. Operators are starting to offer higher speed broadband services at lower prices. A 10GB plan now costs between $30 and $70, compared to more than $100 a year ago. Developing our future-ready digital infrastructure also entails addressing resource constraints as we pursue growth. We must explore ways to support Singapore's AI ambitions while keeping to our climate commitments, as well as balance digital infrastructure growth with environmental sustainability. IMDA launched the Green Data Centre Roadmap last year to guide data centres to improve energy efficiency and use green energy to grow AI compute capacity sustainably. We have made good progress. For example, the Building and Construction Authority (BCA)-IMDA Green Mark for data centres was refreshed last October to raise the bar for data centre sustainability.”
“We are studying requirements for major operators to report disruptions to the Government, so that we can better learn and improve from these incidents, and support response and recovery efforts where needed. We have been seeking feedback from digital infrastructure providers and some of their customers, since mid-2024. IMDA recently released Advisory Guidelines for cloud service providers and data centres. These guidelines contain key measures that we have been consulting stakeholders on. The guidelines encourage data centre operators to have a robust business continuity system and ensure high availability for their enterprise customers. Cloud service providers are also encouraged to manage data security risks and ensure business continuity planning. All operators are encouraged to implement the measures and many providers, including Microsoft, Equinix and Keppel, and their enterprise customers, have expressed support for the new Advisory Guidelines, which they find to be fit for purpose and aligned with international standards. We are also strengthening the resilience of our Government systems to ensure that Singaporeans have trust and confidence when interacting with the Government online. We have improved the resilience of central systems used by agencies. Service availability for these systems rose from 95% to 99.5% in the last year. We will continue to increase the adoption of tools to improve the resilience of Government applications, including those that monitor system uptime. As resilience measures incur costs, our approach must be calibrated. We will support agencies providing important services to implement more sophisticated measures where appropriate.”
“Should these disruptions occur, the impact is higher, given the increasing utilisation of these services. Last year, we amended the Cybersecurity Act to address new challenges in our operating environment. These amendments, which are expected to come into force later this year, will empower the CSA to better ensure the cybersecurity of important entities and systems beyond the critical information infrastructure (CII). These include data centres and cloud services. This, in turn, improves trust and confidence in Singapore and our digital economy. Owners of CII also have the opportunity, we hope, to review their business models. We hope that they will be encouraged to review their business models and do so with a view to using new technologies, such as commercial cloud solutions. Beyond cyber threats, we must guard against risks that disrupt access to digital infrastructure and services, including physical hazards like fires; and less visible risks, like hardware failure and system misconfiguration. These are risks as a result of our dependence on digital infrastructure and services. We cannot eliminate risk completely, so we must enhance our preparedness by reducing the occurrence and the impact of disruptions. We are working towards introducing a new law this year, called the Digital Infrastructure Act. This will improve Singapore's digital resilience and security. The Act targets foundational digital infrastructure, starting with major cloud service providers and data centres. The Act will require major operators to implement measures to uphold their resilience and security and to minimise disruptions.”
“Mr Chairman, I thank the Members for their cuts and questions, and I hope in my response today to be addressing the cuts filed by Ms Jessica Tan, Ms Tin Pei Ling, Mr Ong Hua Han, Mr Sharael Taha, Mr Dennis Tan and Ms Mariam Jaafar. Sir, trust is at the heart of our Smart Nation efforts. Our citizens and businesses must be confident that the digital systems and services that they rely on and the interactions and transactions that they engage in, can be trusted. I will explain MDDI's approach to building this trust: by ensuring the resilience, security and future-readiness of key digital infrastructure, and by driving Government AI adoption and innovation for the public good. 1.45 pm The Government has existing regulations to reduce risks to digital infrastructure and services, including cyberattacks and service disruptions. For example, under the Telecommunications Act, IMDA requires broadband and mobile network operators to take proactive measures to minimise disruptions. There are also sectoral regulations for digital services, such as the Monetary Authority of Singapore's (MAS') IT resilience and security requirements for financial institutions. But the digital landscape is much bigger and constantly evolving. Digital infrastructure, like data centres and cloud services, have become important in enabling many functions including e-banking and payments, ride-hailing, e-commerce and digital identity. These functions allow citizens to meet their day-to-day needs and to do so conveniently and effectively. They help businesses to grow. However, the growing scale and complexity of our digital infrastructure also means an increased surface area for cyberattacks and a higher risk of disruptions arising from hardware failures, misconfigurations and other problems.”
“And then, as they have now become a little bit older, I take on the responsibility of making the appointment for them to then go and receive their influenza vaccinations. So, from an organisational, a social and a personal level, we can often find ways to constantly remind the seniors amongst us above the age of 65 that a regular influenza vaccination would be a very important part of protecting themselves. In parallel, the good social habits, the personal hygiene that I mentioned in my original Parliamentary Question answer also need to continue to be reinforced.”
“Sir, I thank Mr Yip for his question and for the work that he is doing in his constituency to enhance vaccine coverage. Indeed, we have to increase the awareness of the importance of vaccine coverage for high-risk populations. And high-risk populations for influenza are particularly the seniors that he mentioned, anyone over the age of 65, anyone with chronic medical conditions and people who are vulnerable either because of a condition that causes low immunity or increased risk of acquiring an illness such as influenza. This is something that we have to think about on an ongoing basis. It is not a illness where it comes once and then it is gone. This is illness that is endemic and it is seasonal – the virus changes, every season. And it is also not an illness where you can be vaccinated once and then are protected for life. You have to update your vaccinations on a regular basis. And so, issues to do with awareness and education, we need to continue on an ongoing basis. And we do so at the medical facilities, or if general practitioners, family physicians are seeing someone over the age of 65 for other routine care, they often do and should ask about when the last influenza vaccination was and offer it, if appropriate. Similarly, this is something that anyone who is in regular contact with seniors as a result of the service that they are offering, such as the examples that Mr Yip provided in his constituency, can and should ask seniors. Even on a personal level for family members, children can very often play an important role in reminding their parents. So, for me, for example, for many years, I have had the habit of using my parents' wedding anniversary as a marker in my calendar to nag them, gently nudge them.”
“Mr Speaker, Sir, large-scale influenza outbreaks are not new and will hit us from time to time. The best way to protect ourselves is for the public, especially those who are medically vulnerable, to take preventive measures. These include having updated vaccinations, practising good personal hygiene and when unwell, wearing face masks, limiting social contacts and seeking medical attention promptly when needed. If there is a spike in influenza infections, we may have to release our stockpile of antivirals to reduce the risk of infection and severe outcomes, or to secure more supply of new vaccines. Our public hospitals treat high patient volumes on a daily basis. In surges, they have to tap on alternative care models such as Mobile Inpatient Care at Home for suitable patients and Transitional Care Facilities for medically stable patients.”
“Mr Speaker, Sir, you are very optimistic. Mr Louis Ng has squeezed four substantive issues into one very long sentence. [Laughter.] Since our last update in Parliament in May 2024, the Ministry of Health (MOH) has made progress in implementing the recommendations of the National Wellness Committee for Junior Doctors. Each of our healthcare clusters has appointed Chief Wellness Officers. Our public hospitals have also designated wellness officers to better understand the concerns of their healthcare staff as well as to support their welfare and well-being. Sir, the Hospital Clinician (HC) Scheme has been rolled out in all our public hospitals. Currently, around 100 doctors have either enrolled in or been appointed to the HC scheme. These HCs will work alongside family physicians and specialists to deliver team-based care. Where appropriate, HCs may lead healthcare teams and be responsible for the care of patients under their charge. Since its introduction in 2020, we have refined the scheme to enable junior doctors to join earlier in their careers. Doctors now also have the flexibility to switch into the HC career pathway from other medical career tracks. In collaboration with our healthcare clusters, MOH has implemented pilots aimed at improving the work hours of our junior doctors. Through these pilots, we hope to identify best practices to share across our hospitals. To date, close to half of all clinical departments with junior doctors have implemented shift rosters or have limited their doctors to working no more than 24 hours continuously. This practice will be extended to more departments progressively as we expand our medical workforce. 11.30 am”
“Sir, I thank Mr Giam for his questions. The Government does not generally comment on specific commercial products. We advise companies to evaluate products on their own merits and the risks of use, including their compliance with relevant laws. Pair does indeed access large language models, but it does not access only one. The specific details of Pair, I do not have them on hand. If Mr Giam is interested in the technical details, I would be happy to follow up with him offline or he can file a subsequent Parliamentary Question.”
“I take his feedback and we will continue to try our best. And if there are specific suggestions about buttons, banners, transactions, workflows, I would encourage him and other Members to provide us the information and we will certainly find a way to optimise the experience for all our users.”
“Sir, I thank Dr Tan for his feedback and suggestions. We do recognise that as our population ages, as we have a growing number of people who have long-term health problems and multiple contacts with clinical providers, they may need multiple care settings to address their healthcare needs. And currently, that may mean navigating different apps to manage medical transactions across institutions for themselves and their family members. So, we are looking at ways and how we can improve our digital services. We are indeed learning from the experience across the rest of the digitalisation in the public sector that GovTech and others have been heavily involved in. The teams that are working with the healthcare service providers – we have the Synapxe digital team, we also have got the GovTech teams, as well as private vendors. So, there is a significant amount of experience from the public sector and the private sector, drawing on the lessons of other care and business process transformation and applying that to what happens within the healthcare ecosystem. Dr Tan made a point about the consolidation of the apps and the user interface. These are, in a way, two distinct issues. The matter of how we provide the digital infrastructure for the clusters to ride on and provide their individual apps at the moment is something that we are studying, as to whether or not there is a need to then consolidate and streamline. This is distinct from the issue of the user interface and the user experience that he mentioned. We do indeed test with a variety of users from all backgrounds. We do indeed want to make sure that the digital services that we offer are accessible to the population and easy to use, so that they can engage in these transactions.”
“Sir, I thank Ms Ng for her two suggestions. We will consider both and look at them closely. Indeed, we are always looking to see how we can improve the user interface and user experience of our digital products. I am glad that she has found a GP that she trusts and is providing her with quality, in-depth care. I think we do need to find ways to reognise and incentivise this type of behaviour from the family physicians that look after all of us.”
“On the other hand, there are also advantages to having a consolidated HealthHub. This is an issue that we will continue to explore.”
“Thank you, Sir. I invite Ms Ng to seek clarifications, if need be. If the question has been addressed, it may not be necessary for the Member to proceed with the Question for a future Sitting. Sir, HealthHub is our national health app and web portal which allows the public to interact with all three public healthcare clusters. One of its key functions is appointment booking. Through HealthHub, users can schedule cross-cluster appointments with the public healthcare institutions. This feature is also extended to Healthier SG general practitioner (GP) clinics that have opted to participate in the functions of this app. At this stage, we do not think it is appropriate to compel all private GPs to come onto the app. They are private clinics and they are operating within a market, albeit one that is heavily regulated. We have not received much feedback on the difficulties in making cross-cluster medical appointments. This may be because the public are also familiar with alternative booking channels, such as the call centres of the institutions. HealthHub also provides a range of other services to patients such as viewing laboratory reports, health screening results, prescription records and Community Health Assist Scheme (CHAS) balances. These functions are also extended to participating GP clinics, except the medication refills which only apply to the public healthcare institutions. From time to time, we will receive suggestions to consolidate the cluster apps under HealthHub. The cluster apps do serve a purpose, in having features customised to their particular facilities and services. These apps also allow the clusters to innovate on user-interaction features, helping them to better connect with and address the unique needs of the patients they serve.”
“Mr Speaker, may I have your permission to answer Question Nos 1 and 2 in today’s Order Paper? My response will also cover the matters raised in the question by Ms Ng Ling Ling1 which is scheduled for a subsequent Sitting.”
“Sir, the number of patients that could potentially benefit from this is relatively small. The education and counselling is done for those patients and their families on a one-to-one basis by the clinical providers, and I think that is probably the correct approach for now. There are many drugs with serious side effects or potential abuse and misuse, where use in a controlled setting is possible. This is something that we have been doing for, for example, opioid agents, anesthetic agents and many other controlled drugs and substances, where there is a public protection and it is a drug of abuse outside this controlled setting, and then, appropriate counselling for the patient and the family when there is an indication and there is a benefit. 1.00 pm”
“Sir, I thank Dr Wan Rizal for the supplementary question. The use of ketamine is not a substitute for all the other treatments that are available for depression and other psychiatric treatment. It should only be used when indicated and for those situations where the other treatments are not effective. So, we will continue to study its effectiveness, analyse the cost benefit analysis and make sure it is available for those patients who need it.”
“Sir, ketamine in the form of a nasal spray was approved in October 2020 by the Health Sciences Authority (HSA). It is to be administered together with other oral anti-depressant therapy for the treatment of depression. Clinical trials have demonstrated that the use of ketamine nasal spray resulted in improvements in symptoms of major depression with mild side effects and minimal addictive potential. Overall, the benefits of ketamine nasal spray outweigh its risks. There are several safeguards in place to ensure the safe use of ketamine for severe depression. It is classified as a controlled drug under the Misuse of Drugs Regulations, which means that the product must be kept under lock and key with stringent records of the product inventory. Further, it can only be supplied to hospitals and clinics providing specialist services for psychiatry, and prescribed for use by a registered psychiatrist. It is administered strictly under nursing supervision with resuscitation equipment and doctors on standby. Patients are continuously monitored during and after the treatment for adverse effects before they leave the clinical setting. Specialists also review patients regularly to assess treatment effectiveness.”
“Mr Speaker, may I have your permission to answer Question Nos 16 and 17 on today's Order Paper?”
“Sir, I thank Ms Ng Ling Ling for the suggestions. For the second question, indeed, we do regularly review the criteria for national vaccination programmes and for programmes under Healthier SG that are subsidised. In general, the approach that we take is that we do want to focus on those interventions which have some evidence that they are going to have a significant effect on the health outcomes downstream. Something like a flu vaccine is something that you need to do on a regular basis. It is not something that you do once and then you are done for life. It has to be topped up every year. And so, the considerations are different compared to, for example, a vaccination like measles, mumps and rubella, where, maybe, you do it once in your lifetime and then it has a long effect across your life. The short answer to her question, we will always be reviewing the criteria that we use for these types of programmes. She also had a suggestion about alerts for flu variants. In general, when we are considering what are the things to put an SMS alert or some kind of alert out to the population, it is where there is a specific action that they need to take, such as going and getting a vaccination for the new season's variants of influenza, where there is a vaccine. For respiratory diseases where there is no vaccine, whether it is a variant or different variant or whatever the species of virus is, the advice is the same. It is the same throughout the year, which is: to practise good personal hygiene; do not go and mix with people when you are sick; and if symptoms worsen, seek medical care. So, we do have to be judicious about when we send out alerts, so that there is something specific in terms of the action that the citizens can take, rather than just providing information.”
“Mr Speaker, my response will also cover the matters raised in Question No 40 by Ms Joan Pereira on human metapneumovirus (HMPV) in today's Order Paper. Sir, HMPV is a respiratory virus that has been prevalent globally, including in Asia, for many years. The symptoms are similar to a common cold. Patients typically recover quite uneventfully. HMPV surges are common during the colder months in temperate regions. There have been significant surges in some parts of Asia this winter. In Singapore, based on our ongoing surveillance for acute respiratory diseases, we also have observed an increase in HMPV activity during the year-end period, similar to previous years. This has started to subside. There are currently no vaccines for HMPV and the influenza vaccine does not provide protection against HMPV infection. Similar to other respiratory infections, the advice to the public and especially medically vulnerable persons, such as young children, the elderly and those with chronic medical conditions, is to take preventive measures, such as the practice of good personal hygiene, limiting social contacts when sick and seeing a doctor promptly if symptoms worsen.”
“Sir, to answer Mr Sharael Taha's first question, in 2024, we received a total of 59 complaints regarding telemedicine and this involved more than 20 licensees. So, that is the number that we are dealing with. The monitoring of the quality of care is an important issue that Mr Sharael Taha brought up. There are a variety of ways that we can do this. Some of it is through the professional route and some of it is through public complaints. The issue of whether or not a clinical service is being abused for the purposes of a medical certificate that may or may not be necessary, again, is not a telemedicine issue. This type of inappropriate use can occur in-person as well. And so, there is a variety of things we look at, the metrics in terms of the numbers, the type of patient mix and the justifications for the medical certificate or any other therapeutic intervention. Ultimately, has a correct assessment been provided and is the treatment, whether it is medication, investigation or a medical certificate, appropriate to the clinical condition that has been detected and appropriately documented?”
“Sir, some of the investigations are still ongoing, so I do not think I can answer the second part of the first question that Mr Ang had asked. There are a number of licensees involved and, indeed, there were some very short teleconsultations. As I said, the investigations are still ongoing, so we are trying to establish the exact number. A short teleconsultation is not automatically incorrect, if it is a regular patient, if it is a follow-up, if the necessary information has been obtained. So, I think we have to look at the entire clinical care that has been provided and make sure it is appropriate. It is not the fact of telemedicine that is necessarily the problem. It is whether correct clinical care has been provided through this modality and that sometimes requires an inpatient consultation, sometimes it requires the appropriate breadth and time for the interaction so that the correct information is provided, and, in some cases, it is an issue of whether or not the correct documentation of the process has been carried out. So, all of these things are part of the investigation process.”
“Sir, can I just ask Mr Ang to repeat his first question?”
“Sir, arising from the Ministry of Health's (MOH's) regular audits and enforcement actions, eight telemedicine providers have been or are currently being investigated for non-compliance related to the provision of teleconsultation services. The issues of non-compliance fall largely into two categories: one, lapses in clinical care, such as doctors issuing prescriptions and medical certificates without proper clinical assessment or not conducting video consultations for first-time patients; or two, inappropriate advertisements, such as those promoting the unnecessary use of telemedicine services. Investigations on three of these cases have been concluded and enforcement actions have been taken. One of the cases, which is MaNaDr, has had its outpatient medical service licence revoked. The others involve a short suspension and a stern warning, commensurate with the severity of the breaches. In addition, medical practitioners have also been referred to the Singapore Medical Council (SMC) for potential lapses in professional standards. SMC’s review is currently underway. It is important to recognise that telemedicine can bring tremendous benefits to patients, especially those who are immobile or doing regular follow-ups. It makes healthcare much more accessible and convenient to our patients. However, as in any new service delivery model, there will be potential for abuse and misuse, especially in the initial period of implementation. MOH will take the necessary enforcement actions so that, over time, best practices become normalised. In the meantime, the public should raise concerns regarding the provision of telemedicine to MOH via the public feedback channels available on the Ministry’s website.”
“Mr Speaker, may I have your permission to address Question Nos 44 to 46 together, please?”
“Ms Tin had also suggested to allow the use of Dupilumab for children below six. There are several subsidised treatment options available for children, such as topical steroid creams and, for the more severe patients, oral immunosuppressants. We note that some of these young patients may still require Dupilumab if they are not assessed to be suitable for these subsidised treatments. And notwithstanding the benefits of Dupilumab for this age group, Dupliumab remains non-cost-effective at the population level in this setting. So, if patients face issues affording Dupilumab, they may approach medical social workers at our public healthcare institutions to apply for financial assistance through MediFund. We will continue to regularly review the list of subsidised drugs to ensure that the list stays relevant to changes in our local population needs, medical practice and the evidence on clinical and cost effectiveness. Mr Speaker, Sir, MOH will continue to review the adequacy of support for eczema patients, taking into consideration the safety, clinical efficacy and cost-effectiveness of these treatments. No Singaporean will be denied access to appropriate healthcare due to an inability to pay. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)]”
“Additionally, Singaporeans aged 60 and above can use up to $300 a year of their MediSave, under the Flexi-MediSave scheme to pay for their outpatient eczema treatment and medication at polyclinics, SOCs and CHAS clinics. I would also like to acknowledge Ms Tin's suggestion to include biologics or monoclonal antibodies, such as Dupilumab, into MOH's list of subsidised drugs. Today, MOH provides subsidies for a list of drugs that are assessed by the DAC to be both clinically- and cost-effective. This ensures that limited healthcare resources are directed to therapies that provide good value compared to existing standards of care and keeps healthcare spending sustainable. In 2023, the DAC listed Abrocitinib on the MAF for people who do not respond adequately to immunosuppressants. Abrocitinib was assessed to be at least as efficacious as Dupilumab and available at a cheaper price. It is also an oral medication. Dupilumab, an injectable, was not recommended for subsidy, as its benefits do not justify its costs, at the current price proposed by the manufacturer. Ms Tin mentioned that overseas incremental cost-effectiveness ratios for Dupilumab range from $48,000 to over $160,000 per quality-adjusted life year, or QALY, gained. However, we are unable to rely on cost-effectiveness assessments, if there were significant limitations in the methodology and design of the studies. For example, many published industry-sponsored cost-effectiveness studies provide favourable results due to overly optimistic assumptions made about the clinical outcomes of treatment. The studies may also not be generalisable to our local setting if the price of the medication differs significantly compared to that offered to patients here in Singapore.”
“Gout, allergic rhinitis and chronic hepatitis B were most recently added to the CDMP on 1 July 2022. In selecting conditions for review for inclusion into the CDMP, the CAC takes into account feedback from medical professionals, patients and the public. The CAC consults clinical experts in various healthcare settings and considers factors, such as the disease burden, potential benefits of early interventions to patient outcomes, and the cumulative cost to the patient from long-term treatment, and the availability of evidence-based clinical guidelines for appropriate care of the condition. In 2020, the CAC had decided not to include eczema under CDMP. Care practices for eczema currently vary significantly, and there are currently no standardised national guidelines for the treatment of eczema. Without such standardised and accepted guidelines, we may run into challenges, such as overdiagnosis or inappropriate treatment. The Agency for Care Effectiveness at MOH is currently developing these clinical guidelines for the treatment of atopic dermatitis. Once these guidelines have been established, the CAC will review if eczema can be included into the CDMP. Even though eczema is currently not on the CDMP, patients can already receive subsidies for the treatment of eczema today. Topical steroid creams and oral systemic immunosuppressants, such as ciclosporin, azathioprine, methotrexate and mycophenolate mofetil are listed on the Standard Drug List. Abrocitinib, a Jak inhibitor, as mentioned by Ms Tin, is also listed on the MAF for patients who do not respond adequately to immunosuppressants. Eligible patients who are prescribed these drugs for eczema can receive up to 75% subsidies at polyclinics and Specialist Outpatient Clinics, or SOCs.”
“Mr Speaker, Sir, I would like to thank Ms Tin Pei Ling for raising the situation of patients with eczema and for explaining to the House the condition and the symptoms suffered by these patients. Eczema can affect anyone at any age. As Ms Tin pointed out, in Singapore, about 20% of children and 11% of adults have eczema. Most cases are mild to moderate and, for most patients, the symptoms can be managed with over-the-counter moisturisers, topical and oral medications, self-care measures and the avoidance of triggers. For most patients, this approach works quite well. Ms Tin has highlighted the difficulties faced by the patients that have the most serious forms of atopic dermatitis and eczema. I thank Ms Tin for her suggestion to include moderate-to-severe eczema into the CDMP. The CDMP is a programme established since 2006, with the intention to improve care for chronic disease patients, by making treatments more accessible and affordable for Singaporeans. Today, the CDMP covers 23 chronic conditions, including common conditions, like diabetes mellitus, hypertension and hyperlipidemia. Patients with these conditions can use MediSave to pay for the out-of-pocket costs for their outpatient treatment. Those with complex conditions can claim up to an annual limit of $700. They can also tap on Government subsidies of up to $500 per year under the Community Health Assist Scheme (CHAS), if they are eligible for CHAS, and special subsidies of up to $540 per year if they are Pioneer Generation or Merdeka Generation cardholders. Conditions under CDMP are regularly reviewed by the Clinical Advisory Committee (CAC). This comprises Family Physicians and specialists from the public and private sectors.”
“Sir, the number of seniors attending polyclinic has increased from over 260,000 in July 2023 to over 300,000 in July 2024. Generally, patients having their chronic conditions managed at the polyclinics have their appointments for chronic disease management booked ahead of time. If a senior requires assistance to book a new polyclinic appointment digitally, he or she can seek assistance at a polyclinic, at the Active Ageing Centres, at Community Health Posts and other locations where staff can assist seniors to make polyclinic appointments. Seniors can also contact the call centres for an appointment or walk into a polyclinic where they can be assigned an appointment slot if one is still available. If the available appointment slots have run out, depending on demand for the day, the polyclinics will triage and attend to walk-in patients with urgent medical needs, which could include elderly who are frail and have mobility issues.”
“Sir, the work of engaging the public and educating the public on responses to crises, whether of a personal nature or a social nature, continues. We know we have a number of initiatives including, for example, Emergency Preparedness Days, we do table-top exercises around, for example, incidents that can affect our social harmony, including those involving in race and religion. A key component of all of these is, indeed, the act of communicating: how is it that we make sure that we have access to reliable information, we are able to connect with appropriate services and disseminate the information out. So, the very short answer to Mr Yip's question is yes, and as he is aware, we are doing many of these things already, but we will continue to learn from every single incident. So, as I have noted, we are conducting a review. As Minister of State Sun has noted, MHA and IMDA are working very closely on the review of this particular incident. If there are lessons that we can extract, we will then engage with some of our efforts around public education and do that better; and it is certainly something that we will do.”
“Sir, I thank Dr Tan Wu Meng for his three questions. The landlines are regulated at the system level. So, Singtel is a key service provider, as there are the other telcos. This is a very important infrastructure. They are regulated and are required to provide a very high level of service reliability. Dr Tan was asking from the perspective then of the 995 line or 999 line – and there, they have a sectoral requirement for communications in general which is not just only about a single telco. I will have to leave MOH and MHA to answer the specifics for 999 and 995 lines. But the reality is that the landlines are not the only channel of communications. I think it was SCDF and SPF who put out a public notice about other alternative means for the public to contact them. And I will leave MHA and SCDF to answer that question. So, from IMDA's perspective, we look at the system as a whole and, indeed, Singtel is held to a very high level of reliability through our regulatory framework. Dr Tan also asked about whole-of-Government crisis planning and we, indeed, do model, red team and think through a number of scenarios, including what happens if our telecommunications infrastructure is affected. There is a certain level of redundancy required within a given network at the level of various points that they have and the infrastructure they have. There is internal redundancy that is required and internal resilience that is required. But, then again, across our nation we have resilience by having more than one network. So, indeed, we do model and red team a number of different scenarios. Sir, as I said, I will leave the MHA to answer about the specifics of the 995 and 999 lines.”
“IMDA holds key service providers, like Singtel, to high service standards and requires them to conduct regular audits on their network and infrastructure. This includes ensuring the security of network design, redundancy measures and business continuity plans. Service providers must also ensure that their networks are resilient against disruptions. IMDA will not hesitate to take strong action under the Telecommunication Act, including imposing financial penalties, should any lapses be identified. IMDA is working with MHA, SCDF and SPF to conduct a comprehensive review on the availability of our emergency hotlines when disruptions occurred.”
“Sir, on 8 October 2024, Singtel's fixed line voice service faced intermittent service disruption. This affected some residential and corporate users, including Government emergency phone lines such as the Singapore Civil Defence Force's (SCDF's) 995 and the Singapore Police Force's (SPF's) 999 lines, and customer service lines for some Government agencies, healthcare organisations and companies. The Ministry of Home Affairs (MHA) and Ministry of Health (MOH) will be responding to queries on the service impact on their respective sectors arising from the incident. During the disruption, it is estimated that half of the calls could still be connected. All services were progressively restored over a four-hour time period from the start of the incident. The Infocomm Media Development Authority (IMDA) takes a serious view of this incident and is investigating the cause of this disruption and whether Singtel's incident response was adequate. Preliminary findings suggest that there was a technical issue which affected the proper functioning of a network component in one of the two systems supporting Singtel's fixed line voice service. The two systems, located in separate telephone exchanges, are designed to immediately take over the full load of the other system when one system malfunctions. However, in this instance, the failover did not happen seamlessly, which caused the intermittent service disruption. There is no evidence to suggest that the incident was related to a sabotage or cyber-attack. IMDA is continuing its investigations. The telecommunication network in Singapore is a key infrastructure that supports our nation's connectivity needs and requirements.”
“Sir, I thank Assoc Prof Razwana for the questions. Actually, her query has two different parts. Are we partnering with social media companies and tech companies? The answer is yes. As we develop our various codes of practice, as well as regulatory frameworks around various aspects of social media, we do indeed partner very closely with the social media and tech companies. This is the work on the MDDI side of the House. It is independent from the mental health strategy. The separate issue is then the use of telemedicine and teletherapy services. Under the MOH, we are indeed studying this and looking to see how we can use these types of technologies to better reach out to persons in need and this is not just about mental health, but there are a whole variety of indications for telemedicine services and we have a framework for assessing the governance, the safety, the approach towards telemedicine. And so, the social media companies or the tech companies may well be a platform through which telemedicine services are delivered, but actually, it is the service provider then that we need to work with for the assessment of those services.”
“Mr Speaker, we will be designating first-stop touchpoints to enable individuals to receive support early and to facilitate access to higher-tier services when needed. For instance, a new National Mental Health Helpline and Textline service will be introduced in mid-2025 to offer psychological first aid for those facing mental distress. Those who require additional support, including crisis management, will be referred to the relevant services. Our other upcoming measures include the Positive Use Guide on Technology and Social Media, which will be ready in the first half of 2025. It will guide healthy and positive uses of technology and social media, and provide recommendations to mitigate their potential negative impact. In addition, the Ministry of Digital Development and Information (MDDI) and Infocomm Media Development Authority (IMDA) are studying whether further requirements, such as age assurance, are needed to prevent children and youths from accessing age-inappropriate content on relevant online communication services.”
“Thank you, Sir. I just wanted to offer a clarification to the data provided to Ms He. This referred to the number of unique patients, aged zero to 18, who experienced anaphylactic shock due to food. I believe I may have misspoken and referred to "admissions" during my answer to her initially. [Please refer to "Tracking and Increasing Public Awareness for Food Allergies in Children", Official Report, 15 October 2024, Vol 95, Issue 143, Oral Answers to Questions section.]”
“So, that will lead to a change in our prevalence. Similarly, how we deal with hygiene in the environment. We have now come to the realisation that there is some benefit for young children to be exposed to, for example, outdoor environments and unstructured play, and places which, perhaps, my generation were used to, and which the generation in between would have seen as inappropriately dirty and not adequately sanitised. We now know that there is some benefit for children to play in the outdoors, with some degree of dirt – this is known as the hygiene hypothesis. Why am I highlighting these two things? Well, we do need to pay attention to this issue of allergies in general and we do not want our population to be inappropriately exposed to some of the risks. We are taking appropriate steps and the most important thing that we can do is provide the right kind of guidance. Having said all that, we do have some numbers suggesting that while the incidence of positive skin prick tests – so, trying to confirm the number of people with positive allergies – has increased, those with serious allergies requiring admission, potentially treatment, appears to be a stable incidence as a proportion of the population, ranging from 6.1 per 100,000 children in 2014, to about 8.5 in 2023. [Please refer to "Clarification by Senior Minister of State for Health", Official Report, 15 October 2024, Vol 95, Issue 143, Clarification section.] And so, it is not necessarily rising in an alarming fashion, something to pay attention to.”
“Sir, I thank Ms He Ting Ru for her questions and the points that she has made. I think we would all agree, and I certainly do, that we should continue to educate and raise awareness on matters such as this. Indeed, the various agencies and training providers for the workers, whether they are food handlers or early childhood educators, people in a position of responsibility around food and vulnerable people – this is an issue and it is something that we will have to continue to do and to continue to improve on, and learn from the lessons. So, for the second part of her question, there is no disagreement. Indeed, the work is ongoing. With respect to the first part of her question about the prevalence, it is not so straightforward to draw an inference or a clear conclusion on the basis of the numbers, partly because awareness, as she has pointed out, is rising, and so, what we may be seeing is an increased detection of cases that were already present. Secondly, our population continues to grow slowly. You have to normalise for that. So, the absolute numbers may not necessarily be the correct reflection. More importantly, our dietary patterns and the practices around how we raise our children have changed quite significantly over the last two generations. In two of these factors, one, for example, is the issue of when to introduce allergens into the diet. So, do you start feeding at the age of six months, one year or late? And the current guidelines are such as between the ages of four and six months, children should be introduced to normal food and potential allergens so that they can adapt to them. It was not always so that that was the guidance and so the people who are my age and, perhaps, a little bit younger, were brought up under a slightly different approach.”
“Sir, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) in 2017, showed that the overall prevalence of childhood food allergy in Singapore was low, between 1% and 3% in children aged 18 months to four years in age. This is generally lower than the prevalence reported in other jurisdictions. The National University Hospital (NUH) and KK Women's and Children's Hospital (KKH) plan to carry out another study to determine the current prevalence of food allergies in children. There are also a number of inter-agency efforts in place to increase awareness on how to better prevent and manage food allergies. For the food industry, KKH is working with the Singapore Food Agency (SFA) to raise awareness among food handlers on food allergen risks by enhancing the content covered in the Workforce Skills Qualification (WSQ) Food Safety Course. In schools, our public healthcare institutions have been working with the Ministry of Education (MOE) and Early Childhood Development Agency (ECDA) to train primary and preschool teachers on emergency treatment of children with severe allergic reactions. To better educate the public on food allergies and preventive measures, KKH and the Health Promotion Board (HPB) are developing more resources on managing and living with food allergies to complement existing materials available on Parent Hub. NUH has also been educating and supporting patients and caregivers on food allergies, in partnership with polyclinics, patient support groups and non-profit organisations.”
“Mr Speaker, may I have your permission to answer Question Nos 11 and 12 on the Order Paper today, together, please?”
“Sir, I thank Ms Denise Phua for her micro-question. I would recommend that her residents who are in the position that she described should best be directed to a ServiceSG Centre because that is where there are staff who are able to help them conduct the transaction on their behalf or help them navigate the online space and do so in a way that perhaps gives them some confidence about the security and safety of the transaction. That is what the ServiceSG Centres are for – to assist the residents in these transactions. There may well be a digital component to the transaction at the ServiceSG Centre and the staff there will help the resident do that or the family member who accompanies the resident. I hope that provides Ms Denise Phua an opportunity to assist the residents in that way. 1.31 pm”
“The metrics that we have, they show an increasing acceptability and increasing engagement and increasing utilisation over time. So, it is unlikely that that represents a large number, but if there are specific instances that we can assist with, I would be more than happy to take some feedback from the Member. Did I address all four of the Member's questions? Or three?”
“Sir, I may have miscounted and can stand corrected. I thought it was four. I do agree that we have to make sure that we implement properly the various schemes and strategies that we have. I do agree that UI and UX, the user interface and user experience, is a key part of the implementation of the digital services. We do have some expertise amongst our public officers in designing digital user interfaces and user experiences. Some of this expertise rests within GovTech centrally, and agencies that have a large volume of digital transactions have also started to build up their expertise in this. There is an extensive process of testing and user viability that many products go through. But even then, or I should say most importantly, after the products are made available to the public, we do pay a lot of attention to how they engage with it and seek to then improve the user interface and the user experience. This includes formal testing by engineers and teams at GovTech, developing and deploying tools that test readability, accessibility, but also then informal in terms of dealing with feedback, including through Members of the House. So, if there are specific issues around user interface and user experience, I would encourage Members of the House to let me know and we will follow up. Sometimes, the best feedback comes from our constituents, members of our family, our own elderly relatives. Rest assured, my elderly relatives do message me quite regularly about how to improve Government digital services and that is useful feedback. We take that seriously, that real-life experience and we will try to re-engineer those products to improve the experience. We do not specifically track the digital drop-off that the Member talked about.”
“Sir, I thank Mr Yong for his three supplementary questions. The short answer to all three is yes. We do want to make sure that our seniors benefit from the various efforts that we are making around digitalisation and for them to then have the opportunity to go online. We have a number of training programmes that we have explained in this House and outside. We have the Silver Digital Ambassadors as well that we train. They are peer influencers along the lines that Mr Yong spoke about. And we have spent some time and effort trying to educate all members of the public, including seniors, about how to better protect themselves as they transact online. Maintaining that trust in online transaction is important. However, we are not insisting that they go online. And I hope that Mr Yong and other Members of this House can help to spread that message that if they choose to transact in person, if they choose to transact via other means, then we will find ways to make that possible. However, the approach around the public sector officers is to make sure that the public sector officers that help the seniors are themselves empowered by a digital backbone that makes their work as productive and efficient and as secure as possible to optimise the service they offer to the citizens.”