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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“Since 2023, we have used Purple A11y to make Government digital services more accessible, and it has been directly integrated into the development for websites like MyCareersFuture, to ensure that they are accessible. Sir, I have so far focused on digital products. But there is another aspect to the work that we have to pay some attention to – the infrastructure, the interconnected systems that must work together to make such products even possible. I would like to now explain how we are strengthening Singapore’s digital infrastructure and investing in research and development so we can continue to have a conducive environment for digital innovation. Mr Sharael Taha asked how MCI is equipping Singapore to make the most of latest technological developments, especially in AI. Ensuring Singapore has the foundational infrastructure to power AI activities is vital. To that end, we will be investing up to $500 million to ensure that Singapore can have sufficient high-performance compute to support our ambitions in AI innovation and capacity building. We envisage that these resources will support use cases across sectors, such as financial services, healthcare, transport and logistics. And over time, we hope for this seed funding to catalyse greater development and the use of AI in Singapore and spur additional industry investment in compute infrastructure. Ms Tin Pei Ling asked about plans to implement the Digital Connectivity Blueprint. Launched last June by MCI and IMDA, the Digital Connectivity Blueprint (DCB) outlines Singapore’s strategy for building the next generation of our digital infrastructure.”
“We have also built tools specifically to support those with differing needs. One example, and Members can try this out for themselves at Level 1, is a product called “ReadLiao”. This is one of the prototypes that emerged from our recent Hack For Public Good hackathon. Today, seniors sometimes struggle with long and complicated letters and often have to rely on caregivers, including children, to summarise the information for them. Those with older relatives might be familiar with the experience of looking at these letters, explaining such letters to them. It is often not just the language but also how the material is presented. So, ReadLiao uses Optical Character Recognition together with an AI platform, repackages and displays documents in a clear and comprehensible format to better communicate the content to seniors. We intend to pilot ReadLiao within the community in the coming months and hopefully build it into a full-fledged product. It is literally only a few weeks’ old, at the prototyping stage. We have another tool which is more mature. This is called “Purple A11y”, GovTech’s open-source, automated testing tool. It scans webpages and it identifies potential accessibility issues. Developers can use it to identify improperly labelled buttons or images. For most of us, these are things we do not notice. These are not necessarily errors that we pick up and we do not see the difficulty that such a design might present. But if you are visually impaired, if you use a screen reader to navigate digital services, getting this type of design correct makes a huge difference.”
“And back in 2021, Mr Hamzah saw first-hand the challenges his close friend faced in settling his late father’s affairs in the midst of grieving. Learning from this experience, Mr Hamzah and his wife decided to start planning early and turned to MyLegacy for help. With the MyLegacy product, Mr Hamzah could easily record important details – his various accounts, his insurance policies – and share that information with trusted persons. He describes the portal’s dashboard as intuitive, very easy to use and navigate, and he takes heart from the assurance that this information would not be used for third-party marketing, and he has become an enthusiastic advocate for MyLegacy among his friends and family. Again, I would encourage Members to look at the MyLegacy product and encourage their residents and constituents to consider signing up for it. The third part of our strategy is to be more inclusive. Mr Eric Chua had some questions about this and brought up some points. He asked about the mobile phone access of our seniors. Chairman, 89% of seniors aged 60 years and above own a smartphone in 2022 and this has increased from 74% in 2017. And our Mobile Access for Seniors' scheme has approved more than 16,000 assistance packages for low-income seniors since the launch of the scheme in 2020. Mr Chua also spoke about the need to better support seniors in general to navigate the digital space. And to do this, we launched the Seniors Go Digital programme, and over 280,000 seniors have been trained so far. At the same time, we also have to take efforts to be inclusive in our design and development; take the process to our seniors. We test our digital services with a wide range of users, including seniors, to ensure that their needs are met.”
“It is one of our most wide-reaching tools in the fight against scams and I would encourage Singaporeans to use it. Second, is offering better and more integrated Government services and a couple of examples here. One is the Health Appointment System (HAS). Users can easily make appointments for vaccinations, for screenings, such as mammograms. This product is available in English, Mandarin, Malay and Tamil. Again, that is an aspect of the service that is difficult for the market to solve in the way that we need it to, in multiple languages. This product also allows users to see what subsidies are applied to their health appointments from schemes, such as the Community Health Assist Scheme and MediSave. 6.15 pm And so, we are bringing together two or three different aspects of the service the market is unlikely to do – an appointment scheme provided in multiple languages and so that you can see the subsidies that you would get for these appointments at the time to help you make your decision. Another example is MyLegacy@LifeSG. This goes a step further. It brings together reliable information and digital services related to end-of-life planning as well as post-death matters in a convenient portal. Because navigating such matters can be difficult. It is difficult, even for those of us who have thought ahead. These times of our lives do not happen very often; a lot of stress, a lot of uncertainty and a lot of things to get done, a lot of services and transactions that we need to get done. So, every bit of support helps at a time like this. One example of this sort of experience is Mr Christopher Hamzah. He is married, he has got a four-month-old daughter.”
“But sometimes, if there is a need for more general information, so we produced another product, SearchSG, which is a search engine that uses AI to provide citizens with relevant up-to-date search results scrapped from a variety of Government sources. So, multiple strategies and try to solve the same problem. In doing so, we are able to learn about the needs and experiences of our users as they engage with our digital products. And the faster we learn, the faster we improve. Ms Jessica Tan asked how the push for digitalisation has improved Singaporeans' lives as the Smart Nation initiative enters its 10th year. Between 2014 and 2023, citizen satisfaction with Government services has improved from 73% to 83%. Over the same period, business satisfaction with Government services has also risen, from 69% to 83%. Allow me to share some of the key strategies that we are applying, that we think have resulted in this improvement. There are three strategies. One is that we have to work to improve the day-to-day lives of Singaporeans. Secondly, in doing so, we have to offer better and more integrated Government services. Third, in doing so, we have to be more inclusive. If I could, perhaps, share some examples in each of those categories. There are many digital services available through websites, app stores or other channels. There are also needs that the market does not address or finds it difficult to address. One example of this and it keeps Singaporeans safe from scams is ScamShield. It is difficult for there to be a market solution that can adequately protect Singaporeans in quite the same way. It is a difficult problem that affects us on a day-to-day basis. And now, we have a product, ScamShield, and it appears to be well-received – 850,000 downloads.”
“They had some concerns about the installation, the maintenance of the device and also about how it worked. So, after considering these insights, the team has paused the development on MoneySound three months after it began. Come up with an idea, move quickly, establish through "proof-of-concept" whether it is likely to be well-received and, if it does not, we have to press pause. It is disappointing when these ideas do not work out as expected. But this is the process of experimentation that our Digital Government engineers are working through. But the insights from such an approach are useful and they will help us to tackle the next problem or the next iteration of the product. This experimentation approach also allows us to try multiple strategies at the same time to tackle big problems. For instance, GovTech teams have been exploring how to help citizens access relevant information from Government websites. Providing the right information for citizens in the right way is a big problem. Instead of searching for a single silver bullet, we have launched several products. Each targets a different segment of users to address different needs. Singaporeans in need of assistance can use SupportGoWhere. It is a one-stop portal to find Government schemes or funded services. One of its key features is the Care Services Recommender for caregivers to find care services, financial support schemes and future planning tools suited to their circumstances. This enables them to find support conveniently, instead of having to navigate various Government websites in search of relevant information. They do not need to know where to go to find the relevant information. They just have one portal.”
“Ahead of Build For Good 2023, the organisers collected over 700 problem statements from the public. One of the teams tackled the problem of student counsellors having to spend time writing case notes. Their solution is a product called the NoteFlow. It is a tool for transcribing and summarising case interviews and counsellors can then focus on caring for their students. NoteFlow and other promising ideas coming out of Build For Good are prototypes and we are hopeful that some of them will mature in time and make their own contribution to the public good. Having identified the problem, we explore different solutions to tackle it: build prototypes quickly; test them out with real users; and scale the ideas which show promise. The problems the Government has to tackle are challenging, and trying different things to figure out what works best is our best bet to solve these problems for Singapore. The ideas that we experiment with, as I have described, multiple approaches to a single problem means that some of the ideas that we experiment with will not work out. Let me provide one example. This was a product called MoneySound. The team had observed that it is sometimes difficult for hawkers, especially elderly hawkers, to visually check for proof of an e-payment on a customer's device. So, having identified this problem, within a couple of months, a small team from GovTech had built a "proof-of-concept" prototype for MoneySound. It is a device which reads out incoming digital payments so that the hawkers' hands are not occupied and they do not have to look to then check this digital payment. We tested it with the hawkers but we found out that they were not keen. Their feedback was negative.”
“Mr Chairman, I thank Members for their cuts and their questions. Today, I would like to take the opportunity to explain MCI's approach towards Digital Government: how we need to create and are creating effective digital products, being citizen-centric by looking at Singaporeans' needs by experimenting and embracing experimentation and how we are investing in digital infrastructure and research and development. All these, so that Singapore is well-equipped to realise our Smart Nation ambitions. Sir, good Digital Government begins with understanding what citizens need and solving the problems that matter to them. Our most successful products are the result of asking the same question: what challenges do Singaporeans face? One example is RedeemSG. This lets residents claim and spend Government-issued digital vouchers, including the CDC vouchers. It has been a key enabler in our shift away from paper vouchers. The drawbacks of paper vouchers for the consumer are obvious. Merchants have faced challenges, too. The paper vouchers received had to be bundled together daily, then collected, manually processed. Reimbursement took days or weeks. RedeemSG provided a better way. Households have claimed over $1 billion in digital vouchers since 2020. Simple effective digital products can have a tangible impact on people's lives. Ms Tin Pei Ling asked how the Government can facilitate greater citizen participation in identifying problems and co-creating successful digital solutions. Mr Sharael Taha also asked how the Government can continue to better Singaporeans' lives through new digital products. Build For Good is a good example of how we do both. This brings together volunteers to build digital solutions for fellow citizens. We adopt a problem-first approach.”
“Sir, I thank Mr Yip for his question. The current licensing and regulatory structure, as well as any potential review, does not in any way change the possibility for these professionals to be involved in policy development or for them to be involved in research. So, the issues are to do with consumer protection, regulation of clinical practice. Today, Allied Health Professionals, including psychologists and other healthcare professionals can and do participate in policy development – some of them are employed directly through MOH or some of its entities, some of them come and sit on our panels and our consultative entities and they already participate in research. And the protections around research are afforded by the academic institutions as well as the funding bodies that are supporting the research and none of that should change on the basis of the review that we are conducting, which, as I said, is focused on consumer protection and clinical practice.”
“Mr Speaker, Sir, psychological practice is evolving given the increasing importance of mental health and encompasses diverse fields with their own unique patient safety concerns. The Ministry of Health (MOH) is working with agencies, service providers and professional associations to update the risk assessment. This includes determining if there is a need for registration of psychologists to better support the safety and quality of the practice. The advertising controls under the Healthcare Services Act, or HCSA, were put in place to provide greater transparency and protect consumers from being misled by healthcare advertisements which misrepresent the services provided. The restrictions on the use of the term “treat” applies to all non-HCSA licensees, and not just standalone psychology service providers. Likewise, the protection of the title “doctor” applies to all non-registered healthcare practitioners and not just clinical psychologists. MOH is presently engaging with the psychologists and their association to clarify the proper use of these terms.”
“Sir, the answer is yes. I would refer the Member to the digital connectivity blueprint which stated exactly that. That is distinct from the question that Mr Giam had asked, which is, whether there is a target of the proportion that we would have or the amount of compute, and that is a separate issue which is how we match needs to the demands. So, are we ramping up? Yes. Do we have a set absolute target? No such target has been set.”
“Mr Speaker, Sir, are we pushing for more data centres? The answer is yes. I would refer the Member to our digital connectivity blueprint as well as documents associated with how we have called for more applications for data centres which conform to sustainability measures – in answer to his second question. These have been published, where we are pushing for the data centres that are located in Singapore to be more environmentally friendly, to be more sustainable in terms of the energy used for computing, the software that runs on them, as well as how they maintain their facilities, the cooling standards. How will Singaporeans benefit? Well, again, I would refer to the various documents that we published, looking at how we are digitalising a variety of industries and this digitalisation of the industries should, through these strategies, result in better jobs. We are also trying to make sure that Singaporeans have the training and skills necessary to take advantage of these opportunities that are brought here.”
“Sir, I thank Ms Denise Phua for those suggestions. Indeed, the answer is yes, we have met with them. I have met with them as well and we will continue to explore how we can raise the awareness of not just ADHD, but a wide range of neurodevelopmental conditions, so that we can detect them earlier but also provide the right type of support to the families that are dealing with these challenges.”
“Sir, the studies that I quoted and looked at were international studies, not confined to the Singaporean population. But we have no reason to believe that they do not apply to our population base.”
“So, for parents, they are not explicitly taught the symptoms and signs of ADHD, just as they are not expected to know about pathologies and diseases. But when they engage in looking at their child, reading about developmental milestones, understanding whether their child is within that range of normality, this is actually one of the things that they are doing: is my child progressing through the normal neurodevelopmental stages? And so, if they have concerns and they approach the professionals that deal with these issues, ADHD is one of the differential diagnoses that they will be considering at the time. The financial support, as I have explained in my original reply, is available as part of the subsidy process that we have within our healthcare framework.”
“Sir, I thank Mr Giam for the questions. I will note that his five questions are related to the treatment of ADHD, and his original question was to do with some data statistics. So, I will try to answer the questions he has asked, partly on the basis of my prior professional experience rather than the data that I have been able to gather in advance of his Parliamentary Question. We do not require the reporting of a diagnosis, such as ADHD. So, his first question on what proportion has been treated, we do not have the data because practitioners and parents are not required to report the suspicion of a diagnosis or the confirmation of a diagnosis. And so, we are unable to confirm a global national number on what proportions are treated. Individual clinics perhaps and, especially those clinics which are operating as part of an academic medical institution, will have institution-based or demographic-based data, but that does not represent the national database. ADHD is one of a number of neurodevelopmental conditions that may manifest as an educational challenge or a neurodevelopmental challenge. So, parents certainly are supported in this as part of the consultations and the contact that they will have with healthcare workers and teachers around the neurodevelopmental progress and educational progress of their child. So, ADHD is not the only thing that is looked out for when a GP or community health professional looks at, for example, whether the child is reaching appropriate developmental milestones. But it is certainly one of the possible differential diagnoses in addressing whether a child is reaching the developmental milestones within an acceptably normal range. It is something that GPs, paediatricians and community health workers are trained for.”
“Mr Speaker, Sir, academic research has estimated the prevalence of attention deficit hyperactivity disorder (ADHD) among children and adolescents to range between 5% and 8%, and among adults to range between 2% and 7%. Children aged six years and below are eligible to receive subsidised consultations and therapy of up to 70% for ADHD under the Child Development Programme (CDP) at the KK Women's and Children's Hospital and National University Hospital (NUH), if referred to the programme from polyclinics or from Community Health Assist Scheme (CHAS) general practitioner (GP) clinics. For school-going students aged seven years and above, school counsellors and special educational needs officers provide school-based interventions at no charge, in consultation with the Response, Early Intervention and Assessment in Community Mental Health (REACH) teams when necessary. Cases requiring further medical attention will be referred by REACH to the Child Guidance Clinic (CGC), which offers subsidised consultations and therapy of up to 70%. Eligible patients referred from polyclinics and CHAS GP clinics to public Specialist Outpatient Clinics (SOCs) for the management of ADHD can also receive means-tested subsidies of up to 70%. Singaporeans who face difficulties with their remaining bills can approach medical social workers for financial assistance, such as MediFund.”
“Mr Speaker, Virtual Reality Exposure Therapy (VRET) is a nascent form of psychological therapy that is not yet approved currently for the treatment of disorders in Singapore. Research is still being conducted to evaluate its effectiveness.”
“Sir, for clarity, participation in the I Quit programme does not change the likelihood of prosecution or the penalties. I think Assoc Prof Lim understands that it is the current status quo. I think he is making a suggestion – that perhaps that should change, that either participation in the programme should change the likelihood of prosecution if someone confesses or comes clean, or he is suggesting that the penalties for such participants should be different as a result of their participation. That is not the current situation, as I have explained in my answer. I thank him for his suggestion. And certainly, we want to continue to study ways to make the I Quit programme successful and improve the likelihood of people ceasing from smoking or vaping.”
“Mr Speaker, the team that runs the I Quit programme does not presume that participants currently possess or use vaping products. So, participants need not worry that they will be fined or prosecuted, just for joining the I Quit programme or for turning up for the sessions. That said, I Quit participants are not immune from criminal prosecution with regard to the illegal possession or use of vaping products. If caught, they are subject to the same enforcement actions as other offenders. A total of 112,000 participants have joined the I Quit programme since May 2014. The number is correct as of December 2023. The programme does not keep track of which participants are smokers or vapers.”
“Mr Speaker, I thank Ms Usha Chandradas for the question. We will be very happy to follow-up with her and other practitioners to look to see how we will engage with the practitioners, provide for an appropriate level of access, depending on the effectiveness of the various components of the intervention. As has been brought up in the House, actually, Members have differing views as to how far regulation should go – which professions should be regulated, which interventions should be regulated, which settings should be regulated. It is something that we are studying and we will be very happy to study it together with the professionals involved in the space.”
“I would like to thank all the Ministries and agency officers who have come together to better support and advance the mental health and well-being of our population. The collective dedication and commitment of our Government agencies and the whole of our society are instrumental in driving positive change and fostering better mental health for all. [Applause.]”
“The need for stronger partnerships between clients and providers, but also partnerships across different service providers. It is very important that we must not forget these fundamentals even as we talk about all the other things that we are doing around the implementation of the strategy. We will continue to address these issues as we go forward. There are many initiatives rolled out by the various Ministries and agencies to support individuals with mental health needs. Ms Carrie Tan asked about the need to transition the current interagency task force to a permanent national well-being committee. We have a plan for a whole-of-Government coordination, which is the National Mental Health Office. It will be established by 2025 with officers from the health, social and the education sectors to oversee the implementation of the strategy to ensure cohesive alignment of policies and programmes at the national level and to track the progress and impact of the strategy. Actually, these teams and officers have already begun work. They began work in supporting the work of the Inter-Ministry Taskforce. They are the ones that worked together to put the strategy in place and they are already working together to implement our various programmes and recommendations. So, the work will continue and the work is not done. Members have highlighted issues that we have to continue to study, whether it is about the regulation of some professionals, issues to do with how insurance is made available and issues to do with stigma and access. So, we are quite clear that the work is not done and there is need for continued work in this space.”
“So, even though we are expanding our capacity to provide mental health support for persons with severe mental health needs, it does not mean that we are adopting a purely medicalised approach towards mental health. There is room for non-medical interventions, such as art-based interventions, to play a bigger part in promoting mental well-being. To cultivate mental wellness, we need to live healthily. That means having friends, having adequate sleep, a healthy diet, taking part in sports, arts and volunteer work. These are not medical interventions, but they make a huge difference to an individual's life and a huge difference to an individual's health. The National Mental Health and Well-Being Strategy puts forth a comprehensive and holistic approach to addressing mental health issues across many different facets of society. It encompasses a preventive component as well as curative perspectives. We want to tackle the whole continuum of mental health issues coherently, with an emphasis on community, schools and workplace settings. We want to foster a whole-of-society approach, uniting efforts across different sectors to build a mentally healthy and resilient population. After we launched the strategy last year, in late 2023, we have continued to engage with professionals and stakeholders in the space, and we have sought their feedback on the strategy and how the implementation was going. All of them supported the strategy recommendations, but consistently, all of them – professionals working in the mental healthcare space, whether they are healthcare workers or they are social workers in the community and within institutions – raised concerns about persistent stigma and the need for stronger partnerships.”
“Under the National Mental Health Competency Training Framework, service providers in the community would be equipped with suicide risk assessment and intervention skills, so that individuals with suicide risk can be detected early and be provided with the relevant interventions. But we will continue to work on this and find ways to do what we do better and to make sure that every individual who needs help can find it. As a safety net to meet the care needs of individuals with severe and chronic mental health conditions, MOH will be expanding our hospital and our long-term care capacity. This will be supported by plans to expand the pool of psychiatrists and psychologists in our public healthcare institutions, as has already been shared. So, the balance of that capacity increase will be different, depending on whether we are talking about inpatient psychiatric beds at places like IMH and the redeveloped Alexandra Hospital compared to, for example, long-term psychiatric care capacity. We hope that with all the things we are doing with our mental health strategy, while we will increase inpatient acute psychiatric capacity, the need for that will not be so significant because of the things we are doing upstream in the population and within the community. But we will continue to need some increase in facilities in long-term psychiatric care capacity. Today, we have almost 1,000 acute psychiatric beds. By 2030, this will be 1,070. Today, we have 3,000 step-down residential care beds – long-term psychiatric care facilities. By 2030, we will have 3,500 of such beds. So, the balance is on the long-term residential psychiatric care.”
“To raise the capabilities of these practitioners, MOH and the Ministry of Social and Family Development (MSF) are collaborating with NUS, the Nanyang Technological University (NTU) and Singapore University of Social Sciences (SUSS), to develop an onboarding course for practitioners providing Tier 3 support to equip participants with skills to provide Cognitive Behavioural Therapy (CBT) for a range of common mental health conditions, including depressive and anxiety disorders, schizophrenia, obsessive compulsive disorders and insomnia. We aim to upskill 80 practitioners a year through these courses, starting from this year. This is part of our commitment to proactively upskill practitioners in the community to effectively support individuals with diverse mental health needs. Mr Keith Chua, Ms Mariam Jaafar, Mr Yip Hon Weng and Mr Vikram Nair highlighted concerns about persons with suicide risk. The causes of suicide are multifaceted and it requires a holistic, multi-agency approach to address them. For example, in schools and IHLs, students at risk of suicide are supported by school counsellors, referred to REACH, Community Health Assessment Team (CHAT) or emergency services in hospitals. CareLine, a 24/7 social support hotline, provides tele-befriending as well as emergency response services to seniors in distress and it is operated by staff who can speak various dialects. Those in crisis can access crisis helplines, such as the Samaritans of Singapore's (SOS') Hotline and Care Text and IMH's Mental Health helpline.”
“The eventual goal is to extend this training approach to over 130,000 frontline personnel and volunteers by 2030. So, to have a broad network of support and individuals for mental health needs. We have created the learning modules. AIC has worked on this and put it online: awareness of the signs and symptoms of mental health conditions; and how to support individuals. They are accessible and open to the public. There are courses that you can go for psychological first aid. So, caregivers for individuals with mental health needs may also find it beneficial to participate in these courses and enhance their ability to care for their loved ones, the care recipients. The issue here is supporting individuals with mild symptoms of mental health conditions. How to identify the individuals, prevent an escalation of their symptoms and de-escalate a mental health crisis and formulating a safety plan for individuals with suicide risk. Next to this, we have plans around what to do to support individuals with moderate symptoms of mental health conditions. For that, service providers are trained to conduct mental health assessments and provide psychotherapy. So, we distinguish those 130,000 frontline personnel and volunteers focused on mental health needs of people with mild conditions; and then a separate tier of interventions for individuals who can support people with mental health needs that are moderate in nature, with moderate symptoms – providing assessments, psychotherapy to reduce the severity of their symptoms.”
“Importantly, this national mental health competency training framework is designed to be inclusive and it encompasses all practitioners and individuals involved in mental health support. So, one single, national mental health competency training framework, from lay responders, like peer supporters, to mental health professionals, like psychologists and counsellors. As we step-up our capability building efforts, a substantial pool of peer supporters and service providers across Tiers 1, 2 and 3 will have the necessary baseline competencies to support individuals with mental health needs over the next two years. We will equip a wide spectrum of practitioners and enhance the overall capability of the community to provide effective support for individuals with mental health needs. But we will also engage peer supporters and frontline personnel that are not within the healthcare and social space. They will be trained to identify mental health needs and provide psychological first aid, if needed. So, the term is appropriate. Just as you do not need to be a healthcare worker to provide first aid, it is something that all of us can do. We want to train people to be able to provide psychological first aid, even if they are not a healthcare worker or a care professional. Today, over 48,000 frontline personnel, including school teachers and officers from agencies, such as the Singapore Police Force (SPF), Housing and Development Board (HDB), Central Narcotics Bureau (CNB), Social Service Offices and FSCs, have been trained, together with 54,000 volunteers, to recognise and provide basic emotional support to individuals in need and to refer these individuals for further support as needed.”
“But Members have made the point that perhaps it is insufficient for our situation today and, potentially, insufficient for the outcome of the shift that our national mental health strategy will engender. Psychology practice is evolving and already encompasses diverse fields with their own unique safety concerns. So, MOH has been working already with agencies, service providers and professional associations to update the risk assessment and that updating of the risk assessment will have to take into account, then, what developments occur in the field in the near future; review and study these findings; and study the possible need to regulate clinical psychologists. So, I thank Members for their suggestions. There is, I think, not a consensus among the suggestions within the House from which professions need what type of regulation. So, we will study all the suggestions that are being made very seriously and look at these possibilities. But beyond the regulation of clinical psychologists, building the competencies of other mental health practitioners and the community to effectively support individuals with mental health needs is another critical component of our strategy. So, we have introduced the National Mental Health Competency Training Framework to enhance the capabilities of practitioners across the various tiers of care. This framework will complement existing professional standards for mental health professionals, such as psychologists and counsellors. It provides guidance to service providers in acquiring the necessary competencies which will then be aligned with the tiered care model.”
“We have another set of teams, which are the Community Intervention Teams (COMIT). They provide mental health assessments and psychosocial interventions. Today, we have 29 of such teams, with four of them catering to youths. By 2030, we will expand the number of these teams as well to have 50 COMIT teams, with 15 catering to youths. MOH is working with AIC to publicise these services as well, so that more people can benefit from access to these community-based mental health services. Other than expanding mental health services in primary and community care settings, we must also continue to ensure the safety and quality of services. I thank Dr Syed Harun, Ms He Ting Ru, Miss Rachel Ong and Assoc Prof Razwana Begum for their suggestion to introduce regulatory frameworks for psychologists and other professionals. I would point out that this space is not entirely a vacuum today. There are, indeed, some regulatory processes and frameworks in place. Today, services provided by clinical psychologists in healthcare institutions are subjected to the clinical governance framework of these healthcare institutions and existing healthcare legislations, such as the Healthcare Services Act. In a non-healthcare setting, such as MSF-funded early intervention programmes, the operators do, indeed, employ mental health professionals, including clinical psychologists, to provide therapy services. These funding agreements for these services specify the minimum qualifications and training required before staff can be deployed to provide such services. So, there are some regulatory frameworks in place.”
“The processes in this Practice Guide will be piloted with some of the service providers and fine-tuned before being disseminated to mental health practitioners across our ecosystem by the end of the year. GP clinics and polyclinics are important touchpoints for all of us, especially for individuals with mental health needs. They are community-based, easily accessible and we know that there is a strong association between physical and mental health conditions. So, the primary care service, primary care doctor and primary care clinic are ideally placed to treat the patient's physical and mental health conditions simultaneously and holistically. Today, 19 out of the existing 25 polyclinics provide mental health services. These services at polyclinics are helmed by multi-disciplinary teams with family physicians, psychologists, medical social workers and nurses. In addition, over 450 GPs in GP clinics are trained to support persons with mental health needs under the Mental Health General Practitioner Partnership. To ensure that more patients with common mental health conditions, such as anxiety and depression, have access to mental health services in a primary care setting, we aim to make these services available in all polyclinics and 1,350 Healthier SG GP clinics by 2030. Expanding mental health support in the community beyond healthcare settings is essential. Today, 73 CREST work tirelessly to raise awareness, detect and refer individuals with mental health needs to the appropriate services. Eight of these teams currently cater to youths. By 2030, we will expand the number of outreach teams to 90 and we will have 15 teams that cater to youths. The CREST teams work on awareness, detection and referrals.”
“So, as has been discussed, there will be four levels of mental health support: from mental health promotion, self-help and peer support at Tier 1, to the most intensive level of care in hospitals and by specialist clinics at Tier 4. Based on the severity of symptoms, individuals can tailor care according to their needs. Individuals with severe symptoms of mental health conditions will benefit from hospital-based psychiatric and medical treatment. Those with mild to moderate symptoms are best supported by mental health practitioners in primary care and community settings. The majority of individuals, who may experience mental distress periodically without mental illness, could be best supported by peer supporters in schools or workplaces, as well as using self-help resources, including online. Overall, we aim to ensure that individuals with mental health needs receive the right support at the right time. This reflects a more nuanced and responsive approach to mental health. Senior Parliamentary Secretary Eric Chua shared about the Practice Guide that is being developed by the Interagency Taskforce on Mental Health and Well-Being together with key stakeholders from the health, social and education sectors. This will translate the core concepts into practical steps to help practitioners effectively apply this tiered approach; make the framework work for their clients and for their patients; and enhance the integration and coordination of our mental health support system. We have already put in place implementation teams, working groups and committees to execute our various plans and strategies.”
“How we are doing so, I will go on to explain some of the details, and in particular, the tiered care model. This has been brought up by Senior Parliamentary of State Rahayu Mahzam. It has been a central part of the strategy and has been discussed. I will highlight that this tiered care model is not something we need members of the public to internalise or use as a guide on how they seek services. Someone with mental health concerns does not need to look at the strategy and ask, "Am I a Tier 1?" That is not the point. The tiered care model is an internal way of organising our services. It is an internal way of thinking how we will invest the development of our services, shift the development of our professional capacity and capability, and integrate the various parts of our system with each other. But the reason we explained it and, I will now explain it, is to make the point that we are very serious about what we want to do. We are very serious about reorganising how we deliver our services and how we develop our capacity and our capability. So, in explaining the breadth and depth of what we are doing, I will need to explain a little bit about how the tiered care model will be developed and implemented. It will guide the delivery of our mental health services according to the severity of mental health needs and apply across a variety of settings. It serves as a framework, a foundation for strategic enhancements to our mental health ecosystem. Our overall goal is to improve access to care and mitigate unwarranted medicalisation and to reduce stigma. Because not every mental health issue needs to be addressed by a psychiatrist, just as not every medical condition needs to be treated as an inpatient by a specialist.”
“The National Population Health Survey in 2022 reported that our residents are more willing to seek help informally from their social circles, rather than formally from healthcare professionals. By shifting the focus of our efforts, the centre of gravity, into the community, by broadening the number of professions and processes that can be involved in mental health and by engaging larger and larger circles of the community, we are hoping to do a number of things in terms of changing what we do for mental health in Singapore. The first of many, I will just highlight three, but the first is increasing access to our mental health services ecosystem. We want to be able to make it easy for people to find the help that they need and access the touchpoints that will provide them the interventions that they will find useful. The second, is to make sure that we make these interventions effective and certainly, for persons with mild mental health concerns or mental health conditions that are mild, care in the community, where they are able to continue to interact with their social circles, with their friends, with their family, with their workplace, have that normal routine of life, interventions in those settings may be more effective than removing the person from the natural rhythm of their life, institutionalising them and providing a very clinical response. The third reason is that by involving a much wider variety of partners and more and more members of the community, we hope to be able to drive that shift in attitude that so many Members of this House have spoken about as being key to changing our approach towards mental health here in Singapore. That is what we are trying to achieve and why we are trying to do this.”
“Mr Speaker, I rise in support of the Motion. I want to thank Dr Wan Rizal, Mr Edward Chia, Ms Mariam Jaafar, Dr Tan Wu Meng and Mr Yip Hon Weng for putting forward this Motion on advancing mental health and highlighting the need for a whole-of-Singapore effort to implement a national strategy to enhance mental health and well-being. I would also like to thank my colleagues who had just spoken, sharing on efforts in the health, social, education, workplace and community sectors; and many Members of Parliament, who have supported the various mental health initiatives and provided suggestions for improvements. I would also like to record my thanks to all the members of the task force, political office holders, people that we have consulted, community representatives, the Civil Service officers as well as the professionals that have contributed to not just the development of the strategy, but so much of what we have done since we launched the strategy to implement these programmes into action. What is it that we are trying to do? What is it that we are trying to achieve? As many colleagues have emphasised, mental health exists on a spectrum and requires a comprehensive approach involving the entire government and society. Instead of managing mental disorders only or solely, largely in hospital-based settings, the aim is to bring mental health support closer to individuals' everyday environment. Their homes, workplaces and social circles. By integrating care within the community, mental health support can be seamlessly delivered within natural social settings, such as schools and workplaces; and leveraging existing social and support networks, such as families, friends and coworkers.”
“Sir, I thank the Member for his questions. For the first one, in terms of the relative demand, for enrolment at polyclinic versus a GP, 65% of the total that have enrolled, are enrolled with a Healthier SG GP clinic. Among the polyclinic enrolees, 81% are existing regular patients, while the remaining 19% are non-regular and new patients. Of the regular polyclinic patients, about 26% have enrolled with a GP clinic. It ranges from about 19% to 34%. That gives you a sense of the behaviour amongst the enrollees and our residents across the landscape. To Member's second question, the short answer would be, no. Because he has asked an absolute question: whether all or every single regular patient can continue to enrol. So, it depends on what it is they are a regular patient for: do they have a chronic disease that falls under the Healthier SG programme; are they regular for a short period of time or have they been a regular patient over a longer period of time? So, if you take it in the spirit that the polyclinics would like to continue to serve those patients who have chronic diseases; which they have been following up and which Healthier SG would be able to assist them, then the answer is, yes.”
“Mr Speaker, the Healthier SG enrolment capacity of each polyclinic is different, depending on their sizes and existing workload. The average enrolment capacity is close to 30,000 per polyclinic. Of the 25 polyclinics, 19 polyclinics still have spare capacity to take in more enrolees; while six are reserving their capacities for their regular chronic patients to enrol, before deciding if they could take in non-regular or new residents. Residents are encouraged to also consider enrolling with other Healthier SG private general practitioner (GP) clinics. A key design feature of Healthier SG is to extend the benefits of fully-subsidised preventative check-ins, health screening and vaccinations and chronic drug subsidies to private clinics. There is currently capacity at Healthier SG GP clinics to enrol more than 700,000 residents.”
“Mr Speaker, I thank the Member for his questions. I would take his second one first. The issue has got to do with health literacy and the public education that is received. As a result, it does not only result in a change in behaviour for health-seeking at an A&E department. These are public health messages that are useful for the public, in general, to understand about their own health, the health of their loved ones, the health of their family and where and how they can access medical help. We will continue to do so, but I am not sure that I quite agree with the very tight link that the Member has put out in his question. It is worth doing, but perhaps, we measure its effectiveness in a different way. As far as urgent care centres are concerned, I thank him for the question. We are piloting the urgent care centre at Admiralty. It is opened daily, including public holidays, from 8.00 am to 11.00 pm. There is another urgent care centre at the National University Hospital (NUH) Children's Urgent Care Clinic @ Bukit Panjang for the paediatric population opened daily from 2.00 pm to 10.00 pm. At Admiralty, they have seen over 16,000 patients in 2022; and at the NUH clinic, 21,900 patients in 2022. Other than the usual conditions that primary care physicians will be managing, the urgent care centres can also perform simple blood tests and X-rays onsite and provide services that you do not usually see at most GPs, such as plaster casts for minor fractures and sometimes, intravenous fluids for short periods with observation.”
“Mr Speaker, we agree with the Member and will continue to educate members of public on the proper use of accident and emergency (A&E) departments. With the implementation of Healthier SG, all 1,000 Healthier SG general practitioner (GP) clinics are on board the GPFirst programme. We have also set up an Urgent Care Centre in the north, to ease the A&E cases at Khoo Teck Puat Hospital. Our hospitals are encouraging the greater use of telemedicine, including a helpline to advise people where to seek treatment. All these initiatives are ongoing, as we continue to manage rising case loads as a result of frequent outbreak of infectious diseases and an ageing population.”
“Mr Speaker, I thank Mr Yong for the question. The advisory when travelling is the same as the advice given in Singapore. So, the fact of travelling does not change the advice and if I may, I will just quote from our general advice that we have provided that is worth highlighting. The following precautions are advised: that individuals should monitor their health, maintain a high standard of personal hygiene, frequent hand washing after going to the toilet or when hands are soiled, avoiding contact with persons who are unwell or objects that became contaminated with infectious fluids, such as soiled clothing, bedding or towels. The avoidance of high-risk sexual activities, such as having multiple partners and casual sex when travelling, the avoidance of contact with wild animals that could harbour the virus and, in particular, the consumption of bush meat. This advice applies whether travelling or not, and, in addition, to seek medical attention if one develops symptoms, such as the sudden onset of high fever, swollen lymph nodes and rash and, when doing so – obtaining medical attention – informing the clinical team of recent travel and exposure.”
“Mr Speaker, since mpox was made legally notifiable on 30 June 2022, the Ministry of Health (MOH) has been reporting up to 20 cases per quarter, with 18 cases in Q3 2022, 20 cases in Q4 2023, and zero to six cases in between. The increase in cases in the last quarter of 2023 corresponded with a rise in cases globally and regionally. No new mpox cases were reported in Singapore in January 2024.”
“I would point out that companies have to invest tens-of-billions of dollars – billions with a "b" – of US dollars for one generative AI model. If we took the approach that he suggests, we may only be able to afford to participate in one or two projects. And is that going to be the best approach for Singapore? AI is a fast-moving, inherently borderless technology. For Singapore to succeed, we must remain open. Open to innovation, to talent, to data, to ideas from around the world. We will also need to work with partners from around the world to address the wide-ranging impact that AI can potentially have. Taking a protectionist stance will do us more harm than good and it will undermine our hard-won credibility as a serious, constructive, inclusive society and nation. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)]”
“We have to have sufficient compute power so that industry, academia and the Government can innovate, build and deploy high value solutions. Our strategy on data is important in advancing our AI aspirations. Our approach on data is premised on supporting innovation, serving the public good and making sure that relevant safeguards are in place. We focus on improving the quality of data sets, building up our capability and ensuring that data use for AI development is aligned with trusted data sharing frameworks. But domestic data and local AI models are not enough for Singapore to achieve our ambitions. We must maintain our ability to access and use global data and models to deliver good outcomes for Singapore and Singaporeans. It is important to resist the allure of data localisation narratives. It sounds very seductive. But instead, we need to remain connected, allow for and advocate for cross-border data flows as long as adequate protection is ensured. Recent legislation in large countries avoid this idea of explicit localisation provisions. Even with their large markets and large data sets, they recognise the benefits of being connected to the world. And we benefit from openness and connectivity to the world for our partners to share with us in good faith, and they are less likely to do so if we close ourselves off. Singapore has thrived as part of a connected world. Mr Giam spoke about industrial policy. It is the nature of the tech and digital space that Government cannot pick winners and certainly cannot centrally plan their way to success. There is also the issue of the cost associated with the approach he suggests. He proposes, I believe, that we rely on our own data only and develop an AI model at scale ourselves. I think that is what he suggesting.”
“Anchoring AI activities is only one part of the picture. A strong AI ecosystem also requires skilled AI practitioners. We want to grow a pool of such high value and skilled jobs here in Singapore. As discussed extensively in this House, including by Dr Tan Wu Meng on behalf of his Clementi residents and I think representing the concerns of residents across Singapore in successive Budget speeches, the 2023 Presidential Address Debate, Parliamentary Questions, our recent Parliamentary Motion. None of this will become a reality if we do not train, upskill and reskill our labour force. That point has been made and the Government's key focus is thus on training our people. This will allow Singaporeans to capture new opportunities and shape their future. For example, the Tech Skills Accelerator and AI apprenticeship programmes have trained many Singaporeans to take on AI related roles and we will elaborate on additional plans at the COS. We have also started work on equipping our students with skills relevant to artificial intelligence. The Ministry of Education develops students foundational knowledge of AI and promotes its safe and responsible use in schools. That said, it is important to recognise that global AI talent plays a complementary role. They serve as a bridge to expertise, perspectives, innovative approaches elsewhere that are crucial for the information exchange and skills transfer to strengthen our ecosystem. Today, we are already experiencing strong demand for AI talent here in Singapore. Given the fierce competition for this talent globally, it would be quite unwise to limit the pool of skilled practitioners we can draw from and potentially hindering our ecosystem growth. There are some other essential enablers that we need here.”
“We will anchor integrated and transformative AI innovation and value creation activities here, working with companies to base their AI Centres of Excellence, to build new products, develop intellectual property across the AI stack here in Singapore. We have a new model of sectoral Centres of Excellence, partnering industry champions to identify sectoral use cases, developing a broader base of researchers and companies to intensify sophisticated AI development and deployment here. We are also working to speed up value discovery, experimentation and innovation, including the AI Trailblazers Initiative, working with Google Cloud to help enterprises bring novel generative AI use cases to life in a hundred days. Creating this environment for many projects, many peaks of excellence, has two key benefits. One is that it makes it more likely that we benefit all either through economic opportunity by being part of the industry or as a beneficiary of the new service. The second key benefit is that not all projects are successful. With moonshots, Mr Giam will know that outcomes are inherently uncertain and the original moonshot certainly did not have a friction free path to success. Outcomes are inherently uncertain. They are not always clear, and even with the best efforts we may not get the desired or expected results. So as we embark on ambitious and innovative projects, I hope we can count on Mr Giam's support to still stand in support of us having made the attempt in the spirit of a moonshot even when it does not quite work out in the way we expect. So, trying several different ideas, creating the opportunity for innovation and inventiveness, rather than trying to pick symbolic projects, is far more likely to generate a success.”
“It outlines key enablers and actions that Singapore will take in the coming years to achieve the twin goals of excellence, developing peaks of excellence in AI, including to address the needs and challenges of our time, such as climate change and population health. Secondly, empowerment, where we raise up individuals, businesses and communities to use AI with confidence, discernment and trust. Our approach is for AI to have widespread and positive impact on our economy and our society. That is why we will develop peaks of excellence across domains, across our economy, selected on the probability to deliver an outsized impact to Singapore and the lives of Singaporeans, including leading economic sectors such as manufacturing and financial services, those relevant to Singapore's smart nation priorities, healthcare and education. For healthcare, we have dedicated $35 million through the AI in Health Grand Challenge since 2019 to support innovative projects that use AI to predict risk, tailor treatments and enhance health coaching. We already use datasets across various healthcare registries and databases to train AI models, and these are already being piloted for use in clinics across Singapore. SingHealth, together with the Ministry of Health (MOH), A*STAR and the National Supercomputing Centre recently organised the AI Health Summit 2023. It featured local and international experts discussing the application of advanced AI in healthcare, and it demonstrated many of the projects that are already in development here in Singapore. Across our society, we will address peaks of excellence for AI.”
“He talks about the constraints of our local private sector and our small domestic market, but he wants to suggest exactly doing that in restricting the development of an AI system within Singapore. He talks about how there is no global cross-border framework around data sharing, but he wants to worsen that by suggesting data localisation and sovereignty strategies. At one part of his speech, he talks about how there is a level playing field for AI with a highly collaborative open source community and then later on, he worries about how there is market dominance and network effects that would make it hard for us to penetrate the market. So, there are internal contradictions. He has differing views, depending on the differing recommendations. I think the Government also has a different view of how we should achieve the outcomes, but I would reiterate, we agree that the outcomes are the same. So, on the outcomes, traditional industrial policy approaches, where governments pick winners and centrally plan the way to success, are not going to be effective for frontier digital technologies like AI. Our approach should target excellence in key domains and create an environment with solid foundations that maximise our chances of success. We should not seek global leadership just for the sake of it. We advance Singapore's interest by growing our AI ecosystem, partnering internationally, creating good jobs, benefiting our companies and our citizens. We will be sharing more details on the implementation of the recently launched National Artificial Intelligence 2.0 at the Committee of Supply (COS) debates. But let me just recap on a few ideas. The strategy focuses on harnessing AI for the public good for Singapore and the world.”
“Thank you, Mr Speaker. I thank Mr Giam for raising some very important issues to do with AI. I thank the Member for reading our National Artificial Intelligence Strategy, in some detail. I would encourage the Member to read the many other documents that we have written, which describe how we are already doing many of the things the Member has listed in his speech. And, I thank him in advance, for supporting the investments that we plan to make to deliver the various outcomes that he has detailed. He suggested a number of important outcomes. We have made some of the same points in the past. I thank him for agreeing with us on a number of key ideas, such as the use of technology and AI should benefit Singapore and Singaporeans, we agree. How we approach AI development should result in better jobs for Singaporeans, we agree. Our approach should lead to skills development and knowledge transfer to Singaporeans and Singapore, we agree. Ambitious, innovative projects should be attempted to create opportunities, AI can be transformative for healthcare and our small size as a nation should not deter us from seeking excellence and potentially global leadership in AI, we agree with all this, we have said all this before. And I am glad that he thinks we should do this. But how we do so and how we proceed, matters. How we should achieve these outcomes. Here, perhaps our views differ. I will point out that in talking through the mechanisms and the suggestions that Mr Giam has made, his speech does have some internal contradictions. Statements that he makes to support one strategy, perhaps contracts another. Here are three examples.”
“Sir, I thank Ms Soh for the supplementary question. We are reviewing the regulatory requirements and so, one of the things that we will be reviewing is the frequency as well as the type of inspections, audits and review.”
“Sir, all cord blood banks in Singapore are currently subject to scheduled inspections every two years to assess their compliance with regulatory requirements under the Healthcare Services Act (HCSA). In addition, the Ministry of Health (MOH) may conduct additional visits, including unannounced visits, if there are any specific areas of concern or suspected lapses. Arising from the Cordlife incident, MOH will review the regulatory requirements under the HCSA and the Healthcare Services (Cord Blood Banking Service) Regulations, including frequency of inspections and other aspects of inspections as well as the monitoring and reporting requirements. However, in reviewing these regulations, we also need to be mindful not to add inappropriate costs and regulatory compliance burden. We need to take a risk-based approach. Many clients of Cordlife have approached MOH for assistance. Most have wanted Cordlife to rectify their shortcomings and this will be MOH's supervision priority as investigations are being conducted. MOH has also received enquiries about transferring cord blood units to another provider. We have engaged the other storage providers, who are prepared to assist. MOH has advised that clients wait for the investigation to complete, likely in a few weeks' time, before deciding whether to do so. Transferring cord blood units at ultra-low temperatures is a complex task and carries risks that are not insignificant.”