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.”
The complete record
Every one of 1,326 lines we hold for Janil Puthucheary, in date order, each linked to its source. Free to read, in full, without an account. Page 7 of 27.
“Mr Speaker, Sir, may I have your permission to answer Question Nos 6 and 7 in today's Order Paper.”
“But we are happy to take in suggestions and optimise our processes further. 3.59 pm”
“I thank Mr Yip for his supplementary question. We do have some processes in place. If the Member would like specific details about the management of the complaints process and the outcomes, I suggest he files a separate Parliamentary Question. This one was about resource allocation. But if I could just take him through the thinking and framework that we have for the SMC's disciplinary process; it is not a single process. There is not a single committee. I say this because it depends on how you define "baseless". The reason for a complaint is that the complainant, the family or the patient has a concern. There may be an issue of communication or the care that is delivered. So, there needs to be some investigation and some processes to ascertain the facts, whether or not there are lessons to be learnt or actions taken. So, we have Inquiry Committees, Complaints Committees and the Disciplinary Tribunal. We also have the processes that potentially could go up to the High Court. So, where you then define "baseless", I think it is not necessarily particularly useful because what is important is that, with the concern, the investigation has proceeded and the facts are established, and then the appropriate action is taken. I think the Member has a separate point, which is whether or not there should be action taken to prevent frivolous complaints. I think the main thing that we would need to have is a clear sense of responsibility among the care teams to engage with the families and the patients to explain the processes for their care so that, when there is a misunderstanding, this can be dealt with long before a formal complaints process is engaged with. That is the starting position that we have around this issue.”
“Mr Speaker, the Singapore Medical Council (SMC) depends on both its own manpower resources as well as an external volunteer pool, such as doctors and lawyers, to support the handling of various complaints and discipline cases. SMC has expanded its resources over the past few years to better manage their workload. Equally important is to have processes that are streamlined and efficient. The amendments to the Medical Registration Act in July 2022, resulting in the introduction of Inquiry Committees and the ability for SMC to tap on a wider pool of chairmen for complaints-related committees, has helped improve the efficiency of SMC. SMC has also enhanced training for committee and tribunal members and worked with the Academy of Medicine Singapore and the College of Family Physicians Singapore to expedite the processing and completion of expert reports. These efforts have resulted in improvements where 70% of the complaints lodged in 2022 were concluded within the year, compared to the 23% in 2018. The Ministry of Health will continue to work with SMC to facilitate the timely conclusion of complaint cases.”
“The Government also has been proactively looking at how to develop FMs to improve our own productivity. My key point then, Sir, is that I would characterise the issue not as either indigenous capabilities or outsourcing but, in truth, the appropriate combination of both and we have already begun on this journey. 12.02 pm”
“Sir, I am mindful of time. On the last question that Mr Gerald Giam has asked, it is large area about how we protect the privacy of our systems and the management of data around AI. I think it is a whole area. I would encourage them to file a question on that so that we could have a discussion. Let me try and address his first two questions. I would say though that I would push back a little and disagree with his characterisations that we are either going to outsource or we are going to develop capabilities locally. And, in truth, you have to do both and even large continent-sized countries are doing both. We do recognise the potential of FMs to significantly enhance productivity to enable new services. And most use cases in the world leverage on existing FMs, either off-the-shelf, customise via methods, such as retrieval augmentation of finetuning. We do have groups that are experimenting and building FMs on such issues, such as to better translate regional languages, improving our understanding on how to govern FMs. But we do so in a prudent and phased manner. We are starting with smaller size models. We have received industry interest to collaborate. These efforts are relatively nascent and we will be examining our plans on how to scale up further with details to be announced later this year. We are supporting an initiative to build our own family of FMs through AI Singapore, named SEA-LION, or Southeast Asian languages In One Network, and training to better address regional use cases, which is a gap in existing FMs. So, we are building these models in a phased manner. We have developed two small ones so far. They have been published. They are open for public and research use and we have received industry interest.”
“Sir, Singapore's research capabilities in artificial intelligence (AI) are well-regarded. We generally rank among the top 10 countries based on publications at leading AI conferences across areas, such as natural language processing and computer vision. We also have an active AI industry research scene, with industry research and development (R&D) centres by companies, such as Salesforce, SAP and Alibaba. As such, Singapore has a strong base of AI researchers who are already working on various aspects of foundation models (FMs), such as helping FMs better understand visual and audio inputs, evaluating the performance of FMs and developing FMs that are more suited for regional use cases. It is not usually necessary or beneficial to rely solely on indigenous capabilities to advance our economic interests. For example, Singapore has built up thriving aerospace manufacturing and aviation services without developing or owning aircraft technologies. That said, we recognise the value of investing in research capabilities to support talent development and enterprise innovation. We have a vibrant research ecosystem for AI and will continue to support useful endeavours, including various aspects of FMs.”
“Sir, I thank Ms He for the questions. The short answer to both questions is yes. There will be further surveys and studies conducted and released, and MOH and MAS do continue to work together to see how we can appropriately regulate and guide the insurance industry to be able to provide these products in order to appropriately protect the public. 3.00 pm”
“Sir, I thank Dr Tan for his suggestions. Firstly, a website or a social media page portal does not need MOH to set it up. These are experiences that the public can, indeed, share. But I think the larger point is, perhaps, should we take into account complaints or concerns expressed by members of the public and how they have been dealt with by their insurance companies and use that in some way to inform the public. But it is a good suggestion. I will take it back to my colleagues in MOH and we will study to see how this can be used to improve conditions for all the insured.”
“MAS will take action against insurers whose practices are in breach of MAS’ regulations or guidance. Individuals who have concerns over their insurer’s underwriting decision can make an appeal through their insurer’s feedback channel or through MAS.”
“Thank you, Sir. My response will also cover the matters raised in the written Question No 24 by Dr Tan Wu Meng in today's Order Paper. Sir, according to the Singapore Mental Health Survey 2016, 2.8% of Singapore residents aged 18 to 34 years had bipolar disorder. The proportion with active symptoms was lower, at 2.1%. Members raised concerns about individuals being denied health insurance coverage due to their mental health conditions. This is a valid concern and should be considered within the larger context of our S+3M healthcare safety net system. All Singaporeans are eligible for healthcare subsidies of up to 80% in public healthcare institutions. All Singaporeans and Permanent Residents are also covered under MediShield Life (MSHL), regardless of pre-existing conditions, including mental health conditions. MSHL is sized to cover nine in 10 bills in the subsidised wards of public healthcare institutions. Beyond subsidies and MSHL, individuals can also buy private Integrated Shield Plans (IPs) and other insurance plans. In making underwriting decisions, insurers are fully expected by the Ministry of Health (MOH) and the Monetary Authority of Singapore (MAS) to deal fairly with their customers. For example, insurers should not indiscriminately reject an application solely on the basis of declared personal information, such as occupation, income, disability or medical condition, including mental health conditions. Insurers should carry out an objective assessment of every application, based on reliable information or data relevant to the risks being insured. Where an application is rejected or approved with higher premiums or additional conditions, insurers should properly explain to the customer the basis for the underwriting decision.”
“Sir, I thank Dr Lim for his very important question. The core of the strategy is educating the public, engaging them on their fears and concerns and explaining to them the importance of vaccination and not just for COVID-19 but for many other diseases. Vaccination works and it is an important part of how we defend ourselves against infectious diseases. We will continue to provide public health education materials, engage the public on their fears and concerns, and we hope that the Members of this House will help us in doing so.”
“The COVID-19 situation is quite dynamic. The virus mutates. What it does, it is still changing. So, there is really insufficient data to commit to a long-term vaccination strategy at this time. MOH will continue to monitor the situation closely. We will take into account expert advice, the latest evidence and will update our recommendations on the basis of those, as needed.”
“The Expert Committee on COVID-19 Vaccination is currently reviewing the data of the updated Comirnaty vaccine and will be providing its recommendations. The updated Comirnaty vaccine could arrive in Singapore by end-October. We will share more details when operational arrangements are confirmed. We are able to achieve DORSCON Green not because COVID-19 became a mild disease. It is still a dangerous virus, especially for our vulnerable individuals and seniors. We can live with the virus now because our resilience has strengthened due to vaccinations and safe recovery from infections. It is, therefore, important for us to maintain our resilience. That is why MOH strongly recommends that seniors aged 60 years and above, as well as residents living in aged care facilities and medically vulnerable persons, continue to receive a booster dose of the updated vaccine one year after their last booster dose. Healthy persons aged 12 to 59 may also receive the additional dose in 2023, which remains free under NVP, if they choose to. There are no plans to charge for COVID-19 vaccines because vaccines still play a critical role in keeping COVID-19 at bay.”
“Thank you, Sir. My response will also cover the matters raised in the written question by Ms Joan Pereira. Sir, since the transition to Disease Outbreak Response System Condition (DORSCON) Green in February 2023, all COVID-19 measures have been stepped down, with the exception of the National Vaccination Programme (NVP) which serves as our first line of defence against the fast-mutating COVID-19 virus. However, we have also adjusted our normal time practices, such as requiring mask wearing in patient-facing settings, to better protect patients and healthcare workers from respiratory infectious diseases in general, not just for COVID-19. The Ministry of Health (MOH) will continue to monitor the broader communicable disease situation, review our disease control practices and adjust our approach. New COVID-19 variants will continue to emerge. The latest variants of interests are EG.5 and BA.2.86, which have a number of additional mutations compared with previous Omicron variants. Fortunately, so far, the science and empirical evidence show that existing vaccines continue to accord good protection against severe illness for individuals. The pharmaceutical industry continues to update COVID-19 vaccines to preserve the effectiveness against new variants. For example, Pfizer’s latest vaccine specifically targets XBB1.5. Our contracts with suppliers enable us to procure the latest vaccines once they are assessed to be appropriate for the local situation. Recently, the Health Sciences Authority (HSA) has approved the monovalent XBB 1.5 vaccine from Pfizer for patients aged six months and above and is reviewing other XBB.1.5 vaccines.”
“Mr Speaker, Sir, may I have your permission to take Question Nos 6 and 7 together?”
“Sir, indeed, when a suicide occurs, we do look at whether there were things that we could have done better, if that person had sought help before or interfaced with professional services. There are a significant number who had not sought assistance before the tragic events. As to Mr Vikram Nair's suggestion about improving access to counsellors and psychologists as well as the capabilities to the people they do access, indeed, that is part of the work that the Interagency Taskforce on Mental Health and Well-Being is studying. There are a number of ways to do this. One is to find ways to reduce the barriers for people seeking help – some of that is stigma, some of that has to do with information, some of that is where the services are provided. Another approach is to provide increased personnel in the locations where people perhaps might seek help so that there is more capability. The third is to provide capability to other types of professionals where people are seeking assistance of another nature but where now they can continue to go on to seek mental health support as well. We are exploring all of these as part of the work of the Interagency Taskforce on Mental Health and Well-Being. 12.31 pm”
“Meanwhile, in the community, Well-being Circles have been set up to strengthen community and peer support by equipping citizens with the skills to care for their own mental well-being and that of others around them. We are making a major push to engage seniors who live alone, lack social support or are at-risk of social isolation through our Silver Generation Ambassadors and the network of Active Ageing Centres. Assistance is also available in the community for individuals who are in psychological distress. Community mental health teams supported by the Government and set up by social service agencies provide mental health assessment and psychosocial intervention for such clients. Those requiring crisis support can access various crisis helplines, such as the Samaritans of Singapore Hotline and Care Text service and the Institute of Mental Health's Mental Health Helpline. CareLine, a 24/7 social support hotline, also provides social support and emergency response services to seniors in distress and is operated by staff who can speak various dialects. Many of the above-mentioned services in the community are provided at no cost. The Interagency Taskforce on Mental Health and Well-Being continues to review existing interventions and is working together to enhance the quality and accessibility of mental health services. At the same time, society plays a critical role in upholding a supportive social environment where there is little or no stigma against mental illness, where friends, family members and individuals feel safe to seek help, where parents work with schools to address their children's stress challenges and where everyone takes active steps to build up our mental well-being.”
“Mr Speaker, my response will also cover Written Question Nos 26 and 27 from yesterday's Order Paper and Written Question Nos 21 to 22 in today's Order Paper. Sir, suicide is tragic, personal, complex and multifaceted. It is a sensitive topic and we need to bear in mind that the nature of public discourse may affect the actions of others, especially among the young. To address the issue of potential suicide, the best interventions include building mental resilience, encouraging help-seeking, spotting early indicators for crisis intervention and supporting individuals who are in crisis. This approach requires help from many stakeholders. There have been multiple initiatives introduced across agencies to raise awareness and build mental resilience. At the national level, the Health Promotion Board (HPB)'s MindSG portal and the "It's OKAY to Reach Out" campaign promote self-help and provide guidance on maintaining good mental well-being, such as managing emotions and stress. In addition, the National Council of Social Service's "Beyond the Label" movement addresses mental health stigma and promotes social inclusion for persons with mental health conditions. To enable children and youths to take active steps in building their mental wellness, mental resilience is taught in schools through the refreshed Character and Citizenship Education curriculum. Peer support structures are also set up in all schools and Institutes of Higher Learning to help youth cope better with stress. We also recognise the important role that parents play in their children's mental well-being. HPB rolled out a campaign in 2022 to help parents better understand their child's emotional health, identify early warning signs and provide support for their child.”
“Sir, the compliance with the Correction Direction is not for the site to decide which parts of the Correction Direction they comply with or they do not comply with. They are required to comply with the entirety of the Correction Direction and Asia Sentinel did not comply with the entire Correction Direction in the time required. So, they complied late. They also did not comply with the requirement to have the Correction Notice at the top of the main webpage and they had changed the design by including another article. And so, you have partial compliance, which means they have not complied with the Correction Direction.”
“Sir, I thank Mr Singh for that explanation. The use of this type of tool, a Correction Notice on the main website, I think, should not be predicated on a certain number of strikes. This is not a fixed threshold. It needs to take into account, for example, the design of the website, the way in which links are made to other feeds because, otherwise, the process can be gamed. There is a significant amount of leeway and freedom in how online sites are designed and published. So, we take into account the design of the website, the feed, the way in which user behaviour is guided by that, but also the kind of content and the kind of notice that is required. I would point out that if Mr Singh is concerned about past track records, Asia Sentinel did not comply with the Correction Direction on 26 May, so, then an access blocking order was issued. And so, we do give an opportunity for the sites to comply, to provide information to the readers. We take into account the fact that the design of the site and the design of the particular article are important and we give an opportunity for people to put things right.”
“So, as I said, I did not quite get an understanding from him that he agreed that we did not, in any way, intend to deny the readers of Asia Sentinel access to the other articles by the publication of the Correction Notice on its main website. It was a tool to make sure the facts are well-read and well-understood.”
“Sir, Mr Singh did not quite address my clarification. So, I am going to assume that he agrees with me that the publication of the Correction Notice on the main webpage does not, in any way, impede a reader from accessing all the other articles on Asia Sentinel's website. And what that Correction Notice does is add further information and transparency for people to make up their own mind about the facts at hand. So, I hope that is my understanding of his position. And I hope he will agree that then, there is no overreach or damage done to Asia Sentinel by requiring them to add a notice which essentially carries a correction, in other words, the correct understanding of the facts. If I take the analogy from what happens in the print publication, I am sure if Mr Singh was concerned about a piece of article in a magazine or a newspaper which he disagreed with, which he required a correction, he would not be satisfied if the only thing that was done was the newspaper went out and published a Correction Notice next to the original article because nobody is going to read the same newspaper again from three or four days ago. And he would require a notice carried in the same publication in a prominent place that people could read and, especially to do so in a way that as many of the readers of the original false statement will then be better informed. The analogy breaks down a little, clearly; this is an online digital publication and not something in print. But the intent is the same – to make sure as many of the original readers of that false statement see the Correction Notice, understand the correct facts – and I hope Mr Singh agrees that there is no harm caused by that.”
“Sir, can I just seek a clarification from Mr Singh? He said that the action denied Singaporeans the opportunity to read other articles on the Asia Sentinel site. I do not quite understand why the publication of a Correction Notice on its main webpage should in any way impede readers from accessing other articles. Surely, he would agree that if that Correction Notice is necessary to correct a falsehood, it should be seen by as many readers as possible.”
“I do not have the details about the specific Correction Directions and which used this tool versus the other types of Correction Notices. I can get the information to Mr Singh. The reality is that each Correction Notice needs to take into account the design of the feed and the website. But I will get the information to him separately, Sir.”
“Sir, as far as the first question is concerned, the idea that we have to put the Correction Notice only next to the original article, Mr Singh has asked if this may be overreach. I think you would characterise this as overreach only if you felt that the inclusion of the Correction Notice, in other words, the correction of the falsity, was, in itself, not necessary or was itself false, or that it was inappropriate to have this viewed by as many people as possible. Mr Singh, who was part of the Select Committee that produced the White Paper that led towards the legislation that turned out to be POFMA, would agree that it is easier for the false statement of fact – a lie travels faster than the truth – and so, you do need to make sure that you have as much coverage as possible when you want to correct the falsity. The behaviour of people reading online material is not all homogeneous; people access material in different ways. And it is not often that someone will necessarily go back to the original article after having read it. And so, you do need to put the correction in place so that as many readers of the original falsehood as possible will have that corrected. And so, we need a variety of tools and, depending on how the site is laid out and how the publisher manages its material, propagates its material, there needs to be some assessment of that done to make sure then that the correction is visible. And even with the tools, such as placing the correction on the main webpage, I am sure the Member would agree, it is unlikely that all the readers of the original falsehood would have that Correction Notice brought to their attention. We do try and so, we do need this type of tool.”
“Sir, I thank Dr Lim for his questions. The main cause of the increase is the increase in the complexity of care. We are seeing more aged patients, frailer patients and patients with more co-morbidities. And so, the main reason that it is taking longer for them to stay in hospital is because the amount of care they need is more. They are more unwell and it takes longer for them to recover. So, 6.1 days to seven days is a 15% increase. It is not small. It is a significant increase in the length of stay. And that is what has fundamentally affected the strain on our capacity. We have not been able to increase as much as we have previously projected because of the delays and the infrastructure upgrading and roll-out of capacity because of COVID-19. But we are trying our best to catch up. Can we go back, Dr Lim asked. I do not think there is a foreseeable way in which we can go back to shorter stays because our population is getting even older. So, you will have more patients with complex healthcare needs. We do have to put in quite a lot of effort to keep us as healthy as possible for as long as possible to mitigate this burden. But once you need hospitalisation, the likelihood is that your care is likely to be more complex and longer than in the past. What we have to do then is to optimise the use of the capacity we do have, which is to transfer patients to step-down facilities, community facilities and also, where possible, to recover at home, so that our hospital facilities are focused on those who need that complex acute care.”
“Mr Deputy Speaker, as we exit from the COVID-19 crisis, hospitals have found that average length of stay has increased significantly, from 6.1 days to seven days. This translates into 15% more utilisation of hospital beds and is the key driver for longer waiting times for admission. The patients who need longer stays are older with co-morbidities and complex conditions. The situation is aggravated by healthcare infrastructure projects being delayed due to COVID-19. We are actively working on increasing acute bed capacity, community hospital bed capacity and Transition Care Facilities to address the capacity constraint. In the meantime, our hospitals will continue attending to life-threatening cases at the Emergency Departments (EDs) immediately and carry out urgent surgeries promptly. For non-life-threatening patients who require admissions, hospitals will activate inpatient teams to start investigations and treatments in the EDs, even before a ward bed is available. If need be, we will tap on the capacity of private hospitals, as we did during COVID-19.”
“Putting that aside, the risk of true adverse events where something goes wrong is extremely low in the data that I have quoted. And the benefits are there, and I hope he and other Members of the House will continue to help explain to seniors especially, that vaccination is a very important public health matter. It is not just about COVID-19, it is about a wide variety of vaccinations that are available and we do encourage the seniors and our community to be as protected as possible.”
“Madam, I thank Assoc Prof Lim for the question. I hope he will help in dealing with dispelling some of the misconceptions involved. As the data I quoted in the main answer shows, the second shot and the vaccines that we have here in Singapore continue to be safe, continue to have a low incidence of adverse events and risks, and, on balance, it is better for you to take the vaccine and be protected from COVID-19. And I hope he will also help to dispel the misconception that we no longer recommend that second booster dose for the elderly. In fact, it is quite the opposite. We continue to recommend that the elderly continue to receive doses of COVID-19 vaccines and that they receive it one year after their last booster dose, and they can start to receive it from five months after their last booster dose, and persons are recommended to receive the bivalent vaccine. If I could diverge a little from the Parliamentary Question, which is the health advice, perhaps, as to why having received one dose, you might have an event or an adverse response to a second or third dose later on, because this is not an allergic reaction, it is an immunologically mediated reaction. What that means is that there is a spectrum of responses that the body mounts to the vaccine, some of which are mild and easily tolerated, and some of which, perhaps, you have some discomfort. That is part of how the body is responding to the vaccine. And so having had a mild response to the first vaccine does not automatically mean you will have a mild response to the second vaccine. There may be a bit more discomfort. Or it might be the other way around. In biology, it is very hard to predict exactly how you respond to any given dose.”
“The same Committee also recommended manufacturers to produce updated vaccines targeting the XBB sublineage of the Omicron variant ahead of the Northern Hemisphere fall season. Pfizer, Moderna and Novavax have indicated that they would do so and the updated vaccines may become available in the US later this year. The Ministry of Health (MOH) will monitor these developments closely. Our contracts enable us to procure the latest vaccines, should they be assessed to be appropriate for our local situation.”
“Mdm Deputy Speaker, my response will also cover the matters raised in the question by Ms Joan Pereira. Assoc Prof Jamus Lim asked about, and I quote, "the recent decision not to recommend those aged 60 to 75 from taking the second COVID-19 booster dose". His understanding is incorrect. The current recommendation for COVID-19 vaccination is for seniors aged 60 years and above, and medically vulnerable persons, to achieve minimum protection and receive the updated bivalent booster around one year after their last booster dose. This will naturally include the second booster shot. Instead of counting doses, the current phrasing better communicates the recommendation for the longer term: to have regular doses and maintain immunity. COVID-19 vaccines offered under the National Vaccination Programme have been assessed to be safe for use and the benefits of such vaccines continue to outweigh the associated risks. As of 31 May 2023, based on the Health Sciences Authority (HSA) surveillance, the serious adverse event rate of the mRNA COVID-19 vaccines in Singapore was two in 100,000 doses for the second booster dose, lower than nine in 100,000 and four in 100,000 for the primary and first booster doses respectively. Ms Joan Pereira asked about the supply of updated COVID-19 vaccines. The bivalent mRNA vaccines against the Omicron strain currently offered under the National Vaccination Programme are the most updated formulations. In June 2023, the US Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee noted that the current vaccines, which include those adopted by Singapore, continue to offer good protection against severe COVID-19 infections and death.”
“Thank you, Mdm Deputy Speaker. I raised my hand, but I think Minister Tan had already made the point. The information is being taken from other parts of the phone, not as Mr Giam had asked about. But the point has been made by Dr Tan already.”
“Madam, I thank Dr Tan for his suggestions and his questions. Indeed, we will continue to explore how we can track the data to inform our decisions on resourcing the polyclinics and have a balance between online appointments, walk-in appointments, and the behavourial incentives for patients to choose between them. But as I have explained, I do not have that data with me. Dr Tan's question about supporting healthcare workers in polyclinics is important. They have been working very hard. They continue to deal with an increase in demand, both through the COVID-19 pandemic and beyond, and I do want to record our thanks for the work that our primary care practitioners and the teams that they work with, have put in to support our residents and citizens and we are trying to make sure that they are as much as possible provided with access to the resources within primary care. We continue to try to support them by expanding the role of GPs, by expanding the role of CHAS clinics, by helping to make sure that we right site care within the primary care space, by providing training and staff and resources to be able to support the very important role that primary care plays in our health ecosystem. And we will continue to do so.”
“Madam, I thank Assoc Prof Lim for his suggestions and questions, and the acknowledgement that I am not going to comment on MOM's remit. Indeed, we are exploring the use of telemedicine to improve the delivery of services from the polyclinics. I think we leave it to the professional teams in terms of how they assess the referral information, the patient demographic, as well as the presenting problems as to which patients can be dealt with an online consultation and which patients will need an in-person appointment. I think that is something for a clinical judgement, rather than a policy position. But we will support the teams so that we can optimise the use of telemedicine and make sure that we improve the capacity available at the polyclinics.”
“Madam, I thank Mr Yip for his questions. I do not have the data for the first question that he has asked. It is possible that we are unable to get the data because what he is asking for is those who have not booked, how to track them. I would be happy to try and fulfil but I do not have the data with me today. The second question is a good suggestion. We are happy to explore how we can leverage on other types of resources to be able to help people have better access and utilisation of services. I will work with the teams to explore the use of that suggestion.”
“So, I take the feedback from the Leader of the Opposition and other Members of the House, and will continue to work with our cluster management and operational teams that run the polyclinics and see how we can optimise the correct balance of online appointments made ahead of time, same-day appointments and walk-ins.”
“Madam, I thank Mr Pritam Singh for the questions. I do not have the data to answer his second question; that was not part of the Parliamentary Question that was filed. For his first question, yes, there is the possibility to increase the proportion of walk-in slots. I would point out that that does not change the overall capacity available at the polyclinics. That is actually the heart of the issue. I understand there is frustration with the online system for seniors, but there are also people who are able to use the online system and as a result, the availability of the resources and the capacity for the services at the polyclinics are better matched to those patients. It means that the clinical notes are available ahead of time, preparations can be made ahead of time for investigations, tests and the allied health services that support, given the instance of someone coming down to the polyclinic. So, I think we have to have a balance. If we went to a fully walk-in system, that would have an implication on the ability for the care teams to deliver the service that they are used to delivering. If we went to a fully online system, indeed, the frustrations that Members in this House have highlighted will become worse. So, we need a balance: we need some walk-in slots and some pre-booked slots. The question then is, what is the best way of determining that balance. This is left to the operational teams running the polyclinic to take into account their capacity, the services that they deliver, the demographics of their population. And it can vary over time.”
“Madam, I thank Mr Liang for his questions. We do indeed set aside a proportion of the slots for walk-in appointments. So, not all the appointment slots at a given polyclinic, on a given day, are only for online appointments. There are slots that are set aside for walk-in patients. The potential walk-in patients are assessed and so, sometimes, they will be given advice to come back on another day or to seek help at a GP clinic, depending on what it is they present with. Sorry, I did not quite catch the second question. Oh, the capacity. Indeed, the capacity is constrained. There is a combination of factors: there has been a delay in the building and operationalisation of polyclinics as a result of the COVID-19 pandemic; some of them delayed by up to two years. Recently, in the news, we had the Khatib and Sembawang Polyclinics' timings talked about. But there is also an increasing demand as our population ages and the aged have increasing frailty and co-morbidities that will require further care. So, it is a combination of growing demand and the projected supply having been constrained by the pandemic. We are trying our best to catch up and provide more services to increase our capacity.”
“Madam, I thank Dr Tan for the questions. We will continue to explore the role of things like hotlines and other ways to improve our processes so that the appointments and the services available at the polyclinics are indeed more accessible and more user-friendly, especially to seniors. I thank him for his suggestion and I will take that up with the teams that our running our polyclinic systems. The question of subsidies at the CHAS GP clinics and how they relate to the charges and the costs at the polyclinics is an important one. As Dr Tan knows and as Members know, this is something we are constantly reviewing, on an ongoing basis. We will have to constantly review the conditions as well as the level of subsidy that we provide for the CHAS GP clinics and indeed, taking into account the relationship with what happens on the polyclinics. I thank him for the reminder that we have to keep doing this.”
“My response will also cover the matters raised in the written questions by Dr Tan Wu Meng. Our healthcare system is facing increasing demands, as our people age and need more healthcare, including primary care. At the same time, the completion of new polyclinics that were planned had been delayed due to the pandemic. As a result, some polyclinics have greater demand and less easy availability of appointments. Pending the development of new polyclinics, they are putting in place short-term measures to address this. The polyclinics will set aside some slots for walk-in patients with urgent medical needs, as well as for elderly patients, particularly those who are frail and who have mobility issues. To do so, non-urgent cases may be given an appointment for another day or advised to seek treatment at a nearby Community Health Assist Scheme (CHAS) general practitioner (GP) clinic. Polyclinics will also try to leverage telemedicine as much as possible and contract private GPs to help deliver the service. Some polyclinics already adopted the practice of releasing polyclinic appointments in tranches. However, this does not solve the issue of capacity constraint and in fact may frustrate patients more if they are repeatedly unable to book appointments. The Ministry of Health (MOH) does not have the data requested by Member Dr Tan Wu Meng.”
“Mdm Deputy Speaker, may I have your permission to answer Question Nos 1 and 2 on today's Order Paper?”
“Sir, I thank Dr Tan Wu Meng for his three questions. The answer to all three is yes. Yes, residents can continue to exercise choice about where they enrol for Healthier SG. Yes, resident can exercise choice about where they seek specialty care at the public hospitals, with the caveat that the service is available at that hospital. Sometimes, it is not widely known how sub-specialty services are divided amongst our public healthcare institutions. And three, yes, if there are any issues with this, there are routes for appeal that residents and MPs on their behalf can pursue.”
“Public hospitals do not reject patients referred by polyclinics based on their residential address. Public hospitals may occasionally reject patients if the referrals are inappropriate, such as to a specialty that the hospital does not provide. Patients are also prioritised based on their medical condition and need. In rare situations, if the hospital is not able to provide an appointment within the time demanded by the urgency of the case, the hospitals will then inform the patients and refer the polyclinics to direct the referral to a more appropriate institution, for example, one where there are more timely slots available. The polyclinics will discuss alternative arrangements with the patient, including making a referral to another institution where applicable. Patients may also contact the polyclinic, hospital or the cluster's main appointment centre to seek clarification and assistance for their referrals.”
“Mr Deputy Speaker, may I have your permission to answer Question Nos 24 and 25 from today's Order Paper?”
“Residents can use Healthy 365 to see and sign up for nearby healthy lifestyle programmes, track their physical activity and collect health points from clocking steps and making healthier food choices. We will continue to enhance such digital tools to help residents sustain good health and well-being. Sir, in summary, with increased accessibility to trusted platforms for appropriate health information and interventions, and support from healthcare providers and community partners, we hope individuals can make informed choices to enable better mental health, better oral health and better health for themselves and their loved ones. Mr Deputy Speaker, Sir, I support the Motion.”
“We are bringing onboard more healthcare providers to contribute to the NEHR, by extending the Early Contribution Incentive scheme to GPs, private hospitals, radiological laboratories and clinical laboratories to support them in data contribution. With the Health Information Bill (HIB), it will become mandatory for them to contribute patients' data to NEHR. We have been extensively consulting stakeholders such as our licensees and healthcare professionals, on issues surrounding data privacy and sharing, related to the HIB. We had intended to table the HIB to Parliament sometime this year. But this is quite a very significant Bill and we felt more time is needed to engage our stakeholders and members of the public. We thus expect to introduce the Bill in this House, in the first half of 2024. I would also like to thank Mr Yip Hon Weng for raising the need to enable data sharing between the health and social sectors, this is indeed one of our aims under the HIB to support more integrated care and reduce administrative work, while ensuring data security. Ms Ng Ling Ling and Mr Yip Hon Weng also raised the need to empower Singaporeans with more knowledge and support to manage their health better. We will do this through tools such as the HealthHub and Healthy 365 applications. For example, residents and their authorised caregivers can view health information from the NEHR, such as discharge summaries, selected blood test and radiology results, via HealthHub. We will explore how we can reflect more results in these platforms. Residents and their authorised caregivers can also use HealthHub to book and manage their medical appointments across all public healthcare institutions, as well as to enrol in Healthier SG and view their Health Plan.”
“Additionally, we will continue to review our subsidy framework and award scholarships for residency training programmes in the various disciplines of dentistry so as to ensure our dental workforce can continue to meet the oral health needs across all ages and care settings. Sir, I would next like to highlight the importance of having a well-integrated and reliable IT system to connect the healthcare providers, community partners and our residents. Members of the House have raised this in past Parliamentary sessions such as the White Paper for Healthier SG and also at the Committee of Supply 2023 debate. I thank both Dr Tan Yia Swam and Mr Yip Hon Weng for emphasising its importance. One key system will be the National Electronic Health Record System (NEHR), which is a common platform that captures selected patient health information from various healthcare providers and allows providers to view these health records for patient care. Mr Gerald Giam asked about the implementation of security enhancements for NEHR. The NEHR has been subjected to cybersecurity reviews, infrastructure vulnerability scans and application penetration tests. MOH and Integrated Health Information Systems (IHiS) have reviewed the findings and most of the key enhancements to NEHR have been completed, with one further to be completed tentatively by 2025. On the matter of IT support for GP clinics, that Mr Gerald Giam also raised. We do want GPs to use a Clinic Management System (CMS) that supports their daily operations well and connects to key IT systems, to save them time on administration. We have been working closely with the CMS vendors to improve their products and strengthen their backend services to support the GP clinics.”
“Additionally public-private partnerships in addition to the existing ones like Enabling Village, Agape Village, HealthServe and Saint Andrews Mission Hospital will be further explored to better serve the primary medical and dental care needs of underserved communities including migrant workers. For our migrant workers, the Ministry of Manpower (MOM) will also continue to explore working with key partners such as NGOs to facilitate accessible dental care for migrant workers and provide oral health education through Project MOCCA, the Management of Oral and Chronic Conditions and Ailments. Project MOCCA was launched by MOM last year and is a preventive health framework to enhance the care of oral and chronic diseases among workers. And in this, MOM works closely with partners such as MigrantWell Singapore. We recognise the efforts of independent volunteer initiatives that provide dental services within the community, intermediate and long-term care settings and in special needs organisations. To improve the coordination of these services, we will be encouraging larger volunteer associations to help provide a platform for communication, for sharing of resources and for coordination. As the practice of dentistry constantly evolves with changes in population demographics, advances in technology and shifts in care approaches, the local dental landscape will shift accordingly. To better support dental professionals and other healthcare and non-healthcare professionals providing care for older adults and persons with special needs, we will look into the development of clinical practice guidelines and appropriate care guides to help establish standards of care and promote better health outcomes.”
“One recommendation from the task force is to designate a few first-stop touch points to provide individuals with easy access to mental health support and advice. Some respondents from the consultation felt that there was value in having more than one way to deliver a service to take into account user preference. We are developing a number of service modalities such as hotlines, text messaging, in-person services and digital resources to ensure that there are sufficient and different ways for people to access these first-stop touch points for mental health. Sir, if I now may shift to oral health care for older adults, persons with special needs and migrant workers in Singapore in response to Dr Shahira Abdullah. The Government has introduced initiatives to ensure the access to affordable and quality health care for Singaporeans such as through the Community Health Assist Scheme (CHAS). Most oral health needs of these population groups can be met by general dentists at the polyclinics, CHAS clinics and private dental clinics. Individuals with complex needs and those with medical conditions or multiple morbidities that require a higher level of care are cared for and can be cared for by specialists at our National Specialty Dental Centres and the hospital dental clinics. To facilitate access, MOH has worked with MSF to list the details of dentists and private dental clinics providing special care dentistry services so as to raise the awareness regarding the availability of services for persons with disabilities.”