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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“As part of the public consultation, we received very useful feedback on the implementation. One example would be, for the tiered model to work well, service providers need to be sufficiently competent to fulfil their roles and responsibilities. We completely agree, that for this tiered care model to be implemented effectively, an important aspect is to ensure adequate competencies and standards amongst all mental health practitioners. So, we have the National Mental Health Competency Training Framework Workgroup. The framework that they are developing will guide mental health practitioners on the knowledge, skills and competencies necessary to deliver quality and effective care. It will apply to all practitioners, from lay responders such as peer supporters, to mental health professionals, including nurses, social workers and counsellors, amongst others. I thank Dr Wan Rizal for highlighting the importance of this. In addition, there is already a system in place to safeguard professional practice today. Mental health professionals are regulated through professional boards and councils and set practice standards through professional associations. For example, psychiatrists, nurses and occupational therapists are regulated by the Singapore Medical Council, the Singapore Nursing Board and the Allied Health Professions Council, respectively. Professional associations such as a Singapore Association for Counselling and the Singapore Psychological Society provide guidance on the professional and ethical conduct for counsellors and psychologists respectively. There is also the need to help individuals with mental health needs access the appropriate services in a timely manner.”
“Activities such as teacher-guided class discussions were brought to mainstream schools and Institutes of Higher Learning (IHLs). Outreach efforts to promote mental health awareness and literacy among Singaporeans have continued through online efforts and in-person programmes. In addition to all this, the National Council of Social Services (NCSS)' Beyond the Label (BTL) movement which was launched in 2018 by NCSS, continues. In the next phase, BTL 2.0 moves to inspire action. NCSS has brought together 26 partners across the people, public and private sectors to promote and enable help-seeking and help-giving behaviours in schools, workplaces and the community. Sir, the Interagency Taskforce on Mental Health and Well-being was established in July 2021 to oversee and coordinate mental health efforts across different sectors, focusing on cross-cutting issues that require interagency collaboration. At the task force, we have identified 12 preliminary recommendations and sought the public's views in a consultation process last year. There were over 950 responses, with feedback from groups such as youths, parents, persons with mental health conditions, service providers, employers and community agencies. The respondents were supportive of all the recommendations and the task force will be releasing a short report of the consultation's findings soon, even as we commence with the implementation plans for these recommendations. One of the recommendations is to implement a tiered care model for mental healthcare delivery. This is a framework that matches the level of care to the degree of mental health need, allowing for a more effective allocation of mental health services based on the severity and complexity of an individual's needs.”
“In addition, those who wish to learn about mental health and self-care tips can access MindSG, a portal for mental health and well-being resources that are curated by mental health experts. It is important to address mental health issues that affect us at the workplace, whether that workplace is an academic setting or otherwise. The Tripartite Advisory on Mental Well-being at Workplaces was jointly launched in 2020 by MOM, the National Trades Union Congress (NTUC) and the Singapore National Employers Federation (SNEF) to support employees' mental well-being and provide resources for employers, employees and self-employed persons. Dr Tan Yia Swam shared her experience as a junior doctor where there were occasions when she worked for more than 24 hours a day when she was on call. The Ministry is reviewing the total working hours of junior doctors, including hours worked while on call. The public healthcare clusters have been piloting shorter call hours for junior doctors in selected departments as well as using electronic logging and surveys to monitor junior doctors' working hours. This is a complex subject which requires a fundamental relook at manpower deployment and the sharing of responsibilities between senior and junior doctors. This will take some time to study and work out and we are engaged on this matter. Dr Tan Yia Swam and Prof Koh Lian Pin shared about the importance of mental health education and de-stigmatisation. HPB launched the "It's OKAY to Reach Out" campaign in October 2021 to normalise the topic of mental health by building awareness and encouraging conversations. The campaign in 2022 was focused on youths to help them overcome their hesitation to seek support and address their concerns about seeking help.”
“Mr Deputy Speaker, Sir, I rise in the support of the Motion standing in the name of Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad. Sir, all of us play a key role in ensuring the good health and well-being of the population. As individuals, we need to take active steps to live healthier lives and minimise the risk of falling ill even as the Government builds a supportive environment to help us do this. I will speak about mental health, oral health and the healthcare IT infrastructure and digital tools to support individuals on healthy living. Sir, good mental health is essential. It lies along a spectrum and is multifaceted. Mental health issues can arise from a range of factors, including physical health and social determinants. Addressing these issues will require a collaborative and integrated approach that involves multiple stakeholders from the health, social, education, workplace and community sectors. This is already happening. For example, under the Community Mental Health Masterplan, MOH, the Agency for Integrated Care and social service agencies have worked together to establish community mental health teams across Singapore. These teams provide mental health education to residents and bring care, such as mental health screening, assessment and therapy, closer to home, where there is less stigma and individuals feel safe to seek help. Prof Koh Lian Pin spoke about mental health in academic settings. HPB has worked with Institutes of Higher Learning (IHLs) to establish peer support structures. Training is provided in empathetic listening and basic mental health first aid skills to support one's peers who show signs of emotional distress.”
“Sir, I would perhaps simplify the answer by saying that we would in these cases suggest that, whether it is the resident or the IP or the Member of Parliament representing the resident, the thing to do is to submit the appeal and we will look at it and assess the ways in which we can help that patient receive the most appropriate care – whether it is in the private sector, the public sector, whether it is about the drug or whether it is about the subsidy. There are a variety of mechanisms that we can use to try to find the best way to assist. I would encourage the Member to reach out, including to reach out to me, if necessary.”
“Sir, I do not have the data on how many appeals have been forwarded to MOH. Perhaps Mr Singh might like to file a separate question on that.”
“Sir, patients who are using cancer drugs that are not on the Cancer Drug List (CDL) may appeal to the Ministry of Health (MOH) to use more MediSave for their treatment. Subsidised patients being treated in public health care institutions can also approach the medical social workers to apply for financial assistance if they are unable to afford their healthcare bills. Under the CPF Reduced Life Expectancy scheme, terminally ill patients may also withdraw their CPF savings including MediSave savings in a lump sum, subject to retaining a minimum balance of $5,000.”
“Sir, I thank Mr Leong for his question. The charging model for individual patients under Healthier SG is not what we are doing with capitation. Capitation is about how we assign our budget to the clusters. What he is asking about is how will patients be charged when they go and see their GP, whether you have a Healthier SG programme or whether you are going for a fee for service. That is not what we are talking about when we mean capitation funding, which is a way of deciding how to assign the MOH budget to the clusters, to hospitals and to different services. I appreciate that he may indeed be reflecting the concern of resident citizens about how they are charged, I believe those issues have been discussed at some length and are available in a fairly transparent and documented way at a number of sites, but perhaps today is not the place or the time to debate them.”
“Sir, I thank Mr Leong for his question, but that is not what capitation payment is – which is, capitation is a mechanism to bundle the budget that is allocated at the cluster level and what he is asking about are the charges that are made available at the patient level, and potentially the subsidies associated with those charges and to offset those charges. Those are very, very different issues. When we talk about capitation, it is about how we take the budget that is available for healthcare and decide what are the allocations to each of the clusters, what are the allocations to each of the priority areas or the diseases or the care models, at a big picture level. So, the question that he is asking, in a way does not apply to the issue of capitation funding.”
“That is an example, I do not know if that is the best example, but I think the examples and the specific clinical initiatives need to come from the professionals and the care teams that are involved.”
“Sir, I thank Ms Ng for the questions. On the first, how will we know that they are indeed channelling resources to primary and preventive care, well, we work very closely with the clusters on a day-to-day basis, with the clinicians at all levels of our healthcare ecosystem. The healthcare services have to interface with MOH on licensing decisions, on regulatory decisions, on the provision of resources. And so, we will indeed have very close feel of where manpower resources and effort across our healthcare system is being asserted and will then know whether or not these measures around funding and around governance are resulting in the operational changes and the service delivery changes that we are hoping for. And we will pay very close attention to this. She asked for an example. I am a little hesitant because the whole idea is indeed to incentivise the clinicians and the service delivery teams to be able to think through what works best for their residents and their clinical service teams and their operational model. But a hypothetical example, let us say something like diabetes, if you wanted to institute some particular care around diabetic eye disease, for example, you may choose to do this essentially and through the Eye Centre, through the ophthalmologists; or you may choose to do this on a screening basis and perhaps increase the capability at the level of the polyclinics, in the GPs to be able to detect this early; or you could potentially even go into the community and explain how having good care around your diabetes can prevent eye disease from happening in the first place. And clearly, what we hope would be that the clusters and the professionals would do more of the third and prioritise the third and we should see that type of approach happening.”
“And as I explained in my main answer, the answer to his last question, it does not restrict the choice of where a resident or a patient can receive their care from. They can access care services from across the three clusters, even if they have been assigned as part of a population base for one cluster, MOH will work with the clusters and the administrative side of the healthcare system to do back-end transfer payments so that the residents do not have to worry about this and they will have that choice of where to receive their healthcare maintained.”
“Sir, I thank Mr Yip for his four supplementary questions. The first was whether there would be an issue around exceptional cases that do not follow the usual trajectory for diseases and the short answer is that, this is not a problem. While the rates are set on the basis of a mean because they are covering a large population base, it does take into account the great variance on an individual basis around disease and disease progression where some patients will do very well, short stays, minimal intervention and some will require a lot more, and that has been factored in to the calculations around the funding mechanism. And it does not change the way in which the individual care decisions are made. Will care protocols be reviewed? Yes. Capitation is a funding mechanism at a large population level. It does not remove the various other governance mechanisms that are in place across our healthcare system from the professional boards, the licensing boards, the interface with research and academia and the clinical review processes. All of these will continue to review care protocols to make sure the care that is delivered is entirely appropriate. Mr Yip also asked if there is less incentive to innovate and think out the box? The answer is no. That the personal level or the individual level of the clinicians will of course continue to be driven by their professional desire to provide the best possible care, whether it is following a standard protocol well demonstrated or whether it is looking for innovative ways to deal with unusual and exceptional circumstances. At the system level, the idea is to put in place mechanisms that drive innovation and thinking to be able to derive efficiencies, but more importantly, better care through the resources that we have.”
“We should expect many more initiatives in the preventive care space in the coming years.”
“Each cluster will be paid funding rates based on the age bands of their residents. The rates are designed so that there is no reduction – and in fact a slight increase, to the cluster budgets in previous years. As our population gets older, more residents will require higher capitation rates and the clusters will correspondingly receive higher budgets. We maintain a flexible system where residents can continue to choose which hospitals they would like to go to and need not go to only the hospitals from the cluster that they are assigned to. Transfer payments between clusters will be made to take this into account. With capitation funding, the Ministry of Health (MOH) sets priority areas and key indicators for the immediate, medium and long term, while the public healthcare clusters have the mandate and operational flexibility to decide the resource allocation across their institutions and services. These key indicators were outlined in the White Paper on Healthier SG. Healthcare clusters will take into account various factors when deciding how to allocate their funds. These factors may include the cost of operations incurred by various healthcare institutions under their charge, the mix of residents that they serve and the performance management system under that cluster. It does not mean that cluster have to pass through the funding mechanism in the form of capitation funding to their individual health institutions, which may not be practical. However, with capitation at the cluster level, there is a strong incentive for the clusters to invest more in primary and preventive care, and to work with all community partners, to help their residents stay healthy or delay disease progression.”
“Another model is pay-for-performance which provides financial incentives for clusters to perform well in key priority areas. Our pilot projects delivered positive results, leading to better health outcomes without compromising care. However, these mechanisms, such as bundled payments by care episode, do not in themselves incentivise the reduction of what is known as population level wastage, that is, some patients should not become sick in the first place where preventive steps could have been taken in homes or communities to keep the residents healthy, before they become patients. Capitation funding aims to incentivise healthcare providers to place a greater emphasis on preventive care. Under this funding model, healthcare providers are assigned a population base and are paid a pre-determined amount per resident under their charge. They will thus be encouraged to incur a lower cost by intervening upstream and early to keep the patient healthy, knowing that it will require them to spend more to treat or cure patients in hospitals after they fall sick. This method of funding is commonly practised around the world as well. Different methods of funding for healthcare, be it bundled payments or capitation, if designed and implemented well, will not negatively affect the quality of service at hospitals. If wastage and unnecessary procedures can be removed, it will improve the effectiveness of our healthcare workers as well as their well-being, it will reduce the financing burden of healthcare and can improve the level of service. From 1 April 2023, we transited to a capitation funding model for our three healthcare clusters. Each has a population of about 1.5 million residents assigned under them.”
“Sir, my response will also cover the matters raised in the separate question filed by Ms Ng Ling Ling1 which is scheduled for a subsequent Sitting. I would invite Member to seek clarifications today, if need be. And if the question has been addressed, it may not be necessary for her to proceed with the question for future Sitting. I will first provide some background on the different methods of funding for healthcare institutions. For various reasons – asymmetry of information between doctors and patients, the moral hazard of insurance, the anxiety of patients and their loved ones – healthcare is highly susceptible to funding wastage. Better funding methods can reduce such wastage, without affecting service quality. For example, funding by workload, such as the number of procedures, surgeries, scans, hospital bed days, does not in itself incentivise hospitals to be more targeted and efficient in delivering healthcare services, because all activities will be funded anyway. Bundled payments, which are commonly practised around the world, help to remove what are known as disease-level operational inefficiencies. This means that hospitals get funded per care episode, rather than based on a detailed breakdown of workload. We had implemented the bundled payments pilots, which allowed institutions to generate cost savings, for instance, by facilitating earlier transitions from acute hospitals to community hospitals, where appropriate. As hospitals attend to patients with varying degrees of disease severity, some requiring more interventions than others, so, bundled payment rates are set at an average to cover the total cost of all care episodes. This provides an incentive for the hospital to be more efficient.”
“Mr Deputy Speaker, Sir, may I have your permission to answer Question Nos 1 and 2 raised by Mr Yip Hon Weng together?”
“Madam, I thank the Member for the questions. The role of the private sector is important. We have significant representation from the private sector in our Advisory Council on the Ethical Use of AI. We hope through that platform, these best practices as well as the moves that the public sector is making can also influence the standards and approaches that occur in the private sector; and vice versa, as we learn best practices from the private sector for our role and mission in the public sector. On his second question about the role of a proof of human marker, I think it is something worth studying. But I would caveat that it is not necessarily something that you may want to introduce as a general rule across all AI mechanisms. I think the Member would appreciate there are a fair number of tasks which can be very safely and reasonably automated without the need for demonstrating a human in the loop. In our day-to-day work and our interactions with our many devices, we know that this is the type of technology that is being deployed safely and to good effect. 12.30 pm”
“Madam, I thank the Member for the questions. His supplementary questions touch on a number of areas – malware mitigation, installation of software, installation of apps, the use of personal devices versus official devices. We do have policies as well as technical solutions that apply to all of those areas that he had asked about. But the key issue is the behaviour of our personnel. Every single one of these technical software solutions can be weakened by inappropriate behaviour. So, the key is really to make sure that our public officers understand what they are allowed to do and how what they do exposes themselves as well as our systems to risks, and to make sure that their behaviour is not compromised. The short answer is, we do have technical solutions to each of the issue that he has brought up, but what we really need to emphasise is the process and people factors in order to make sure that we secure this space. And I thank him for his questions.”
“Madam, Government-issued mobile devices are secured through technical controls and policies on appropriate use. Technical controls include the installation of Mobile Device Management software, which allow for remote removal of data from compromised devices. Connectivity to the Government network must be done via a virtual private network. Emails are screened by a security application that blocks emails containing suspicious attachments. As a policy, such devices cannot be used to process and store highly classified information that may cause serious damage to national interests. We also educate public officers through regular training so that they are aware of cybersecurity risks, including rogue apps or spoof websites. As Members will appreciate, cyber risks can never be fully eliminated. We will implement appropriate safeguards while enabling officers to be effectively supported with information technology tools.”
“I thank the Member for his questions. For his first supplementary question, I do not have the data with me about the proportions of seniors that are attending now as compared to historical data. I would be happy to provide it if he would like to file a separate Parliamentary Question. But, in general, as I engage with the polyclinic staff and the clinicians who provide these services, it is quite clear that a very high proportion of their workload is, indeed, the seniors. And so, the senior residents within the geographical area are, indeed, attending, are able to access the services and receive the care from the polyclinic care teams. But as I said, I would be happy to look at the data, specifically, if he would like to file a related question. On his suggestion about integration of the CHAS GP clinics into an online booking system, it is a suggestion worth studying and we will, indeed, look to see how we can improve access to primary care services for residents.”
“Sir, I thank Ms Joan Pereira and Mr Saktiandi Supaat for asking that question. As I mentioned in my original answer, the walk-in residents, the walk-in patients are triaged and assessed, and part of that assessment will, indeed, be their state of frailty, and their age and their mobility are considered as part of that assessment. I think the right thing to do is to allow the professional judgement of the clinical team at the site to make the assessment as to the urgency of their needs, rather than set a very arbitrary cut-off in terms of an age, for example, or other factors where actually the key thing is to assess the needs of that patient at that time. And that is, indeed, what the clinical services will do. I thank the Members for their question.”
“Sir, I thank the Member for his questions. We will look at his suggestion in terms of the queuing system and the appointment booking process. We are trying very hard to improve the service provision for primary care by both expanding our network of polyclinics, as well as leveraging on the experience and capability of the GP clinics and family physicians that are in the community and that can serve this resident population very well.”
“Sir, I thank the Member for his questions. On both his questions, he has highlighted the direction in which we are moving, which is for the polyclinics to work in partnership with the GP clinics and family practitioners in the area that they serve. We do want our residents to understand that these are part of a continuum of primary care services. For the polyclinics, if the patient turns up without an appointment, wants to walk in and if they have an urgent need, they will be attended to. There will be triage, they will be assessed and, if there is an urgent need, they will be attended to. If it is something elective and there are no appointment slots left, the recommendation will be that they seek care electively in a planned way, make an appointment with the GP within the vicinity. I am not sure whether there are specific details about how the Member feels the CHAS scheme is not helping much. Perhaps if there are specific cases, we could look into that and see how we can assist. In general, we are trying to find ways to help the GPs, the family physicians, as a community, upskill and deliver these types of cares in partnership with the polyclinic teams as well. In general, the GPs and the family physicians are more than willing and able to do so.”
“Sir, our polyclinics take in all patients with appointments. As for walk-in patients without appointments, those requiring urgent medical attention will be attended to, those not requiring urgent medical attention may be asked to book an appointment or seek treatment at a nearby general practitioner (GP) clinic. We are continuing to expand our network of polyclinics. We opened Bukit Panjang, Eunos and Kallang Polyclinics in end 2021 and another two polyclinics in Sembawang and Tampines North are slated to open later this year. Khatib Polyclinic will open in 2024 and Serangoon and Tengah Polyclinics in 2025. At the same time, we will work with GP clinics, which play an important role in treating acute diseases at the primary care level, too.”
“Another tool is AI Verify, a self-testing framework and toolkit to demonstrate responsible deployment of AI. It has attracted the interest of over 50 companies.”
“Another tool is AI Verify, a self-testing framework and toolkit to demonstrate responsible deployment of AI. It has attracted the interest of over 500 companies. [Please refer to "Regulatory Framework for Artificial Intelligence Governance in Singapore", Official Report, 21 April 2023, Vol 95, Issue 101, Oral Answers to Questions section.] [(proc text) Written Statement by Dr Janil Puthucheary circulated with leave of the Speaker in accordance with Standing Order No 29(5): (proc text)] I wish to make the following factual correction to my statement made during the response to the question on "Regulatory Framework for Artificial Intelligence Governance in Singapore" at the Sitting of 21 April 2023. My statement should read as follows:”
“Sir, I thank Ms He for her questions. I would take this opportunity to point out that in her questions is an assumption that AI is "one thing", and this is something that the public and commentators often treat it as. AI is a group of technologies. Currently, there is a lot of excitement around ChatGPT, which is an example of a large language model based on machine learning techniques. When it comes to the issues of how we should deal with the impact of AI, its impact is going to be quite different in different domains and the impact is going to be quite different in how we regulate it, depending on the various components of what the AI tool rests on. When the Member asks about what we will do to protect citizens from scams related to AI, it is not necessarily something that we need to be specific about AI regulation, it is something that we need to deal with in terms of our scam efforts, our initiatives around fraud and cybersecurity and criminal activity. And our colleagues in this House have spoken about that and we will continue to address that. Similarly, when we talk about what we are doing around data, cybersecurity, online harms and misinformation, it is not that that is separate from what we are doing with AI, because those are things that AI-related tools may influence and may subsequently introduce harms to our public. I just want to reassure the Member that we agree with the concerns, that we do have to address how technology is being used, make sure that the technology and the technological spaces are trusted and allows the development of initiatives that will benefit all of us and this includes protecting citizens from scams and efforts associated with that, whether AI-related or not.”
“Sir, I thank Mr Louis Ng for the questions. Closure of preschools is only one of the strategies and one of the tools when an outbreak occurs of HFMD or other mild, self-limiting, low severity diseases which are common in the community. The key to controlling spread is through early detection, isolation, maintaining high standards of personal and environmental hygiene – washing hands, covering the mouth and nose, avoiding sharing food and drinks or personal items. At MOH, we work closely with the Early Childhood Development Agency (ECDA) and the Ministry of Education to monitor outbreaks of infectious diseases in preschools. We provide public health advice, including on how to prevent infection and implement control measures. We will continue to work with ECDA and the relevant agencies on the issues of how to support the preschool sector, as well as the parents to deal with clusters and outbreaks of diseases such as HFMD.”
“Mr Speaker, the Ministry of Health (MOH) monitors the hand, foot and mouth disease (HFMD) situation through a sentinel surveillance programme involving selected hospitals, polyclinics and general practitioner clinics. HFMD is a mild and self-limiting illness and there were no reported severe HFMD cases since 2019. HFMD is common during childhood, and it is not unusual to have HFMD cases or clusters of two or more cases in preschools. Based on data from 2018 to 2022, the annual number of preschools with HFMD clusters ranged from 352 to 1,073 for childcare centres and 34 to 152 for kindergartens, accounting for about 23% to 66% of childcare centres and 11% to 37% of kindergartens. The numbers of reported clusters in childcare centres and kindergartens had decreased in 2020 and 2021, likely influenced by COVID-19-related community safe management measures. Although the numbers of reported clusters had increased in 2022, it is too soon to determine whether this reflects a rising trend beyond that seen in 2019, before the COVID-19 pandemic.”
“Sir, the answer is yes. Not all of the resource allocation is tagged specifically to digitalisation, care or elderly. There is great overlap in many of the projects: something that applies to acute care may well have an impact on elderly care; something that applies within the hospital may have an impact on the community; something which is labelled as a productivity improvement may indeed rest on digitalisation. So, I think we do need to look at the overall effect of our various efforts to improve care, improve productivity, improve the effectiveness of our interventions and, where appropriate, use technology.”
“Mr Speaker, there are several efforts to encourage the use of technology to enhance care. Under the Research, Innovation and Enterprise 2025 programme, the $90 million Population Health Research Grant supports projects that seek to improve health outcomes through a population health approach, including projects that aim to optimise resource allocation, improve healthcare manpower productivity and leverage technology to improve health. The $18 million Community Care Digital Transformation Plan supports Community Care Organisations to adopt a comprehensive suite of digital solutions that help to raise digitalisation levels and improve productivity. In addition, the National Innovation Challenge on Active and Confident Ageing had awarded close to $70 million to 35 research projects to address the needs of seniors or improve productivity of care staff. One example is a web-based system integrating technology to enhance care at home, including the use of smart home sensors to detect falls, automated pill dispensers to track medication adherence and a nutrition database that recommends meals based on the senior's health condition. Another used artificial intelligence to provide personalised educational resources and care triage services to caregivers. Each project is measured for their impact, with a view to scale them up if proven to be effective.”
“Sir, in all the cases that I have mentioned, where action was taken, the Government was already aware of the falsehoods prior to receiving the feedback and had begun an assessment of the falsehoods. The Government took and continues to treat COVID-19 misinformation very seriously, even if the feedback did not result in a POFMA action. The feedback highlighted gaps and understanding that potentially would deserve attention. As a result, other than the POFMA direction, the Government has also used public communication and education efforts to provide accurate and timely information relating to COVID-19. This includes, providing up-to-date information directly to Singaporeans through various channels, such as the Gov.sg's WhatsApp channel, which grew to over 1.2 million subscribers during the pandemic. Some of our polls in 2022 show that three in four members of the public think that the Government has provided sufficient information on COVID-19. A 2021 survey showed that over 86% agreed that these messages helped in their decision to get vaccinated. Our actions and our concerted efforts to counter COVID-19 misinformation contributed to high levels of public trust, which have allowed us to come together as a country to achieve high vaccination coverage and implement effective COVID-19 measures.”
“Sir, the overall median and 95th percentile doctor consultation waiting time for walk-in patients at polyclinics in February 2023 was 17 minutes and 164 minutes respectively. We currently do not track the number of patients turned away from the polyclinics, nor the proportion above 55 years of age. Given their high volumes, the polyclinics generally operate on an appointment basis to optimise capacity, patient waiting times and manpower allocation. For walk-in patients who are unable to get a same day appointment, the polyclinics will triage based on medical needs. Patients requiring urgent medical attention will be seen by the doctor, whilst non-urgent cases may be advised to seek treatment at a nearby general practitioner (GP) clinic. Community Health Assist Scheme (CHAS) cardholders can receive subsidies for medical care at CHAS GP clinics. Such triaging is generally independent of age. To meet anticipated healthcare needs, we are developing more polyclinics and are on track to meet our target of 32 polyclinics by 2030.”
“Sir, the responsibility is for Ministries and Government agencies to assess the operations and functions within their facilities and make an assessment. How they choose to rely on MTLs where it is relevant to meet the needs of their stakeholders is an assessment for the individual Ministry or agency to make.”
“Sir, the committee is indeed looking at the issue of working hours for the junior doctors.”
“Sir, I thank the Member for the supplementary questions. The answer to both questions is yes.”
“Sir, the committee is indeed reviewing these matters as well as the issues of night calls and duty hours. We are doing electronic logging and surveys to monitor the workload of junior doctors. However, the issue goes beyond just the simple redistribution of workload or the simplistic hiring of more manpower. Both may be necessary, but the changes will impact the overall optimisation of our system in our current multidisciplinary model. It is a complex subject, and this part of the review will take some time to study and work out and recommendations will be made.”
“It will take some time to study these matters and make appropriate further recommendations.”
“Sir, my response will also cover matters raised in the question by Dr Wan Rizal1 scheduled for a subsequent Sitting. I would invite Dr Wan Rizal to seek clarifications today if need be and if the question has been addressed, it may not be necessary for him to proceed with the question for the future Sitting. Sir, the attrition rate of doctors in the public healthcare sector has remained stable in the last three years, ranging from 3% to 5%. Nevertheless, we continue to make efforts to improve the well-being of our doctors and to retain them in public service, including the formation of the National Wellness Committee for Junior Doctors (NWC-JD) which has been studying initiatives to promote and improve the well-being of junior doctors in the public healthcare system. The committee is conducting a series of in-depth small group discussions with junior and senior doctors. Through these, we have sought to validate the approach to key concerns such as the need to improve career pathways, address work hours and improve work conditions. The committee is concluding its engagements with stakeholders and finalising its recommendations. Early initiatives already in place include the appointment of Chief Wellness Officers in our public healthcare clusters. These officers have a responsibility to enhance the well-being of all healthcare staff. We have also begun to expand and refine career pathways, such as the introduction of the Hospital Clinician scheme to provide doctors with more diverse career options. Sir, the worst of the pandemic is over and patient numbers have reduced. However, all our healthcare workers remain busy serving the healthcare needs of Singaporeans. The committee continues to review the working hours, working conditions and well-being of junior doctors.”
“Sir, may I take Question Nos 3 and 4 together?”
“Sir, I thank Ms Ng for her question. If the issue is the subsidies for vaccination, that is beyond the scope of this Bill. I will encourage the Member to file a Parliamentary Question or bring it up in an appropriate point in time. If the question is about could GPs perform vaccinations in the community centres and other locations, it is precisely this sort of flexibility that this Bill now provides. The specifics would depend on which GP, which vaccination and which community centre. And so, there would have to be an application made to MOH for approval. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)] [(proc text) The House immediately resolved itself into a Committee on the Bill. – [Dr Janil Puthucheary]. (proc text)] [(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]”
“I would also like to take the opportunity here to thank our licensees, healthcare professionals, professional associations and members of public who have contributed throughout our stakeholder consultation exercises, including virtual sessions which have involved more than 1,000 attendees, helping with ideas and suggestions to jointly improve the healthcare services regulatory framework. Mr Speaker, I beg to move.”
“Indeed, the point he brought up around international providers around the virtual tele-consultations is important. We cannot regulate what people has access to through the Internet, but we do want to educate members of the public to be discerning about where they get their healthcare information from. Ideally, they should get it from identified locally registered licensed healthcare provider. If they do get information online from healthcare providers overseas, that is not something that this Bill is going to be able to regulate. However, if that advice then requires them to have prescribed medication, consume medication, treatments and services and interventions, those are controlled by a variety of legislation and regulatory frameworks and that is where we can perhaps assure more patient safety. Ultimately, the main thing is that when people look for information, they should be doing so ideally from a licensed, locally registered healthcare provider. Assoc Prof Jamus Lim also brought up the issue of midwifery professionals and nursing professionals. This Bill does not regulate any of those. This Bill is a Bill to regulate the provisions of services. It is not a Bill to regulate the professional certification of individuals. There are other legislation and regulation for that. Sir, in conclusion, this Bill introduces changes to future-proof our regulatory framework for agility, to enhance the operational efficiency and clarity, as well as strengthen safeguards to patient safety and welfare to ensure our regulatory regime remains robust, agile and responsive to provide better healthcare services to our population in Singapore. I thank Members for their support of the Bill.”
“I would point out that several of his questions addressed healthcare manpower, the professional certification of individuals, pastoral support for healthcare workers who are burning out, the universities and medical schools – none of which is covered by this Bill before the House. I would suggest that he might want to either raise the appropriate Parliamentary Questions or take these up at an appropriate time. There are some issues that he raised that are indeed covered and I would like to just go through them. The first on the issue of TCM practitioners and other complementary and alternative medical practitioners. They are not prohibited from advertising, from describing what they do. What they are prohibited from is purporting to treat and diagnose medical conditions. I just want to make sure that we have a clear understanding. The TCM practitioners themselves have their own Professional Board that regulates them. So, that is not something that, under this legislation, we require them to state their qualifications. Assoc Prof Jamus Lim also brought up the issue of the language around premises. The intent is not to constrain premises. The intent is to regulate the service provisions. So, in describing premises, we have tried to cover indeed as many possible premises and models of service delivery. So, the intent is to look at the service and then specify and agree with the licensee how they will provide that service. Hence, we do need the language to cover the various possibilities of how and where a service will be provided. I hope that addresses Assoc Prof Jamus Lim's query about why we have the language around permanent versus non-permanent versus conveyancing within the Bill.”
“And you can extend this to other public health emergencies that are conceivable, and we would need to be able to react to these in a relatively swift manner. Based on our experience in COVID-19, licensees can indeed meet the requirements and can do so at a relatively short notice. I would like to assure Mr Yip Hon Weng and Mr Louis Ng that the aim of this amendment is to provide the Ministry with the power to direct groups of licensees to take immediate action. The focus is on saving lives through the quick introduction of safety measures and not on penalising licensees for not being able to comply with the Ministry's direction despite their best efforts. Ms Ng Ling Ling also asked if it was too onerous to place the burden of approvals on one authority. I would like to reassure her that MOH and agencies that are part of the family, we have a number of Expert Committees and Appeal Advisory Committees that are part of our normal processes. So, when guidance is given by Directors of Medical Services and decisions are made by the Minister, it is informed by a wide group of experts, academics, practitioners and professionals from the associations and various bodies representing healthcare workers, including the Academy of Medicine Singapore, the Singapore Medical Association, Singapore Dental Association, the College of Family Physicians Singapore and our various Expert Committees and Appeals Advisory Boards. These are all very much part of our ongoing process; that is not going to change with HCSA. There were a number of questions by Assoc Prof Jamus Lim.”
“Beyond this list, service providers who wish to co-locate their services must seek MOH's approval and conditions will be imposed, including requirements to comply with for their advertising. In particular, the advertising must not result in a misperception by patients that the co-located non-licensable healthcare service is actually licensed by HCSA. Where an advertisement covers both the licensable healthcare service and the co-located non-licensable service, it is the HCSA licensee that is responsible for ensuring compliance with the Healthcare Services (Advertisement) Regulations for the entire advertisement. I would also like to address Dr Tan Yia Swam's concern. The amendments already cover misleading claims made by non-HCSA licensees, including building and wellness service providers. This means that any salon that purports to treat the medical condition will be in contravention of the law. We continue to encourage the public to exercise discretion. And if the public is aware of such misleading claims, please escalate this to the Ministry for further investigation. Sir, Members have also asked about the safeguards in the regulatory process. Mr Yip Hon Weng highlighted that healthcare institutions may not have sufficient turnaround time given the 14-day notice period being removed. I would like to stress again that we are only removing the 14-day notice period for a class of licensees, such as all licensees that provide an acute hospital service and only in situations where there is immediate or imminent harm to patient safety. Such a situation would have significant impact on our healthcare worker safety and our public health safety as well. Members will remember exceptional circumstances that include the recent COVID-19 pandemic.”
“We will look at the visual imagery, but we will also take into consideration the overall content and intent of the advertisement before we decide on whether we take an enforcement action. The intent is to make sure that those providing treatment and medical services are appropriately regulated for the safety of the public. Mr Louis Ng suggested banning the use of the term "Doctor" outright for healthcare service advertising. We tried to have a balanced approach. The title "Doctor" is something that is afforded not only to medical doctors. The PhD holders would also have that title. And having the title of "Doctor" as a medical doctor, does not automatically mean one is licensed but one does have that title. So, we are trying through our approach, to achieve the right balance and make it clear that where you are advertising a healthcare service, the appropriate description is used, including the description of your qualification or lack thereof for the provision of medical or dental services. So, we do not think it is tenable to restrict the title of "Doctor", prevent it completely in all healthcare service advertising. But we think having this mandatory disclosure is a more balanced approach. Ms Ng Ling Ling had some questions on the co-location of non-licensable healthcare services, such as Traditional Chinese Medicine (TCM) practitioners together with licensable healthcare services. We have prescribed a list of services that can be co-located without needing to seek prior approval and this includes TCM acupuncture services and services provided by registered allied health professionals, such as physiotherapists.”
“A list of licensees with the modes of service delivery and Specified Services that they are approved to provide will be published and also made accessible through HealthHub so that the public can check if the healthcare provider they wish to obtain services from has the necessary approvals to provide those services. We hope that the public will also participate and report errant institutions through feedback channels, which we can then investigate and take the appropriate enforcement action. Mr Louis Ng brought up some issues around healthcare service advertising that may mislead using visual imagery. I agree with Mr Ng that this risk exists and we have provided restrictions on the use of certain terms, not just in the licensees' names, but in the use of those terms within the logo. However, the extension of restrictions to the use of visual imagery completely may limit businesses' ability to create a brand to distinguish themselves, and I think there is room to significantly overstep. One example I might provide for Mr Ng's consideration is the use of the heart shape. I think it is quite commonly used in a variety of settings. I do not think anybody would say that it is exclusively the purview of cardiologists, especially if it is the simplified cartoon-shape heart. So, we do need to be quite careful, not to prevent all advertising. We will investigate complaints, however, on a case-by-case basis, and the examples that he cited, if there is a non-licensed provider, or someone purporting to treat when they should not be, and doing so through the use of visual imagery, we would suggest that these cases are reported.”