Lam Pin Min
Singapore
“Mr Speaker, on behalf of the Minister for Transport, I beg to move, "That the Bill be now read a Second Time". This Bill, together with the Active Mobility (Amendment No.”
“It is timely for us to put in place a regulatory framework to ensure that active mobility devices being brought into and used in Singapore are safe. This is a key step in helping us put in place a safe and sustainable active mobility landscape in Singapore. Mr Speaker, I beg to move. [(proc text) Question proposed. (proc text)] 1.55 pm”
“Clause 6 facilitates the transfer to and vesting in the financial security provider of a seafarer's rights against a shipowner as a result of any liability arising from the shipowner's obligation to repatriate the seafarer. For example, the liability to pay the seafarer's wages and entitlements.”
“Mr Speaker, to ensure a safe and high-quality blood supply for our patients in Singapore, pre-donation interviews are conducted to screen blood donors for risk factors and blood donations are also tested for blood-borne infections. However, infections can only be detected some time after the blood donors have been infected.”
“I thank the Member for that clarification. As far as I know, not all mental conditions will be excluded from blood donation. In fact, we have checked with HSA. There is a wide spectrum of mental illnesses – from very mild mental conditions to very severe conditions.”
“I think we must be cognisant that the reason why they are inmates is because of certain things that have happened, prior to that. That actually pre-disposes them to some high-risk behaviours.”
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“PCNs are made up of GPs who are organised into virtual networks and deliver care through a multidisciplinary team of doctors and nurses to manage patients' needs more holistically and effectively. Patients will benefit from nurse counsellors who will provide individualised advice to better manage their conditions. In addition, diabetic patients will be able to access diabetic foot and eye screening services more conveniently at the PCN GP clinics, allowing for early detection and treatment. Through PCNs, GPs also have greater scale to link up with community providers. Dr Tan Wu Meng and Assoc Prof Fatimah Lateef suggested strengthening primary care to manage patients in the community and better streamlining of care coordination across care settings. I agree with both of them. The RHSes and public healthcare institutions have care coordination programmes and care coordinators for patients with multiple needs and frequent hospitalisations. PCN care coordinators would also be able to spend more time evaluating care needs holistically and refer these patients to the appropriate channels of social assistance, including VWOs and MSF's Social Service Offices. The team-based arrangement will also facilitate like-minded GPs in cross-sharing and peer learning of best practices across PCNs. MOH will provide GPs participating in PCNs with funding and administrative support to implement team-based care to better track the care outcomes and monitor patients more closely. MOH will be launching the PCN application call on 1 April this year for a period of two months and interested GPs are encouraged to participate in this application. Funding support will also be available to enable GPs to better care for patients with complex chronic conditions, such as diabetes.”
“Patients themselves also have a vital role to play to achieve optimal control of diabetes. The key to managing diabetes starts with taking active steps to lead a healthier lifestyle and to comply with treatment. To better support patients, we are developing a framework to empower them to initiate and sustain lifestyle changes and enhance treatment adherence. Diabetic patients are also best managed when anchored in meaningful doctor-patient relationships in the community. This brings me to primary care. Primary care is the bedrock of our healthcare system and the key to enabling the shift to bring healthcare beyond hospitals into the community. It is an integral component in our transformative efforts to bring patient-focused care closer to home. Currently, only 20% of our primary care attendances are in polyclinics, the remainder are with private GPs. This is also reflective of where our primary care doctors practise today. Eighty percent of our primary care doctors are private GPs and a small number of them provide medical care in nursing homes and home medical services. Within primary care, we are also seeing an increase in attendances with chronic medical conditions, like diabetes, hypertension and hypercholesterolaemia, rising from 18% in 2010 to about 27% today. Our GPs are, therefore, very much a part of our healthcare ecosystem in delivering care in our communities and providing better chronic disease management for our patients. We have introduced the CHAS scheme in 2012 to provide means-tested patient subsidies at participating CHAS GPs. We have also piloted the Primary Care Networks (PCNs) in 2012 which have shown promising results, in terms of the outcome of chronic diseases management. This year, we will be scaling up our PCNs to better support GPs.”
“In 2011, the National University Hospital (NUH) and the National Healthcare Group Polyclinics developed the Nephrology Evaluation, Management and Optimisation programme (NEMO). The pilot programme initiates and optimises kidney protective medication for suitable patients showing early signs of kidney disease. As of September 2016, about one-third enrolled on the programme demonstrated improvements, while over 60% maintained stable kidney function. These positive outcomes give us confidence to scale this initiative nationwide. From April this year, we plan to extend an enhanced version of the NEMO programme. We will call it "HALT-CKD", which stands for Holistic Approach in Lowering and Tracking Chronic Kidney Disease. The new national programme will benefit more patients nationwide and will be implemented progressively at all polyclinics. Minister Gan also spoke about the setting up of the Agency for Care Effectiveness (or ACE). This will help clinicians and patients alike achieve value, beyond quality, in the area of drugs and healthcare technology, which will support our War on Diabetes. To better equip our primary care doctors to care for diabetic patients, we will roll out two Appropriate Care Guides (ACGs) in July this year. The first care guide will provide recommendations on medications for type 2 diabetes and, the second, a systematic way to manage pre-diabetes. ACE also recently evaluated two classes of patented diabetic drugs. One of them was found to be significantly more cost-effective. Arising from this, MOH will be listing the drug from the more cost-effective group under the Medication Assistance Fund (MAF), and eligible patients can apply for financial support for this drug.”
“For example, parents who establish regular sleep patterns for children and reduce the amount of screen time for computers, television or mobile phones before sleep, will go a long way towards ensuring quality sleep and better physical and mental health for their children. To Dr Chia Shi-Lu's queries on Nurture SG, the initiative will benefit our children and young from preschool to IHLs. The respective agencies will be supporting the respective recommendations. However, as this is a multi-year ongoing effort and builds on top of existing efforts on child health, it is more meaningful to focus on the programmes and on an overall budget. As reported in HPB's student health survey in 2015, one in six of our Secondary 1 to Secondary 5, junior colleges and centralised institute students do not eat breakfast at all. This is of concern and we hope that Nurture SG's plans will better guide our youths to live a healthier life. Minister Gan has spoken about the War on Diabetes. I will now focus on the clinical management of diabetes and the development and implementation of evidence-based clinical and lifestyle management of the disease. This work is led by a Disease Management Workgroup under the National Diabetes Prevention and Care Taskforce set up in July last year. Good clinical management of diabetes is important, as poorly controlled blood sugars can lead to multiple complications in the long term, such as diabetic retinopathy, limb amputations and chronic kidney disease. In 2014, two in three new kidney failure cases were due to diabetes. Early detection and treatment can prevent or slow down the progression of diabetes-related kidney disease.”
“With regard to the nutrition of our preschoolers, let me share an example of how the HPB's Healthy Meals in Childcare Centres Programme (HMCCP) contributes to our vision of "Healthy Meals for Every Child". This is Raenelle. Since 2015, she has been attending Agape Little Uni @ Sengkang, which participates in HMCCP. Raenelle has grown to love healthier food and is a health ambassador in her home. As a result, her mother, Regina, has adopted healthier cooking methods, such as steaming and stir-frying at home, and also taking right meal portions. And when they shop for groceries, they look for healthier food options contributing to a balanced diet. Although certain healthy food options can be slightly more expensive, there is also a wide variety of affordable alternatives labelled with the Healthier Choice Symbol (HCS). By making the right choices, Raenelle and Regina are on track towards a healthier future. To complement the efforts of improving nutrition in the meals served in preschools, the Early Childhood Development Agency (ECDA) will double the minimum daily time for physical activities for full-day preschool programmes to an hour a day, of which, 30 minutes will be conducted outdoors to cultivate young children's interests in physical activities. 2.00 pm We also have plans to teach our young to manage themselves well, by equipping preschool educators with the knowledge and understanding of socio-emotional development in young children. Last but not least, we want to raise awareness on the importance and benefits of adequate and quality sleep. A lack of sleep is associated with impaired cognition, obesity and an increased risk of mental health issues. HPB will be launching a campaign in mid-2017 to share tips about good sleep habits.”
“In addition, the physical and social environments are key determinants of health, particularly for children who are in the early stages of development. Hence, NurtureSG will also focus on fostering active and healthy living in the school and the community so as to integrate health promotion into the daily activities of our young. In order to deepen and strengthen health education in educational institutions, we will provide more opportunities for children and youths to be more active in physical activities and have access to healthier meal options. We will help them understand the importance of quality sleep and enhance their socio-emotional skills so that they stay healthy, both physically and mentally. As long as we all work together, I believe we can raise awareness of the importance of good health amongst young Singaporeans and create a healthier future for them. (In English): We announced the plans for NurtureSG two weeks ago. I thank Dr Chia Shi-Lu for his strong support for the NurtureSG Taskforce's recommendations. NurtureSG seeks to foster healthier habits in our young in three key areas, namely, physical activity and nutrition, mental well-being and sleep health. And we will do so through two enablers: through parents, who are role models in shaping the attitudes and behaviours of our children, and through the school and community. Dr Janil had elaborated during the MOE COS the various initiatives that mainstream schools will be embarking on to address these three focus areas. I will now share with Members what we will do in going further upstream to target children of preschool ages.”
“The foundation of a healthier future is in our children and youth. There is strong evidence that good habits start from young, and these continue to reap benefits in healthier lifestyles and choices into adulthood. Minister of State Dr Janil Puthucheary and I co-led an interagency NurtureSG Taskforce last year to jointly guide the development of a plan to enhance the health outcomes among our young. Mdm Chairman, before I elaborate further, I would like to request to deliver a summary of the NurtureSG plan in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] Good health will lay a good foundation for the holistic development of our children and youths. However, we are now seeing several new trends, such as more frequent use of electronic gadgets, easy access to high-calorie food and drinks, and increasingly sedentary behaviour. Therefore, we need to look into nurturing healthier children and youths in a sustainable way. Last year, Minister of State for Education Dr Janil Puthucheary and I co-chaired a taskforce to jointly develop a NurtureSG plan to enhance the health outcomes of young Singaporeans. NurtureSG focuses on the health of our children and youths in three health considerations, including physical activity and nutrition, mental well-being and sleep health. We will equip young Singaporeans, their parents, caregivers and teachers to help our children and youths lead a healthier lifestyle. NurtureSG will focus on the greater engagement of parents by equipping them with relevant knowledge and parenting skills so that they can play an active role in providing a health-promoting home environment for their children.”
“Minister Gan Kim Yong has highlighted key shifts in our healthcare system to help build a sustainable healthcare system for Singaporeans in the future. I will focus on how we are working to implement the "3 Beyonds" − beyond hospital to community, beyond quality to value, and beyond healthcare to health – in laying the foundation for a healthier future. Mdm Chairman, let me begin by illustrating with a story of two villages that are situated along a river. This river is the source of life as it provides food and water to the people living along it. However, the inhabitants up-river are dumping waste into the river polluting the water downstream. Villagers staying down-river are falling ill as a result of bathing in and drinking the polluted water. The affected village has several options. It can invest substantial resources researching the health effects of polluted water or put lots of money into expensive technological solutions to treat and purify the water. It can also look for alternative sources of drinking water. All these options would translate into long-term commitment of time and resources in managing the consequences of a real problem. However, the underlying root cause has not gone away. Alternatively, the affected village can work with the inhabitants upstream to identify and remove the source of pollution into the river. This would definitely help address the real problem, without having to resort to expensive and complex solutions. Yes, this upstream approach is one of the fundamental shifts that Minister Gan has alluded to in his speech − beyond healthcare to health. Besides advocating health promotion in the general population, our focus now has shifted even more upstream to target Singaporeans as young as possible, from the preschool ages.”
“Mdm Chairman, may I have your permission to display some slides during my speech?”
“I would like to thank Assoc Prof Fatimah Lateef for the supplementary questions. These are, indeed, very pertinent questions. As clinical genetic testing is very new and the field of Precision Medicine is evolving, like I mentioned in my reply, MOH is in the process of drafting standards for the provision of clinical genetic testing applicable for healthcare institutions and laboratories. These sets of standards will be ready by the second half of 2017 and will be promulgated first as a code of practice to all licensees for a year, before being ramped up to make sure that these licensees are operationally ready to meet the draft standards. Thereafter, these sets of standards will be enforced by the end of 2018, under PHMCA, whereby MOH will set up an inspection and audit mechanism to assess the healthcare institutions' compliance with these standards. With regard to the second question, all licensees who wish to provide genetic testing services in the healthcare institutions will need to seek approval from MOH and fulfil a set of stringent standards which will include ensuring specialised expertise and qualifications of the medical personnel to interpret test results as well as ensuring proper pre- and post-genetic test counselling to allow patients to make informed decisions and understand the cost benefits of such genetic tests. MOH's inspection and audit teams will also check that these tests were ordered by qualified medical personnel and counselling was conducted appropriately.”
“Speaker, Personalised Medicine, also known as Precision Medicine, generally refers to the customisation of medical treatments and clinical care to specific patient groups based on their underlying clinical, socio-demographic or genetic profiles. There are existing safeguards on preservation of confidentiality of medical records and informed consent-taking that apply to practice and research in Precision Medicine. These safeguards are provided for under the Private Hospitals and Medical Clinics Act (PHMCA) and the Human Biomedical Research Act (HBRA). PHMCA stipulates requirements on the protection of medical records, including the confidentiality and integrity of the records. HBRA provides a consent framework for the conduct of human biomedical research, including requirements relating to appropriate consent-taking from research subjects. Given that the field is evolving rapidly, there is a need to keep abreast of developments and review our safeguards so as to ensure patient and public interests. The Ministry of Health (MOH) has started the process of drafting standards for the provision of clinical genetic testing services in Precision Medicine. These will help address issues, such as pre- and post-test counselling, competency of personnel involved in the delivery of the services, as well as appropriateness in the ordering of genetic tests and interpretation of test results. The need for informed consent, security and confidentiality of information and disclosure of test results to third parties outside direct healthcare providers will also be addressed. MOH will consult relevant stakeholders on the draft standards when they are ready.”
“I would like to thank Mr Leon Perera for the supplementary questions. Like I have mentioned, nursing homes do have certain procedures to try to establish contact with the family members of the residents. Different nursing homes have different procedures but, fundamentally, they are quite similar. They will make phone calls, they will try to email them, they can send letters, and some will also attempt to visit their homes at the last known address. With regard to residents who are unable to pay for the nursing home cost, the Government does provide financial assistance for those who are eligible under the means testing regime. For those who cannot pay the remaining portions of their bills, they can also tap on MediFund as well. I would like to reiterate to all Members of the House that every single case of abandonment is sad and heart-wrenching. The Government cannot mandate filial piety but will definitely step in to help whenever possible. While the Government can provide financial support through the various assistance schemes that I have mentioned just now, we cannot play surrogacy to the love and warmth of the family.”
“Mdm Speaker, we do not specifically track the number of nursing home residents who are abandoned by their families. When families fail to visit, nursing home staff will try to re-establish contact. They may try to contact family members or visit them at their last known addresses to encourage them to visit their loved ones. The Government provides means-tested subsidies of up to 75% of nursing home costs. Residents who require additional assistance can tap on financial assistance schemes, such as MediFund. Many nursing homes are also run by voluntary welfare organisations and may tap on charitable donations to provide further financial support to their residents. Nursing homes can also provide assistance to eligible residents to seek legal recourse under the Maintenance of Parents Act if they wish to do so.”
“Mdm Speaker, the Ministry of Health and the Agency for Integrated Care (AIC) have been working with the Office of Public Guardian to reach out to aged care providers and the public to raise awareness on the Lasting Power of Attorney (LPA). We have reached out to staff in close to three-quarters of all nursing homes on Advance Care Planning which can include the planning for an LPA so that care decisions can be in line with an individual's wishes in the event of mental incapacity. AIC conducts regular talks and case discussions with aged care providers to raise awareness on legal issues, such as LPA. For example, in October 2016, AIC partnered All Saints Home and the Pro Bono Services Office of the Law Society of Singapore to organise a seminar to provide nursing home staff a basic understanding of legal concepts, such as LPA, Mental Capacity Act and the Maintenance of Parents Act. Close to 120 staff from more than half of local nursing home providers attended the event. Separately, AIC is also working with the Pro Bono Services Office lawyers and aged care providers to offer legal clinics. These legal clinics will provide pro bono services and consultation on legal issues, including LPA, for nursing home staff as well as residents and their family members. We will continue to work on increasing the awareness of LPA and making LPA more accessible to the elderly. 12.30 pm”
“I would like to thank the Member for the two supplementary questions. For the one on community pharmacists, yes, currently, pharmacists are already allowed to prescribe certain drugs. For example, simple drugs like those for the treatment of common cold and running nose, community pharmacists are allowed to prescribe such drugs. As to the suggestion of enhancing the role of nurse practitioners, we are already doing that. Many nurse practitioners in the polyclinics, as well as in the hospitals, do perform these expanded role, part of which actually superimposes with those of a doctor's, for management of simple conditions.”
“I would like to thank Er Dr Lee for the two supplementary questions. On the first clarification on the data collected, I would like to inform the Member that due to the change in data collection system and the classification of bill-related feedback, we are unable to compare accurately the figures year-on-year over the past five years. However, for the data collected over the past two years, there was an average of about 160 cases of bill-related feedback from both the public as well as the private medical institutions. In 2016, 23 cases received through emails were specific to overcharging, of which 90% are private medical institution related. Ten percent are public healthcare institutions. With regard to the Member's second question on the appropriateness of prescribing non-standard drugs, I would just like to remind and also reiterate that doctors should and must prescribe appropriately and it should be in the interest and well-being of the patients and not for personal financial gains. For patients, especially PG patients who need to be on non-standard drugs and who cannot afford the cost of the medication, there is always the Medication Assistance Fund, which helps these eligible patients to pay for expensive drugs that are not in the standard list. I want to encourage these patients, if they do encounter any difficulty in their medication bills, to apply to the Medication Assistance Fund. I would also like to inform the Member that MOH has also set up an Agency for Care Effectiveness (ACE). This agency issues guidelines on the use of cost-effective drugs for treatment of common medical conditions, and these will be implemented in time to come.”
“I would like to thank Ms Thanaletchimi for the two supplementary questions. On the role of community pharmacists, MOH does study the role of community pharmacists, focusing more on the areas of public education, such as educating patients on prevention of certain diseases as well as the proper use of certain medications. However, with regard to prescription rights, this is one area that MOH will have to seriously consider the pros and cons, because we do receive feedback from patients that when they see a doctor and collect their prescriptive medicine from the doctor, it adds to a lot of convenience, rather than to have them to travel to a pharmacy elsewhere to buy the medication. With regard to publishing the fees of GPs, this is an area that MOH is currently looking into.”
“Mdm Speaker, the Ministry of Health (MOH) receives feedback on a variety of issues, including on doctors' fees and charges. Occasionally, there are cases relating to alleged overcharging. Doctors are ethically responsible for charging fair and reasonable fees to their patients. The Singapore Medical Council (SMC) Ethical Code and Ethical Guidelines requires doctors to charge reasonably and ensure that their fees are transparent and made known to patients in advance. SMC can take disciplinary action against errant doctors who do not meet these requirements and has done so before. MOH is working with healthcare providers on ways to improve fee transparency. MOH has published "Total Hospital Bill" data for common conditions and "Total Operation Fees" for common surgical procedures for both public and private hospitals. MOH also requires all hospitals to provide patients with financial counselling upon admission. In the outpatient setting, MOH requires all general practitioners (GPs) and dental clinics under the Community Health Assist Scheme (CHAS) to issue itemised bills to CHAS patients from January this year. These measures ensure more fee transparency and enable patients to make more informed decisions. MOH is also studying the recommendations from the Health Insurance Task Force (HITF) relating to overcharging. Each of us has to play our part to keep our healthcare costs sustainable while ensuring that patients continue to have access to good quality and appropriate healthcare.”
“I would like to thank the Member for the supplementary question. MOH is constantly trying out different pilot programmes to see how we can provide better primary care and enhance primary services in the community. The Family Medicine Clinics have shown some positive results but, at the same time, we do understand that the scalability can be a challenge because of the fact that we need to mobilise the GPs, who are mainly in the solo practices, to come together to form a Family Medicine Centre. At the same time, MOH is trying out other initiatives and one of these initiatives that MOH will be embarking on is that of a primary care network, where a network of GPs can come together to provide team-based care on a virtual basis, where they will still practise at their own clinic premises but, at the same time, share processes, resources as well as other ancillary support.”
“I would like to thank the Member for the questions. MOH is increasing infrastructure development as one way to cope with the increased waiting times in the polyclinics. In the coming few years, we will be building more polyclinics. But at the same time, we are also encouraging patients who qualify for CHAS to utilise some of the services that are provided by the CHAS GP. This is one way we can shift the utilisation of polyclinic services to the GPs, where they have more spare capacity. With regard to having more community volunteers, that is a good suggestion that we can take up. We can work with partners and other stakeholders within the community to see how we can provide such services to the elderly who find that going to the polyclinics or GPs can be a bit of a hindrance because of the distance and their physical conditions.”
“Mdm Speaker, in 2015, the number of primary care visits totalled 7.3 million, based on our records which cover polyclinic and Community Health Assist Scheme (CHAS) general practitioner (GP) visits. Non-CHAS visits to GPs are not included as the Ministry of Health (MOH) does not routinely collect such data from GPs. Of the patients included in our records, 82% visited polyclinics and 36% visited GP clinics. Some among them visited both polyclinics and GPs. Referrals from polyclinics and GPs make up 32% and 7% respectively of new attendances at our Specialist Outpatient Clinics (SOCs). The rest include hospital referrals and walk-ins. MOH has introduced initiatives to anchor the care of patients in the primary care setting. We enhanced CHAS and the Chronic Disease Management Programme to make care in the community more affordable. We also provided GPs better access to support services, such as diabetic eye and foot screening, through the Community Health Centres. In addition, we have introduced standardised management and referral protocols between polyclinics and SOCs, starting with high volume conditions in the areas of orthopaedics, gastroenterology, and cardiology. The early results are encouraging. On cardiology, for example, preliminary findings showed that about 57% of heart patients who previously would have been referred to specialists can be safely managed mainly in the primary care setting. MOH will continue with efforts to strengthen primary care and anchor the care of more patients, especially those with chronic conditions, in the primary care setting.”
“Mdm Speaker, as the Bill is, in your opinion, a hybrid Bill, in accordance with the provisions of Standing Order 68(1), the Bill will be referred to a Select Committee. I beg to move, "That the Select Committee on The Kwong-Wai-Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill consist of Mdm Speaker as Chairman and the following Members: (1) Dr Chia Shi-Lu, (2) Ms Chia Yong Yong, (3) Miss Cheryl Chan, (4) Mr Christopher de Souza, (5) Mr Gan Kim Yong, (6) Dr Lam Pin Min, (7) Mr Low Thia Khiang." [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That the Select Committee on The Kwong-Wai-Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill consists of Mdm Speaker as Chairman and the following Members: (proc text)] [(proc text) (1) Dr Chia Shi-Lu, (proc text)] [(proc text) (2) Ms Chia Yong Yong, (proc text)] [(proc text) (3) Miss Cheryl Chan, (proc text)] [(proc text) (4) Mr Christopher de Souza, (proc text)] [(proc text) (5) Mr Gan Kim Yong, (proc text)] [(proc text) (6) Dr Lam Pin Min, (proc text)] [(proc text) (7) Mr Low Thia Khiang." – [Dr Lam Pin Min] (proc text)]”
“Lastly, I would like to thank Mr Louis Ng for his suggestion to consider the possibility of nursing homes accommodating patients with higher care needs. MOH is currently looking into this and we will share more details in future. Mdm Speaker, let me conclude. The Kwong Wai Shiu Bill will modernise Kwong Wai Shiu's corporate structure and put Kwong Wai Shiu in a stronger position to respond to future challenges. At the same time, Kwong Wai Shiu will also have greater flexibility to continue providing quality healthcare services to Singaporeans. Moving forward, MOH will continue to work closely with Kwong Wai Shiu, as well as other like-minded partners to continue improving the accessibility and quality of ILTC care for Singapore. Together, we will make Singapore an ideal place to age gracefully in. I call on Members of the House to give their support to the Kwong Wai Shiu Bill. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Bill accordingly read a Second time. (proc text)]”
“I am confident that they will be able to fulfil their objective of serving the community for the next 100 years. (In English): Mdm Speaker, Mr Louis Ng queried how the new entity will be funded and operated. He also asked for clarifications on how the transfer of employees from the existing Kwong Wai Shiu entity to the new entity will take place. I would like to reassure Mr Louis Ng that the transition to the new entity is purely a change in Kwong Wai Shiu's corporate structure and does not affect its operations. As mentioned earlier, under this Bill, all records, legal rights and obligations of the former Kwong Wai Shiu will be transferred to, and assumed by, the new CLG, in a seamless manner. This means that the "new" Kwong Wai Shiu will continue to run its nursing home and receive the same funding from MOH to care for its clients. In line with this, Kwong Wai Shiu's employees will simply become employees of the new entity, with their employment terms unchanged. I am glad that Mr Louis Ng raised the question on whether Kwong Wai Shiu's trustees and committee members will still be able to contribute to Kwong Wai Shiu after the transfer to the new entity. Kwong Wai Shiu's trustees and committee members have been closely involved with its operations for many years and contributed significantly to its strong track record in community service. I understand from Kwong Wai Shiu that the trustees and committee members have been invited to serve on the new board and that most have agreed to do so. I am confident that the board members will continue to lead and guide Kwong Wai Shiu as it expands its mandate and infrastructure. I would also like to take this opportunity to update that the new 12-storey facility is on track for completion in end-2017.”
“This platform pulls together several streams of services, including the TCM clinic, to support seniors with varying needs and help them to stay well within the community. Kwong Wai Shiu and ACMS will also jointly work on research study and training programmes to benefit clients and the TCM industry. As mentioned by Mr Gan Thiam Poh, it is to Kwong Wai Shiu's credit that they have managed to adapt over time despite being constrained by its antiquated Ordinance. I commend the Kwong Wai Shiu leadership for having the foresight to look ahead and push for these changes to their corporate structure so that they are able to move more quickly and confidently to meet future challenges. MOH is happy to support them in these efforts. The Members have also raised various comments and questions on the Bill. Let me address the various comments and questions raised by them. I was heartened to hear Mr Gan Thiam Poh's affirmation of Kwong Wai Shiu's efforts in helping patients in need over the years. Indeed, Kwong Wai Shiu has a team that evaluates cases submitted by medical social workers. Those who are assessed to be in need will be assisted using Kwong Wai Shiu's charity funds. Apart from helping indigent patients, I understand that Kwong Wai Shiu also caps its nursing home inpatient fees to ensure that they remain affordable for Singaporeans. This is also why it is important for Singapore to have VWO care providers. They have a passion to serve and can harness the joint resources of the community to help patients in need. Kwong Wai Shiu has promised me that it will continue to fulfil its mission of providing healthcare services to the sick and poor in Singapore regardless of race, language or religion, and serving the community with passion.”
“Mdm Speaker, allow me to respond in Mandarin first. (In Mandarin): [Please refer to Vernacular Speech.] Mdm Speaker, first, let me thank Mr Thomas Chua, Mr Gan Thiam Poh and Mr Louis Ng who have expressed their appreciation to KWSH for its contribution to healthcare in Singapore and voiced their support of the Bill. Indeed, KWSH has played an important role in developing our healthcare system. As one of Singapore's oldest charitable healthcare institutions, KWSH has cared for the sick and needy for more than 100 years since it was established. It has continuously developed and evolved its services to cater to Singaporeans' healthcare needs. In the early days, KWSH responded to national needs by providing maternity services and treating communicable diseases, such as Tuberculosis, and even continued its operations during the Japanese occupation. To ensure that it could care for Singaporeans regardless of race, language or religion, KSWH also went beyond its Ordinance and opened its doors to all Singaporeans in 1974. In recent years, KWSH started to provide additional services, such as speech therapy, cancer rehabilitation and home care. I understand that KWSH also actively engages the community through mobile health screening, public health talks, and active ageing programmes. As mentioned by Mr Thomas Chua, KWSH has been innovating to help seniors age well in a familiar environment. The Active Ageing Hubs that I earlier mentioned, is a good example of KWSH's efforts. In addition, Kwong Wai Shiu is also collaborating with the Academy of Chinese Medicine (ACMS ) to provide better care services for the elderly. ACMS will be part of Kwong Wai Shiu's new integrated hub concept to provide better TCM services, and to more Singaporeans.”
“As a result of the modernisation, Kwong Wai Shiu will have greater flexibility to expand its charitable activities, thereby further benefiting the broader community and public. The transfer will take place after the Kwong Wai Shiu Bill comes into force. Upon the transfer, all records, legal rights and obligations of the former Kwong Wai Shiu will be transferred to, and assumed by, the CLG. This includes staff employment − the continuity of the staff's employment, and the terms and conditions of their service, will not be affected by the transfer to the CLG. Likewise, Kwong Wai Shiu's rights, powers, duties and liabilities as an employer will be transferred to the CLG. As such, the Kwong Wai Shiu Bill will not have any adverse impact on Kwong Wai Shiu's employees. Kwong Wai Shiu has also engaged its union, the Manual and Mercantile Workers' Union, and I understand that the union is supportive of the new corporate structure. Kwong Wai Shiu has also engaged its internal stakeholders, including employees and board members. I would also like to highlight that the hospital's operations will not be affected and patients are unlikely to experience any inconvenience or any adverse changes as a result of the transition. Mdm Speaker, I will now conclude. The objective of the Kwong Wai Shiu Bill is to support Kwong Wai Shiu to modernise its corporate structure and place the hospital in a stronger position with greater flexibility to provide healthcare services to Singaporeans, while ensuring transparency and accountability. I hope that Members will support the Bill. Mdm Speaker, I beg to move. [(proc text) Question proposed. (proc text)]”
“The Ordinance restricts Kwong Wai Shiu's role to provide hospital services for "indigent persons connected with the Kwong-Chau, Wai-Chau and Shiu-heng prefectures of the Canton Province of China", hence, the name "Kwong Wai Shiu Hospital". In reality, Kwong Wai Shiu has gone beyond this limited scope and has long been serving the general public, regardless of race, religion and dialect. The breadth of Kwong Wai Shiu's current activities is worthy and welcome, and it is opportune that the formal limitations imposed by the Ordinance are removed in support of its noble and beneficial activities. Mdm Speaker, I shall now highlight the main features of The Kwong-Wai-Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill, hereby referred to as the Kwong Wai Shiu Bill. The Kwong Wai Shiu Bill will allow Kwong Wai Shiu to modernise and strengthen its corporate structure and provide flexibility in managing its assets and operations. The CLG, named "Kwong Wai Shiu Hospital", was incorporated last year and has been registered as a Charity and obtained IPC status as of 18 July 2016. The Commissioner of Charities, and specifically, MOH as the Sector Administrator for healthcare charities and IPCs, have been identified as the supervisory regulatory authority for Kwong Wai Shiu. The Bill will transfer all the assets, rights and liabilities of Kwong Wai Shiu to the new CLG. The new CLG will be governed by the Companies Act. A new constitution has been established for the CLG, under which there are clear guidelines for governance and the avoidance of conflicts of interest. A board of directors will oversee the management of the CLG.”
“For example, before Kwong Wai Shiu can dispose of any immovable property, it is currently required to first seek the leave of the High Court and serve the application on the Attorney-General. This unduly hampers Kwong Wai Shiu's ability to efficiently manage and control its assets and property to respond to the changing needs of Singapore and ensure that the hospital's activities remain relevant and viable. In comparison, assets of modern charities and Institutions of a Public Character (IPCs) are usually governed by their boards, and these charities and IPCs are not required to routinely obtain the leave of the High Court and to serve the application on the Attorney-General when disposing of their immoveable property. Another example is the requirement for Kwong Wai Shiu to follow the Chinese lunar calendar for the submission of its accounts to the "Secretary of Chinese Affairs", a position which no longer exists today. Second, the Kwong Wai Shiu management wanted to improve and strengthen KWSH's overall governance and corporate accountability framework. The Ordinance is not fully compatible with the guidelines recommended in the Code of Governance for Charities and IPCs. For example, the Ordinance does not include guidelines pertaining to board governance, as well as the avoidance of conflicts of interests. As a CLG, Kwong Wai Shiu will be governed by a constitution which contains such guidelines. This will ensure that Kwong Wai Shiu will continue to operate in a sound manner and assure its donors and members and the public that its funds and assets are responsibly managed. Last, and most fundamentally, the Ordinance limits the scope of Kwong Wai Shiu's operations and beneficiaries.”
“The new Nursing Home, which will also house a Senior Care Centre, will be completed later this year. When fully opened, it will have more than 600 beds and will be the largest nursing home facility in Singapore. Kwong Wai Shiu's upcoming Active Ageing Hubs in the vicinity of its current Nursing Home will also support our seniors to age in place. The Active Ageing Hub is a new concept we are trying out as part of the Action Plan for Successful Ageing. It is a one-stop centre for our seniors, where they can participate in active ageing programmes, and receive care services at the same place if needed. The centre can also provide assisted living services, such as housekeeping and grocery shopping, to seniors living nearby. As Kwong Wai Shiu enhances its services and infrastructure to cater to the changing health needs of our population, it will also need to keep up with the times and ensure the hospital is well-positioned to support its mission to serve all Singaporeans. It is thus timely for Kwong Wai Shiu to review its organisational framework, which is currently set out in the Ordinance, and modernise its corporate and governance structure. The Kwong Wai Shiu management, therefore, sought the Ministry of Health's (MOH's) support to repeal the Ordinance and establish the hospital as a Company Limited by Guarantee (CLG) similar to other voluntary welfare organisations (VWOs), for the following reasons. First, the current Ordinance has not been substantively amended since its enactment. As a result, its provisions have become antiquated and are impeding Kwong Wai Shiu's development and growth as a modern healthcare provider.”
“Mdm Speaker, I beg to move, "That the Bill be now read a Second time." Mdm Speaker, before I begin, I would like to acknowledge Mr Patrick Lee, Chairman of Kwong Wai Shiu Hospital (KWSH), Mr Leong Sin Yuen, Board member, and Dr Ow Chee Chung, Chief Executive Officer of KWSH, who are here with us today to witness the deliberations on the Kwong-Wai-Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill. Mdm Speaker, the Kwong-Wai-Shiu Free Hospital, or "Kwong Wai Shiu" for short, was established in 1910 under the Kwong-Wai-Shiu Hospital Ordinance (the Ordinance) to provide needy immigrants from the Kwong-Chau, Wai-Chau and Shiu-heng prefectures of the Canton Province of China with free healthcare. Since its establishment, Kwong Wai Shiu has played an important role in providing quality care to patients in Singapore. It has expanded the scope of its services significantly over the years, and currently operates a nursing home, a senior care centre, a Traditional Chinese Medicine (TCM) Centre, and provides home care services. Demand for healthcare services is expected to grow as a result of Singapore's rapidly ageing population. Not only do we need to add capacity, especially in the Intermediate and Long Term Care (ILTC) sector, we will need to also build up strong providers to deliver affordable, quality care. Service providers like Kwong Wai Shiu will have an increasingly important role to play in serving needy patients and leading the way to innovative solutions. To better position itself to meet the future challenges, Kwong Wai Shiu is expanding its capacity and capability. Kwong Wai Shiu is doubling its capacity at its current Nursing Home with the redevelopment and expansion of its facility at this site.”
“I would like to thank Ms Thanaletchimi for the supplementary questions. Mdm Speaker, there are currently no preparatory programmes offered for QE candidates, as the preparatory requirements of each candidate may vary depending on individual needs. NUS, however, does send all QE candidates an examination package, which I have already alluded to during my answer and that includes the rules and regulations of the examinations, the curriculum, extracts for the various key disciplines that these students need to undertake as well as the examination papers for the past three years. For candidates who wish to familiarise themselves with our healthcare system, they are also encouraged to apply directly to the respective regional healthcare clusters for clinical attachment.”
“Mdm Speaker, it is important to ensure that graduates from both local and overseas medical schools are competent before they can practise medicine in Singapore. Graduates, including Singaporeans, from overseas medical schools that are listed under the Second Schedule of the Medical Registration Act can apply to the Singapore Medical Council (SMC) to practise in Singapore. These medical schools have been assessed by SMC to have the standing and capability of producing doctors suitable for practice locally. Singaporeans from overseas medical schools that are not listed in the Second Schedule of the Medical Registration Act (MRA) can still apply to SMC to sit for the Qualifying Examination (QE). If they pass the QE, they can then practise in Singapore under provisional qualification, similar to a Page: 26 new graduate from recognised medical schools. The QE is similar to the final examination for the MBBS Degree conducted by the Yong Loo Lin School of Medicine, National University of Singapore (NUS), for their final year medical students. To help candidates prepare for the QE, NUS sends them an information package which outlines the examination rules, curriculum extracts for the various disciplines, and past examination papers. There are, however, no preparatory programmes offered by NUS or our hospitals for the purpose of preparing candidates for the QE.”
“Like I have mentioned, MOH is actually in the process of looking at it and we are seriously considering making it compulsory. Once the details are out, we will announce it very soon. I just want to reiterate that the medical profession has been a noble profession and I want to believe that it still is. Many patients hold doctors in high esteem and expect a high standard of professionalism from them. Since we are talking about CHAS overcharging and the perceived misconduct, I would like to remind all doctors that they are affirmed to the SMC's Physician's Pledge and they are also bound by the SMC's ethical code and ethical guidelines. I also want to reiterate in this House that MOH will not hesitate to take errant doctors to task if they are found to be engaged in professional misconduct or in contravention of the guidelines.”
“At this point in time, it is not mandatory for clinics to issue itemised receipts to their patients. We do encourage patients to request for it, as well as for doctors to issue it, whenever possible. MOH is in the process of looking into whether it is necessary to make it compulsory in the future. As for the CHAS hotline, I take the Member's suggestion and we shall Page: 30 encourage clinics to put up clearer signages or even the CHAS hotline number so that patients will be aware and can actually gain access to the information easily. Er Dr Lee Bee Wah: May I ask why is it that it is not compulsory to issue an itemised invoice? Why is it so difficult, given the many feedback on over-charging?”
“I would like to encourage all Members to inform MOH of any complaints or feedback by residents on CHAS clinics and we will look into each case to address their concerns. Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, I would like to ask the Minister of State it is compulsory for a clinic or doctor to issue invoices with the itemised breakdown. If it is not compulsory, I would suggest to make this compulsory with itemised breakdown so that the residents can check. And the second question is that though there is a CHAS hotline, can it be more prominently displayed, maybe in front of the registration counter of the clinic, so that the residents know where to direct their grievances?”
“Mdm Speaker, we have received about 300 complaints against CHAS GPs and dental clinics from 2013 to 2015, or about 100 a year. In comparison, about 5.8 million CHAS claims were made over the same period. About half of the complaints were related to charges at the CHAS clinics, including incorrect billing and high fees. Other complaints included operational issues resulting in incorrect subsidy, refusal by the clinic to provide itemised billing, customer service issues and concerns over the professional practice of the doctor or dentist. In each case, the AIC had engaged the clinic involved to seek clarification on the issues raised by the patient. For example, for complaints on fees, AIC would obtain and review the bill breakdown from the clinic and explain to the patient whether the fees were due to the length of consultation or type of medication prescribed. If there was a need to correct the bill, AIC would work with the clinic to effect it. Where the complaint was related to professional misconduct or professional ethics and standards, the patient would be advised to lodge a complaint with the Singapore Medical Council (SMC). Some of these complaints could be avoided with clearer communication between the clinics and patients. Clinics are strongly advised by MOH to prominently display common charges in their clinics and provide itemised billing to patients. Patients can also seek clarification from their clinics and request for itemised receipts which will show them their bills before and after subsidy. Patients can also check how much CHAS subsidies their clinics have claimed for them, by logging into the CHAS website or calling the CHAS hotline.”
“I would like to thank the Member for the suggestions. MOH conducts very regular audits on CHAS claims and we do look into the clinics' compliance according to the existing Page: 29 CHAS guidelines. And if we do receive feedback or complaints from residents, then we will audit the clinic in even more detail to ascertain the rationale, as well as how the charges are being made. If there is any misunderstanding between the patients and the doctors, the Agency of Integrated Care (AIC) will then explain to the residents. But if we do find any misconduct, we will not hesitate to take action against the doctors.”
“There are two different forms of subsidy according to the CHAS scheme, that is, there is a subsidy for acute conditions, as well as a subsidy for chronic conditions. For acute conditions, it is claimed on a per visit basis, and we do have a limit to the number of visits the patient can make within a month. With regard to chronic condition subsidy, there is a claim limit that a patient can claim for a particular year. So, if the patient has already exhausted the total amount that has been allocated, then the patient may have to come up with out-of-pocket expenditure. With regard to the Member's particular concern, it would be best if the Member can write to us so that we can investigate the matter and have more clarity on whether there is any misconduct or malpractice.”
“I would like to thank the Member for the supplementary questions. While there have been some complaints alleging high fees or suspected over-charging, so far, we have not found any clear evidence of over-charging in these cases. Given the considerable variation in GP practices and the autonomy of GPs to determine their charges, cases of overcharging can sometimes be very difficult to define. Furthermore, like I mentioned in my reply, there are many factors that can result in the variation of the bill sizes and these include the patient's condition, how long the consultation is, the type of treatment, the type of medication and the complexity of the medical conditions. All these will be taken into consideration during our investigation on some of the feedback from patients. We also understand that some patients are quite concerned about being over-charged by their GPs. However, if we compare this to the large number of CHAS claims, we have received a relatively small number of such concerns, although many of us do hear from some of our residents. While we take such feedback very seriously, the small number suggests that the large majority of CHAS clinics continue to be reasonable in their charges. With regard to the Member's last question on the number of clinics being investigated, other than the two dental clinics which we have suspended CHAS accreditation and are currently being referred to the police for further investigation, there are just a couple more clinics that have been referred to the police for investigations. Because of that, we are unable to provide further details until the investigations have been completed.”
“Mdm Speaker, under the Community Health Assist Scheme (CHAS), lower to middle-income Singaporeans and all Pioneers enjoy subsidised outpatient treatment at participating private medical and dental clinics, so that primary care is more accessible and affordable. MOH has provided guidelines to the participating clinics to ensure that the subsidies are appropriately applied. We review these guidelines from time to time to ensure they remain in line with our objectives. We also conduct regular audits of CHAS claims to ensure compliance with our guidelines and investigate complaints that we receive. We take a serious view of any errant practices and have recently suspended two clinics' participation in CHAS. Charges may vary across clinics and patients, depending on multiple factors, such as the patient's condition, the length of consultation, the treatment and medication provided and the cost structure of the clinic, including rental and other overhead costs. We, therefore, encourage doctors and dentists to actively engage their patients, and vice versa, to address any concerns from patients on their treatment and charges. We also encourage clinics to display their common charges like consultation fees prominently in their clinics and provide itemised receipts to patients on request. These will make their charges more transparent to their patients and minimise misunderstanding. With the number of CHAS clinics more than doubled over the past four years to about 1,600 island-wide, CHAS cardholders and Pioneers have more choices now, compared to when the scheme was first launched. Patients can also be alert to check their bills and alert MOH on any concerns that they may have and we will investigate and advise the clinics if appropriate.”
“The Blue CHAS covers up to the 30th percentile, whereas the Orange covers from the 31st up to the 50th percentile.”
“I would like to thank the Member for his suggestions. In fact, I myself face certain suggestions and pressures from my own residents, too. Like I mentioned in my reply, MOH takes feedback from patients, Singaporeans and also from GPs on the scheme. In my previous reply, I mentioned some of the enhancements over the past years. I promise the Member that MOH will regularly review the subsidy quantum, as well as the scope of coverage of CHAS, including the eligibility criteria in the years to come.”
“Mdm Speaker, there are 1.4 million Singaporeans on the Community Health Assist Scheme (CHAS) currently. This includes about 400,000 Pioneers who receive special subsidies under CHAS. Excluding Pioneers, there are 600,000 and 400,000 Blue and Orange cardholders respectively. Usual feedback on CHAS includes eligibility assessment, level and coverage of subsidies, application and renewal process, as well as charges at CHAS clinics. The Ministry values the feedback provided. We take them into consideration in our periodic reviews of the design and implementation of the scheme, as well as guidelines and advice given to the CHAS clinics. For example, in 2014, we removed the age criterion for CHAS, which allowed all Singaporeans of eligible households, regardless of age, to benefit from the scheme. We streamlined the application process, as well as claims submission process. The Ministry will review CHAS regularly to ensure that the scheme continues to meet the objective of providing Singaporeans with access to affordable and quality primary care in the community.”
“If we do have a first case of positive Zika infection, then isolation will be necessary to prevent its spread through the bites on this infected person by the Aedes mosquito. So, we try to contain it. But, of course, not forgetting the good old effective vector control. I think all of us have a part to play in performing the 5-step Mozzie Wipeout routine. To manage pregnant patients who may be affected by Zika, MOH has also set up a clinical advisory group on Zika virus infection and pregnancy and it comprises obstetricians, public health specialists as well as infectious disease specialists who advise MOH on the different aspects of management of a pregnant patient who may be suspected of being infected with Zika. So, I want to reassure Ms Tin Pei Ling that MOH will closely monitor the development of Zika infection overseas as well as the development of other potential treatment modalities including vaccines.”
“Mdm Chair, I would like to thank Ms Tin Pei Ling for the two clarifications. On the issue of the TAF programme, it was implemented in 1992 and discontinued in 2007. Ms Tin is probably young enough to have either personally experienced the TAF programme or have witnessed her classmates going through it. The objective of the TAF programme is to enable all our overweight and obese students to achieve a healthy weight and while it showed success in reducing obesity rate from 14% to about 9.8% in 2002, MOE did receive quite a number of feedback, both from parents as well as students, that some of the students felt stigmatised by this programme. Since it was discontinued in 2007, MOE replaced it with a different programme called the Holistic Health Framework (HHF) which is a more holistic approach towards health, rather than just focusing on weight alone. It addresses other aspects of physical health as well as mental and social health. So, that is the reason and the answer to the Member's first clarification. For the second one on Zika, just like any emerging diseases, including Zika, MOH adopts a three-pronged approach which I have mentioned in my reply. One, to reduce the risk of importation; two, early detection; and three, containment. In reducing the risk of importation, MOH issues travel advisories on affected countries for Singaporeans who are travelling out of Singapore. Even for women who may get pregnant, they are advised strongly not to travel to these affected countries unless there is a strong reason to do so. To enhance early detection, we have enhanced vigilance amongst our healthcare providers as well as public healthcare institutions. We also have to step up public education amongst the general public about this disease.”
“Thirdly, our healthcare insurance financing features like co-payment and deductibles are built into our MediShield Life as well as some private healthcare plans and this will, hopefully, discourage the "buffet syndrome". Last but not least, which is the most important, is that I would like to remind all doctors that we are bound by the Singapore Medical Council and Singapore Dental Council's ethical code and ethical guidelines and that we should not abuse the doctor-patient relationship for our own personal gains.”
“I would like to thank Dr Chia Shi-Lu for the two clarifications. I would like to say that we do not have a big war chest fund like in the US. Having said that, MOH does build in contingency requirements into our service contracts to respond to health emergencies. And in the event of a disease outbreak, MOH will reprioritise our budget to ensure that we are able to implement all these control measures. In addition to that, like I have mentioned in my reply, we do stockpile medical equipment and supplies like our personal protective equipment, anti-microbials and even vaccines, if necessary. I would like to reassure Dr Chia that we take a whole-of-Government approach to tackle disease outbreaks and, if additional funds are needed, we will definitely work with MOF to ensure that there will be sufficient funding support to implement our efforts. With regard to the second clarification on the control of costs in the private sector, in my speech, I did mention that we have published the professional fees on our MOH website which include total hospitalisation fees both in the public and private sector, the total operation fees in the public sector. And most recently, like I have just announced, we will be publishing the total operation fees of the private hospitals, and this will actually serve as a point of reference for both the healthcare professionals as well as the general public, so that they can make an informed decision. Minister Gan Kim Yong has also announced the setting up of ACE, and this agency will evaluate the clinical and cost effectiveness of health technologies and all the different expensive treatment modalities.”
“Sorry, Mdm Chair, can I answer the other two questions asked by Dr Chia Shi-Lu?”
“The key focus in the Health Sciences Authority's (HSA's) review is to ensure that the vaccine is safe, of good quality and is effective for use in our local population, taking into consideration the local prevalent strains of dengue and its potential risks and adverse effects. Nonetheless, there is currently no vaccine that confers 100% protection against all known strains of the dengue virus. If it is found to be efficacious locally and subsequently introduced, dengue vaccination should be coupled with other dengue control and healthcare strategies in Singapore, such as having a strong disease surveillance system and maintaining effective vector control measures, to keep the mosquito population low. All of us still have a part to play in staying alert and fighting dengue. Mdm Chair, we see an increasing need to shift the focus from healthcare to health. However, we cannot do this alone. Let us encourage one another, including our children and youths, to adopt a healthy and active lifestyle to keep chronic diseases at bay. Our regular family doctor shall be our trusted health partner throughout the different stages of our lives. At the same time, we introduce further measures for greater fee transparency at the hospitals. Not forgetting our vulnerabilities in an increasingly connected global community, we will remain vigilant in responding to public health emergencies. On this note, I urge Singaporeans to partner us in building strong foundations for better care and better health.”