Lily Neo
Singapore
“Thank you, Mr Speaker. May I ask Minister for Health on MOH's capacity in coping with serious cases of COVID-19 in terms of adequacy in respirators and in our ICU beds. Am I correct to say that already half of NCID's ICUs are taken up? What will happen when it reaches its full capacity?”
“But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes.”
“Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it?”
“Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?”
“Thank you, Mr Chairman. Earlier in my speech, I asked whether there are assessments by HDB for applicants of Joint Singles Scheme (JSS) to ensure that they are free from mental illnesses and medical conditions before compelling them to stay together.”
“Many of them have lived in rental housing for more than six years and some more than 10 years. Thus, there are signs of entrenchment. What are the schemes in place and the success rate of such schemes, to assist them in looking for better options in their housing needs and to help them get out of their predicaments?”
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“Thank you, Mr Speaker. May I ask Minister for Health on MOH's capacity in coping with serious cases of COVID-19 in terms of adequacy in respirators and in our ICU beds. Am I correct to say that already half of NCID's ICUs are taken up? What will happen when it reaches its full capacity? And may I also ask the Minister, so far, what is the average length of stay of patients in our ICU beds by COVID-19 cases?”
“Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it? And what are the schemes in place to help them overcome this challenge?”
“Helping Rough Sleepers in in Public Areas”
“Five, many community agencies on the ground can be roped in to provide a variety of support services to those families in need, from family matters to financial aid and even healthcare. As social needs become more complex, individuals in needs may require multiple forms of social support, which could be provided by the different community agencies today. Are there plans to help direct these efforts through better coordination and sharing of information about individuals or families in need in the community? Comprehensive assistance can be facilitated by data and digital technologies, on implementations and on follow-up. I hope MSF can facilitate the adoption and wider use of such technology. This will enable good coordination and good outreach to families in need by the various agencies, but more importantly, it is to spread the resources for better coverage and to prevent duplication or uneven distribution of help. Social service agencies are critical partners in providing such support programmes and services to help individuals and families overcome their difficult circumstances. The social service sector will have to adopt more productive and innovative processes, as well as continually build up new competencies. What are the Ministry's plans to strengthen capability development amongst social service agencies, to meet growing social needs? Six, there is higher chance of those from low-income single parent families of being disadvantaged. Can there be priority given to these families to assist their children better? Seven, there are more transnational families who belong to the families in need. Apart from assisting their children's education and well-being, the spouses of these families also require hand holding assistance in finding employment.”
“More social workers who can understand the needs of each family, sorting out the families' issues; by tapping into the various Government schemes, by working and coordinating with social service agencies (SSAs) to benefit these families. Three, do we have an upstream measure in place to handhold such families? Many of these families have disadvantaged children that need longer follow-up, especially the young children. The reason is that such families may have entrenched problems that cannot be solved overnight. Priority must be given to their children in their well-being as they grow up especially in their education, health and character development. Our system must be robust to ensure that these children are on track to get out of their families' predicament and the chance to climb the social ladder or to break the poverty cycles. Four, a higher percentage of the children of these families is not in pre-schools when it is even more crucial for them to do so. Can MSF ensure that all of these children are placed in pre-schools? Evidence shows that the developmental years, especially the first few years of a child's life are fundamentally important. Special attention and assistance given to the first few years of children's lives lead to better economic, social and emotional benefits later on. In disadvantaged families, many parents are unable to support their children's education due to limited resources and their own educational level. Others tend to be permissive and take a hands-off approach. This results in higher absenteeism from schools. These families and children need closer follow-up and supervision by MSF.”
“There are many families who are in need in our society. They face many issues, such as financial inadequacy, poor health, low education, unemployment, single parenthood, many members to support, physical or mental disability and so on. According to a survey, there are least 20% of Singaporeans who are earning less than their monthly expenditure. Many families, when faced with multiple problems and stresses, become overwhelmed and ill equipped to care and provide for their children. These children will not enjoy the same fighting chance as their better-off peers, and thus may grow up to be in the same predicament as their parents if intervention and help are not rendered in time or in a sustainable manner. These families require intensive, holistic and coordinated assistance. Would MSF look into the following issues of such families? One, how do we identify such families? Has there been any survey done to see how many of such families who are in need? We need to know who they are before we can reach out to them. Can MSF provide the resources for good outreach to touch base with these families, to understand their needs, to assist them with their urgent needs and to coordinate and follow-up with them in a sustainable manner? These families need intense hand holding, because just informing them on the many assistance schemes that they can tap on will not work for them. Two, do we have plans and effective programmes in place that are able to collectively solve the needs of these families in areas such as financial, education of children, medical health referrals, childcare placement, re-employment and so on.”
“Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?”
“Because of this fact, and the fact that there are HPV vaccines that protect against infection with HPV, some countries like Holland and Australia are adopting a HPV DNA assays as primary screening methodology for cervical cancer prevention. Will MOH adopt the same strategy for better cervical cancer prevention? Stomach Cancer is the seventh most common cancer in men and the ninth in women here. Every year stomach cancer takes more than 300 lives in Singapore. Chronic infection with Helicobacter Pylori (H. Pylori), a bacterium that lives in the mucous lining of the stomach, may increase the risk for stomach cancer. H Pylori infection is a common infection in Singapore affecting about 31% of the population, and infection increases to 71% in adults above 65 years. H Pylori is an important pathogen that can be treated with antibiotics and should be eradicated if detected. A recently published report of a working group of the International Agency for Research on Cancer (IARC) of the WHO concluded that-randomised clinical trials have found that H pylori treatment is effective in preventing gastric cancer, and models indicate that H pylori screening and treatment strategies would be cost-effective. Will MOH raise the awareness on this finding and look into the feasibility of population based screening and prevention of stomach cancer? Adult Vaccinations”
“If diabetes and hypertension are detected earlier, there will be lesser morbidity and disability amongst the seniors. All senior care centers can be tasked to assist detecting and maintaining good control for these two chronic conditions. Breast cancer remains the most frequent cancer among women in Singapore, and approximately 6% of all women will be diagnosed with invasive disease in their lifetime. The underlying premise for breast cancer screening is that it allows for the detection of breast cancers before they become palpable. Small tumors are more likely to be early stage disease, having better prognosis, and are more successfully treated. May I ask MOH on the percentage of women screened yearly and the percentage in detecting smaller treatable breast cancers? And how to improve its take-up rate? Colorectal cancer is now the commonest cancer in Singapore. The average population risk for developing colorectal cancer in Singapore is among the highest in the world. Most colorectal cancers develop from adenomatous polyps, thus its early detection and removal reduces the risk of colorectal cancer. Pre-malignant period of the adenoma-carcinoma sequence makes it ideal to screen for colorectal cancer and such screening has been proven to save lives. Will Minister consider subsidised colonoscopy screening, as it is more accurate and is also preventive in nature by removing polyps early, compared to present occult blood testing? Cervical cancer is the sixth most common cancer among Singapore women. The human papillomavirus (HPV) is the causative agent of essentially all cervical cancer cases.”
“Mr Chairman, I want to start by commending MOH as well as other Ministries in their efforts in tackling COVID-19 and limiting its spread, that has impressed WHO. Healthcare workers' calling and dedication are at the greatest committal situation presently; knowing that while looking after the sick, there is possibility that they and their family members may also get sick as a result of COVID-19. May I also encourage all our healthcare workers in both the public and private sectors, especially those in the frontline, to keep up their good work and keep their spirits high. May I also thank all other frontline workers that help us in limiting the transmission of COVID-19. I hope MOH will spare no effort in sharpening its future preparedness by enhancing this episode’s good practices and registering and correcting its shortfall. There may be areas that need attention, such as being self sufficient with locally manufactured preventive and protective items, for example masks, and enhancing our health scientist sector capability to fight viruses. Adherence to a healthy lifestyle is associated with a lower risk of mortality. It reduces the risk of chronic diseases such as type-2 diabetes, hypertension, hyperlipidaemia and disability. May I ask MOH if there are new initiatives to assist more Singaporeans to achieve healthy living? Diabetes and hypertension can cause heart disease, renal failure and so on. Compliance on diet and medication are key factors on the outcome on war on diabetes. Can MOH promote and motivate more healthcare providers and patients themselves to achieve it? A local study found that the proportion of older adults with three or more chronic diseases nearly doubled from 2009 to 2017.”
“But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes. The Agency for Integrated Care (AIC) of MOH has in place such a program that presently looks after about 500 frail seniors living alone at HDB rental flats in the Chin Swee and Kreta Ayer precincts. It is an excellent scheme that should be extended to other constituencies. AIC has a team of two nurses and eight healthcare aides, who attend to the seniors; supervising their medical conditions and daily living essentials. This team also arranges for the grassroots volunteers and various voluntary care groups on assisting the social needs of these seniors in a coordinated effort. This has enabled residents to have lesser frequency of hospital visits and has enabled them to stay in their own homes despite their illnesses and immobility. Supporting Seniors Age in Place and Grace”
“Sir, may I ask MOH what further plans are in place to enhance the care of our seniors? Many seniors express the desire to age in place for as long as possible. What are the measures provided to facilitate them to achieve this aim? It is a known fact that keeping seniors socially, physically and mentally active early on when they are mobile will assist them to have healthier and happier lives as they age. This will enable them to lead independent lives, ageing in place in their own homes and in the community for as long as possible. Will MOH implement a baseline service model for all our eldercare centres to have programmes that will help achieve the above targets? 2.00 pm Preventive healthcare, such as preventing premature mobility difficulty or disability, will enable our seniors to live independent lives for as long as possible. Thus, the aim is to limit and delay the onset of disabilities in old age which more often than not are due to diseases. The most common causes of disability among older adults are chronic diseases, injuries, mental impairment and visual impairment. Early detection and having good control on chronic diseases can prevent disabilities such as strokes and heart diseases. Physical activities and keeping active can make our seniors stronger and lower their chances of falling, reduce their fracture rates and prevent injuries. Regular eye checks to diagnose cataracts and other visual impairments for early treatment can also prevent disability in seniors. Our eldercare centres can support our seniors in this area by paying attention to their health, by checking their hypertension, monitoring their diabetes, arranging yearly eyes check and when necessary, referring them for medical help. As seniors live till ripe old age, frailty may inevitably set in.”
“I believe the Government should aim higher now and make mental wellness clinics available to Singaporeans in all 18 polyclinics. The other issue is the availability of psychiatrists and psychologists, especially in the public health sector, as the 2016 study noted the low rate per 100,000 residents here compared to higher income countries. Are there plans to improve on this front? On accessibility, five of the seven wellness clinics in the polyclinics only see referred patients and the two Community Wellness Clinics run by IMH allow for consultation by appointments. Persons suffering from mental disorders are already finding it hard to come forward for treatment due to social stigma, thus we need to make the clinics as accessible as possible. Would the Ministry make all mental wellness clinics at polyclinic open to consultation by appointment? Lastly, on affordability, patients can withdraw from MediSave up to $500 a year for outpatient mental health treatments, but estimates for subsidised treatments ranged from $220 to $380 a month. I believe there is a need for the limit to be raised to at least $1,000 a year to make mental health treatments more affordable.”
“00 pm A majority of those with mental disorders do live at home. Even those with major disorders are usually not hospitalised. It is always a drain on the care-givers to look after those afflicted family members, especially those with major disorders. May I ask whether there is any scheme to better support such care-givers? Mental Health Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Chairman, Sir, the 2016 Singapore Mental Health Study found that one in seven Singaporeans have experienced a mental disorder in their lifetime. Depression is the most common disorder, with around 6.3% of adults suffering from major depressive disorder at some point in their lives. The good news is that people are now more aware and more willing to seek treatment. Thus, the years of delay in seeking treatment for major depressive disorders have dropped from four in the 2010 study to one in the 2016 study. The Government's efforts to ramp up mental wellness promotion are starting to bear fruit. Indeed, the increased prevalence rates in the 2016 study could be attributed to greater awareness and willingness to seek treatment. But this also means that we are really only catching up to the true extent of mental health disorder and there are a lot more Singaporeans who remain undiagnosed. Sir, the Government and many community initiatives have been doing well in generating awareness about mental well-being. I want to focus instead on three other As – availability, accessibility and affordability. On availability, MOH announced in Budget 2017 that one in two polyclinics will have a mental wellness clinic, or a dementia clinic, or both, by 2021. There were already such clinics in seven of the 18 polyclinics in 2017.”
“Sir, WHO once reported that depression was poised to become the second largest cause of disability worldwide after heart disease by 2020. According to the Singapore Mental Health Study conducted in 2010, 5.8% of our adult population in Singapore suffered from Major Depressive Disorder some time in life. There is a stigma attached to mental conditions that stops people acknowledging them and seeking medical help. It is important to note these afflicted persons need medical care and treatment that can relieve them from their predicaments and bring them back to normality and happiness. May I ask MOH what plans are available in detecting and treating mental illnesses and especially for depressive disorders? As good community mental health provision will enable us to have better outreach to those afflicted, may I ask how MOH is ensuring this adequacy? Raising awareness and educating more people about depression, especially on the symptoms of depression, such as suicidal thought, sleep disorder, feeling of hopelessness and loss of interest in daily activities, will prompt family members or friends to intervene earlier. Seniors especially those living alone or those with no family support are more prone to having depression. May I ask MOH whether there can be a targeted approach to reach out to these vulnerable seniors. Depression occurs in the young too. Last year, IMH said that stress-related anxiety and depressive disorders are common conditions seen at its Child Guidance Clinics which treat children aged six to 18. Our youths have long precious journeys in their lives. May I ask MOH whether there can be a holistic support for youths-at-risk to detect, to prevent and to provide early medical assistance, when necessary, to ensure their mental well-being? 1.”
“Thank you, Mr Chairman. Earlier in my speech, I asked whether there are assessments by HDB for applicants of Joint Singles Scheme (JSS) to ensure that they are free from mental illnesses and medical conditions before compelling them to stay together. May I ask Minister Wong whether he will look into the JSS for those who have no family members to share with. Because I also noticed that HDB always gives applicants a list of names for them to call themselves to choose their own tenants to share with. And that is really very difficult. So, as Minister Wong earlier said, we have been improving our HDB policies to facilitate Singaporeans in their housing needs. JSS has been around for the last 30 years. So, why can we not tweak this to facilitate just the most vulnerable group in our society? Would he consider?”
“Many of them have lived in rental housing for more than six years and some more than 10 years. Thus, there are signs of entrenchment. What are the schemes in place and the success rate of such schemes, to assist them in looking for better options in their housing needs and to help them get out of their predicaments? Overcrowding – Public Rental Flat Scheme”
“In order to ensure prudent use of our limited land and fiscal resources, MND enforces the rule of the Joint Singles Scheme (JSS). But conflict between co-tenants is a problem more than reported. Many suffer in silence. It is difficult for complete strangers compelled to stay together. Many live miserably with frequent quarrels and even fights. The Community Mediation does not work for them for many reasons. These affect the well-being of many co-tenants, also cause depression in some and others resorting to become rough sleepers. Does MND screen potential tenants to be free from mental illnesses or medical conditions before putting them together? If not, can there be such assessments for all potential tenants put in place? Can HDB offer more partitioned rental flats under JSS to provide more privacy? Can HDB provide newer models of HDB rental flats with better use of space and cost as well as giving privacy to tenants? Those that seek rental flats are usually the disadvantaged and more vulnerable members of our society that our Government can assist with more of their housing needs. I want to urge our Government to review JSS, which had been in existent for the last 30 years. Singapore has progressed in the last 30 years and it is time for Singapore to be more gracious towards the most disadvantaged group in our society, in providing them the basic need of roofs over their heads. It is time to tweak this policy for humane reasons. Will MND allow flexibility for rental flats tenants to opt for single tenancy, especially for those with no family members to share with, while also giving tenants the flexibility to share with co-tenants for companionship and mutual support if they so choose. There are many needy families with children living in HDB rental flats.”
“Mr Speaker, I would like to pose two questions to the Minister for Health. First: what would his comments be for those employees who seek certification on being free from the novel coronavirus in order to go back to work? Second: is there a shortage of ambulance services right now because, lately, GPs have had to wait many hours for such services for emergency and novel coronavirus suspected cases?”
“The Ageing Gracefully at Home programme at Chin Swee, supported by AIC, is a good home care programme. This home care provides the seniors living alone in HDB rental flats with medical, social and daily needs, nursing care, mental wellness and so on. I hope MOH will continue to support this programme and to expand it to other constituencies. This home care programme emphasises on prevention of further deterioration of medical conditions or frequent visits to hospitals. We also need to expand other home care programmes for complex long-term care needs in the community. I hope the Minister can look into the requirement and supply of personnel for such home care as soon as possible to expand this sector. This will facilitate many Singaporeans to age gracefully with their loved ones in the comfort of their own homes.”
“The reason is that many Singaporeans do not know the various schemes available or how to apply for them. This is especially useful and convenient for those low-income patients who are already applying for MediFund to pay for their hospital bills. They have already given all the eligibility information to hospitals for MediFund assistance. Will the Minister make it easier for relevant Ministries to share information, so that claimants do not need to submit the same documents multiple times for various subsidies? Many seniors with three ADLs living in the community will also benefit from the one-stop assistance channel for referrals to various Ministries to claim insurance or to apply for subsidies. Will the Minister assist in identifying and facilitating this group of Singaporeans? Sir, many Singaporeans shared that they would prefer to live at home with their families as they grow old. Home care is an important component of Long-Term Care services. It is a good alternative to institutional care setting for many reasons. But our home care in Singapore is presently inadequate. This is worrying, with our fast-ageing population and the fast increasing need for home care. May I ask the Minister how he plans to expand and better equip on the availability of home care? May I request the Minister to prioritise home care for seniors, especially those living alone in Housing and Development Board (HDB) rental flats? The number of Singaporeans aged 65 and above living alone, or with their spouse but without children, has grown by more than 50% from 2010 to 2015 or from 94,000 to 148,400. This number may increase in future. Could the Minister expand home care quickly with the tenets of prevention of further deterioration of physical frailty and mental disorder, such as depression?”
“Can the criteria be made less stringent, for example, with two ADLs instead of three ADLs to qualify? Two, the "three ADLs" criterion for CareShield Life eligibility claim is challenging. While I agree that there will be a lot more claimants with two ADLs instead of three ADLs, thus resulting in higher premiums, my contention is that many, if not all, afflicted with two ADLs cannot continue to work as before. They would need to depend on personal savings or family members. Thus, better awareness on long-term care financing and long-term care insurance should be raised so that people can better plan ahead for possible eventualities. Three, claimants of CareShield Life payouts must go through the stringent assessment by stipulated assessors. May I know how many of such assessors are available presently and how many more will be required going forward? May I ask how often are claimants required to go through assessments to enjoy confirmed payouts? Will the Minister exempt those newly discharged from hospitals from assessment by stipulated assessors once specified by their own public hospital doctors to be having three ADLs? Can public doctors looking after their own patients endorse the three ADLs, since they know their patients well? This will greatly convenience the claimants. Will the Minister consider setting up a one-stop assistance channel or centre for mobility-afflicted Singaporeans to tap on the various available schemes? For example, patients on discharge from hospitals can be assisted to claim for Home Caregiving Grant, MediSave withdrawal, Elderfund, Pioneer Generation Disability Scheme, Senior Mobility Fund, Interim Disability Assistance Programme for the Elderly (IDAPE) and so on?”
“While I can understand that higher payouts will require higher premiums, the purpose of insurance is to give peace of mind on future unforeseen needs. In view of its inadequacy, there is a need to depend on personal savings or family help should the need arise. For better piece of mind and coverage, individuals can take up extra insurance for higher payouts with private insurers. May I ask the Minister whether the Government can administer these "riders" for those who want better payouts, rather than depending on profit-orientated private insurers? On MediSave withdrawals for Long-Term Care of $200 per month for the severely disabled who are above 30 years old and subject to a minimum MediSave balance of $5,000, can they tap on their children’s or siblings’ MediSave once their own MediSave has been exhausted? New assistance scheme from 2020 will provide lower-income Singaporeans who are severely disabled and need additional support for Long-Term Care costs of up to $250 per month. May I ask the Minister what is the income eligibility for this assistance scheme? May I also ask whether they are still eligible for this assistance if they are tapping on their MediSave accounts or on their Home Caregiving Grant of $200 per month in lieu of Foreign Domestic Worker (FDW) Grant? For Pioneers, can they also receive this assistance on top of the $100 per month PG Disability Assistance Scheme and the use of MediSave of $200 per month? May I ask the Minister whether the Home Caregiving Grant of $200 can be made less onerous in its criteria of disbursement, such that the assessment requirement can be done by applicants’ own doctors, instead of stipulated stringent assessors, for convenience and easier access?”
“Mr Speaker, Sir, I stand in support of the CareShield Life and Long-Term Care Bill. This Bill is timely because one in two healthy Singaporeans aged 65 today could become severely disabled later in their lifetime, family units are becoming smaller, life expectancy is increasing and the population is rapidly ageing. I view the CareShield Life and Long-Term Care Bill as the finishing piece of an encompassing "medical safety net" that includes the Community Health Assist Scheme (CHAS), MediShield Life and MediFund. This Bill has its good points but also some minus points in several areas which I shall elaborate. I shall start with this Bill’s plus points. One, the lifetime payout is welcome as severely disabled individuals require lifelong assistance with their daily living. Two, the setting up of the Long-Term Care Support Fund which sets aside monies for premium subsidies and incentives, capital injection and other public schemes that provide support for disabled persons. This fund will ensure that the CareShield Life premiums will be affordable for the majority. May I ask the Minister if there are any postulation calculations done on the amount required for subsidies and long-term care support and how long will the $5.1 billion last to serve its intended purpose? Three, those eligible severely handicapped presently will receive CareShield Life payouts immediately for life after paying their first premium. It is rightly so that we can show benevolence to this group of Singaporeans with this immediate payout. I consider the following as minus points for this Bill. One, the monthly payout of $600 is inadequate for severely handicapped individuals in long-term care basic costs.”
“May I ask the Minister whether there is any concern on the hazardous contaminants to health in the water supply from Johor? How vigorously do we check on the quality of the water from Johor? And lastly, does Singapore have any say on the factories' waste discharge in Johor that ends up in the reservoirs supplying water to Singapore?”
“Mr Speaker, may I ask the Senior Parliamentary Secretary how big is the problem of drug-resistant TB in Singapore? Have we done any studies on that? And is MOH using any new drug cocktail to overcome this problem?”
“Mr Speaker, I would like to seek a clarification from the Minister on the two cases of Dr Lim Lian Arn's and Dr Soo Shuenn Chiang's fines. May I ask the Minister whether he concurs that the fines meted out to these two doctors were not really commensurate with the offences? Therefore, going forward, how do you rectify this problem?”
“Mr Chairman, two clarifications, please. May I ask whether there is sufficient aged care capacity to support our ageing population? Secondly, what is HPB doing to make healthier food options more affordable?”
“Labelling of the sugar and calorie contents should be made widely available in the food on sale here, even at our hawker centres. Such information will not only remind people to keep healthy but also give consumers an informed choice, to better plan their sugar and calorie intake for the day. 3.30 pm I favour to go for "half of your sugar intake or no sugar intake" campaign. Other measures should include sugar taxation and to reduce the sugar content in beverages. In our schools, we can go further in helping our children by reducing their palate for sweetness, by not selling beverages and other sugar-added food in school canteens. We should facilitate our young to achieve a reduced palate for sweetness when they are in schools, so as to achieve better health when they grow up. Outreach to Malay and Indian Communities”
“May I ask MOH on the details of subsidy for the expanded CHAS scheme for chronic diseases for all CHAS cardholders? May I also ask MOH how it plans to ensure that the intent of preventive healthcare with regard to chronic diseases can be achieved with the expanded CHAS? It will be a pity if we have such a good CHAS scheme but people do not make full use of it. This may be due to either insufficient information about the scheme or the patients are not bothered to go for early and continuous treatment of chronic diseases, due to a lack of knowledge of chronic diseases and their side effects. I urge MOH to raise awareness and campaign on the importance of early diagnosis and treatment of chronic diseases. Could MOH provide an update on the war on diabetes, the Healthy SG task force and HPB’s progress on healthy lifestyle promotion? Promotion of mental well-being is an integral part of preventive healthcare. Presently, MOH's psychiatric and mental healthcare is insufficient, especially in the community setting. Could MOH expand and provide more resources in this area? There is a saying "We are what we eat". Singaporeans' sugar intake increased from 59 grammes (gm) a day in 2010 to 60 gm last year. The World Health Organization (WHO) recommends a daily sugar intake of 25 gm ideally. However, Singaporeans are already taking more than twice that. Sugar provides calories with no added nutrients. Excessive sugar intake may result in excessive weight, diabetes, heart diseases, fatty liver and so on. Could MOH strategise more effectively to nudge Singaporeans to reduce their sugar intake? MOH will need to adopt a range of measures, including better information and a national campaign to facilitate better-informed choices.”
“Sir, I have been an advocate on preventive healthcare all these years and I have spoken many times before in this House on this topic. Thus, I agree with the Minister for Finance wholeheartedly when he said, "The best way of protecting ourselves is to lead a healthy lifestyle and take preventive actions". This is the best approach as it will result in quality of life and a happier populace. Preventive healthcare means adopting healthy lifestyles to stay healthy and to prevent diseases, especially chronic diseases. It also means detecting and treating chronic diseases early and consistently. The purpose is to prevent severe ill health and disability as a result of chronic diseases like diabetes, hypertension and hyperlipidaemia. Untreated, chronic diseases can lead to heart diseases, stroke, renal failure, foot amputation, blindness and so on. We cannot carry on with just the traditional approach of healthcare systems on diagnosing and treating diseases alone, because this will lead to increasing demand on healthcare services, which can be daunting in an ageing population. Preventive healthcare has to be expanded quickly and urgently, as the success of which will allow people to live healthily and happily, and will cushion the demand for increasing healthcare services. I am glad that the Minister for Finance has announced that CHAS is now expanded to subsidise all Singaporeans in seeking treatment for chronic diseases at private clinics. This will encourage more people to seek treatment early for chronic diseases. Subsidising the treatment for chronic diseases is a good way to prevent the complications of such diseases, will reduce ill health and lessen the demand for acute care.”
“Many caregivers are family members who also hold employment. Could our Government facilitate flexible work arrangements (FWAs) for caregivers? Would our Government also consider paid "Care Leave" for caregivers? It can be two weeks per year, for a start, similar to "Parental Leave" for fathers. Caregivers can suffer "burnout syndrome" from emotional and physical fatigue. Could we have more respite care centres that are accessible and affordable? Could there be a one-stop centre for information and respite care referrals for caregivers? Many caregivers also get domestic helpers to assist them with their caregiving roles. However, many foreign domestic helpers are ill-equipped to take up this role. Could we improve the know-how and enforce this area of domestic employment requirement? The number of seniors who will live alone will double to about to 92,000 by 2030. Could we provide more housing adaptability to accommodate seniors' mobility to facilitate independent living, as well as having a seniors-friendly environment in the vicinity, such as food centres, health facility and wellness centres? Examples of housing adaptability are doors for motorised mobility aids, appropriate-height kitchen tabletops, hoisting aids to get out of bed, emergency call points and so on. Technology adaptability, such as smart home aids for seniors, fall sensors, emergency medical detection sensors, can enhance quality of life.”
“We should also encourage the community to come together to make this work. Every few HDB blocks should have at least one SAC to promote the physical, mental and social wellness of the mobile seniors and to facilitate them to remain active and healthy in the community. For frail seniors, the Ageing Gracefully @ Home (AGH) programme carried out by full-time shared caregivers that include nurses should be expanded, especially at HDB rental blocks. Under AGH, home visits are provided for these frail seniors with the following services: daily supervision on meals, blood pressure checks, medicine intake, home cleaning services, bathing, identifying people who are sick, medical assistance, hospital transportation and so on. VWOs can be roped in to provide the assistance to the seniors to fill the gaps. We need to expand homecare expeditiously to allow seniors with medical conditions to remain in their own homes and in the community. This is especially useful after discharge from hospitals. Homecare in Singapore is at its infancy. Under homecare, MOH can facilitate services, such as medical caregiving, nursing, medication, nutrition, occupational and rehabilitation therapy. Physiotherapy at home is especially crucial to allow earlier regaining of mobility from reversible medical conditions, such as mild strokes and surgeries. At discharge from hospitals, patients can be dispensed with mobility aids to facilitate independent living at home. Homecare aides can be recruited and trained to provide specific job scopes. Transitional Care Programme by acute hospitals to help caregivers look after their loved ones at home enhances homecare and should be expanded. Seniors with ADL deficiency need caregivers for their daily living. Caregivers can assist seniors live with dignity.”
“MOH estimates that one in two healthy Singaporeans aged 65 could become severely disabled in their lifetime and may need long-term care. About 7% of the population or about 83,000 individuals in 2030 will have deficit in one or more ADLs. This is about two-and-a-half times that today. May I ask MOH whether there is any postulation on the healthcare services required to meet the needs of an ageing population, especially the disabled seniors requiring long-term care? Are we building enough infrastructure, such as acute hospitals, community hospitals, nursing homes, dementia-care, palliative-care and respite homes and so on? Can we also provide more daycare centres, dementia, rehabilitation and respite daycare centres, and senior activity centres (SACs)? Are we training enough medical personnel to cushion the impending explosion on the need for healthcare providers? Last year, the social aged care functions, under the Senior Cluster Network, was transferred from MSF to MOH. What are MOH's plans to better support an ageing population with its expanded functions? One important form of preventive healthcare is allowing seniors to remain active and independent within the community and living in their own homes. This is because being active and independent in the community will facilitate the physical, mental and social well-being of seniors. As what the Finance Minister said, "The best way of protecting ourselves is to lead a healthy lifestyle". What is MOH doing to support seniors who wish to remain independent in the community? Many seniors have expressed that they prefer to live for as long as possible in their own homes, in the familiar environment and in the community with families and friends. We should have policies to enable this.”
“May I ask the Minister whether he knows the numbers of vulnerable families in the community? The Minister mentioned earlier that he wanted to give more help to these families. May I ask whether MSF has enough capacity to reach out to them, and how many is MSF going to help in these families, and whether we have any target on the outcome benchmark for these families?”
“The Early Childhood Industry Transformation Map (ITM) was launched last year by MSF. What initiatives will MSF implement under the ITM to improve the productivity and working environments of operators and early childhood professionals? Free Childcare for Low-income Parents”
“Brain development is highest during the first four years of life. The brain is forming important neural paths to help develop the child's ability to perform and function and learn well. One United States study showed that the quality of children’s early childhood experiences affects how well they learn; and the early years set the stage for the rest of their lives. Singaporeans have to adapt in this globalised and fast-changing world to stay ahead. Our Government emphasises the importance of entrepreneurial spirit, a resilient workforce and lifelong learning to succeed as a country. Our preschool is a good place to start to equip our next generation for this reality. Can we ensure that we develop our young's curiosity and avoid rote learning in our school education? In the preschool curricula, can we emphasise on unlocking creativity, inspiring curiosity, building character and igniting a true love for learning? The aim is to meet today’s realities with tomorrow's possibilities. Could our Government facilitate more co-working places with childcare facilities to help young parents balance their working and caregiving roles? This is especially helpful for parents with infants and toddlers. Can the Government ensure that early education is accessible and affordable to all children and especially children from disadvantaged background? The Government provides generous subsidies for early childhood services, but the application process can be difficult to navigate. How can MSF smoothen the subsidy application process and make it simpler? MSF mentioned better integration of social services and holistic support for residents. What does it mean for residents? How will MSF ensure that children with developmental needs can receive the support they require?”
“Mr Chairman, I would like to have two supplementary questions, one for Minister Indranee Rajah, the other for Minister Desmond Lee. For Minister Indranee Rajah, earlier on she mentioned on the expansion of after-school care. Can I ask the Minister how many community or grassroots-initiated after-school care centres there are in the community, and whether she could support or even take over CATCH Plus? CATCH Plus stands for Children and Teens Community Hub started since 2014 at Kreta Ayer precincts, that is, at the Jalan Kukoh rental blocks. It is a holistic care programme for the disadvantaged children there, with a membership of 100 right now. So, could MOE help with that one and maybe take over the CATCH Plus Centre? That is my first question. For Minister Desmond Lee, on ComLink, may I ask what kind of outreach will there be, because that is most important as the core success for this project? Will there will be enough social workers that can have a handholding approach to all these disadvantaged families with multifaceted problems, and also if we can have a long-term basis approach for the children of such families?”
“Thus, we should assist in childcare, kindergarten, after-school care placement for them, as well as individual handholding approach and follow-up for those with more educational needs. Many of these children, especially the youths, may be at risk of falling into bad company. How can MSF intervene early and better support these children and youths so that they can seize opportunities and achieve success? Improvement of delivering assistance to those in need is core to helping this group. Unless we have this good outreach, the intention and whatever good schemes there are, will be wasted. We need to identify and reach out to those in need, even if it means incurring expenses in manpower to do so. We can tap this information of those in need from data with SSOs, grassroots and VWO referrals, house-to-house visits and so on. There are many schemes available to help those in need, but they are mostly incomprehensible and untapped by this group. In order to reap the desired outcome, MSF can coordinate and facilitate those in need to apply and to tap from the various schemes at a "one-stop service centre". This will ensure that such families will not fall through the cracks. This would, in turn, contribute to our goal of pursuing a sustainable approach in helping lower-income Singaporeans becoming more upwardly mobile. What are MSF’s plans to support Singaporeans from the low-income groups, to help individuals and families improve their circumstances? MSF had earlier announced the plan to set up social service hubs in and around rental precincts. How will this initiative better support families living in rental flats and how can the community play a part?”
“Sir, I want to continue the conversation on the topic of inequality and poverty in our society. One of the best ways to mitigate this issue is giving more support to Singaporeans facing challenges. An integrated case management approach focused on development of the human capital, which I suggested in 2008 in this House, is even more relevant today. Prime Minister Lee said that Singapore must not allow social stratification to harden. As my Parliamentary colleague Mr Seah Kian Peng said, "I wish to repeat my call for a comprehensive assistance package for low-income families, focused on human capital investment." The package includes employment-upgrading opportunities for parents, new employment opportunities for unemployed spouses and continued assistance and handholding for these parents. Helping needy families with jobs, upgrading them and encouraging them to stay in employment will assist them to support their family members, especially their children, better. 6.45 pm We need to address holistically the many complex and intertwining problems that many such families face. These are: financial difficulty, balancing low-paying jobs with family responsibilities, childcare facilities, housing and healthcare needs and so on. These problems are compounded in single-parent or foreign spouse households. We have to tweak our policies to favour Singaporean children, regardless of the residency status of their parents. One example is to allow foreign mothers to place their Singaporean children at childcare with full subsidies and to allow these foreign mothers to find employment. Children from such families face a greater challenge participating in the education process.”
“The majority of people aspire to continue to live in their own homes as they age. Housing adaptability to accommodate seniors’ mobility as they progress in years, as well as having a senior-friendly environment in the vicinity, will enable them to live their normal lives for as long as possible without having to rely on others. Examples of housing adaptability are the installation of ramps and grab-bars, having space and doors for motorised mobility aids, non-slip bathrooms, appropriate-height kitchen tabletops, hoisting aids to get out of beds, emergency call points and so on. Technology adaptability, such as smart home aids for seniors, fall sensors, emergency medical detection sensors and so on, should be used to enhance their quality of life. A friendly environment in the vicinity of seniors’ homes should have food centres, health facilities and wellness centres with barrier-free access to these places. Every few blocks should have at least one Senior Activity Centre to promote physical, mental and social wellness of the seniors. I urge our Government to build new homes at the outset of public housing construction to be “future-proofed” for the consideration of independent living for seniors. Mr Speaker, Sir, as we strive to be an inclusive nation, let us endeavor to ensure that our seniors, after contributing in their younger days, will age with dignity in their retiring years, as valued members of our society.”
“Will our Government consider requiring employers to grant paid "Care Leave" to their staff who are caregivers? By so doing, the Government will send the right message, in an ageing population, on the importance of empathy for the caring roles of caregivers. Such paid "Care Leave" can be two weeks, for a start, similar to "Parental Leave". FWAs should be encouraged and incentivised in our workforce. Government Ministries should take the lead to implement it. This will improve caregivers' employability, with less frequent absenteeism and lack of concentration at work. Caregivers can suffer burnout syndrome from emotional and physical fatigue. Respite care can be further made more readily available for caregivers to better perform their roles. Social Service Offices (SSOs) should be the one-stop centre for information and respite care referrals for caregivers. AIC can station their staff at the SSOs to provide this role. The pricing for respite care services can be daunting for those without subsidy. Prices can range from $100 to $125 per day. A family with an average income of $5,000 may have to fork out almost $1,000 for one-week respite care. Many caregivers are interested to take up courses to better equip themselves for their roles. Many caregivers also get domestic helpers to assist them with their caregiving roles. But the Caregivers Training Grant annual subsidy is only $200 for each care recipient. If multiple caregivers of the same care recipient wish to attend the training, the $200 would need to be shared amongst them. Most home training courses cost $200 for the basic two-hour training. I hope MOH can make caregiving training more accessible and affordable. Lastly, independent living for seniors.”
“AIC is now supporting this programme. I hope the Government can look into similar models to benefit more seniors in other precincts. I also hope that the caregiver support grant which I proposed earlier can be extended to the community caregivers, such as AGH, to look after seniors with needs better. Sir, I have spoken many times in this House to develop our homecare as an integral part of healthcare in an ageing population. The purpose of homecare is to enable seniors with medical conditions to remain in their own homes. This is especially useful after their discharge from hospitals. Homecare in Singapore is at its infancy. Under homecare, MOH can facilitate services, such as medical caregiving, nursing, medication, nutrition, occupational therapy, rehabilitation therapy and other domiciliary services in seniors’ homes. May I request MOH to dispense mobility aids, such as wheelchairs, walking aids, joint braces and so on, tailored to the needs of patients and using SMF, before sending seniors home at hospital discharge? This is a better step-down care approach, which will improve outcome of residents coping at home. Many family members, usually caregivers themselves, have told me that they were apprehensive and concerned that they would not be able to cope with their family members who are just discharged from hospitals. To better equip caregivers, it is thus good practice to ensure family members get the information and support they need at this early stage, before discharging patients to their own homes, and to hold caregivers’ hands in managing their care recipients at their own homes subsequently. Three, better support for the caregivers. Many employed caregivers have expressed difficulty balancing between holding demanding jobs with their caregiving roles.”
“Many seniors have expressed that they prefer to live for as long as possible in their own homes, in the familiar environment and in the community with old friends. Many do value the joy of living with their family members. We should have policies to enable this. We should also encourage the community to come together to make this work. Kreta Ayer-Kim Seng constituency has such a grounds-up grassroots and community initiative. It is called Ageing Gracefully at Home (AGH). This was set up in 2014 in the Chin Swee Housing and Development Board (HDB) rental blocks and now also extended to the Kreta Ayer HDB rental blocks. AGH is a holistic care programme carried out by half a dozen full-time caregivers who include nurses for the frail seniors with mobility disability living alone at the rental blocks. These disabled seniors do not have family caregivers and cannot afford domestic helpers. Under AGH, home visits are provided for these frail seniors with the following services: daily supervision on meals, blood pressure checks, medicine intake, home cleaning services, bathing, identifying people who are sick, medical assistance, hospital transportation and so on. Able-bodied residents of the blocks are remunerated in kind to provide befriending services to those disabled residents. VWOs are roped in to provide the assistance to the seniors to fill the gaps. Presently, AGH is looking after about 500 dependent care recipients in these two precincts with 1,155 rental flats. Since its inception, I noticed that more seniors could remain in their own rental homes. There were lesser fatalities in these homes with lesser admissions to hospitals. More importantly, residents are happier living and ageing gracefully in their own homes with AGH-assisted programmes.”
“They contribute much to their family members, friends and community. Their deeds are commendable and they need to be better acknowledged and supported with better Government policies in place. I would like to suggest the following to better enable our dependent seniors to have dignified living, as well as facilitating caregivers to assist seniors to achieve this. One, financial assistance. To give financial support for dependent seniors will help them cope with daily living and lessen the burdens of their caregivers. Financial support is an important and integral part of help to achieve the desired outcome. I favour the monthly remuneration to these eligible care recipients. This amount should be commensurate with the amount required to pay for a full-time domestic helper to assist with daily activities for dependent seniors. Presently, the Interim Disability Assistance Programme for the Elderly's (IDAPE’s) eligibility is stringent with three ADL deficits requirement and the amount of about $150 to $250 per month on a means-test basis is insufficient. ElderShield's criteria are just as stringent, with three ADL deficits before being eligible. The amount claimable of $300 to $400 for limited years is not sufficient for long-term care, as disability and frailty of seniors are usually not reversible. Many seniors are also not on ElderShield and the new CareShield's premiums are out of reach for most seniors. I, therefore, urge our Government to better provide our seniors with a better financing grant. I hope the existing grants will not be removed even with any new grants. Two, facilitating seniors to age in place in the community.”
“Hopefully, with preventive healthcare approaches as above, we can keep seniors as healthy and happy and reducing disability for as long as possible. But inevitably, many, if not all, seniors will become frail, especially towards the end of their lives. Hopefully, the frailty stages can be minimised. In 2010, there were about 31,000 individuals who needed help with one or more Activities of Daily Living (ADLs). These ADLs are dressing, eating, toileting, transferring and continence. About 7% of the population or about 83,000 individuals in 2030 will have deficits in one or more ADLs. This is about two-and-a-half times today. Today, I want to focus my speech on seniors who require assistance in their daily living due to frailty or disability. They need special attention and assistance. These seniors need caregivers to enable them to live with dignity. With Singapore’s demographic profile, especially going forward, many people are required to provide these caring roles for dependent seniors. The report on the survey of Informal Caregiving in Singapore showed that in 2010, 8.1% of Singapore residents aged between 18 and 69 indicated that they provided regular care or assistance to friends or family members. Some 37% of caregivers reported that they had been providing care to their care recipients for over a decade. According to this survey, close to three-quarters of caregivers, or 74%, were in employment. Surveys in other countries had shown that many caregivers face challenges with financing constraints, with juggling between jobs and their caregiving roles and, in some, with having to look after their young children as well. Many also face physical and mental fatigue. Caregivers are valued members of any society.”
“Mr Speaker, Sir, I stand to speak in support for both Motions raised by Mr Henry Kwek and Dr Chia Shi-Lu. Sir, in my maiden speech in Parliament in 1997, I spoke on my foremost concern and that was the topic on the best ways forward to cope and plan for the seniors in an ageing population. I spoke on the need to plan in advance and better prepare in the provision of healthcare and social needs. Today, 22 years later, this topic is still relevant, with increasing pertinence. And I am glad that many Members of this House are speaking up on this area and in support of it. I have been an advocate on the promotion of quality life for seniors all these years as the main basis of the best way forward for successful ageing in our population. The aim is for seniors to live healthily and happily with good physical, mental and social well-being, for as long as possible, with the promotion of healthy lifestyles. This is the reason for the four Senior Activity Centres (SACs) in Kreta Ayer-Kim Seng Constituency for the last 20 years. The other aim is delaying and limiting the disabilities in the seniors, by preventing diseases and detecting diseases early and treating them early, to prevent complications of diseases. Our Government had acknowledged the importance of healthy living for a happy populace, through the promotion of healthy lifestyles, to be adopted by seniors. Thus, the island-wide community Active Ageing, under the People's Association's (PA's) Wellness Programme for seniors, is now adopted by almost all Residents' Committees (RCs). In the area of preventing disabilities, the Ministry of Health (MOH) had also emphasised on the prevention of chronic diseases, an example of which is the recent campaign on the "War on Diabetes".”
“Mr Speaker, Sir, I would like to declare that I am a medical practitioner. May I seek clarification from the Minister for Health on the implementation of the recommendations he mentioned earlier. Will MOH also assist private practitioners in coping with this cyberattack, especially those who are already embarking on NEHR? My concern is that cyberattacks on NEHR in the private sector may be linked to the public sector's. So, if there is a soft part in this area, will that affect the whole public sector in the end? I would also like to echo Dr Chia Shi-Lu's question earlier whether the Minister will ensure that the NEHR is robust before it is widely implemented, to give confidence to patients and doctors.”
“Mr Speaker, may I ask the Senior Minister of State how are deductibles derived at, and how do we make them more affordable? I am glad to hear that SNEC will look into the high cost of the eye duct operations. May I now ask whether MOH would also look at other departments, especially those with high charges on the conditions that require operations, in order to keep healthcare costs down? And how does MOH reassure Singaporeans that public healthcare costs, including the deductibles, are affordable to give them peace of mind?”
“Mr Deputy Speaker, I would like to declare that I am the grassroots adviser in charge of Chinatown festivals. May I ask the Minister whether it is correct to say that the tenders for the Chinatown festivals had been properly procured at every festival for the last 16 years, and they were all itemised tenders? May I also ask the Minister whether it is correct to say that the Chinatown festivals had always been self-funded and self-sufficient and only depending on public money, as mentioned earlier, or PA's funding had always been only about 1%-2%, on average, for the last 16 years? I would like to clear that, please.”