Mariam Jaafar
Singapore
“One trusted person who knows their story, who checks in, who believes in them when they do not believe in themselves can make all the difference. As we scale, how do we protect that relational core as numbers grow?”
“I thank Members for the robust debate. I think healthcare is probably one of the most complex Ministries. On behalf of this Health Government Parliamentary Committee, I would like to say thank you to the healthcare family, from everyone at MOH to the frontliners in the hospitals and community. With that, I seek to withdraw my amendment.”
“Every young Malay/Muslim deserves to know: they are seen, they are valued, they are supported – in faith and in life. When our youths are anchored in faith and supported in well-being, our community – and our nation – are stronger. Singapore College of Islamic Studies”
“We must adapt S+3M: financing not only healthcare, but health itself, not by abandoning the principles, but by fulfilling them fully. Shared responsibility must include shared prevention. Personal ownership must empower early action. Equity must recognise cumulative burden. This is not about spending more.”
“Could MOM share the uptake and outcomes so far? And could we expand practical models so seniors can pace themselves while staying engaged? And with the Tripartite Workgroup on senior employment, when can we expect key recommendations and how will success, beyond placements, be tracked?”
“Can we strengthen incentives for FWAs and provide structured coaching at key transition points, so caregivers do not have to choose between career and care. Third, re-entry. Can we create structured return pathways so that stepping up for family does not mean stepping back professionally. Supporting caregivers is not charity.”
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“Singapore launched our National AI Strategy in 2019, which reflects our commitment to being a leader in developing and deploying scalable, impactful AI solutions, in key sectors of high value and relevance to our citizens and businesses along with five National AI Projects and five ecosystem enablers. AI Singapore has partnered with businesses to nurture the development and adoption of AI models in key sectors like healthcare, transportation and finance. It also runs the AI Apprenticeship programme. In this year's COS, Minister Josephine Teo, shared that AI Singapore will double the number of AI Apprentices trained over the next five years from 200 to 400. All this is good progress. But if we are standing at the precipice of an AI revolution, do we need to revisit the ambition, scope and pace of our national AI strategy and our AI policies, to avoid being left behind in the arms race, and to create more value for the world and for ourselves? Today, I want to focus on two potential areas to double down on: one, building an AI and GenAI-ready people; and two, leading the way in promoting better and safer AI and GenAI development and deployment. First, building an AI and GenAI-ready people. This AI revolution will have a massive impact on people and jobs. There are four things we need to do. First, anticipate. Anticipate how jobs will change in a GenAI world. Instead of creating content or code or preparing or processing documents, people will be supervising first drafts by AI while focusing more on strategic thinking, building customer relationships and developing more complex campaigns using AI tools. Some jobs will be eliminated. This is not new – we are used by now to technology disruption.”
“Then, we have the speculative doomsday scenarios, where machines attain human level intelligence or artificial general intelligence (AGI), and take over the world, destroying humanity in the process. Speculative or not, so great is the worry, that the Future Life Institute put out a call for a six-month pause, or moratorium, on training AI models more powerful than OpenAI's GPT-4 model, and some very smart people have signed this proposal. In reality, we are further away from AGI than the recent hype may suggest. As Yann Le Cun of META put it, we humans are very language oriented. "We think when something is fluent, it's also intelligent, but it's not true". And I think that resonates with many of us. I will not go into the merits of the moratorium proposal – others much deeper in this field than me have opined on this, but as a believer in progress through knowledge, the idea seems unfruitful and impractical. For me, the real question is not whether machines can attain human intelligence, or even when that might happen, but rather: how do we, as a country, best prepare for the eventual future and have a voice in influencing how it all develops to protect and advance our interests. The time has come for governments to recognise that we are at a precipice and that they must act to determine the position they want to hold with respect to AI, the impact on their people and the required adaptations and the policies they must make going forward, to ensure the effective and ethical development and deployment of AI and GenAI.”
“Insilico Medicine uses GenAI to identify a novel drug candidate for the treatment of idiopathic pulmonary fibrosis in just 21 days, compared to years in traditional drug discovery. But there are also a lot of risks and worries about GenAI and rightly so. Anyone who has used ChatGPT will know that the model can generate nonsense output. There are also real issues of output that is not factual or bias, due to bias in real world data. Businesses engaging in AI are grappling with the risk of data leaks, copyright infringement and uncontrollable shadow AI in their organisations. Companies and societies worry about socioeconomic displacement, the potential of job losses at an unprecedented scale, including of "knowledge workers" – marketers, lawyers, accountants, architects, developers, engineers, analysts, and, yes, even management consultants. No less worrying is the risk of ever more sophisticated phishing, deepfakes and fraud at the hands of bad people – cybercrime has never been easier! – the potential impact on security and defence, and the very institution of democracy itself. Then, there is the fact that a few companies control a large share of the technology, tech that is now moving from open source to proprietary ownership by companies with a for-profit motive, leading to an AI arms race among companies and countries, for bigger and better algorithms, data, computing power and talent. And what about the environment? If you thought Bitcoin's energy consumption was bad, well, an OpenAI study showed that the energy cost of training an AI algorithm is increasing at an exponential rate, which if it is continues, by 2027, in just four years, the largest model's cost will surpass the gross domestic product of the US.”
“I wish to speak today on one of these things that has become a preoccupation on my mind and that of many business leaders, that is, the rapid advancement of AI, precipitated by the explosion of interest in generative AI (GenAI). GenAI has been developing quietly for some time, gaining attention in recent years with the launch of technologies, like DALL.E, Image Generation, Mind Journey, Stable Diffusion. But it got a massive shot in the arm with the launch of ChatGPT in November 2022, which became the fastest growing app in history, reaching 1.6 billion visits in March. Suddenly, in the words of Andrei Karpathy, one of the founders of OpenAI, "English is the hottest new programming language" and anyone could access ChatGPT to generate the most likely output to any query and take advantage of its key distinguishing feature – the ability to generate new realistic content – text, image or video. In effect, GenAI has democratised AI – and when democratisation happens, revolution is usually swift to follow. Much as the launch of the first Web Browser MOSAIC in 1993 democratised the Internet and triggered the Internet revolution, ChatGPT and other GenAI technologies are triggering the AI revolution and will transform all industries and societies. The possibilities opened up by GenAI are well documented. The hon Member Dr Tan Wu Meng, and others have referenced some of these in their speeches this week. GenAI enables greater productivity and the turbocharging of innovation to solve unsolved problems in business, but also in education, in healthcare and in other areas that are going to help a lot of people.”
“On the announcements, there are a few areas where I would offer a slightly more nuanced view. Take, for example, the idea of supporting workers to take time off to train. The reality is, many companies, especially small- and medium-sized enterprises (SMEs), find it challenging to give "time off" to train and this is exacerbated by the experience that some SME owners have shared with me – that their employees do not seem to bring something useful back to the business after going for training, so, it is almost like sending them on a holiday. This is not good for employees either – the forgetting curve I referred to in my maiden speech tells us that they will quickly forget what they have learnt. Sir, it is really as what Minister Chan Chun Sing has said before – business transformation and workforce transformation must go hand in hand. Decoupling training time and working time is less optimal than designing training to be integrated with their jobs while those jobs and the companies they belong to are being transformed. We have to push both, not separately, but together. An even more joined-up approach among the economic, workforce development and skills development agencies, would be incredibly useful. But generally, the policy questions being considered and positions being taken address a lot of the preoccupations on my mind two and a half years ago. So, this could be a rather short speech, if the environment around us had not changed. But in that same two and a half years, some things have changed or accelerated, significantly and suddenly. Prime Minister Lee and other Members have talked about the different storms and opportunities that preoccupy us today.”
“Mr Speaker, I stand in the support of the Motion. I declare that I am the Managing Director and Partner of a management consulting firm that does work in the areas of digital, artificial intelligence (AI) and skills development. At the start of this Parliament term, I delivered my maiden speech titled "The Nation that Learns the Fastest". I spoke then about what I felt was needed for Singapore to thrive in a rapidly changing world: the importance of lifelong learning; the need for companies to take responsibility for their employees' learning; the need for companies to give more Singaporeans a chance and to look beyond paper qualifications; the need for stronger anti-discrimination protection; the need for each of us as leaders to go beyond telling people to be better, faster; work harder to providing emotional support, networks and social capital; and the need for companies to be better corporate citizens and proactively address critical social issues in order to earn the social licence to operate. So, it is with the greatest humility that I express my appreciation to the Government for the significant moves that have been made in the past two and a half years on each of these, and the significant moves that will be made in the next two and a half years, some of which have been announced in the past weeks and days, and some that are yet to come but were foreshadowed in the ForwardSG conversations. I do not claim to be the first to bring forth any of these ideas. There is no such thing as a monopoly of ideas, but if my analysis and the voices of my residents and other Singaporeans that I have surfaced have had even a small impact on their thinking, I think the past two and a half years would have been well spent.”
“(In Malay) [Please refer to Vernacular Speech.] Sir, flagship programs such as the MENDAKI Tuition Scheme and KelasMatematika are now well known in the community, serving students across all levels from preschool to university. A hallmark of the MENDAKI programs has been the mobilization of volunteers and the community, to bring up the community. In other words, it instills the spirit of cooperation and sense of ownership in the effort to achieve progress for our Malay-Muslim community. While progress is being made, we must keep pushing ourselves to achieve even more. How can we do more to reduce the barriers that prevent students and parents from enrolling in the programs and getting the most out of it. How can we further improve the quality and consistency of our community engagement? How can we do more to support our children even earlier in their educational journey? How can we continue to work with our community, and also cooperate with other communities to pool resources and do joint projects for our mutual benefit? How do we respond to the shifts that the education system will go through moving forward? Malay/Muslim Youth Mentoring Efforts”
“Mr Chairman, in Malay please. (In Malay): [Please refer to Vernacular Speech.] Who is the Malay Singaporean and what are his contributions to the nation? The truth is, the Malay community is a diverse community, with many talents. The Malay Singaporean is a CIO at the IMF. The Malay Singaporean is Singapore's favourite footballing son. The Malay Singaporean is a top trade negotiator. The Malay Singaporean is the Asian idol. The Malay Singaporean is a navy officer, an army officer, a police officer, an SCDF officer, a healthcare worker. The Malay Singaporean is the champion of the side hustle, from gifted photographers to thriving home based business that bring joy to customers. To be sure, the Malay community faces challenges, and there are niggling issues including deep rooted prejudices that we still find troubling. But rather than crippling us, we have become a role model in managing challenges and diversity as a community and other communities learn and can learn a lot from us, whether it is in setting up self-help groups to improve education outcomes or bringing down drug abuse. In an increasingly noisy and uncertain world, by practicing the values of our culture including humility, respect, moral and ethical living and family, we can continue to set an example. How do we best harness the talents of the Malay community and inspire and motivate ourselves to build a community of success, and to be recognized for our contributions to the nation? Progress of Malay/Muslim Community”
“Sir, during the debate on the Healthier SG White Paper, I advocated that MOH, in addition to electronic medical records, and simplifying and automating processes and digital tools, really push the envelope in using digital technology and data analytics to personalise how we engage and advise citizens with relevant information and make targeted interventions, at the right time, on their journey towards preventive health. The Healthier SG plan will allow citizens to follow their personalised health plans on HealthHub and track their physical activities on the Healthy 365 app. But the vision I shared would be a significant jump from this. Can the Minister provide an update on what the minimum viable product would look like at the launch of Healthier SG, and a roadmap for subsequent releases? Updates on Mental Health Efforts”
“Sir, I have spoken during the past two COSes for healthcare manpower, especially nurses, perhaps not as vociferously as Mr Louis Ng, but with no less personal conviction. There has been a multi-year shortage, and our healthcare workers are overworked. Looking at the plans for more healthcare facilities and nursing homes coming onstream, we know that many, including Woodlands Health, are struggling with a shortage of nurses and other healthcare manpower, in advance of their opening. We might say that we are just coming out of a pandemic. But in truth, the demand for nurses will only get worse as Singapore ages. There has been welcome news in the past few years of the increase in salaries and efforts to reduce administrative workload. But recruiting is taking a lot of time and the attrition rates remain high. Beyond the clinical and non-clinical workload, it is also not uncommon now to hear reports of harassment and abuse from unreasonable patients and families. Much more needs to be done to educate the public. Can more be done to entice nurses who have left the profession to rejoin nursing? Can immigration privileges be temporarily enhanced for trained foreign nurses? What more game-changing moves is MOH considering, to recruit and retain healthcare workers fast? Healthcare Workers”
“Just a clarification for the Minister. I wanted to follow up on my question or suggestion, in order to unlock the resale market, whether those who are buying private property can be asked to sell their flats or be barred from renting their HDB flat.”
“Sir, the increase in CPF housing grants for first-timer buyers resale flats has been welcome news for many. But there has been some debate on whether the grants will be capitalised in higher resale prices. MND has said that it has evaluated the risks and will monitor the situation. Given the potential distortionary impact of subsidies, especially when supply is inelastic, I want to repeat my suggestions in the housing debate. Will MND consider further measures to unlock the resale supply in the resale market, such as requiring HDB owners who buy private property to sell their flats, or to ban them from renting their HDB flats? Helping Seniors to Monetise Their Flats For many seniors, a significant portion of their wealth lies in the value of their flats. HDB has come up with a number of schemes for senior to monetise their flats, including the Silver Housing Bonus for those who want to downgrade, the Lease Buyback Scheme, allowing them to rent a room to supplement their retirement income and building new 2-room Flexi flats. As we live longer, more and more seniors may have trouble with retirement adequacy. Can the Minister provide an update on how many seniors have applied for the Silver Housing Bonus and the Lease Buyback Scheme respectively? How many have been approved, and how does this compare to MND's planning parameters? What more can be done to increase understanding and adoption of the scheme? Would the Minister consider further enhancements to the Lease Buyback Scheme to make it more attractive, such as increasing the cash payouts? How will Government continue to support seniors looking to monetise their flats? Assisted Living Options for Seniors”
“I thank the Minister for the response. Can I also check how does this number of 1,000 applications measure up to what MTI had expected or desired when launching the scheme, bearing in mind that the scheme is now being extended for another year? Do you have additional targets in mind and what can be done to increase adoption, if it falls short of expectations?”
“Sir, declare that I am a managing director and partner in a consulting firm that does work in the skills development space. I spoke during the debate on the Budget Statement of how reskilling programmes are critical to building resiliency in our workforce and our people as the economy and job market become more unpredictable. It has been several years now since we laid down the importance of lifelong learning in Singapore. Over the years, the Government has sharpened its support of SkillsFuture to prioritise the development of skills needed to be competitive in the future economy, as seen in the one-time top-up SkillsFuture credit and additional SkillsFuture credit for Mid-Career Support. Support is now more geared towards getting adult learners into new jobs and the range of courses supported has also been refined. Identifying the right set of skills to offer courses for is important, but there are many factors that influence the attitudes of and persistence to succeed for adult learners – from structural factors like range, availability and delivery methods of the courses, including pre- and post-employment support, as well as environmental factors such as a growth mindset, family and financial responsibilities and time constraints. Each individual context is different. Can the Minister share how the Government now measures the success of the SkillsFuture programme? What are the metrics and where do we stand? How will the Government continue to evolve its support to develop resilient adult learners? Streamlining SkillsFuture Singapore”
“Sir, since its inception, the Polytechnic Foundation Programme (PFP) for Normal (Academic) students who have done well has been a success, with the vast majority of students progressing to their diploma course, for which they are also better prepared for the different learning style and discipline that helps them to succeed in polytechnic. It is certainly something that has been appreciated by my residents. It is a great example of how we can give a headstart for Normal (Academic) students who are traditionally seem as being behind the Express cohorts. It has taken away stress and opened doors, giving them flexibility to choose a pathway that is based on their aptitudes and interests. Given this success and in light of concerns over the diverging employment outcomes of ITE versus polytechnic and university graduates, could the Minister consider expanding the PFP scheme to allow more students to benefit? Indeed, the flexibility provided by the PFP would ideally be in a future of full subject-based banding, pervasive in the system rather than a special scheme. Can the Minister provide and update on how admission pathways to various post-secondary education institutions will be updated in line with the shift to full subject-based banding to make it easy for all students to develop to the best of their potential? Flexible Post-secondary Pathways”
“Sir, to support our net-zero transition, and to turn the green economy into an engine of growth, we face a significant skills challenge. There is a high demand for talent to field green jobs and greening jobs, but there is a significant gap in supply. There is a need for a more urgent agenda in green skilling that addresses these gaps. Existing skilling efforts must be sharpened and accelerated. The green skilling agenda must address gaps in green technical skills including deep engineering skills and supply chain skills, and move from awareness building to application orientation. Can the Minister provide an update on how Singapore will develop the skills needed for a green economy in its workforce? Singapore as an International Green Hub”
“Sir, the protracted energy crisis continues to be a major challenge for the world. Faced with the need to keep prices low, countries are stockpiling energy and going back to coal. If this continues, it will be a vicious cycle, putting the planet's net-zero transition in jeopardy. The notion that energy security has to be secured at the expense of energy transition is a false one. We need to address both in parallel. In Singapore, this dilemma is an existential one that could erode our competitive position in the world economy. Businesses are citing energy prices as one of the main drivers of business cost in Singapore. At the same time, other geographies are luring industrial investments with cheap energy price, and luring clean energy investments by providing very attractive tax credits for producing clean energy. Despite our challenges, Singapore has committed to drive energy efficiency and to decarbonise. But because 40% of our overall emissions comes from the power sector, decarbonising the power sector therefore has to be an even more urgent priority. For example, we have put solar panels all over many of our HDB blocks. 12.00 pm Can I ask the Minister how many of the solar panels are actually in operation today? Can the Minister also provide an update on Singapore's efforts to enhance our energy security and accelerate our energy transition, including driving energy efficiency, deployment of solar energy, development of emerging low carbon technologies such as hydrogen and carbon capture, utilisation and storage (CCUS) and the import of renewable energy? SMEs and Sustainability”
“I thank the Senior Minister of State. We agree that the Government has done quite a bit in trying to contain the issue of motorcycle COEs, including the move on prudent bidding. It did have an impact for a few months after the implementation. But motorcycle COEs are now going up again. This is a really important issue to the people who actually rely on their motorcycles to do their work. Can the Ministry say more if it is willing to consider raising the bid further? Or if that is not the issue, are there any other moves that can help to bring down motorcycle COEs?”
“In Singapore the Government has many fiscal and non-tax levers to drive the transition which it has used, such as carbon tax, and funding for research. Given recent developments, can the Minister provide an update on how MOF is supporting the transition to net zero? Enabling Philanthropic Impact”
“Sir, like many in this House, I was cheered when Singapore brought forward its Singapore's NDCs to reach net zero by 2050, and for the public sector to achieve net-zero emissions by around 2045. This is a significant commitment and a non-trivial one to achieve, especially in the midst of an energy crisis. Many decarbonisation technologies are already ready today, but the speed of rollout depends on various other factors like infrastructure upgrades, business model and regulatory changes. EVs come to mind here. While other decarbonisation technologies, especially in hard to abate sectors of the economy, are not yet available at scale today. Until technologies like green hydrogen or CCUS become cost competitive versus carbon intensive alternatives, it will be difficult to mobilise the capital needed to scale and bring them down the cost curve over time. Governments must play their part to incentivise the flow of investment into these climate solutions, and the transition to these solutions given their cost disadvantage. By giving incentives to reduce the “green premium”, and through innovative risk sharing and financing structures, including public-private partnerships, Government can be the catalyst for a faster transition. Some governments have made bolder policy moves. The US Inflation Reduction Act (IRA) of August 2022 has been billed as the largest piece of federal legislation to address climate change. Investing $391 billion in provisions related to energy security and climate change, including tax incentives and a green bank. The tax credits of $3 per kg of hydrogen is particularly notable, turning the US into one of the cheapest countries in the world to produce green hydrogen.”
“Mr Chairman, the Government has embarked on the Forward Singapore exercise to refresh and renew our social compact. It is an opportunity for Singaporeans to take part in a national conversation on the values, priorities and policies we want to see going into the future. Implicit in a discussion on social compact though, is the notion of a society, but what does that society look like? What is the size and make-up of the population, what are the population dynamics and what are the impacts on our social and economic development? The Government would, no doubt, have received a lot of views on population issues over the course of the Forward SG exercise: views on immigration policy, ageing population, encouraging marriage and parenthood, for example. How has this informed the refinement of our population strategies? And how do our population strategies support the refresh of our social compact. Overall Population Strategies”
“We drew on our reserves to keep Singapore and Singaporeans afloat throughout the pandemic while continuing efforts to keep our economy competitive. Today, we have emerged from COVID-19, DORSCON Green and our economy is in relatively good shape. Yet, new storm clouds have gathered and we are in a new era of increased complexity, uncertainty and competition, even while we tackle domestic challenges of ageing and slowing social mobility. We need a Budget that can move us forward in a new era. Our response in Budget 2023 is clear – to build resiliency. Notwithstanding my suggestions to improve some existing schemes to help some segments of our population to bounce back, I support the Budget.”
“As financial resilience is a critical part of building personal resilience, I urge the Government to further strengthen the national financial capability programme such as by targeting specific segments with lower financial capabilities and in tandem with a stronger consumer protection framework. Mr Speaker, I have focused my speech on the challenges faced by three segments of Singaporeans for whom building resilience is particularly difficult and what the Government could do to help. But beyond the "what", allow me to say a word about the "how" as we try to help Singaporeans build resilience. Mr Speaker, as our colleague Mr Sitoh Yih Pin put it yesterday, pain is not always bad. Building resiliency does not mean removing adversity or pain altogether. Adversity helps to develop new skills, capabilities you may not know you had. But too much adversity can overstrain a person, such that it delays recovery and growth. I echo Mr Sitoh's call for greater empathy. But let us do it by setting goals for someone who is being assisted, that gets progressively higher and harder as he or she gains in capabilities and confidence. And let us remove unproductive stress and frustration that is created through excessive complexity and bureaucracy. So, can we spend less time on a multitude of forms, CPF statements and bank statements, and more time on real conversations to push people to grow? Mr Speaker, when we began this term of Parliament, we were in the throes of COVID-19, and then-Minister of Finance Deputy Prime Minister Heng Swee Keat had the unenviable task to deliver four Budgets in a single fiscal year. We said then that we were facing the crisis of our generation.”
“Debt is not just a financial problem. It can quickly go down a downward spiral, breaking up relationships and families. Mr Speaker, I have asked a few times in this House whether debt repayments can be considered as living expenses in determining a person's eligibility for and the quantum of social support to be granted. The Ministry of Social and Family Development’s (MSF) view has been that it is not appropriate to fund debt payment out of public resources given they arise out of personal decisions. I see the logic. Perhaps more can be done in raising awareness of various debt management and repayment schemes, and provide more counselling and support to these individuals. But I think the true answer lies in going upstream, investing further on financial capability building. I stress financial capability, not just financial literacy. It is not enough to increase knowledge of financial concepts. Ultimately, Singaporeans must change their behaviours in positive ways. MoneySense is Singapore's national financial education programme. There are also initiatives such as the Financial Education Network and financial literacy programmes in schools, workplaces and the community. While we have made progress in the 2021 MoneySense Financial Capability Survey, four in 10 respondents still did not understand financial concepts such as "simple and compound interest" and "risk diversification". More than half of the respondents had not developed a plan for retirement savings. A lack of financial resilience also often leads to high risk-taking that one is ill prepared to manage and the proliferation of scams.”
“After his discharge, he stayed with his niece for a short while and then stopped coming back home and was no longer contactable. I could not help but wonder if he would have been better off if he had stayed in prison. Another ex-offender wrote to me for help with an appeal to be eligible for the Enhanced Housing Grant. He has four children, the oldest in polytechnic and the youngest is one year old. His family lives in a rental flat. While in prison, he resolved to turn his life around and provide a better living environment for his family. He and his wife applied for a flat of their own. They were overjoyed to be successful in their application, only to learn that they were not eligible for the Enhanced CPF Housing Grant, because he had not worked for 12 months prior to the date of application for the flat. But how could he? He was in prison. But at the time of the appeal, a month before his scheduled key collection, he had worked very hard for 12 months to support his family to be ready to buy the house. Cancelling the application would also cost him his $1,000 deposit, not a small sum for him. Early intervention programmes on housing, even prior to release and more flexibility on eligibility requirements can go a long way to giving our ex-offenders a better shot at re-integrating and turning their lives around. The third group of Singaporeans I wish to highlight are Singaporeans who are struggling with debt. Sometimes it is a business loan or loans taken on to finance necessary expenditure like healthcare or education, but more often than not, the struggle is due to unsecured loans, credit card debt, renovation loans and yes, gambling debt, that have been allowed to balloon. "I made a mistake," they say. And they find it very hard to dig themselves out of the hole.”
“But on balance, I believe there is merit in considering ways to moderate the impact of a job loss on middle-income Singaporeans, helping them to meet their commitments and focus on recovery and growth. Second, ex-offenders. We know how challenging it can be for ex-offenders to integrate back into society and pick their lives back up. The efforts of organisations like Yellow Ribbon Singapore and the support of employers and the community in the form of counselling, resilience training, job flexibility and other forms of support have been instrumental in supporting ex-offenders on the ground. I am very glad to hear of the new Uplifting Employment Credit in Budget 2023 to help ex-offenders to find jobs. But I think we can be more holistic in our support. One area that ex-offenders I see could use more help in is housing. Mdm Deputy Speaker, as we know, the home environment has a big role in shaping a person's determination, confidence and support. In disadvantaged surroundings, social problems are reinforced. Many ex-offenders are fortunate to go back to living with their families, who become their pillars of support in the difficult journey of integration. But many also go from prison to less than ideal home environments or are disowned by their families who want nothing more to do with them. This was the case for a resident who came to me to appeal for a rental flat. He had been sleeping rough for a few weeks. He claimed that he had approached the Family Service Centre (FSC) for shelter but had been told the shelter was full. He came every week with the same appeal for four weeks in a row, looking worse each time. And then he stopped coming. Upon investigation, I learned that he was in the intensive care unit (ICU) after being attacked.”
“MPs from both sides of the House, including various Members of the Workers' Party and Mr Patrick Tay from the People's Action Party (PAP), have raised the possibility that with the increasingly volatile environment and whispers of more retrenchments, the time may have come for Singapore to implement some form of redundancy or unemployment insurance. The Government has cited concerns on the moral hazards and the cost of such insurance. We also know that people have other formal and informal forms of insurance such as retrenchment benefits, savings, the ability to cut discretionary spending and, for dual income couples, the income of their spouse. While we cannot be certain what the takeup would be, in a straw poll that I conducted of middle-income earners, very few said they were likely to take up a voluntary scheme and even fewer would support a mandatory scheme, say, one that deducts premiums from CPF. So, how would we create the market needed for the premiums to be super affordable? Mdm Deputy Speaker, I believe an effective monetary and fiscal policy that keeps unemployment low and stable is likely to eliminate much of the need for the unemployment insurance scheme. Arguably, this is where we are in Singapore – with very low unemployment. But perhaps existing schemes could be tweaked to make it easier for people who have lost their jobs to bounce back. For example, we could tweak the ComCare scheme to tier the assistance level based on pre-job loss income – time-limited and subject to efforts to look for new jobs or attend suitable reskilling programmes. I know there may be concerns over equity of having higher tiers of assistance for some.”
“I will highlight three groups of residents today for whom I believe we might need a stronger trampoline: first, Singaporeans, in particular, middle-income Singaporeans, who lose their jobs; two, ex-offenders; and three, Singaporeans in debt. First, Singaporeans who lose their jobs. The Government has built up many schemes to help Singaporeans who lose their jobs, from short-term relief through ComCare to extensive subsidies on skilling programmes like Career Support Programmes, Professional Conversion Programmes and so on. During the pandemic, the Government turbocharged this with the COVID-19 support grant and SGUnited training programmes and helped many Singaporeans, including middle-income Singaporeans. But these moves are sometimes not enough for middle-income Singaporeans who have larger financial commitments – commitments that payouts from ComCare cannot support. Like one of my residents, Mr I. He had a high paying job in an MNC but was retrenched in his 40s after a merger. He struggled for more than two years to find suitable employment. He tried his hand at his own business but it did not work out and cost him a chunk of his savings and put him in debt. He could not pay off his renovation loan and his business loans, ended up under a debt repayment scheme (DRS) and becoming a platform worker. One day, he shared with me a picture of his bank balance. It was in double digits. I asked him what he spent his income on: his DRS payments, household expenses, car, the money he gives to his parents and health and life insurance. I could not with a clear conscience tell him to let his health and life insurance policies lapse.”
“Similarly, while a rich man could build financial buffers with insurance, a poor man may turn more to belt tightening and community support. There is no one-size-fits-all. Budget 2023 contains several initiatives and programmes designed to help companies build resilience, such as the extension of productivity grants, energy efficiency grants, support for nurturing and sustaining innovation and developing local enterprises, including the Singapore Global Enterprises. I will discuss some of these in my Committee of Supply cuts but I will focus today on helping individual Singaporeans to be more resilient. Mdm Deputy Speaker, the Government has made big investments in strengthening our social safety nets over many years. Social spending almost doubled between 2010 and 2019. Beyond financial support, the Government has made huge investments in lifelong learning, from early childhood education to new education pathways, to upskilling and reskilling. The Government has also encouraged Singaporeans to seize new opportunities and embrace change, risk-taking, failure and learning, though admittedly, this shift is a work in progress. Budget 2023 goes further in this direction and I welcome the move to strengthen the link between training and job placement with Jobs-Skills Integrators to enhance employment support and to strengthen retirement adequacy despite the pain that some will feel in the short term. But while I recognise the efficiency and effectiveness of these broad-based measures, I also think we need to recognise that there are Singaporeans who are being pushed to their limits of adversity more than others and to be truly inclusive, we need to face up to this and push ourselves to consider whether it warrants more specific support for them to build resiliency.”
“Resilience is not only about bouncing back but about being prepared for bigger shocks and about seizing opportunities that arise out of uncertainty. It is not only about grit and determination in the face of adversity but about being able to anticipate adversity, cushion its impact, adapt and even shape the future. I would like to make two observations on resilience. First, resilience operates at multiple levels. There is personal resilience, organisational resilience and national resilience. Personal resilience and organisational resilience are mutually reinforcing. Resilient individuals can contribute their skills to making their organisations more resilient and resilient organisations can develop and invest in their staff to build their resilience. Similarly, for Singapore to be resilient, Singaporeans and Singapore businesses must be resilient – with one important caveat – that care must be taken to ensure that resilience is built in an inclusive way so that we do not end up with widening inequalities where some people and some businesses are better able to bounce back and exploit uncertainty than others. Our social compact must recognise this. Second, building resilience means different things to different people and organisations. How best to build resiliency depends on one's starting position. For example, a company with a strong financial position operating in a volatile market might best act by diversifying its business model, expanding its supply chain and looking to get a leg-up on its competition. A company with a weak financial position in a more stable market has to focus first on changing its business model in ways that will shore up its financial position and consolidate its supply chain.”
“Mdm Deputy Speaker, we are living in a time fraught with uncertainty. Global disruptions and macroeconomic headwinds show little signs of slowing. For the first time in a long, long time, global trade, a key driver of Singapore's GDP, is projected to grow slower than global GDP over the medium term. It all makes for unprecedented complexity and uncertainty in the economic and competitive environment for companies and for countries. Given our size, lack of natural resources and reliance on trade, it is an environment that makes us more vulnerable than many. But it is an environment that Singapore is prepared to handle – if we leverage on our solid financial foundations to buffer ourselves against disruptions and seek out opportunities amidst uncertainly, if we can build resiliency. Before I elaborate on building resiliency, I would like to thank the Ministry of Finance (MOF) for its work on the Occasional Paper on Medium-Term Financial Projections. In debating fiscal policy, it is always helpful to take a medium-term view and understand the drivers of Government finances. The Occasional Paper outlines the external and internal challenges that will shrink our fiscal space. Without the Budget moves of 2022, we would have been at risk of not having enough revenue to cover projected public expenditure, which has grown fast in recent years and will continue to grow rapidly on the back of higher healthcare, social and infrastructure spending, let alone to deal with unexpected contingencies. Resilience. The term "resilience" was introduced into the English language in the early 17th century from the Latin verb "resilire", meaning "to rebound". In recent years, as we moved from one crisis to another, the word has become more commonly used and taken on a broader meaning.”
“We worked out a personal savings scheme that allowed them to own an apartment painlessly through instalments over 20 years. We sold the apartments to them at below cost to enhance their assets. Today, 95% of Singaporean households are home owners. It has immeasurably increased their wealth and our social stability." It is uncanny how it remains true today. Let us renew, therefore, our vision, our focus, and our hearts, so that current and future generations of Singaporeans will have the opportunity to own a home that enhances the dignity, well-being and wealth. I support the Motion moved by the Minister for National Development. [Applause.]”
“Another perhaps more palatable option, is to ban such owners from renting their flats, which would likely induce many of them to sell their flats at more reasonable prices. Together with the cooling measures and the dissipation of induced demand as BTO projects are delivered, the suggestions above could increase resale supply and moderate resale prices, providing more opportunity for more first-time homebuyers to get the flat they want in the locations they want. Mr Speaker, I am confident that the Government and HDB will get us past the current situation and continue to evolve our housing policies. I have focused on first-time buyers in my speech because they are, rightly so, the first priority. But I urge HDB to not declare victory when the first-time buyers are "settled". Look out for the other groups that face frictions in getting on, off and sometimes back on the housing ladder today – the non-traditional families, transnational or reconstituted families, the ex-offenders, the singles. HDB will also has to address the concerns of seniors in our ageing population, though here I think the range of options available including the Lease Buyback Scheme are quite comprehensive and should be further promoted. It is not easy to meet the needs and aspirations of all, but I have full faith in the HDB that has the vision, the focus and the heart to do this. I would like to end by quoting our Founding Prime Minister, Mr Lee Kuan Yew: "Soon after separation, I resolved to enable every household to own its own home. If we were going to get the people to take National Service seriously, I could not ask their sons to fight and die for the properties of the wealthy.”
“There is research though in other cities in the world that shows that subsidies tend to be capitalised in housing prices. Hence, the benefit is captured by the owners, especially if housing demand is driven up by the subsidy scheme while housing supply is rather inelastic. Personally, I have grappled with the merits of the subsidy and whether increasing them further would just drive higher prices and create more economic rent for owners. But, Mr Speaker, if we look in our hearts, I think the need to get the first-time buyers a home should trump this. Applied with the right limits, only for first-time buyers, only in areas with high BTO application rates and in concert with other levers to loosen supply, the price effect of subsidies could be more controlled. Secondly, require HDB owners to sell their flats if they buy private property. As mentioned before, the Government has said that it is soliciting views on this as part of the Forward Singapore conversation. Given the state we are in, I urge the Government, to put in crudely, to hurry up. Doing this would signal that public housing is primarily a place to live in. In fact, if a stronger signal needs to be sent, the Government could consider additionally requiring HDB owners who own private property today to sell their flats. Three percent of HDB owners, slightly over 30,000 HDB owners own at least one private property. Of which, 45% rent out the whole flat and another 4% rent out one or more bedrooms. It is not a large number that would disrupt the market, but not insignificant relative to the number of first-time buyers. Given the social benefit, this exercise could be sweetened by offering breaks on stamp duty for selling their HDB flat.”
“These Zero Waiting Time flats would increase the responsiveness of housing supply, which will help achieve better outcomes, including helping moderate housing prices, provide for population growth and improve choice. A further suggestion for the BTO market that seems worthy of further consideration is building shorter tenure flats, say 50 years as in the case of the Ang Mo Kio SERS replacement flats. This will allow cheaper flats while shifting the market a little further away from speculation, while helping to set price levels for flats of different tenures. Next, unlocking the resale market, because the solution cannot and should not lie in building new flats alone. You cannot build flats fast enough to meet the demand in the short term, nor is it sustainable or an optimal use of resources for the long term. After all, our country is small, with many competing demands for our reserves, including land, and our population is ageing. There will be more people dying every year, leaving behind empty flats. The key to giving Singaporeans a chance to own homes that allow them to start a family today, not in five years' time, to live close to their parents and their support networks, not on the other side of the island, lies in unlocking the resale market, making it more affordable and accessible for Singaporeans not lucky enough to secure a suitable BTO flat for themselves. There are a number of measures that could provide some immediate relief and I would like to share a couple today. First, to increase the Proximity Grant for first-time buyers in areas with high BTO application rates. Today, HDB offers a number of grants to make resale housing affordable.”
“The BTO model was created to prevent the supply overhang in the 1990s from being repeated. And it has served us pretty well until recent times. The current waiting times are an anomaly. Prior to COVID-19, it was three to four years. Yes, a three- to four-year wait was less than ideal for some, but the model largely was passable for most. HDB has also shown itself to be responsive to the needs of first-time buyers by introducing Short Waiting Time (SWT) flats, announced as early as 2017, albeit in small numbers. So, I do not believe the BTO model is fundamentally flawed, though I hope the waiting time can go down. I have confidence that the building programme will bring the BTO market to pre-COVID-19 norms in the next couple of years. I am also comforted to hear the Minister speak about building more SWT flats and over time, recalibrating its building programme so that SWT flats form a larger proportion of new flats. But the problems we see today would still be there if another COVID-19 happens even if we had a lot more SQT flats. And contrary to the Member Ms Hazel Poa, I actually do not think it is quite so easy to predict demand, given the number and dynamism of the factors at play. Further, as supply chains in other industries have learnt following the pandemic, there is a need to strengthen resilience against potential black swan events going forward. There is a financial cost to building what is effectively surplus flats to the demand forecasted. But if we really take into account the social benefit of housing and the cost of housing delays, there is potential merit in maintaining a safety stock of readily-available or some might say, Zero Waiting Time flats, while maintaining a baseload of BTO and SWT flats.”
“I hope the PSP in particular, will clarify how they imagine the resale market will remain “buoyant” and address the need for people to upgrade or downgrade as their life circumstances changes, under their proposed affordable housing model. But lest anyone think that I am somehow afraid to touch the resale market, quite the contrary. I believe the resale market is part of the problem and has to be part of the solution. And I also believe that the problems faced by the first-time buyers is not the problem of the first-time buyers alone. There is a huge social benefit of housing and a huge social cost of housing delays – on fertility rates, on how well kids can focus and do in school, on productivity and mental well-being. In the kinder, gentler, more inclusive Singapore that so many of us have talked about in this House, these social costs will only result in more Government expenditure down the road. Thus, in my vision for a new social compact, everyone in the housing market should be willing to play their part. Home owners should not necessarily expect that the value of their flats will increase inexorably year after year because housing goes in cycles. Landlords should not push to maximise their rents or prices at all costs. Buyers should not be jumping into the BTO market when they do not really need a flat, just because they can. And HDB should revisit the balance of financial costs and benefits of housing policies with the social and environmental costs and benefits. So, the resale market has to be part of the solution. But if the market is a bubble, the more responsible way is to take some of the air out, bit by bit, through carefully calibrated measures acting in concert, in both the BTO and the resale market. First, my suggestions for the BTO market.”
“Some of my residents try again and again for BTO and Sales of Balance Flats. One couple told me they had applied 11 times, because they want to stay in or near Woodlands – that is their expectation. But resale has become too expensive for them, especially with the recent sharp rise in interest rates and lower loan values. And even if they can afford it, when resale prices get so far away from BTO prices, it creates another issue. Those who get BTOs can make huge profits when they sell, those who do not get BTOs have much less upside, even with all the grants. Plus, because BTOs are such a good deal, everyone wants to jump in. So, it is not just a housing affordability issue; it becomes a fairness issue and an incentives issue. Mr Speaker, I will move now to solutions. In a debate on housing though, it can be difficult to distinguish between fact and opinion. We have heard a lot of opinions and I will add my opinions to this. But first allow me to lay down one fact. There are currently approximately 1.1 million HDB flats; and that means 1.1 million HDB households for which their flat represents a significant part of their wealth. And so, any proposal that ignores this fact or is cavalier about the trade-offs that ensue are really non-starters – lacking in rigour, responsibility and realism. I listened carefully to the proposals presented by PSP and WP for significantly cheaper BTO prices. I cannot help but feel a sense of disquiet at how they gloss over the potential disruption to the wealth of 1.1 million Singaporean families, families that comprise low-income, middle-income and affluent families.”
“While 20,000 new BTO flats used to mean pretty close to 20,000 less expensive flats in non-mature estates, in the August 2022 launch, more than 60% of the 3- to 5-room flats on offer were in more expensive mature estates, including the PLH. This creates the perception that BTOs are getting more expensive overall, when in fact BTO prices in non-mature estates have not gone up so much. As the hon Member Mr Cheng Hsing Yao has eloquently explained, there is good reason why flats in mature estates cost more and to suppress BTO prices in these mature estates would create unfair windfall gains for a small group – a situation that HDB rightfully guards against, in setting BTO prices. This shifting BTO mix has different implications for buyers who want to buy in a mature estate and those who want to buy in a non-mature estate. For the first-time buyer who wants to buy a BTO in mature estates, they now have more choices, if they are prepared to pay the higher price. The innovations in the PLH model provide a useful reference to explore more ways to make them more affordable. For first-time buyers who want to buy a BTO in a non-mature estate, the supply is sometimes not as high as it used to be. Many of my residents, first-time buyers but also second- or third-time buyers who come to see me at my Meet-the People Sessions want to stay in or near Woodlands. It is cheaper, closer to their parents and support networks, and, dare I say, we have done a pretty good job of making Woodlands a nice place to live, with noticeable improvements in connectivity and amenities. In the last BTO launch in Woodlands in August 2022, Woodlands South Plains, the application rate was 8.1 and 11.7 applicants per unit for 3- and 4-room flats respectively versus 2.7 and 6.1 for the Bukit Merah PLH BTOs.”
“For all the above reasons, home ownership must remain not just the Singaporean dream, but the Singaporean reality. But that reality appears to be challenged today. Rising resale prices and rents have sparked debate about whether public housing is still affordable. Housing related appeals make up a third of our weekly Meet-the People Sessions (MPS) case volume for me, and for many of my parliamentary colleagues. There is genuine concern among young Singaporeans and their parents whether they will be able to afford a flat. I hope that the Minister’s explanation of how HDB keeps BTOs affordable has reassured them. Because, and this is why I am rather bemused by the more far-reaching proposals to bring BTO prices down, the core problem today is not overall BTO affordability. The real issues to solve today are: (a) BTO shortage and long waiting times, driven by, as we have said, COVID-19 disruptions and construction delays; (b) a shifting BTO mix with a higher proportion of BTOs in mature estates against expectations of home buyers; and (c) high resale prices partly driven by the supply-demand imbalance which is itself partially real, partially induced, partly by nearly a decade of low interest rates. Taken together, these three issues mean some people find they cannot get the flat they want, BTO or otherwise. Allow me to say a little more about the BTO mix issue. We are reaching the development limits in many areas, even in some non-mature estates, including in my own constituency, Woodlands. We also have more BTO configurations to cater for, to more diverse needs, for example, the needs of seniors and singles.”
“Mr Speaker, I thank the Member Mr Leong Mun Wai for bringing this debate to Parliament and the Minister for National Development for filing a Motion in response to be debated together. When it comes to a topic like housing, something that has such a disproportionate impact on our lived experience and which holds so much of Singaporeans’ wealth, it is important to get the facts on the table and to flesh out the arguments rigorously, responsibly and grounded in reality. We have had a broad subject before us and it has been a long debate. I am going to focus on getting first-time buyers on the home ownership ladder. It is where everything starts. I will start by reaffirming the importance of home ownership, before sharing my views on the present situation and some proposals for consideration. Mr Speaker, I have lived and worked in many big cities, from Jakarta to New York City. And the idea that a city-state such as ours could achieve over 90% home ownership has been a great source of pride as a Singaporean abroad. Home ownership allows people to settle down, to start families, to grow old, without the fear of having to move from place to place when the landlord wants to raise the rent. Home ownership gives people something to be proud of, something they can make as an expression of their selves. And home ownership provides ordinary Singaporeans, regardless of income or family background, the opportunity to build an asset and to build themselves up. For HDB homes, home ownership provides the ultimate security, something to fall back on, the one thing that cannot be taken away even if you go bankrupt. Finally, home ownership anchors people to Singapore, gives them a stake in our nation’s continued development and a reason to defend Singapore.”
“I thank the Minister for the response. I wanted to follow up on my PQ. I think I did not hear the answer to the first part of my PQ, which is the portion on those impacted; how many of those are Singaporeans versus foreigners. My second supplementary question would be, I understand that there are still a lot of jobs available. But, in the current climate where businesses are also relocating or looking at their location strategies, is the Minister concerned at this point, given the rise in tech sector salaries in the recent past, whether our competitiveness as a tech sector – in terms of cost and availability of manpower and the ability to fill these roles quickly – is in any way compromised?”
“I think we would need to look at different KPIs. Some KPIs, maybe you can set the target. I believe we need to walk before we run. This is a very major transformation and like I said, we should scrutinise the KPIs on the page first to make sure that those are the right ones that we want to measure. I cannot say when the right time is to measure it, but I expect that will come in future once we have more data, I think it is important to do this based on a good fight, based on data.”
“Thank you. I think I am just making a general point that we have seen in multiple studies, that sometimes target-setting too early when you do not actually have a good base behind it can create a lot of perverse target-setting. I am not saying that hospitals will do it, not saying that doctors will do it, but I do not think we need to take that risk and instead focus on the measurement, identifying the right ones in the first place, measuring, and then also making sure that we keep doing better and better in those KPIs.”
“They must be comfortable dealing with a wider range of complex conditions, working with data and technology, working in multidisciplinary teams, including specialists, and new ways to engage patients. We need everyone in the healthcare delivery system to be rewired around prevention and putting care in the right place. This will not come naturally. Today, they are not trained in that way, they are not compensated in that way, and let us face it, their intellectual respect – our intellectual respect – is not for prevention. Our intellectual respect is for the surgeon who pulls off a complicated surgery. So, we need to respect family doctors a lot more. If Healthier SG is to succeed, we have got to get this rewiring right. I believe that, for most clinicians, the language of health outcomes is an inspiring and powerful one versus administrative tasks. It can underpin the enormous change management effort that will be required. Mr Speaker, MOH has implemented a series of individual reforms in recent years. Healthier SG is a fundamental and comprehensive transformation that will require institutional commitment to work things out, considerable investment and new organisational and people capabilities and ways of working. They say, "health is wealth". To put our healthcare system now on a more sustainable footing and to get a healthier Singapore and Singaporeans – for Mr Z, Ms N, Mr T and millions of other Singaporeans like him – we cannot fail. I support the Motion.”
“The hon Member Tan Wu Meng has made the point that digital solutions must be easy to use and reliable. I absolutely agree. To change behaviour though, doctors and patients alike must be excited and willing to use these tools. Here is where the lens of outcomes pushes us to go even further and, that is, data – clinical data, pharmacy data, health screening data, health app data, cost data, but also data about the individual and how he likes to be engaged. Can we use all that data and analytics to identify risky individuals for whom we can have the right conversations and make the right targeted interventions in order to make a meaningful impact? Can we engage patients and physicians, not only with apps and technology and tools but with data – data that tells them where they stand in comparison to others and advises them with personally relevant information of actions that they can take, including, of course, working with community partners? I think the role that data and analytics can play in driving outcomes for Healthier SG is incredibly interesting and I would suggest doubling down on the capabilities to do this. Last but not least, healthcare manpower. I have spoken a number of times in this Parliament on the adequacy of healthcare manpower, including the shortage of nurses and the need for healthcare manpower transformation in preparation for a future that is much more focused on value-based care and prevention. For Healthier SG to work, we not only need more nurses, we need enough good family doctors, nurses, allied health professionals, pharmacists and care coordinators.”
“These successful models point to a few prerequisites for capitation to be truly value-based. It needs to be organised around defined patient groups and population segments, adjusted for risk, and linked to quality thresholds or improvement in health outcomes. Otherwise, capitation could create incentives for "cherry-picking" of healthier patients or for limiting access to required care or what we call "rationing" behaviour. To that end, can the Minister clarify the capitation model envisioned under Healthier SG, including how will the payments be risk adjusted based on patient profiles in the cluster? Will there be bonus payments for achieving better health outcomes? How will health outcomes be shared across the delivery value chain to encourage people to work together? How much autonomy will be given to the clusters and clinical teams to do what they believe is right to deliver better care, informed by care protocols and outcomes? Can there be participation payments for tracking and reporting health outcomes? How will adjustments be made at the backend when someone uses healthcare services outside his or her own cluster? Second, healthcare IT. The enhanced National Health Electronic Records system under Healthier SG is much needed. We should not need to tell every new doctor or specialist we see about our medical history or our prescriptions or to have to repeat expensive tests and x-rays or to repeat information needed by our medical social worker at every hospital you or your child goes to. Digitising and automating processes, leveraging mobile apps like MyHealthHub and Healthy 365, all these make sense, though implementation is non-trivial, as some colleagues have raised.”
“One successful example is CMS Medicare Advantage in the US, where Medicare pays private insurers a fixed risk-adjusted payment for the total cost of care for a patient. Then, it is up to the insurer and its provider partners to figure out the best way to invest that money to provide the care. Insurers, such as Humana, have built their own or partnered provider networks to help them create more value-based models. Oak Street Health, which I mentioned earlier, is one such Humana partner. Oak Street clinicians are given the autonomy to do whatever drives best outcomes for the patient. Working in multidisciplinary teams of GPs, nurses, specialists, nutritionists, they take input from the patient and caregiver, and also consider the patient's social determinants of health, such as food security and social support. This holistic approach often drives new insights and innovation. So, if the patient needs a surgery to be healthy, they will make the referral. If he needs food delivered to him to make sure he eats healthy, that is what they do. Or if it takes a house visit to make sure that the home does not have hazards – a stray rug or slippery tiles that could cause him to trip and fall, that is what they do. Or if they think the most meaningful thing is to have someone put their arm around him to be comfortable with his life situation, that is what they do – and they are achieving good outcomes. Another example is Kaiser Permanente, also in the US, where transparency about outcomes and costs encourages the clinical teams to avoid low-value care and right-site care within its integrated network of hospitals and primary care providers. A system of incentives encourages clinicians to work together and share best practices and always driving continuous improvement.”
“I am a little bit more ambivalent about the suggestion by the Member Mr Gerald Giam to put a target on every KPI, especially with some of these KPIs, as the Member Ms Denise Phua said, it is very easy to achieve them, can set some perverse incentives. What is important is to identify the right KPIs, measure them and actually use them to make our system better. So, I urge MOH to consider a real push to measure health outcomes from the beginning. And with this lens of focusing on outcomes, I turn now to what it is going to take to make Healthier SG work. First, healthcare financing, an area that will undergo significant reforms in Healthier SG, with a move towards capitation funding. The drawbacks of our current model of a fee for service are clear. It motivates doctors to take on more and more patients, even if they do not have time, to order that extra MRI, even if it is not necessary, to prescribe the most expensive drug instead of a generic that does the job. It feeds off a very human trait – love, the love that makes us willing to try anything, spend anything, if we believe it might keep our loved ones alive. And trust me, I know how that feels. But, Mr Speaker, more expensive care is not necessarily better care. More treatment is not better care. This is why healthcare systems around the world are implementing payment reforms, with mixed results. There are different forms – pay for performance, bundled payments, capitation and they can be used in combination, but the fundamental logic is the same – pay for quality and value rather than volume. Capitation, in particular, gives healthcare providers a powerful incentive to manage total systems costs. Most capitation systems are geared to encourage providers to focus on prevention and early detection and intervention.”
“Another example, in Sweden, the Stockholm County Council launched a value-based payment programme for hip and knee replacement in 2009, led to a rapid shift of care from acute care hospitals to cheaper specialty clinics. In the first two years, complications decreased by 18%, re-operations by 23%, and revisions by 19%, cost per patient declined 14% in terms of resources used by providers and 20% in terms of money paid out by the Council. Finally, the Lumos programme, an initiative to integrate healthcare data in Sydney, Australia, developed a model that shows the high value impact that can be obtained through early detection in primary care specifically. When a patient is diagnosed with diabetes early in primary care, and has regular GP visits forthwith, their diabetes journey is much more likely to be managed over time in the community setting. In contrast, when the diagnosis is done later and in a hospital setting, and he does not engage much with primary care, this could result in poorer management of diabetes and increased re-admissions. But here is the good news. The Lumos data also suggests a GP visit within one week of discharge of an unplanned re-admission can substantially reduce the risk of an unplanned hospitalisation in the five to 12 weeks following discharge. This is data that we can act upon and do something about. The common thread in each of these examples is "think big but start small" – focus on a specific population group and patient segment, for example, people over 60 with diabetes and identify a subset of outcomes for that patient segment, and set the system to work to track and improve those outcomes and make this visible. And I stress to focus first on managing and tracking and doing something with it.”