Ong Ye Kung
Singapore
“The Ministry of Health (MOH) recently enhanced the Community Health Assist Scheme (CHAS) dental subsidies, which are tiered by income, for common preventive and restorative procedures.”
“Healthier SG GP clinics may also refer their enrolled patients to Active Ageing Centres and Community Health Posts to fulfill their social prescriptions and for subsidised services, such as medication management.”
“Public hospitals, such as the National University Hospital, the Singapore General Hospital and Tan Tock Seng Hospital, have deployed robotic-assisted surgical (RAS) systems for minimally invasive soft-tissue surgeries.”
“The Health Sciences Authority (HSA) welcomes drug producers to choose Singapore as part of their first-wave filings. As long as a pharmaceutical product is approved by at least one regulatory agency, such as China's National Medical Products Administration (NMPA), it would also qualify for the abridged route.”
“A decrease in estimated glomerular filtration rate in patients with diabetes can be due to multiple reasons. Doctors will first investigate the underlying cause before determining whether the patient should be referred to a specialist. Some causes are reversible and cause transient reduction in renal function.”
“Information on the Lasting Power of Attorney (LPA) cannot be made visible on the National Electronic Health Record system as it is protected under the Mental Capacity Act. Such information may only be disclosed by the Public Guardian to specified persons upon satisfactory submission of evidence(s) required under the law.”
The complete record
Every one of 2,932 lines we hold for Ong Ye Kung, in date order, each linked to its source. Free to read, in full, without an account. Page 12 of 59.
“My response will also address the oral question filed by Assoc Prof Razwana for the subsequent Sitting. I would invite Members to seek clarifications, if need be. If the questions have been addressed, it may not be necessary for them to proceed with the Questions for future Sittings. Regarding Dr Wan Rizal’s queries on targeted measures and preventive strategies, upstream efforts include Mental Health Education integrated into the school curriculum to help students regulate their emotions, recognise mental health symptoms and seek help early. Student Development Experiences like co-curricular activities and camps reinforce such learning, fostering resilience and mental well-being. Peer support structures established in all schools and Institutes of Higher Learning also enable students to look out for one another and encourage peers in distress to seek help from trusted adults. These efforts are aligned with the protective factors identified in the National Youth Mental Health Study, including resilience, social support and self-esteem. To ensure mental health services are accessible to youths in the community, Youth Community Outreach Teams (CREST-Youth) and Youth Integrated Teams (YITs) provide mental health services to all youths aged 12 to 25 and are fully funded by the Government without any out-of-pocket payment. Subsidised mental health services are also available at most polyclinics and participating general practitioner clinics. We aim to extend these services to all polyclinics and Healthier SG GP clinics and expand the number of CREST-Youth and YIT teams to 15 teams by 2030.”
“Over the last three years, the Health Sciences Authority (HSA) has detected an average of 10 cases per year, of health products containing banned and prohibited substances. HSA regularly issues press releases on the adverse reactions that result from use of illegal health products. Consumer advisories on making discerning choices in the purchase of health products from reputable sources, such as pharmacies or online shops with established retail presence in Singapore, are provided through HSA's website, social media platforms and the local news media.”
“Based on data collected in national health surveys, the prevalence of self-reported hearing loss in adults 18-74 years old has increased from 1.3% in 2013 to 9.2% in 2023. This increase is most significant in adults aged 60 years and above. The significant increase is likely due to increased awareness. The School Health Service and Student Health Centre run by the Health Promotion Board conducts hearing screenings for Primary 1 and Secondary 2 students. In 2023, 0.4% of Primary 1 students and 0.2% of Secondary 2 students were found to have some degree of hearing impairment. The trend has been stable over the last five to 10 years. There has been heightened concern about hearing loss amongst youths lately, due to their lifestyles. Indeed, research has shown that prolonged or consistent exposure to loud noise or music, including the use of audio devices like headphones, can lead to hearing loss. The Government can do what we can to minimise the risk exposure to hearing loss. For example, at birth, all newborns undergo a hearing screening test. Infants at high-risk of hearing impairment, such as preterm infants born before 32 weeks, will also have formal audiological evaluation. Schools take precautionary measures when students are in noisier settings, such as operation of machinery in Design & Technology workshops or shooting activities during Uniform Group Co-curricular activities, by requiring students to use ear plugs or earmuffs. As for exposure to loud noise in youth because of social and lifestyle choices, we can educate and raise awareness as much as we can.”
“This question has been addressed in the reply to Question No 60 on the Order Paper for the 9 September 2024 Sitting. [Please refer to "Review of MediSave Withdrawal Limits with Rise in Healthcare Costs", Official Report, 9 September 2024, Vol 95, Issue 140, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“Singaporeans aged 60 and above can tap on Flexi-MediSave for general outpatient medical treatment. This includes outpatient consultations and medications for common acute conditions, such as the common cold, as well as chronic conditions under the Chronic Disease Management Programme (CDMP), including diabetes and hypertension. Flexi-MediSave can also be used on-top of other outpatient withdrawal limits, such as the MediSave500/700 limit for CDMP and approved vaccinations. Flexi-MediSave was recently reviewed in 2023, where it was expanded to cover home medical and home nursing services provided by selected providers. In 2023, fewer than three in 10 of those eligible to use Flexi-MediSave reached the annual $300 limit. We will continue to regularly review the Flexi-MediSave scheme to ensure that it remains relevant for the needs of Singaporeans.”
“The Member is referring to data in the Report on Registration of Births and Deaths 2023 published by the Immigration and Checkpoints, which are provisional. The finalised figures will be published next year. We adopt a whole-of-society approach to address the issue of suicide. We have run several public education campaigns, trained peer supporters and frontline personnel to support those with mental health needs, built up resilience among our youths and students, and expanded community mental health services and 24/7 crisis helplines. However, what is most important and hopefully starting to reduce the incidence of suicide, is to change societal attitudes, by normalising conversations around mental health and reducing stigma in seeking early help.”
“Reducing the current 10-year gap between health-span and life-span, is the ultimate objective of healthcare and which all our efforts revolve around. This includes efforts to expand healthcare capacity to enhance accessibility, leveraging technology to improve healthcare in a sustainable manner, shifting the centre of gravity of care to communities and homes as far as possible, tackling the "buffet syndrome" caused by excessive insurance, developing our manpower and, very importantly, building up population health through preventive care strategies such as Healthier SG and Age Well SG. Employers can play a major role because work is such a significant part of our lives. There are many areas where employers can contribute, but let me highlight a few key areas. First, and a very critical one, is to be able to employ older workers for as long as possible, even beyond statutory retirement and re-employment age, so that those who want to work can continue to do so. This may mean having employees and employers work together to ensure there is flexibility in deployment and in adjusting roles, responsibilities and remuneration. The ability to contribute and learn, and having colleagues around is a major factor that builds health. Second, employers can adopt good workplace health practices, advocate healthy lifestyle initiatives for employees, and strengthen monitoring and management of occupational diseases. In this regard, the Ministry of Health and the tripartite partners jointly released the Tripartite Statement on “Enhancing Employee Health and Well-being in Support of Healthier SG” in July last year. Recommendations for employers included actively supporting Healthier SG enrolment among their employees and implementing health-promoting workplace practices.”
“Glucagon-like peptide-1 (GLP-1) drugs are prescription medicines which can only be dispensed by a registered medical practitioner or a licensed retail pharmacy to a patient with a valid prescription, and are strictly prohibited from advertisements and sales on local online platforms. Since 2022, the Health Sciences Authority has investigated a total of 16 unauthorised sales or illegal advertisements of GLP-1 receptor agonist drugs. Investigations are on-going for most of the cases and no prosecutions have commenced yet. A further 82 non-compliant listings of such drugs were removed from various e-commerce platforms. The nature of the Internet makes stringent enforcement almost impossible. It is important that consumers avoid purchasing medicines from overseas or unknown sources, including online and through influencers, as these may be unregistered, substandard, or counterfeit, posing significant health risks.”
“There are currently no plans to extend the Award for Nurses' Grace, Excellence and Loyalty (ANGEL) scheme beyond nurses. The ANGEL scheme is designed to encourage nurses to stay and build their careers in the publicly-funded healthcare sector. The considerations for each healthcare profession are unique, including factors like the strength of the recruitment pipeline and global competition, the nature of the job and career structure. Nurses make up a large proportion of the workforce in public healthcare, which makes retaining them through a scheme like ANGEL necessary. The Ministry of Health regularly reviews the salaries of all our public healthcare workforce and ensures that their total remuneration is fair and competitive. We will continue to look into other attraction and retention measures to ensure that we are future-ready, such as by supporting mid-career entrants to the sector, providing opportunities for job redesign and career development, and ensuring a conducive and safe work environment in our public healthcare institutions.”
“The Ministry of Health (MOH) tracks healthcare-associated infections (HAIs) in acute Public Healthcare Institutions for (a) device-associated infections and (b) various multi-drug resistant organisms (MDROs) in the Intensive Care (ICU) setting. These are the most common sources of HAIs. In the ICU setting, the rates for hospital-associated urinary tract infections and central line infections are 3.56 and 2.15 per 1,000 device-days respectively in 2019, and 2.80 and 1.51 per 1,000 device-days respectively in 2023. For ventilator-associated infections, the infection rates are 8.23 in 2019 and 11.70 in 2023. For MDROs, the prevalence rates for Methicillin-resistant Staphylococcus aureus are 0.54 per 10,000 patient-days in 2021, and 0.35 per 10,000 patient-days in 2023. In the same period, the prevalence rates for Carbapenem-resistant Enterobacteriaceae (CRE) are 0.45 and 0.91 respectively. This rise in Carbapenemase-producing CRE (CP-CRE) prevalence is similar to what has been observed globally and related to antibiotic usage practice in the hospitals. MOH aims to bring down HAIs to as low as possible. Ultimately, there needs to be a strong culture of vigilance, embedded within care protocols and clinical practice. A Technical Advisory Group on CP-CRE has been convened to recommend further targeted actions to reduce Carbapenemase-producing Enterobacteriaceae infections within the next three years.”
“Postgraduate medical training is highly subsidised by the Government, regardless of specialty. Residents undergoing specialist training in selected popular specialties co-pay $450 per month for their training. This takes into account the high costs of specialist training and is to encourage junior doctors to consider specialising in other areas, that are more needed to meet future national healthcare demand.”
“Investigations by the Ministry of Health (MOH) against MaNaDr Clinic, and its practicing doctors are on-going. Appropriate enforcement actions will be taken against the licensee if there were any breaches under the Healthcare Services Act 2020. Medical practitioners found to have breached the Singapore Medical Council’s (SMC) Ethical Code and Ethical Guidelines will also be referred to the SMC for disciplinary actions. MOH will provide further details when the investigations against MaNaDr Clinic are completed.”
“We have addressed similar questions at the previous Sitting and the answer has been provided in the written answers for Question Nos 33 and 34 for the 6 August 2024 Sitting. [Please refer to "Vaping in Private Hire Cars and Measures to Protect Drivers Reporting Such Incidents", Official Report, 6 August 2024, Vol 95, Issue 138, Written Answers to Questions section.] Nevertheless, for completeness, I will provide a reply to this question today. While it is not mandatory for the taxi and private hire car drivers to report vaping by passengers, they may do so to the Health Sciences Authority (HSA) via its hotlines. The identities of persons who report these cases to HSA are kept confidential by HSA. Drivers will also not be penalised for passengers vaping in their vehicles. If passengers retaliate or are uncooperative, drivers can seek help from the relevant authorities, such as the Singapore Police Force, where appropriate.”
“The Member is referring to the data in in the Report on Registration of Births and Deaths 2023 published by the Immigration & Checkpoints Authority. These are provisional data and the finalised figures will be published in the following year's report. We have adopted a whole-of-society approach to address the issue of suicide. We have run several public education campaigns, trained peer supporters and frontline personnel to support those with mental health needs, built up resilience among our youth and students and expanded our community mental health services and 24/7 crisis helplines. However, what is most important and hopefully starting to reduce the prevalence of suicides, is to change societal attitudes, by normalising conversations around mental health and reducing stigma in seeking help early. These are fundamental goals that we are on. For youths, we will continue to promote mental well-being and resilience and equip them with skills, such as emotion regulation. Educators and school counsellors are also trained to identify students with mental health challenges and refer them to additional support where necessary. We are also building up peer support. For seniors, the Silver Generation Office reaches out to those aged 60 and above to identify their needs and refer them to relevant support or services, such as Active Ageing Centres for regular check-ins, and befriending and buddying services.”
“Pharmacists play a pivotal role in safeguarding medication safety for patients. Pharmacists participate in medication reconciliation, both in the inpatient and outpatient settings, to ensure that patients' medications are correct and safe. This helps to reduce the risk of patients taking their medications inappropriately. Not all the benefits from pharmacists' interventions are quantifiable. Local studies have demonstrated that pharmacist-led medication therapy management service in the outpatient setting decreased unplanned hospital admissions and emergency department visits. Pharmacists helped to optimise patients' medications and worked with the healthcare team to resolve medication issues, which would have otherwise increased patients' risk of adverse outcomes, such as falls, heart attack and stroke. Pharmacists work in multi-disciplinary care teams to help patients achieve good chronic disease control and avoid potential complications. A 2017 study showed that regular follow-ups by pharmacists in a collaborative care model with physicians, nurses and dieticians improved blood sugar control for patients with poorly-managed Type 2 diabetes. Pharmacists worked with patients to address common misunderstandings about their medications to improve adherence to the treatment and empowered patients to manage their own conditions. In the intensive care unit (ICU) setting, a 2023 study showed that timely interventions made by critical care pharmacists to correct inappropriate drug regimens and discontinue unnecessary medications helped to reduce the ICU length of stay and the overall healthcare expenditure borne by patients and the system.”
“The Ministry of Health (MOH) conducts regular engagements through surveys, workshops, focus group discussions and international experts' consultations to evaluate the diversity of job roles, duties and skills for pharmacists. Such engagements have contributed to greater clarity of the breadth of pharmacist competencies across different domains. For example, the Development Framework for Pharmacists (DFP) published in May 2020, set out four levels of pharmacy competencies in the domains of professional practice, education, research and evaluation, as well as leadership and management. The public healthcare institutions identify appropriate local and overseas training programmes and skills attachments and sponsor pharmacists to undertake such training, to prepare them to take on specific higher-level roles. This could take the form of enhanced clinical roles, such as those in antimicrobial stewardship programmes, medication therapy management clinics or anti-coagulation clinics; specialist clinical roles in areas, such as Oncology, Critical Care and Geriatrics; as well as general management and leadership roles within the institution.”
“The prevalence of perinatal depression in Singapore, which comprises antenatal and postnatal depression, is estimated based on local research studies. The local prevalence of antenatal depression is about 7% to 9%, while that of postnatal depression ranges from 6.8% to 10.4%1.”
“MediShield Life is a basic health insurance plan that is designed to cover subsidised bills at public hospitals locally and, hence, is not extended for medical treatments overseas. Nevertheless, MediSave use is currently permitted for overseas elective hospitalisations and day surgeries at accredited hospitals. In the last three years, around 250 MediSave claims were made annually with an average claim of $3,400.”
“The Ministry of Health and the Agency for Integrated Care are continually seeking ways to increase the coverage of Active Ageing Centres by finding sites that are more accessible to seniors, including those living in private estates. This includes reviewing the suggestions by respective Grassroots Advisers. Besides ensuring the sites are accessible, we have to consider other factors, such as the size of the site and the availability of basic utilities needed to run programmes for seniors.”
“Around 50,000 Pioneers are currently receiving $100 in cash monthly under the Pioneer Generation Disability Assistance Scheme (PioneerDAS). PioneerDAS is part of a broader suite of Government support measures for long-term care needs, which includes mean-tested subsidies, insurance, grants and MediSave top-ups and safety nets. We will continue to review these schemes from time to time to ensure that care remains affordable to those who require it.”
“There are three sources of financial support for patients with advanced dementia. First, they are eligible for means-tested subsidies of up to 75% for nursing home-care and up to 80% for home-care. Second, individuals who are assessed to have severe disability can withdraw up to $200 per month from their own or their spouse’s MediSave accounts, under the MediSave Care scheme. This can help to offset their long-term care costs, including but not limited to nursing home fees. Third, they may also benefit from long-term care insurance schemes, such as ElderShield and CareShield Life. If these avenues are still insufficient, those who have challenges affording the residual nursing home fees may apply for financial assistance, such as MediFund.”
“The Ministry of Health (MOH) takes a serious view against providers who make wrongful financial claims. This is unfair to patients, a waste of public resources and goes against the professional ethics of a healthcare provider. As of 1 April 2023, MOH has, therefore, instituted a more robust enforcement framework for such wrongful claims. Wrongful claims are surfaced via whistleblowing, complaints channels or analytics. Hence, the claims adjudication process takes place post-claim and the claims process for policyholders is unaffected. After an errant claim is discovered, MOH takes steps to require the healthcare provider to rectify the wrongful claims without affecting the patients. All treatments and procedures must be administered in the appropriate setting. MOH encourages doctors to perform treatments and procedures in an outpatient or day surgery setting, if it is safe and delivers similar clinical outcomes to inpatient admissions. At no time should they admit patients for the sole purpose of making insurance claims. MOH has allowed MediSave and MediShield Life claims to be made for selected outpatient treatments and tests, such as scans and blood tests ordered for a patient as part of cancer treatments, or for the purposes of diagnosis and treatment of a medical condition. MOH will continue to review existing healthcare financing schemes to ensure that they address Singaporeans’ needs while ensuring the long-term sustainability of healthcare costs.”
“The public healthcare clusters monitor and manage staffing needs to balance the workload of its healthcare workers. Based on a recent survey conducted for medical residents, about nine in 10 residents kept within the guidelines of an 80-hour work week and one out of seven days free from educational and clinical responsibilities. That said, at times when there is high patient load, healthcare professionals complete administrative tasks after their official duty hours, when they are not busy attending to patients’ needs. Ageing and rising patient load mean that the health system is under significant pressure and healthcare workers are all working hard. We need to recognise that relieving workload of one group often means more work for others or reduced patient care. Ultimately, we will need to expand the healthcare team, inculcate teamwork, foster understanding amongst healthcare professionals, enhance efficiency, deploy suitable technologies and encourage good health to manage workload.”
“Based on national survey data, the proportion of women aged 50 to 69 who have ever been screened for breast cancer through a mammogram increased from about 60% in 2007 to about 75% in 20231,2. However, the proportion for those who go for the recommended regular screening every two years is lower, at 35%2. We will continue our efforts to increase the uptake of regular breast cancer screening through the Health Promotion Board, which works with the healthcare clusters, Singapore Cancer Society and Breast Cancer Foundation, to raise awareness, address barriers and dispel misperceptions to screening. Under Healthier SG, mammograms are fully-subsidised for eligible Singapore Citizen enrollees. The Ministry of Health is assessing the clinical and cost-effectiveness of selected cancer genetic tests among high-risk populations. Subsidies are generally provided for tests that are found to be clinically and cost effective.”
“MediSave is intended to help Singaporeans offset healthcare expenses over their lifetime, especially during significant health episodes requiring surgery and long hospital stay, which tend to happen during old age. It is, however, understandable that when young, we want to use more of our MediSave balances as we cannot anticipate the need for MediSave when we are old. Hence, the Ministry of Health has schemes like MediSave 500/700, Flexi-MediSave and MediSave for diagnostics scan to cover more regular outpatient treatments. The areas of coverage and its limits are regularly reviewed and adjusted. For example, in 2021, we introduced a higher $700 limit to better support patients with complex chronic conditions who needed to seek care more frequently. In 2023, residents enrolled in HealthierSG can use MediSave to cover their copayment under the Chronic Disease Management Programme fully, without having to make any cash contributions. Over the last three years, around 1,500 appeals were received annually from Singaporeans requesting to use their MediSave beyond withdrawal limits, out of roughly 1.4 million Singaporeans who make MediSave withdrawals each year. Around 40% of these were assessed to have genuine affordability concerns and were approved.”
“Yes to all three. For the first question, I think in the coming weeks and months, especially when we have our first case, we do expect it to arrive at some point, we will have to put out more information for people to watch out. It is not difficult to miss because you will start to get lesions on your skin. And I think people will be quite concerned. That relates to the second question, what is more important is to educate the general public that when you see such symptoms, please see a doctor. And then, the best community monitoring is still through our network of GPs and family doctors who have been briefed on what to look out for and what are the protocols. And finally, the answer is yes. Because of a long incubation period, I think it is not practical to detect and be able to isolate people at the borders. Many will be incubating and will go through our checkpoints before they exhibit symptoms and are picked up. Having said that, remember the main characteristic of this virus that we are dealing with is a R of 1.3. So, while someone is incubating, our memory is always focused on the last crisis and our memory is COVID – someone incubating; no symptoms can spread to 10, 20 people and we have many of those clusters. In this case, it does not look like a virus that exhibits those characteristics. In fact, it is an R of 1.3 which means even if you are incubating, even if you infect someone, it is through very close physical contact. And in Africa, those tends to be their family members, immediate family members that spend a lot of time with you, with physical skin-to-skin touch and physical contact, living together in the same household.”
“I think closer surveillance will be a good idea in those settings that the Member mentioned and they will be implemented. That means a closer watch-out for symptoms and able to have in situ isolation facilities. So, in all those settings that the Member mentioned, those contingency plans have been developed since COVID-19.”
“Most older Singaporeans would have taken the smallpox vaccine at birth. I have one. The coverage before 1981 has been very broad – well over 90%. So, if they have not taken for some reason, it could be because it is not suitable for them, in which case, then I think we have to look at the other alternatives. But I think, in general, the mpox vaccine JYNNEOS will be offered free to the two groups I mentioned – healthcare workers who are directly exposed to the virus in taking care of patients as well as post-exposure prophylaxis for close contacts of an infected person. We think this is better use of the stock of JYNNEOS that we have to suppress transmission, as opposed to offering it widely and free to the population, because given the characteristics of this virus with an R of 1.3, I think our method, our vaccination strategy will be more effective, given the stockpile of JYNNEOS that we have.”
“MOH's bottomline assessment is that mpox Clade I is likely a troublesome virus which will cause us some inconvenience, but all in all, is something we can manage. It is unlike COVID-19 that will lead to widespread safe management measures or even a circuit breaker, very unlikely. Exercising personal responsibility, especially when symptomatic, and practising good personal hygiene, remain effective at reducing the risk of transmission of mpox in the general population. However, we should not be complacent. The situation is evolving and there is still some uncertainty around the disease characteristics. We will learn more about the disease in the coming months and should be prepared to change our plans as we understand the disease more.”
“Schools have existing protocols to manage outbreaks, such as for hand-foot-and-mouth disease, which are relevant in an mpox Clade I outbreak. These include ensuring good hygiene practices and screening students for symptoms. Cases will only be allowed to return to school once fully recovered and no longer infectious. Premises will be cleaned and contact tracing of students and staff will be conducted promptly. If necessary, outbreak management measures, including temporary closure of a class, a level or a school, may be implemented to contain disease spread. Fourth, vaccination. Although smallpox has been eradicated, we kept some stock of smallpox vaccines, called JYNNEOS, to counter orthopoxviruses, such as the mpox virus. Based on our current understanding of the disease and its relatively low reproduction rate, population-wide mpox vaccination is not necessary and not recommended. It is more effective to focus our vaccination on healthcare workers who need to care for mpox patients, and on close contacts of infected persons as a form of post-exposure vaccination to suppress the transmission of the virus. Based on this vaccination approach, our existing supply of vaccines are projected to be sufficient. To better strengthen our preparedness and resilience, MOH is also looking at procuring more doses when available. Fifth, masking. At present, we do not recommend wearing a mask for people who are well, given that the primary mode of transmission is close physical contact. However, should there be evidence of significant respiratory transmission, such as outside of households, MOH will consider implementing masking on public transport, and in crowded indoor settings. Our current mask stockpiles and local manufacturing capabilities will assure us of adequate supply.”
“We have retained digital declarations for travellers coming into Singapore using the SG Arrival Card. Several Members have asked me why do we keep that. Now you know why. Because such outbreaks will happen from time to time. We have, however, adjusted the questions, so that travellers are now required to declare mpox-related symptoms and travel history on the SG Arrival Card. We have put in place temperature and visual screening for travellers arriving from higher risk areas, at both air and sea checkpoints. Second, testing, tracing and isolation. As mpox has a long incubation period of up to 21 days, cases may not be picked up at the borders. They may seek medical help later when they turn ill in Singapore. Therefore, we have notified our doctors to be on the alert to spot and immediately report any suspected mpox Clade I cases to the Ministry of Health (MOH). All suspected mpox Clade I cases will be conveyed to designated hospitals for further assessment and testing. If tested positive, these patients will be isolated in healthcare facilities until they are no longer infectious. Based on what we currently know of the Clade I virus, our existing hospital capacity, including the intensive care units (ICUs), remains adequate to treat and isolate infected cases. Contact tracing will be conducted for all confirmed cases. The National Environment Agency will oversee environmental cleaning and disinfection for places visited by the infected persons. Close contacts of Clade I cases will be quarantined in a designated government quarantine facility for up to 21 days from their last date of exposure. Third, schools and preschools. We have been working closely with the Ministry of Education and Early Childhood Development Agency on contingency plans.”
“Out of every 100 cases in the Democratic Republic of the Congo (DRC), there were about three to four fatalities. Three to four out of 100. This is a concerning number, similar to COVID-19 when it first broke out. If it comes here, the case fatality rate will most likely be lower because first, the recorded number in DRC probably has a larger denominator base of undetected cases; so the fatality rate should be lower. Second, there will be better access to quality medical care in Singapore. Evidence also shows that smallpox vaccination renders cross-protection against mpox. Since smallpox vaccination was required in Singapore up till early 1981, there will be some immunity among a large segment of Singaporeans aged 45 and above. Fourth, specific groups that will be especially affected. One group includes the weak and vulnerable, such as the old, sick or the immunocompromised. Further, a large proportion of cases and deaths in DRC are in children below the age of 15. Some of this is due to socioeconomic reasons, such as malnutrition or that the children are already afflicted with certain diseases. We believe that the clinical outcomes will be different in countries outside Africa and we are paying close attention to the risks amongst children. Based on the current evidence, we are not dealing with a respiratory virus like COVID-19 that required extensive safe management measures, much less a circuit breaker. With an R of 1.3 – and that is a decisive consideration – we think the best way to suppress the spread of the virus is to detect and isolate cases, and quarantine close contacts early to reduce the risk of spread to the community. That brings me to the key aspects of our response plan. First, border measures.”
“Thank you. I have shared our assessment of mpox Clade I and our response plan in a press conference last week. Let me reiterate the points briefly and then invite Members to ask supplementary questions. As of 5 September 2024, there have been no mpox Clade I cases in Singapore. As for the less severe mpox Clade II, 15 confirmed cases have been detected this year. Although there are no Clade I cases in Singapore as yet, we should expect it to arrive here at some point as it spreads beyond Africa. Every pandemic is different – I have to keep emphasising that. We need to respond according to the characteristics of the virus. This is a key lesson from COVID-19. The key characteristics of mpox Clade I based on what we know so far, are as follows. First, mode of transmission. This is mainly through close physical contact with infected persons, such as sexual contact, mouth-to-mouth, skin-to-skin and skin-to-mouth contact. In Africa, it appears to be family members living in the same household as the primary cases, who are infected. We cannot rule out mpox spreading through the air, but based on current evidence, even if it does, it does not spread far and wide like COVID-19 – like one person gives a speech and many members of the audience can get infected. There is no evidence showing that mpox Clade I or Clade II spreads that way. But this is something we will continue to watch and which should become clearer in the coming months. Second, transmissibility. As of now, the mpox Clade I virus has a known reproduction number, or "R", of about 1.3. This means that every 10 infected persons will spread the disease to an average of 13 persons. This is less infectious than other diseases such as COVID-19 with an R value of five, or chickenpox with an R value of 12. Third, severity.”
“Mr Speaker, Sir, may I have your permission to address Question Nos 12 to 15 on today’s Order Paper, which are related to Monkeypox (mpox), please? My response will also cover the matters raised in the questions by Ms Joan Pereira1 and Mr Sharael Taha1 which are scheduled for a subsequent Sitting.”
“Amongst patients referred to the KK Menopause Centre, the top symptoms were hot flushes, poor sleep/insomnia, mood disorders (low mood/ feelings of anxiety), vaginal dryness and sexual problems. Under Healthier SG, the relationship between the primary care doctor and enrollee is central. Women who are experiencing menopausal symptoms can inform their primary care doctor, who would be well placed to assess the symptoms and the patient’s needs and make recommendations on further management.”
“We encourage the import of generic medicines into Singapore, after the original patents have expired. However, all medicines, including generic medicines, have to be evaluated and approved by the Health Sciences Authority for safety, quality, efficacy and ability to meet Good Distribution Practice standards before they can be supplied in Singapore.”
“The electronic Health Declaration through the SG Arrival Card is an essential public health surveillance measure to manage infectious diseases of concern, such as Yellow Fever, Ebola, Middle East Respiratory Syndrome (MERS) and Mpox. Some of these diseases are already endemic in many countries, but not Singapore, which explains why we still retain this border measure. It facilitates the early detection of high-risk travellers and reduces the risk of such infectious diseases taking root in Singapore. All travellers entering Singapore who declare symptoms and have relevant travel history are medically assessed. On average, there are about 240 such travellers per month. Further, travellers who are well and with recent travel history to Yellow Fever endemic countries but do not have a valid Yellow Fever Vaccination Certificate, will be quarantined to protect against the risk of spread of Yellow Fever in Singapore. The Ministry of Health will update the health declaration for new emerging infectious diseases when necessary. So long as there are risks of importing new emerging infectious diseases of concern that are not endemic in Singapore, there will be a need for the health declaration.”
“This question has been addressed by written answer to Parliamentary Question No 35 on the Order Paper for 6 August 2024. [Please refer to "Trend and Waiting Times for Nursing Home Admission for General Care, Psychiatric Care and Intellectual Disability", Official Report, 6 August 2024, Vol 95, Issue 138, Written Answers to Questions section.]”
“Between 2020 and 2022, around 70% of practising nurses registered with the Singapore Nursing Board were working in the public healthcare sector. Fresh nursing graduates from our local Institutes of Higher Learning who join the public healthcare sector can expect to earn a starting base salary of between $2,050 and $4,050 per month, depending on their qualifications. This excludes shift allowances, overtime and bonuses. The Ministry of Health does not collect salary data from private healthcare providers.”
“The median waiting times for new specialist outpatient appointments in 2023 are as follows: By and large, for serious diseases like cancer, treatments are often carried as soon as possible. However, the Ministry of Health does not track the median waiting times to treatment for cancer patients as it is not a meaningful indicator. Waiting times to chemotherapy, radiotherapy and cancer surgery vary depending on the type and stage of cancer and treatment modalities. In addition, some patients with other accompanying chronic conditions may require additional pre-operative management prior to treatment. Some patients may also require stepwise treatment where surgery is performed before or after chemotherapy or radiotherapy. As treatment poses much discomfort and inconvenience, others, after discussing with doctors, may choose to delay their treatment.”
“As of June 2024, more than 304,000 Singaporeans born before 1980 have signed up to join CareShield Life (CSHL). About three-quarters have upgraded from ElderShield plans. For Singaporeans who were born before 1980, we have decided to give them the option to convert, based on their needs and circumstances. Participation incentives were introduced, but they have to be time-limited to encourage early enrolment into CSHL and discourage procrastination. Last year, the Ministry of Health introduced a final extension of participation incentives by another year to continue encouraging sign-ups. Participation incentives of up to $3,000 over 10 years will be provided to all Singaporeans born before 1980 to offset premiums, as long as they sign up for the scheme by 31 December 2024.”
“In general, Ministry of Health (MOH) restricts the advertising of healthcare services, through the Healthcare Services Act, to ensure transparency, prevent excessive consumption of healthcare services and protect consumers from being misled by advertisements. This is regardless of whether the professional is registered with the professional associations or not. MOH also does not collect data on individuals advertising psychology or other healthcare services. MOH is currently working with agencies, service providers and professional associations, such as the Singapore Psychological Society, to update the risk assessment and review the need to regulate psychologists to better ensure the safety of psychological practices in Singapore.”
“Government subsidies are already available to lower the cost differential between polyclinic and Community Health Assist Scheme (CHAS) general practitioner (GP) visits for eligible patients. This includes seniors who enjoy higher Pioneer Generation (PG) and Merdeka Generation (MG) subsidies at CHAS GP clinics than the standard tiers of CHAS subsidies. In addition, under the Healthier SG Chronic Tier, CHAS/MG/PG cardholders can access selected chronic medications at their enrolled Healthier SG GP clinic at prices comparable to those at polyclinics. Beyond this, patients can also use MediSave to pay for their chronic disease treatments under the Chronic Disease Management Programme at CHAS GP clinics, no different from that at the polyclinics. Polyclinics generally operate on an appointment basis to ensure better allocation of resources. Patients who are unable to obtain a slot from online booking systems can still call to make their appointments or walk into the polyclinics to book an appointment if needed. The polyclinics will set aside some slots for walk-in patients with urgent medical needs, as well as for elderly patients, particularly those who are frail and have mobility issues. Non-urgent cases may be given an appointment for another day or advised to seek treatment at a nearby CHAS GP clinic.”
“Our public hospitals appoint vendors to operate food establishments through tender, based on key considerations, such as price affordability for public and staff, food variety and quality, and availability of healthier options. Hospitals will compare prices submitted by the potential vendors with prices of similar food establishments to ensure competitiveness. They also have in place measures to ensure reasonable prices and affordable options for the public and staff, such as requiring vendors to seek approval for any price adjustments. If the Member has any feedback on food establishments or particular stalls in public hospitals that charge high prices, please let us know and we will look into it.”
“My response will also address the written question filed by Dr Syed Harun Alhabsyi for the subsequent Sitting. [Please refer to "Data on Trends and Waiting Times for Entry Into Nursing Homes for Respite Care and Night Respite Services", Official Report, 7 August 2024, Vol 95, Issue 139, Written Answers to Questions section.] The median wait time for a nursing home bed for general care needs has remained stable, at around one month for the past five years. Over the same period, the median wait time for a nursing home bed for psychiatric care needs is around two to four months. Service providers have generally been able to place clients into nursing home respite and night respite services upon request. As caregivers submit requests for service with different lead times, wait times for nursing home respite and respite services are not meaningful.”
“When taxi and private hire car drivers observe their passengers vaping, they are encouraged to inform their passengers that vaping is illegal in Singapore. While it is not mandatory for the drivers to report vaping by passengers, they may do so to the Health Sciences Authority (HSA) via its hotlines. The identities of persons who report these cases to HSA are kept confidential by HSA. Drivers will also not be penalised for passengers vaping in their vehicles. If passengers retaliate or are uncooperative, drivers can seek help from the relevant authorities, such as the Singapore Police Force, where appropriate.”
“The question has been addressed in my oral reply to Parliamentary Question Nos 16 to 20 on the Order Paper for 6 August 2024. [Please refer to "Data on Doctor Representation, Claim Rules and Premium Charges of Integrated Shield Insurance Plans", Official Report, 6 August 2024, Vol 95, Issue 138, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“Since 2019, close to 2,450 clinics have been audited for Community Health Assist Scheme (CHAS), MediSave and MediShield Life (2M) and COVID-19 related claims. Of these, the Ministry of Health (MOH) has revoked or suspended the 2M and CHAS accreditation of 11 clinics; and suspended or terminated the CHAS participation of a further three clinics, for egregious non-compliances. MOH takes a serious view of any attempts to defraud patients and the healthcare system and will not hesitate to take action in such cases. For the small minority with non-compliances, MOH will take enforcement action, calibrated according to the severity of their non-compliances. These range from engagement and training to suspension and revocation for egregious cases. Where warranted, we also refer the clinics and doctors/dentists to the Police, Singapore Medical Council and Singapore Dental Council for further investigation.”
“Necrotising fasciitis is a rare but serious skin and soft tissue infection associated with necrosis of the infected tissue and is potentially life-threatening. This infection may be caused by many types of bacteria, such as Streptococcus pyogenes and Vibrio vulnificus, which can be found on body surfaces, including skin, nose and throat; or in the environment, such as natural water bodies, that is, seawater, lakes, rivers. These bacteria are often reported in the media as "flesh-eating bacteria". Individuals with weakened immune systems and with breaks in their skin are at greater risk of developing necrotising fasciitis when exposed to such bacteria. Infections have also been reported from consumption of raw or undercooked seafood. Based on claims data, the number of cases has remained stable in the last five years, at about 80 on average per year. No clusters of infections have been reported. Necrotising fasciitis is treated with antibiotics and surgery to remove the dead soft tissue as well as to control sepsis. To minimise the risk of infection, individuals may avoid consuming raw or undercooked seafood and keep any skin wounds dry, clean and covered. If unwell or when wounds are infected, individuals should seek prompt medical treatment.”
“Whether an ambulance is needed to convey a patient during a medical emergency, depends on the circumstances. Although, it is most likely that conveyance by emergency ambulance service is needed for serious work injuries. Investigations on the fatal incidents at the worksites for the North-South Corridor at Cavenagh Road on 16 September 2023 and the Tengah integrated rail and bus depot on 2 December 2023 are ongoing. The Ministry of Health will provide further details when ready.”