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.”
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“The first question is about the young. Even with the GP, if that particular clinic has capacity, we do need to look at the nationwide capacity. We need to prioritise capacity for those who are older. So, from a national perspective, from a systemic perspective, it will be difficult for us to implement this. In any case, Healthier SG is about MOH as well as the health ecosystem doing more to help people to take care of their own health. So, for young residents, I will encourage them, with or without the Government's explicit support, they can always do more to lead a healthier lifestyle. And I think the young are increasingly mindful of that. So, please do help us encourage them. There is a lot they can do here – eat less sugar, eat less salt and have less device time – to start with. As for our more senior ones, we will encourage private GPs to price their consultations and their services competitively. I do know that because of rising healthcare needs plus Healthier SG, costs can increase. But through benchmarking, persuasion and encouragement, plus giving more options to patients and residents, we hope there would be competitive dynamics that can keep prices in check as much as possible. So far, healthcare inflation has lagged behind national inflation, and we will try our best to continue to do so.”
“And the Ministry of Health (MOH) provides full funding to these teams, and residents that can access their services and support at no cost. As Healthier SG is progressively rolled out and stabilised, it is possible for residents to receive annual health reports, as suggested by Dr Lim Wee Kiak. With Healthier SG, enrolled residents will have access to a personalised Health Plan via their HealthHub mobile application or the web portal. If the resident is diligent with his health screening, he will also have access via HealthHub to his latest health screening results. We will monitor the usage of such information on HealthHub and explore how we can further enhance it to support residents' health journeys.”
“My response will also cover the matters raised in the question by Dr Lim Wee Kiak1 which are scheduled for a subsequent Sitting. Dr Lim Wee Kiak is not here but I hope he gets to read my answer and if it answers his question, he may want to withdraw his question for a future Sitting. We started a Healthier SG pre-enrolment exercise in May this year so that residents aged 40 and above with chronic care needs can continue to be cared for by their regular general practitioner (GP) clinics. So far, over 47,000 of these residents have been pre-enrolled. So, the response has been encouraging. We are commencing national Healthier SG enrolment from 5 July this year. We will need to do this in phases, to manage the workload of our GP clinics and polyclinics and ensure residents have a positive experience when they enrol to Healthier SG. We will prioritise those with chronic conditions, followed by those aged 60 and above. We hope to extend this to residents aged 40 to 59 sometime next year. In providing care to residents with chronic conditions under Healthier SG, family doctors will be guided by care protocols. We have, so far, developed 12 such protocols. Every one of them requires significant consultation, coordination, preparation as well as training. We will expand the coverage and intend to cover mental health in due course. In any case, Healthier SG is not the only avenue to care for residents experiencing mental health issues. Under the Community Mental Health Masterplan, we work with social service agencies to set up community outreach and intervention teams to support persons with mental health needs as well as their caregivers. This includes educating caregivers on stress management and self-care, linking them with counselling services and support groups when needed.”
“Mr Deputy Speaker, may I have your permission to answer the next two Parliamentary Questions together, please?”
“I explained in this House before, I think it was during the White Paper debate on COVID-19, that the main reason for the crunch is that within a very short span of two years, you suddenly see average length of stay going up significantly. It used to be 6.1 days in 2019, and it has increased to 7.0 days in 2022.”
“I explained in this House before, I think it was during the White Paper debate on COVID-19, that the main reason for the crunch is that within a very short span of two years, you suddenly see average length of stay going up significantly. It used to be six days. Now, it is 7.1 days. [Please refer to "Supporting Healthcare", Official Report, 10 May 2023, Vol 95, Issue 104, Motions section.] [(proc text) Written Statement by Mr Ong Ye Kung circulated with leave of the Speaker in accordance with Standing Order No 29(5): (proc text)] I wish to make the following factual correction to the speech made during the debate on the Motion “Supporting Healthcare” at the Sitting of 10 May 2023. It should read as follows:”
“I believe the Member is asking this question due to a recent media report of an individual who developed anaphylaxis after taking Lianhua Qingwen. Investigations are ongoing and there is currently no evidence to suggest the causality of the allergic reaction and consumption of Lianhua Qingwen. Traditional Chinese Medicine products, such as Lianhua Qingwen, are natural herbal products that are not regulated like pharmaceutical medicines by the Health Sciences Authority (HSA). Allergic reactions may occur in any individual susceptible to the substances present in health products, just as in the case of food. Nevertheless, HSA will conduct post-market surveillance of such products and take necessary actions.”
“I just thought that it is not very fair that the NMP has to answer a policy question. So, it is better for MOH to say something. Ours is a variegated healthcare system, unlike, say, NHS, where everything is nationalised, all drug prices are more or less the same, centrally procured. We are deliberately catered to a variegated market. And for private sector doctors, as Dr Tan Yia Swam said, they do have different models. There are doctors that charge very low consultation fees, but instead, they earn some margins by selling their drugs. Others do the reverse. So, when we put forward an idea – but, luckily, it is from the Member and not from me. If we put forward an idea to say, "Let us all sell at the same price", actually, doctors, their rice bowls gets affected and it can be quite a major issue for them. So, I think there is some wisdom in what Dr Tan Yia Swam said. In the private space, sometimes, you want to let market forces operate, but, at the same time, have some discipline through how we structure insurance, what we subsidise, what we do not. And I think that is how we reign in unnecessary healthcare costs. Mr Deputy Speaker, I know Mr Leong has more questions. But really, I think this is a Motion about Ministries and all of us, all stakeholders coming together, a very meaningful Motion. And I would urge that we do not prolong further this to-ing and fro-ing and let us give our stepping-down NMPs strong support for their very meaningful Motion. [Applause.] [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support." (proc text)]”
“Ageing is going to be the big challenge that affects all of us – and MOH cannot be alone in this. The passion and activism of our NMPs help uplift the standard of debate in this House and bode well for the democratic discourse for Singapore. So, please rest assured that the issues close to your hearts will continue to be given due attention in this House, even as your term comes to an end. There will be a new batch of NMPs who are passionate about issues too, and take up the issues that you care about. On healthcare, there will be MPs who are healthcare professionals, Government Parliamentary Committee (GPC) Members for Health, Labour MPs and NMPs, Members who feel strongly about healthcare who will carry the torch forward. Most importantly, the MOH political officeholders will continue to put forth our agenda and address the concerns of our stakeholders. We are not on different sides. We are all on the same side, trying to make the system better for Singaporeans. For NMPs, after you have stepped down, I hope you will continue to advise and cheer us on, at the side. So, let us all continue to advocate for a better healthcare system for everyone. Health is for All and All is for health. [Applause.]”
“These are many examples of how agencies are coming together to better support health and we are committed to continue to do so. Mr Deputy Speaker, let me conclude. I am mindful that our Nominated Members of Parliament are coming to the end of their term. This is perhaps your second last Sitting. I do not know for sure, but Leader told me, it might be your second last Sitting. I know some of you hope to have the assurance that even as you step down, the issues close to your heart continue to receive attention in this Chamber. So, I feel honoured and privileged – although it got me a bit busy – that you have chosen to table a Motion on healthcare, just as you have actively been speaking up on healthcare issues during your term. In particular, Dr Tan Yia Swam, who was also the President of the Singapore Medical Association (SMA). She has been a strong advocate for various healthcare-related issues. I attended an SMA dinner some time ago hosted by her. In her speech during that event – it is public, so I think I can say it – she said that she was an angry young doctor. And now, you are a less angry middle-aged doctor. But the difference is that you have learned how to channel your energy to a greater good and be a better advocate. I say Dr Tan is doing a good job, both in SMA as well as in this House. But I do not think Dr Tan is angry. It is important that we are passionate in our cause and be active in our advocacy. I greatly appreciate this Motion, highlighting the need for MOH to work with other agencies and for other agencies to support us. Today, we have MOE and MCCY's political officeholders (POHs) deliver their speeches. Actually, we could have gotten many more, but we did not want to prolong the debate for too long.”
“And it actually does affect their PSLE results, based on our research findings. [Laughter.] Maybe that is the right button to push, I do not know. So, MOH, MOE and MSF; we are studying the linkages between early education and health, and developing possible interventions. Fourth, the media. Information and media literacy is our first line of defense against false and viral health myths. We will continue to work with the Ministry of Communications and Information (MCI) and other media agencies to do this, just as we did during COVID-19 to dispel falsehoods about vaccination. Healthier SG gives us an opportunity to address the problem of health misinformation. How so? This is because we are advocating and trying to build stronger patient-doctor relationships. Because with a trusted relationship and the family doctor and his care team knowing the health condition and history of the patient, they become the patient’s trusted source of medical information and advice. In this digital era of information overload, online falsehoods, myths and AI bots, perhaps what we need in healthcare is stronger human relationships, especially between doctors and patients. We can use technology to strengthen the relationship and improve the quality of care rather than replace the human relationship. That must ultimately be the mode of co-existence between humans and AI. Finally, our infrastructure and transport planners. Over the years, MND and MOT colleagues have expanded green spaces, cycling paths and fitness corners islandwide to support active living. There are also plans to have more Silver Zones and Green Man+ at pedestrian crossings to allow our seniors to travel more safely and with confidence in their neighourhood.”
“Indeed, when we consulted the public during Healthier SG, we heard from many residents that peer and family influence is a key factor in motivating them to adopt healthy life habits, such as regular exercise and to eat healthily. So, under Healthier SG, our healthcare clusters will work with community partners – HPB, PA, SportSG – to proliferate physical activities in the community and encourage strong participation by residents. We welcome other ground-up initiatives and activities that rally the community. If we take a walk in our public parks today, we can spot many of these activities. Many of them not organised by any agencies. Friends getting together to cycle, run, play football. Masters teaching their disciples qigong or tai-chi. All of them are now part of the healthcare system. Third area, schools and education institutions. I thank Minister of State Gan Siow Huang for speaking about MOE’s efforts in building this health foundation for our young. Indeed, good health starts from our values, habits and choices. Our schools help to build this foundation of health literacy. They introduce our young to sports, help them make friends and form social groups, teach them life skills and knowledge to be useful citizens, all of which are essential building blocks to good health. As mentioned by Minister of State Gan Siow Huang earlier, through the years, MOE has worked with MOH to thoughtfully infuse health education in its curriculum from early childhood to primary, secondary and tertiary education. Research findings now show good health habits, such as proper diet and use of devices, inculcated from as young as three or four years old, have a profound impact on the cognitive development and well-being of the child later on in life.”
“When healthcare is mostly treating sickness, it falls under the domain of hospitals. But when healthcare is about creating health and caring for people in their homes and communities, it becomes everyone’s business. Hence, in order to realise Health for All, we also need All for Health. I think this is really the spirit behind the Motion put forward by the Members. In particular, the following stakeholders can make significant contributions to health. First, employers. I thank Dr Tan Yia Swam for speaking on this. Many of us spend a considerable amount of our adult lives at work and hence the workplace is highly influential in shaping our health habits. I value our existing partnerships with NTUC, SNEF and the Tripartite Oversight Committee on Workplace Safety and Health (TOC) who have been working with companies to promote good workplace health practices. With Healthier SG, employers can work closely with your panel doctors to join Healthier SG and to continue providing regular and proper screenings for employees, provide healthier canteen food, physical activity programmes, mental well-being programmes and better work-life balance. We also urge employers to play their part in making sure those eligible are all part of Healthier SG. By promoting good health, employers will have more productive and happier employees, which is good for businesses. Second are our community partners. Senior Parliamentary Secretary Eric Chua has shared about MCCY’s efforts to mobilise the community to foster social cohesion, promote health and develop a strong partnership with family doctors. Dr Tan Yia Swam also suggested the need to have activities that cater to different segments of population and their varied interests.”
“Essentially, the idea is that healthcare needs to go beyond treating sickness in hospitals and clinics, but creating health in homes and communities. In other words, health is not just relevant to patients who have fallen sick. Health is for all. And that is why we now regard the healthcare system as three inter-linked systems. If I may briefly recapitulate. Ms Janet Ang has just explained this earlier. First, we have the acute care system, which is essential in ensuring that those who are sick get treatment. Second, the population health system, which we are building up through Healthier SG, and we are mobilising all our family doctors and GPs to focus on preventive care that is anchored in the community. The third system is the aged care system. The default for aged care cannot be nursing homes or seniors living alone with no social support. In other countries, loneliness and social isolation of seniors have become an epidemic. We also see this happening in Singapore. I think it is one of the reasons why length of stay has gone up, especially after COVID-19. If we can do this right, I think we can do what Mr Yip Hon Weng suggested – integrate care across medical and social realms. And we need to urgently step up this whole-of-society efforts to enable our seniors to live their golden years in dignity, age actively in their community with their friends and family, involve them in activities including training programmes, like what Mr Mark Chay has suggested. And if they wish, leave well in a family environment surrounded by their loved ones. So, this aged care in community is the next major area of work in healthcare. To make Health for All possible, we need the contribution of every stakeholder, public or private.”
“Recently, a well-known Chinese infectious disease expert, Dr Zhang Wen Hong, after he observed how life in China has gone back to normal during the May Day Golden Week, he wrote a blog post and he said, “It was as if nothing had happened, yet everything has happened”. In Chinese, 一切都没发生，一切都已发生. It was a rather poignant expression of the post-crisis state of mind which may be relevant in Singapore and relevant to today’s debate. We do not want to hang on to and relive the crisis. We need to walk out of the shadows, put it behind us and look into the future. And yet so much has happened. The experience and lessons learnt will reshape the way we look at healthcare and the way we look at inter-agency collaboration. Those cannot be forgotten and go to waste. So, I share Members’ hope that while the crisis may be over and peace time workload has resumed, it cannot be business as usual. We should usher in a new era of even tighter inter-agency collaboration. And this is especially relevant for healthcare for two reasons. Number one, as I have explained, ageing is probably the biggest social transformation for Singapore in the next 10 years, as we become a “super-aged” society. This will have implications across multiple policy areas – in employment, in our competitiveness, retirement adequacy, urban planning, education and, of course, healthcare. It will draw Ministries together to work in concert. Second, post COVID-19 crisis, we have decided that the conditions and timing are right for us to effect a major healthcare transformation, building upon all the work that was done in previous years. I have explained in this House why and what we are doing in this transformation.”
“Third is recruitment, which I have explained before. I think although it is very competitive, Singapore continues to be an attractive location for foreign nurses to want to come to Singapore. The healthcare profession continues to be quite attractive to our locals as well. Today, one in 25 students will join nursing and I cannot hope for more. That is not bad at all considering the number of options they have. So, I think we are getting our fair share of local talent and we are competitive in hiring foreign nurses as well. But of course, I hope the House, having raised all these issues, will support the necessary steps that we need to take in order to recruit local as well as foreign nurses. Let me come back to the substance of the Motion, which is really why we are here – and it is an important Motion, urging a whole-of-Government approach to support healthcare, even after the COVID-19 crisis has passed. Our Public Service has a long history of inter-agency collaboration. But COVID-19 was special. It was a period when we witnessed the tremendous potential of inter-agency cooperation, united in a common objective to overcome a national crisis. If you look at our schools, they kept education going, shifted to home-based learning only for a couple of months. Our economic and social agencies worked together to support businesses and workers. Various agencies got together to set up quarantine facilities, testing and community care facilities. I cannot emphasise enough how much that meant to the hospital system, which would have, otherwise, borne the full brunt of the pandemic and we would have likely collapsed.”
“There were no more community activities, which actually is so crucial to keep them healthy. So, with social isolation, their health deteriorated. And then, when they get infected, they stay in the hospital for very long. The 15% increase in utilisation alone explains why we have a crunch now. And it is happening not just in Singapore. It is happening all over the world. Every country is facing a crunch in their beds. All of us agree we must have redundancy but all of us are facing a crunch, including and especially in OECD countries, despite their higher bed to population ratio. So, what do we need to do? First, catch up on the capacity. Many of our projects have been delayed due to COVID-19. We have to catch up but some things cannot be rushed. We just have to implement them. So, sometime this year, the Integrated Care Hub at Novena will open. It will add a couple hundred beds. The Woodlands Integrated Health Campus, by end of the year, may have one ward open; hopefully, next year more wards will open. And then we have the redevelopment of Alexandra Hospital and the eastern regional hospital Assoc Prof Jamus Lim talked about. We have the redevelopment of SGH campus that is ongoing. Although it is an existing campus, it is a significant redevelopment with many more beds added. Two, is to build more Transitional Care Facilities (TCFs), which I have explained before. It is actually very useful. Today, in our hospitals, there is still quite a number of seniors who are staying there not because of medical reason, but because of social reasons. TCFs have rehabilitative care and good medical facilities, and we can allow those who are stable to move to TCFs, thus freeing up acute beds. So, we are building that up quite actively.”
“So, their lifetime benefits need to be funded from the MG and PG Funds. But the Government will continue to regularly review the adequacies of these two Funds. Third issue is healthcare capacity that Assoc Prof Jamus Lim just raised. We agree that 80%, 85% occupancy rate is probably ideal. And you do not need an engineer to conclude that you must have redundancy in your system. It is not a new concept. It is something that I think we all agree to. But why is there a crunch now? Of course, there will be crunch during COVID-19. It was an emergency, it was a crisis of a generation. I do not think any country or any system can plan for that kind of capacity to cater to a crisis. But post-crisis, we do have a crunch today. I explained in this House before, I think it was during the White Paper debate on COVID-19, that the main reason for the crunch is that within a very short span of two years, you suddenly see average length of stay going up significantly. It used to be six days. Now, it is 7.1 days. [Please refer to "Clarification by Minister for Health", Official Report, 10 May 2023, Vol 95, Issue 104, Correction By Written Statement section.] This means your utilisation has suddenly gone up by 15%, over two years, post-COVID-19. It is a post-COVID-19 phenomenon. I think in time, researchers and clinicians will study why. But there could be a few hypotheses. One is that there is some kind of immunity debt – more old folks are getting infected with viruses, bacteria post-COVID-19. And when they do, they fall quite sick and they actually stay in hospitals for quite long. And that pushes up average length of stay. Another reason, which is a possible one, is that during COVID-19, too many of our seniors decided to hide at home, afraid to come out.”
“In the decade after 2010, our nominal Government health expenditure tripled. In the following decade, that means up to 2030, it is expected to triple again. So, triple and triple – it means an increase by nine times over 20 years. This is driven by an ageing population, who is also getting sicker. MOH already has the second largest Ministry budget, after Ministry of Defence (MINDEF). In the coming years, our challenge is not to spend more, but to ensure we do not go the way of many OCED countries, with the healthcare fiscal burden spiralling and escalating out of control. Finally, it is therefore much better that we continue our sensible and practical approach: have different layers of safety nets – subsidies, MediShield Life, which I thank Prof Hoon Hian Teck for explaining why it is necessary, MediSave and MediFund. This is the S+3Ms approach, which has worked quite well. We now combine this with a very important strategy in Healthier SG and our effort to enable ageing in communities, so that we can avoid sickness and reduce our disease burden even as our population ages. Mr Leong also talked about the seemingly large balances in the Pioneer Generation (PG) and Merdeka Generation (MG) Funds, and concluded that more subsidies can therefore be given to PG and MG members. His understanding is misplaced. Both Funds were sized based on the projected lifetime cost of the benefits, and accounting for inflation and interest accrued. To illustrate, the oldest and youngest MG member is about 73 and 64 years old. PG members will be at least 10 years older, with the youngest at 74 years old now. They still have quite a bit of runway ahead of them and we do expect many of them to live until 90 or 100 years old.”
“Yet, US and UK continue to face high incidence of chronic illnesses, high obesity rates and their expected lifespans are lower than Singapore. I was inspired by Mr Eric Chua and also checked out ChatGPT: "what do you think of the US system, what do you think of the UK system". Actually, it is quite well-known. In the US, healthcare is very expensive, despite spending 17% of their GDP. In the UK, the National Health Service (NHS) is crushed down by the workload. The waiting times are far longer than in Singapore, despite spending 10% of their GDP on healthcare. We have delivered good health outcomes given what we are spending. The second point, for whatever we are spending, we are able to make healthcare affordable for middle to lower-income groups. Today, about seven in 10 of Singaporeans in subsidised wards do not have to pay any out-of-pocket expenses. Eight in 10 pay less than $100 cash out-of-pocket; nine in 10 pay less than $500 in cash out-of-pocket. So, when Mr Leong asked the Government to spend more to lower out-of-pocket expenses further, he really meant to channel resources to unsubsidised patients, that is, those staying in A class wards or private hospitals. This is where the big bucks and the big expenditure are, and it will push our healthcare expenditure and spending to the levels of the OECD countries. Third, while Mr Leong asked Government to spend on healthcare, he failed to mention that Government expenditure ultimately has to be raised from the people through taxes. Mr Leong had not made any mention of where PSP will get the funding from. Fourth, the fact is that we are already spending more and more on healthcare. We do not need Mr Leong's urging. Healthcare spending is going up.”
“I do expect some to write to the Ministry to complain to me why do our supervisors and nurses act this way. We will be very careful. We will make sure that we will effect the consequences only for the most genuine cases and care will always be prioritised. Should I get a complaint, I will back our ground supervisors; and healthcare workers. Should it comes to this Chamber, because I think some of the residents will complain to their MPs: "why MOH act like that, can they appeal against this, they disengaged with me and I was just demanding good service." When the time comes and test comes, I hope to have the support of this House. We will be careful and we will do it judiciously if we ever have to disengage an abusive patient or next-of-kin, so, I seek the support of the whole House. Let me move to healthcare financing. Mr Leong Mun Wai made a few points yesterday. I am glad he agreed with our policy to use MediFund to support low-income families. The MediFund disbursed $164 million in FY2021, not $100 million as stated by Mr Leong yesterday. The Government further topped up MediFund by $1.5 billion in FY2023. However, Mr Leong also delivered a political statement yesterday. He declared the Progress Singapore Party (PSP)'s position that Government ought to spend more in healthcare like other OECD countries. Let me make a few points in response. First, it is widely known that spending more on healthcare does not mean better health outcomes. Most health economists will know that. Since Mr Leong is benchmarking ourselves against OECD countries, let us just cite two examples, US and UK. They are spending about 17% and 10% of their GDPs on healthcare, compared to us, 4%.”
“We are doing what we can to alleviate the situation at the hospitals post COVID-19. It will take time. But heavy workload cannot be an excuse for anyone to physically or verbally abuse our healthcare workers. Mr Raj Thomas mentioned that another reason is expectations are high and when it is not met, people get upset. It is totally all right to have expectations and to demand good service. By all means, do that, but there is no need to abuse healthcare workers should service delivery fall short. I should say that notwithstanding the heavy workload and the occasional abuse and harassment, most healthcare workers I have met – and I hope it is not just because I am Minister – remain positive, professional and passionate about their jobs. Ms Koh Fang Qi, for example, was a senior staff nurse in Khoo Teck Puat Hospital since 2015. She has now become a Nurse Manager. Over the years, she dealt with many abusive patients and next-of-kin, but she continued to calmly handle each one with empathy and became an expert in this field. Once, she witnessed a junior nurse being abused physically and verbally by the next-of-kin of a patient. So, she bravely stood up, managed the situation and escalated the incident to the authorities for follow-up and remained calm throughout the incident. And despite all these challenges, you can tell she loves her job. She continues to treat patients and their loved ones with care and kindness. She constantly shares her knowledge and experience dealing with abuse cases with her colleagues. The test of zero-tolerance policy is in the second half of this year when we have guidelines and supervisors to disengage abusive patients or most likely, their next-of-kin.”
“I am glad many MPs spoke up against abuse and harassment of healthcare workers. This is one of the top issues in the minds of our healthcare workers. I think, in general, I would say, to be fair, the regard and appreciation for healthcare workers has generally gone up amongst our society post COVID-19. And for the majority of the public, they are appreciative and respectful towards our healthcare workers. Those who physically assault, threaten or hurl vulgar and condescending remarks against healthcare workers, I think is really a small minority. But because the acts are so egregious, it feels like a big thing. And it is a big thing. We cannot tolerate such behaviour. This is unfair to healthcare workers and unfair to the great majority of the public who respect our healthcare workers. As Members know, MOH has recently announced a zero-tolerance policy against abuse and harassment of healthcare workers. And we intend to translate this to procedures and guidelines for all our healthcare institutions in the second half of this year. I will not elaborate what it entails as I have spoken about this before. But since the announcement of the policy, I have noticed some reactions. First and the best is that most members of the public support the policy. Second, a few raised concerns that there were occasions where healthcare workers did not behave appropriately. We acknowledged that. There are always a minority of black sheep. But there are appropriate channels to report such matters and the hospital management will look into them seriously. Some have said that one of the root causes of abuse is the heavy workload at the hospitals and long waiting times, and therefore, we should address that first.”
“These are some things we need to address to make sure we are competitive. Of particular urgency now is to actively recruit both local and foreign healthcare workers to boost the workforce, given the rising attrition suffered in the last two years due to the COVID-19 pandemic. For local healthcare workers, we are looking forward to the inflow of the latest batch of polytechnic graduates who, I think, just graduated and they will be joining the workforce and our hospitals soon. Mr Abdul Samad had feedback about interns not getting paid for their internships. I would like to clarify this. All Institute of Technical Education (ITE) and polytechnic nursing students are given allowances for their internship attachments. However, for certain healthcare-related courses, such as Biomedical Science, allowances are an arrangement left between employers and the school to set, and practices can differ across health clusters. But given the Member's feedback, let us look into the specific instances where our public health institutions do not offer internship allowances. As for foreign healthcare workers, it takes time to conduct selection and examinations overseas and for the shortlisted candidates to move here. They have so far been trickling into Singapore, but we hope in the second half of the year, more of them will start to come onboard. And for those who have performed well and are committed to Singapore, we welcome them to apply for permanent residency (PR). A few Members of Parliament (MPs) have suggested granting PR status to their dependents as well. We thank the MPs for their suggestion. This is worth serious consideration. For everyone in our healthcare workforce, we will need to ensure their well-being.”
“But before I talk about these priorities, let me first address three specific issues on healthcare that were raised by Members: manpower, financing and as Prof Jamus Lim just raised, healthcare capacity. It is last minute, but I will respond to you. First, manpower. At the heart of any healthcare system are the workers. Several Members of Parliament such as Dr Tan Yia Swam, Ms Janet Ang, Dr Wan Rizal, Mr Gerald Giam, Mr Abdul Samad and Mr Raj Joshua Thomas have spoken about the issues confronting them. We have to support healthcare workers as much as we can. The NTUC and Healthcare Services Employees' Union (HSEU) have been fervent supporters for the welfare of healthcare workers. Ms Thanaletchimi, President of HSEU, used to be a Nominated Member of Parliament in this House and spoken about it many times. The partnership between the People's Action Party (PAP) Government and the Labour Movement is a strong institutionalised arrangement, and MOH looks forward to our continued partnership in advancing the welfare of our healthcare workers. Part of this work, very importantly, is to regularly review remuneration of healthcare workers, to ensure that we recognise their contribution and to make sure that remuneration is competitive. Mr Leon Perera suggested some benchmarking. We will internally benchmark not just the pay but also taxes – because it varies across countries – and also the living conditions and rental. But I suggest we do this internally, because competition is now so tough, you do not want to benchmark and then show everybody. But we certainly want to benchmark and make sure we are competitive. Right now, in fact, rental becomes a problem for foreign nurses to come to Singapore and out of pocket expenses are high.”
“Mr Deputy Speaker, I rise in support of the Motion. I want to thank Dr Tan Yia Swam, Dr Shahira and Mr Abdul Samad for tabling this Motion, and pointing out passionately that health is everyone's concern, and it is only with everyone’s action that we can improve the health of individuals and our nation. I would also like to thank all the Members of Parliament and representatives of Ministries who have, through your speeches, supported the various health-related policies and also given suggestions for improvements. This includes Healthier SG, our preventive care strategy; championing the well-being of our healthcare workers; developing more centralised IT systems; group buying of drugs with private doctors; ensuring that healthcare remains affordable for everyone and so on. Members have also raised a range of challenges and frustrations of the healthcare system. Indeed, healthcare is probably one of, if not the most, complex public service systems in our whole public service. It will be unrealistic of me if I were to say we have a solution to every problem that you have raised. Even if we have, theoretically, it is not practical to implement them all. We will need to work within the budget and time resources we have, our management bandwidth to plan and effect change, our people's appetite to accept changes. We have to improve step by step. What we will do is to prioritise the areas that we can make the most meaningful changes, where there is bang for the buck and focus on them. This is what we are doing. So, we are focusing on expanding our healthcare capacity, which includes manpower, rolling out Healthier SG, and building up an effective system for ageing in community. Together, they represent a major transformation of our healthcare system in the medium-term.”
“The data for heat-related illnesses is available on an annual basis. The number of hospitalisations for heat-related illnesses have remained generally stable over the last 10 years and has most recently decreased from 71 in 2021 to 47 in 2022. The Ministry of Health will work closely with the Ministry of Sustainability and the Environment to raise public awareness on heat-related illnesses, particularly on preventive measures that can be taken by the public to reduce the risk of heat-related illnesses.”
“Ozempic and Wegovy contain Semaglutide and belong to the class of medicines called GLP-1 agonists. There are three GLP-1 agonists registered as Prescription Only Medicines (POMs) in Singapore to treat diabetes and weight management in specific patient populations. Doctors will assess patients' conditions and prescribe according to clinical guidelines. As POMs, Ozempic and Wegovy can only be obtained from a doctor or from a pharmacist with a prescription from a doctor. While social media trends have marketed Ozempic and Wegovy as quick fixes for weight loss, it is important that consumers know the risks associated with these medicines. Like all POMs, there are considerable risks involved if a medication is used inappropriately, without a prescription and without clinical supervision. The Ministry of Health works closely with healthcare institutions and drug companies to monitor local and international usage patterns to minimise potential disruption to treatment and to ensure drug resiliency.”
“There are, currently, 154 Active Ageing Centres (AACs) – previously termed as Eldercare Centres – which are sited close to and can support around 53% of the total senior population. By 2025, the Ministry of Health and the Agency for Integrated Care (AIC) aim to grow this number to 220 AACs that will cover an estimated 80% of the total senior population. The estimated number of seniors aged 65 and above who live alone in Singapore in 2022 was 79,000. In FY2022, the Silver Generation Office (SGO) under AIC engaged more than 230,000 seniors through their outreach efforts, of which about 27,000 were living alone. SGO will prioritise seniors who are living alone for their outreach efforts this year and link them up with AACs and other community partners for follow-ups and assistance, such as regular home visits and check-in calls.”
“For 2022, elective admissions form around 23% of total hospital admissions in the public hospitals. In general, the proportion of non-resident foreigners1 who are admitted to our public hospitals constitutes less than 0.5% of total admissions. To manage bed capacities better, especially when the public hospitals anticipate a surge in emergency admissions, hospitals may temporarily defer non-urgent electives. Patients requiring urgent medical care, including those requiring urgent elective procedures, will still be prioritised for admission.”
“While the Ministry of Health provides guidelines on MediFund assessment, such as means-testing and amount of assistance provided, the MediFund Committees have full discretion to deviate from these guidelines and take into account other factors and family circumstances when assessing applications. There are no guidelines on the number of MediFund recipients per household.”
“The Rare Disease Fund (RDF) raised $4.9 million in public donations in the calendar year 2022, with $2.3 million contributed by foundations, $1.3 million from companies and the remaining from individuals and others. Together with the Government's $3-to-$1 matching grant, this brings the total funds raised by RDF in 2022 to $19.2 million. The RDF Committee has been actively reaching out to potential donors and conducting publicity efforts to raise awareness of the Fund. It will consider stepping up efforts in this area.”
“Thank you. The answer to both questions is yes. VIFAP applications have to be based on scientific and medical assessment. That is why we have an independent group of doctors who assess the VIFAP applications. And of course, if there are new understandings and/or new findings establishing the causal links of adverse reactions versus vaccines, old cases will be relooked at.”
“This is the recommendation of both the Expert Committee on COVID-19 Vaccination as well as Health Sciences Authority. Specifically on myocarditis, this is a known illness associated with infections, including those by the COVID-19 virus. It can also occur, albeit at a lower probability, when taking COVID-19 vaccines, and it tends to affect young males aged 12 to 30 years old. The local incidence of vaccine-related myocarditis in this age group is low, at about one in 100,000 doses, and it is even lower at 0.1 in 100,000 doses with the latest bivalent mRNA formulations. As of 27 April 2023, out of more than 17 million COVID-19 vaccine doses administered in Singapore, there were 160 reports of myocarditis and pericarditis linked to the vaccines. Of these cases, 32% had initial symptoms reported within one day of vaccination, another 20% reported within two days and another 24% reported within one week. The majority of cases of myocarditis from vaccination are generally mild and respond to treatment. As of 27 April 2023, about 340 Vaccine Injury Financial Assistance Programme (VIFAP) applications are cardiology-related. Eighty-one of the applications were approved and financial assistance has been extended to the applicants. Myocarditis was picked up as a safety signal and reported in June 2021. A look-back at VIFAP applications from before June 2021 did not identify anyone with myocarditis. At present, COVID-19 vaccines are not known to be causally associated with any other cardiac conditions other than myocarditis.”
“The current Omicron variants are highly infectious and we no longer impose social restrictions, which means that even if you do not go out of your home, it can find its way to your home through visiting family members or anyone you may come into contact with. So, it is much better to get the vaccinations and consider going out from time to time, meet friends, have coffee and join us for group exercises. It is, actually, good for your health. Second, some seniors are also concerned about the risk of side effects if they take further vaccination shots. To date, hundreds of millions of vaccine doses have been administered globally. The incidence of severe adverse reactions is very low in Singapore, at about seven in 100,000 doses, and it is even lower at one in 100,000 doses with the latest bivalent mRNA formulations. These severe adverse reactions are mostly myocarditis, anaphylaxis, serious allergic reactions and most resolve after some treatment. So, let me summarise what is the deal. If you belong to a vulnerable segment of the population and choose not to take vaccinations, there is a significant chance that you will get infected at some point by the Omicron variant, which can cause severe illnesses that require hospitalisation and oxygen supplementation. If you attain minimum protection and keep your vaccination status updated through boosters, the chance of developing severe illnesses will be significantly reduced if you are infected. There is an added risk of developing a severe adverse reaction after vaccinations but that is very low, especially with the new bivalent formulations. In other words, the benefits of COVID-19 vaccines continue to far outweigh the risks and you should keep your vaccination updated.”
“5% of them developed severe illnesses and have to be hospitalised. For those with minimum protection, that is, three doses of mRNA or Novavax, or four doses of Sinovac, the rate of severe illnesses was about 4%, half that of those who are unvaccinated. For those with minimum protection and kept their vaccination status up-to-date – that is, most of them got themselves boosted and their last shot was less than 12 months ago – the incidence rate of severe illnesses is even lower at 3.4%. So, it is 7.5%, 4% to 3.4%. Hence, if you are aged 60 and above or are vulnerable due to underlying illnesses, please get your minimum protection of three shots of mRNA or Novavax, or four shots of Sinovac as soon as possible, if you have not already done so. And if you have minimum protection, please take a booster every year. This will enhance your protection against the Omicron variants and minimise the risk of being infected and developing severe illnesses. Unfortunately, despite the benefits of vaccinations, the proportion amongst seniors aged 60 and above who are updated with their vaccinations have been declining. From 58% at the beginning of this year, it has slowly declined to 50% currently. Because once they pass their 12-month mark, they are no longer updated. So, every day, every week, that number is dropping. Now, it is only 50%. So, if this trend continues, our resilience against COVID-19 will weaken over time, making ourselves vulnerable to the virus again. Falling vaccinations, even amongst the vulnerable segments of the population, is due to a few reasons. First, there is a common thinking amongst seniors and amongst the public, "that I seldom go out of my home and hence, I do not have to take the vaccinations". This is not recommended.”
“Many members of the public, in fact, are not even aware that we are undergoing a COVID-19 infection wave. This is what we have planned for when we transited to DORSCON Green and it is another important and noteworthy milestone. However, we can maintain this public health posture, provided we continue to take our COVID-19 vaccinations. It is of critical importance that we understand that COVID-19 did not become a milder disease just because we transit to DORSCON Green. WHO no longer declares COVID-19 as a public health emergency of international concern, but it also added that it does not mean that COVID-19 is no longer a threat. In fact, it remains a dangerous disease. But our population resilience has strengthened due to vaccinations, boosters and safe recovery from infections. These are the reasons that enabled us to treat it as an endemic disease. So, it is of critical importance that we continue to take vaccinations, based on MOH's latest recommendations, to keep the level of our resilience high. To illustrate what I just said, let me share some data collated over the first four months of 2023. Seniors aged 60 and above continue to be more vulnerable to developing severe illnesses if infected with COVID-19. But amongst these seniors, the incidence of severe illnesses – that is, the infected persons need to be hospitalised or require oxygen supplementation – differs, depending on the vaccination status of the individuals. So, I am going to cite some incidence rates of severe illnesses, but please bear in mind what I am about to cite are over-estimates because, these days, cases are under-reported. So, these are over-estimates. But the point in the comparison is still the same. For those seniors 60 and above who are unvaccinated, about 7.”
“My response will also cover the matters raised in the written question by Mr Shawn Huang, which is scheduled for a subsequent Sitting. I would invite the Member to seek clarifications, if need be. If the question has been addressed, it may not be necessary for him to proceed with the question for a future Sitting. Let me, first, give an update on the current COVID-19 infection wave. By all indications, the wave peaked about two weeks ago, at an estimated 4,000 infection cases per day. It has since subsided to about 3,000 infections per day. The key strains circulating are XBB.1.9, XBB.1.16 and XBB.2.3 – each accounting for about a quarter of all infections. The World Health Organization (WHO) has re-designated XBB.1.16 from being a Variant under Monitoring to a Variant of Interest. There is however no evidence, internationally or locally, that any of the variants have a clear growth advantage over the others or can lead to more cases of severe illnesses. The Ministry of Health (MOH) will continue to monitor the characteristics of the various strains. There are now over 300 patients infected with COVID-19 in our hospitals. It is a fraction of the hospitalisations at the peak of the pandemic. For the Delta wave, it was about 1,800. Now, it is about 300-plus. Nevertheless, that added a significant workload to our hospitals. We should also see the number of COVID-19 hospitalisations falling in the coming week as the infection wave subsides. This is the first infection wave we have encountered after transiting to Disease Outbreak Response System Condition (DORSCON) Green and treating COVID-19 as an endemic disease. We have weathered through it, without imposing any further public health measures.”
“Mdm Deputy Speaker, may I have your permission to answer Question Nos 5 and 6 together, please?”
“With COVID-19 being regarded as an endemic disease, it should be treated similarly as other infectious diseases. Hence, healthcare workers who are unwell should rest at home and be granted sick leave. For individuals who feel well but have tested positive for COVID-19, they are not required by law to self-isolate. Instead, they can work from home if possible, or return to work on-site with the necessary precautions, such as redeployment to non-patient facing areas.”
“The Bioethics Advisory Committee has also issued a draft advisory report and recommendations on the ethical use of big data and AI in human biomedical research on 2 May 2023 for public consultation. MOH will continue to study international best practices, consolidate and develop our AI governance framework.”
“Artificial intelligence (AI) is ubiquitous and being used in healthcare in Singapore. For example, it is used in JARVISDHL, a programme by SingHealth and NUS to prevent diabetes, hypertension, hyperlipidemia. It is the engine for SELENA+ (Singapore Eye LEsioN Analyzer plus) to diagnose diabetic retinopathy. It is also used for diagnosis and management of cardiovascular and chronic diseases. It is deployed in health apps for preventive care, as well as in pharmaceutical research. The Ministry of Health (MOH) is open to the use of AI technologies in healthcare where they are proven to be safe, clinically efficacious and cost-effective. With the rapid advancement of AI technology, we believe many treatments using AI will emerge. The challenge is to embrace and encourage them, while ensuring the safe adoption and deployment of AI in healthcare. To do so, we have progressively put in place safeguards over the past few years. The MOH’s AI in Healthcare Guidelines guide AI Medical Device (AI-MD) developers and implementers on the good practices they should adopt in rolling out such clinical services to patients. The Health Sciences Authority regulates multiple aspects of AI-MD development as part of its medical device registration process to ensure the quality, safety and efficacy of AI-MDs and requires continued post-market surveillance to ensure continued real-world effectiveness. MOH will be issuing an AI Governance Framework for healthcare that recommends detailed development and implementation-level good practices, such as risk prompts to help identify risks, and controls for risk mitigation.”
“Every year, a small number of patients are unfortunately afflicted with rare diseases. While treatments may be available for some rare diseases, they are often highly expensive. The Rare Disease Fund (RDF) was established in 2019 as a charity fund to provide financial support to Singapore Citizens requiring such treatments. It is managed by the RDF Committee, which comprises community representatives and is advised by a panel of medical experts. Eligible donations to RDF attract three-for-one Government matching and a tax deduction of 2.5 times the qualifying donation amount. Given the high cost of treatments and limited funds, RDF’s support is currently focused on rare diseases that are life-threatening and treatments that are required by the patients on a lifelong basis. Nonetheless, the Ministry of Health (MOH) recognises that with technological advancement, more novel and expensive treatments may become suitable for rare disease patients. MOH is currently working with the RDF committee to explore the coverage of some of such treatments, where appropriate.”
“Car seats come in a variety of makes and set-ups and, hence, public hospitals may not be able to practically advise parents-to-be on how to select a car seat and teach them how to install it, in the context of a prenatal class. Further, not every parent-to-be attends prenatal classes. In order to reach a wider audience, resources on the importance of infant car seats and car safety guidelines have been made available in HealthHub, as well on public hospitals’ websites. Parents-to-be are also reminded about the importance of infant care seats during their pre-delivery preparation at public hospitals and are encouraged to bring along an infant care seat for their newborn at discharge.”
“The Ministry of Health does not have detailed data on influenza cases per year. In the first four months of 2023, a total of 68 influenza-associated severe cases, including seven deaths, has been reported. Based on the National Population Health Survey 2021, about 32.4% of Singapore residents aged 65 to 74 had received influenza vaccination in the preceding 12 months. Adults who are at a higher risk of developing severe influenza infection and complications, namely, all persons aged 65 and above and younger persons with underlying illnesses, are strongly recommended to go for influenza vaccination. There has been no shortage of supply of influenza vaccines.”
“In the last five years, 23,700 Singaporeans have signed their Advanced Medical Directive (AMD) and 26,500 have made their Advance Care Plan (ACP). We encourage all Singaporeans to discuss their healthcare preferences with their loved ones and healthcare providers and document them through the ACP and AMD, so that their wishes can be honoured when they are unable to express them. We will amplify these messages through a nationwide campaign to be launched in the later part of this year. It will include roadshows, media and publicity efforts and a digital campaign on the importance of planning ahead and how to do so. To encourage uptake, we also launched the My Legacy portal in 2020, which serves as a one-stop portal for the public on end-of-life issues. We will continue to make it easier for Singaporeans to plan ahead.”
“The Serangoon Polyclinic is currently undergoing construction and is on track to open by 2025.”
“Magnetic Resonance Imaging (MRI) scans are needed for diagnosing conditions, such as tumours and inflammation. The more common MRI scans cost around $1,000 per scan. To make scans more affordable, the Ministry of Health (MOH) provides means-tested subsidies of up to 70% to patients at public Specialist Outpatient Clinics. Pioneer and Merdeka Generation seniors get additional subsidies covering 50% or 25% off their remaining bill respectively. In addition to subsidies, patients can offset their remaining bill by tapping on their MediSave for up to $300 per year for outpatient diagnostic scans, including MRI scans. Seniors aged 60 and above can withdraw an additional $300 per year from MediSave for MRI scans under the Flexi-MediSave scheme. Taken together, Pioneer and Merdeka Generation seniors would likely incur low, if not, zero out-of-pocket payments at public Specialist Outpatient Clinics. Patients who still face difficulties coping with their bills can approach Medical Social Workers to apply for financial assistance, such as MediFund. MOH commits that no one will be denied basic healthcare due to inability to pay. We will continually review our healthcare financing framework to ensure that healthcare remains affordable and accessible to the population.”
“The Ministry of Health provides funding for Medical Escort and Transport (MET) services which help frail seniors to attend medical appointments if they are unable to do so independently. MET capacity is generally sufficient, though with our ageing population, we will need more in the future. Hence, the Government provides grants to community care organisations, social service agencies and professionals, such as the Community Silver Trust and the Professional Capability Grant, for capability building. Providers can also tap on manpower recruitment and training initiatives under the Agency for Integrated Care. These include courses relating to safe management of seniors with mobility needs.”
“The number of residents aged 65 and above who live alone in Singapore is rising, from 58,000 in 2018 to 79,000 in 2022. This number is expected to continue to increase as our population ages and average household size decreases. The Silver Generation Office under the Agency for Integrated Care identifies seniors with needs or are at-risk, such as those who are living alone or are frailer. Silver Generation Ambassadors will visit them once a year and connect them with the relevant support or services. As for seniors identified to require social support, they are referred to the Active Ageing Centres (AACs) which provide a suite of services, including active ageing programmes, referral to care services and health-related initiatives. AAC befrienders reach out to them typically at least once a month. Other agencies, such as volunteers from the People’s Association and grassroots organisations or SG Cares Volunteer Centres under the Ministry of Culture, Community and Youth, will also reach out to seniors who may need assistance and befriending. Indeed, there will be seniors who decline assistance and choose to remain reclusive. Our experience is that if community partners continue to try to build trust and rapport, through check-ins and visits, we can eventually persuade them to take up care and support services when ready. Ageing in communities will be a major national initiative under the Forward Singapore exercise. We will step up, expand and deepen our efforts in this area. Details will be announced later in the year when ready.”