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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“When these two cannot prevent cases, the third lever – which is our healthcare system – will then have to manage; it has to catch the problem and then, manage it by treating and caring for infected patients who become severely ill. Let us take stock of the three measures. For SMMs, we have removed almost all restrictions, so that life goes back to the pre-COVID-19 normal. This is what all Singaporeans wish for and the whole point of treating COVID-19 as an endemic disease. Therefore, the Multi-Ministry Taskforce (MTF) has been very reluctant to re-impose SMMs, unless it is absolutely necessary. The second public measure, vaccinations. We have already covered the great majority – over 90% – of our population. Our vaccination exercise is ongoing, but this is largely to extend our coverage at the margins, namely, now, infants and very young children, and to keep vaccinations up-to-date for the others. So, we are just maintaining our immunity and resilience, now no longer able to achieve the kind of quantum improvement in resilience that we could achieve when we first started our national vaccination programme. That means that the burden of endemicity will fall disproportionately on the last public health measure – which is our healthcare system. That is why our wards and EDs have been very busy over the past year. The media highlighted it only recently, but really, our hospitals have been experiencing it for the whole year. I hope that as we enjoy our hard-fought freedom from COVID-19, we remember the toil and sacrifice of our healthcare workers – doctors, nurses, social care workers and so on. They are sacrificing and toiling away, in order to secure freedom and the state of endemicity for the rest of society.”
“Sir, during the Delta wave last year, our Intensive Care Unit (ICU) wards came under immense pressure. This year, as we encountered the Omicron infection waves – and we have had three so far – the pressure shifted from the ICU to the regular hospital wards, and by extension, the Emergency Departments, or EDs. This is because Omicron is a less dangerous variant, and our population has become more resilient due to vaccinations and safe recovery from the infections. Hence, over the past year, I have reported to this House on several occasions that although we did not let the virus overwhelm our healthcare system, our hospitals and, especially, the EDs, have been very busy. Why are the hospitals still experiencing heavy workload, given that life has gone back to pre-COVID-19 normal? The simple and fundamental reason is that the pandemic is not over. It may feel like it is over for most of us, but it certainly is not over for hospitals and our healthcare workers. We are learning to live with the virus, as an endemic disease. As I have explained to the House before, endemicity does not mean the virus disappears from our lives. On the contrary, it means that it is a permanent feature of our lives, circulating amongst us and we have to take personal precautions and implement public health measures in order to manage and live with it. What are these public health measures? Essentially, there are three. First, the safe management measures (SMMs) to restrict social interactions and, therefore, reduce viral transmission. Two, transmission still happens and, therefore, we do vaccinations, so that infections do not translate into many cases of severe illnesses and deaths.”
“Mr Speaker, Sir, with your permission, may I address Question Nos 2 to 10 in today's Order Paper, please?”
“The Centre for Climate Research Singapore (CCRS), under NEA, examines the impact of climate change on Singapore and develops scientific projections to inform policymaking. Through the Climate Impact Science Research Programme launched in July 2022, CCRS works with public agencies, research institutes and Institutes of Higher Learning to support research in key areas, such as how climate change affects the transmission of infectious diseases and the potential impact on Singapore. To prepare for the next pandemic, agencies adopt a whole-of-Government approach to detect emerging public health threats, including diseases that may arise due to climate change. Government agencies have pooled resources to strengthen their global and local surveillance capabilities for timely detection, joint risk assessment and reporting. This takes into account the latest available information, international developments and the outcomes of our own research in climate science.”
“The subsidies at Public Health Preparedness Clinics and polyclinics for the management of Acute Respiratory Infections (ARIs) were put in place during the early stages of the pandemic. This is to encourage persons who might be infected with COVID-19 to seek medical care promptly, so that cases can be detected quickly to prevent disease spread. Almost three years on, we are living with COVID-19 as an endemic disease, with the virus circulating in our community. Vaccination has significantly reduced the risk of severe illness when infected. The original objective of the subsidies for the management of ARIs is less valid today. Further, as we increasingly live with COVID-19, just as we step down safe management measures, we would similarly need to scale back the pandemic subsidy policy and revert back to the regular healthcare financing frameworks. Nevertheless, fully Government-funded swabs and oral antivirals continue to be provided to eligible symptomatic patients. Residents with ARIs will also continue to enjoy prevailing subsidies at polyclinics or Community Health Assist Scheme general practitioner clinics.”
“This question will be further addressed together with other similar Parliamentary Questions on 8 November 2022. [Please refer to "Long Waiting Times at Accident and Emergency Departments of Restructured Hospitals", Official Report, 08 November 2022, Vol 95, Issue 74, Oral Answers to Questions section.]”
“The top 10 medical consumables by volume used in public hospitals, excluding personal protective equipment and cleaning supplies are: (a) alcohol swabs; (b) body wipes; (c) ear thermometer probe covers; (d) medicine cups; (e) kidney dishes; (f) gauze swabs; (g) swab sticks; (h) cotton wool balls; (i) adult diapers; and (j) hypodermic needles. All of these consumables have unit cost of less than a dollar, with most having unit cost less than 10 cents. In general, MOH does not determine the prices of consumables charged by public and private hospitals. To improve transparency for patients, MOH publishes on its website bill size information of public and private hospitals. This allows patients to make comparisons on bill sizes so that they can make informed choices on where to seek medical attention. To continue to keep the cost of medical consumables low, MOH ensures that the demand of public hospitals is consolidated to achieve economies of scale and that the consumables are procured through an open and competitive tendering process.”
“The average cost prices of the top 10 drugs by spending in the public sector have remained relatively constant between 2017 and 2021. A few have dropped in prices. However, it is not meaningful to compare these prices with those in other countries as pharmaceutical companies differentiate prices according to the size and income levels of each market, as well as Government policies. We keep public sector drug procurement prices competitive through the efforts of ALPS – the supply chain agency for public healthcare – to aggregate demand and centralise procurement. This is complemented by the efforts of the Agency for Care Effectiveness to negotiate lower prices. To ensure patient affordability and access, we subsidise up to 75% for clinically- and cost-effective drugs. Pioneers and Merdeka Generation seniors will benefit from additional subsidies. Patients facing financial difficulties will be further assisted through MediFund.”
“We continue to review our efforts to ensure the decline of vaping. This will be addressed on 8 November 2022 together with similar Parliamentary Questions for a more holistic reply.”
“The model of nursing care differs between jurisdictions. In Singapore, our nurses develop competencies that empower them to lead in team-based practices, as well as to work in extended settings beyond ward-based care and into the community, where they are increasingly adopting trans-disciplinary roles which expand their scope of work to preventive and rehabilitative care. Senior nurses like nurse clinicians also conduct case management and care coordination to help integrate care services across settings, such as from acute hospitals to the community. Advanced Practice Nurses (APNs) can perform collaborative prescribing and other expanded clinician roles. Finally, nurses take on expanded roles in education and research, which go beyond direct patient care. Nurses are appraised holistically based on their different responsibilities within the local model of nursing care.”
“Medical social workers provide social, emotional and psychoeducational support for persons with epilepsy and their caregivers, like that for other individuals, as well as employment support through referrals to agencies, such as Workforce Singapore and NTUC's Employment and Employability Institute. For persons with epilepsy who also have cognitive difficulties or mental health issues, psychological support is also provided by psychologists who assess and advise on targeted areas and intervention. In addition, support groups and community organisations allow individuals with epilepsy, their caregivers and families to network, providing a platform for mutual support.”
“Since September 2021, the tripartite partners, MOM with NTUC and SNEF, had issued advisories to encourage employers not to request employees who self-test positive for COVID-19 but are physically well or have mild symptoms to obtain a medical certificate for the purpose of taking paid sick leave. Based on feedback from the tripartite partners, employers have, generally, heeded the advisories. Hence, MTF, on 15 October 2022, further urged employers not to require medical certificates from employees who have Acute Respiratory Infection (ARI) symptoms or common cough and cold. This reduces the pressure on our healthcare capacity and lowers the risk of transmission of infection within the workplace. As our population ages and disease burden increases, we have to ask ourselves if issuance of medicate certificates for common and minor ailments is the best way to use the scarce medical resources. We should review if the practice that has developed for COVID-19 should be extended to other illnesses with non-severe symptoms.”
“Eligibility for the Vaccine Injury Financial Assistance Programme (VIFAP) is determined by an independent clinical panel, who will consider: (a) whether the side effect is likely to be caused by vaccination or other factors, such as underlying health conditions; and (b) the severity of the side effect caused by the vaccination. A serious side effect is typically considered one that minimally required hospitalisation. Cases that were not hospitalised but require long-term follow-up, including that of skin conditions, are also reviewed for assistance on a case-by-case basis.”
“Under the Community Mental Health Masterplan, MOH works with various stakeholders, including the Agency for Integrated Care (AIC) and Social Service Agencies (SSAs), to reach out and provide mental health information and support to individuals, including seniors, in the community through the community outreach teams (CREST). As of December 2021, 68 teams have been set up and have reached out to over 510,000 persons. The Silver Generation Ambassadors engage seniors in the community through home visits and phone calls, including seniors who may be lonely or socially isolated. Seniors who exhibit signs of depression or are in low spirits are referred to mental health support service providers, such as CREST, for further assessment and intervention. The Health Promotion Board (HPB) also conducts mental well-being workshops known as "Balik Kampung" for seniors in the community. These workshops help seniors to keep socially connected and mentally stimulated to reduce their risk of developing mental health conditions, such as depression. The workshops also highlight tips on staying mentally well and share about resources available in the community so that seniors can seek help early, if required. Efforts are made to cater to seniors and caregivers who do not speak English as their main language. For instance, CREST conducts outreach in mother tongue or dialect to reach out to different target audiences. In addition, SSAs develop materials to better cater to the needs of their clientele groups. For example, Club HEAL has resources available in both English and Malay for both clients and their caregivers. MOH will continue to work closely with our partners to increase mental health awareness among seniors and ensure that the support and resources are relevant to their needs.”
“With our high vaccination and boosting rates, we have been able to overcome a few infection waves without overwhelming our healthcare capacity. After each wave, we have progressively stepped down safe management measures (SMMs) and resumed many social and economic activities. But the COVID-19 virus is still circulating globally and will continue to mutate. We must learn how to take necessary precautions and live with the virus. A big part of living with COVID-19 and the risk of transmission is to take our personal precautions and responsibility seriously, because the risk of infection is inherent in our daily activities. There are also various settings and activities, such as big meetings and conferences, social gatherings and parties, night life activities and events like Formula 1, which carry higher risks of transmission, but are part of the normal functioning of Singapore’s society and economy. It is, therefore, important for us to keep our vaccinations up to date to prevent severe illness and to practise social responsibility, such as isolating ourselves when unwell and wearing a mask when visiting a vulnerable senior or in a crowded place, to protect ourselves and the people around us.”
“A small number of patients are, unfortunately, inflicted with rare diseases every year. The treatments are often expensive, lifelong, with varying efficacies. Healthcare financing systems are not designed to support such treatments and, hence, the Government established the Rare Disease Fund (RDF) for these patients. It is a charity fund that provides long-term financial support for Singapore Citizens with rare genetic diseases. The Government tops up $3 for every $1 raised. It is overseen by an independent RDF Committee comprising community representatives and advised by a panel of medical experts which determines the medicines to list for coverage as well as the amount of financing support for each application. A key consideration of the Committee when evaluating applications is the effectiveness of the treatment in extending a patient's lifespan and improve their quality of life. This can vary across each rare disease, given their uniqueness and complexity. Further, given the limited size of the fund, the benefits have to be weighed against the cost of the treatment. For treatments that are supported, the Committee then determines the quantum of support. So, in effect, a tiered support model, as suggested by the Member, is in place. As more funds will be needed to enable more medications to be listed and conditions covered, we encourage members of the public to support RDF with their donations. Donations attract three-for-one Government matching and are eligible for a tax deduction of 2.5 times the donation amount.”
“Currently, about 17% of seniors living in private housing estates are within the service boundary of an Active Ageing Centre (AAC). With the expansion to 220 AACs by 2025, this figure is estimated to more than double. There is, currently, no AAC for the Serangoon Gardens private housing estate area, and MOH is in the process of expanding AAC service coverage to the seniors living in this area.”
“Over the last five years, there were 2,780 foreign-trained doctors newly registered in Singapore. Of these, 274 are, currently, on the Family Physicians Register, comprising 116 Singapore Citizens, 133 Permanent Residents and 25 non-residents.”
“MOH will continue working with our partner agencies to enhance and expand the suite of existing measures to curb the supply and demand for e-cigarettes. This will be addressed in the next Sitting together with similar Parliamentary Questions for a more holistic reply. [Please refer to "Upstream Preventive Strategies to Counter Misperceptions of Vaping", Official Report, 08 November 2022, Vol 95, Issue 74, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“This question has been addressed by the reply to Question 1 for oral answer on the Order Paper today.”
“Under Healthier SG, participating general practitioner (GP) clinics will receive an annual service fee for the time and effort taken to care for and manage each enrolled resident. This service fee will not be differentiated by nationality. At the same time, Singapore Citizens (SCs) and Permanent Residents (PRs) will receive an onboarding consultation and annual check-ins that are fully subsidised with the family doctor they are enrolled with. SCs will further receive fully subsidised nationally recommended health screenings and vaccinations. Foreigners are not eligible for these subsidies.”
“During recruitment, only doctors who graduated from the two recognised medical schools with at least three years of work experience in selected hospitals are considered. Applicants are interviewed by a panel of local clinicians to ascertain their clinical competencies; applicants are also required to produce a Certificate of Good Standing from the India National Medical Commission and testimonials from their workplaces. The Singapore Medical Council (SMC) conducts source verification on the applicants' medical qualifications before they are allowed to practise medicine in Singapore.”
“The Health Sciences Authority (HSA) approves cough syrups for sale only after they have been assessed to have met the stipulated international standards of quality, safety and efficacy. HSA assesses the clinical studies data and manufacturing and quality control processes. HSA also conducts checks to ensure that the manufacturers conform to international Good Manufacturing Practice standards. HSA requires manufacturers to test all batches of cough syrups sold in Singapore, including for levels of contaminants. HSA regularly inspects local companies that are licensed to manufacture, import or distribute medicines. HSA also conducts post-market surveillance, which includes risk-based product testing, and actions will be taken to stop the sale and supply or to recall cough syrups that may pose harm to patients. Anyone who supplies cough syrups that do not conform to quality and safety standards is liable to prosecution and, if convicted, may be imprisoned for up to two years or fined up to $50,000, or both.”
“The Government recognises the need to address the challenges of an ageing society, which is associated with a growing care burden and potentially more elderly caregivers. This will require a systematic approach. First, the Government has embarked on a Healthier SG strategy to encourage Singaporeans to lead healthier lifestyles. This will help delay the onset of frailty for all seniors. Second, the Government is undertaking further steps to empower seniors to live and age well in the community. For example, we will expand the network of Active Ageing Centres to enable seniors to come together to partake in activities, form strong social networks and tap on the community to look out for one another. These build on our existing support for seniors and their caregivers, including those who are elderly. Eldercare services, such as day and home care services, help to relieve the caregiving burden. We will also further ease caregiving costs by enhancing the Home Caregiving Grant in 2023, from the existing $200 per month to up to $400 per month. Seniors who had low incomes during their working years and now have little or no family support in their retirement may also be eligible for the Silver Support Scheme. For caregivers of persons with disabilities, they can look forward to initiatives under the Enabling Masterplan 2030 (EMP2030), which was launched by MSF in August this year. One recommendation included the piloting of Enabling Services Hubs (ESHs), which will enhance respite options for caregivers of persons with disabilities and enable better access to appropriate support and services. Caregivers in need of further assistance may approach the Agency for Integrated Care (AIC) for more information.”
“It is important to plan ahead to ensure our affairs are taken care of when we are unable to do so ourselves. To do this, we can make our Lasting Power of Attorney (LPA), Advance Care Plan (ACP), Advance Medical Directive and wills early. While next-of-kin are often involved in making these decisions, seniors who do not have suitable next-of-kin can get help from professionals or other facilitators. More information is available on the My Legacy portal. The My Legacy portal is a whole-of-Government initiative that was launched in 2020 to help Singaporeans plan ahead. It offers comprehensive information and services on legacy-related issues, such as life planning, end-of-life care, post-death matters and estate settlement. To encourage the uptake of LPA and ACP, there is an LPA-ACP bundled tool which enables individuals to draft both instruments in one sitting. Individuals can retrieve and share these important documents through the My Legacy Vault for easier future reference. To increase awareness, workshops promoting life planning via My Legacy are conducted at Active Ageing Centres. MOH and MSF have also been conducting outreach at community touchpoints, such as public libraries, faith-based organisations and community centres.”
“We are encouraging Singaporeans who study medicine in recognised overseas universities to return home to contribute to our healthcare system. The Pre-Employment Grant (PEG) was introduced in 2010 for this purpose. In recent years, an average of 120 students have been awarded PEG annually. The median grant amount is about $80,000 per student over two years. The number and percentage of successful applicants vary from year to year, depending on each year’s applicant pool and hiring demand among the public healthcare institutions. All applicants are assessed holistically, based on a range of factors, including their overall academic performance, professionalism and commitment to serve in the public healthcare system.”
“Until March 2022, MOH facilitated the temporary deployment of around 900 aviation crew from the Singapore Airlines Group as Care Ambassadors in our healthcare institutions. Our aviation crew brought to the table strong service and communication instincts, which are key to effective patient care. Their contributions helped alleviate the manpower tightness in healthcare institutions during the pandemic, allowing our nurses and other healthcare staff to focus on more complex clinical and care-related work. Our experience with the Care Ambassadors reminds us that, with the right training, it is possible for individuals from other sectors to make meaningful contributions to healthcare. This is something MOH has been doing and we will continue to invest in mid-career training pathways for individuals interested in making a career switch into support care.”
“The disruption to the electronic medical records system on 29 September 2022 was the result of a software error in the firewall of a backup data centre. The root cause has been fully rectified with improvements to the network and disaster recovery design. We will upgrade systems when this is assessed to be necessary. We are also reviewing our downtime and business continuity processes to minimise the impact during outages.”
“For example, the Community Intervention Teams (COMIT) provide assessment and psychosocial therapeutic interventions to individuals, including seniors, with mental health and dementia needs. Family Service Centres (FSCs) also provide case management and counselling support to low-income and vulnerable seniors, to help them with issues, such as family, financial and emotional difficulties. There are services to support crisis intervention. For instance, hotlines, such as the Samaritans of Singapore (SOS) Hotline and the Institute of Mental Health (IMH)'s Mental Health Helpline, provide counselling and self-harm prevention resources, as well as crisis support. MOH will continue to work closely with our partners to develop community resources and build capabilities to better support at-risk seniors.”
“MOH does not keep track of the overall prevalence of elderly self-harm cases in Singapore, but the number of elderly self-harm cases seen at our public acute hospitals was stable for the last five years at around 10 annually. The circumstances of elderly self-harm cases can be complex and multi-faceted. MOH, together with other Ministries, adopts a multi-pronged approach to provide support for elderly at risk of self-harm: upstream prevention, proactive outreach and professional support and crisis interventions. In upstream prevention, MOH builds public awareness among seniors on the importance of mental well-being. For example, under the "Live Well, Age Well" (LWAW) programme, the Health Promotion Board (HPB) conducts healthy ageing workshops. These workshops include psychosocial modules that equip seniors with knowledge and skills to maintain their mental well-being and provide information on where to seek help if needed. These programmes are rolled out within the community, such as in Community Clubs, and can also be accessed virtually. To support vulnerable and socially isolated seniors, befrienders from the Active Ageing Centres (AACs) proactively reach out to these seniors through regular home visits and check-in calls. The Silver Generation Office (SGO) complements AACs by conducting targeted outreach to seniors who are living alone or are frail. Together with the Agency for Integrated Care (AIC), MOH has also set up Community Outreach Teams (CREST) to reach out to seniors with or who may be at risk of depression or dementia, to provide mental health information and education and basic emotional support. Seniors who require care and support are referred to the appropriate services.”
“The answer is yes. Once you reach the booster stage, it is best to ignore your infection. Now that we have hybrid immunity from our vaccination as well as infection, there are many individuals who hardly have any response or symptoms after they are infected. So, I think it is best not to count infections. Take our boosters and take our jabs diligently.”
“I thank the Member for that question. It is a very common question we face on the ground. I meet so many people that I have to repeatedly answer this question. The answer is yes, five months after their second booster, they are recommended to take their bivalent vaccine. As I had explained earlier, we have moved to a new system where we have stopped counting the number of booster shots we take. We are living with the COVID-19 virus. So, what we are recommending now is: one, please attain your minimum protection, which is, three doses of an mRNA vaccine; and two, beyond that, take an additional latest vaccine five months after your last shot and no longer than 12 months – so, five to 12 months. Essentially, for most people, it works out to taking a booster shot every year. So, for our residents who are aged 50 and above, please advise them. I understand there has been some confusion. Some people are mixed up over bivalent and the second booster – which all have the concept of two in it. If you use vernacular languages, some of them are even more confusing. We are thinking of some simple publicity, simple graphics, which we intend to use advertising space to communicate and communicate clearly to the public in the next few days.”
“Vaccination Centres (VCs) and Joint Testing and Vaccination Centres (JTVCs) are chosen based on their proximity to high population density areas, good accessibility and availability of the venue to support vaccination operations over a sustained period of time. Currently, we have 11 JTVCs and VCs and, together with our network of 221 participating Public Health Preparedness Clinics and 20 polyclinics, they provide sufficient convenience and access to vaccinations. But as demand changes, we will continue to review the adequacy of this network.”
“Mr Speaker, Sir, my response for Question No 1 will also address the Parliamentary Question for written answer raised by Mr Leon Perera in today’s Order Paper and a similar question raised by Assoc Prof Jamus Lim1 for a future Sitting. A couple of the questions have been overtaken by events. Nevertheless, I thought it would be useful to answer them and take some supplementary questions. We have started using the bivalent Moderna/Spikevax vaccine on 14 October 2022, and there is another bivalent vaccine – the Pfizer-BioNTech/Comirnaty – which is expected to be available by the end of this year. Bivalent vaccines provide better protection against newer COVID-19 variants compared to the original vaccines and we recommend individuals who are eligible to take it. We are prioritising persons aged 50 and above for the additional booster dose with the bivalent vaccine as they are at higher risk of severe disease from infection. We are planning to invite those aged between 18 and 49 for vaccination later in the year as we secure more supplies. And I hope we will secure them in a matter of weeks. Those who are eligible and have recently recovered from a COVID-19 infection are recommended to receive the bivalent vaccine three months after the infection. This is a very common question. If you are infected, wait three months and you can take the bivalent vaccine, if you are eligible. Mr Leon Perera had asked about reopening vaccination centres at community clubs and community centres. He asked specifically for Serangoon community club.”
“Based on the most recent 2019/20 National Population Health Survey results: (a) Crude prevalence of obesity was 10.5%; (b) 38% of adults with known diabetes had good control of their glucose levels; (c) 35.7% of adults with known hypertension had good control of their blood pressure levels; and (d) For hyperlipidaemia, the recommended LDL-cholesterol target levels varied based on the individual's risk status of developing future coronary events and was not captured. Based on the pre-COVID period of 2017 to 2019: (a) The average hospital admission rate for avoidable emergency department attendance was 44.8%; (b) The average hospital admission rate of falls and fall-associated injury among the elderly was 44.6%; (c) The average 365-day readmission rate due to all causes was 33%. The technical specifications for this indicator are still under review by MOH and clusters, to better align with the objectives of Healthier SG; and (d) The indicator of average bed-days per capita is under review. MOH is focusing on designing the Healthier SG scheme right, rolling it out and stabilising operations. We will then set targets, taking into account the current baselines, monitor the key performance indicators and disclose them to the public from time to time.”
“We are setting targets under Healthier SG to ensure that the short-, medium- and long-term outcomes can be achieved. They need to be done in the right spirit, bearing in mind that this is an act of enterprise and a dynamic and multi-year transformation effort with a certain amount of uncertainty. Right now, we are focusing on designing the scheme right, rolling it out and stabilising operations. We will then monitor the key performance indicators and disclose them to the public from time to time.”
“MediShield Life limits for inpatient treatment of serious pregnancy and delivery-related complications are pegged to the prevailing normal and intensive care unit ward daily limits of $800 and $2,200 respectively. These limits were last reviewed and increased on 1 March 2021. MOH will continue to review the claim limits regularly to ensure that they provide adequate coverage.”
“To enhance the palliative care process, MOH works with healthcare providers on protocols for the early identification of patients with palliative care needs. Patients can then receive care in the appropriate setting (for example, at home, in a day hospice, an inpatient hospice or a nursing home) and transfer between these settings as required. To support this, we are building both capacity and capabilities in all the various settings. This includes bringing palliative care into nursing homes. MOH also works closely with Agency for Integrated Care, Singapore Hospice Council, and the Health Promotion Board to raise awareness of end-of-life (EOL) issues through the national Advance Care Planning programme, sharing EOL caregiving resources and public communications and engagement efforts, such as events and roadshows. MOH is reviewing how to further improve hospital discharge processes for palliative care at home. This includes increasing support and respite services for caregivers.”
“The mean and median number of days of annual leave taken by nurses in the restructured hospitals between 2018 and 2021 is shown in the table below:”
“As explained in the White Paper on Healthier SG, MOH will make drug prices for a whitelist of common chronic drugs at participating general practitioner (GP) clinics more comparable to those at polyclinics, through a combination of enhanced drug subsidies and drug price limits. However, we will not be able to equalise patients’ costs across GPs and polyclinics down to the last dollar for all components of care, such as consultations and investigations. This is due to differences in costs and operating considerations between polyclinics and GP clinics. The Member’s last question is somewhat puzzling. We are giving additional subsidies to remove the differences in patients’ costs between polyclinics and GPs. The reason for any polyclinic fee adjustments has been to reflect changes in underlying costs, such as the salary costs of our healthcare workers.”
“Singaporeans can continue to choose to seek care at any location, even after they have enrolled with a clinic under Healthier SG. They may also choose to enrol with a GP clinic or a polyclinic. For continuity of care, we encourage Singaporeans who enrol with a clinic to return to their enrolled clinic for care as much as possible.”
“The withdrawal limit for MediSave continues to be relevant and will be in place, to ensure adequacy in healthcare savings through life. In 2021, about nine in 10 of all patients who withdrew MediSave under the Chronic Disease Management Programme did not reach their annual limits. The Ministry will continue to monitor MediSave utilisation and review withdrawal limits regularly.”
“Public healthcare institutions abide by MOH regulatory and services planning frameworks for the provision of clinical services. Medical practitioners are also bound by the Singapore Medical Council Ethical Code and Ethical Guidelines which stipulated that patients should be treated according to generally accepted methods, based on a balance of available evidence and accepted best practices. Hence, any proposed novel innovative therapies will have to be assessed, balancing the available evidence for safety, efficacy and ethics, against accepted best practices. There must be professional consensus on the use of such novel therapies for the particular clinical situation should be sought from independent external experts and Clinical Ethics Committee, where appropriate. Untested treatments that are not accepted as standard of care should only be offered under the strict context of research or clinical trial. These are subjected to MOH and HSA regulations and approval by institution’s ethics review committee and with informed consent from patients. The term “remission” and “no evidence of disease” are commonly used to describe a clinical state where no evidence of cancer is currently detected in the body. Regardless of treatment type, patients will need to continue regular follow-up to screen for possible relapse, the frequency of which is based on clinical assessment and guidelines for specific cancers.”
“It sounds like a specific Bukit Panjang issue which we can discuss. We always do not say no right at the outset. Let us look at the circumstances. But the larger point is this. We also tend to look at the problem and then we want to solve the problem and the first thing is, we need real estate. As I mentioned earlier, if we want to enable ageing in communities, look at what assets is already right in front of us. And visiting Block 115 in Ang Mo Kio is a bit sobering but it is so inspiring too. They are using their void deck spaces. They took back four units or HDB helped take back four units on the second floor. And in that four units, there is a medical centre, there is a therapy centre, there is a place for them to have activities. And so, you create the space. Look around our communities, HDB estates are brilliantly built with lots of shared places. We just need to activate them. So, while we will look at the Member's proposal, let us not close our minds to also the assets that is already right in front of us. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, (proc text)] [(proc text) That this House endorses Paper Cmd 19 of 2022 on "White Paper on Healthier SG" as the basis to transform our healthcare system by (a) focusing strongly on preventive care; (b) fostering lasting relationships between residents and family doctors; and (c) building strong partnerships within the community, so as to support individuals taking care of their own health and wellness and strive towards our vision of long and healthy lives for Singaporeans. (proc text)]”
“Ms Hazel Poa asked a question but she is actually making a statement. She is saying that Healthier SG, $400 million to spend, as I just answered, $400 million is, first, to subsidise residents for health screening, health points and all that. The other half is a service fee to GPs to help us take care of population. And I think she just made a statement to say this is not a good spend of money and if you want it to be spent well, give KPIs and targets to the GPs, and if they do not meet, claw back the fees. This is not what we should do. In a major effort like this, we want to bring in the GPs to be part of this. Of course, there will be KPIs with targets and we collectively work together to achieve it. At the GP level, they will have certain targets as well. But I do not think we want to treat them like vendors and contractors where if you missed out on a certain KPI, we claw back the fee. They care about the health of the population as much as we do, maybe more than Members in the Chamber. Treat them as part of the team, together in the right spirit, we will look at how well we are doing together by reviewing the targets and adjust along the way to achieve good health for Singaporean. A billion-dollar set-up, $400 million, if we can keep the population healthy, is money well-spent, even though the Member may think otherwise.”
“I will take the first question and then Senior Minister of State Janil will take the next two. I thank the Member for the clarification about KPIs and targets. I think we are now essentially on the same page.”
“On the second issue, that is natural. For MOH, we always err on the side of over-consulting especially our medical experts. On representing healthcare workers in the Chamber, I think we have NTUC here and they will always champion workers and especially nurses and healthcare workers. We had Ms K Thanaletchimi as Nominated Member of Parliament before. But even we do not have a healthcare worker as a Nominated Member of Parliament, be rest assured NTUC is there and the Minister for Health will be here too.”
“I do not have the numbers with me but of the $1 billion, slightly over $1 billion, there is a chunk for the central IT system, there is a chunk to upgrade the capabilities and IT capabilities of GPs, there is a chunk to upgrade or build up capabilities within the clusters in order to be regional health managers, there is a chunk to do a one-time ramp up of social activities. We are also thinking during enrolment, there could be some incentives – so, there is another chunk there. So, they all add up to over $1 billion . But what the Member did not ask is also, in terms of recurrent, I did mention recurrent expenses of about $400 million a year. That recurrent amount, about half will go to GPs as their service fee, the capitated service fee, for looking after enrolled patients, and another half will be the additional subsidies for residents, including healthpoints, health screening and so on, which will be free. So, it is about 50-50 for recurrent.”
“Thank you. We will try our best to streamline the procedures, but without belaboring what I have just said in my closing speech, frailty, we may see it as a permanent condition but they can improve. And if you ask Mr Henry Kwek, in his Block 115, people have improved. They saw seniors who could not walk, you create that common space in that block. First step, make sure they stick to their medication; take their medication; gradually, they improve; then, give them better food, social connections with nutrition and confidence interacting with people; they actually become better, even though they are in their 80s. I think Mr Henry Kwek can tell more of that story. But we see it. It can happen. We see in Kampung Wellness that Ms Carrie Tan spoke about. A different shape but similar effort. So, without belabouring the point, I think there is a lot of potential we can do for the current generation of aged, ageing in community's social care, including healthcare, can improve their health and push back frailty as long as possible. For the younger group, Healthier SG – postpone frailty as long as we can, make sure our healthy life is as long as our biological life.”
“Healthier SG is a key effort to activate and reform the public health system, empower individuals to choose health and lay the foundation for the aged care system I spoke about. We need all stakeholders – doctors, community partners, healthcare clusters, employers, residents – to join us in this effort, to shape a healthier Singapore. We do this for ourselves, we do this for each other. All societies, at some point, will have to confront population ageing. It is an urgent and stern test, and some societies end up with bankrupted healthcare systems or let healthcare cripple their society and economy. We are determined to overcome this test. We have the resources, ability, organisation and determination to do this. I seek the support of this House and of the people of Singapore to endorse this Healthier SG effort as the basis to transform our healthcare system, so as to strive towards the vision of long and healthy lives for Singaporeans. [Applause.]”