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 mental health conditions1 listed under the Chronic Disease Management Programme are Schizophrenia, Major Depression, Bipolar Disorder and Anxiety. In 2021, the average length of stay for admitted patients with schizophrenia was 50 days, major depression was 14 days, bipolar disorder was 33 days and anxiety was 16 days. In 2020, 2021 and 2022 (up to August), the general ward nurse-to-patient ratio in IMH has remained relatively stable at one nurse for every five or six beds. On the ground, staffing ratio will vary according to the levels of care required by patients.”
“In line with the Employment Act and Child Development Co-Savings Act, local and foreign nurses working in public and private healthcare institutions in Singapore are entitled to various types of leave, including annual leave, maternity leave and childcare leave. Further, the Child Development Co-Savings Act provides paternity leave and unpaid infant care leave if the child is a Singapore Citizen. There is also support that is extended to all staff, including foreign nurses. To support staff with care responsibilities, public healthcare institutions and some private sector employers also offer family care leave and flexible work arrangements (FWAs) such as staggered hours, compressed work week and flexi-load, subject to the organisation's requirements. There are also childcare centres located onsite in certain hospitals for the staff to enrol their children while at work.”
“The Ministry of Health (MOH) continues to monitor developments in COVID-19 vaccines, including nasal vaccines and assesses their safety, efficacy and suitability in meeting the needs of our population.”
“Influenza cases are expected to increase and revert to levels similar to pre-COVID-19 levels. However, we hope that individuals will keep the good practices of isolating themselves if they feel unwell and wearing a mask if they have to go out. That will moderate the infection rate of diseases like Influenza. The National Adult Immunisation Schedule (NAIS) and National Childhood Immunisation Schedule (NCIS) recommends that individuals at a higher risk of developing severe influenza infection and adverse outcomes should receive influenza vaccination. These include all persons aged 65 and above, young children between six months and below five years, and vulnerable persons between five and 64 years of age with certain medical conditions predisposing them to severe influenza. The public is encouraged to consult their family doctors for more information about the vaccinations. The influenza vaccinations are highly subsidised for at-risk groups to keep them affordable and accessible to the public. The Ministry of Health (MOH) and the Health Promotion Board will continue to work with our primary care partners and other stakeholders to promote influenza vaccination.”
“Based on the latest National Birth Defect Registry Report in 2016, about 30 newborns had birth defects for every 1,000 livebirths in Singapore. The most common birth defects for the newborns in our population are of the circulatory system. Depending on the complexity of the condition, the costs of testing and treatment for children with birth defects can vary widely. Based on data in 2020 tp 2021, for newborns with birth defects in the circulatory system, the average annual out-of-pocket cost for testing and treatment in their first year of life is around $850 after accounting for Government subsidies, MediShield Life, Integrated Shield Plans and MediSave. Parents can tap on their MediSave or their child’s MediSave Grant for Newborns to pay for medical expenses under the prevailing MediSave withdrawal limits. Singaporeans who have difficulty paying for their healthcare bills may approach medical social workers in the public healthcare institutions to apply for financial assistance.”
“The Rare Disease Fund (RDF) was established in 2019 to provide financial support to Singapore Citizens with rare genetic diseases who require high-cost treatments on a lifelong basis. As of 31 July 2022, the RDF has raised about $137.9 million from both public donations and the Government's three for one matching contributions since inception. This includes $37.9 million raised in FY2021 and $8.6 million raised in FY2022 as of 31 July 2022. However, RDF does not accept donations that are earmarked for specific individuals. This is to be fair to all patients. The RDF Committee in turn has the difficult task to decide on which patient to support, after assessing their medical conditions, the effectiveness and cost of the treatment, and funds available. As patients with rare diseases often require high-cost medicines on a lifelong basis. Let me take this opportunity to encourage Members and the public to support the RDF with their donations so that we can cover more conditions. Donations attract three for one Government matching and enjoy tax deduction of 2.5 times the donation amount.”
“Between 2017 and 2021, arrears by foreigners constituted less than 0.1% of the total bills issued by Public Healthcare Institutions (PHIs). This includes foreigners residing and working in Singapore, as well as some short-term visitors. Nevertheless, PHIs take various steps to mitigate the risk of arrears, such as offering downgrading options to assist patients with managing costs, sending reminder letters, as well as follow-up calls to patients to prompt for settlement of arrears. If the arrears situation deteriorates significantly, the Ministry of Health (MOH) is prepared to consider additional measures.”
“The Interagency Taskforce on Mental Health and Well-being was set up last July to oversee and coordinate mental health and well-being efforts, focusing on cross-cutting issues that require interagency collaborations. The Taskforce has recently concluded the public consultation to seek views on its preliminary recommendations. The Taskforce is currently reviewing the feedback from the public consultation to refine its recommendations and how it can best coordinate national efforts in this regard.”
“Mental health and well-being, including studies exploring suicide and suicide-related behaviours and risk factors, is an area of interest amongst researchers. For instance, the Singapore Mental Health Study (SMHS) examined the prevalence of common mental disorders and suicidal ideation among the adult population in Singapore. The Inter-Agency Research Workgroup for Youth Suicides led by the Institute of Mental Health (IMH) brought together various public agencies1 to study the risk and protective factors of suicides and suicidal behaviours in the young. The Ministry of Health (MOH) has also been supporting research in this area through various competitive research grant schemes under the national Research, Innovation and Enterprise (RIE) Plans. In the current RIE2025 Plan, MOH has identified mental health as one of the priority areas for research. MOH also launched the $90 million Population Health Research Grant in July 2022, of which mental health is one of the priority research themes.”
“Patients with mobility issues who need blood tests can obtain home phlebotomy services from certain Home Medical and Home Nursing providers, public healthcare cluster diagnostic service providers and private laboratories. Such home-based services reduce their need for travelling. The Ministry of Health (MOH) does not track patients' savings on transport costs and time.”
“The Ministry of Health/Health Promotion Board (MOH/HPB) will implement the mandatory labelling in a practical way. For example, instead of using laboratory analysis, establishments may refer to nutrient databases to estimate the sugar and saturated fat content from the amount of individual ingredients added into the beverage. We will provide further industry guidance later this year, ahead of implementation of mandatory labelling by end 2023. MOH/HPB will also apply measures to only larger establishments and exempt smaller establishments at the start. We will review this concession over time and adjust as appropriate. We encourage F&B establishments to come on board HPB's Healthier Dining Programme, which provides product development and commercialisation support to develop healthier food and drink products.”
“Every year, when there is a season, take an influenza vaccination that will protect you throughout the year and we need to. As we gather more data, as we have the shipments in and operations are ready, we will announce the details and move to a new mode of vaccinating the population.”
“On vaccination eligibility, the question is actually the other way around. We would very much want people to be vaccinated but, usually, it is the resident who comes forward to say "I am not eligible. I have got eczema, I have this, I have that". And then some are not so valid medically; others we have to take a closer look, especially if they have some adverse reaction after their first shot and they then may become ineligible. And that is a medical indication which we will have to respect, notwithstanding the fact that we bring in different types of vaccines now with different technological platforms and, hopefully, they will be able to take one of them. Second, how do we further increase the rate of vaccinations? We have to keep on explaining why it is beneficial to vaccinate. We have to get the momentum. Vaccination begets vaccination. When we see more of our friends and relatives vaccinated, we also, notwithstanding some hesitancy, will get vaccinated. So, we have to bring vaccinations to the community, which we are still doing through our mobile teams. And also for those who are not mobile and are stuck at home, we will go to their homes to provide the vaccination. But, as mentioned in the House earlier, we are trying to move to a new definition of "up to date" vaccination. Today, vaccination is pretty much all covered. Whoever is holding out probably is very hesitant, unable to change their mind or, indeed, have medical contraindications and you cannot vaccinate them. Moving forward, it is more the booster rate and we should move to a stage where we stop counting the number of boosters, such as booster one, two, three and so on, but move to a concept where we really live with the virus closer to how we live with influenza.”
“I thank the Member for that suggestion. It is a good one. We have the Saw Swee Hock School of Public Health. Maybe that is something they can look into but, so far, we have not compiled those numbers. But if we look at the literature and our own experience, the two main drivers of excess deaths have been, first, are you vaccinated? Second, your age, and that will continue to be the case. Notwithstanding, it is an interesting line of enquiry which our researchers will definitely look at.”
“If and when there is a surge in infection and severe illness numbers, we cannot rule out the re-imposition of safe management measures. But we will only do so when it is absolutely necessary to save lives and to protect the healthcare system. What we managed to achieve is due to the fact that the great majority of our people did their part and did the right thing. The pandemic is not entirely over, but we hope we are at the end game and will continue to navigate through the crisis with resilience and unity.”
“It is worth reiterating here that, to be properly protected against the Omicron virus of COVID-19, we need to get a booster, in other words, three doses of mRNA vaccines. It will reduce the risk of severe illnesses and deaths significantly. Two shots do not do the job properly. We are currently bringing in the updated bivalent vaccines that can offer better protection against variants. The second factor is whether the healthcare system had been overwhelmed at any point during the pandemic – the second factor for excess deaths. "Overwhelme" is not the same as hospitals being very busy, which ours have been and are still very busy. "Overwhelme" means there were so many severely ill COVID-19 patients that the hospitals ran out of beds, oxygen and medical staff to take care of them. Patients are, essentially, left to demise. Whenever a bed or an equipment becomes available, doctors have the unenviable task of choosing whom they should save amongst everyone that is waiting. When that happens, many non-COVID-19 patients, such as those with heart attacks, injuries, strokes will be affected and, without proper care, many of them will also die. And that happened in many countries. In Singapore, we did not let that happen, mostly because when there was a risk of that happening, we went into the circuit breaker mode or the heightened alert mode to slow down the rate of infection to protect our healthcare system. Hence, throughout the pandemic, despite our public hospitals being strained while coping with the pandemic, our hospital and ICU beds were able to support patients with urgent medical needs. Looking ahead, we can continue to prevent deaths by preserving healthcare capacity and ensuring that our healthcare workers are well-resourced in such situations.”
“Members have asked for a breakdown of the numbers by year. So, if we break up our estimated excess deaths, there were 1,140 from January 2020 to December 2021 and 1,350 from January to June 2022 respectively. There are two key ways to reduce excess deaths associated with the COVID-19 pandemic. The first is vaccination. COVID-19 vaccination plays a big part because it significantly reduces the risk that infections translate into severe illness and deaths. The fact that Singapore got 93% of its population vaccinated – and that base includes children who are not eligible – and 80% boosted, is a key reason why we have low excess deaths. To answer Mr Yip Hon Weng's question, which has been scheduled for another Sitting, in the same vein, in Singapore and elsewhere in the world, unvaccinated persons disproportionately contributed to COVID-19 deaths. In the first half of 2022, about 5% of the eligible population are not fully vaccinated, but they contributed to 28% of COVID-19 deaths. MOH does not comprehensively track the number of persons who are medically ineligible for COVID-19 vaccinations. However, as at 30 June this year, the number of persons who applied to be exempted from vaccination-differentiated safe management measures (VDS), claimed they have adverse reactions to COVID-19 vaccines and we have looked at them and have granted 2,100 such exemptions. For this group, the observed rate of COVID-19 deaths in these individuals was about two in 1,000, compared to 0.3 in 1,000 observed in the whole population. Again, this is the group which applied to be exempted from VDS. In reality, the number of people who are medically ineligible for COVID-19 vaccines is small, given the choice of vaccines that they have access to.”
“Mr Speaker, Sir, my response today will also address the question filed by Mr Yip Hon Weng1 which is scheduled for a subsequent Sitting. The COVID-19 pandemic has posed a severe dilemma – summarised as lives versus livelihoods – for all regions in the world. When you close the borders and lock down society, you can save lives, but people will suffer tremendously from economic paralysis and children held back, perhaps permanently, in their learning. When you open up society and the economy to resume normalcy quickly, many people will suffer from falling severely ill and die from infections. Every region in the world knows it has to strike a very careful balance between lives and livelihoods. Three years into the pandemic, Singapore has been able to open up our society and economy, with life almost going back to normal and yet we maintain an excess mortality rate that is one of the lowest in the world. In September 2022, the Ministry of Health (MOH) released a public report on the excess deaths in the Singapore resident population over the pandemic. Between January 2020 and June 2022, there was an increase of 24.9 deaths per 100,000 persons per year, using the pre-COVID-19 year of 2019 as the baseline. So, our death rate during this pandemic, essentially, took us back to 2018 levels, wiping out improvements over a few years. The World Health Organization (WHO) uses a slightly different methodology to compute excess deaths, but the results are similar. Based on WHO's estimates for the years 2020 and 2021, Singapore experienced 26 excess deaths per 100,000 persons per year, compared to our estimate, which was 24.9. It is about the same. But it is still, again, much lower than many countries, especially those that have opened up like us.”
“These questions have been addressed in my reply to Question Nos 1 and 2 for Oral Answer on the Order Paper for 13 September 2022.”
“We have not come across literature that recommends an optimal time duration for communication between healthcare professionals and their patients or family members. From our experience, effective communication varies with factors, such as disciplines or specialties and individual circumstances, including but not limited to case complexity and the baseline health literacy of the patient and their family. As of now, manpower planning is still, primarily, based on patient load and the complexities of their diseases.”
“The hiring of staff and determination of staffing numbers are managed by the healthcare clusters, not MOH. What MOH does is to work with the clusters to help redesign healthcare roles and facilitate equipping staff with the skills and training to allow them to grow throughout their careers. Every job in a hospital or the healthcare sector needs to be meaningful, dignified and enable the worker to develop and grow.”
“Ambulance services providing non-emergency conveyances are licensed as Medical Transport Service under the Healthcare Services Act. Licensing condition includes adhering to regulations covering quality assurance standards, such as training and competencies of service crew, ensuring that vehicles are equipped with necessary medications, consumables and equipment; and service-related standards that cover price transparency and bill itemisation. Waiting times are not specifically included in the requirements, but licensed providers are required to establish care protocols, which, if adhered to, will ensure the safe and timely conveyance of patients.”
“In the past five years, the number of tobacco retail licences granted is set out in the table below. Under the Tobacco (Control of Advertisements and Sale) (Licensing) Regulations 2017, tobacco retail licensees must not site their premises in unsuitable locations, including healthcare institutions, pharmacies, educational institutions, childcare centres and computer gaming/video gaming centres.”
“I think it is difficult to adopt a blanket policy to say all in the public sector shall not insist on VDS. It all depends on the settings. For each setting, it depends on whether it is crowded, whether seniors are present in those settings, what is the risk of transmission. So, I think we always need to take a differentiated approach. We must remember that as we increasingly treat COVID-19 as endemic, "endemic" does not mean that it is not there. Endemic means to acknowledge that it is there and we have to adjust to our normal life and normal procedures in order to live with the virus. And one of the principles to do so is to make sure that, according to the risk of different settings, we adopt the necessary measures to manage the risks. Therefore, it is in this spirit that we allow employers and building owners to impose their own VDS requirements should they need to. Nevertheless, as I mentioned in my main reply, we are reviewing VDS together with the requirements for vaccinations and it should be completed in the next couple of months.”
“On the second question first, children under five, we have the supplies; it is part of our supply agreement. HSA has also approved the use of the Moderna vaccine, which is a two-dose vaccine, on children aged six months to under five years old. But because cases are now low and we also want to vaccinate children below five and give the booster for children aged six to 12 years at the same location, it is more convenient for parents to bring siblings often falling into both age groups together to the vaccination centre. But the older age groups, those in Primary schools, many of them are also getting into examination mode and given that the current situation is stable, the cases are relatively low, our intention, as we have announced at the MTF press conference, is to time it around end-October or early November, when examinations are over, so that, with peace of mind, parents can bring their children – those from six months up to 11 years old – either for their primary series or for their booster. That is our current plan. Details will be announced once we are ready. As we open up vaccinations to all the children for booster or primary vaccination, we want to continue to disclose as much medical information as we can, for example, as the Member has asked, "What is the MIS-C rate for children who are fully vaccinated and not vaccinated?" We can tell there is huge difference. Therefore, it is through encouraging parents through transparent information that we hope more parents will bring their children to get vaccinated.”
“However, when cases are lower and steady, many of these measures, including mask-wearing, for example, have been removed. Others, such as vaccinations and vaccination-differentiated safe management measures (VDS), are kept in some form, in anticipation of another infection wave. This is the nature of crisis management – we stand down many measures when they are not needed but we need to keep some, in anticipation of something worse happening later. While VDS is mandated for specific settings, such as events with more than 500 participants at any one time, business owners and employers also have the flexibility to implement conditions of service that are relevant to their settings, such as requiring the donning of masks, as well as adopting vaccination-related instructions for customers or for workers. Nevertheless, as the Multi-Ministry Task Force (MTF) had explained in previous replies, we are reviewing vaccination requirements, from one of counting number of doses and boosters we are taking, to ensuring that our vaccination is "up to date". This will be a more enduring posture as we live with COVID-19 as an endemic disease. We expect to complete this review in the next couple of months and will review VDS at the same time.”
“Nevertheless, existing vaccines remain highly protective against severe disease, including for the Omicron BA.5 variant. If you are eligible to receive another vaccine dose, please receive your vaccination without delay and not wait for variant-specific vaccines, as COVID-19 is still spreading in the community. I will now turn to the Member’s question about COVID-19 in children. As of 29 August 2022, amongst young people under the age of 18 who are infected with COVID-19, the incidence of Multisystem Inflammatory Syndrome in Children (MIS-C) was 5.7 per 100,000 for those fully vaccinated, versus 38 per 100,000 amongst those not fully vaccinated. The Member also asked about children’s vaccinations for COVID-19, such as whether Novavax will be made available for those aged 18 and below and whether the vaccines have long-term effects on children. Currently, HSA as well as the Expert Committee on COVID-19 Vaccination (EC19V) are independently evaluating the Novavax vaccine for young persons aged 12 to 17. Novavax has not submitted the application for its vaccine to be administered to children under 12. There is so far no evidence suggesting COVID-19 vaccines result in potential risk of toxicity to humans or developmental defects in children. There are no plans to include COVID-19 vaccinations into the National Childhood Immunisation Schedule at this point as the pandemic situation is dynamic and the recommendations continue to evolve with new data. MOH will review this when appropriate. Assoc Prof Jamus Lim asked about vaccination-differentiated measures. At the height of an infection wave, measures are taken to prevent our healthcare system from being overwhelmed.”
“I am very thankful that the number of questions on COVID-19 has decreased significantly. Mr Yip Hon Weng asked about COVID-19 hospitalisation rates that our public hospitals can accommodate. As our society becomes more resilient to COVID-19 due to vaccinations as well as safe recovery from infections, we have observed that the incidence of hospitalisation has fallen in the most recent Omicron infection wave, compared to previous waves. However, it is not possible to estimate a hospitalisation incidence rate which our healthcare capacity can handle, because it is also a function of the transmissibility of the variant and the number of people who get infected on a daily basis during a big wave. So, what we need to do is to continue to keep our vaccinations "up to date", prevent ourselves from falling severely ill if we are infected, we must exercise social responsibility, such as staying at home and self-testing when not feeling well, and do whatever we can to optimise our hospital capacity. We have been and will continue to re-allocate our healthcare resources on a dynamic basis to where they are needed most. Mr Yip Hon Weng also asked about vaccines. We are bringing in bivalent vaccines into Singapore. It is provided for in our agreements with the pharmaceutical companies. The Health Sciences Authority (HSA) has completed the evaluation of the Moderna bivalent vaccine and a decision will be announced soon. The bivalent vaccines will target both the ancestral strain of COVID-19 and the Omicron variant. Our intention is to update our vaccines for the National Vaccination Programme as the formulations improve. We will share more details when the arrangements are confirmed.”
“Mr Speaker, Sir, with your permission, may I address Question Nos 1 to 2 for oral answer and Question Nos 21 to 23 for written answer on the Order Paper, please?”
“The Institute of Mental Health (IMH) provides immediate crisis care for patients with mental health conditions. Between 2019 to 2021, IMH saw an average of 13,000 individuals annually at their Emergency Services. Close to 22% of these attendances were referrals from the other public hospitals. Patients who require mental health support and present at public hospitals are assessed by the medical team and those with more severe conditions will be given earlier appointments or be admitted for closer monitoring. Mental health services are also available in the community and primary care, provided by the polyclinics, GPs, the community outreach teams (CREST) and the allied health-led community intervention teams (COMIT). As of 31 December 2021, there were over 310 trained Mental Health General Practitioners (MHGPP) and 14 polyclinics that provide mental health services in the primary care setting. We have been expanding services in the community through increasing the number of teams and service providers. By strengthening mental health services in the community, persons with mild to moderate mental health needs can be cared for in the community.”
“The attractiveness of work as a nurse in Singapore vis-à-vis a foreign country is not determined by the basic remuneration alone, but also taxes, cost of living, working conditions, training opportunities and living environment. MOH regularly review our competitiveness holistically. In general, we remain competitive, but COVID-19 has exacerbated international competition for nurses, and almost every country is encountering challenges in retaining their nurses.”
“The number of adult diabetic patients seen at the Specialist Outpatient Clinics (SOCs) at public acute hospitals for the past four years are shown in Table 1. Full data set for 2017 is not available. The absolute numbers are on an upward trend, because of an ageing society, and likely because of higher awareness of diabetes. Through programmes such as Chronic Disease Management Programme, we try as far as possible to manage such chronic diseases in primary care settings, but detailed numbers are not available. With Healthier SG, we aim to have more patients anchored in primary care with a familiar family doctor for the management of chronic diseases including diabetes.”
“The Residents Network under the People’s Association (PA) works closely with partners in the community to offer a variety of physical activity programmes. The Health Promotion Board (HPB) is one such partner, amongst many others. Physical activity sessions organised by HPB across all Residents Network each month averaged 3,100 in 2019, 2,400 in 2020, 800 in 2021 and 3,200 in 2022 up to the month of June. The average monthly number of participants in these physical activities was 82,100 in 2019, 55,600 in 2020, 11,300 in 2021 and 39,000 in 2022 up to the month of June. HPB works with Resident Networks and community partners to organise programmes on the ground based on demand and geographical spread. There is no maximum number or cap to the number of physical activities that Residents Networks can partner HPB on.”
“From 2019 to 2020, there were on average around 330,000 Integrated Shield Plan (IP) inpatient and day surgery claim episodes at public healthcare institutions (PHIs) each year, and around 130,000 at private healthcare institutions. Data on the number of claim episodes involving upfront payment is not available.”
“The Ministry of Health (MOH) maintains a stockpile of medication to treat fever, cough and cold from multiple countries and suppliers. These supplies can be released to retailers in the event of a widespread shortage. When COVID-19 cases were high, there had been shortages reported for specific brands of these medications at certain retail outlets. These shortages are temporary, as retailers are bringing in additional supplies. Alternative brands remain available for these medications.”
“The HPV vaccination is nationally recommended for females aged nine to 26 years for prevention of cervical cancer. MOH offers fully-subsidised (free) HPV vaccination to all female Secondary 1 students as part of HPB’s school-based health programme. Most countries with school-based HPV vaccination programmes do so around this age, as early vaccination can produce a higher immune response and prior to onset of sexual activity. Secondary school-aged female students who did not receive or complete their HPV vaccination in school can still receive free HPV vaccination at HPB’s Student Health Centre. Under the National Childhood Immunisation Schedule, free HPV vaccination is also available for Singaporean females aged 17 and below at Community Health Assist Scheme General Practitioner (CHAS GP) clinics and polyclinics. For Singaporean females 18 to 26 years of age, they can receive means-tested subsidies for the HPV vaccination at CHAS GP clinics and polyclinics as per the National Adult Immunisation Schedule. Information on this can be found on MOH website under Vaccination and Childhood Developmental Screening Subsidies (VCDSS).”
“The LumiHealth programme is an ongoing programme, and will extend its benefits beyond its initial two-year run as part of the Healthier SG programme. The programme has been successful in encouraging healthy behaviours across different age segments through gamification. There has been a total of over 300,000 downloads since the app was launched in October 2020. For physical activity, LumiHealth active participants have completed 32.9 million workouts since the programme started in October 2020. This works out to an average of over 20 workouts per participant per month, which is double the number of average workouts compared to before joining LumiHealth. The groups with 'Low Activity' or have a higher body mass index (BMI) of 23 and above before joining LumiHealth, have increased their weekly exercise minutes by about 88% and 42%, respectively. 74% of participants completed mental wellbeing challenges, which increased their awareness and adoption of mental wellbeing management strategies. The Health Promotion Board (HPB) will continue to various partner device and technology companies to offer technology-enabled population-wide initiatives like the National Steps ChallengeTM.”
“As of 2021, the life expectancy of Chinese, Malay and Indian residents in Singapore were 84.3, 79.4 and 81.311 respectively. Life expectancy is influenced by various factors, such as prevalence of severe diseases, chronic conditions and lifestyles. MOH will continue to work with other agencies and social organisations to improve these social determinants, with the aim of sustaining increases in life expectancy over time for all ethnic groups.”
“This question has been addressed in my reply to Question Nos 12 and 13 for oral answer on the Order Paper for 2 August 2022.”
“The Government recognises that the COVID-19 pandemic has affected our seniors' social and emotional well-being, and has worked with various stakeholders to support our seniors. Helplines are available for vulnerable seniors to receive timely support. Over 35,000 seniors have received assistance through The Seniors Helpline and CareLine during the pandemic. Seniors who need more help will be referred to appropriate agencies, such as Family Service Centres, Social Service Offices and Active Ageing Centres for continued care and follow-up. Since November last year, we have worked with community partners to progressively resume active-ageing programmes and facilitating seniors' participation in a safe manner. The Health Promotion Board (HPB), People's Association (PA) and Council for Third Age (C3A), as well as others, restarted face-to-face classes and activities in tandem with the adjustments in the national safe management measures (SMMs). Seniors may also continue to engage meaningfully through our partners' range of digital offerings.”
“In 2018, NKF started the "Know Right, Start Right" programme in public healthcare institutions (PHIs) and deployed its teams on-site at the hospitals as care counsellors and coordinators, to provide pre-dialysis education and counselling services for patients in late stages of CKD. KDF has also been active in engaging the community to advocate for better kidney health, through public health talks and sporting events. To ensure sufficient dialysis capacity in Singapore, MOH works collaboratively with all social services dialysis providers to develop new dialysis centres. In recent years, MOH has been working with providers to encourage suitable patients to opt for Peritoneal Dialysis (PD), which can be administered at home. MOH is also supporting service providers such as NKF, Ang Mo Kio-Thye Hua Kwan Hospital and Home Nursing Foundation to improve access to home support services for PD patients. To improve kidney transplant uptake, MOH and the National Organ Transplant Unit have been working to promote greater awareness of organ donation and shift societal attitudes and views towards Living Donor Kidney Transplant.”
“End-Stage Renal Disease (ESRD) patients are those where kidney function has declined to the point where the kidneys can no longer function on their own and must receive dialysis or kidney transplantation. From 2017 to 2021, the number of ESRD patients on definitive dialysis, inclusive of haemodialysis and peritoneal dialysis (PD), increased from 7,007 to 8,668. Over the same period, 458 patients had a kidney transplant. The number of ESRD patients is expected to rise due to Singapore's ageing population. Chronic kidney disease (CKD) is a long-term condition which involves a gradual loss of kidney function, usually due to risk factors such as diabetes and high blood pressure. If untreated, CKD can progress to ESRD. MOH has been working with the public and private healthcare providers, as well as social services agencies involved in dialysis services to tackle CKD care holistically, from upstream prevention efforts, timely diagnosis and implementing appropriate patient-centred management options. These partners include the National Kidney Foundation, Kidney Dialysis Foundation (KDF), Muslimin Trust Fund Association, Ang Mo Kio-Thye Hua Kwan Hospital and Buddhist Compassion Relief Tzu-Chi Foundation. MOH has also been working with our healthcare partners to focus on upstream prevention to reduce ESRD prevalence. Since 2017, we have implemented the Holistic Approach to Lowering and Tracking Chronic Kidney Disease (HALT-CKD) programme, which uses a systematic approach to managing CKD. This includes early initiation and optimisation of kidney-protective medications and controlling risk factors for kidney damage, such as optimising management of diabetes, high blood pressure and addressing lifestyle factors, like smoking.”
“The number of outpatient attendances by youths1 at IMH in 2021 increased by 6%, while inpatient admissions decreased by 14.5%, compared to pre-pandemic baseline in 20192. There was no significant change in the number of emergency psychiatric attendances by youths over the same period. MOH has developed various mental health services catering to youths: Multidisciplinary Response, Early Intervention and Assessment in Community Mental Health (REACH) teams provide mental health support to students in school. Outside school, the Community Youth Mental Health Teams and Community Health Assessment Team (CHAT) reached out to at-risk youths in the community, provide them with mental health assessments, and links them to appropriate resources and services for further support. Youths may also tap on counselling services and helplines offered by various National Council of Social Services (NCSS) organisations. All acute hospitals are able to provide general psychiatric screening for children and youths with psychiatric conditions, and selected public hospitals, such as NUH, KKH, CGH and KTPH provide child and adolescent outpatient psychiatric services. The National University Health System (NUHS) will be developing a wider scope of psychiatric services at the new Alexandra Hospital. These will include inpatient beds for acute and sub-acute psychiatric care and rehabilitation, as well as Child and Adolescent Psychiatry outpatient services. There is no plan at this juncture to develop a second psychiatric hospital. We should understand that not all illnesses, including mental health issues, are always best addressed by an inpatient admission to an acute care hospital.”
“The Seniors' Mobility and Enabling Fund (SMF) was enhanced in February 2022 to provide seniors with subsidies for replacements when the current device reaches the end of its lifespan. For devices not reaching the end of its lifespan, SMF can also cover the replacements, or repairs if they are cost-effective, on a case-by-case basis.”
“The WHEELS programme was a three-year pilot to train seniors to provide free wheelchair servicing and basic repairs at 13 Senior Activity Centres and Senior Care Centres. Unfortunately, many participating centres could not find enough volunteers to deploy the service or meet demand. The pilot ended in March 2020. The Seniors' Mobility and Enabling Fund (SMF) was enhanced in February 2022 to provide seniors with subsidies for replacements when their current devices, including wheelchairs, reach the end of its lifespan. SMF can also cover repairs, if they are cost-effective, on a case-by-case basis.”
“Osteopathic medicine is considered a form of complementary medicine in Singapore. Although there are some small studies done in other countries on its use in pain management related to musculoskeletal disorders, better designed, higher quality, multi-centre, randomised control clinical trials are needed to affirm the efficacy and safety of osteopathic medicine. There are currently no plans to register and regulate osteopaths as allied health professionals.”
“Due to the implementation of COVID-19 safe management measures (SMMs), the number of individuals outreached by the CREST teams had reduced in 2020 and 2021, compared to that in the pre-pandemic period in 2019 (Table 1). The number of clients with mental health needs supported by the COMIT teams has been relatively stable over the past three years. With the relaxation of SMMs, the community teams have progressively resumed their activities to reach out to and support those at risk of or with mental health conditions.”
“These questions have been addressed by Questions 7 to 15 for Oral Answer on the Order Paper for 1 August 2022.”
“This question will be addressed in my reply concerning the nursing workforce on 2 August 2022. [Please refer to "Nurse-to-patient Ratio and Efforts to Reduce Nurses' Administrative Workload", Official Report, 02 August 2022, Vol 95, Issue 66, Oral Answers to Questions section.]”
“Data on the MediSave balances of Singaporeans who incur cash out-of-pocket (OOP) after hitting their MediSave withdrawal limits is not readily available. MediSave withdrawal limits are generally adequate to cover the majority of bills incurred by subsidised patients, after taking into account Government subsidies and MediShield Life payouts where applicable. In the inpatient setting, seven in 10 Singaporeans did not have cash OOP for their subsidised hospitalisation bills after subsidies, insurance and MediSave. The MediSave withdrawal limits are largely sufficient in the outpatient setting as well, hence only a small proportion would hit the MediSave withdrawal limits and incur cash OOP. For instance, about nine in 10 patients who withdrew MediSave under the Chronic Disease Management Programme did not reach their annual limit. Patients who face difficulties affording their cash OOP may apply for financial assistance such as MediFund at our public healthcare institutions.”