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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“Healthier SG is a significant and transformative national healthcare strategy, requiring many stakeholders and partners to work together to support our residents’ needs. Traditional Chinese Medicine Practitioners (TCMPs) are important stakeholders, especially given their emphasis on holistic and long-term care. However, unlike western doctors, TCMPs are not tightly regulated by MOH, the standard of care delivery varies widely and we will not be able to take the same approach as we have for western doctors. Since July this year, MOH has started engagement efforts with the TCMP community, through the Traditional Chinese Medicine Practitioners Board (TCMPB), to hear their views and discuss with them how they can play a part in Healthier SG. TCMPB welcomed the initiative and will work with MOH and other community partners to support Healthier SG initiatives.”
“Some international studies had shown that long working hours were associated with increase in risks to patient safety, for example, medical errors and adverse events, especially when doctors worked continuously beyond 24 hours. Therefore, inter alia, local work hours guidelines limits work hours for junior doctors to a maximum of 24 consecutive hours of clinical care duties with not more than six hours for handover. Besides working hours, patient safety can also be affected by other factors, including work processes, environmental and organisational factors. On the other hand, some international studies also showed that reduced work hours may result in shortage of manpower and reduced opportunities for learning. By inference, this will have a negative effect on clinical outcomes and safety. MOH is looking into the wellness of junior doctors under the National Wellness Committee for Junior Doctors (NWC-JD), and that includes a review of junior doctor work hours and training outcomes while ensuring that patient safety and training requirements are not compromised.”
“These questions 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.]”
“The 1,000 beds I mentioned referred to public hospitals only. If we include private hospital beds that we can acquire, that is another couple hundred more – I cannot remember the number. Today, hospitals are busy, not because of COVID-19 patients, but a lot of business-as-usual patients. Ninety percent occupancy is quite common. And this is after taking into account, setting aside some beds for COVID-19 patients. As I mentioned, it is a dynamic plan. When we see a curve going down, numbers going down, we may release more beds. When we see the epi curve going up, we may take out more beds and inch towards the 1,000-bed scenario. So, it is a dynamic plan. But what is important, what I mentioned, is that for this wave, we managed to ride through it. I think the worst is over. We managed to go through it better prepared and better response than the last wave.”
“Yes, it does. And thankfully, we have been able to keep our nursing homes safe. It makes all the difference. We will continue to try hard to protect our nursing homes and community hospitals.”
“Currently, our rules do not provide for that. If you are below 50, you have taken three shots already and you are healthy, our rules do not provide for them and they would not be offered. But if they have underlying conditions and they suspect they are sick, they can let us know and we will offer it to them. The reason is, as I mentioned earlier, protection against severe illness is what is important and it continues to stay very high, especially if you are young. And towards year end, we do not know what is coming our way. In the Northern Hemisphere, many countries are worried about new variants. So, therefore, sometimes, it is also worthwhile to keep our powder dry, especially for the younger group.”
“I am sorry to disappoint Mr Seah Kian Peng. But even if we hit 100%, we will not have "herd immunity". It is no longer a function or percentage coverage of vaccinations or infections but it is the fact that it is a fast mutating virus and it will escape prior infection protection as well as vaccine protection. So, therefore, do not aim for "herd immunity" where we think the virus will disappear but instead live with the virus and protect ourselves against severe illnesses. What other solutions are there? Mobile teams have been useful; home vaccination teams have been useful. Eighty thousand is a big number. But on the other hand, compared to other countries, we are 93% covered by vaccinations; 79% covered by booster. These are very, very high by international standards. We will continue to try hard. But I suspect, especially the 40,000 seniors who have not even taken two shots, they must have deep personal reasons not to do. For the other 40,000, they have taken two shots but somehow have not taken the booster. For them, I am a bit more sanguine because they have taken two before; I think we can persuade them to take a third. But those who have not taken, we have met them and we have tried to persuade them; it is difficult. The better way now is for us to be considerate that there are such vulnerable seniors amongst us. So, we must always exercise our social responsibility. If we do not feel well when we are meeting one of these seniors, avoid meeting them or test yourself before you meet them. In other words, the rest of us who have been vaccinated or have been infected, we have to protect those who are not protected and are vulnerable.”
“We have a few non-mRNA vaccines. Novavax has shown to be efficacious in preventing severe illnesses. The other two slightly less. I do not have the data. But the data has shown that these are slightly less efficacious; not just us, but Chile, Malaysia and other countries have also published similar data and admit similar observations. Having said that, they do have a protective effect. Having those vaccinations is better than not having vaccinations. So, please encourage residents to take them. As for mobile vaccinations, for those who are not seniors, we will do so and we have been doing so. If you come across any residents that need them, you can always raise with MOH and we will assess and try to be as helpful as we can. Do we administer flu vaccines together? In practice, we can. But unlike many other countries where there are four seasons and there is a winter and a flu season, they find it useful to administer flu vaccines and COVID-19 vaccines concurrently, which is what Australia is doing currently. And towards the fall, many Northern Hemisphere countries intend to do so. We do not have a flu season. It comes and goes. It could be anytime. So, it is harder for us to combine two vaccinations at the same time because of the lack of a flu season. But theoretically, it is possible. And if someone wants both together, we should think of a way to administer both.”
“Notwithstanding deactivation of the Flu Subsidy Scheme, as I have mentioned, the current subsidy schemes, especially CHAS, polyclinic subsidies, continue to be there. Does the Flu Subsidy Scheme increase the number of people seeking medical treatment? I believe that is a reasonable effect that we should expect of any subsidy. I think in the community, we have seen and we have probably met residents who say, "Since there is the Flu Subsidy Scheme and it costs $10, no harm. I think I might have COVID-19. Just go to the GP," and when they are very well, young and probably can recover uneventfully at home, drinking more water, rest, taking ART. I think, when we have a subsidy scheme like that, on the one hand, more people may come forward; on the other hand, you can also overcrowd the GP clinics. As we enter into a phase where we are more prepared and better able to live with COVID-19, just as we wound back our SMMs, we also need to go back to the subsidies schemes, pre-COVID-19. That is what we are trying to do for one of our smaller schemes, which is Flu Subsidy Scheme. Hospitalisation, testing – all these continue to be fully subsidised. And that is an even larger amount that we continue to support. Will this therefore reduce the detection rate of COVID-19? I think a lot depends on self-testing, much more than testing at the GPs. You can now use telemedicine, as Ms Joan Pereira said. Using telemedicine, test in front of a camera on Zoom and the doctor can record it in the system. So, by and large, people know how to use the system and we continue to be able to monitor our epi curve with the reports from people, very promptly and quite accurately.”
“I heard only one question. I will try to answer it. As I have reported just now, MOH, likewise, is monitoring empirically the rate of reinfections in Singapore. By and large, we have noticed that our rate of reinfection is lower than many other countries. We are at a stage where every country's experience is different because they experienced different waves with different dominant strains and different vaccination and booster rates and also different age profiles, old and young. So, when you take all that into account, every country's experience is now unique. We know Portugal's experience. In fact, Portugal has gone through a wave with many hospitalisations. Australia is undergoing a BA.5 wave with many hospitalisations. In our case, due to a combination of factors – high vaccination rate, high booster rates and the fact that we recently went through a BA.2 wave which gives better protective effects against BA.5 – we have waded through this current wave much more smoothly, compared to Portugal. We will continue to monitor the reinfection rate. As I have mentioned, what is important is whether reinfections or infections translate into hospitalisations. So, what is important is vaccination effectiveness against severe illness. We will monitor that closely. As I have mentioned and as I have shown in the chart earlier, after 10 months, the protective effect is still strong but we will monitor closely.”
“Mr Deputy Speaker, Sir, notwithstanding these words of caution, let me underscore the importance of what Singapore just went through. With each wave, we are coping better. We are riding through this current BA.5 infection wave without imposing further social restrictions or imposing border measures. In our hospitals, we imposed fewer restrictions and hospitals are, generally, able to cope better than the last wave. That means that the Singapore society has taken another major step forward in living with COVID-19 as an endemic disease and I think this is a big National Day present for all Singaporeans.”
“I want to reassure Members of the House that for residents who see their primary care doctors, they will continue to receive institutionalised, pre-COVID-19 subsidies, such as CHAS, polyclinic subsidies, health screening subsidies and so on. PHPCs and polyclinics will also continue to provide Government-funded swabs to eligible symptomatic individuals at no charge. Mr Deputy Speaker, Sir, while the current wave is subsiding and I think the worse is over, it is important that we do not be complacent. As the protection of vaccines and prior infection wanes, the virus will circulate in our society again and cases will rise. We must anticipate when that will happen and take the necessary precautions, including the most important of all, which is to keep our vaccinations up to date. I have deliberately used the term "up-to-date vaccinations", rather than a second, third or fourth booster shot. This is because, at some point, just like flu vaccinations, we have to stop counting the number of boosters we have taken. Instead, we must ensure that we get a jab at a suitable interval – maybe nine months or a year. This is something MOH will try to determine in the coming months. As of now, there is no change to MOH’s guidance and recommendations. It remains what have already been announced. We need to be alert to the threat of a new variant that is more infectious, leads to more severe illnesses or evades the protection of current vaccines. We hope it will not happen, but many countries in the northern hemisphere are worried about that and what might come up in the coming winter. If we encounter such a variant, I am afraid social restrictions will become necessary again.”
“So, a patient who has been infected twice, we count him only once and there are very few of them. With more reinfections, from today, we will report the infection episodes instead of infected persons. This will be a more accurate reflection of the pandemic situation. Mr Zhulkarnain Abdul Rahim asked about COVID-19 therapeutics. All polyclinics and more than 130 participating PHPCs can prescribe oral antivirals to clinically eligible patients in the community. To date, more than 3,200 patients have been prescribed such therapeutics across different healthcare settings. It is a small percentage of all infections, reflective of the fact that the vast majority of infected cases are of low risk. Mr Saktiandi Supaat asked about the Flu Subsidy Scheme. As at end FY2021, the Government has spent about $178 million on the scheme for over 11 million attendances at private clinics and polyclinics for the treatment of acute respiratory infections. As we progress towards living with COVID-19, Singaporeans have become familiar with exercising social responsibility through self-testing by following Protocol 1-2-3. By keeping ourselves healthy, getting up-to-date vaccinations and with employers and education institutions not always insisting to see medical certificates, most COVID-19 patients can recover uneventfully by resting at home and seeking care only when needed. Our policies will, therefore, need to evolve with the state of our preparedness. For safe management measures, we refrain from imposing additional restrictions even as we ride through a wave now. Likewise, healthcare financing policies would also need to start evolving and progressively scale back from subsidy policies that were enacted under exceptional pandemic circumstances.”
“MOH will continue to study the emerging data, including the benefits of newer vaccine formulations, weigh against the risk of new variants and update our recommendations, as and when necessary. Ms Joan Pereira asked about the incidence of reinfections. It does occur in Singapore, but by and large, reinfection rate during the current wave has been low in Singapore and we recorded reinfection rates that are lower than many countries. This is likely because we have very good vaccination coverage and that we just went through a fairly large BA.2 infection wave, just at the beginning of this year. MOH has been watching the reinfection numbers very closely, because it will inform us of the likely timing of future waves. Our observation is that for those who were infected over the last three months, the chance of getting another infection is very rare. For those infected four to seven months ago, the probability of getting infected again is about 3% that of an uninfected or naïve person. If you have been infected with the Delta variant last year, the probability of getting infected again is about 20% that of an uninfected person, or COVID-19-naive person. Of course, this picture will change as time goes by and the protective effect of prior infections wanes. Hence, having been infected by COVID-19 before, should not be a reason to let your guard down. In the meantime, reinfections are taking place, albeit not as frequently in Singapore, compared to other countries, but they are likely to increase as protection of prior infections wanes. We should, therefore, start to include reinfection numbers in our daily reported case counts. In the past, we report the number of patients who had been infected every day.”
“At the top left-hand corner, the line shows "Vaccination Effectiveness Against Severe Illness"; at the top left-hand corner is for the age group above 80; top right hand, 70 to 79; bottom, 60 to 69. And Members can see that the graphs are not dipping; in fact, they are staying at a high level. And that is 10 months' worth of data. So, our empirical data shows that after 10 months, the protective effect of three doses of mRNA vaccines remains very strong in preventing severe illnesses. That is why as of now, our recommendation is for those who are 80 and above to receive their second booster, or fourth shot, to better protect against severe illness. Members will notice that at the top left-hand corner is the chart for those aged above 80. In fact, it has not dipped, but in general, the protection level is lower than younger cohorts, which is why we recommend that they take a fourth shot, or the second booster. As for those aged 50 to 79, although the protection levels continue to be strong, this is also the age when chronic illnesses start to set in. So, they have been offered the second booster if they want to take it, either because they are travelling, or they are worried about their health because of underlying chronic illnesses. Our experts are actively studying the benefits of a fourth shot, or a second booster, for the age group of 60 to 79, in further reducing the likelihood of severe illnesses. We will announce their recommendations shortly, once they are ready. As for the younger individuals below 60 years old, they have the protection of both the third shot, as well as age. Currently, they do not require a second booster if they are healthy.”
“All of them are vulnerable to severe illness, if infected. We will continue to try to reach out to them through our Mobile Vaccination Teams, through our home vaccination teams. The second concern – MOH knows that vaccine protection against severe illness will not last forever. So, Mr Shawn Huang has, therefore, filed a very pertinent question on when this will start to wane. MOH monitors this data closely. Mr Deputy Speaker, Sir, with your permission, may I show some graphs on the screen, please?”
“Mr Seah Kian Peng asked what percentage of our population has been infected. On record, we have about 1.7 million reported cases, which is about 30% of our population. MOH also systematically monitors blood samples from routine polyclinic cases and other healthy volunteers for signs of previous infection. From these samples, we estimate about 60% of local residents are likely to have been infected with COVID-19. Notwithstanding that, this does not confer us "herd immunity". By and large, scientists around the world do not think herd immunity is achievable because the virus will continue to mutate, escape the protection of vaccines and then, infect people. What is achievable is population protection against severe illness through vaccinations. This is what enables our healthcare system to weather through an infection wave, even with high case numbers, because the translation of case numbers into severe illnesses is very low. During the last Omicron wave at the beginning of this year, 2.4% of infected persons needed hospitalisation. During this wave, 1.9% ended up in hospitals. The actual percentages are likely to be lower because not all cases are reported. Notwithstanding our strong resilience due to good vaccination coverage, MOH still has some concerns and we can never be complacent. First concern, coverage of the vulnerable, especially our seniors. To get good vaccine protection against severe illness from the Omicron variants, we need three doses of mRNA shots. It is no longer a two-dose vaccination; it is three doses. However, we have more or less hit a plateau – there remains 40,000 seniors, aged 60 and above, who have not received their booster shots, even though they are eligible. Another 40,000 seniors have not completed two doses yet.”
“However, the 5% cut today is far less than the 15% cut that we had to implement during the first Omicron wave in the beginning of this year. Hospitals restricted but did not suspend visits to patients. We also did not suspend the leave of healthcare workers, so they can still take breaks, including flying to their home countries to see their loved ones and their family members. This is extremely important in maintaining the morale of our healthcare workforce. Mr Yip Hon Weng asked if hospital-acquired COVID-19 infections is contributing to a bed crunch. The answer is no. Absenteeism in hospitals due to the current COVID-19 wave has been lower this time round, at about 2%. As far as we can determine, while there had been some transmission within hospitals, overall, hospital-acquired COVID-19 infection has been low and very likely, lower than community-acquired infections. This is because of good infection control measures in hospitals. We need to recognise that bed crunches are mainly caused by high case numbers because of an infection wave and how those case numbers translate into severe illnesses that need hospitalisation. There are only two ways to minimise this: one is social restrictions, two is to ensure good coverage of vaccination amongst the population. All of us do not want to bring back social restrictions as far as possible. The rule of five, the rule of two – we try to avoid that. And so, therefore, we need to rely on vaccinations. In that regard, like many Singaporeans, I am very proud that Singapore has achieved what many countries want to achieve, which is that most people have gotten up-to-date vaccinations. The resilience has been further strengthened as many people recovered safely from COVID-19 infections.”
“The first important measure to achieve that is to set aside sufficient bed capacity to cater to COVID-19 patients. So, in response to Mr Louis Chua, based on our worst-case scenario projection for the current wave, we have plans to set aside up to about 1,000 COVID-19 hospital beds for COVID-19 patients. This is a dynamic plan and fortunately, in the course of this infection wave, we did not have to activate all of those beds. In the same question, Mr Louis Chua asked about foreign patient arrivals for the last five years. I think that this is a non-COVID-19 related question, we will answer it separately and Senior Minister of State Janil Puthucheary will touch on that. Second, we eased the workload of hospitals by transferring lower-risk patients to COVID-19 Treatment Facilities and discharging long-term stayers back to community care facilities, like nursing homes. Many of these facilities and services are run by private or social sector providers and we are deeply appreciative of them for doing this work. Compared to the last Omicron wave, the transfer processes are now a lot smoother and patients and their families have also become a lot more understanding when hospitals say that your loved one needs to be transferred. As a result, for this infection wave, we have been able to make many more transfers than the last and this has made a significant difference to the workload of hospitals. Finally, hospitals also have to manage their own demand for beds. They have cut down on "business-as-usual" workload, by about 5% and this comprises of mostly elective surgeries. This is not ideal, because it builds up the backlog of work which have to be attended to eventually.”
“I will touch on the COVID-19 situation, healthcare capacity and vaccination programme. Thereafter, Senior Minister of State Janil Puthucheary will address PQs for our treatment and vaccination plans for children. And if the Members who filed tomorrow's questions are satisfied with the answer, they may wish to withdraw their questions. My Deputy Speaker, we are still in the middle of an infection wave driven by the Omicron variant BA.5. Over the last 10 days, infection numbers have been falling and the week-on-week ratio has dipped below 0.9 over the last week. We should see the wave subsiding further this week. We did not tighten any social restrictions during the current wave. Everyone went about our lives normally: going to work, visiting families, going out with friends, travelling in and out of Singapore. However, life is not as normal in our hospitals. Without additional social restrictions, our healthcare system is bearing the brunt of the current wave. Healthcare workers have been very busy. Polyclinics and our general practitioner clinics also saw higher patient volumes. To answer Ms Joan Pereira, we are indeed promoting the use of telemedicine for mild COVID-19 cases. It is now a lot more accepted by patients than before. But even so, we need to be realistic that in a big infection wave, the healthcare system will come under stress, notwithstanding the common usage of telemedicine. Waiting times at private clinics, polyclinics and hospitals will inevitably go up and I seek the patience and understanding of all our residents. In such a situation, the key is to ensure that hospitals are not overwhelmed and that those who need urgent care can be attended to promptly. By and large, we have been able to achieve that.”
“Mr Deputy Speaker, with your permission, may I and Senior Minister of State Janil Puthucheary address the COVID-19 related Parliamentary Questions (PQs) for oral answer, Question Nos 7 to 15 in today's Order Paper; and then those filed by Mr Saktiandi Supaat1 and Mr Yip Hon Weng2, filed for 2 August; and Parliamentary Questions for written replies filed by Mr Zhulkarnain Abdul Rahim, Dr Shahira Abdullah and Mr Shawn Huang, please.”
“Healthier SG is a complex and multi-year national programme. In the initial phase of implementation, eligible residents will be invited to enrol with a primary care clinic of their choice and to develop a long-term supportive relationship with their local family physician to support better care and, especially, in managing chronic illnesses. MOH recognises that Traditional Chinese Medicine Practitioners (TCMPs) have been playing an important role in our communities to guide residents to better health. TCM methods are often holistic, long-term and complement western medicine. MOH will continue to engage TCMPs to hear their views and discuss with them how TCMPs can be part of the community involved in Healthier SG.”
“The current MediSave withdrawal limits are adequate for the vast majority of patients with conditions under the Chronic Disease Management Programme (CDMP). In 2021, about nine in 10 patients with complex chronic conditions who withdrew MediSave under CDMP did not reach the annual $700 limit. Similarly, about nine in 10 patients with simple chronic conditions did not reach the annual $500 limit. Nevertheless, patients who face difficulties paying for their medical bills may apply for financial assistance, such as MediFund, at public healthcare institutions. MOH will continue to review our financing schemes regularly, taking into account any rise in healthcare costs, so that healthcare remains affordable for Singaporeans.”
“Quarantine Orders are issued to a close contact of a COVID-19-positive person to ringfence the spread of the disease. So, the quarantined person is well, able to work but not allowed to. The Quarantine Order Allowance Scheme was introduced to encourage the adherence to the quarantine and to cushion the impact on self-employed persons and companies. Isolation Orders are issued to a COVID-19-positive person who is infectious and is not expected to move around. There is no allowance allocated to such a person, as in all other illnesses.”
“This question has been addressed by the oral reply to Question Nos 2 and 3 on the Order Paper for 5 July 2022.”
“Persons who submit the form for "Request to be Exempted from COVID-19 Vaccination Requirements" will be reviewed by doctors on their eligibility for COVID-19 vaccines. All our doctors have been provided guidance from MOH on the conditions to look out for and will recommend blanket exemption when appropriate.”
“Dengvaxia is, currently, the only dengue vaccine approved in Singapore for individuals aged 12 to 45. However, the vaccine is not recommended for individuals who have no prior infection, because of the increased risk of developing severe dengue, should they get infected with dengue later in life. Due to Singapore’s relatively low dengue prevalence, most people are ineligible to receive the vaccine. As such, Dengvaxia vaccination is not an effective way to control dengue at the population level and Singapore does not track the number of people who have taken the vaccine. Other than Dengvaxia, there are, approximately, six dengue vaccine candidates in various stages of clinical development, with Takeda’s tetravalent, that is, targeting all four dengue strains, dengue vaccine (TAK-003) being the most advanced candidate. Takeda has submitted its dengue vaccine candidate for registration in Singapore and the application is, currently, being reviewed by the Health Sciences Authority (HSA). MOH will continue to monitor the development of the dengue vaccines and therapeutics as part of a multi-pronged approach to dengue control in Singapore.”
“Eye drops and medication prescribed for glaucoma in public healthcare institutions, generally, cost about $20 to $30 a month, after subsidies. Singaporeans aged 60 and above can use up to $300 a year of their MediSave to pay for their glaucoma medication and eye drops at public healthcare institutions and Community Health Assist Scheme (CHAS) clinics. The Ministry will continue to regularly review healthcare financing schemes to improve affordability of healthcare, while ensuring there remains sufficient savings for future healthcare expenses.”
“Eldercare centres (ECs) are supported mainly by administrative staff and a strong pool of volunteers. Healthcare clusters with their nurses and Allied Health Professionals (AHPs) will also work with ECs to bring in other preventive care services to the community. There are ongoing efforts to both recruit and retain staff in the community care sector. We are enhancing salaries in the sector through the ongoing Community Care Salary Enhancement Exercise. We develop staff and attract talent to join the sector through funding support for scholarships and training. Job redesign will also help increase productivity and value of the jobs. We are also enhancing the public image, respect and understanding of the community care sector through the Care to Go Beyond campaign. Finally, we will continue to complement our local workforce with foreign manpower wherever needed.”
“So, therefore, we must be able to accept that, over time, we have to recruit more foreign nurses from different sources, be able to take them in, train them and, over time, recognising that there is international competition, be able to review their pay and pay them competitively. The good ones, over time, should be able to become part of our community and become PRs, live with their family here, go to the local schools. This is the only way for us, to not just weather through this wave, but, also as our population gets older, the size of our healthcare workforce will have to increase and we have to tap on both a strong local pipeline, as well as foreign recruitment.”
“Let me answer the second question first. The answer is yes. The number of hospitalisation cases has reached almost 700 now. So, it has increased quite significantly. This is as compared to the height of the Omicron variant wave earlier this year, where we have about 1,700 hospitalisation cases. Now, it is close to 700. At that time, we cut back business-as-usual (BAU) surgeries by 15%. We have now started to trigger some cut-back of BAU, mostly electives, and it is at about 4%. So, about 700 beds, 4% cutbacks in BAU, compared to the height of the Omicron variant, 1,700 beds, 15% cut. As I have mentioned earlier, from today's number, we have reason to believe the wave should be near its peak and I hope, from here, things will be better. Manpower, indeed, is a challenge. The current attrition rate is comparable to what we had experienced in 2019. In February, there was a slight spike after bonuses have been received. But, otherwise, in the latest number, month-on-month, it is comparable to what we experienced in 2019, pre-COVID-19. Having said that, it is increasingly difficult to hold on to and to recruit foreign nurses, because, with COVID-19 being a global pandemic, the hiring of nurses is a matter of international competition. The good thing is that, locally, young people's perception of the nursing career is, by and large, a positive one. I am very thankful, actually, that, in MOH and healthcare, we have our fair share of talent. And when Nanyang Polytechnic, Ngee Ann Polytechnic or SIT open up their courses, it is always oversubscribed, lots of competition. People cannot get in and they have come to us to appeal to get into nursing courses. Mid-career conversions also have a healthy pipeline. But our cohort size is limited. Our healthcare demand is growing.”
“Thank you. Of all infections now, the latest number is about 50% are the BA.4 or BA.5 – mostly BA.5 – subvariants. It has been doubling every week. It started with 3%; then 5%; then 8%; then 16%; then 30% last week and50% this week. By next week, I would expect it to be 70%, 80%. It is clearly a more dominant subvariant, compared to BA.2. Pfizer-BioNTech and Moderna, as the Member pointed out, are, indeed developing bivariant vaccines, which means these target two viruses: the original wild type that started in Wuhan as well as the Omicron variant. Early data does show that these bivariant vaccines elicit a stronger immunity response in individuals who have taken them but it is very early days. We will continue to study the risks and benefits of using such a bivariant vaccine, how to apply it in Singapore. As of now, our contracts with both pharmaceutical companies do allow us to accept shipment and implement them when ready, probably by end of the year, if they are approved, the data shows it is alright and we receive the shipment. But – I should add the very important "but" – do not wait for this bivariant vaccine and hold back taking your booster. We have 60,000 seniors, and also those with health conditions, they are vulnerable. If you have not taken your first booster, you need to take it now. And if you are 80 years old and above, living in an aged care facility and vulnerable, you do need to take your second booster now. The current booster, the current formulation works very well in preventing you from falling very sick. So, do not delay taking your booster.”
“Alongside our polyclinics, PHPCs play critical roles in providing Government-subsidised swabs, COVID-19 vaccinations and oral antivirals. We did not reduce the number of PHPCs earlier because we anticipated a new wave of infection, which did happen. We are now in the middle of this new wave and it will be inappropriate to stand down PHPCs at this juncture. This is in response to Ms He Ting Ru's question. In conclusion, Singapore has been weathering the COVID-19 pandemic through a comprehensive approach. While we have assessed that there is no need to tighten SMMs for now, we urge everyone to play our part to take the necessary precautions, exercise individual and social responsibility to keep infection rates low, support our healthcare workers and healthcare institutions to weather through this wave.”
“This will make it easier to transfer patients from acute hospitals to CTFs without a significant drop in level of care. They are now about 25% occupied. Our GPs continue to take care of COVID-19 cases within the community. Nursing homes are equipped to manage lower risk cases within their facilities. To help reduce risk of developing severe disease and hospitalisation, COVID-19 therapeutics, such as oral antivirals, for example, Paxlovid, are made more readily available in primary care and nursing home settings as early treatment, and pre-exposure prophylaxis is available in hospital outpatient settings for at-risk populations. As of 30 June, all polyclinics and 103 participating PHPCs can prescribe oral antivirals to clinically-eligible patients in the community. With these measures, the vast majority of cases are managed outside of hospitals, which is appropriate, given the high level of vaccination in our population. However, our public hospitals continue to face high demand from non-COVID-19 patients, what we call the "business as usual" (BAU) patients. Over time, we hope more of our CTFs can be multi-purpose isolation and treatment facilities for both COVID-19 and non-COVID-19 patients. We have already reconfigured one of our CTFs at Sengkang Community Hospital into this new model and we will explore converting other CTFs. Finally, Ms He Ting Ru asked about healthcare subsidies related to COVID-19 pandemic. As at end FY2021, the Government has spent about $730 million and $220 million on subsidising inpatient and outpatient treatments for COVID-19 respectively. Since February 2020, we have progressively stood up more than 1,000 PHPCs.”
“I also know that many Members of this House have been reaching out, talking to seniors and engaging them. Thank you very much for doing so. Persons who are recommended to receive the second booster under prevailing recommendations should proceed to do so, even if you have contracted COVID-19 previously. Ideally, an individual should wait 90 days after infection to take your second booster. It will help the booster work better. So, wait 90 days and take your booster. But if you are in a hurry for whatever reasons, we will offer the second booster at least 28 days after your infection. So, please tell your residents, "If you have been infected, it does not mean you are exempted from the booster". All of us respond differently. Some of us hardly have any response. So, to be safe, take your booster shot. The second prong of our strategy is to augment and optimise our healthcare capacity. While current international and local evidence show that severity of the Omicron subvariants is not worse, compared to that of the earlier Omicron strains, our hospitals, GPs and other healthcare institutions are on standby to bolster their capacity to prepare for future waves. Our hospitals remain ready to ramp up dedicated ICU and isolation bed capacity should there be an increase in the number of COVID-19 patients who require hospitalisation. Actually, there is and they are already doing so and are now very busy. We have also maintained sufficient beds in our COVID-19 Treatment Facilities, or CTFs, to manage serious cases that do not need hospital care. We have recently consolidated our CTFs from about 2,000-over beds, to about 1,300 beds, but with a higher manning ratio.”
“There are about 60,000 seniors aged 60 and above who have not taken their first booster or third shot. This number has come down from last week, when Deputy Prime Minister Lawrence Wong and I announced that there were 70,000. It has now come down to 60,000. So, they are coming forward, which is a good thing. But we urge all our seniors who have not taken your booster shot, your third shot, to do so quickly because it makes a huge difference whether you will fall severely sick if infected. We have also recommended since March that vulnerable individuals should take a second booster, or your fourth shot. This includes all persons aged 80 and above, those living in aged care facilities or those with underlying illnesses and are vulnerable. In recent months, we have stepped up our efforts to remind seniors to do so. We made regular announcements and have been progressively sending out SMS notifications and reminders to eligible individuals. They can walk into any Joint Testing and Vaccination Centre or participating Public Health Preparedness Clinic (PHPCs) or polyclinic to receive their second booster dose. Alternatively, individuals can also book an appointment using their notification SMS. Since 27 June this year, we have also been sending out mobile vaccination teams (MVTs) to our heartlands to make it even more convenient for our seniors to get vaccinated and boosted. We will cover a total of 60 sites. Last week, we planned for 50. We are going to increase it. Now we will cover 60 sites. Staff and volunteers from our partners, People’s Association and Silver Generation Office, are also reaching out to our seniors through house visits and engagement dialogues to address many of the queries that our seniors may have.”
“In South Africa, the second Omicron wave, driven by these two subvariants, was approximately one-third of the peak of the previous Omicron wave. Every country’s experience will be different and unique, but we have good reason to believe that this will be a smaller wave than the last. Today is Tuesday. Tuesday is always the day when cases spike. We should expect at the end of today case numbers of over 12,000. This is a tad higher than the same time last week, which was over 11,000, 10% more than last week. So, there are indications that we are near the peak, if not at the peak. And we should be relieved that the number this week did not double from last week. Otherwise, we will be at 24,000 or 22,000 this week. The key is to ensure that hospital capacity is not overly stressed. And here, we have been relying on two strategies that I will go through today: first, ensure high vaccination and booster coverage so that as many people as possible are protected from severe illnesses, if they are infected; second, ensure that our healthcare institutions and facilities are prepared and able to ramp up capacity, should there be increased admissions. These strategies continue to be relevant for this current wave. Let me talk about the first point, in response to Mr Ang Wei Neng and Mr Yip Hon Weng’s questions. The most important is for everyone who is eligible to take their first booster or their third shot. After several mutations, we now need three shots of vaccines to properly protect ourselves against the Omicron variant. The vaccines were developed in the early days, the wild type – or Alpha and Beta – when you need only two shots. With more mutations, we now need three shots.”
“Thank you. Mr Ang Wei Neng asked how we will reduce infection rates of the Omicron subvariant transmission. We anticipated this wave when we learnt about the subvariants BA.4 and BA.5, which have a significant growth advantage over BA.2. This wave, however, arrived slightly earlier than the July and August timeframe that we expected. That is why we have maintained the indoor masking requirement even when cases were low and stable, in order to moderate the infection rate when this new wave arrives. The high vaccination coverage that we have will also temper the size of the wave. To reduce the infection rate further, all of us can play our part: stay at home when we do not feel well, test ourselves regularly, especially if we are meeting people who are vulnerable, or if we attend big meetings or events, such as before coming to Parliament. And if we still want to reduce the infection rate even further, more stringent safe management measures (SMMs) will need to be implemented. And that means reintroducing things like group sizes, capacity limits and masking outdoors. As the Minister for Health, I can never say we will rule out these steps. We cannot rule out these steps when we are hit with a serious infection wave but, as far as possible, we should avoid them, especially if we are reasonably confident that our hospital capacity can hold up and that we are determined to live with COVID-19 and continue our journey of endemicity. For this current wave, our assessment is that it will not be as severe as the Omicron wave we experienced earlier this year. This is because many more of us have gained stronger immunity either through booster shots or recovery from infections. This will significantly impede the circulation and transmission of the BA.4 and BA.5 viruses.”
“Mdm Deputy Speaker, with your permission, may I address Question Nos 2 and 3 together? And in my reply, I will also cover written Question Nos 43 and 21 filed by Ms He Ting Ru and Mr Yip Hon Weng on the topic of COVID-19, filed for 4 and 5 July respectively, please.”
“This question will be addressed in my reply to Mr Ang Wei Neng and Mr Yip Hon Weng on 5 July 2022.”
“Respite care services tap on the existing capacity of long-term care services, and providers activate places in response to demand. Providers are generally able to meet the demand for respite care, with the Agency for Integrated Care (AIC) working with providers to prioritise clients with urgent care needs. The Ministry of Health (MOH) is reviewing the respite care landscape, including how to improve the availability and accessibility of respite options.”
“This question will be addressed in my reply to Dr Lim Wee Kiak and Mr Yip Hon Weng on 5 July 2022.”
“The current Additional Withdrawal Limits (AWLs) range from $300 to $900, with higher limits for older policyholders in their 70's, whose premiums for the private insurance component could be up to four times that of the MediShield Life premiums. We need AWLs to strike a balance between helping Singapore Residents pay for IPs, which are optional and often premium products beyond MediShield Life, and conserving MediSave savings for other healthcare needs especially in old age, as IP premiums can rise very quickly which policyholders may not expect. Notwithstanding, MOH is constantly reviewing our healthcare financing policies, including usage of MediSave, as new data and evidence emerge.”
“Today, healthcare subsidies are generally extended to the patients based on their own citizenship status, and not that of their spouses. To support Singaporeans with dependents who have not obtained permanent residence or Singapore citizenship, the Government had extended healthcare subsidies at the same level as PRs since 2012 for inpatient services to Long-Term Visit Pass-Plus (LTVP+) holders. This includes Obstetrics and Gynaecology (O&G) services. SCs and PRs can also tap on their MediSave to pay for the pre-delivery and delivery expenses of their foreign spouses, up to the prevailing withdrawal limits. Patients who are facing financial difficulties may approach the medical social workers for assistance. Our public healthcare institutions may provide some assistance using their own hospital charity funds, or offer instalment plans for payment where required, based on their medical social workers’ assessment.”
“As part of local undergraduate training, medical students are equipped to provide care for persons with intellectual disability (PWID). MOH is also collaborating with the College of Family Physicians Singapore to provide a Family Practice Skills Course to further strengthen our medical practitioners’ skills in this area. This helps to ensure that primary care doctors have a good understanding of the physical health issues and behavioural concerns of PWID, and can better manage them in primary care.”
“The EMBRACE programme, which was piloted at Yishun Polyclinic since September 2020, offers integrated services for the mother and child dyad during the same visit to the polyclinic. This includes vaccination and childhood developmental screening for the child, and maternal health services which include post-natal depression screenings and management of gestational diabetes mellitus. In view of the good results and positive feedback received on the mother-child dyad service model, the Child and Maternal Health and Well-being Taskforce has recommended that the mother-child dyad services be scaled up to 12 more polyclinics. In particular, the EMBRACE programme will be expanded to all existing NHGP Polyclinics to allow more mothers and their children to benefit from the programme. In addition, we are also scaling up ante-natal and post-natal mental health screening for mothers and mothers-to-be at other relevant touchpoints like at KKH and NUH. Through these programmes, women who are at-risk of mental health depression could be identified early, and provided with early intervention and support during their pregnancy and transition to motherhood.”
“The Government supports seniors and residents who require wheelchair-accessible transport through various schemes including the Medical Escort and Transport service under the Ministry of Health (MOH). MOH and MSF also subsidise the cost of transport for seniors, including those on wheelchairs, to attend Government-funded senior and disability programmes through the Voluntary Welfare Organisation (VWO) Centre Based Transport services and VWO Transport Subsidy schemes. Beyond means-tested transport services, there are private transport operators that provide point-to-point services for wheelchair users. Availability and cost of these services may be subject to private operators’ business decisions. MOH will continue to monitor the range of accessible transport options for seniors on wheelchairs, to ensure that they can receive appropriate care and services.”
“Hospital admissions are only for patients assessed to require inpatient treatment because of their medical needs. All patients, regardless of their age, who are assessed to require hospitalization will not be denied treatment. MOH is actively increasing our acute hospital capacity to meet the growing demand of our ageing population. In addition, MOH has also increased the capacity of our community hospitals, community and home care services, as well as primary care services, to support the healthcare needs of our seniors.”
“MOH and the Life Insurance Association (LIA) has therefore introduced the 'Moratorium on Genetic Testing and Insurance' in 2021. Under the moratorium, genetic test results from biomedical research will not be used in insurance underwriting. Life insurers are also generally not allowed to use predictive genetic test results in assessing or deciding the outcome of insurance applications. MOH will continue to review the international developments in Precision Health, and to conduct our own research and studies, to inform our health policy guidelines and improve healthcare outcomes.”
“Precision Health technology is advancing rapidly, and has the potential to transform how we manage our health and improve healthcare. This includes identifying groups who are at higher risk of disease or its progression, to allow for early screening and preventive action. To harness its benefits and mitigate risks and downsides, there are three things that MOH is doing. First, continue to develop our capabilities in this area. The Precision Health Research, Singapore (PRECISE) programme is a key research initiative, to develop breakthrough and cost-effective clinical applications of companion diagnostics for precise health prevention and treatment. For example, it is studying whether familial hypercholesterolemia, an inherited condition that results in very high cholesterol levels, can be identified and treated early. Second, to ensure that the activities surrounding Precision Health is guided by ethics and a code of conduct. In anticipation of the increasing use of genetic testing, MOH had developed in 2018 the 'Code of Practice on the Standards for the Provision of Clinical Genetic/Genomic Testing Services and Clinical Laboratory Genetic/Genomic Testing Services'. The Code of Practice will be translated into standards and requirements under the new Clinical Genetics and Genomics Services Regulations under the Healthcare Services Act in 2023. Third, continue to ensure inclusivity in our healthcare support and safety net. With genetic testing, it has become possible to deny individuals’ insurance coverage due to their higher propensity to contract certain diseases. Precision in diagnosis and treatment does not necessarily have to lead to precision in insurance coverage, which can be socially undesirable.”