Ong Ye Kung
Singapore
“The Ministry of Health (MOH) recently enhanced the Community Health Assist Scheme (CHAS) dental subsidies, which are tiered by income, for common preventive and restorative procedures.”
“Healthier SG GP clinics may also refer their enrolled patients to Active Ageing Centres and Community Health Posts to fulfill their social prescriptions and for subsidised services, such as medication management.”
“Public hospitals, such as the National University Hospital, the Singapore General Hospital and Tan Tock Seng Hospital, have deployed robotic-assisted surgical (RAS) systems for minimally invasive soft-tissue surgeries.”
“The Health Sciences Authority (HSA) welcomes drug producers to choose Singapore as part of their first-wave filings. As long as a pharmaceutical product is approved by at least one regulatory agency, such as China's National Medical Products Administration (NMPA), it would also qualify for the abridged route.”
“A decrease in estimated glomerular filtration rate in patients with diabetes can be due to multiple reasons. Doctors will first investigate the underlying cause before determining whether the patient should be referred to a specialist. Some causes are reversible and cause transient reduction in renal function.”
“Information on the Lasting Power of Attorney (LPA) cannot be made visible on the National Electronic Health Record system as it is protected under the Mental Capacity Act. Such information may only be disclosed by the Public Guardian to specified persons upon satisfactory submission of evidence(s) required under the law.”
The complete record
Every one of 2,932 lines we hold for Ong Ye Kung, in date order, each linked to its source. Free to read, in full, without an account. Page 31 of 59.
“We already have such collaborations on the ground – some Members have mentioned it – in Queenstown and Tampines. We need to roll out such initiatives across every town to make good health not just a matter for doctors in clinics, but for all of us in everyday life and places. That brings me to the fourth component. Once the first three components are in place, we will roll out a national Healthier SG enrolment programme. That is when I mentioned by enrolling into Healthier SG, a resident will commit to see one family doctor and adopt one care plan. The national enrolment programme will be coordinated by our three healthcare clusters. Each will look after a region of up to about 1.5 million residents and work with the family doctors and other partners in the region to reach out to as many residents as possible. We will probably start with people in their 40s and older, because that is when chronic illnesses may start to set in. Then, we will have to build up the participation base progressively. When HPB rolled out the latest season of the National Steps Challenge, it recruited 900,000 participants. We hope Healthier SG can be even more successful than that. I want to specifically highlight the importance of this collaboration between healthcare clusters and the family doctors. It is a very important nexus, because the family doctors will receive support from hospitals in looking after residents with more complex needs. Hospitals, after discharging a patient, can refer them back to the family doctor. This is exactly what we did during COVID-19. It works and there will be seamless coordination and continuity of care.”
“I do not think we can implement them all, but we will try to put together a package that is compelling, attractive and which we can afford. Perhaps, some ideas: preventive care consultations with family doctors and recommended health screenings could be made free or costing only a nominal sum. Just to assure Dr Tan Yia Swam, this does not mean that GPs will not be paid, they will just be reimbursed elsewhere. Perhaps we can claim higher CHAS benefits for drugs if we go to the same doctor; perhaps we can tap on MediSave more for our care plan. Perhaps we can offer insurance premium discounts or vouchers if we diligently follow our care plans or even, better still, show good outcomes. These are all possible ideas. By enrolling on Healthier SG, a resident will commit to see one family doctor and adopt one care plan. Our third component is that we then need community partnerships. Preventive care plans involve lifestyle adjustments, which need to happen outside of the clinics and in our living environments. Doctors have a name for these. They call these "social prescriptions", as opposed to drug prescriptions. We, therefore, need the support of agencies, many of them, Health Promotion Board, Agency for Integrated Care, People’s Association, SportSG, National Parks Board and community partners that oversee various social services. They run various activities and programmes in the community which we then get family doctors to tap on. So, one analogy: if we have a major illness, we go to a doctor, the doctor often refers us to a few specialists or therapists. But in a preventive care plan, the family doctor may refer us to a qigong class, to a brisk walking group, or a community farming club, for example. Social prescriptions.”
“MOH has been working in partnership with GP clinics for some time, started by my predecessors. They are part of our CHAS programme. They also serve as Public Health Preparedness Clinics (PHPCs) during pandemics. COVID-19 has deepened that partnership and now, we can leverage on this in order to implement Healthier SG. We can leverage GPs to attend to more patients, not for coughs and colds, but devoting time to provide preventive care. MOH will support this, by building up the clinics' capabilities, such as telemedicine and IT systems. We will work with the GPs to develop the skills of clinic healthcare team and forge partnerships with hospitals to deliver more integrated team-based care. The second component of Healthier SG is healthcare plans. Seeing our family doctor for preventive care is different from the occasional visit to their clinics when we do not feel well. It means regular scheduled check-ins – at least once a year – so that the family doctor can assess your overall health condition, conduct necessary health screenings, track your results, administer vaccinations if need be, advise you on adjustments in lifestyles to help you achieve your health goals. And this is especially useful if you are at risk of developing a chronic condition, like diabetes. A care plan can help prevent it. To support residents to follow through with the care plans, we need to make them accessible, attractive, maybe even rewarding. 4.45 pm We will conduct public and stakeholder consultations to work out these proposals and incorporate them in a White Paper. I am very sure there will be no shortage of ideas and we have heard several today from Members.”
“The family doctor can do for you what my friend has done for my chronic condition. They can be what Dr Tan Wu Meng described as the "coordinating physician". However, only three in five Singaporeans have a regular family doctor. The other two tend to doctor-hop. Go to doctor A for hypertension medicine, go to doctor B for cough and cold and get MC. So, there is no one family doctor who knows our overall health condition and family health history well enough to be able to see the link between different care episodes, even across different family members. And we now have a golden opportunity to bring as many of our family doctors as possible into this long-term national public health programme – and that opportunity is made possible by COVID-19. When we needed more people to get vaccinated against COVID-19, I personally wrote to the GPs and also to TCM practitioners and asked them for help. So, they heeded the call, explained the need for vaccinations and persuaded many of their patients to take the jab. GPs are nodes of trust. Throughout the pandemic, they served as the first port of call for people who fell sick and suspected that they might have been infected by COVID-19. Then, during the Omicron wave, GPs took on an even greater role – they assessed the severity of patients coming to them, placed them on home isolation if they have mild symptoms and low risk and then supported their recovery, often by telemedicine. And therefore, they demonstrated that rest and recovery at home is appropriate for many ailments and that telemedicine does work. Our COVID-19 response would have been inadequate, even crippled, if not for the contributions of our family doctors. They have been a key component of the national crisis response.”
“Those are important but good health is more likely to come from an accumulation of the humdrum and the mundane, because as the saying goes, "prevention is better than cure." We need to, as Mr Ang Wei Neng and Mr Henry Kwek said, maintain health, rather than treat sickness. That is why we are not called the Ministry of Sickness, but we are called the Ministry of Health! The measures must be taken early, when the person is still healthy. It must identify the risk factors in our lives that will erode our health slowly and quietly, and then address these factors. It must be done in homes and in the community, not in hospitals or clinics. It is best centred on the family doctors – in polyclinics and GP clinics – and less on surgeons and specialists in hospitals. Family doctors must then become the most important anchor of our healthcare system. This new strategy centred around primary care is called Healthier SG. We have worked out the broad plan but still finalising the details. Over the next few months, we will be consulting different stakeholders, Singaporeans from all walks of life, GPs, healthcare workers and community partners to gather their inputs and views. MOH will then flesh out the details in a White Paper and table it in this House for debate. Today, I will outline five key components of the Healthier SG strategy. First, mobilise our network of family physicians and family doctors. Studies have shown that people who go to only one family doctor consistently, are generally healthier. They have fewer visits to the emergency department and fewer episodes of hospital care. This is because the doctor and his care team know you well and can detect early signs of any problems in a timely and accurate way.”
“It will still slope upwards but we can bend it downwards. How are we doing this? Let me explain. Many doctors that I have spoken to have always wondered: how did a patient become so stricken with chronic illness? Why did not he make lifestyle adjustments when he was younger? Why did he leave it too late? Why only now that he comes to me when he is so sick? I can relate to that inaction. When I was younger, in my 30s and 40s, you feel almost invincible – you will never fall sick. And I did not feel the need to take care of my health too. Then, a doctor friend of mine kept nagging me to go for health screening. "Go for health screening." He sees me, he says, "Go for health screening." Since he is my friend, I listened to him. Then, after the test, he found that I have quite high levels of cholesterol. Based on my risk level, he performed further tests and found a very small calcium deposit in one of my heart arteries. So, at his advice, I started taking some medication, adjusted my diet – nothing very austere. I have to cut down chilli crabs, prawns and sotong – not a huge sacrifice, as Mr Pritam Singh is acknowledging. That is austere? No, I can still eat them once a month. I just do not eat them every other day! So, eat in moderation but certainly not deprivation. If anyone wants to treat me to seafood, I will say yes! I just went two weeks ago and my reading are now fine. More importantly, because of early intervention, I probably averted a major heart bypass surgery when I become old, or worse, a heart attack that may kill me and distress my family and my loved ones. We usually associate better healthcare with fascinating medical technology or heroics in the operating theatre like when we watch Grey's Anatomy.”
“For this generation of seniors, many have several children, who can all chip in to help take care of them. And even so, it can be quite taxing. But people around my age, slightly older, slightly younger, we have fewer children and we are likely to live longer. That means when we are in our 80s, 90s and if you are lucky, 100s. If you fall very sick, unable to walk, change, eat, shower, our children will be in their 50s or 60s and hopefully, they will be able to take care of us. Beyond the immediate family, sickness across the population imposes a huge burden on the healthcare system and on our taxpayers. We heard this sobering piece of data during the Budget debate and Minister Lawrence Wong mentioned – Government healthcare expenditure tripled over the last 10 years. Based on current trajectory, it will again, more or less triple in the next 10 years, to $27 billion in 2030. By then, healthcare budget may well be larger than that for defence and education. To make healthcare affordable, the Government will have to continue to subsidise healthcare. And that is the key reason why additional revenue from GST increases is needed. Even so, the two percentage-point increase in GST may not be sufficient given the rate at which healthcare costs are increasing. That is why we also need to control costs. We have been doing so through bulk buying of drugs, using cost-effective treatments, better clinical procedures, right siting patients and moderating the buffet syndrome caused by healthcare insurance. But the more fundamental way to tackle cost is at its roots. That is, to make us healthier. It would not reverse the impact of an ageing population, but it can reduce the rate of increase and "bend the cost curve" downwards in the long run.”
“Second driving force, which is quite aside from age, Singaporeans young and old, are, generally, getting less healthy, even after adjusting for age. For example, in 2017, about two in 10 has high blood pressure. In 2020, this has become about three in 10. There are more of us with high cholesterol, from about three in 10 to four in 10, and I am one of them. Fortunately, for diabetes, the prevalence rate has been constant, likely due to our efforts in the War on Diabetes. More of us are getting obese. From 2017 to 2020, the obesity rate has gone up from under 9% to over 10%, undoing many years of progress. The first factor of ageing, that is due to the march of time. There is very little we can do about. The second driving force due to deteriorating health, this is due to the will of people, of which there is plenty we can do about it. Because deteriorating health is mostly a function of lifestyle – too sedentary, too much device time, too little exercise, too much sugar, salt and fat in our diet; and putting off looking after our health until it is too late. And indeed, living unhealthily is often more carefree and often more enjoyable. But we do not realise that we are paying for these instant gratifications by instalments, with our long-term health – bit by bit – until we realise the snowballing cost later in life. So, a young person who is obese, or has high blood pressure or high blood sugar, he may feel all right now, but actually, he may be a walking "time bomb". When he is older, there is a high chance of him being struck with a heart attack, stroke or require dialysis. When these illnesses strike, they are painful. They snatch away from us quality of life and happiness. They will burden family members and loved ones, emotionally and financially.”
“In terms of policies, we implemented MediShield Life and CareShield Life; we rolled out the Pioneer and Merdeka Generation Packages; we introduced the Community Health Assist Scheme or CHAS. In terms of structures, we established three healthcare clusters, centering around Singapore General Hospital (SGH), Tan Tock Seng Hospital (TTSH) and National University Hospital (NUH), each with significant economies of scale and capabilities. Outcomes have improved. Between 2015 and 2020, there are fewer readmissions into hospitals within 30 days after discharge, fewer U-turns, from 11.5% in 2015; 2020 – it came down, 10.7%. Response time to cardiac and stroke care at our hospitals have also improved. So, now, if you look across 204 countries in the world, Singapore had the highest life expectancy at birth – for men, at 83 years; and women, at 87 years. After 10 years of foundation laying, plus a pandemic crisis, it is time for us to take the next big step. There is urgency to this, because in the next 10 years, long after the COVID-19 dust has settled, we will have to tackle our biggest healthcare challenge since our nation began – the deteriorating health of our population. Dr Lim Wee Kiak asked what is driving cost increases. Deteriorating health is driving cost increases. What then in turn drives deteriorating health? Two major driving forces. 4.30 pm First is ageing. Currently, about one in seven residents in Singapore are seniors aged 65 and above. By 2030, that number goes to one in five. An older person is more likely to fall sick or suffer from severe illnesses compared to a young person – it is a fact of life. We see this in our parents and grandparents and in time, we will feel it ourselves.”
“] Mr Chairman, today, I would like to update Members on a major healthcare initiative to focus on preventive care. It is called Healthier SG. It will address the questions on preventive care from several Members – Dr Tan Wu Meng, Ms Ng Ling Ling, Mr Ang Wei Neng, Dr Lim Wee Kiak, Mr Henry Kwek and maybe others. This is a journey started more than 10 years ago by previous Health Ministers, to focus on health, rather than cure. During this journey, we have built a very robust foundation for the Singapore healthcare sector. The changes I am about to announce are only possible because of all these past achievements. For example, from 2010 to 2020, the capacity and capability of the healthcare system have been strengthened significantly. Let us take acute hospital beds which increased by 40%, as we opened three new acute public hospitals – Ng Teng Fong General Hospital, Sengkang General Hospital, Khoo Teck Puat Hospital. Nursing home beds increased by 70%. Senior Care Centre capacity expanded almost four times. The number of doctors and specialists increased by 65% to almost 15,000 now; nurses increased by 45% to 42,000 now. As a result, the number of doctors per thousand population improved from 1.8 to 2.6 and that for nurses gone up from 5.8 to 7.4. These ratios are similar or higher than most Asian regions and territories, normalised to the proportion of older people in the population. But they are lower than ratios in OECD countries, as observed by Ms Mariam Jaffar. This is due to a variety of reasons, including the population age profile, the model of care in different countries, between western countries and in Asia, and also the way western countries fund, subsidise and insure healthcare.”
“Mr Chairman, I want to thank Members for all your questions and your cuts, and my MOH colleagues for addressing most of them and stitching up most of the cuts. There is a remaining batch mostly on preventive care, which I will address. Mr Chairman, please allow me to start with a tribute to our healthcare workers. For over two years, they have toiled and fought against the COVID-19 virus, putting themselves in harm’s way, undergoing tremendous stress and, even as we speak, they are keeping our population safe and life in Singapore as normal as possible. At MOH, we have been doing whatever we can to support them, ensuring sufficient PPE, prioritising them for vaccinations, decanting as many patients as possible to COVID-19 Treatment Facilities and out of the hospitals, persuading the public to undertake self-recovery if they are infected and experience mild or no symptoms, and imposing the very difficult "no visitor" rule in hospitals. More than these clinical protections, we must stand up for them, against the abuse they suffer under the hands of a small minority of our population. I thank Members who have spoken up for healthcare workers on this. MOH’s instructions to the leaders of our public health institutions are clear – we must always protect them against abuse and insults. This is something that we must also do as a society. There are now good indications that the Omicron transmission wave has peaked and starting to subside. With that, I hope, not too long from now, healthcare workers will finally have a well-deserved and lasting respite. The men and women of the healthcare sector, are brave, dedicated, committed, big-hearted, professional and they deserve all the support, respect and understanding that we can give. [Applause.”
“To minimise the risk of contamination and leakage, manufacturers pack the various components of ART kits individually. Nevertheless, MOH will work closely with MSE to encourage manufacturers to reduce ART packaging and to move towards more environmentally-sustainable packaging, where feasible.”
“Trans fat can come from both natural and artificial sources. Natural trans fat occurs in dairy products and red meats, such as beef and lamb, hence, it is not possible to reformulate or remove them from products. Before the partially hydrogenated oils (PHO) ban, the majority of the trans fat in our diet came from artificial trans fat. The main source of artificial trans fat is PHOs that can be found in products, such as snacks and fat spreads. Singapore tackled trans fat in the food supply in two phases. In 2013, Singapore implemented trans fat limits in fats and oils, across supermarkets and eateries. In 2021, we introduced a ban on PHO, to eliminate artificial trans fat in Singaporeans’ diets. Since the announcement of the PHO ban in June 2019, high-risk products, such as fat spreads and frozen cakes, have already been reformulated to be PHO-free. After the ban came into effect in June 2021, we have not detected any non-compliance from our surveillance. The Health Promotion Board will continue to conduct regular surveillance and monitor the average daily trans fat intake among Singaporeans.”
“Currently, MOH does not track the breakdown of those seeking mental health intervention by age bands for adults. However, surveys, such as the National Population Health Survey, have shown that the proportion of seniors aged 60-74 with poor mental health was 11.4% in 2017 and 9.4% in 2020. The second Well-being of Singapore Elderly study is under way and we will continue to track and better meet the mental health needs of our seniors. As there is inconclusive evidence on the benefits of mass mental health screening, efforts are focused instead on increasing mental health literacy and awareness, as well as identifying and providing support to persons at risk or suspected to have mental health conditions in the community. In the past two years, the community outreach teams have reached out and provided information and/or assistance to more than 128,000 people. To complement the above, our Eldercare Centres (ECs) work with the Silver Generation Office (SGO) to proactively reach out to vulnerable seniors who have no or limited social support. Seniors identified to require care and support are referred to the appropriate care services, such as befriending and mental health services. MOH will continue to work closely with our partners to develop community resources and build their capabilities to better support the mental health and well-being of the population.”
“The mean and median charges of a fresh In-Vitro Fertilisation (IVF) cycle and a frozen IVF cycle in local public Assisted Reproduction (AR) centres from 2017 to 2021 can be found in Table 1 below.”
“Registered medical practitioners who promote or prescribe such pharmaceutical products outside their approved indications and outside the scope of a clinical trial may be – and, indeed, some have already been – referred to the Singapore Medical Council (SMC) for disciplinary action.”
“MOH and the Health Sciences Authority (HSA) monitor websites and social media platforms, including online chatgroups, for false claims about the efficacy of certain pharmaceutical agents, such as ivermectin and hydroxychloroquine, in treating COVID-19. Evidence to date shows that these agents are ineffective in treating COVID-19, and their use is, in fact, associated with serious health risks to patients. On 15 October 2021, MOH issued a media statement to call out these websites and platforms and to debunk the misinformation found there. On 24 October 2021, a Correction Direction order was also issued to the "Truth Warriors" website for false statements of fact and misleading information relating to COVID-19 treatments. Various subsequent clarifications and facts have also been published by the Government, and MOH and HSA have proactively put up consumer advisories on their websites to increase public awareness. From February 2020 to January 2022, HSA detected and directed the removal of 740 listings of pharmaceutical agents on e-commerce platforms and social media apps claiming to be effective in preventing or treating COVID-19. More than 150 sellers were issued with a stern warning. Sellers who falsely advertise pharmaceutical products as being able to prevent or treat COVID-19 are liable to prosecution and, if convicted, may be imprisoned for up to 12 months and/or fined up to $20,000 under the Health Products Act. Individuals who bring in such pharmaceutical products and distribute them for use without a doctor’s prescription, with the intent to treat COVID-19, can be taken to task as unlicensed medical practitioners under the Medical Registration Act.”
“Patients who seek treatment at multiple medical institutions for their chronic complex conditions are eligible for the $700 limit. We are working to enhance our claims system to automatically identify patients who are receiving treatment for different Chronic Disease Management Programme (CDMP) conditions at different medical institutions within the year. In the interim, patients with complex chronic conditions and who are unable to use up to $700 a year from their MediSave for their treatment can call the Healthcare Hotline at 1800 222 3399 to request for the higher $700 withdrawal limit.”
“Mr Speaker, Sir, amongst the 21,800 individuals aged 18 and above, whose vaccination status had lapsed on 14 February 2022, 38% are work pass holders, 14% are Permanent Residents and the remaining are Singaporeans. The Ministry of Health (MOH) is unable to ascertain the reasons for them not getting their boosters, but indications are that many of them are overseas. As for the Singaporeans who are not boosted, the majority are seniors aged 60 years and above. A common reason for not getting booster jabs is that they seldom go out, they feel adequately protected with their primary vaccination and they prefer to delay their booster vaccination. MOH will continue to encourage individuals to come forward and take their booster shots when they are eligible, using SMS reminders, making vaccination as convenient as possible and, also importantly, deploying Mobile Vaccination Teams to the heartlands to reach out especially to seniors.”
“Between 2018 and 2021, there was an average of 2,100 doctors in residency training every year, with approximately equal proportion of males and females. Around 13% of the residents currently in training had at least one newborn child during training over the past four years. Most of them were able to consume their full entitlement of maternity or paternity leave. For residents with at least one newborn child between 2018 and 2021, 2% had their training extended for more than a year due to maternity leave and no-pay-leave-related absences and less than 5% resigned from training due to family commitments.”
“This question has been addressed by the reply to Question No 41 for written answer on the Order Paper for 14 February 2022. [Please refer to “Voluntary Enrolment of Persons Born Before 1980 into CareShield Life Scheme to-Date and Their Profile and Premium Payable“, Official Report, 14 February 2022, Vol 95, Issue 47, Written Answers to Questions section.]”
“Confirmed COVID-19 cases may be isolated together in the same room as there is no risk from reinfection during the course of their infection and immediately after an infection. This is no different from other infectious diseases, such as measles or chicken pox, where patients with the same infectious disease can stay together. Such arrangements ensure that we have sufficient overall capacity to handle a surge in cases.”
“Based on latest available data, the most common congenital illnesses for newborns are of the circulatory system and the urinary system. All Singapore Citizens, including those with congenital illnesses or pre-existing conditions, are automatically covered from birth by MediShield Life. Parents can also tap on their MediSave or their child’s MediSave Grant for Newborns to defray expenses incurred for the treatment of congenital illnesses of their children. Over 2018 to 2020, Singaporeans paid less than $200 in cash, on average, for subsidised hospitalisation and day surgery bills for their newborns, beyond delivery. MediShield Life and MediSave also cover serious pregnancy complications. For those who prefer additional coverage, Integrated Shield Plans (IPs) do so as well, though coverage varies between insurers. Around four-fifths of women aged 18 to 45 have an IP that covers serious pregnancy and delivery-related complications. Alternatively, expectant mothers may choose to purchase maternity insurance policies to have added coverage over pregnancy complications and congenital illnesses. As these are optional products offered by private insurers, MOH does not have data relating to the take-up, claims or rejections of maternity insurance policies.”
“MOH, HSA and HPB will continue working together to enhance and expand the suite of existing measures to curb the supply and demand of e-cigarettes to protect the health of the population.”
“The Health Sciences Authority (HSA) has been monitoring and gathering intelligence on illicit sales of e-cigarettes via social media and messaging platforms, and from 1 January 2018 to 31 December 2021, has carried out 201 operations targeting sales of e-cigarettes on online platforms. HSA also collaborates with platforms, such as Instagram, Facebook and Carousell, to remove postings on the illegal sales of such products. In 2021, 4,210 such postings were removed. Concurrently, the illegal importation of e-cigarettes is monitored at Singapore’s borders and intercepted as necessary to prevent entry of these e-cigarettes into the local market. These enforcement activities need to be complemented by public education efforts to deter the public, particularly youths, from vaping. The Health Promotion Board (HPB) had previously conducted a survey in 2019 which found that almost seven in 10 young people were not aware that e-cigarettes contained harmful chemicals. To further increase awareness of the harms and effects of e-cigarettes, HPB works closely with MOE and the Institutes of Higher Learning (IHLs) to incorporate more information on the harms of vaping in the virtual assembly skits and talks organised for the students. Training is also conducted to equip educators to discuss the harms of vaping with their students. When students are caught using or possessing e-cigarettes and other types of vaporisers, school-based disciplinary action is also taken. They are reported to HSA, which may fine recalcitrant offenders, and they are required to attend cessation programmes run by HPB. Students are guided by counsellors through their cessation journey to make long-term behavioural changes.”
“SHS has a Contingency Nurse Pool allowing nurses who have left service because of family responsibilities to continue with clinical practice on an ad-hoc basis by signing up to be activated on a contingency basis. Professional development pathways and traineeships for doctors, nurses and pharmacists do make accommodations for healthcare workers with family caregiving responsibilities. Doctors on postgraduate medical training are also entitled to additional study leave. While there is a maximum number of days that they can be absent from training to ensure that the quality of training is not compromised, flexibility has been provided for them to manage their leave arrangements with their training programmes to attend to their caregiving responsibilities. Special consideration has also been provided during the COVID-19 period to allow for slightly longer periods of absence. Provisions have also been made to accommodate nursing students who are pregnant to defer training. With supporting documents, students will be given approved leave if their children and parents require their care.”
“Public Healthcare Institutions have various support measures for staff with family caregiving responsibilities. Employees with at least three months of service are entitled to three to six days of Childcare Leave, Extended Childcare Leave or Family Care Leave, depending on the eligibility criteria. Those whose new-born child is a Singapore Citizen are eligible to 16 weeks and two weeks of maternity and paternity leave respectively. Three days of Compassionate Leave will be given to staff whose immediate family have critical illness or passed on. Beyond leave benefits, there are additional options, such as flexible hours, staggered shifts and compressed work weeks. Public healthcare institutions have progressively moved to electronic rostering systems to support flexible work arrangements in a bigger way. Work-from-home arrangements also enable staff to work remotely where feasible. In the past year, 100% of eligible female staff in the public healthcare clusters took up post-childbirth maternity leave, while 80.4% of eligible male staff took up paternity leave. Fifty-three percent of female staff tapped on childcare, eldercare and other family caregiving leave, whereas 48% of male staff did so. The take-up rate for part-time work arrangements was 1.3% for males and 4.1% for females. Aside from flexible work arrangements and leave benefits, other support measures have been put in place. Most public hospitals have childcare centres and caregiving facilities, such as lactation rooms, on site for their staff. NUHS has a "Eat with Your Family Day" every quarterly to remind employers and families to spend dedicated time with their loved ones. Change of job roles, where feasible, can be requested to accommodate staff’s family caregiving needs.”
“Dysphagia is a swallowing impairment which can occur due to multiple medical conditions. The prevalence of dysphagia increases with advancing age. In October last year, Alexandra Hospital (AH) started a pilot – Smaller Bites to Swallow Right (SBSR) campaign – to help their dysphagia patients. Such patients or their caregivers can ask participating stalls or hawker centres to get their food chopped, minced or pureed at no charges. The campaign had started at Alexandra Village Food Centre and ABC Brickworks Food Centre, as well as Keng Eng Kee Seafood Restaurant. AH intends to expand it to Mei Ling Market and Food Centre and Tanglin Halt Food Centre by 2H 2022. MOH will learn from AH’s experience and work with other stakeholders to explore expanding participation at other food establishments.”
“Caregiving expenses vary across households, depending on care needs and preferred caregiving arrangements. Hence, while MOH does not track the caregiving expenses incurred based on the number of activities of daily living that care recipients need assistance in, MOH does monitor the expenses incurred for various care services and review the level of financial support accorded to caregivers accordingly. To this end, MOH introduced the Home Caregiving Grant (HCG) in October 2019 to support community caregiving. The HCG provides a monthly $200 cash grant which can be used flexibly to defray the costs of caregiving for eligible individuals with at least permanent moderate disability. MOH is studying how to enhance the scheme and will announce more details in the coming months. The HCG is one of many financial support measures that can help to defray caregiving expenses. Other support measures include subsidies for long-term care services and schemes like the Seniors’ Mobility and Enabling Fund to defray the cost of assistive devices and home healthcare items. For severely disabled Singaporeans, other schemes, such as CareShield Life, ElderShield and MediSave Care, may also provide monthly cash payouts. Families who require additional support can approach the AIC Link or the Social Service Office.”
“MOH’s expenditure on public acute hospitals, including public specialist outpatient clinics, grew from $6.7 billion in FY2017 to $6.9 billion in FY2019. MOH’s expenditure on the primary care sector and intermediate and long-term care sector, including community hospitals and nursing homes, increased from $1.4 billion in FY2017 to $2 billion in FY2019. We expect this trend of rising investment in primary and intermediate and long-term care to continue. We have ramped up capacity and capability in the primary care and intermediate and long-term care sectors to provide care that better meets the needs of patients closer to their homes. By 2030, the number of polyclinics will increase from 23 today to 32, and we will build another three new public community hospitals. Aged care services will also expand considerably to support seniors to age-in-place.”
“So, we are able to answer well over 90% of the calls without them dropping. So, that is coping well. But the GPs are facing quite a bit of pressure. Queues are long. If you go to our community GP clinics, you can see there are queues. So, I think on that front, we have to help the GPs. GPs have given feedback to us that the patients either have mild or no symptoms. They had self-tested, got a positive result and decided, "I had better see a GP, either to get an MC or some ART kits from the doctors." Many of them also worry about travel. If they have to go through a PCR test while travelling, they like to say, "I register a positive result, but I am a recovered shedder". They want to show that, actually, they have had COVID-19, they are shedders and they have recovered. So, for various reasons, people are visiting doctors and GPs, not because they are very sick. So, it is the operational side that is posing a challenge. Later, MOH will be making an announcement. We are going to allow individuals to come to the Quick Test Centres (QTCs), go through a supervised ART test and, within 30 minutes, we can ingest their infection record, if they are tested positive, into their HealthHub record. From there, they can also withdraw ART kits. What they will not get is a doctor's MC because, for that, you would have to see a doctor. So, that way, I hope we can divert many of the very mild cases away from GP clinics into the QTCs. We have about 200 QTCs now, all over, including in malls. We will start with about a quarter of them. So, by the end of today, you will be able to book an appointment with the QTCs and go through an ART test and then ingest the record, if you are positive, into your HealthHub. I hope I have answered the question.”
“Mr Speaker, the Member asked a question not quite related to vaccines but on healthcare workers, so, I thought I might as well answer. Right now, we are getting 10,000 or more cases on a daily basis. It is within our expectations. We had earlier said that, at its peak, we may reach 15,000 to 20,000 cases a day or even more. That is within our expectations. Right now, the week-on-week increase is about 1.5. So, it is not increasing at three times multiples anymore. But whether cases will go up further, I think that is a possibility and we should be prepared for that. Having said that, as we have always explained, what is important now is not so much the topline infection numbers but how that translates into disease severity and impact on our healthcare capacity. Yesterday, there were a few Written Questions on this topic, and we put out some responses to those. By and large, our healthcare system is coping well. I will give an example – the ICU beds. At its peak, during the Delta wave, we had 171 ICU beds occupied, out of a capacity of 200-plus, close to 300. Today, even at 10,000 cases a day, as of last night, it was 23 beds occupied. The week before, at one point, it reached 30 and it actually came down and it is now 23. So, we see it hobbling between 20 and 30. So long as we maintain that, ICU is in good shape. If you look at those who need oxygen supplementation, those who require hospitalisation, the healthcare system is coping. But I think where we face pressure now is not on the clinical side of healthcare but on the operational side of healthcare because the number of calls from patients to our hotline is increasing. Fortunately, we have the help of many public agencies like CPF Board, and SAF stood up a fairly big team to support the operations.”
“The estimated average additional annual budget required for the Seniors' Mobility and Enabling Fund (SMF) expansion is $49 million over the next five years, compared to the average annual utilisation of around $27 million over the previous five years. For the Assistive Technology Fund (ATF), the estimated annual budget over the next five years is $7 million, compared to the average annual utilisation of $4 million in the previous five years.”
“From 2017 to 2021, the proportion of students who were overweight (BMI-for-age at or above the 90th percentile1) in schools (Primary, Secondary and pre-University levels) had increased from 13% to 16%. The increase was mainly observed in the last two years. Due to COVID-19, opportunities for physical activities in schools had been impacted over the past two years. This might have led to a more sedentary lifestyle and contributed to the increase in obesity among students. More studies are needed to analyse the impact of COVID-19 on the prevalence of obesity among students by housing type and race. We have undertaken various measures to prevent and address childhood obesity. We work with MOE, Early Childhood Development Agency and preschools to provide school health promotion for students, parents and staff. In schools and Institutes of Higher Learning, we provide healthier meals. HPB also supplements school-based efforts with community-based healthy eating and physical activity programmes. Secondary schools and the Institute of Technical Education also offer lifestyle coaching to severely overweight students. In 2021, 64% of the participants achieved BMI reduction of more than 0.5 points or reached their acceptable weight by the end of the six-month programme.”
“Over the past five years, the Agency for Integrated Care (AIC) received an average of 100,000 enquiries per year through their physical and virtual touchpoints. As multiple enquiries could be submitted through different channels, this figure is not reflective of the number of unique individuals. AIC does not track whether enquires were made by caregivers, seniors, or healthcare professionals, nor the duration of assistance provided. AIC supports caregivers through a variety of means. AIC places seniors with various eldercare services, such as day and home care, palliative and nursing home care, and respite care services, to meet their short-, medium- and long-term care needs. Over the last five years, AIC referred about 34,000 seniors per year to eldercare services. AIC also administers support schemes, such as the Caregivers' Training Grant (CTG), the Home Caregiving Grant (HCG), and the expanded Seniors' Mobility and Enabling Fund (SMF), to enable caregivers to receive training and financial support. In 2021 alone, around 34,400 and 19,500 beneficiaries received the HCG and SMF, respectively.”
“In 2020, about 1.05 million Singapore Citizens (SCs) and Permanent Residents (PRs) had ongoing follow-up Specialist Outpatient Clinics (SOC) appointments at the public hospitals or national specialty centres. More than 90% of the patients have a travel time of less than an hour. The estimated travelling time of these patients by public transport from their place of residence to the public hospitals or national specialty centres is shown in the table below.”
“A clinical trial is a research study of a health product to discover or verify its effects and ascertain its safety or efficacy in trial participants. Since the beginning of the COVID-19 pandemic, the Health Sciences Authority (HSA) has approved one COVID-19 clinical trial on migrant workers. The trial recruited 4,257 migrant workers to assess whether existing treatments could reduce the spread of SARS-CoV-2 infection. Institutions who wish to conduct clinical trials are required to obtain regulatory approval from HSA under the Health Product (Clinical Trials) Regulations based on prevailing requirements. The principal investigator (PI) for the study is also required to seek ethical approval from the relevant Institutional Review Board (IRB) and ensure that written informed consent is obtained from trial participants in accordance with the requirements under the Health Products (Clinical Trials) Regulations. It is an offence under the Regulations for any person to cause, compel or induce another person to give consent or to participate in a clinical trial by coercion, intimidation, deception or misrepresentation. As necessary, PIs should document informed consent by means of a written, signed and dated informed consent form. During consent-taking, PIs should also ensure that participants understand the contents of the form, provide ample opportunities for clarification, and inform participants that they may choose to withdraw from the trial at any time without penalty.”
“Healthcare institutions (HCIs) use various methods, including electronic logging and surveys, to monitor the work hours and well-being of junior doctors. MOH Holdings also regularly checks proxy indicators, for example, late night transport claims which may indicate junior doctors working beyond logged hours. In addition, we have a whistle-blowing channel for all junior doctors to anonymously report incidences of wrongful workplace practices. MOH Holdings takes such feedback seriously and will investigate the reported incidents. Based on all the data and feedback collected, we have not detected any systemic under-reporting of working hours.”
“MOH has tapped on the SAF and Public Service, as well as private sector resources, in the national effort against the COVID-19 pandemic. For example, during the surge in COVID-19 cases at the end of last year, public healthcare workers from Woodlands Health, medical officers and medics from the SAF medical corps, and nurses and dental therapists from the Health Promotion Board (HPB) jointly ran a COVID-19 Treatment Facility (CTF). Private healthcare workers have also helped us on our vaccination drive, and management of cases at GPs and in the CTFs. We thank all our partnering organisations for working closely with us. Our healthcare officers have been under immense stress for the past two years. These contributions and staff expertise have been an invaluable help.”
“As stated in my address at MOH's work plan seminar on 25 May 2021, Singapore's National Health Expenditure could increase from $22 billion in 2018 to $59 billion in 2030 as our population ages.”
“As at end January 2022, around 537,000 ElderShield 400 policyholders born in 1970 to 1979 have been automatically enrolled into CareShield Life. In addition, we have approved about 60,000 applications from persons born before 1980 to join CareShield Life. All auto-enrollees and approved applicants will have their CareShield Life covers fully activated after their first premium payment, starting from March 2022. However, in the event an individual becomes severely disabled before that, he or she will be allowed to claim. CareShield Life premiums vary widely across individuals depending on multiple factors, such as age, gender, whether they have an existing ElderShield policy and year of joining CareShield Life. For those who are upgrading from ElderShield 400 to CareShield Life in 2022, the annual premiums for 50-year-old males and females are about $470 and $600, while that for 65-year-old males and females are about $630 and $830. Premiums would be higher for those without an existing ElderShield policy or with ElderShield 300 policy, while premiums could be lower for those who are eligible for means-tested premium subsidies and participation incentives. To encourage those who are born before 1980 to apply for CareShield Life, the Government has been raising awareness of the scheme through the media and targeted outreach efforts in collaboration with the People's Association, the Silver Generation Office, Social Service Offices, unions and insurers. In addition, the Government provides participation incentives of up to $4,000 for those born before 1980 who join CareShield Life by 31 December 2023. These participation incentives would be used to offset the premiums over 10 years.”
“Currently, about 15% of local Omicron cases sequenced were of the BA.2 sub-lineage. Preliminary studies overseas have found BA.2 to be more transmissible than BA.1. However, there is currently no indication that BA.2 causes more severe illness, compared to BA.1, or that vaccines will not work as well against the subvariant. MOH will continue to monitor circulating COVID-19 strains as well as international and local data on the BA.2 sub-lineage.”
“This question has been addressed in my reply to Question No 80 for Oral Answer on the Order Paper for 14 February 2022.”
“Patients diagnosed with atrial fibrillation arising from a condition under the Chronic Disease Management Programme (CDMP), such as hypertension, can use MediSave for their treatment, including medications such as apixaban. However, atrial fibrillation, as a stand-alone condition, is currently not under CDMP. CDMP conditions are regularly reviewed in consultation with the CDMP Clinical Advisory Committee (CAC) and based on considerations, such as disease burden, effectiveness of early intervention to reduce complications and availability of clear clinical treatment guidelines. We will take atrial fibrillation into account in our next review.”
“The Ministry had recently increased the Flexi-MediSave limit from $200 to $300 on 1 June 2021 to better support elderly patients in seeking outpatient treatment. Around eight in 10 patients who tapped on Flexi-MediSave did not reach the $300 annual limit in 2021. We will continue to regularly review our MediSave withdrawal limits to strike a balance between improving affordability for ongoing treatment and ensuring sufficient savings for future healthcare needs. Patients who cannot afford their treatments after subsidies and MediSave can approach the medical social workers in public healthcare institutions for MediFund and other assistance.”
“Persons at risk of stroke should adopt risk reduction steps, such as regular health screening, maintaining a healthy lifestyle by exercising regularly, maintaining healthy weight and diet, and avoiding smoking and excessive drinking.”
“Stroke is a time-sensitive condition and, for ischaemic stroke, the sooner blood flow is restored to the affected part of the brain, the better the clinical outcomes. Since 2016, MOH has been putting in place various measures to improve public awareness about stroke and to reduce the time taken for a suspected stroke patient to reach the hospital for assessment and treatment. Annual stroke awareness campaigns are conducted to raise public awareness on the early identification of acute stroke symptoms and response actions. Paramedics from the Singapore Civil Defence Force (SCDF) are also trained in pre-hospital stroke protocols to enable swift identification and conveyance of suspected stroke cases to the appropriate hospital for treatment. Public hospitals monitor the access time to stroke treatment as well as the clinical outcomes of stroke patients closely. The Stroke and Bleeding Risk calculator is a tool developed by the American College of Cardiology under their patient engagement programme CardioSmart, to estimate the risk for stroke and bleeding only for patients with atrial fibrillation and not for the general public. There are other risk calculators developed by clinical experts to assess stroke risk in patients with cardiovascular disease by considering risk factors, such as diabetes, hypertension, high cholesterol levels, smoking and drinking history. MOH will study these risk calculators with inputs from local stroke care experts and, where appropriate, will incorporate these as part of the overall stroke risk prevention framework.”
“For example, institutions have cross-deployed staff across professions and departments into areas of need, and leveraged volunteers and other short-term sources of manpower to further augment the workforce. We have also partnered private healthcare providers to ensure smooth delivery of healthcare services, including the running of Community Care Facilities and Community Treatment Facilities, and telemedicine consultation for home recovery patients. MOH will build on the lessons from COVID-19 and continue to work together with our stakeholders to secure sufficient manpower to meet our future healthcare needs.”
“In 2020, these efforts recruited about 900 locals for over 48 CCOs. In addition, AIC introduced a Senior Management Associate Scheme to facilitate the recruitment of mid-career locals for leadership and managerial roles in CCOs. Between 2017 and 2020, more than 150 mid-career locals had successfully transited into the community care sector, working as centre managers and human resource managers. Salaries play a key role in the attraction and retention of staff. We regularly monitor and review the salary competitiveness of our public healthcare institutions to ensure that they are competitive against the market. This also includes the review of starting salaries, to ensure that healthcare professions are attractive to students. In July 2021, a round of salary enhancements was rolled out for all nurses, allied health professionals, pharmacists, administrative and ancillary staff in both the public healthcare institutions and community care sector. We will do this carefully and reasonably, since increasing manpower and salaries also add to healthcare costs. Attrition and rising workload due to COVID-19 have been recent challenges, but we are determined to overcome them. We are encouraged that hiring into the public healthcare sector has remained strong and that people still do want to join healthcare. For example, the combined annual inflow of nurses and allied health professionals has increased, from 1,900 in 2018 to 2,300 in 2020. But we are a small country and there is a limit to recruitment for any one sector. So, this will continue to be a major challenge to address. Our public healthcare institutions rose to the challenge and have evolved their recruitment, hiring and deployment practices.”
“MOH has always been committed to ensuring sufficient manpower in the healthcare sector. With an ageing population and rising prevalence of chronic diseases, we anticipate that the demand for healthcare services and, therefore, the demand for healthcare manpower will continue to increase. Over the years, even before the pandemic, we have established various schemes and programmes to attract and recruit local fresh graduates, mid-career individuals and mature workers as well as retain healthcare workers in the sector. Our local intakes for healthcare professional programmes remain healthy, with intakes increasing by 27% in the past 10 years, from around 2,700 in 2010 to 3,400 in 2020. We will continue to work with educational institutions to ensure an adequate training pipeline, supported by outreach and Education and Career Guidance to encourage students to consider a healthcare career. We also have our Healthcare Career Conversion Programmes (CCPs) to support individuals in making a mid-career switch into professions, such as Nursing, Physiotherapy, Occupational Therapy and Diagnostic Radiography. Some of these are accelerated programmes, allowing eligible individuals to complete their training in a shorter time. We have seen an encouraging increase in interest in the CCPs over time. Between 2019 and 2021, we enrolled an average of around 180 mid-career locals per year into our healthcare CCPs, up from an average of 110 per year between 2016 and 2018. For the Community Care Sector, the Agency for Integrated Care (AIC) has been working with community care organisations (CCOs) and recruitment partners like Workforce Singapore (WSG) and Employment and Employability Institute (e2i) to attract and recruit more locals.”