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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“I thank the Member for his question. I have addressed it in my reply to Question Nos 77 to 85 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“MOH has been working with the Agency for Integrated Care (AIC) to increase the accessibility of mental health services in the primary and community care settings, in order to strengthen community support for people with mental health needs. In this regard, mental health shared care teams have been set up in the public hospitals to support our primary and community care providers in mental health management through training and capability building. This includes training of community mental health teams, polyclinics and general practitioners in assessment and intervention. Thus far, we have met our targets of having one in two polyclinics provide mental health services, trained over 220 general practitioners in mental health management, 50 community outreach teams to engage and provide basic emotional support to individuals at risk of or with mental health conditions, and 18 community intervention teams to provide therapy, by end of 2021. MOH will continue to review mental health service provision in the community so that we can meet the needs of the population.”
“As of September 2021, about 5,800 personnel have participated in the training. Schools and Institutes of Higher Learning (IHLs) have systems of support in place to detect early signs of distress in students. Schools have trained teachers and staff to identify signs of distress in their students, monitor their well-being and provide guidance and support. In-house counsellors also provide additional support to students who need it. For students who require further assessment and intervention, counsellors will refer students to mental health professionals in the community and hospitals. Students are also taught how to recognise common mental health issues and symptoms through mental health lessons in the enhanced Character and Citizenship Education (CCE) curriculum in schools, and mental wellness programmes in IHLs. Through established peer support structures, students help look out for one another and encourage peers in distress to seek help.”
“The Government adopts a risk-based approach for health assessments for at-risk individuals. This enables resources to be better directed towards the early identification and intervention for persons with health needs. This approach also applies to mental health. To this end, we have increased community touchpoints to enable the early identification and targeted assessment of persons at risk of mental health needs and link them to relevant services for further intervention. As at end 2020, 50 community outreach teams have been set up and they have reached out to over 350,000 persons and then provided assistance to more than 26,000 persons who were at risk of developing mental health conditions and/or dementia. In addition, over 220 General Practitioner (GP) partners are trained to identify, diagnose and treat persons with mental health conditions in the community. Hospitals and specialist clinics screen high-risk patients for mental health conditions during their inpatient stay or clinic appointments to deliver early intervention, where indicated. For example, the National University Hospital (NUH) Women’s Emotional Health Service (WEHS) and KK Women’s and Children’s Hospital (KKH) Postnatal Depression Intervention Programme (PNDIP) have been screening and providing early intervention for perinatal mental health conditions. KKH also conducts psychosocial assessments at its paediatric outpatient clinics and provides mental health screening for adolescents at the inpatient wards and the Children’s Emergency department. In the workplace setting, HPB conducts training for managers, human resource (HR) personnel and employees interested to be peer supporters, on recognising the signs and symptoms of common mental health conditions.”
“We are also actively reaching out to vulnerable seniors at risk of social isolation, such as those with limited social support. The Silver Generation Office (SGO) has introduced tele-engagements since April 2020 to supplement in-person visits, to ensure that those who require care and support continue to receive assistance. Lastly, even as the Government and our community partners expand our efforts to engage our seniors in a safe and meaningful manner, this ought not to diminish or replace the role of family support. As a key pillar of our Social Compact, families are the core of our society and our first line of support. Family members have shared responsibility in providing care and support for each other, including our seniors, alongside Government and community support. Together, as a society, we can play our respective roles in protecting, engaging and caring for our seniors during the pandemic.”
“As the number of COVID-19 cases in the community remains high, seniors are advised to stay home as much as possible, except for essential activities, during the extended stabilisation phase. This is to protect them and to minimise their risks of exposure to the virus. MOH recognises that reduced social interactions can negatively impact our seniors’ socio-emotional and mental well-being. As such, centre-based services, including exercise and cognitive activities, remain available, albeit with reduced capacities and safe management measures. We are working to augment these in light of the extended stabilisation phase. The People’s Association (PA) will also be piloting the resumption of selected activities for fully vaccinated seniors aged 60 and above. This will cover selected recreational activities ranging from sports and fitness, health and wellness to lifestyle and leisure, with safe management and infection control measures set in place. As the COVID-19 situation stabilises, we aim to have more partners gradually resume their activities. Our partners have also made available digital offerings to keep seniors meaningfully engaged from home. For example, the Council for Third Age (C3A), Health Promotion Board (HPB), Sport Singapore (SportSG) and PA have pivoted their activities and talks onto various social media platforms to allow seniors to remain connected during this challenging time. Nonetheless, we recognise that not all seniors may be familiar with accessing services online and may face barriers. To complement this, the SG Digital Office under the Infocomm Media Development Authority (IMDA) actively trains seniors in basic digital skills. More than 100,000 seniors have benefited from this initiative to date.”
“I thank the Member for his question. I have addressed it in my reply to Question Nos 77 to 85 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“The current stabilisation measures will not remain static throughout this coming month. We will monitor the situation and relax restrictions wherever we can, as we transit to living with COVID-19. A key indicator which we are monitoring closely is the weekly infection growth rate, that is, the ratio of community cases in the past week over the week before. If the ratio goes below 1.0 and hospital/ICU situation remains stable, it will give us scope to relax restrictions. This will include resuming sports, school activities and allowing members from the same households to dine together at food and beverage (F&B) establishments without having to spread across multiple tables.”
“Formal requests for a doctor’s memo or medical test result through hospital administration cost $8 on average. However, results from routine laboratory tests performed in restructured hospitals are available in HealthHub and can be accessed freely by patients. Patients may also request for their doctor to review these test results with them during their regular consultations. Medical reports containing more details of the patient’s medical condition, such as reports required for insurance underwriting, could range from about $90 to $535, depending on the complexity of the medical report. Restructured hospitals charge for these reports on a cost recovery basis for manpower and other administrative costs incurred. For more complex reports, a doctor may need to review the patient’s medical records in order to produce the report. Charges are, therefore, levied for the service of generating these reports. Patients with financial difficulty can request for these charges to be waived. Other reasons, such as whether the report is an official requirement, may be submitted to the hospital, for consideration for fee waivers.”
“As of 30 September 2021, 90% of the rough sleepers and homeless accepted into MSF’s temporary shelters have been fully vaccinated. We are unable to monitor the vaccination rate of those still sleeping rough on the streets. MSF is collaborating closely with partners to conduct physical outreach (in alignment with allowed group sizes) to continue to encourage these individuals to be fully vaccinated and get their booster shots when eligible. The rough sleepers can also walk into our mRNA vaccination centres without appointment to receive their primary doses since 10 August 2021.”
“I thank the Member for his question. I have addressed it in my reply to Question No. 72 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Assessment Criteria for Sinovac and Sinopharm COVID-19 Vaccines for Inclusion in National Vaccination Programme", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“I thank the Member for his question. I have addressed it in my reply to Question No 72 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Assessment Criteria for Sinovac and Sinopharm COVID-19 Vaccines for Inclusion in National Vaccination Programme", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“I thank the Members for their questions. I have addressed them in my reply to Question Nos 77 to 85 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“Each individual who receives a Health Risk Warning (HRW) can collect six Antigen Rapid Test (ART) kits from vending machines located islandwide. Workers on mandatory regular testing regimes are currently also provided with free kits by the Government. To support individuals to self-test regularly, we had distributed six kits to each household from August to September, and are distributing another 10 kits from October to December. Individuals who need more kits can purchase them from major retailers and e-commerce platforms.”
“To date, S$16.2 million has been distributed to eligible applicants under the Quarantine Order Allowance (QOA) Scheme. Typically, payouts are made to successful applicants within three months of submitting the QOA application. There has been a recent surge in QOA applications over the past two months and MOH is working to expedite processing of these cases.”
“The profession and medical fraternity have traditionally undertaken the responsibility to take care of their juniors. In response to feedback from junior doctors about working hours and well-being, the Director of Medical Services in MOH had commissioned a national committee, chaired by a very senior doctor, to lead initiatives to promote and improve the well-being of junior doctors in the public healthcare system and look into factors associated with work-related stress among junior doctors, such as work hours, duration of night-calls and work structure. This is in addition to the various initiatives already in place in the healthcare institutions to look after the well-being of junior doctors. MOH and the public healthcare institutions will continue to better support junior doctors and improve their well-being while balancing against the demands of the profession and the duty towards patients.”
“Working hours for medical doctors depend on a number of factors, not just the cohort size and number of doctors. The Singapore Medical Council (SMC) has guidelines on the work hours of junior doctors, such as total allowable work hours per week and the provision of sufficient rest periods. Doctors undergoing training to be specialists also need to comply with guidelines for working hours and training. Efforts are made to ensure that the public healthcare institutions and doctors adhere to these guidelines. Based on an annual survey of residents, 84% complied with work hours of a maximum 80 hours a week, 90% have at least a 10-hour interval between duty periods and after in-house calls. Of special mention is the traditional night-call system for junior doctors. This is a 24-hour duty, which is a longstanding practice that all doctors have gone through to ensure a seamless continuity of care for the patients. To support the well-being of doctors, guidelines on the frequency and duration of night-calls have been introduced. For example, for Post Graduate Year 1 doctors, after a 24-hour duty, they should spend no more than six additional hours for handing over and other activities. Surveys showed that 85% complied with this requirement. Number of calls are mostly within SMC guidelines of four to seven per month. Some of the departments have also introduced night float systems. Unlike the traditional night-call system, doctors on night float perform approximately 12 hours of on-site duty during evening or night shifts usually for one or two weeks at a stretch with no other duties in the day. MOH is studying if the float system could complement the traditional call system.”
“Singapore has been closely tracking the progress of COVID-19 therapeutic options under development globally and actively engaging key pharmaceutical companies. As a result, we have procured, in advance, a portfolio of COVID-19 therapeutics. Our current treatment options consist of five classes of drugs: steroids, anti-virals (Remdesivir), monoclonal antibodies (Sotrovimab and Regeneron), IL-6 inhibitors (Tocilizumab) and JAK inhibitors (Baricitinib). All prescription medicines require approval by HSA before they can be legally supplied in Singapore and companies licensed to import or distribute prescription medicines are regularly audited. HSA works closely with the Immigration and Checkpoints Authority to monitor and stop illegal imports of health products and monitor various local online sales platforms to detect illegal sales of prescription medicines. Anyone who contravenes this law can be fined up to $50,000 and/or jailed for up to two years under the Health Products Act.”
“Nursing home infections are a small percentage of the total senior infection. The last I calculated, about 6.8% of the cases who were critically ill, in ICU or died, were cases from nursing homes. The large majority is actually transmission within the community.”
“Nursing home infections are a small percentage of the total senior infection. The last I calculated, it is not updated but it is about 6.4%. So, it is a small percentage. The large majority is actually transmission within the community. [Please refer to “Update on ICU and Hospital Capacity”, Official Report, 1 November 2021, Vol 95, Issue No 41, Ministerial Statement section.] [(proc text) Written statement by Mr Ong Ye Kung circulated with leave of the Speaker in accordance with Standing Order No 29(5): (proc text)] After the Ministerial Statement on “Update on ICU and Hospital Capacity” at the Sitting of 1 November 2021, Mr Leong Mun Wai asked about the infection rates of seniors in nursing homes. My reply should read as follows:”
“This question has been addressed in my reply to Question Nos 70 to 71 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Steps to Curb Spread of Misinformation through Social Media and Closed Messaging Systems on COVID-19 Treatments", Official Report, 01 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“This question has been addressed in my reply to Question Nos 77 to 85 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams", Official Report, 01 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“The question for written answer has been addressed by the Ministerial Statement delivered by Senior Minister of State for Health, on behalf of the Minister for Health on 1 November 2021. [Please refer to "Update on ICU and Hospital Capacity", Official Report, 01 November 2021, Vol 95, Issue 41, Ministerial Statements section.]”
“This question has been addressed in my reply to Question Nos 70 to 71 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Steps to Curb Spread of Misinformation through Social Media and Closed Messaging Systems on COVID-19 Treatments", Official Report, 01 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“Please refer to the table below on the number and proportion of community cases and residents by housing type.”
“Within the public healthcare institutions1 (PHIs), approximately 99% of all staff were fully vaccinated2 with either mRNA or non-mRNA COVID-19 vaccines3 as of 22 October 2021. About 99% of doctors, dentists, nurses and pharmacists are vaccinated. About 98% of staff in all other groups are vaccinated (see Table 1). Vaccination was prioritised for healthcare workers when the mRNA vaccines were first made available in Singapore. COVID-19 vaccine booster shots were also extended to the healthcare workers after first being introduced for the seniors.”
“The personal data of COVID-19 patients is treated as sensitive personal data and is protected accordingly. The management and protection of personal data held by public sector agencies, including those of COVID-19 patients, is governed under the Public Sector (Governance) Act (PSGA) and the Government Instruction Manuals. The Infectious Diseases Act (IDA) imposes additional requirements for the protection of patient information. This includes the limited grounds on which disclosure of such information may be made, such as to prevent the spread or possible outbreak of infectious diseases. Non-government entities receiving such information for delivery of public services and care to COVID-19 patients are obliged to comply with the IDA restrictions, as well as the Personal Data Protection Act (PDPA) and further data protection safeguards stipulated in Government contracts. Data that has been anonymised can be disclosed without breaching confidentiality restrictions over personal data. There are safeguards in the PSGA, IDA and PDPA which make it an offence for authorised individuals who re-identify anonymised information in a knowing or reckless manner. These safeguards are a further layer of protection to maintain the confidentiality of patients’ personal data.”
“The Health Sciences Authority (HSA) is currently investigating the unauthorised distribution and supply of SG Diagnostics’ Antigen Rapid Test kits, which are meant for use by healthcare professionals only in a healthcare setting. Appropriate enforcement action will be taken against the responsible parties. Based on the sales and distribution records by the company, approximately 1,800,000 pieces had been sold by the company from January to September 2021, which includes distribution to professional users and the general public. The number of test kits sold only to the general public is not yet known. HSA has required SG Diagnostics to issue print advertisements in all four languages to communicate to consumers that its test is not licensed for consumer use and has not been validated for this use, and that all kits purchased should be returned to the company. HSA has also published a list of all COVID-19 tests that have been authorised for self-testing purposes on the HSA website. HSA will continue to work to communicate this list of authorised ART self-test kits and also step up its surveillance of these test kits sold in the market.”
“The corresponding figures for protection against severe illness requiring ICU care were 90% and 98% respectively. Current evidence shows that persons vaccinated and boosted with the PSAR-authorised mRNA vaccines develop the strongest boosting in antibody levels and protection against infection and severe disease, compared to other COVID-19 vaccines. The Health Sciences Authority (HSA) closely monitors the safety of the COVID-19 vaccines. As of 18 October 2021, the rates of reported Severe Adverse Events for Sinovac-CoronaVac and the mRNA vaccines were similar, at around 0.005%. Management of adverse events from vaccines, as with other conditions, is evidence-based and takes into consideration local and international data as well as the patient’s medical condition.”
“Members are interested to know how different COVID-19 vaccines compare in terms of their protection. As we roll out our vaccination and booster programmes, MOH and HSA have continued to collate and analyse data on the effectiveness and safety for different vaccines. The following are what we have found out so far. First, there is a big difference between being vaccinated and not vaccinated. Between 1 May 2021 to 30 September 2021, the COVID-19 mortality rate was 7.5 per million persons among those vaccinated with the two mRNA vaccines. In contrast, the mortality rate among those who were unvaccinated or partially vaccinated was 92 per million persons. In the same period, the risk of severe disease, including the need for intensive care and/or oxygen supplementation, was 86 per million persons for those vaccinated with the two mRNA vaccines, and around 530 per million persons for those who were unvaccinated or partially vaccinated. Second, both mRNA vaccines in our National Vaccination Programme work very well. Both mRNA vaccines protected infected persons against severe disease by around 90%. The mRNA vaccines also reduced the risk of infection by around 40% and halved the risk of onward transmission. However, a comparison with the non-mRNA vaccines cannot be made at this time, as the number of persons vaccinated with them is much smaller. Less than 2% of the population was fully vaccinated with Sinovac-CoronaVac as of 30 September 2021. Further, in Singapore, a very small proportion of seniors aged 60 years and above chose to be vaccinated with Sinovac-CoronaVac, as the take-up has been mostly in younger people. In a recent study in Chile, Sinovac-CoronaVac was found to confer 58% protection against symptomatic infection compared to 88% for Pfizer.”
“Data prior to and after 2013 are not comparable due to changes in data collection from 2013. Between 2013 and 2019, 72,668 unique Singapore residents aged 30 years and below sought care for a psychiatric condition at public or private healthcare institutions. These numbers indicate an increasing trend in the number of Singapore residents who sought care for mental health issues over this period. The breakdown of the annual number of Singapore residents who sought care is summarised in Table 1.”
“Anyone who publishes advertisements on health supplements which contain prohibited claims that the product will prevent or cure diseases such as cancer or diabetes can be fined up to $5,000 and/or jailed up to two years under the Medicines Act. This case is the first prosecution of this offence to date. Although the Health Sciences Authority (HSA) generally adopts a light-touch approach for first-time offenders who are remorseful, firm prosecution action was taken in the present case in light of the company’s persistent disregard of the advisories issued. In prosecuting the company, HSA had also considered that the offences were committed with the knowledge that the publicity materials would be used to reach out to a wider audience through the company’s product distributors. However, the company’s profits from the sale of the products were not factored into the sentencing as there was insufficient evidence to establish a link between the publication of these advertisements and the company’s earnings. In line with HSA’s submissions, the Court ultimately imposed a $3,000 fine out of the maximum prescribed fine of $5,000 on the single proceeded charge. Apart from the penalty imposed by the Court, HSA has also publicised this case on its website and published advisories to educate and warn consumers against falling prey to the company’s misleading claims.”
“Second, the Silver Generation Office has also introduced tele-engagements since April 2020 to ensure that vulnerable seniors requiring care and support can continue to receive assistance. Seniors experiencing loneliness or mental distress can reach out to The Seniors Helpline, which provides tele-befriending and tele-counselling services. Seniors and their caregivers can also call AIC’s hotline if they require more information on the various eldercare and caregiving support services. Third, for seniors who require face-to-face interaction, MOH has put in place safe management and infection control measures so that partners may continue to provide essential services to keep them engaged. Such services include social, recreational and cognitive activities at the Senior Care Centres and Active Ageing Care Hubs located within the community. Befriending services are also available to provide vulnerable individuals, such as those with limited family or social support and are at greater risk of social isolation, with psychosocial support. Even as the Government and our community partners expand our efforts to engage our seniors, this ought not to diminish or replace the role of family support. In Singapore, families are a key pillar of our Social Compact. They form the core of our society and are our first line of support. Family members have shared responsibility in providing care for one another, including our seniors, through the ups and downs of life, as a stable anchor of support, complementing other forms of Government and community support. As a society, together, we can all play our part to engage our seniors and to keep them safe during this pandemic.”
“As the number of COVID-19 cases in the community remains high, seniors are advised to stay home as much as possible, except for essential activities, during the stabilisation phase. This is to protect them from the virus. Nevertheless, MOH recognises that reduced social interactions can negatively impact one’s socioemotional well-being, especially seniors living alone who may be at risk of social isolation. Hence, we will need to strike a balance in our approach. To this end, the MOH is working with our partners to ensure that our seniors remain meaningfully engaged during this challenging period in three ways. First, we are pivoting our engagement strategy and supporting our partners to leverage virtual platforms to engage seniors, where it is practically feasible and meaningful to do so. For example, the Council for Third Age (C3A), Health Promotion Board (HPB), Sport Singapore (SportSG) and People’s Association (PA) have pivoted some of their activities and talks onto the various social media platforms so that they remain accessible, rather than being entirely held off. Several Eldercare Centres (ECs) have also converted their activities to online sessions, in order to reach more seniors. Nonetheless, we recognise that there may be hurdles preventing some seniors from accessing services online, especially if they are unfamiliar with the platform. Therefore, to complement this, the SG Digital Office under the Infocomm Media Development Authority (IMDA) actively trains seniors in basic digital skills so that they are able to use digital platforms and participate in these virtual activities, and use online communications to keep in touch with their family and friends. More than 100,000 seniors have been benefited from this initiative to date.”
“There have also been efforts to promote workplace screening and follow-up such as HPB’s Workplace Outreach Wellness (WOW) Package, and efforts focused on workplaces with low income workers. We will continue to broaden the network of healthcare providers and the appropriate touchpoints to increase accessibility and encourage diabetes screening.”
“Diabetes screening is recommended for individuals aged 40 years and above once every three years and for younger individuals with high risk. From our National Population Health Survey, the overall diabetes screening participation among residents aged 40 to 74 within the past three years was 78.5% in 2020. The screening participation rate was 75.2% for those aged 40 to 49 and rose progressively to 87.8% for those aged 70 to 74 years. Amongst residents below the recommended age of 40 years, 57.6% of those aged 18 to 39 participated in diabetes screening within the past three years. The risk of developing diabetes is low for this age group. Diabetes screening is voluntary and based on personal responsibility for one’s own health. MOH and the Health Promotion Board (HPB) have been putting in measures to encourage diabetes screening participation, such as offering subsidised screening for eligible residents under the national health screening programme, Screen for Life (SFL). Younger individuals aged 18 to 39 assessed to be of higher risk by the Diabetes Risk Assessment tool available on HealthHub are also eligible for subsidised screening under SFL. MOH and HPB collaborate with Regional Health Systems, Social Service Agencies and self-help groups such as the Malay-Muslim Organisations and SINDA to reach out to many communities and groups, to improve the uptake of screening. Routine screening for gestational diabetes during antenatal follow-up at public hospitals and postnatal screening for diabetes for women with gestational diabetes are examples of leveraging on key life stages to enhance screening and detection of diabetes.”
“During the ongoing COVID-19 pandemic, we continued to make available our community mental health and dementia services, with added precautionary measures. Intervention and counselling are conducted through telephone or video consultations as far as possible for patients who are assessed to be suitable. For interventions that cannot be delivered effectively online or for patients who are not suitable to receive intervention remotely, service personnel meet patients at community sites or their homes, with safe management measures (SMM) in place. While certain high-risk activities such as group activities, mask-off activities and door-to-door outreach services have been curtailed, in-person service is allowed to support patients with severe conditions, inadequate family support and intensive care needs, such as those at risk of injury or who are at high risk of relapse of their psychiatric conditions. Patients may also seek support through helplines such as the Samaritans of Singapore (SOS) 24-hour crisis hotline, Institute of Mental Health’s Mental Health Helpline and the Senior Helpline operated by SAGE Counselling Centre.”
“In anticipation of the increase in mental health needs in our population, the Government and various agencies have expanded and introduced a range of mental health-related initiatives. Mental health is supported through the existing framework of subsidies and support that apply to all health issues. Eligible patients can receive up to 75% of subsidies for mental health services at polyclinics and public specialist outpatient clinics (SOCs). All Singaporeans are also eligible for means-tested subsidies under the Community Health Assist Scheme (CHAS) at GP clinics for the treatment of mental health conditions under the Chronic Disease Management Programme (CDMP). They receive subsidies up to an annual limit of $500 depending on income. Patients can use their MediSave – up to $500 per year for simple chronic conditions and $700 per year for complex chronic conditions under the CDMP – to further lower their out-of-pocket costs. In 2019, about seven in 10 patients who withdrew from MediSave for the treatment of mental health conditions under the CDMP did not reach the yearly $500 withdrawal limit. For inpatient treatment, patients receive up to 80% subsidies at our public hospitals and can use MediShield Life and MediSave up to the prevailing limits. Singaporeans who are unable to afford their mental health treatments can apply for MediFund. No Singaporean is denied access to appropriate treatment due to an inability to pay.”
“The Duke-NUS Medical School was established in 2005 and admitted its first batch of students in 2007. A total of 558 students have graduated with Doctor of Medicine (MD) or MD-PhD degrees since its establishment. Close to 10% of the MD students enrol in the combined MD-PhD pathway and the majority of the graduates undergoing post-graduate clinical training are engaged in research. As the first batch of MD students only graduated in 2011, currently only 79 (14%) of its graduates have fully completed their post-graduate clinical training. Among the School’s graduates, 30 held or currently hold appointments as Adjunct Research Fellows at Duke-NUS. To date, Duke-NUS graduates have published more than 540 research papers in peer-reviewed journals and presented more than 450 presentations at local and international conferences. The Duke-NUS project is strategically important to the development of the medical science and healthcare landscape in Singapore. It has met the objectives for which it had been established, including injecting capabilities and diversity into the healthcare system, to realise the synergies between clinical service, research and education. MOH therefore fully supports NUS’s commitment to continuing its close collaboration with Duke University.”
“COVID-19 Treatment Facilities (CTFs) are an important part of our COVID-19 response strategy. By providing care for patients who are stable but at higher risk of serious illness, CTFs alleviate the burden on our public hospitals, allowing them to focus on patients who are more seriously ill. CTFs are located in different parts of Singapore, with the first one set up in Tampines. We would like to thank residents for their understanding and support as we ramp up more of these facilities in our community to ease the strain on public hospitals. CTF facilities are subject to stringent infection control measures. Further, the COVID-19 virus typically transmits through modes such as close interactions, sharing of food or items, or prolonged exposure in an enclosed space. It is not known to spread airborne from one premise to another.”
“All self-test ART kits currently available legally in the local market have to be authorised by the Health Sciences Authority (HSA) under the Pandemic Special Access Route (PSAR). MOH and HSA have put together a robust process to ensure that the self-test ART kits introduced into our local market meet and maintain stringent quality standards. MOH conducts analytical and clinical validations of the test kits, supported by our healthcare institutions and the Diagnostics Development Hub. Only tests that meet our stringent validation requirements are authorised under PSAR by HSA. After tests have been authorised and are in use, MOH continues to monitor the performance of these ART kits. HSA also ensures that only ARTs authorised by HSA are being sold for self-testing purposes. To ensure adequate market competition and diversification of supply, MOH continues to evaluate ART kits and to bring those of good quality into the local market. We also keep a close watch on prices, but to date, we have not observed nor received reports of businesses profiteering from the sale of ART kits.”
“Both MOH and commercial retailers are already buying in bulk, to replenish our stock and supply their stores respectively. MOH has also taken further steps to make antigen rapid test kits as available and affordable to the public as possible. We sourced and approved affordable and effective kits, have distributed a round of free kits to all households, and are currently doing a second round of distribution. Individuals on Health Risk Warning can also withdraw free kits from 200 vending machines around the island. We also monitor the overall supply levels and are prepared to release Government stocks to retailers when there are shortages.”
“Since 2015, MOH has added 4,600 day care places and 3,100 home care places to ensure that we have sufficient capacity of home and day care services to support ageing in place in the community. Beyond capacity, we also focus on enhancing the quality and coverage of our community-based services to support ageing in place. For example, we had rolled out the Eldercare Centre (EC) service model since May 2021. This provides seniors with convenient access to a common suite of active ageing programmes, befriending as well as information and referral services in the community. We will on-board more than 200 centres onto this model by 2024. MOH develops new community initiatives through pilots to broaden the range of options for our seniors and their caregivers. MOH reviews various factors, such as the programme’s cost effectiveness in meeting seniors’ care needs and its scalability, before deciding whether to mainstream a pilot. The pilot on night respite care for dementia patients has been extended as it was suspended for a period of time due to the COVID-19 pandemic.”
“In the past three months, over 179,000 persons were placed on Quarantine Order (QO). More than 106,000 were issued with Health Risk Warning (HRW) and about 111,000 persons were issued with Health Risk Alert (HRA). These protocols have been simplified and streamlined, with emphasis on personal responsibility, since 11 October 2021. Among Singapore residents who travelled overseas and returned over the same time period, close to 14,000 of them had served their Stay-Home Notice in their own place of accommodation.”
“Factors that need to be considered are the COVID-19 situation in Singapore, vaccination coverage of the whole population and amongst vulnerable groups, international practice and availability of fully registered COVID-19 vaccines, bearing in mind that current approval is still under pandemic special access. Introduction of vaccination-differentiated safe management measures (VDS) and workplace requirements had allowed fully vaccinated persons to participate in more community and economic activities, while protecting persons who are not vaccinated. This has led to more coming forward to get vaccinated. We have also made progress in reducing the numbers of unvaccinated among our elderly population from 200,000 in July this year to fewer than 70,000 currently. For those who remain unvaccinated, we will continue to reach out and provide detailed information on the benefits of vaccination against the risk of disease to address their concerns and convince them to be vaccinated. We take note of the Members' suggestion, that perhaps the unvaccinated should also be responsible for part of their medical bills should they be infected. We have been receiving similar suggestions from members of public and will consider this carefully. We should be clear that the objective is not for collecting revenue and cost of treatment will still be heavily subsidised. Instead, this serves as a strong signal for the unvaccinated to get their jabs. MOH continues to strive to expand the portfolio of COVID-19 vaccines that we bring in under the NVP, so that there is a suitable vaccine for everyone. We strongly encourage all medically eligible persons to take the vaccine and booster once they are eligible.”
“I will address oral questions related to COVID-19 vaccination together. For a COVID-19 vaccine to be authorised for use in Singapore, HSA will first have to evaluate the vaccine under the Pandemic Special Access Route (PSAR), where detailed safety, efficacy and quality control data have to be submitted and examined. Second, for vaccines approved under PSAR, MOH will consider if it should be included under the National Vaccination Programme (NVP). In the case of the Sinovac-CoronaVac vaccine, MOH decided to include it because we did not have a non-mRNA vaccine in the NVP, the vaccine had demonstrated efficacy against severe disease and its safety profile was consistent with other registered vaccines against other diseases. We have no plans to evaluate Sinopharm and AstraZeneca vaccines under PSAR at this juncture. Our Expert Committee is also monitoring vaccines developed based on other platforms, and studying the possibility of a heterogolous strategy, that is, using a booster vaccine of a different technological platform from the primary series. If this is proven to be safe and effective, we will consider including other vaccines into the PSAR and NVP. For children aged 12 years and above, HSA has authorised the use of Pfizer-BioNTech/Comirnaty Vaccine. HSA is in discussions with the company to facilitate the regulatory submission for vaccination in those aged five to 11 years. Mr Murali Pillai and Mr Yip Hon Weng had asked about mandating COVID-19 vaccination. Making COVID-19 vaccination compulsory is a significant move and should be carefully considered.”
“We do not have to sit up there in the Gallery anymore. Everybody can sit in the Chamber, engaging each other. We all wish to do that and I think we will get there. We get there by continuing this path, building up our antibodies day by day. I do not know how long it would take. The Prime Minister said maybe three months, maybe six. We wish it is shorter rather than longer. But many countries have gone through the process and reached there, and we shall reach there too.”
“They all went through that. Near home – Indonesia, Malaysia. They all went through that. We avoid excess death by avoiding that, by preventing that totally. How do we do that? By not being dogmatic. There are two camps in the world. One says zero-COVID-19 strategy is the right way to go. One says, no, you have to have living-with-COVID-19 strategies and maybe even Freedom Day. We say, we do both. Last year, before we had vaccinations, when we were vulnerable to the disease, we took a zero-COVID-19 strategy. Everything was tight. Borders were closed as a result. Quarantined everybody. We kept incidences very low. We kept deaths very low. That was last year. Then, we went on to a national vaccination programme, got ourselves to about 70% to 75% by National Day. Then, we said, zero-COVID-19 is over, we need to start opening up. But yet, we do not take another dogmatic approach to say we must go for Freedom Day and open up all at once. But we take the middle path: not total lockdown, neither is it Freedom Day, but we open up gradually. And what is the limiting factor? It is our healthcare system. Making sure that it can cope, given the infection rate and how that translates into ICU cases and to people who fall severely ill. That is how we have been proceeding. As Senior Minister of State Janil Puthucheary said, with each passing day, with more vaccinations and some people recovered well and built up natural immunity, we accumulated antibodies and resilience within our society. I know Members of this House, including myself, all wish that life goes back to normal, that we can have dining in five or more, we can have our proper wedding dinners and events, go back to our grassroots functions and community functions. We all wish we can all do that.”
“Then, during the subsequent days, another 2% then got transmitted. Therefore, I think from the evidence that we have been tracking so far, the incidence of transmitting at home, so long as you take the precautions, is actually not high. The high transmissions still happen within the community, through person-to-person interaction. I want to just maybe make some general comments after hearing all the questions. Dealing with COVID-19 is quite different from business or organisation planning, where you know that this season or this month, if it is coming to Christmas, business is going to go up, so, let us plan for it, make sure we have manpower and capacity. But we are looking at a crisis of a generation, a global pandemic crisis, not something that we plan year-to-year based on seasons or a five-year plan. It hits you and it overwhelms the healthcare system all over the world. You look at the papers today on the G20 meeting and in France and Italy, life seems to be normal, but we forget what they went through last year. Go back, dig up the papers last year on how the whole healthcare system was overwhelmed. Regardless of what you say about their ICU provisions and all that, or their healthcare workers' provisions, when COVID-19 hit those societies, they were totally overwhelmed. Doctors had to choose who got the hospital bed, who did not, who they had to save and who does not get saved. Those were the painful human tragedies that happened and the big human price that they paid to get to where they are today. Do not forget that. Mr Lim Biow Chuan asked, how do we prevent and minimise death? We prevent and minimise death by making sure we do not go through that, of what other countries have gone through. You name it. Whether it is the US, the UK, France, Germany, Italy.”
“Thank you, Mr Speaker. I want to make a comment but also to go back to two questions that were raised earlier. One is by the Member, Mr Gerald Giam, who asked about Sinovac. As the Senior Minister of State mentioned, it is now available as an option under our National Vaccination Programme. So, it is generally available in some clinics and also at the Raffles City Vaccination Centre just nearby. So, if you are 60 and above, cannot take or just do not want to take mRNA, you can walk in to take your Sinovac. Yesterday, I think a few hundreds did so, covered by Zaobao. If you are below 60, you have to make an appointment, but it is generally available. The second point I want to mention is what Mr Leong Mun Wai raised, where he talked about some rumours. I am not sure you can repeat rumours in this House; I will leave it to the Leader. But he mentioned something about "nursing home", something about "home transmission". Nursing home infections are a small percentage of the total senior infection. The last I calculated, it is not the most updated but it is about 6.4%. So, it is a small percentage. The large majority is actually transmission within the community. [Please refer to "Clarification by Minister for Health", Official Report, 1 November 2021, Vol 95, Issue No 41, Correction by Written Statement section.] He asked about transmission in households. We have been tracking this. Within a household, if somebody is positive, approximately 10% of household members will subsequently get infected. So, about one in 10. But out of that 10%, 8% get it very early on. That means at the point of entry into quarantine or into Health Risk Warning (HRW), you are tested and you are positive; suggesting that actually, they got it at the same time as the index case.”