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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“And we can inadvertently bring the virus to them. I have a neighbour, an unvaccinated senior and she has streams of visitors coming to visit her, persuading her to get vaccinated. So, I was persuading their visitors maybe stop coming to persuade her, just give her a call. But this is life in Singapore. So, we do have to pay attention to that. There is always a comparison with why is it that we can open for travel but not for dine-in. The difference is this, that in the initial stage, Singapore has very low infections and the world around us has very high infection rates. So, when you open up borders at that time, you are opening up the floodgates. Today, the situation is entirely different. Our infection rates and the rates outside are similar. In fact, they may have lower infections than us because they went through huge waves and we are still going through ours. Furthermore, we limit travel or SHN-free travel to only vaccinated individuals and at the border, you are subject to tests. So, theoretically, if you can have an event, like a wedding, a bigger wedding, everybody is subject to a test, you can sit in fives. So, it is actually a similar concept. This also present possibilities for the MTF to think about in future, whether through testing, through vaccination, we can allow gathering that is a bit less restrictive. These are all possibilities that we will continue to think about.”
“I will take the first two questions and maybe Senior Minister of State Janil Puthucheary can also comment on the first question and answer the third. I remember quite vividly that we talked about the possibility of ramping up to 1,000 beds. I spoke about it at a press conference illustrating how if cases doubled every week, in five weeks, the beds will actually be exhausted. It is the illustration that even with that kind of capacity, if infections run away from us, it will be of no use. We would just get overwhelmed in a matter of weeks. I also remember vividly – do not even get near that – not even near the 1,000 limit. Senior Minister of State Janil Puthucheary is a lot more experienced in this and he knows it inside out. I think he had explained that we have all the logistics and all the consumables to set it up but I think manpower will be a serious constraint. Can they handle 1,000 ICUs? I think not without a major degradation of care. So, I think it is not a black-and-white kind of situation. With every step up in the number of beds, there is degradation of care and there is a trade-off. The second question on whether we can increase dining to five for vaccinated diners. We wish to get there too. We were there before. We were even at eight at one point. It is important to the F&B industry, it is important to Singaporeans, it is important for families to get together. But I think the time is not here yet. I think we will get there. Because when you meet with five, as explained by Senior Minister of State Janil Puthucheary, you do increase the risk of transmission. If it is transmission within vaccinated individuals, it may not be that serious. But we also live with older people, with seniors who may be unvaccinated.”
“Thank you, Mr Speaker. I thank Dr Lim Wee Kiak for asking the question on recognition for healthcare workers. Many people contributed to this fight against COVID-19. We have the people who do all the swabs, supervise our self-swabs, the people who run our vaccination centres, people who make sure the vaccines arrive on Singapore shores, the people who do conveyancing every day – hundreds, thousands of trips to and fro, hospitals to treatment facilities – all our officers on the ground, safe distancing ambassadors, our vendors who disinfect places that we have been to, teachers who kept schools going for past 20 months, preschool teachers included, social workers, our community volunteers who help out those who are in need. We all owe a debt of gratitude to all of them for collectively putting up this fight. But as Senior Minister of State Janil Puthucheary has very vividly and, in a very heartfelt way, described, I think the role of healthcare workers is especially important. They are not like the other frontliners, they are also our last line of defence. So, while the rest of Singapore try to get back to a normal life, we try to get back to work, to travel for work or study, they bear that disproportionate responsibility. If something goes wrong, they are the ones who carry the burden and are literally the last line of defence, while the rest of us can continue our work and life. So, I know that monetary award is not everything but I think it is probably appropriate and the least we can do to recognise their commitment, their dedication and all the physical, mental, emotional stress that they are going through. So, thank you for that suggestion. It is something that we are seriously looking into.”
“This question for written answer has been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021. [Please refer to "Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation" and "Updated Protocols for Serving Quarantine Orders at Home and Support Measures for Persons with Disabilities, the Young and the Elderly", Official Report, 4 October 2021, Vol 95, Issue 39, Oral Answers to Questions section.]”
“MOH has strengthened community support for seniors so that they may continue to age-in-place in the community. This includes strengthening of the network of eldercare centres and enhancing the range of community care services and primary care services. Since May 2021, we had rolled out the Eldercare Centre (EC) service model, to serve as go-to points for seniors in the community. We will on-board an addition of more than 200 centres onto this model by 2024. They will promote active ageing, befriending of seniors and provide care services. To support our seniors’ care needs, we have added 4,600 day care places and 3,100 home care places since 2015. For seniors requiring medical and clinical support, we have strengthened primary care infrastructure. There are currently 10 primary care networks involving over 600 GP clinics to help seniors manage chronic diseases. We are also expanding our network of polyclinics to 32 by 2030, some of which will be co-located with eldercare services such as nursing homes and/or senior care centres. We are proactively building up manpower for the sector. Recently, we have announced funding support to raise salary competitiveness of the community care workforce. We have also embarked on a job redesign pilot to enhance opportunities for career progression.”
“This question for written answer has been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021. [Please refer to "Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation" and "Updated Protocols for Serving Quarantine Orders at Home and Support Measures for Persons with Disabilities, the Young and the Elderly", Official Report, 4 October 2021, Vol 95, Issue 39, Oral Answers to Questions section.]”
“The question has been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021. [Please refer to "Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation" and "Updated Protocols for Serving Quarantine Orders at Home and Support Measures for Persons with Disabilities, the Young and the Elderly", Official Report, 4 October 2021, Vol 95, Issue 39, Oral Answers to Questions section.]”
“The question has been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021. [Please refer to "Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation" and "Updated Protocols for Serving Quarantine Orders at Home and Support Measures for Persons with Disabilities, the Young and the Elderly", Official Report, 4 October 2021, Vol 95, Issue 39, Oral Answers to Questions section.]”
“The question has been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021. [Please refer to "Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation" and "Updated Protocols for Serving Quarantine Orders at Home and Support Measures for Persons with Disabilities, the Young and the Elderly", Official Report, 4 October 2021, Vol 95, Issue 39, Oral Answers to Questions section.]”
“Based on the data available, there has been a gradual decline in the annual number of cases of post-partum depression seen at our public hospitals over the last 10 years, from 421 cases in 2011 to 362 cases in 2020. Data from NUH showed that about one in five of these mothers require some financial assistance and this proportion has remained consistent. One of the aims of the ongoing Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study is to investigate the association between maternal emotional health and the child’s health and development in later years.”
“For children or adolescents seen in a primary care clinic with symptoms of depression, the polyclinic doctor or general practitioner (GP) will make a clinical assessment on the diagnosis and severity of the condition; subsequent recommendations for treatment or referral would be based on their clinical assessment. Clinical practice guidelines developed by the professional community and experts in practice exist to guide doctors on how to prescribe, taking into consideration the risks and benefits of treatment. The Member may wish to refer to the MOH website for specific details. MOH or the Singapore Medical Council (SMC) will investigate if it receives complaints on inappropriate prescription for mental health services.”
“The new Interagency Taskforce on Mental Health and Well-being will look into developing a comprehensive strategy to strengthen the mental resilience and well-being of the population, including suicide prevention. The Taskforce, which comprises members from various agencies across multiple sectors, will also serve as the platform to coordinate whole-of-Government efforts on mental health and well-being, focusing on cross-cutting issues that require multiple agencies to collaborate and collectively address. The Taskforce was convened in July 2021 and will be proposing substantive recommendations that will be translated into our policies and practices. We will provide an update on the recommendations when ready.”
“There are 2631 psychiatrists registered with the Singapore Medical Council as at end-2020 and 5512 psychologists on the Singapore Psychological Society register as at September 2021. This works out to be 4.6 psychiatrists and 9.7 psychologists per 100,000 in the population. There is no international consensus on the optimal ratio of psychiatrists and psychologists to population. MOH will continue to work with stakeholders and agencies such as MOE and MSF to assess the need and monitor the number of mental health professionals to ensure appropriate access to and quality of mental health services. All our healthcare workers including mental health practitioners as well as those supporting their colleagues at the frontline, have worked very hard to care for their patients throughout this period. Notwithstanding their passion and strong sense of mission, our healthcare workers face tremendous stress and are at risk of burnout. To address burnout among our healthcare workers, mental health practitioners and other healthcare staff, our public healthcare institutions have stepped up their outreach to staff on the support measures available to them. This includes counselling services, staff helplines, and peer support programmes. Let us continue to demonstrate our recognition and appreciation to all our healthcare workers.”
“Based on MOM's 2020 Labour Force Survey, about 119,000 residents outside of the labour force cited care for family members or childcare as the main reasons for not working. Our population’s care needs will increase as we age, with one in four Singaporeans aged 65 and above by 2030. Caregiving arrangements vary depending on each family’s circumstances. Some hire help, but some prefer to look after their aged loved ones themselves. We will support the different caregiving needs through increasing and strengthening care services, including respite care services, and enhancing support for caregivers. For example, MOH is reviewing the Home Caregiving Grant to provide more help for targeted groups. Since 2015, we have added 4,600 day care places and 3,100 home care places. We are also piloting new respite care options in addition to existing ones at eldercare centres and nursing homes. To ensure sufficient and qualified manpower for these services, MOH and the Agency for Integrated Care (AIC) help providers through schemes to support local recruitment, branding of the sector and salary enhancements. Providers can also tap on training grants and sponsorships to build capabilities.”
“The well-being of our frontline workers, who are crucial in our fight against COVID-19, is an important priority for the Government and our tripartite partners. At the workplace, transport operators and public healthcare institutions (PHIs) support workers through initiatives such as the formation of driver relations team among taxi and private hire car (PHC) operators, as well as implementation of peer support programmes for healthcare workers, respectively. Within these groups, frontline workers are able to voice out mental health concerns and seek support to cope with stress. Supervisors in both the healthcare and transport settings also closely monitor the wellbeing of frontline workers. Where necessary, workers may be referred for counselling services if they require further support. In addition, the Government also works with PHIs and transport operators to conduct training sessions to better equip frontline workers and their supervisors in promoting positive mental well-being. For example, HPB collaborated with transport operators and unions to organise mental well-being workshops for over 4,000 transport workers and leaders. Similarly, the PHIs have rolled out stress management training, to help staff cope with stressful situations. Frontline workers can also tap on mental health resources such as Mindline.sg, as well as national and community-based hotlines which are available to the broader public, if they require further support and assistance.”
“These questions for written answer have been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021.”
“The Singapore National Eye Centre (SNEC) is unable to quantify the number of patients seeking medical attention for eyesight problems arising from the Work-from-Home and Home-based Learning arrangements since 2020. Since the onset of the COVID-19 pandemic in 2020, SNEC ophthalmologists have been giving education talks through public webinars organised by the SNEC as well as in partnership with grassroots organisations such as Lions Clubs of Singapore. The talks cover a wide range of topics including myopia prevention and eye care while working or studying at home. SNEC consultants have also provided useful tips on how parents can care for their children’s eyes via interviews with various mainstream media. The Health Promotion Board (HPB) has been actively promoting myopia prevention through programmes such as the National Myopia Prevention Programme (NMPP), which was launched in 2001, and involves annual vision screening for children and workshops to equip parents with strategies to develop good eye care habits in their children. The Ministry of Health, HPB and public healthcare institutions will continue to look into avenues to promote eye health in the new normal.”
“These questions for written answer have been addressed by oral reply to Question Nos 1 to 20 on the Order Paper for 4 October 2021. [Please refer to "Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation", Official Report, 4 October 2021, Vol 95, Issue 39, Oral Answers to Questions section.]”
“Our two National Specialty Dental Centres (NSCs) namely, the National Dental Centre, Singapore (NDCS) and the National University Centre for Oral Health, Singapore (NUCOHS), are referral centres that provide the full range of subsidised dental services, including specialty and sub-specialty dental services. On the other hand, Hospital Dental Clinics (HDCs) were set up to provide medically-indicated subsidised dental services to hospital patients across inpatient, outpatient and day surgery settings, and HDCs may refer patients to NSCs when services capacity or capabilities are not available at the HDCs. Where appropriate, HDCs can partner the NSCs to provide an expanded scope of subsidised services at the hospital based on services needs and specialty support by the NSCs, subject to approval by the Ministry of Health.”
“Technologies such as biosafety-level 3 containment laboratories, electron microscopy and next generation sequencing platforms, has allowed us to identify and respond to emerging threats such as Zika virus, avian influenza, monkeypox and SARS-CoV-2. Partnerships exist between various laboratories within and outside of Singapore to drive research and capability development for the detection of new and emerging pathogens. As technologies evolve rapidly, new tools including metagenomics become available to augment the detection of emerging pathogens. There is currently limited evidence to support the utility of metagenomics in predicting emerging pathogens. Due to the complex microbiome in the environment, the use of metagenomics in detecting novel pathogens in the environment must be complemented and supported by epidemiological and disease information from human or animal studies.”
“Singapore has a multi-layered approach for the early detection of emerging infectious diseases and novel pathogens. This is enabled by the expertise of our professionals, state-of-the-art facilities and technologies, and international networks. Externally, we have established links with the World Health Organisation (WHO), governments, and key institutions in the region and internationally. We collaborate closely with international partners to share information and facilitate research. These processes and relationships provide us timely information about emerging disease threats globally. The insights gathered guide our surveillance and risk assessment of potentially important public health threats to Singapore. Within Singapore, our professionals form the next layer of defence. Officers across One Health agencies (human, animal, food and environment sectors) work together to detect diseases and pathogens in these settings. Our medical community, including general practitioners, play a key role in the early detection and notification of infectious diseases of public health concern. The Severe Illness and Death from Possibly Infectious Causes (SIDPIC) programme in public hospitals also aims to identify emerging infections and novel pathogens among persons with serious illness of unknown cause. We have developed a comprehensive laboratory system supported by specialist laboratory scientists and state-of-the-art technologies. This includes the National Public Health Laboratory (NPHL), which is actively involved in surveillance for highly infectious pathogens, and NEA’s Environmental Health Institute (EHI), which conducts environmental pathogen surveillance.”
“Based on the Global Burden of Disease 2019 study, the annual total number of deaths attributable to second-hand smoke for Singapore was estimated to be 261 in 2015, 266 in 2016, 271 in 2017, 284 in 2018, and 296 in 2019. However, after adjusting for the effect of an ageing population, a reduction in the age-standardised death rate was observed from 4.32 per 100,000 population in 2015 to 4.00 per 100,000 population in 2019.”
“Patient safety and well-being is a top priority of our public healthcare institutions. We do not tolerate any inappropriate behaviour against patients and will take action where necessary, as with the recent IMH case. Within IMH, staff are trained to care professionally for mental health patients, and staff work in teams to support one another. Care and clinical protocols are also in place to manage challenging situations. Some patients who are well enough participate to improve ward safety through feedback and suggestions during weekly discussions with IMH’s nursing management. Internal nursing auditors carry out monthly audits of staff knowledge, documentation and the environment to ensure the safety of patients and staff. Any unexplained injuries and reported incidents will be thoroughly investigated. Working in the mental healthcare setting can be challenging. IMH looks after the mental well-being of its team by ensuring that staff are equipped with knowledge and skills to de-escalate difficult situations and by instituting peer support for daily work with a team-based work structure. Individualised assistance is also offered to staff who require emotional and psychological support after experiencing work-related challenges. Supervisors and staff are reminded to look out for their fellow colleagues who may be stressed or burnt out and extend support to them. The Ministry will continue to work with our public healthcare institutions to care for the well-being of our patients and healthcare workers.”
“Currently, there are numerous online resources on mental health and well-being by government agencies and private providers, which can be confusing and overwhelming for those who are searching for information. In addition, the information at some of these online resources may not be relevant, current or credible. In view of this, the COVID-19 Mental Wellness Taskforce (CoMWT) had recommended for a one-stop online portal for mental health resources to be developed. The one-stop portal does not aim to reduce the number of online information sources or portals on mental health. Rather, it aims to serve as a trusted resource that will allow Singaporeans to access reliable, comprehensive and current information that have been curated by experts and various agencies, in an easy and convenient manner. The portal will be developed on HealthHub, which is an existing one-stop platform offering Singaporeans access to a wide range of health content, rewards and e-services.”
“The Institute of Mental Health (IMH) Community Mental Health Team (CMHT) is a multidisciplinary team that provides psychosocial rehabilitation for discharged patients, in their homes. The CMHT has served about 2,300 patients since August 2019. The mobile crisis team delivers crisis interventions to individuals with a known or suspected mental health condition who are at risk of harm to self or others, or are impaired such that they are unable to look after themselves.”
“And all the complaints about conveyancing, calling, not getting in, people not getting responses. It is not because the beds were not catered for, but processes with regard to HRP were not totally ready. We were caught by the sudden increase. We are still implementing the pilot programme when all these happened. But the team swung into action, the call of public duty kicked in and everybody was putting in their heart and soul to solve the problem. So, day by day, we are seeing improvements and we will continue to do so. We have to make HRP work, then the great majority of patients who are well, no symptoms, mild symptoms can recover at home. Then, the hospital capacity that we plan for can focus on the 2% that really need help. Things are improving.”
“And that is why, through our communication with the public, you would hear us – whether myself, Minister Gan Kim Yong or Minister Lawrence Wong – always saying, cases will rise; and when cases rise, the number of people with severe illnesses and deaths will rise. And we have been saying that. I also mentioned at end August, when we started seeing this wave, we said, that doubling cycle, if it happens five times, we will reach 3,200. Therefore, we have always sized ourselves up for that kind of number. We hope that we can do so progressively, and not suddenly, which is why we also announced a four-stage opening process: preparatory stage, where we try out home recovery, build up, our CTFs, CCFs and so on. And then transitions – we call it transition stage one, if people still remember – and stage two, and then, finally, endemicity. We gave no deadline or timeline, for reasons I have explained earlier, that we need to watch the situation. But we were just in the preparatory stage. The Delta variant came in and then cases started to shoot up. But, fortunately, we have always been planning ahead, which is why, at that point in time, we were already ready to handle 1,500 cases a day, in terms of Community Care Facilities (CCFs), hospital beds, ICU beds, and then also thinking already about setting up the Community Treatment Facility (CTF) beds and we are also starting with HRP. By now, we have capacity to handle 3,000 cases and ramping up in one to two weeks to handle 5,000 cases – but we do not know whether we will reach there. And then, already thinking about the next step on how to handle 10,000 cases. So, in terms of planning capacity, manpower, we are always one, two bounds ahead. What I think did not go well, and I fully acknowledge that, was the HRP.”
“I thank the Member for acknowledging that it is a complicated situation. Over 20 months, we have developed many responses, many protocols, in order to handle the situation, which is why there is now a plethora of different protocols. But as I mentioned during our press conference over the weekend, now, we are in a different phase. Many of the protocols were designed at a time when the public wants to see us snuffing out every single cluster. And so, we have all these tight protocols. But, now, we are in a phase of trying to live with COVID-19 and there are protocols. So, we announced last weekend that we are in the process of holistically reviewing all the protocols with a view to streamline them. I do not think we can get away with some abbreviations and some alphabet soup. That will still be around. It is after all, a very complicated situation. But we will try our best to streamline as much as possible, so that people would understand it, able to do their part to fight against COVID-19 and also, to help others. Back to the numbers and planning criteria, the Member seems to have a narrative that we totally did not plan for all these. On the contrary, we have always planned for a big surge. You would hear from Saw Swee Hock School of Public Health, and these are partners that we work very closely with, they have projected 5,000 and 10,000 cases a day, as high as that. You speak to different epidemiologists, they may have different views, but these are the numbers, if we fully open. You have seen it in other countries happening that kind of peak.”
“I am not making any projections or predictions, but these are things that I learn from MOH, and I am trying to explain honestly to the public to the best of my abilities. As for children under 12, actually, they can serve home recovery. We do encourage them to serve home recovery. And many parents, in fact, like to serve home recovery. I am not sure if it is made the default, but, certainly, it has great potential to be made a default. And a great majority of children can recover very well at home and they are happier that way.”
“I will answer both questions. I do not think we characterised our safe management posture as opening and shutting. But depending on the situation, we have to make adjustments and, over time, we have made progress in the sense that I think we have put the circuit breaker behind us. If we remember, in April last year, almost all businesses were shut. And then, we had Heightened Alert, which is a far more moderate form of slowing transmission, slowing economic activities. This time round, we try not to go back to Heightened Alert, but, instead, it is mainly restaurants and F&B that are affected. We want to keep them open, try not to affect businesses so much. MOF provided financial assistance, but they can operate with table of two. So, we are making progress and I think we should also feel encouraged that, because of vaccinations, we are able to move forward. As for the numbers, if I remember correctly, in late August, when we started seeing a wave, I mentioned 3,200 as a possible daily number, if the doubling cycle goes on five times. We were at 100 cases then; if it goes on five times, we would have reached 3,200. The "100 and 200" number, I am not sure where it comes from. A lot of things were said during the MTF press conferences, but I did refer to it, as, during the preparatory phase, we were hoping to maintain around that number. Because we were still preparing ourselves. And when the whole thing is over, in the endemic stage, perhaps, we will see 200 cases, maybe more. But I hope we take all these numbers in that spirit. I speak to epidemiologists, doctors all the time. They explain things to me, they cite numbers. I then try to explain things to the public. And so, some numbers may be picked on, but let us take it in the right spirit.”
“Thank you. As for the Member's second question on trigger points before we loosen our safe management measures further, we are aware and we are all well aware that certain countries have declared certain dates or certain vaccination levels, and then, they will open up. We have not adopted that approach. Because we recognise that in battling COVID-19, this is a live, evolving, fast-changing situation and it is not wise for us to tie our hands and limit our options as we adapt and stay agile in battling the COVID-19 virus. Therefore, we will have to take into account of the situation in hospitals, our case numbers, how people are reacting, what is our social preparedness to live with the virus and how businesses are doing, and we adjust our measures from time to time. But our direction is very clear: we have to live with COVID-19, we have to become a COVID-19-resilient nation. The direction is clear, but, from time to time, we may take a longer route, we may take a detour, but we will stay on course.”
“HRP is the default, provided you meet certain criteria, such as you are younger, you are vaccinated, some not vaccinated but younger. But within this default, while it is the default, it is not rigid. It is important that once the person is notified that he is on HRP, he is also given a phone number to call to reach what we call an HRP Buddy. If he is not comfortable because of living conditions or he is living with vulnerable seniors or unvaccinated children, they can then make the request to say, "While I am asked to go on HRP, can I be taken out to a CCF?" And we will try our best to accommodate those requests. So, your residents can certainly, request by calling the HRP Buddy. As for how would the public know, mass media is one way. We put out FAQs as simply as we can. But even so, it is hard to understand for many members of the public. Another layer will be our community volunteers, our Community Centres (CCs). Many do call up our CCs to ask questions. So, we also need to arm PA and our CCs with answers for all these questions. Most, or 80% of the questions, are related to those few things. Our volunteers should be also equipped with the information and they can reach out and explain to them. Finally, it will be the hotline. It has been difficult to call through in the past few days. But we have been beefing up the resources day by day and, with SAF's help, it has really improved a lot. As of yesterday, when I checked, we are able to attend to almost 70% of the callers. So, it is improving and we continue to improve it. Once that happens, as more people can call through, get the answers, they will also tell their friends, and I think the situation will change.”
“I thank the Member for raising this issue. Indeed, I have received a lot of feedback, too, where a person, after his discharge, does not have his TraceTogether indication lifted. So, we are fixing that. It is, essentially, an IT issue. The reason why there is now a fixed day of discharge is because, once a person is vaccinated, the viral load drops very quickly, especially after day 5. And by day 10, NCID finds that they cannot culture the virus anymore because the viral load becomes quite low. Which is why we can safely discharge patients who are vaccinated on day 10. The IT system needs to keep up with that policy. So, in the next few days, the TraceTogether issue will be resolved as we will also synchronise the removal of the alert in line with the discharge day. So, once you are infected, the TraceTogether app would know and it will count that 10 days from then, if you are vaccinated, you will be automatically removed. If you are not vaccinated, it will be, removed after 14 days. So, I expect this problem to be resolved. As for CCF, I thank the Member for raising that issue. There are nurses and workers available at the CCF. So, if we come across such cases where the senior is alone or illiterate, let us know and we will alert the CCFs. There are people on hand, medical workers, who can help out and help the senior navigate and understand the messages that we are sending to them.”
“Senior Minister of State Janil Puthucheary will elaborate on other parts of the plan. It is still a long battle ahead, which we will prevail as one Singapore. It has been a challenging 20 months for all of us, especially our healthcare workers. Although it was posed as a question, I fully agree and thank Mr Xie Yao Quan’s suggestion to recognise healthcare workers. We have enhanced their salaries but I think recognition needs to go beyond that. In good time, when the pandemic has settled down or is over, we must properly express our gratitude to them and make sure that generations of Singaporeans will be inspired by their bravery and dedication during the COVID-19 pandemic.”
“At this stage, individuals' vaccination status, as listed on the TraceTogether app, will not change, regardless of their booster dose status. We are administering the booster in good time and, so, this issue of expiring vaccination status has not arisen yet. But, in time, this is an issue that we will need to review. Mr Yip Hon Weng asked about the possibility of exploring a combination of vaccines to be used for the booster jab. The Expert Committee on COVID-19 vaccination is still studying the heterologous strategy of administering a non-mRNA booster shot that is different from the first two primary series mRNA doses as data emerges. In the meantime, we will administer mRNA vaccines under the booster programme as the best available data utilise these vaccines for boosting with good effect. Ms Jessica Tan asked if our current measures are effective in ensuring that Singapore is prepared for COVID-19 to be treated as "endemic". Our transition journey to living with COVID-19 is unique in this world, in the sense that we did not allow ourselves to go through big waves of transmission last year, which many countries did and suffered tremendous loss of lives. Today, when we see other countries opening up and living lives almost normally, let us not forget the heavy price that they have paid last year. We commenced our transition journey only after we have vaccinated the large majority of our population, so that, for the vast majority of infected persons, they now have no or mild symptoms. I believe our plan is as comprehensive and effective as it can be, given what we know about the virus and the tools we have on hand. But we continue to learn about the virus and improve our responses day by day, week by week.”
“We have also commenced our booster programme. To date, about 550,000 individuals have been invited to take their boosters. Three hundred and fifty thousand of them have taken their jabs or booked an appointment. This is before this weekend. I think, by now, the numbers have gone up. Two hundred and forty thousand of them have completed their jabs. So, we are off to an encouraging start. To Ms Ng Ling Ling’s question, the Expert Committee has recommended, and MOH has accepted, that individuals eligible for boosters will include those aged 50 and above and all those who are immunocompromised. The Expert Committee continues to review international data to assess the efficacy and safety of booster shots for younger groups, as well as those exposed to high-risk environments, such as healthcare and frontline workers. In time, we will also be inviting eligible individuals who have taken the Sinovac or SinoPharm vaccine to take their mRNA booster shots. However, most of them are not due yet. For policy consistency, the Vaccine Injury Financial Assistance Programme (VIFAP) will only apply to the vaccines used under our National Vaccination Programme. Ms He Ting Ru asked whether VIFAP applicants would have access to the findings by the Panel as well as avenues for appeal if their applications are rejected. The VIFAP Clinical Panel assesses applications based on two considerations. First, whether the patient’s conditions are related to the COVID-19 vaccination. Second, the severity criteria. The reasons for rejected applications are made known to the applicant and unsuccessful applicants may apply for a reassessment if there are new supporting medical information.”
“As for the Sinovac vaccine, the number of people who have been administered with the vaccine in Singapore is low, at less than 2% of our population, and we do not yet have meaningful data to gauge its effectiveness – whether against infection or against severe illnesses. But the Member who asked this question is probably interested to know about the relative effectiveness of the vaccines. There has been some international data available, including a fairly extensive study done earlier this year – it was pre-Delta – that was done in Chile, which uses a mixture of vaccines. Our neighbouring countries, too, have released some data. All these data showed that just like the mRNA vaccines, breakthrough infections are not uncommon amongst individuals vaccinated with the Sinovac vaccine, but the Sinovac vaccine does accord protection against severe illnesses. For those who are not fully vaccinated due to concerns over medical complications or because they experienced severe side effects after their first dose of mRNA vaccine, they may take the Sinovac vaccine at public hospitals. As of 3 October, under this public health programme, more than 1,900 individuals have taken the first dose of the Sinovac vaccine and around 1,300 individuals have completed their full vaccination regimen. To Dr Lim Wee Kiak’s question on whether we intend to grant full registration to the Pfizer-BioNTech vaccine, this is something we are looking into, once the longer-term follow-up data is fully available to us and HSA has completed its evaluation. To Mr Dennis Tan's question, we are also waiting for data from Pfizer-BioNTech with the view to extend the use of the vaccine to include children aged five to 11. These are areas we are proactively working on together with the pharmaceutical companies.”
“In response to Ms Ng Ling Ling, amongst those on HRP, as of 26 September, about 400 are Persons under Quarantine, who subsequently, tested positive for COVID-19. Ninety-five percent of them are eligible for HRP and have recovered or are recovering well at home. Five percent needed to be conveyed to a care facility and this was generally done within 24 hours of the request for conveyance. I would like to assure the House that MOH and SAF are working hard together, devoting a lot of attention and resources to continue to improve HRP and its processes. Ms Sylvia Lim also asked about a related issue concerning the procedures of quarantine and Stay-Home Notices (SHN) for travellers. There have been some changes to the SHN procedures, which were announced last week, namely to align SHN duration with the quarantine duration. As I have explained at the Multi-ministry Task Force (MTF) press conference over the weekend, the healthcare protocols developed over the past months have become complex and confusing to most people. We are undertaking a holistic and comprehensive review to simplify them, so that people understand them and can, therefore, do their part in the fight against COVID-19, and also help others who are in need of assistance and guidance. Let me now move on to vaccination and boosters. Vaccination remains key to our battle against COVID-19. Those who are fully vaccinated with Pfizer-BioNTech or Moderna vaccines are about 40% protected against infection from the Delta variant. This is protection against infection of the Delta variant. Nevertheless, both vaccines remain very effective in protecting against severe illnesses from COVID-19 infections.”
“Over the past week, and with the SAF overseeing and operating the programme end-to-end, we have been ironing out the teething issues, resolving service lapses, including those relating to timeliness of notification and conveyancing, and also improving communications with patients and their families. Things are improving day by day. In response to Miss Cheng Li Hui, currently, there are about 9,800 people on HRP and they are recovering well. Over 2,800 have been discharged as of 3 October 2021. Every day, over half of infected individuals will be onboarded on HRP and we expect the proportion to continue to rise. In recent days, for those eligible for HRP, 93% are contacted promptly and smoothly onboarded. But we still have difficulties contacting the remaining minority because there was either no response or contact details are not accurate. So, this is another teething issue that we are ironing out using IT solutions. As for those who are illiterate and do not understand the SMS notifications from MOH, we hope family members, neighbours and volunteers can give them a hand. That is why our partnership with the People's Association (PA) is very important. Over the weekend, volunteers have been mobilised to reach out to residents who have been served HRP notifications. I thank the PA and all our volunteers for their hard work on the ground. As the patients are generally well, we have also kept the involvement of telemedicine providers quite light and have patients call them only when they need medical attention. In response to Mr Xie Yao Quan, typically, after a person is detected as COVID-19-positive, MOH will contact him within 24 hours, where triaging will be done and a decision made on whether he will be on HRP or needs to be conveyed to a care facility.”
“On the Home Recovery Programme (HRP), this is an important part of our response, given that the vast majority of infected individuals have mild or no symptoms. These individuals do not need special medical care and can, therefore, recover safely at home. Mr Dennis Tan asked if individuals can request to be sent to an isolation facility instead. We have been considering and accommodating such requests, taking into account the medical conditions of the individuals and their family circumstances. But it is also important to emphasise that individuals and families should make, and have been making, some adjustments to their living arrangements to make HRP safe and possible at home. Because it is only with a high take-up of HRP, that our hospitals can focus resources on those who may require greater medical attention, including non-COVID-19 patients who need acute hospital care. This will enable our healthcare professionals to concentrate on those who need acute hospital care. In response to Mr Xie Yao Quan, in the initial days of HRP, a fair number of patients without serious symptoms did make their way to the Emergency Departments of hospitals. We did not compile the numbers but it had led to overcrowding of the Departments. We understand the anxiety of these patients. It is, therefore, important for us to iron out all the teething issues of HRP, so that there is a strong sense of assurance as patients undergo HRP. Over the past few days, such incidences have been significantly reduced.”
“Thank you. Mr Speaker, Sir, the recent move to quickly tighten safe management measures was a difficult but necessary decision. We are committed to our plans to opening up and transit to a COVID-19-resilient nation. Hence, lockdowns like circuit breakers are no longer an option. Many workers, families, students and businesses are going to suffer for it, and it will affect our ability to earn ourselves a living in the long term. With the great majority of our population – over 83% – fully vaccinated, we are one of the most highly vaccinated countries in the world. As a result, during this wave of infections, over 98% of infected individuals experienced mild or no symptoms, 1.7% required oxygen supplementation in hospitals typically for a few days, 0.2% required ICU care and, unfortunately, 0.1% passed away. Although only a small percentage of infected individuals require hospital or ICU care, we also admit many more others for observation, because they are at risk of developing serious illnesses. So, when the infection number rises, all these translate to a larger number of hospital patients, which put considerable strain on our hospitals and healthcare workers. Hence, even as we continue our journey to transit to a COVID-19-resilient nation, we should also have a care for our hospitals and healthcare workers, and "tap on the brakes" to slow down the rate of transmission. This is why we had to implement the measures under the Stabilisation Phase last week. Unfortunately, in this rapidly changing and evolving situation, we have to stay agile, adapt and respond quickly. We will try to give as early a notice as possible to businesses, but there is a practical limit to that, and we seek your understanding.”
“Mr Speaker, Sir, may I request that I answer Question Nos 1 to 9 for oral answer and Question Nos 32 to 36 for written answer together? Thereafter, Senior Minister of State Janil Puthucheary will answer Question Nos 10 to 20 for oral answer and Question Nos 27 to 30 for written answer. And both of us will then take supplementary questions together after our respective answers, please?”
“Subsidised patients from polyclinics and CHAS dental clinics who require specialist or complex dental treatment can be referred for specialist dental care at the National Specialty Dental Centres (NSCs), namely, the National Dental Centre, Singapore (NDCS) and the National University Centre of Oral Health, Singapore (NUCOHS). These centres provide the full suite of subsidised dental services for subsidised patients referred for MOH-approved procedures and treatment. NSCs may also receive subsidised referrals from public hospitals and other Government bodies, such as the Health Promotion Board (HPB), when assessed to be clinically appropriate. The current median waiting time to first appointment for non-emergency cases at NSCs is 33 days. Patients with emergency dental conditions may visit the Emergency Department of public hospitals and will be prioritised and attended to promptly, based on the severity of their conditions. Hospital Dental Clinics (HDCs) were set up to provide dental services to hospital patients who require dental treatment, as part of management of their overall medical or surgical condition(s). As the services and capacity available at HDCs are circumscribed for this purpose, external referral sources are generally not accepted and HDCs should refer eligible patients to NSCs where service capacity or capabilities are not available at the HDCs. Where appropriate, HDCs can partner the NSCs to provide an expanded scope of subsidised services at the hospital based on service needs and specialty support by the NSCs, subject to approval by MOH. We will continue to monitor and meet the dental care needs of Singaporeans at the appropriate settings.”
“The one-year lead time allows existing patients to complete their current course of treatment and adjust their treatment plans, where needed, to alternatives which are efficacious, cost-effective and eligible for MediShield Life claims and subsidies. The lead time is also needed for significant system changes to support claims processing and financial counselling.”
“On average over the past 10 years, the number of Filipino nurses registered with the Singapore Nursing Board increased by about 400 annually. More join the nursing workforce when there are new hospital openings. Over the past five years, the total number of Filipino nurses has remained stable, including the period since the COVID-19 pandemic started, and there was only a slight decrease in the number of Filipino nurses between the end of 2019 and the end of 2020.”
“From 22 July to 18 August 2021, MOH received a total of 111,062 calls via the COVID-19 General Enquiries hotline. This represents a utilisation rate of 246% of the normal call centre capacity of 45,000 calls per month. On average, the COVID-19 General Enquiries hotline operates one-fourth of the time at peak utilisation. During the same period, the number of unanswered calls is 19,735, of which 11,013 (9.9% of total calls received) were dropped before being connected to an operator. Nine hundred and one callers (1% of answered calls) waited for more than 30 minutes before being connected to an operator.”
“About 7,100 individuals were assessed to have allergic reactions to the first dose of an mRNA COVID-19 vaccine, and have been invited to complete their vaccination with two more doses of the Sinovac-CoronaVac vaccine. Three thousand nine hundred individuals have indicated interest and will receive the vaccination at four public hospital clinics for closer monitoring given their reaction to the mRNA vaccine. The wait time between registering with the public hospital clinics for vaccination and receiving a first dose of vaccine is between two and four weeks. MOH is increasing capacity so that individuals can receive their vaccinations sooner. Individuals who have allergic reactions from their first dose of mRNA vaccine are advised not to take the second dose of the mRNA vaccine. However, if they wish to seek a reassessment of their suitability for the second dose of mRNA vaccine, they may provide a supporting memo from any medical provider at their own cost. If the attending doctor at the vaccination provider agrees with the assessment, the individual may proceed with the second dose of mRNA vaccine.”
“Persons under Quarantine (PUQs) and Stay-Home Notice (PSHNs) have been notified to call their Quarantine Order (QO) agent1 and the SHN facility’s managing agent, respectively, should they require medical attention. Documents with detailed instructions and contact numbers to call for assistance are also issued to both PUQs and PSHNs. In the event of an emergency, PUQs/ PSHNs should call 995 directly or seek assistance from their family members to do so. An ambulance will be arranged to convey them to a Public Health Institution (PHI). Arrangements with the PHI are usually made in advance for such cases and public health measures, such as escorting the PUQs/ PSHNs to ensure there is no intermingling with others outside the isolation site, and maintaining safe management measures, are adhered to. For non-emergency cases, the QO agent or SHN facility’s managing agent will assist to facilitate an MOH-approved teleconsultation service as this helps to minimise physical contact and exposure.”
“Under the Private Hospitals and Medical Clinics Act (PHMCA), licensed healthcare institutions in both the public and private sectors are required to have in place adequate safeguards to maintain and protect their medical records against loss, or unauthorised modification, destruction, access, disclosure, copying or use. In addition, they are subject to requirements under the Personal Data Protection Act, which imposes obligations to protect personal data. MOH regularly inspects and audits healthcare institutions to ensure that licensees have taken reasonable actions to implement appropriate and adequate safeguards for the integrity and confidentiality of patients’ medical records. Maintaining a good cybersecurity posture depends not just on technical measures. It is equally important that licensees have in place process measures and the capability to detect, respond to and recover from cyber threats. Hence, MOH had issued a set of Healthcare Cybersecurity Essentials in August 2021 to guide licensees in establishing and reviewing their cybersecurity safeguards. These guidelines cover IT asset management, technical, process and people aspects. Licensees are strongly encouraged to implement measures recommended in the Cybersecurity Essentials. MOH will continue to review and update the regulatory framework to equip licensees in securing their data and IT systems, so as to deliver appropriate and safe care, whilst upholding patient safety.”
“MOH sent out a circular in July to all registered doctors and licensees of medical clinics, outlining the type of domestic abuse cases they may encounter (not just for foreign domestic workers) and how they should manage and report suspect cases of abuse. The circular included guidelines on spotting signs of physical and non-physical abuse. A joint MOM-MOH circular was also sent out in August to doctors and licensees on enhancements to MOM’s six-monthly medical examination (6ME) for foreign domestic workers, reminding them to check and document possible signs of abuse during the 6ME. The Singapore Medical Association (SMA) and College of Family Physicians Singapore (CFPS) have disseminated further guidelines on this circular to their members.”