Rahayu Mahzam
Singapore
“We engage the insurance providers quite regularly, but we are very mindful about where we intervene, especially because they need to be competitive and there is a commercial dimension to it, which we feel that we should respect. So, how we intervene is via the conditions that are put in place vis-a-vis the consumers.”
“So, that is not something they can worry about. There is already the S+3M framework that is already in place, so we know that MediShield Life is one, they have their MediSave and if all else fails, there is MediFund.”
“Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes.”
“It is just a symptom, so the underlying cost pressures still need to be addressed. The description that we had put earlier in the past is that it is a knot that we need to untangle; and that is something we are doing with a multi-pronged, with engagements with different parties and stakeholders.”
“I appreciate the Member's feedback. As I said earlier, this is something that we will continue to consider. But we do also have to appreciate that the information that we get is live, in terms of waiting times and all that.”
“But I do take the point and we are actually reviewing to see what is a meaningful way to put out this information so that the public can understand, so that we can all track properly whether the good health outcomes are a result of the efforts that we are making. I will take the feedback back and we will continue to review this.”
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“I note the Member's concern in this space. The rental subsidies are administered and managed by the agencies that are overseeing that sector. So, the feedback that you have raised and the concerns that she has raised, I would have to take it back to the different agencies and we can see what other support can be provided.”
“So, I believe a lot of this has already been addressed in my speech and I just want to re-assert the point that SLA takes a lot of effort in looking at the overall market, the overall demands of the nation in the decisions they make in the management of these.”
“Chairman, I would just like to give a few responses to address Mr Leong Mun Wai's questions. Firstly, I just want to highlight that the issue in relation to the black and white bungalows and the details that have been asked have been something we have repeatedly addressed in Parliament last year as well as the various questions that Mr Leong Mun Wai had also put up. Suffice to say that the key thing is this. There were assertions Mr Leong made about the management of SLA in respect of these properties. We have also specified and explained quite rigorously and I have also repeated that in the bulk of my speech to explain how efforts are being taken in managing this, in making sure that we do not necessarily overspend or waste resources. I think this actually shows how we have taken great efforts in managing the assets and, as you can see, the figures that I have also given, a large percentage of them are occupied. And we have indicated that the rental that is received far exceeds the maintenance. 12.15 pm Mr Leong had also suggested that, perhaps, there is not enough publicity or information about the efforts that SLA is doing in managing state assets and optimising the resources we have. I actually spent a bulk of my speech explaining all the different uses and the different efforts we are taking with different partners. I think that goes to show that there is a lot of thought put into it. It also ties in with the last question he raised about the overall strategy in deciding what to keep, what not to keep. I have also mentioned that in my speech because it is looking at the overall portfolio and deciding what are the best measures to take in light of the uses that are relevant at that time and in light of the partners that we are working with.”
“I thank the Member for her suggestion. Indeed, I think that would be a useful endeavour. We will take this back and see how best we can enhance this further.”
“Another area which MinLaw and the FJC have been working on is probate and intestacy matters. The FJC launched its Probate e-Service in 2023 for straightforward probate applications where the estate is not more than $2 million. In response to Mr Murali Pillai on the potential expansion of its scope, the FJC will monitor its use first, as the e-Service was only introduced recently. Separately, the FJC also intends to roll out its revamped Family Justice Rules later this year, which will simplify and streamline the rules on family proceedings, including probate and intestacy proceedings. 12.00 pm On other possible areas for law reforms, I thank Mr Murali Pillai for his suggestions. Given the full slate of work outlined earlier, which MinLaw is committed to delivering, some of these reviews will have a longer tail. To round off the MinLaw Committee of Supply (COS), let me highlight the key thrusts of our work. We will in 2024 strive to increase access to justice for more in the community, especially the most vulnerable; strengthen Singapore's position as a leading international legal services hub and seize new opportunities; and finally, optimise our state assets and leverage geospatial technology to support the economy and serve the community.”
“If this is not possible, we will find other ways to get translation done. MinLaw also has non-English versions of brochures relating to some of our services. In addition, MinLaw is also looking at making it easier for litigants to enforce their judgments, as said by Mr Vikram Nair and Mr Patrick Tay. We have received feedback that sometimes, the time and costs spent to enforce judgments may be disproportionate to the outcome. It may simply not be worth the effort to seek enforcement of lower-value judgments. One of the issues is that the current civil enforcement process is overly reliant on the compliance and cooperation of the judgment debtors. Under the Rules of Court, the current process to locate and identify a judgment debtor’s assets is for the judgment debtor to be examined in Court on his or her assets. However, the effectiveness of this procedure is dependent on the truthfulness and cooperation of the judgment debtor. An uncooperative judgment debtor could provide selective or insufficient information, or wear down the judgment creditor by failing to turn up for hearings or bring the required documents. We are thus studying potential enhancements, such as giving the Court greater powers to identify the assets and means of judgment debtors, to help the judgment creditor decide whether and how to enforce the judgment. We are also looking to introduce new powers to deter and punish non-compliance with court orders and to streamline further the process of civil enforcement. Mr Vikram Nair had asked about the status of these proposed reforms. MinLaw has made good progress on refining its proposals, having sought inputs from various stakeholders in the past year. We target to introduce the Bill later this year and will provide details in due course.”
“This is in light of the increase in household income and property value in recent years. The PCHI thresholds will be increased for civil legal aid from $950 to $1,050, and for criminal defence aid from $1,500 to $1,650. The AV threshold for both types of aid will also be increased from $13,000 to $21,000, in line with MOF’s revision of the AV threshold for social assistance schemes. This will cover all Housing and Development Board (HDB) flats. We are working towards implementing these changes by the second quarter of this year. On a related note, Mr Derrick Goh had asked whether exceptions are being considered for those who do not meet the means test criteria. We will continue to exercise flexibility for deserving cases. For instance, a Means Test Panel appointed by the Minister can consider and recommend aid be granted to applicants who cannot afford basic legal services due to extenuating circumstances. Next, we are simplifying the application process for divorce matters in the Syariah Court. In November 2023, LAB launched eBantu. Applicants can use eBantu to get an estimate of the nafkah iddah and mutaah claimable. eBantu also uses a series of guided questions to help the applicant fill in originating documents. This can help applicants minimise form-filling errors, and be better informed of their rights and entitlements. We are looking to translate the tool into the Malay language in the next phase of development. This is related to the point that our services need to be accessible to non-English speakers, which was also mentioned by Ms Sylvia Lim. When an applicant approaches MinLaw for services, we will try to find officers who speak the applicant’s preferred language to assist the applicant.”
“The amendments were significant and focused on: protecting the public by strengthening our levers to tackle crime, including serious sexual crime; and enhancing transparency, fairness and coherence in our criminal court processes. Key amendments included: setting out a clear legislative framework on the conduct of forensic medical examinations; the introduction of a new sentence for enhanced public protection to better protect the public from dangerous offenders; and the introduction of new provisions on criminal disclosure to provide greater clarity, certainty and coherence. Together, these amendments will facilitate more effective criminal investigations, enhance public protection and result in greater transparency and fairness in criminal proceedings. Separately, the inter-agency Sentencing Advisory Panel, which MinLaw is represented on, alongside stakeholders such as the Courts, the Attorney-General's Chambers, the Ministry of Home Affairs, the Public Defender's Office and the Defence Bar, issued its first Guidelines on Reduction in Sentences for Guilty Pleas in August last year. The Guidelines provide more clarity, consistency and transparency to existing sentencing practice. They are intended to encourage accused persons who wish to plead guilty to do so earlier. This has significant benefits, especially for victims, as they can find closure sooner and are spared the need to testify in court. Sir, I will now elaborate on our efforts in ensuring access to justice and build on what Minister Shanmugam mentioned earlier. First, for our civil legal aid scheme and criminal defence aid scheme, we will be revising the quantum of eligibility thresholds for per capita household income (PCHI) and annual value (AV).”
“One initiative is the introduction of barrier-free routes in OneMap. These routes have been piloted with more than 100 wheelchair users, covering about 1,100 kilometres across nine planning areas, including Gardens by the Bay and the Orchard Road precinct. This will help make Singapore a more inclusive society for persons with disabilities. Second, to deepen Singapore’s geospatial capabilities to support national needs. SLA will conduct the third national aerial mapping exercise to capture and update Singapore in 3D in March this year. This supports strategic use cases, such as urban planning, national security, coastal protection and flood mitigation. To address Ms Nadia Samdin’s query on harnessing AI, SLA launched the OneMap GPT Challenge with IMDA in October 2023. This explored the usage of GenAI technology to enhance OneMap’s usefulness and relevance to the daily lives of Singaporeans. Third, to project Singapore’s leadership in geospatial development globally. Since 2022, SLA has been co-chairing the UN Expert Group on Land Administration and Management. This is a strong recognition of Singapore’s achievements in maintaining a robust framework and mapping technology for land registration and ownership management. We have been sharing our experience and contributing to the global shift towards using geospatial information and technologies to address climate change challenges, such as coastal protection and flood mitigation. I turn now to speak about strengthening our criminal justice system, a point which Mr Patrick Tay had asked about. Earlier this month, Parliament passed the Criminal Procedure Code (Miscellaneous Amendment) Bill.”
“Others have been re-purposed for different uses, such as commercial and retail. These are subject to the URA Master Plans. If the heritage bungalows are located amidst or amongst an area zoned for landed properties, removing the properties or redeveloping them and the land around them would not change the area much. The cleared land can only be similarly used for low intensity development. It should be kept in mind that SLA’s portfolio of state properties cannot be directly compared to that of a typical private commercial landlord, as SLA manages a number of heritage bungalows which are conserved or marked for study for conservation. SLA has carefully broadened the usage and deployment of its properties to meet the evolving needs of Singapore over time. A judicious balance continues to be needed, between protecting heritage properties in Singapore and redeveloping them altogether. SLA diversifies the management of its portfolio to include private sector managing agents as they are professional organisations, experienced in managing properties in the public and private markets. Today, overall, the total revenue collected by SLA from state properties significantly exceeds the total maintenance cost incurred. Sir, turning to geospatial technology, this is a crucial tool to optimise land use, enhance productivity and advance new ways of working and living. On the issue of building local capability in geospatial data, SLA will be launching the refreshed Singapore Geospatial Master Plan in March this year. Building on the first Geospatial Master Plan, this will guide our national geospatial initiatives over the next decade. The Master Plan has three priority areas. First, to mainstream geospatial information and technology to benefit Singaporeans in their daily lives.”
“In addition, for heritage bungalows in particular, the pool of potential tenants is limited, because tenants often have to put in considerable additional work to install modern amenities to make the property more liveable. SLA’s approach is to make basic additions to ensure that the properties are in a reasonably good condition so that tenants are able to reside in these properties safely. The incoming tenant will also retrofit and enhance the property based on their preferences. Since the tenant will have to spend a fair bit of money, that reduces the pool of tenants further. SLA will install modern amenities and facilities for selected properties, where the overall circumstances make it advantageous to do so. We have and will continue to rejuvenate properties, with an external private sector partner where possible to place-make the area. It would, however, not be the best use of public resources to always renovate properties to a high standard before a tenant is found. This is because the condition of the property will deteriorate if there is no take-up such as in a poor market. Taxpayers' money would have to be used again, to redo some works and carry out additional works, when a tenant is found. It is also wasteful and inefficient if we retrofit a property in a particular way only for the tenant to redo it in a different way. It was also explained in detail that SLA deploys state properties to a variety of different uses. Likewise, the surrounding state land is used in a variety of ways, having regard to the Urban Redevelopment Authority (URA) Master Plan. While we continue to retain heritage bungalows for their original residential use on the market, some have been demolished as a cluster to make way for newer developments.”
“Another new site is the former Kampong Chai Chee community centre. We have launched a tender to create a new space for social activities and interaction among diverse communities. We are seeking innovative ideas for facilities and programming that will appeal to residents. On Ms Usha Chandradas’ comment relating to use by arts groups, SLA works with our partner agencies to identify suitable properties for arts uses. In general, SLA will consider factors such as market demand for the specific use, as well as feedback from community and stakeholders, including partner agencies. The rental of state properties to arts tenants will be based on the assessed market rate for such arts-related uses. Mr Leong Mun Wai asked about SLA’s management of state land and properties, in particular heritage bungalows. Mr Leong and Mr Patrick Tay also asked about the occupancy rates of state properties. Many of the points raised by Mr Leong were already addressed in Parliament last year. The occupancy rates for residential heritage bungalows from January 2017 to January 2023 were shared publicly last year. In addition, the overall occupancy rate for usable state properties is published annually. In financial year 2022, the occupancy rate for all usable state properties was 99%. This is publicly available information published in MOF’s Budget Book. So, the Member’s statements relate to the remaining 1%. Let me recap some of the points that were shared previously. Occupancy rates of state properties generally move in tandem with changes in market conditions. When market conditions are weak and the demand for leasing is low, occupancy rates will generally be lower, as was the case for the Ridout Road estate in 2018, when a number of bungalows in that and other estates were vacant.”
“Mr Chairman, the last key thrust of MinLaw’s work relates to state assets. The Singapore Land Authority (SLA) plays a key role as custodian of state land and property, optimising land resources for our economic and social development. We continue to plan for the long term, to optimise our limited land and invest in our shared tomorrow. Mr Patrick Tay asked how SLA optimises state assets to meet market needs. SLA remains continually attuned to market needs through extensive engagements, in order to unlock the value of state land and properties. A few examples of SLA’s innovations and curation of new uses include: the former St Andrew’s Mission Hospital in Tanjong Pagar which will be transformed into a creative lifestyle space. SLA has also made available state properties such as 79 to 95 Hindoo Road and 26 Evans Road to meet the emergent demand for co-living spaces. We also recognise that spaces play an important role in forging social cohesion and promoting social good in our community. SLA has been repurposing spaces to serve the community. One example is The Foundry at 11 Prinsep Link, which was the former Elections Department office building. This space will be a collective impact hub that houses social purpose organisations. The Foundry was set up in partnership with The Majurity Trust, Tote Board and the recently launched Singapore Government Partnership Office, and will facilitate the gathering of non-profit startups and social sector partners. Bringing these partners together in a common space will create strong synergies to encourage civic participation. It will act as a base for non-profit organisations and social sector enablers to come together to incubate ideas, drive impactful innovation and build communities.”
“There is different funding support for a suite of initiatives to attract, develop and retain workers in the community care sector.”
“I thank the Member for the question. With regards to the public healthcare institutions (PHIs), as the Member is an advisor to the HSEU, he would then be aware that the PHIs already have prevailing collective agreements signed with HSEU. These collective agreements include information on salary ranges and other information such as leave benefits. This is something that can be accessed through the HSEU's website and that provides a comparison with the CCOs. The Member mentioned effects on staffing. Since 2020, MOH has been funding CCOs through the Community Care Salary Enhancements Exercise. Salary guidelines are published for purposes of transparency and clarity to jobseekers. It is intended to encourage them to see the benefits and salaries, but CCOs also have to do their part. They also have to attract and retain their staff. For PHIs, MOH also does the same thing. We work with them to regularly monitor and review their salaries to keep it competitive against the market. I would like to highlight to the Member that all these are costs. As you would know, our manpower costs already account for 50% of our expenses. This means that we are actually increasing the costs as we increase the services, and Government expenditure is expected to go up. I think all parties have to play a part in this. Already as it stands, we are looking at an increase and this increase has been growing in tandem with the healthcare demands. The Member had also asked about the efforts to attract and retain workers. I think the Member had also filed a written Parliamentary Question, which is also scheduled for answer today, in relation to this. We have done many different efforts. As mentioned earlier, we also look at training and development.”
“We have also worked with CCOs to redesign job roles to elevate community care careers and improve their attractiveness.”
“The salary guidelines for the community care sector have been published to provide greater transparency and clarity to jobseekers and community care workers on salaries in the sector. Through in-depth engagement sessions with Community Care Organisations (CCOs), the Ministry of Health (MOH) provides them with guidance on implementation, such as establishing the appropriate banding of staff and salaries. It is in the CCO's own interest to abide by the guidelines, or they will not be competitive in attracting and retaining their staff, or pay them salaries that is commensurate with their contributions. We will continue to monitor the salary movements of community care staff against the recommended salary levels through yearly surveys. In reviewing the guidelines, we will consider salary movements in relevant labour markets. MOH and the Ministry of Social and Family Development’s (MSF's) salary guidelines apply to the healthcare and social service sectors respectively, as there are differences in the job roles and benchmarked to different sectors. Nonetheless, MOH and MSF will continue to exchange salary review plans and information on a regular basis. Higher salaries will lead to higher operating costs for all CCOs. Since 2020, MOH has funded CCOs through the community care salary enhancements exercise. MOH will continue to fund and support CCOs to adopt the salary guidelines. However, CCOs will need to co-fund some of the salary increases and these could translate into modest increases in their fees. Beyond ensuring that salaries in the community care sector are competitive, MOH and our agencies support the CCOs to ensure that their workforce is future-ready through training and development programmes.”
“Mr Speaker, may I have your permission to answer Question Nos 1 to 3 in today's Order Paper together?”
“Mr Speaker, I beg to report that the Committee of Supply has made progress on the Estimates of Expenditure for the financial year 2024/2025, and ask leave to sit again tomorrow.”
“Chairman, may I seek your consent to move that progress be reported now and leave be asked to sit again tomorrow?”
“I appreciate the Member's concern about the nurses having to undertake many different roles. That is the whole point of creating these patient support roles, which are in the current hospitals. But there are practical limits to actually extending this, because there are issues with truncating job roles into just purely clinical or non-clinical roles. Neither is fully desirable. These patient support roles can be very unattractive and then you end up not actually attracting anyone. So, every job has to bring satisfaction and purpose and we have to look at this holistically. Because of that, the Ministry of Health is already in discussions with the clusters to look at job redesign. With regard to the ANGEL scheme, this is something that we can take into consideration and we can update Members in due course.”
“Mr Speaker, all public hospitals already employ staff who undertake roles similar to Patient Care Officers at Khoo Teck Puat Hospital. They may just have different job titles, such as Care Support Associates or Patient Service Associates.”
“I thank Member for his questions and his interest in this matter. Firstly, I think as a matter of point on the numbers, I think the Member has asked some questions on this previously and we have indicated that a number of 300 will be a good reference. However, as you can see, over time, we have worked on trying to increase the numbers and there are enrolments. The problem is not all then follow through with the process, for many different reasons. And because of that, we have not yet achieved that number for a good statistical reference. Secondly, this is also something that the Member has raised earlier about the extension to the private AR centres. And this is something that we are reviewing and we are looking into. The fact remains that right now the PGS remains accessible to people and experts in the private centres can make referrals to the three AR centres and in the public setting. As a matter of principle, I also want to highlight that there exists an infinite number of tests and screens that are available for many different conditions, including this one. Just because early detection may be valuable for certain circumstances, this does not mean we should deploy all of them and we should subsidise all of them. So, this is something we do need to take into consideration. It is not just an issue of cost. It is also an issue of the side effects and some negative detrimental effects that may come. In this particular case, as we understand, there are some side effects that may happen to the blastocyst. So, we do need to consider this and we need to take into account all these factors before we can decide to mainstream this.”
“Mr Speaker, under the Ministry of Health's (MOH’s) pilot on Pre-implantation Genetic Screening (PGS), any woman enrolled in an accredited in-vitro fertilisation (IVF) programme, who is 35 years and above, who has suffered two or more recurrent implantation failures, or experienced two or more pregnancy losses, is eligible for PGS. This is to improve IVF success rates. As of January 2024, 590 patients were enrolled to the study but only 195 patients had undergone PGS. Of which, 131 completed their embryo transfers. This has led to 70 pregnancies with 56 live births and five ongoing pregnancies. More patients need to be recruited into the pilot for a robust evaluation of the clinical efficacy of PGS, before it can be determined if PGS can be a mainstream clinical service. In the meantime, PGS will remain accessible to eligible patients.”
“I thank the Member for the question. Indeed, manpower is an aspect that we have been monitoring quite closely, especially as we transform the efforts in the healthcare sector, in particular, with ageing. Yesterday, we had also another discussion on the Allied Health Professionals. So, we are looking at the different sectors, the different services that we need to have in place and the different manpower. With regard to the statistics, Sir, I do not have the data on hand. Perhaps the Member would want to file a separate Parliamentary Question on this.”
“Mr Speaker, between 2021 and 2023, about 1,400 individuals joined the community care sector in non-nursing jobs every year, including through schemes, such as the Community Care Manpower Development Award and the Senior Management Associate Scheme, for the training and induction of mid-career entrants into management positions. We do not track the retention rate for this group. To retain staff, the Ministry of Health (MOH) and Agency for Integrated Care (AIC) have been working with community care organisations to implement job redesign, enhance the competitiveness of community care staff salaries and recently published salary guidelines which would help inform job seekers on the expected remuneration in community care roles.”
“Thank you for the question. As I mentioned earlier, there are already existing frameworks and specialisations that the healthcare workers can go into. In particular, for example, in nursing, they have the specialisation on the Advanced Diploma in Nursing (Palliative Care). So, these are some of the examples which healthcare workers who are interested in these, can pivot into and learn more about in the palliative care sector. 11.00 am”
“Mr Speaker, the Nanyang Technological University (NTU) anticipates an initial enrolment of about 15 students for the new Master of Science in Holistic Palliative Care programme (MSc HoPE). Graduates can be employed in healthcare institutions and community care organisations that provide patients with end-of-life support. Workforce training and development is a key enabler to the Ministry of Health's national palliative care strategy. Healthcare professionals are equipped with knowledge on palliative care in two ways. First, palliative care has been integrated into the local undergraduate training curriculum for medicine, nursing, pharmacy and various allied health disciplines. Second, postgraduate training programmes in palliative care are offered by the Agency of Integrated Care's Learning Network, healthcare organisations and Institutes of Higher Learning. Healthcare professionals can tap on training grants and scholarships when they attend such programmes.”
“Thank you, Mr Speaker. I thank the Member for raising this issue. We do not have any plans currently to develop salary guidelines for the private sector, the general practitioner and specialist clinics at this juncture. From our experience, the assessment or the complaint or feedback that we have gotten is there is a move from the public sector into the private healthcare sector. Because of the competitive nature of the competitive salary, we take that into account as we think about whether to have a salary guideline for this space. But I note that the Member was probably referring to those who are in the lower-income bracket within that sector. I will have to take this back and then, we will see and consider whether this is something that we would need to review and look at in the future.”
“I think that is a brilliant suggestion from my fellow Jurong Group Representation Constituency mate. We will definitely take that into account.”
“I thank the Member for his inputs. Indeed, he makes very relevant points. In response, I will just highlight a few things. I think, firstly, indeed, this is the direction that we are going in terms of enhancing skills and making sure that there are sufficient manpower and resources within each domain. As you know, the AHPs are a mixed bag; there are many different types of specialties. Indeed, I think it is a good suggestion for us to deep dive and look as to how we can enhance these specific domains within that sector. So, definitely, as I mentioned earlier, we have already been in engagements with the AHPs. So, this suggestion that is raised will be something that we can take back and look at, and see how we can enhance that profession, while improving the services to the people as well as enhancing the stature of the profession within the community.”
“I thank the Member for the points made. Indeed, we have been working with the community care sector. You have heard announcements recently about Award for Nurses' Grace, Excellence and Loyalty (ANGEL) and we are also working with the community sector, to make sure that it is also something that can translate into that sector. As I mentioned earlier, since 2011, we have been supporting salary enhancements in the community care sector, including for AHPs. So, this is something we will continue to review, look at and enhance when appropriate.”
“Just to clarify the point. AHPs are in the public healthcare sector as well as in the community care sector because they also support some of our roles in the public institutions. So, in terms of the decline, I think there are so many different factors, clearly, and we are looking at how we can improve this. Part of it is salaries and the standing of some of these professions within the community. I think, over time, we have learnt, and we have also been engaging these professions to understand what are some of the challenges and the workplace issues they may be facing. And so, these are the things that will inform us as we have these discussions, moving forward, with the AHPs in enhancing the profession, in making them also part of the larger ecosystem, as we transform our healthcare sector.”
“I do not have the data now on hand, as far as the numbers of foreign AHPs. In respect of the second question on how we are working to enhance the AHP profession, we have been doing this on a few fronts. We have been working upstream. We are working with the IHLs to increase local training pipelines with healthcare employers to attract and retain quality manpower. Over the last 10 years, we have doubled intakes for AHP courses from around 270 to 500. In respect of the foreign AHPs, we also value them. And if they demonstrate their commitment to Singapore, we are also prepared to grant them permanent resident (PR) status. So, that is one thing that is quite encouraging, I believe. We also have healthcare career conversion programmes for mid-career locals to undergo relevant trainings through our IHLs for selected AHP professionals. These are some of the efforts that we have put in place to enhance the profession and to uplift the standing of the profession within the community.”
“I thank the Member for the question. Indeed, the attrition rates for the AHPs are higher than that for the doctors and nurses. The Member is right in that they play a very critical role. We have been engaging AHPs in developing a strategy because they are part of the healthcare ecosystem. And, as you know, we are transforming our healthcare sector – there will be Age Well SG and Healthier SG – and it is important for them to also play that role in this endeavour to have a common understanding of the focus areas and transformation of the allied health delivery that needs to meet these national strategies. We have been working with them to future-proof the allied health workforce to handle future challenges of the ageing population and improving population health and outcomes. These are things that are already ongoing. They are definitely not left behind. They are part of the ecosystem, and we are working together to help us work that journey of transforming the healthcare system.”
“Thank you. Due to our growing healthcare needs, the demand for Allied Health Professionals (AHPs) have been growing. The total number of registered diagnostic radiographers, occupational therapists, physiotherapists, radiation therapists and speech therapists increased by 25%, from about 6,000 in 2019 to 7,500 in 2023. Overall, the attrition of AHPs in the public healthcare sector increased slightly from 8.9% in 2018 to 11.6% in 2022. In the community care sector, the attrition of AHPs has fallen from 17.7% in 2018 to 11.3% in 2022. The Ministry of Health (MOH) continues to work with our public healthcare clusters, community care organisations and our Institutes of Higher Learning (IHLs) to train, attract and retain AHPs. There need to be good career prospects and opportunities for professional development, a conducive workplace environment and salaries will have to be competitive. In this regard, the public healthcare institutions (PHIs) had increased the starting salaries of AHPs in 2023. Since 2021, MOH has also supported salary enhancements in the community care sector, including for AHPs.”
“Mr Speaker, may I have your permission to answer Question Nos 1 and 2 together in today's Order Paper?”
“Firstly, I would like to thank the Member for recognising the need to prioritise beds in the public hospitals for those who really them. Indeed, this is something that we need to grapple with. The concern, though, in respect of the suggestion of incentives, is that we put incentives in place to nudge the right behaviours. We are really concerned if we put the wrong incentives, because then, there may be a perverse reaction of people not getting the treatment they need if they are actually being rewarded for not making a claim. Having said that, I think the larger part of the question is an important one, in relation to transitional care. Indeed, it is something that we have been looking into, as mentioned in my reply. I had said that we are already ramping up and looking into our Transitional Care Facilities – which are already in place, but we are ramping up and expanding. We are also making sure that there is a suite of homecare services that will help address some of the needs, post-discharge. This is something we would continually have to look at, as you can see there is a larger shift towards preventive care, towards Healthier SG. This is something we want to encourage – for more residents to look at the larger picture. We really want to shift care within the community, get people to stay healthy within the community so that we can shift a lot more of these concerns away from the hospitals.”
“Mr Speaker, hospital admissions are based on clinical necessity. Some patients have medical conditions that are non-urgent and yet inpatient care is medically necessary. They account for about 20% of all public hospital admissions, which has been a stable percentage over the past 10 years. As these admissions are medically necessary, they can tap on MediSave and/or MediShield Life. Some patients stay longer in our hospitals as their homes are not ready to receive them. To minimise such over-staying in hospitals, we try our best to right price and right site patients. This includes improving and expanding our Transitional Care Facilities and home care services to provide post-discharge care. We need to be very careful about offering incentives to reward non-claims. It can discourage some, especially the lower-income, from seeking medically necessary care.”
“This took a toll on his mental health and over time, he suffered from comorbid anxiety and depressive disorder. As a result, Mr Chee transited from a student-facing role to an administrative and research position at work. At home, he also encountered issues with his family due to his mood. He then approached the Methodist Welfare Service's FSC under the Ministry of Social and Family Development (MSF), who identified his mental health needs and referred him to one of our COMIT Anglican Care Centre teams for support. Through weekly counselling and psychoeducation on symptoms and treatment plans, Mr Chee made significant progress in his mental health. Today, Mr Chee is coping well with his new position at work and his relationship with his family has also improved. Mr Chee's story underscores the importance of integrating social service and health sectors to enhance mental health care for individuals. In closing, I would like to record my gratitude to Members who have raised this Motion. It has given us the opportunity to highlight the mental health efforts that we have developed and implemented through the years, as well as hear various feedback and suggestions on how we can do more. I would also like to take this opportunity to thank all our community service providers for their unwavering dedication and their instrumental role in implementing these initiatives on the ground. The Government is committed to continue working with the healthcare clusters and community partners to develop and review our strategies to uplift the mental health of our nation. Mr Speaker, I support this Motion.”
“Let me move to the point on manpower for mental health care. One of the key considerations is the adequacy of mental health professionals, including psychiatrists and psychologists. As of 2022, there were 203 registered psychiatrists and 212 psychologists in the public sector. To meet the anticipated increase in demand for mental health services, the Government aims to increase the number of psychiatrists by about 30% to 260 and the number of psychologists by about 40% to 300, in the public sector by 2030. However, solely increasing the number of psychiatrists and psychologists will be insufficient and unsustainable to meet increasing demands for mental health services. This is also one of the reasons why we have developed the tiered care model. With the tiered care model, more patients will receive timely care in the community, provided by appropriate mental health professionals, such as counsellors. This will allow psychiatrists and psychologists to focus on patients with more complex mental health needs. We are, thus, committed to continue to raise the capability and capacity of our community service providers, while monitoring the changes in demand for mental health services to ensure continued adequacy of the manpower required for mental health care. Mr Speaker, issues surrounding mental health has garnered attention globally and in Singapore. I am encouraged by the efforts and progress we are making, as a nation, in tackling this extremely important and challenging area. In particular, we have made advancements in integrating various aspects of our social, education and health sectors. To illustrate, let me share the story of Mr Chee Soon Weng. Mr Chee was an experienced teacher and managed students with challenging behavioural issues.”
“Depending on their underwriting assessment frameworks, insurers may still offer coverage to applicants with pre-existing conditions but with exclusions or higher premiums. It allows this group of applicants to still benefit from some coverage without adversely affecting other policyholders. Notwithstanding, MOH and the Monetary Authority of Singapore (MAS) fully expect all insurers to deal fairly with their customers. Insurers are expected to carry out an objective assessment of every application based on reliable information or data relevant to the risks being insured. Insurers should not indiscriminately reject an application solely on the basis of declared personal information, including mental health conditions. Where an application is rejected or approved with higher premiums or additional conditions, insurers should properly explain to the customer the basis for the underwriting decision. MOH and MAS take this seriously, and MAS will take action against insurers whose practices are in breach of its regulations or guidance. MOH and MAS will review this issue and consider how insurance coverage for persons with mental health conditions can be improved. I also thank Dr Tan Wu Meng for highlighting the Forum Letter by Ms Tan Hui In. MAS does not have records of her feedback in its complaints database. If Dr Tan Wu Meng has additional information to share about this specific case, he can share it with MAS. Then, MAS can promptly look into it with the relevant insurers, if the complainant consents to it. Members of the public with similar feedback can also write to MAS and MAS will investigate accordingly. On the feedback on long waiting times to access mental health treatment services, MOH will, similarly, look into the issue.”
“Patients who require inpatient mental health treatment can claim up to $160 per day, capped at 60 days per year, from MediShield Life; and up to $150 per day from MediSave, within an annual MediSave limit of $5,000. MediShield Life and MediSave claim limits are regularly refreshed to ensure that they remain sufficient to cover nine in 10 subsidised bills. On top of MediShield Life, Integrated Shield Plans (IPs) and other private health insurance plans may provide additional coverage for mental health treatment. Today, all IP insurers offer plans that cover in-patient mental health treatment and the amount of coverage is decided by the insurers. For lower-income Singaporeans who require more financial assistance to pay for their remaining healthcare bills, they may apply for MediFund, which serves as a safety net for needy Singaporeans. No Singaporean will be denied access to appropriate healthcare due to their inability to pay. I share Dr Tan Wu Meng's concern regarding denied access to private insurance for persons with mental health conditions. Several other Members have also raised this concern. This should be considered within the larger context of our healthcare financing system where all Singaporeans are eligible for subsidies and are covered under MediShield Life, which is a national risk pool that helps to ensure its sustainability. On the other hand, IPs and other private health insurance products are optional. Private insurers may exclude pre-existing conditions from coverage upon underwriting, including mental health conditions, informed by actuarial and commercial considerations. Such a process allows insurers to ensure their risk pool remains sustainable, as they, otherwise, have to increase premiums for all policyholders.”
“I welcome efforts being done at the towns such as M3@Jalan Besar led by Dr Wan Rizal. Peer support groups for youths have been set up and the community is invited to co-create solutions. We will continue to implement such initiatives to improve the mental well-being of residents across Singapore. (In English): Let me touch on the affordability of mental health services. In this regard, we have made efforts to reduce out-of-pocket costs through various schemes available. For outpatient mental health treatment offered at polyclinics and public specialist outpatient clinics, eligible patients can receive subsidies of up to 75%. Additionally, individuals who hold Community Healthcare Assistance Scheme (CHAS), Pioneer Generation and Merdeka Generation cards are eligible for subsidies of up to $540 per year for mental health conditions, including depression, anxiety disorders, bipolar disorder and schizophrenia under the Chronic Disease Management Programme. These subsidies are available at public specialist outpatient clinics, polyclinics and participating GP clinics. Patients can also use up to $500 or $700 from MediSave each year, depending on the complexity of their condition, at selected clinics. For patients aged 60 years and above, they can use an additional $300 each year from their Flexi-MediSave to offset out-of-pocket payments for their outpatient mental health treatment. Patients may also receive subsidised or free counselling services provided by various community service providers. For inpatient services, all Singaporeans and Permanent Residents are covered under MediShield Life, regardless of preexisting conditions.”
“In the Malay/Muslim community, we have organisations, like Club Heal, which has championed mental health issues for years. New initiatives are also in place. I lead M3's Focus Area on Community Health, which was introduced last year. M3 is a collaboration between the Islamic Religious Council of Singapore (MUIS), MENDAKI and Malay Activity Executive Committees Council (MESRA). The newly introduced Focus Area on Community Health, aims to promote healthy lifestyles and empower residents to spearhead ground-up efforts, within their own community – including efforts on mental health and well-being. In towns, like M3@Jalan Besar, youth peer support groups have been set up and the community is rallied to co-create solutions. We will continue to roll out such initiatives, to enhance residents' mental well-being in the different towns. Mr Speaker, please allow me to say a few words in Malay. (In Malay): [Please refer to Vernacular Speech.] There has been increasing awareness of mental health issues within the Malay/Muslim community. We are fortunate to have organisations, like Club Heal, which has championed this issue for many years. It is important that we continue to reinforce these efforts and garner more support from the community. As part of the National Mental Health and Well-Being Strategy, efforts are being undertaken to ensure that support and initiatives are readily available in our community. I currently lead the M3 Focus Area on community health and well-being. It was introduced last year. This new Focus Area aims to promote a healthy lifestyle and empower residents to spearhead efforts in their own communities. One cornerstone of this endeavour is addressing mental health and mental well-being issues in our community.”
“Similarly, the Postnatal Depression Intervention Programme in KK Women's and Children's Hospital (KKH), provides routine post-natal depression screening for all pregnant women; and those with depressive symptoms will be referred to the appropriate services available. Mental health services, including mental health screening for mothers, are also available in polyclinics. To support fathers and spouses, NUH will be extending its mental health screening to support them. The programme allows for early intervention, case management and multi-disciplinary treatment. In 2020, the KKH Psychosocial Trauma Support Service also began providing trauma-focused assessments and interventions to women experiencing psycho-emotional difficulties that arose from traumatic incidents. I thank Ms Nadia Samdin for her suggestions on meeting the holistic health needs of persons with disabilities (PwDs). MOH is committed to working with partners to deliver holistic care for PwDs. To address their healthcare needs, MOH works with community partners to provide the Home Personal Care service, which offers a range of services, including assistance with personal hygiene, housekeeping and simple maintenance exercises. Over the past years, we have also collaborated with the College of Family Physicians Singapore to offer a Family Practice Skills Course to equip general practitioners in caring for persons with intellectual disabilities; and, piloted a Community Integrated Health Team, in partnership with a social service agency; as well as, a specialist outreach team from IMH, to offer home- or community-based care for persons with intellectual disabilities, who have complex health needs. We will continue to build these capabilities in the community to support more caregivers and families of PwDs.”
“For caregivers, who have or are at risk of developing depression, anxiety and burnout, due to their caregiving role, CREST can provide dedicated support. These teams support caregivers in self-care, stress management and future planning, such as making a Lasting Power of Attorney and Advanced Care Planning. Where necessary, they will also link caregivers with counselling services and peer support groups, like the Caregiver Support Network. As of September 2023, there are six Caregiver CREST tea,s and over 2,300 caregivers have been supported. The Agency for Integrated Care (AIC) also administers the Caregiver Training Grant, which provides subsidies for caregiver training, including psychosocial management of behavioural issues. For caregivers, who need short-term support to have their loved ones taken care of, some MOH-funded psychiatric nursing homes offer the Nursing Home Respite Care programme, which provides eligible clients with short periods of stay – typically ranging from a week to a month. Such arrangements, allow caregivers some time off, with the assurance that their loved ones are safely cared for in the nursing home. I thank Ms Hazel Poa and Ms Hany Soh for their suggestions on the support for postpartum women and their spouses. Several efforts are ongoing to support the mental health of women. For example, the National University Hospital (NUH) Women's Emotional Health Services (WEHS), provides both antenatal and postnatal mental health screening as well as individualised treatment interventions, for women who need more support. The NUH WEHS team, also works closely with community partners and social service providers to coordinate and provide continuity of care to those who need it.”
“These include, balancing the need for youths' access to appropriate treatment; the involvement of the family and social support in youths' care journey; protection of the youths in view of the risks associated with treatments; and the level of maturity and understanding of the child. Above all, our priority, is to ensure that any approach taken is in the best interest of the child and that they can receive timely mental health care. We are studying this issue and exploring meaningful options to address it. Several Members, like Mr Yip Hon Weng and Ms Nadia Samdin, spoke about the need to do more to support our seniors with mental health needs. Currently, seniors are supported by CREST, to identify their mental health needs and provide basic emotional support and referrals to appropriate service providers. In addition, Active Ageing Centres work with CREST providers, in serving as community nodes, to conduct activities that engage and connect seniors within the community. We have 73 CREST teams island-wide, of which, 65 teams can support seniors at-risk of mental health needs. We understand that some seniors may be reluctant to seek help or accept support for their mental health needs, due to stigma. As part of their outreach efforts, the Silver Generation Ambassadors who come across these seniors would also share about mental health resources in the community and encourage them to seek help. We are glad that there are also community initiatives, carried out by Members in their constituencies, that reach out to these seniors. We are also looking at mental well-being issues of our seniors and tackling the social phenomenon of loneliness, as part of the holistic Age Well SG strategy, announced last November.”
“CHAT, another mental health service which supports youths aged 16 to 30 years old, has assessed over 7,000 youths at risk of developing mental health conditions, as of September 2023. To support youths at risk of suicide or severe self-harm, an intermediate residential facility will also be developed. Not all youths who present with suicidal behaviour, suffer from mental health conditions. Instead, they may have experienced social stressors, such as having difficulties coping with schoolwork and being bullied. Therefore, this facility will cater to this group of youths, aged 10 to 19 years old, to support them within a safe environment. In the facility, youths will be supported by a multi-disciplinary team, consisting of psychiatrists, psychologists, social workers, nurses and live-in care staff. Services provided will include: identifying the needs of youths in crisis; providing psychosocial interventions, such as counselling and supportive medical attention, where necessary; and, facilitating the transition of youths with support from community partners before they are discharged. In the course of supporting the mental health of our youths, there have been ground feedback on the need for parental consent for children and youths below 21 years old, which could hinder their access to mental health support. I thank the Members who have raised this issue earlier. We recognise the importance of our youths' continued access to mental health services, and I appreciate Miss Rachel Ong's earlier suggestion, of having tiered guidelines for the requirement of parental consent on mental health services. In this regard, I would like to lay out several considerations that MOH is reviewing as we navigate this issue.”
“In the community, Well-Being Circles have been established across various neighbourhoods to raise awareness on mental health, the available resources and to empower citizens with skills to look after their own mental well-being as well as that of others. We will continue to encourage the formation of more Well-Being Circles, so that more in the community will have access to the support when they need it. Apart from community-wide efforts in mental health promotion, there are also several initiatives that target specific groups. According to the 2022 National Population Health Survey, youths aged 18 to 29 years old formed the largest proportion of people with poor mental health in Singapore. Currently, we have community mental health teams, known as Community Outreach Teams (CREST)-Youth and Youth Integrated Teams (YITs), dedicated to support youths with mental health needs. CREST-Youth, reaches out to youths and parents to promote early identification of mental health symptoms and provide basic emotional support. YITs, carry out mental health assessments and provide psychosocial interventions for youths who need more intensive support. As of September 2023, we have four YITs that have supported over 3,000 youths and parents; and eight CREST-Youth teams that have reached over 87,000 youths and parents. By 2030, we will be expanding to 15 YITs and CREST-Youth teams each, across the island. In addition to these community mental health teams, the Response, Early Intervention and Assessment in Community Mental Health (REACH) teams work closely with schools to provide mental health assessments and interventions, for students aged six to 19 years old.”