Tan Wu Meng
Singapore
“So, if I may just recall briefly what I said five years ago during the debate on the President's Address. Healthcare is about all our people's lives, your life and mine, the lives of our loved ones, the life of every Singaporean. And with that, let us all hope for healthier and happier lives together.”
“Mr Chairman, I thank all who contributed to this debate. Our MOH leadership and MPs of all persuasions. Also want to express deepest thanks to our entire healthcare family, our front liners, the support team and our public officers. If I may briefly seek the indulgence of Speaker —”
“I thank the Ministry of Transport (MOT) for sharing that there are plans to introduce regulations to address the issue of online shops selling AMDs that are in breach and unsafe.”
“The online Community Justice and Tribunals System brings convenience to those who can go online. What happens to seniors who are less digitally-savvy, less literate or who may not be so familiar with the English language?”
“Mr Speaker, I thank MOE for this move. On the topic of social capital and social network diversity, can I ask the Senior Parliamentary Secretary that for these studies, will MOE look at it much further into the future?”
“Mr Speaker, I thank the Minister of State for her answer. My Clementi residents shared with me that they discovered their child was vaping. Because they did not know what to do, they brought their child to the nearest Police station. The Police referred the case to HSA and the child was issued with a $300 fine for vaping.”
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“Lastly, if I may quote Minister Ong Ye Kung who, on 27 April 2024, was reported in The Straits Times online as saying, he "really hope the insurance industry takes a hard look at the fundamental design of their policies, their riders, how to make it sustainable for the long term". Does the Minister of State agree that there are policyholders who did not ask to be sold products which were unsustainable, and if it can be proven that some insurers sold products knowing the products would be unsustainable someday, does that change the weight of thinking and support towards these policyholders more?”
“Mr Speaker, I thank the Minister of State for her comprehensive and, if I may say, expansive and deeply considered answer. If I may just have some preamble to frame some of the issues my residents in Clementi face, followed by supplementary questions, and I beg Speaker's indulgence. Sir, I have Clementi residents in their 50s and 60s, who bought IPs years, even decades ago, who were told at the time by the insurers' marketing team they could choose their preferred doctor and have peace of mind on treatment choices. Today, I have residents who ask if the insurers have moved the goalposts. Sometimes, the doctor now must be on a panel, but the criteria are not always clear. Sometimes, the insurer has changed the access to policy benefits or how the coverage is administered. Can I ask the Minister of State, notwithstanding the difficulties with portable IP insurers, does the Minister of State agree that these challenges faced by middle-aged Singaporeans, existing policyholders, are real in their lived experience? Secondly, does the Minister of State also agree that, today, given IP insurers enjoy extra access to deduct from the Central Provident Fund MediSave up to the additional withdrawal limits, does the Minister of State agree that not every insurance product enjoys this privilege and therefore, should the IP insurers have a sense of social responsibility, or even some social compact towards these policyholders? And will MOH, therefore, keep a close watch on the insurers, their profit margins and how they approach these policyholders?”
“Mr Speaker, I thank Senior Minister of State for his answer. Let me declare first, there was a fire at my Clementi resident's home on the morning of that day, 8 October 2024. Neighbours called 995, SCDF responded. One resident was trapped in the flat. SCDF saved his life. I visited the site later, met with residents who recognised the importance of immediate 995 availability. Had the same fire happened during the outage, if emergency services were delayed, the outcome might have been different. Can I ask Senior Minister of State two follow-up questions? Firstly, for landlines which supply critical essential life-and-death situation services, are the telecom companies (telcos) required by IMDA to take the very highest level of reliability, because minutes can make the difference between life and death? Second, across the whole of Government, in our crisis and scenarios planning, is there room to be even bolder in testing our assumptions and our imagination? For example, has the scenario of a single telco failure been modelled and gamed in scenario planning and red team planning? If not, why not? And if that scenario had been considered before, why was it that a critical landline like 995 or 999 not better protected from a single telco failure becoming a broader interruption to service?”
“Mr Speaker, I thank the Minister for her answer. I have been approached by residents in Clementi Peaks, a very new precinct in Clementi. My residents share that about one year after they moved in, HDB started installing rain shields at lift lobbies which blocked their view of the beautiful Clementi scenery. We are told that the reason was to prevent rain entering the lift shafts, which would affect lift reliability and corrode the lifts. My supplementary questions are, firstly, does the Minister not agree that heavy rain and strong winds are not unknown in the West of Singapore, including in Clementi? Secondly, can I also ask the Minister – hindsight is of course 20/20 – but in hindsight, could HDB have done an even deeper study into the climate situation in the west of Singapore before the development was being built? And if there was a discovery of rain entering lift shafts during the construction phase, whether these rain shields could have been installed earlier and incorporated into the design earlier? Lastly, Mr Speaker, we know safety is important, especially lift safety, and if there is no other option, safety must come first. But can the Minister assure us that HDB will learn from each new development, including Clementi Peaks, so that future developments will be even better and consider climate change even more closely.”
“I thank the Senior Minister of State for his reply. Can I further ask the Ministry, in the assessment of SAM and POPStations, will the Ministry continue giving attention to the challenges faced by seniors who may be less digitally savvy and less able to use such touchpoints? Secondly, as the Senior Minister of State has mentioned the emergence of ServiceSG Centres, would he be able to advise us where is the nearest ServiceSG Centre to Clementi? And can we have one in Clementi soon, in a substantive way, if not already on the cards?”
“Mr Speaker, I thank the Senior Minister of State for his answer. I have got two sets of supplementary questions. Firstly, does the Minister agree that even though SingPost is a private listed company providing some services for Government agencies on a contractual basis, nevertheless, during COVID-19, we saw how the private firm was brought in to serve a public purpose, such as distributing the Antigen Rapid Test (ART) kits during a national crisis. Today, does the Minister also not agree that the provision of Immigration and Checkpoints Authority passport collection services is considered a quasi-public service as well through SingPost? As such, can the Infocomm Media Development Authority (IMDA) work with other agencies, to explore ways for such postal service providers, private providers with some public service provision, for such providers to continue having a strong presence in our heartlands? For example, better access to void decks or the use of community centres or, for example, if a postal provider sets up a non-profit philanthropic arm, would they be allowed to co-locate postal services in void decks and other such areas? Secondly, can I ask the Minister could IMDA have acted earlier and worked with SingPost to find an alternative venue, given this element of public service character or quasi-public service character for SingPost's services and could SingPost have communicated it better? Some of my residents were told that the nearest available alternative SingPost offices would be in West Coast, Teban Gardens or Ghim Moh, despite Clementi Mass Rapid Transit (MRT) being a transport node and a future MRT interchange.”
“Mr Speaker, I thank the Minister for Transport for his detailed Ministerial Statement and updates. I want to declare that many Clementi residents living around Clementi MRT station and the affected segment were badly affected. Some were, themselves, transport workers and later on were working late through the night, together with colleagues across Singapore, to restore service. If you looked down from some of the high-rise blocks in Clementi, you could see the workers working through the night. Residents were circulating videos as a message of encouragement to one another to pull together. I have got two clarifications for the Minister. The first is, I note that the Ministerial Statement starts out with a very important operative word: safe. A safe, reliable and resilient rail system. Can the Minister continue to assure us that as we review our transport system, safety will continue to be the first priority – safety for passengers, safety for workers, safety for the public? Secondly, in line with this, can the Minister also reassure us that however the after-action review is conducted, however the investigations are approached, that there will continue to be an environment where every worker feels able to speak up on safety-related issues so that we can keep everyone safe in our transport system?”
“And would MOM agree that the next company with retrenchment plans will be watching how this is conducted and that there is a potential risk that such norms can be eroded gradually and then suddenly, and we have to reinforce tripartism at every step?”
“Mr Speaker, I thank the Senior Minister of State for his answer. Can I declare that I have Clementi residents, some of whom are NTUC brothers and sisters, who feel disquiet at how some recent retrenchments have been conducted. Can I ask the Senior Minister of State two sets of supplementary questions? Firstly, the Senior Minister of State would be aware that Dyson's new global headquarters was opened in Singapore two years ago. It was a high signature opening, with the then-Prime Minister of Singapore Mr Lee Hsien Loong in attendance. Can I ask the Senior Minister of State, firstly, given that it was a high-profile company accorded highest recognition, should there be some consideration as to whether such a firm should be benchmarked against the minimum legal standard of what is acceptable? Or whether such firms can have a higher level of ambition in a situation of retrenchments, so as to better support workers to notify the union earlier and thereby, strengthen tripartism and strengthen the firm's reputation as well as a good employer? Secondly, does MOM also agree that our tripartism and labour relations in Singapore, which many brothers and sisters over generations spent their whole lives building up, over 60 years, that such tripartism and labour relations, that spirit of mutual respect and collaboration between Government, unions and employers – does MOM agree that this is precious and underpinned by norms of behaviour and practices as well? And, if so, has MOM considered how such norms might be eroded when companies do not fully respect tripartite best practices during a retrenchment?”
“I thank the Minister for his detailed answer. I can declare that there are Clementi students who are affected by this and a number could not recover some of their lost data. Can I ask the Minister two supplementary questions on behalf of these Clementi students and their parents? Firstly, following the data breach in May 2024, the Minister in his answer mentioned that MOE required Mobile Guardian to have an independent forensic investigation. Can I ask if the forensic investigation contractor was nominated by Mobile Guardian or nominated by MOE? Did MOE have any say in the choice of the contractor to do the audit for the May 2024 data breach incident? Secondly, Mr Speaker, in an era of outsourcing to vendors, we of course must be mindful that the cyber threat surface is no longer within just the Government domain, but also the sub-contractor domain. Can I ask the Minister if MOE is working with CSA and the Ministry of Digital Development and Information (MDDI) to ensure that the same standards of cybersecurity for Government networks that face the public, these same standards are also being applied to contractors such as Mobile Guardian or whatever replaces it in the future, so that the attack surface for cyber threats is contained and has the same level of safety, regardless of whether it is a contractor or whether it is Government's own device management technology?”
“Thank you to the Minister of State for the answer. I have residents worried whether insurers sold them insurance premiums, while knowing the plans might rise and be in the long term not sustainable and that the policyholders may actually give up their premiums before making use of the benefits. Can I ask Minister, previously I asked about making Integrated Shield Plan insurance portable, to give consumers choice and rebalance the relationship between consumers and insurers. Then Senior Minister of State, Dr Koh Poh Koon, had said MOH would study it. Can I ask when MOH might be able to give a further update on this study?”
“Mr Speaker, I thank the Minister for her answer. I start by declaring that I have Clementi residents who were affected by the Mobile Guardian outage and that I have also filed a PQ yesterday on Mobile Guardian. But this question is more generally to the Ministry of Digital Development and Information. Can I ask, in the approach to stress testing and vulnerability testing of gov.sg systems, does the Ministry envisage applying the same level of testing to key vendor systems outside gov.sg? This is because even though we can outsource services, outsource authority, but ultimately, as the key stakeholder, we cannot outsource responsibility.”
“The fourth recommendation: on better supporting philanthropy in the fertility preservation sector. The philanthropy sector is an important part of Singapore's social fabric. Several voluntary welfare organisations support cancer patients, including young cancer patients. Can the Government help crowd-in and stimulate philanthropy to support young cancer patients needing fertility preservation? For example, can the existing 250% tax deduction on charitable donations be enhanced further for specific designated charities or even a specific fund for fertility preservation that could be co-managed by MOH or the health authorities in the public sector? Can there be matching grants to help multiply the impact of charitable donations to help needy young cancer patients when it comes to fertility preservation? There are many ways to concentrate and focus funding and co-funding. Six years ago, in this House, I moved an Adjournment Motion on helping patients with rare diseases. The Government later set up a Rare Disease Fund, which receives 3-for-1 dollar matching of public donations with tax deduction. Fertility preservation for young cancer patients is a different issue, but I wonder if MOH and the Ministry of Finance can draw lessons from that experience and see what can be done for young cancer patients seeking fertility preservation.”
“The third recommendation: I also call upon the Government and MAS to work together with the banks and financial institutions to provide interest-free loans for young cancer patients needing fertility preservation. Let me share, by comparison, an example from the education sector. Today, students on a full-time Ministry of Education course at a polytechnic or autonomous university can apply for tuition fee loans. The loan is interest-free during the first few years when the course of study is ongoing and, importantly, when young students have not had the chance to start work and accumulate savings and financial resources of their own. The purpose of this policy – the interest-free loan – is to ensure that students do not forego the long-term benefits of higher education because of short-term challenges with cash flow. The same approach can be applied for young cancer patients. Some have fallen sick early in life before building their careers. They may be low on savings, low on resources, low on MediSave at that point in life. If they come from a family starting with less, their parents may not be able to underwrite some of these costs. But if the banks provide interest-free loans, it will help ensure young cancer patients do not miss out on fertility preservation because of cash flow concerns. It will help ensure a young cancer patient does not have to choose between their long-term prospects of starting a family, their long-term fertility prospects, and, on the other hand, short-term cash flow considerations. This approach will also help some young cancer patients who come from a sandwiched class situation, where they may not be very wealthy, but at the same time, this will assist with some of the cash flow situation too.”
“To help shape market norms and send a signal to the healthcare insurance sector, I call upon MOH to be the first mover – to see the issue through the lens of natural biological function and preserving or restoring natural biological function so that a fellow Singaporean who becomes ill with cancer and undergoes fertility preservation should be considered the same way as a Singaporean in a major accident who undergoes reconstructive surgery to preserve their ability to have a child. Today, only one of these patients would be covered by MediShield Life for the purpose of preserving the ability to have children. Both should be covered. If MOH moves on this for MediShield Life, it will shape the market and send a strong message to the private sector insurance providers – the healthcare insurers, financial institutions – and encourage them to do the same. That is the first recommendation. The second recommendation: to front-load the funding for fertility preservation for patients who are young cancer patients undergoing medically necessary treatment that might compromise their fertility. Today, married couples undergoing assisted conception procedures in a public hospital can receive co-funding from MOH up to 75% if the couple are both Singaporeans. But what happens if a young woman diagnosed with cancer is not yet married and finds that she has to go for egg freezing to preserve her fertility? To preserve her prospect of having a family in the future? Is there a way to mobilise the future funding and front-load this to help that young cancer patient at a time when the fertility preservation is most likely to be helpful, early on, to help preserve her fertility for the future?”
“These young healthcare workers have put together a number of views and suggestions and approached me in their personal capacities. I have looked, discussed with them and raised their suggestions to MOH because I personally found their suggestions to resonate with me and I have sympathy for their views. Let me share their thinking and some recommendations for the Government's consideration. The first recommendation: can MOH and the Monetary Authority of Singapore (MAS) work with the insurance industry so that fertility preservation for cancer patients is covered under Integrated Shield Plans? This is not a major policy deviation, in my view, and, as I will explain to you, it is actually a harmonisation of existing policy principles. Today, healthcare insurance already covers restoration of natural biological function when someone has been seriously injured. If tomorrow, you are in a life-threatening car accident, you undergo emergency surgery and, as part of that life-saving surgery, you need to undergo some kind of reconstruction which preserves your ability to start a family, if you have bought insurance, you would expect the insurer to cover it. So, why is it different when someone has an accident of fate – a life-threatening cancer? When a cancer patient has life-saving treatment which may compromise their fertility and then needs to restore natural biological function after the illness, surely the insurers could consider it the same way too. Sir, people do not choose to get cancer, so there is no moral hazard arising from including this under insurance coverage. The insurers should move on this.”
“In a Parliamentary Question earlier this year, I asked about fertility preservation for cancer patients undergoing medically necessary treatment where the medically necessary treatment can affect the patient's fertility. These fertility preservations may include sperm freezing, egg freezing or in vitro fertilisation (IVF). I asked the Ministry of Health (MOH) whether the Ministry has evaluated the available insurance policies on the commercial market. Let me quote from MOH's answer, "MOH does not evaluate private insurance coverage of fertility preservation therapy as these are optional products subject to insurers' commercial considerations." Furthermore, MOH said, "MediShield Life does not cover fertility related treatments as it was designed as a basic health insurance scheme." In short, today, fertility preservation is deemed optional by the insurance industry, even if you are a cancer patient undergoing medically necessary treatment which may affect your fertility. In short, today, fertility related treatments, even for cancer patients, are not covered under MediShield Life because these are not considered part of basic healthcare. Mr Speaker, today, I call upon the Government to take a fresh look. This is not just my own view. I have met young healthcare workers across different hospitals and different hospital clusters. They care for young cancer patients, walking with them through the cancer diagnosis, treatment and recovery. They see the ups and downs, the pain, the suffering and sometimes, the heartbreak. Some are trying to help young cancer survivors realise their dream of having children someday despite the treatment journey, despite the side effects of medically necessary cancer treatment.”
“Mr Speaker, I declare that I am a medical doctor looking after cancer patients. In my Member of Parliament capacity, I have also met Clementi residents who are young cancer patients. Many of us know someone who has cancer – a loved one, a friend or a colleague. Some cancer patients are younger. About six out of 100 cancer patients diagnosed each year in Singapore are under the age of 40. Young cancer patients. If you look at the Singapore Cancer Registry, between 2017 and 2021, each year, on average, 340 young men and 620 young women under the age of 40 were diagnosed with cancer – about 1,000 young men and women. Young patients, under 40. In the prime of their life. Some trying to start a family, hoping to become parents someday. Some might not yet have found a life partner, have not yet decided whether they want to have children, but wanting to keep their options open and not close off their future choices. But when a cancer hits you or your loved ones, sometimes, things change suddenly and decisions have to be made on a timeline that you and your loved ones did not expect. Because some cancer treatments, while trying to save the patient's life and cure the cancer, some of these treatments can also affect a patient's fertility. For example, some chemotherapy treatments can affect fertility, sometimes, for the long term. We know from the experience of young cancer patients who became infertile after life-saving cancer treatment that their infertility can be emotionally devastating even years later, among the survivors. So, what is the current situation in Singapore?”
“I thank the Minister of State for her answer and I have got a further supplementary question on this topic. Will the IMC in its deliberations also look at whether there is an increasing nexus of money laundering with organised crime, including organised cybercrime? I raise this because there were media reports of a foreign national arrested in Singapore, following an extradition request. It was reported in the media that this foreign national faced charges, not just of money laundering, but also running a large-scale malware and botnet, relating to cybercrime. And if there is an emerging nexus between money laundering and organised crime and other forms of crime, including cybercrime, will the IMC look at applying the full force of Singapore's policy levers, including the ones we apply to organised crime, today?”
“Yes. So, can I just ask more broadly, and I know this may have bearing on the next Parliamentary Question (PQ) as well, because one of the questions that arises from the Minister of State's and MHA's answer is that these are not crimes of passion. Money laundering offences involve planning, deliberation and calculation. So, can I ask, does the Minister of State agree, more broadly, without reference to any particular specific case, that a potential money laundering criminal will do their sums, including what is the chance of being caught, and if they are caught, what is the chance of being convicted and whether the penalties will outweigh the potential benefits? And so, can the Minister of State also tell us, looking back at the existing cases and looking forwards, does MHA have a sense of how many potential cases of money laundering was strongly suspected, but could not be caught and convicted, and will the Inter-Ministerial Committee look at tightening the evidential searching process and strengthening the potential penalty regime, if appropriate?”
“My apologies. Can I ask on the next one? I will ask on the next one, then.”
“Mr Speaker, I thank the Minister for his answer. I have two supplementary questions to raise on behalf of my Clementi residents, a number of whom are seniors who helped build the Singapore that today can digitalise. Firstly, if I may draw his reference to a quote by former Head of Civil Service Mr Lim Siong Guan, the quote says, "Implementation is policy." Can I ask the Minister if he agrees with that and, if so, would he consider user interface, user experience as implementation, together with implementation being policy? Secondly, can I also ask the Ministry, do our agencies track not just the uptake of digital services, but also whether there is a digital drop-off among seniors who previously accessed Government services but may now feel afraid to go online? Lastly, can the Ministry assure us that it is also looking at the user interface of these services to minimise technical debt taken on by end users who compensate in their own time and personal effort for suboptimal user interfaces and challenging user design?”
“I thank the Senior Minister of State for her answer. I have two supplementary questions. The first question is on whether or not our agencies are actively doing horizon scans of the medical and scientific literature, and further to that, may I draw the Minister's attention to an article published in the international peer-reviewed journal, The New England Journal of Medicine, on 7 March 2024? It is entitled "Microplastics and Nanoplastics in Atheromas and Cardiovascular Events", in summary, the research article looks at whether microplastics and nanoplastics can be found in the blood vessels of persons who are unwell and if they correlate with future risk of cardiovascular illness. So, can I ask secondly to the Minister, although it is still in its early days and although this is just one study published in an international peer-reviewed journal, will the Ministry of Sustainability and the Environment (MSE) work with the Ministry of Health (MOH) and other health agencies, to get a sense of what the evolving evidence is on this, so that Singapore can move and make decisions in a timely way, as our understanding evolves regarding the science?”
“I thank the Minister of State for his answer. I have got two supplementary questions on behalf of my Clementi residents. Firstly, when MAS sets the service standards for the CDP, are these service standards also benchmarked against what a retail bank might provide to its customers? We have Clementi residents, such as those from Faber Hills in Clementi, who are elderly and prefer face-to-face interactions and are still quite worried about access to counter service when transacting with the CDP. So, the first question is, whether the standard of service prescribed is different compared to a retail bank which, like CDP, would have many legacy customers who are older and not so digitally-savvy? My second question, pertains to whether or not the customers who are sent digital notices to provide information to keep their accounts open – do these customers also receive telephone calls or paper, physical letters if they do not respond? I ask this because I have a Clementi resident, a retired stockbroker, his CDP trading account was suspended because he did not use the online system to update his particulars. My resident says he is not computer literate, does not own a personal computer. So, can the Minister of State confirm whether CDP's practices include telephone and paper physical letter outreach before someone's trading account is suspended, due to potential implications if they need to access that account urgently at a future date?”
“Mr Speaker, I like to thank Minister of State for his answer. Can Minister of State reassure the House that in the development of the SRF, there will also be consideration to what has been debated in Parliament as well as suggestions that have been raised? That is my first question, because a number of Members have raised suggestions over the past few years. The second question to Minister of State is will the framework also adopt a forward-looking horizon scan of emerging scam modalities? And I say this because two years ago, in this House, I and some others talked about the risk of deepfake scams coming through and today we see around the world the rise of AI voice cloning and deepfake attacks on public figures, replicating public figures and even the cloning of people's voices which is an emerging technology. Will the SRF consider all this because moral hazard sometimes is not a step off a cliff that people fall off or get cut off by? It can sometimes also exist in a continuum of forced, or unforced errors based on circumstances and what public understanding is of the scams out there.”
“Mr Speaker, I declare that I am a medical doctor at a public healthcare institution. I have a clarification to ask of Minister for Health Mr Ong Ye Kung. With the new Act and the new classifications of public health threat and public health emergency, a number of Clementi residents will be wondering what becomes of the older DORSCON classification – the Disease Outbreak Response System Condition Classification. A number of residents had shared that the different colours green, yellow, orange and red can mean different things to different people. So, can the Minister advise us what will become of DORSCON now that we have the clearer status of public health threat and public health emergency.”
“Mr Chairman, I want to thank all who contributed to the COS debate, our MOH leadership and office holders and our Members of Parliament, our Members of Parliament who spoke as well. Deepest thanks to our entire healthcare family as well, our healthcare workers; our sisters and brothers, who care for patients and residents in the community; our public officers, who worked tirelessly behind the scenes looking after Singaporeans, in sickness and in health. Mr Chairman, I beg leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $17,400,129,600 for Head O ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $1,374,852,500 for Head O ordered to stand part of the Development Estimates. (proc text)]”
“I thank the Senior Minister of State for the answer. I have got two supplementary questions. The first is, can the Senior Minister of State reassure us that the Government is looking at the broader potential attack surface for cyber attacks, including beyond the gov.sg domain? This is because power and utilities companies, even if not under gov.sg, may supply a critical server and thereby be a potential attack surface by troublemakers. My second question is, can the Senior Minister of State assure us that there is ongoing attention to looking for potential convergence points of risk, your acupressure points or your shatter points, whereby those points of failure can have disproportionate risk? Is there ongoing attention to such convergences of risk as well?”
“As I said 11 years ago in The Straits Times and last year in Parliament, if a clinic is too busy and consultation times are too short, it becomes harder to promote health. Because six consultations of five minutes each are not the same as a 30-minute consultation. So, we need to accurately measure how much work is actually being done on the ground, how much work is needed for tomorrow so that we can do right by our patients, caregivers and healthcare workers. When our decision-makers understand the actual amount of work that is needed, the ground situation, it is like flying an airplane. Even the best pilot needs to know what is the altitude, what is the air speed, how much is in the fuel tank. You need that for good decisions. Otherwise, we know what can happen. On healthcare financing, when thinking outside the box, we need to keep the toolbox stocked with new tools. Is MOH working to ensure fair, equitable access to new treatments, such as cell, tissue and gene therapy products? For certain new treatments where the chance of success is very slim, but the cost is very high, are there new billing models such as a “no cure, no pay” funding model? Expensive drug, if it does not work, does not cure the patient, is there a refund from the manufacturer? So, in summary, Mr Speaker, we will need resources, energy and imagination for tomorrow to keep our healthcare system fit for purpose. [(proc text) Question proposed. (proc text)] Waiting Times and Bed Availability”
“As I said to Deputy Prime Minister Lawrence Wong, eight years ago in 2016, during an Adjournment Motion debate when Deputy Prime Minister was Minister for National Development, and I quote, “When we add new innovations, we must be mindful not to subtract from what came before, especially when it affects the vulnerable and disadvantaged among us.” Sir, the current Minister for Transport used to serve at MOH. The current Health Minister used to look after MOT. May I humbly ask MOH and MOT to work together, look at this, do the costing together with the Ministry of Finance and see what can be done to help our seniors in Clementi, especially our frail seniors. Sir, on healthcare capacity. Because even as we think outside the box, we also have to ask ourselves are the existing boxes big enough, deep enough. In short, do we have enough capacity, enough capability? Can MOH tell us, is it tracking the doctor-to-population ratio and how Singapore compares with other advanced economies, in particular, the doctor-to-population ratio when we look at public sector doctors serving the Singaporean population? Is MOH getting ready for what happens when there is more health screening as part of Healthier SG? Residents with pre-existing illness, did not know they were ill, but having gone for screening, having had illness discovered, will need follow-up, will need treatment. Are we looking at the projected increase in demand? Is MOH taking a good look at how much time is needed to deliver holistic care, 21st century care, in Singapore? Because, whether you persuade someone to stop smoking, help someone with a mental health crisis, or support someone with a life-threatening illness and with limited time, all this needs holistic care.”
“30 pm It is not a small matter. For less mobile seniors with a walking stick or mobility aid, imagine holding an umbrella in the rain. If you are an elderly caregiver pushing your loved one in a wheelchair, imagine doing that in rainy weather and trying to hold an umbrella for the two of you at the same time. Mr Chairman, this crossing is right next to Clementi MRT station. And my Clementi residents have been keeping up to date on LTA policy. They have read LTA’s explanation of the Walk2Ride programme, and I quote, “Where feasible, walkways have been built to schools, healthcare facilities and other public amenities within a 400-metre radius of MRT stations.” The new polyclinic is a healthcare facility. The new polyclinic is within 400-metres from Clementi MRT. So, can I ask the Ministries, MOH and the Government more broadly, surely it would be feasible to build that shelter across Clementi Avenue 3 to help seniors and less mobile residents? Especially since we have many Clementi residents who today attend the existing Clementi Polyclinic with sheltered barrier-free access and will find it harder to get to the new polyclinic location on a rainy day, and it would benefit young families as well, children in prams being brought by their parents or sometimes their grandparents too. So, I call upon MOH and LTA to work together, see what can be done, whether this sheltered last-mile barrier-free access can be costed and factored in fiscally as part of the project holistically, because access to care goes beyond having a new, larger polyclinic. It is also about whether frail seniors with mobility needs can feasibly get to that polyclinic the same way they did to the existing polyclinic in the Clementi Town Centre.”
“Many seniors want to stay in the community where friends, coffee shop "kawans", "kakis" are. But some need help with daily living, showering, cleaning up the home. Support for home personal care can make the difference in whether someone is in the community or later institutionalised. Can MOH look at how we can support seniors better on home personal care? On seniors living alone, falls are a worry for our seniors, not just the injury but some seniors having fallen, cannot get up. If the senior is socially isolated, living alone, it may mean not getting help till someone passes by. Or worse still, what happens if the senior has fallen, cannot call for help, does not have anyone coming by and the community only discovers later after that senior has died? Two years ago, in a Parliamentary Question in 2022, I asked MOH about using technology to help look out for frail seniors who had fallen at home. Can MOH give an update? Sir, I want to speak about Clementi, the town which I help look after. I want to speak about the upcoming new Clementi Polyclinic. Today's Clementi Polyclinic is in the town centre, near to the Clementi MRT station, near to Clementi Bus Interchange, with sheltered, barrier-free access for many blocks around the Clementi Town Centre. In June 2022, MOH announced that the Clementi Polyclinic would be redeveloped at a new site, about 650 metres away from the existing site and 250 metres from the Clementi MRT station. There would be addition of new features – bigger polyclinic, more capacity, more services. But there also would be one important subtraction. Many residents no longer will have sheltered last-mile barrier-free access to the new location. Many residents who previously had sheltered last-mile access will have to cross Clementi Avenue 3. 6.”
“In 2016, nearly eight years ago, I asked in Parliament: can we make it smoother for patients on MediFund who are seeking treatment across different public hospitals in Singapore? Last November, Minister for Health Ong Ye Kung, announced the roll-out of mutual recognition agreements for MediFund across hospitals and between acute hospitals and step-down care, intermediate care hospitals. Can we also empower the Social Service Offices (SSOs) or the local Family Service Centres (FSCs) or the Active Ageing Centres (AACs) to assist the public hospitals, medical social workers, to do some of these means test assessments? This can reduce the need for an additional trip to see the medical social worker at the hospital. Reduce the need for additional appointments, especially for lower-wage, lower-resource families for whom travel may be more challenging. On patients with mobility needs, can we also make it easier to find access to subsidised transport for patients who are less mobile with medically necessary visits to the clinic or medically necessary trips to receive treatment? Some months back, a fellow Singaporean and her family – this fellow Singaporean was undergoing treatment for a serious illness at a public hospital – shared about how the multiple visits to clinics for treatment to and fro, this, over the span of a month, especially where some trips were made during rush or peak hour. In one month, the family had clocked up more than $400 in private hire vehicle fares just to get their loved one to treatment because their loved one was less mobile. I will now speak on home personal care because care for a senior goes beyond the clinic and we must look at their daily life at home.”
“So, if we can reduce the number of trips to the clinic, have more care delivered closer to home, it will help patients and caregivers, especially workers who find it harder to take leave and take time-off; workers who are lower-wage; with less bargaining power at the workplace; workers with jobs that cannot be done remotely. I called upon MOH to look into this two years ago during the MOH Committee of Supply (COS). Can MOH give an update on how they are looking at this? Some might ask, why should MOH subsidise home medical care, care closer to home, in order to save jobs for patients and caregivers? But we already accept in principle, in other Ministries, that subsidy and funding can be used to save jobs or create a more level playing field for workers who encounter disadvantages. For example, MOM has the Enabling Employment Credit to help persons with disabilities find work in an uneven job market. MOM has the Uplifting Employment Credit to help people find a second chance in life. MOM has the Part-Time Re-Employment Grant to help senior workers who need part-time employment opportunities or flexible work arrangements. And so, given this precedent in other Ministries across the whole of Government, I call upon MOH and the Government as a whole to look at access to home medical care and home medical treatment through the lens of a coordinated approach to economic and social policies. In short, if better home care helps save the job of a patient, if it helps save the job and career of a caregiver, can the case be made at whole of Government with MOH, MOM and MOF looking together at this? Let me speak on means testing. In particular, can we further reduce the visits to a public hospital for patients who are undergoing means testing for assistance and MediFund?”
“And likewise, I call upon MOH, can our agencies, in assessing the concessionary levy for migrant domestic workers in the approval process for frail patients on home peritoneal dialysis, who already find it difficult to cope without a helper, can they be considered more holistically? For patients with a serious life-limiting disease, not much time left, can they be considered holistically as well? Sir, we must also think outside the box of individual agencies and individual Ministries because home care does not just help the patient, it also helps caregivers who otherwise might have to follow the patient for appointments, accompanying to see the doctor, for treatments, for blood tests and scans, depending on the condition. Back in January 2022, two years ago, I asked a question in Parliament, how many specialist outpatient clinic visits a patient might have in an individual year at a public hospital? The 2019 figures from before COVID-19 showed that over 7,000 patients had 24 or more outpatient visits a year. In short, on average, two outpatient visits a month. There were over 2,000 patients with 36 or more outpatient visits a year, averaging three or more a month for an entire year. Imagine being a patient or a caregiver, this many visits, trying to hold down a job, because we know that not every employer allows flexible working arrangements. We know that not every job makes that flexibility possible. We know that while some employers are kind, there are employers who can be one kind. And so, Mr Chairman, this is something our agencies need to look at. I have Clementi sons and daughters – filial, caring for their parents – but they had to give up their careers to accompany their parents for treatment, the many visits each month.”
“She was getting more ill, getting more frail – more frail, more prone to falls. She was ill with kidney failure for many years, on peritoneal dialysis, finding it heavy going doing her own peritoneal dialysis at home every night. She applied for a migrant domestic worker levy concession – maid levy concession. But she was not old enough to fit the Ministry of Manpower's (MOM's) aged person scheme. So, she applied to the Agency for Integrated Care (AIC) under MOH. She was told that because she did not always require assistance with at least one of the activities of daily living (ADL), did not always require assistance with one ADL and so, she could not qualify. But I ask the Ministry, could the ADL have been looked at in context? Could the ADL have been considered in context of someone who was frail, getting more and more frail, many medical conditions and on peritoneal dialysis at home? Could it have been asked by the agencies, would the patient – would the resident – find it difficult to do peritoneal dialysis at home without the extra help? And if you speak with real-world practitioners on the ground, there are residents – there are patients – who may not fit the technical criteria, always requires assistance with at least one ADL. Many who met my resident in person would have found her frail, even if she did not fit the letter of the policy, many would have felt she fit the spirit of the policy. So, I call upon MOH to consider such situations, see if there is a way to take into account the medical situation of the patient – the spirit of the policy, in addition to the letter. There is another group of patients – palliative care patients with a limited lifespan, life-limiting disease, not much time left.”
“Chairman, I beg to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100". I declare that I am a doctor working at a public hospital. I will speak on our healthcare system and thinking outside the box. Today, we have already started thinking outside the box in healthcare policy. Subsidising health screening in Healthier SG so that illness can be detected earlier, treated upstream, reducing the burden of human suffering down the line years later, all this while maintaining the approach of co-payment established many years ago as part of keeping Singapore's healthcare system sustainable. But there are other boxes we need to think outside of, as part of the next bound of healthcare policy. I will share about this today. Today, we also need to think outside the box of space and place – bringing the care, bringing the subsidy to where the patient is, where the person in need is. Some public hospitals have been testing hospital-at-home services, or what is called mobile inpatient care at home. Can the Ministry of Health (MOH) provide an update on the progress of these efforts? Are they being scaled up? What has been the experience? Can we make it easier as well for MediShield Life and MediSave to be claimable for care that is delivered to patients at home where medically necessary? I want to speak also about the ecosystem of care because bringing care closer to home goes beyond medical care, nursing care or allied healthcare. It must also look at Government programmes that support the sick and unwell. I remember my Clementi resident who passed away. We got to know each other over my eight, coming to nine years in Clementi. She was my resident. We became friends over the years. We visited her in hospital, visited her funeral wake.”
“I thank the Senior Parliamentary Secretary for his answer. I have got two questions to follow up with the Ministry of Transport. Firstly, I note that the Senior Parliamentary Secretary said, currently the agencies can only conduct enforcement operations on physical shops, when the physical shop is selling a non-compliant device or battery that might be a fire risk. Would the Ministry consider, looking at ways to conduct enforcement operations against online platforms with a presence in Singapore, with an office in Singapore, that may have facilitated the sale of a non-compliant battery that is a fire risk? Secondly, would the Ministry also look at a way of establishing some kind of supplier responsibility in this vein as well? Because that way, the online platform, if they know they face some liability if they facilitate the sale of an unsafe product and someone is injured or dies, that is a very strong incentive for the platform to take some responsibility as well for what they are selling or intermediating.”
“Mr Speaker, I thank the Senior Minister of State for her detailed answer. I would like to raise a couple of supplementary questions, questions on behalf of my Clementi residents, in particular residents at Clementi Peaks, which is a very new precinct, brand new. Some of the lifts at Clementi Peaks have issues with mobile reception inside. My residents have observed this. And I and my grassroots leaders, having gone in the lifts and actually done a survey of the lifts, have noticed that in some of the Clementi Peaks lifts. Can I put two questions to the Ministry of National Development (MND)? Firstly, would it shape HDB and IMDA's future planning norms to consider the scenario of a lift breakdown, where for whatever unfortunate reason, the alarm button at the same time is also not working? Secondly, would it also shape HDB and IMDA's planning requirements to consider the scenario where an elderly resident has fallen in a lift or had a medical emergency, let us say late at night, and is not physically able to reach the alarm button and therefore mobile phone reception would be their key lifeline for help? And I hope agencies may consider this amidst our ageing population.”
“I thank the Deputy Prime Minister for his round-up speech. I have two clarifications to ask. One regarding the future of our fiscal reserves, the second regarding the social reserves, which I mentioned during the Budget Debate. On our fiscal reserves, Mr Speaker, we know the world ahead is dreadfully uncertain but there may also be opportunities which allow Singapore, if luck and good policy favour us, to have possibly some exceptionally good years in future. Can I ask the Deputy Prime Minister, in the event of a run of exceptionally good years, better than our predictions, would there be the possibility of putting back some of what we drew down from the Reserves during COVID-19, putting some of that back if we happen to have an exceptionally good run in the future, better than expected? Secondly, on our social reserves, Mr Speaker, I had spoken about how we need to give attention to our social trusts, social mixing, social togetherness. Can I ask the Deputy Prime Minister regarding the idea of the SG Togetherness office, which could be under the PMO Strategy Group, will the Government give consideration to that, so that with that togetherness in our society, we will be better placed to ride the challenges and perhaps have some of those exceptionally good opportunities in future?”
“I thank the Minister of State for her answer and the other Members for their supplementary questions. Can I ask two supplementary questions to the Minister of State? Firstly, if not already done so, would the Ministry of Education (MOE) consider working with the Ministry of Foreign Affairs (MFA) to have a sense of how many former MOE Tuition Grant recipients progress to provincial, regional or national leadership of their home countries in the years following their education journey in Singapore, in the Singapore system while making Singaporean friends? Secondly, does MOE wish to consider working with the Ministry of Trade and Industry (MTI) and the Economic Development Board to see whether some of these tuition grant recipients in the years and decades ahead grow to become leaders of firms doing substantial business with Singapore?”
“I have got one more question to the Senior Parliamentary Secretary. As part of this review which the Senior Parliamentary Secretary has mentioned, will MOH also look at best-in-class jurisdictions around the world and learn from the experience of how AHPs' career journeys, retention, skills and all these have been developed, in jurisdictions such as the United Kingdom (UK), in Europe or in the United States (US)? Will MOH consider looking at that as well as part of this overall landscape review?”
“Mr Speaker, I thank the Senior Parliamentary Secretary for her answers to the various questions on our AHP colleagues. I should start by declaring that I am a medical doctor practising at a PHI and I look after cancer patients as part of that journey. Can I put it to MOH, is there a role to take a detailed look at the evolving landscape of skills across our AHPs, a skills-based assessment and analysis, to see how we can better retain and develop our AHPs? We recognise today that in healthcare, for medical professionals and nursing professionals, deep skills are involved. And it is likewise the case for AHPs, whether these are the therapists, occupational therapists or speech therapists. Secondly, can I also ask MOH, has there been attention given to emerging domains of deep skills in new areas of allied health? For example, in the care of patients who have cancer running in multiple family members, there is a group of experts called genetic counsellors who provide very important support for the medical care team as well. And so, if we look at the emerging role across all these AHPs as having deep skills, skills that can be deepened, best in class in Singapore and across the world, would MOH consider that as a way of refreshing or relooking at how we recognise AHPs as an important and key part of our healthcare system?”
“Because just like fiscal reserves, our social reserves can take generations to build up, much effort to maintain and yet, are so important when a crisis hits. And the world ahead will have more than its fair share of troubles.”
“When we design our education policies and education system, do we encourage our younger generation, in addition to their Mother Tongue, to learn the language of another Singaporean community, not as an examination subject, not just because of the economic opportunities near us in Southeast Asia, but also because it builds understanding and helps deepen our identity as Singaporeans? These are questions that have to be asked not just for these policies but in every policy in Government, moving ahead. And so, I suggest for this Government to set up an SG Togetherness Office (SGTO). I know it sounds like more alphabet soup, amidst many acronyms, but SG Togetherness Office, the SGTO – I suggest for this Government to set up the SG Togetherness Office which can be part of the Prime Minister's Office Strategy Group (PMOSG), which has approached major issues, like climate change, in the same coordinated, whole-of-Government way. The SG Togetherness Office could have an inter-ministry steering committee, chaired by a senior member of Cabinet, a Co-ordinating Minister or a Deputy Prime Minister, with that experience of Ministries and connectivity and links to help drive the agenda. It should have a secretariat, a team of public officers actively looking at the net impact on social togetherness for every policy and every programme across Government. This ethos of strengthening social togetherness and social cohesion, strengthening our social reserves, safeguarding our social reserves, has to be looked at with the same discipline, deliberation and attention that we give to the fiscal bottom line and to Singapore's financial reserves.”
“We have the state capacity, governmental capacity for agencies to work together in teamwork, in cohesion, something that many other countries cannot quite do. We saw that during the pandemic and it will be essential for this next challenging future that we face. So, we must keep building that sense of togetherness so that amidst different views, different backgrounds, different dispositions, everyone in our community sees ourselves as fellow citizens, fellow brothers and sisters, in that Singapore dream, in the idea that is Singapore. That means, across Government, urban design and social policy must actively lean in, to encourage people to meet face-to-face in day-to-day life. All this can help maintain social trust, cohesion, togetherness, even amidst a wave of AI and the deepfakes that will come. So, we must ask ourselves, when a new HDB development is built without the traditional void decks and in a shape that makes it harder for neighbours and their children to naturally meet one another, naturally play with one another, on the way to work, to school and coming back, we need to ask, are we inevitably weakening our social reserves, compared to the older HDB void deck designs? Are there revenue-neutral ways of designing an HDB block differently, so that people are more likely to meet, connect, get along, in a very organic and natural way? When a neighbourhood centre is being built in a new estate, do our planners lean in favour of having more hawker centres, more coffee shops and getting these amenities to start up and activate sooner rather than later?”
“Also, there will be troublemakers outside Singapore, trying to undermine our unity, cohesion and togetherness. In the world today – and we have seen many case studies far away from Singapore, some a little bit nearer – the first shock in a conflict may not be kinetic. It may be an op to undermine the social unity and trust in a society. see how in other countries, certain players are trying to polarise and divide societies. It will be even more challenging in the age of AI. What happens when deepfakes are able to create videos of events which never happened? What happens when you have deepfake videos of public figures on any side of the House, saying things they never said, doing things they never did? What happens if there is a deepfake video of people from different communities arguing or even fighting, a deepfake video of something that never happened but which has the potential to be spread widely and undermine our social harmony and social togetherness? What happens when deepfakes become so similar to reality that people no longer trust what they see or hear even when it comes from a reliable source? What happens when people can no longer tell the difference between what is true and untrue, what is fact, what is falsehood, its big implications for societies, big implications for democracies around the world? There are no easy solutions in a world where anyone has access to the computing power to create a deepfake. But Singapore is small enough that we have a fighting chance. Singapore is small enough that we can bring our people more closely together, build more face-to-face interactions, deepen human relationships. We can do this in a way that larger geographically spread countries are not quite able to do. Singapore is coordinated enough.”
“It will allow Singapore to move quickly and seize opportunities in the energy sector, especially new low-carbon technologies – that in the future will help us secure our energy supply and, in turn, secure our water security for another generation. Having a stronger supply of low-carbon energy will also help Singapore with our AI ambitions. Today, data centres are energy-intensive yet so essential for AI. You can keep a data centre offshore for cloud computing in the commercial sector. But in a world where major economies sometimes do not get along; in a world where, sometimes, you have derisking or decoupling, it makes sense to have more of those data centres, more of that computing power onshore in Singapore. And having low-carbon energy – a greener energy future – more secure energy supply will be key for that AI ambition as well. On social togetherness, Mr Speaker, no amount of fiscal firepower, no amount of policy prescriptions, is going to be sustainable or implementable, if we, as a people in Singapore somehow become divided, fragmented or splintered. I have said this before. If we are splintered, we are going to be less than a dot in the world. And there are deep forces around the world, driving people apart, forces that change societies because with digitalisation, more digital world, it means people are less likely to meet, face-to-face naturally. The social media algorithms that almost everyone has on their handphones, the social media apps; many of these algorithms feed you more of what you have seen before. They bring you to listen more of what you have heard before, leading to echo chambers and, as a result, sometimes, leading to polarisation in society as well.”
“Our energy supply is needed, so that our NEWater plants can expend energy to purify water and make it fresh and consumable again. Our energy supply is needed, for desalination plants to work against the salt gradient and produce fresh water without the salt that comes with the seawater. Our energy supply, our energy security underpins our water security. And all of us know what it means for Singapore if our water supply is ever called into question. And that means, we have to consider our energy security the same way too. Two years ago, in the 2022 Budget debate, I had spoken about this: why we need to diversify our energy sources; why 95% energy generation from natural gas is not good enough for the future era; why 95% can be a concentration risk? I also spoke about how we need to go beyond looking at importing low-carbon electricity through a cable from overseas – because in a challenging world with all kinds of dangers, a cable may break down; a cable may have a technical incident; many things can happen to a cable anywhere in the world. And looking beyond to the future means that we have to consider new low-carbon technologies, such as hydrogen or even the newer next-generation of nuclear technology as well. I called upon the Government to look at moving ahead of the market – especially for hydrogen – and for Singapore's potential as a hydrogen hub. Looking ahead, because in a market where you may not have room for too many hydrogen hubs, it matters whether you are first mover, second mover or too late to move. It matters in that market. It matters for us in Singapore. So, the Future Energy Fund in this year's Budget – the Future Energy Fund, with its initial injection of $5 billion is a significant decisive move. It puts money where the mouth is.”
“And so, we cannot hide from these changes. No country, no economy can hide from these changes in the world with AI. Even if an entire country tries to prevent AI from entering its borders, other economies will do so – your competitors will do so. So, we have to accept the world as it is, the way the world is going to be and look after, support, empower and uplift our people. This is why the new subsidy for Singaporeans age 40 and above to pursue another full-time diploma in higher education – this new subsidy in the Budget, that is why it is so important. Because it recognises that in a world that is changing so quickly, what you learn in school – in education – at age 20, may have changed, transformed and have been replaced by a new world by the time you are age 40. It recognises that change and supports middle-aged and older workers. And having mid-career workers learning new skills alongside younger workers – a middle-aged mid-career worker alongside someone who is 18, 19, 20-plus years' old, learning together, that will also transform the education experience in our IHLs because older workers bring life experience, life skills and living wisdom into the classroom. Even as they bring that into the classroom, they also learn new skills, together with the younger students. These students, by working with each other, they lift up one another. They will transform the classroom even as it allows the older and younger worker to form new friendships, new networks and new opportunities together. On energy security. Another major challenge for Singapore is energy. Our electricity supply today does not just keep the lights on at home. It does not just keep our workplaces and hospitals going. It also keeps our water supply going.”