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.”
The complete record
Every one of 550 lines we hold for Tan Wu Meng, in date order, each linked to its source. Free to read, in full, without an account. Page 4 of 11.
“I thank the Senior Minister of State for his answer. I have got one supplementary question. What efforts and programmes are in place to make sure that workers in general, in the labour market, especially older workers who may be either less literate or less up to date with media news, what measures are there to help workers be aware of this potential practice of misclassifying an employer-employee relationship? I asked this in the context of a previous Parliamentary Question I raised to Senior Minister of State Dr Koh Poh Koon in the previous Parliamentary Sitting about the risk of platform companies' practice of classifying jobs that previously were employee jobs and re-gazetting them as gig platform contracts; and I asked about the risk of such practices catching on in other sectors. So, I was wondering, in context of that, would the Senior Minister of State Mr Zaqy be able to share more? How are we helping workers be aware and to protect themselves?”
“I thank the Senior Parliamentary Secretary for his answer. I have two supplementary questions. The first question is regarding the existing scheme, the DPS. Do we also consider, as part of the assessment, the upkeep needs of the other dependents within the same household? So, for example, if there are very young children, infants who need care, is that a factor considered when there are appeals? Secondly, based on the previous income threshold from 2017, which was six years ago, would the Senior Parliamentary Secretary happen to have information on what percentile household income that was in 2017; and how that figure translates into percentile household income in today's setting?”
“I thank the Minister of State for her answer. Some of my Clementi residents are teachers and I have met a Clementi resident who is a teacher and herself is a young mother with young children. She has found that her workplace requires her to report by 7.15 am, but all the childcare options that she has explored only open from 7.00 am. So, she finds it hard to get to work in time for the prescribed reporting time of 7.15 am. I was told that it has been suggested to her that she should go part-time as the FWA, with implications on salary and career progression. Can I ask the Minister of State if MOE would consider working with agencies, such as the Early Childhood Development Agency (ECDA) to help facilitate childcare arrangements for such young teacher-parents, childcare arrangements as near to the school, place of work, as possible to help these teachers continue as fully as possible at work while maintaining their responsibilities to their own children at home as well?”
“With your permission, may I say, once again, through you: thank you to our frontliners, our healthcare worker brothers and sisters, our public officers. Your courage, contributions and sacrifice made the difference, got us through this, saved so many lives. In Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] Many thanks to our frontliners, healthcare workers, public officers. Through your contributions and sacrifices, we have today’s reopening and sunny skies after the storm. (In Malay): [Please refer to Vernacular Speech.] Thank you so much to our public officers, healthcare workers and frontline workers. As a community caring for one another, as a community united, as a community of friends from multiple races, languages and religions, we were able to overcome the COVID-19 pandemic. (In English): In Tamil. எங்கள் மனமார்ந்த நன்றி or thank you very much. Our sincere thanks for all that you have done and all that you continue to do. In conclusion, Mr Speaker, seven years ago, in my maiden speech in this House, I spoke of the "outside context problem", when a society encounters a life-or-death existential crisis that it did not foresee. So, we must continue exercising our imagination, having the imagination to see what challenges may come ahead from over the horizon. So, we must imagine the unthinkable and prepare to confront the unexpected, preparing not in fear, but with imagination, resolve and togetherness, so that no matter what happens in a dangerous world for small countries, nothing and no one will ever knock Singapore down. I stand in support of the Motion.”
“Second, on the pandemic frontline – same job, same workplace means same risk, even if the contract looks different and says the worker is outsourced. And, importantly, every worker matters, including outsourced workers, because the COVID-19 virus, a pandemic virus, does not ask to read the terms and conditions of your job contract before infecting you, and we need to learn from these lessons of COVID-19. As I highlighted during the MOH Budget debate in 2021, the policy reasons for outsourcing hospital cleaners and hospital attendants are not compelling policy reasons. The demand for hospital cleaners and attendants is not seasonal. It does not fluctuate that much throughout the year. In a COVID-19 world, it is better for the healthcare team to be all based within the same healthcare institution rather than moving between different hospitals, as may happen with an outsourced arrangement. Outsourced cleaners already receive protective gear from public hospitals, recognising they are part of the same workplace. And it also sends a message when our cleaners and hospital attendants are in-house staff. It sent a message that you are part of the same team, you are shouldering the same risk as everyone else, you are one of us, and we are together. We need to send that message. So, I call upon the Government to look seriously at this as part of the post-COVID-19 review and the lessons from COVID-19 for governments around the world because it is part of how we think, how we think beyond pure efficiency, "just in time" towards resilience "just in case". Mr Speaker, I have said this before during the debate on MOH's Budget in the Committee of Supply (COS).”
“In years gone by, these brothers and sisters were hired directly by the public hospitals. Today, many are outsourced. Same job, same workplace, same COVID-19 risks, different contracts and now outsourced to a service provider. But, sometimes, outsourcing leads to unintended outcomes. Again, 20/20 hindsight is always clearer. But looking back, in 2020, the then Finance Minister had stated in the Budget debate round-up speech, "The Government will award public officers on the frontline who are directly battling with the COVID-19 disease up to one additional month of special bonus. This will include many healthcare officers in MOH and the restructured hospitals." But as I pointed out in Parliament in February 2021, there were Clementi residents and brothers and sisters in the Labour Movement who found that some cleaners serving in restructured hospitals did not qualify for this bonus because their contracts were outsourced. In the era before outsourcing, these workers would have been direct hires and qualified for the bonuses and support which in-house staff received. Later that year, in November 2021 and in reply to my January 2022 Parliamentary Question and my March 2022 questions to MOH during the Budget debate, the Minister for Health confirmed that the subsequent COVID-19 Healthcare Award for "all staff of public healthcare institutions" would include frontline healthcare workers from outsourced service providers serving at public healthcare institutions. This was an important step forward, but the deeper lessons from COVID-19 remain. In a pandemic, nobody is safe till everybody is safe. Migrant workers, outsourced workers, gig economy platform workers, informal workers – no one is safe till everyone is safe.”
“We must continue investing in AI to see how it can help us prepare for the next pandemic and strengthen our healthcare system. Sir, I want to talk about our frontliners and our healthcare workers. Our frontliners made many sacrifices during the pandemic. I remember a young healthcare worker, a young mother, married to another healthcare worker. She had has just given birth, newborn baby, born during the pandemic. But because of concerns about COVID-19 transmission between the husband's healthcare workplace and the wife's healthcare workplace, the husband had to move out of the home right after his wife had given birth, in order to keep her and her colleagues safe. It was a big sacrifice. There were nurses who were kicked out of their homes, evicted at short notice by landlords who were consumed by fear about this new and unusual virus. And some frontliners were outsourced workers, worried about falling between the cracks because they were not sure who would take responsibility for their care and support, because although they work in a frontline role, their job contract was with an outsourced company and not the frontline organisation. So, we must learn from our people's stories. See through the eyes of our people and prepare ourselves better to support our people through the next pandemic. I want to speak on outsourced workers in hospitals. Our hospital cleaners and healthcare attendants are part of the frontline, together with our medical, nursing, allied health staff, facing COVID-19 together. Our hospital cleaners helped clean the COVID-19 ward, the toilets of a COVID-19 patient in the ward. Our healthcare Ah Mahs – the uncles and aunties, the attendants – they helped transport COVID-19 patients' samples during the pandemic. They were part of the frontline, too.”
“It is 20 years since Biopolis opened – big investment, biomedical research. There were naysayers back then. But the investments created jobs and helped Singaporeans to build up skills and knowledge so that when a new virus came, we could understand it faster, sequence the genome faster, and develop our own tests, kits and equipment faster. Some R&D is about short-term commercial results. Safe and conventional; everyone agrees it should done, the market already thinks it should be done. But there can be market failure. We know this, especially when planning for what is over the horizon, beyond a five-year plan, but looking at 10 or 20 years into the future. We need to make sure that our R&D, our research projects include a diversity of approaches, including research which might not bear fruit straightaway, but which might be useful in 10 to 20 years' time. Research that can build skills or act as an insurance policy if we face new and unusual challenges in the future. We also need to strengthen Singapore's artificial intelligence (AI) capability. AI is no longer a niche technology. It is everywhere today. It will change how we work, how we analyse data, even how we do research and shape public policy. Five years ago, during the 2018 Budget debate, I called for Singapore to make a big push towards AI because, for certain key capabilities and skills, it is not good enough to depend on the private sector or outsourcing. We want to build in-house capabilities, suited for Singapore's needs and to build these skills in-house as well. In the five years since then, the world of AI changed as well. We now have ChatGPT and GPT-4 has come out. It is moving very, very quickly. Computing power has increased with lower energy cost.”
“Could Singapore, with hindsight – and hindsight is always 20/20 – have moved earlier on this? How could we have opened our assessments and minds more in advance? Or for that matter, studying how a new virus is transmitted – is it by droplets or airborne? Is it something we can detect in the surfaces we touch or the air that we breathe? International organisations like the World Health Organization (WHO) play an important role. They advise countries on whether masks are needed and other such safety measures. But we must still develop our own capability, in-house, in Singapore, to research and understand new diseases, test the evidence and draw our own conclusions as well. On pandemic surveillance, we need to get better at detecting new germs in the environment. Not just what we know but what we do not know. And importantly, to learn about what we do not know and about what we do not yet know. One such technology is metagenomics. In October 2021, I asked MOH on the use of metagenomics. You take samples from the environment – whether it is surfaces, sewage and so on – you then sequence all the DNA, both what is known and unknown, and if the pattern of that metagenomics study, if the pattern of DNA in the environment and the sewage changes at the same time as many people are falling ill, that could be an early indicator of a new pandemic. The Minister in his 2021 reply mentioned technical challenges, such as the complex mix of germs in the environment, complex microbiome. But we should keep on exploring these new technologies. This kind of hard work on sewage – I do not think Speaker will allow me to use the Hokkien phrase – this kind of hard work on sewage research can help save Singaporean lives. This brings me to biomedical research capability.”
“We saw how important those vaccines were. There has been talk of "fill-and-finish" production of COVID-19 vaccines. "Fill-and-finish" means filling the containers and vials with vaccine and then finishing the packaging and process for distribution. But we must ask ourselves, is this good enough or can we aspire to more? If there needs to be a new vaccine against a new COVID-19 variant or a new pandemic, does Singapore have the capability to research, develop, produce the vaccine on shore, either through our own companies or through international partners working with us, based on Singapore's soil? I called for this two years ago, during the debate on the 2021 Budget. Can the Ministry give an update? Because this capability would be good for Singaporeans, good for Singapore and good for the region and the world. On our scientific capabilities, how might we get better at understanding new pandemics, better understanding to make better policy? For example, in testing for COVID-19, what tests and how often? One key early decision was whether to go with ART or PCR tests and in what situations? Whether a frequent ART swab with instant results, compared to a PCR test that is harder to do which may need a healthcare facility and which cannot be done as often as frequent ART tests at home. It is an important difference – a test which is less sensitive but done very often at high frequency, compared to a more sensitive test which can only be done one at a time, less frequently. The concept of frequent rapid ART tests at home to supplement PCR tests in healthcare institutions was already being discussed in expert journals such as the New England Journal of Medicine as early as September 2020.”
“Are we identifying the acupressure points, the points whereby if the supply chain comes under stress, there is disproportionate impact? Are we searching for the shatter points – the vulnerable points in our supply chains, so that we can strengthen, defend and protect ourselves better in a crisis? Because you can have three suppliers providing a tender to supply eggs to Singapore, but if the eggs all come from the same upstream source, from the same basket upstream, it is still a concentration risk for us and we need to learn from this. On our legal capabilities, in a crisis, our ability to assess the legal situation and the rule of law around the world – that is also how we protect ourselves. For certain essential goods which Singapore needs to survive in a crisis, can we look better at the legal process of procurement? How can we defend our interests better? I asked this two weeks ago, during the MOH debate on the Budget. I asked whether MOH is working together with the Ministry of Law (MinLaw) and the Attorney-General's Chambers (AGC) to study whether certain essential supplies required for our survival, whether such supplies, once the purchase is done, can these supplies be gazetted as sovereign state property at that moment, even if the items are still in the suppliers' warehouse overseas. I am sure there are international lawyers with experience in the Ministry, our agencies should be able to study this. And I encourage the Ministry to look at this as well. On our vaccine capabilities, we saw first-hand how important vaccines are; saving Singaporean lives, saving patients, changing what could have been a fatal outcome to a severe disease, a severe disease to a mild illness and protecting fellow Singaporeans and people throughout our island.”
“Mr Speaker, I declare that I am a medical doctor in a public hospital. I will speak today on our pandemic defence and our national capabilities – our frontliners and our healthcare workers. In a crisis, we learn something about the world around us and we learn something about ourselves too. And from the crisis of a generation, we need to learn the lessons of a generation. Because the next pandemic may be Disease X, more severe, more contagious and less forgiving. The fight against a pandemic does not begin when the virus lands on Singapore soil. It starts in the preparation – 10 years, 20 years ahead. And that is what we must do for the road ahead as well. We must strengthen our national capabilities ahead of time, across multiple sectors. First, our supply chains. Our supply chains are our lifeline, whether it is face masks, surgical gloves or personal protective equipment (PPE), whether it is oxygen supplies, ventilators, or medications. These are the battle armour and ammunition that our healthcare frontliners used to protect and save Singaporean lives. These supplies need to be ready and they need to be uninterrupted, going beyond just-in-time delivery and moving towards preparing for just-in-case. We saw what happened in some other parts of the world, when the healthcare system and its supply chains broke down elsewhere, and cost lives and livelihoods and cost hope for many people in other countries. We cannot let that happen in Singapore. So, can I ask the Minister, what are we doing to strengthen our supply chains internationally? What is the Ministry of Health (MOH) doing, to work with the Ministry of Trade and Industry (MTI) on this? Are we mapping our supply chains carefully, not just the superficial layer, but the dependencies? Who supplies the suppliers?”
“I should declare, Mr Speaker, that I do have Clementi residents who have donated shoes.”
“I thank the Minister and Senior Parliamentary Secretary for the answer. I have got two supplementary questions. The first is on the description of lax sorting at the downstream contractor Yok Impex. Looking at the Reuters article of 25 February 2023, I may stand corrected, but there is a phrase that says, "none of the 11 pairs of shoes donated by Reuters were turned into exercise paths or kids' parks in Singapore”. In view of this, what is the Ministry's assessment of how lax the sorting was, given that, none of 11 shoes donated by Reuters actually went to the intended purpose? The second question is, do the authorities' investigations plan to look into whether any sub-contractor or their employee received inappropriate direct or secondary gains or even inappropriate gratification in conjunction with the redirection of these shoes that were meant to be recycled?”
“Mr Chairman, if I may beg your indulgence, through you, may I say a big thank you to our Multi-Ministry Task Force, Ministers, Senior Ministers of State, Senior Parliamentary Secretary, a very big thank you to our frontliners, healthcare workers, public officers. Your strength and effort got us through the pandemic and to a new normal, a new dawn coloured in DORSCON Green. In Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] I would like to thank our frontline workers, healthcare providers and public officers. Because of your contribution and sacrifice, we can finally reopen and see the sunshine again! (In Malay): [Please refer to Vernacular Speech.] As a community that helps one another, as a community that is united, as friends of different races, languages and religions, we were able to overcome the COVID-19 pandemic! (In English): Forward together! Healthier together! Majulah Singapura! Singapore Forever! Mr Chairman, I beg leave to withdraw my amendment. [Applause.]”
“Learning from the lessons of Personal Protective Equipment (PPE) protectionism where some countries imposed export bans, will MOH consider working with the Ministry of Law (MinLaw) and the Attorney-General's Chambers (AGC) to study whether certain essential supplies purchased by the Singapore Government can be gazetted as sovereign state property the moment the purchase is complete, even if the item is still in a overseas supplier's warehouse? The Senior Parliamentary Secretary for Health serves in both MOH and MinLaw, and I hope the agencies will study this too. Sir, in conclusion. I said this three years ago during the debate on the President's Address. I will say it again. Healthcare is about our people's lives – your life and mine, the lives of our loved ones, the life of every Singaporean. Last year, I spoke up to MOH about change – A Change Agenda. And as we emerge from the pandemic, it is a time for choosing. A time for choosing how we shape the future ahead. Because our policy choices today shape all our tomorrows, in sickness and in health. I beg to move. [(proc text) Question proposed. (proc text)] Increasing Healthspan and Longevity”
“And in our ageing society, with patients having more medical conditions, our healthcare system must allow sufficient time because time is as much a part of healthcare, as clinics and hospitals, medication and technology. Time with someone you have just met to build trust and rapport for a long journey down the road. Time with a young Singaporean facing a mental wellness challenge. Time with someone who has just been diagnosed with a life-changing situation, and you are talking to that person, connecting, understanding their hopes and fears, preparing for the journey ahead. All these need time. Time is part of care. And so, whether it is our family doctors' clinics' operations, healthcare IT or the real-world journey of patients and families, our policymakers must continue seeing through the eyes of the people to understand what happens in real life, on the ground. Otherwise, even the brightest policymaker is flying an aircraft through a storm without instruments, not knowing the airspeed, altitude or how much is in the fuel tank. On our pandemic defence, we need to learn the right lessons of a generation, from the crisis of a generation. Excess deaths – I asked this in Parliament. Can MOH give an update? What is driving excess deaths now that the reported infection numbers are subsiding? What was the impact of people delaying care and screening due to pandemic fear? Did socioeconomic status and housing affect COVID-19 outcomes and excess deaths? On securing our supplies in a challenging world, is MOH working with the Ministry of Trade and Industry (MTI) to strengthen our supply chains? If there needs to be a new vaccine, can Singapore innovate and manufacture it on shore? I asked this in the Budget debate two years ago.”
“If in each consultation, you spend one minute less navigating the software, making things happen on the computer, that is 14 million minutes saved – 14 million minutes of technical debt, 10,000 workdays or 27 years of someone working round the clock, 24 hours a day. It is not a small amount. 1.15 pm And with more private clinics plugging into the national IT system for healthcare, there will be far more than 14 million consults a year, depending on that infrastructure. So, it is all the more important we ensure our IT infrastructure in healthcare is best-in-class, not just in Singapore, but internationally around the world. Last year, I asked if this is something GovTech can look at? The Minister-in-charge of GovTech also sits in MOH. Is there an opportunity for deeper synergy, a healthcare IT platform built by Singaporeans for Singaporeans, good enough to compete against the best in the world? It is a matter of funding, willpower, ambition and vision. I want to talk about why time is care. Healthcare economists talk about "supply-induced demand" where in some countries, a patient might be encouraged to use more healthcare resources. The 1993 White Paper on Affordable Healthcare mentioned this. In short, there can be market failure. But there can also be other kinds of market failure. Let me talk about "demand-induced demand". I spoke up on this 10 years ago, in an article in The Straits Times. If a clinic is too busy and consultation times are too short, it becomes harder to promote health. Six consultations of five minutes each are not the same as a half-hour conversation, especially when speaking with someone about quitting smoking, changing a lifestyle to save someone's life.”
“When can our residents start joining Healthier SG? What about patients with chronic diseases, who are already seeing an established doctor in the community? How will the subsidy and financing frameworks operate for chronic disease medications? And how will it interlock with the existing model of care that many family doctors provide? And how will this connect with wellness and exercise programmes in the community? Because my residents in Clementi and in Faber Hills within Clementi, tell me that the Health Promotion Board (HPB) was, at one point, cutting back on exercise programmes in the community. And this meant that some seniors had to travel further, in order to access their usual exercise programmes of their choice. Implementation matters. On IT, or information technology, with Healthier SG, many more general practitioners (GPs) and family doctor clinics will join our national healthcare IT systems. We owe it to patients and healthcare workers to ensure these IT systems are best-in-class, not just best in Singapore, but best in the world. On New Year's Eve last year, the New York Times had a sharply written article on IT and software design and maintenance. The author talked about "technical debt". "Technical debt" is the gap between what software is and what we want it to be. This "technical debt" is paid not by the software developers or manufacturers. "Technical debt" is paid by users. In healthcare IT, "technical debt" is paid by patients and healthcare workers – waiting for computers to load, windows to open. How many mouse clicks and how many keystrokes does it take to make something happen? In 2019, the last year before COVID-19, there were 14 million consultations across the healthcare system alone.”
“These healthcare workers have served on the frontline for decades, full of experience and wisdom. The journeys and wisdom of a lifetime. They still want to contribute. But, sometimes, they also are looking for FWAs as they have elderly parents at home. We should find ways to keep these workers in the workforce serving, as long as they are able to and wish to do so. Progressive, supportive Human Resources practices, it matters in the workplace; it matters in healthcare. It keeps the workplace open to sisters and brothers coming from different backgrounds, different walks of life, different personal journeys. It helps us recruit and retain the full diversity and depth of talent and life experience that is Singapore. And all this adds to the team because healthcare is, fundamentally, a human endeavour, no matter how much technology and science there is. Healthcare is fundamentally about human endeavour and humanity. And when our workforce draws on a full breadth of experience, life experience, talent, diversity, it helps our healthcare system. It makes our system stronger. It strengthens our ability to deliver care. I want to speak on our system of healthcare. Mr Lim Siong Guan was the former Head of Civil Service. I remember a quote which the Senior Minister of State Chee Hong Tat mentioned in a speech at an MOH event in 2017, "Implementation is policy", that is what Mr Lim Siong Guan said. "Implementation is policy", because the effectiveness of policy is not measured by how elegant it looks on paper, but how it is translated into reality during implementation. So, I want to ask MOH some questions on implementation. On Healthier SG, what is being done to help family doctors come onboard, especially at older clinics which are not already digital?”
“I want to move on to talk about our healthcare workers and in particular, Flexible Work Arrangements (FWAs) in healthcare. Amidst our ageing population in Singapore, many healthcare workers are caregivers themselves as well. There is the filial son, the filial daughter, who works a full shift at work in the hospital, comes home, put in that extra mile for their parents too, that extra mile at work, the extra mile as the caregiver after knocking off work, looking after an aged parent who may have dementia, or themselves have a serious illness. There are single mothers working in healthcare on the healthcare frontlines. When they finish their shift, they go home and look after their children, putting their full hearts in at work and at home. There are also healthcare workers who themselves have special needs children at home. Each time a healthcare worker faces challenges with FWAs, it poses challenges at home as well. Some healthcare workers have themselves fallen ill with a serious illness, such as cancer. They have gone through treatment, fighting their way back to health, rebuilding their health even as they rebuild their work identity, trying to make progress, trying to come back to work and helping patients who are recovering from their illnesses. So, FWAs can make the difference between healthcare workers having to choose between their family and their job, or – in some cases – between their health and their job. Can MOH tell us how many healthcare workers have left the workforce in the past five years, despite still being of working age? And how many former healthcare workers have since returned to service in the last five years? I also want to speak for our older healthcare workers.”
“For instance, patients with chronic neurological conditions, such as muscular dystrophy or motor neuron disease. Some patients may be homebound because of old age. And so each trip going out, not so straightforward. And there are also some patients, some seniors, with incurable illnesses, terminal illnesses, with limited time left. And for these patients, every trip to and from a healthcare facility means less time spent at home, less time at home with loved ones in a place that they want to be. So, it matters. Can MOH look at how healthcare financing and healthcare delivery can be made more portable for such patients? Subsidise the 3Ms: MediSave, MediShield Life, MediFund? So that care can be delivered at home, closer to home, especially if the intent is already to subsidise such care. When patients need to do a blood test a few days before the appointment, can MOH make it more straightforward for patients to have these blood tests done at home, or at a polyclinic near to home, to reduce the distance travelled by patients and caregivers? Can MOH make blood test forms more portable across the different public healthcare institutions? My Clementi residents tell me of fellow Singaporeans being discharged from one public hospital, being given blood test forms to be brought to their regular doctor at another public hospital and that the doctor at the second public hospital, their regular doctor, has to reorder, reprint, reissue the blood test form, even though both hospitals were part of the same healthcare cluster. There is more that can be done to make the journey smoother for our patients. In short, policy design must be about seeing through the eyes of our people, because that is how we make better policies and deliver better care.”
“She could not make use of her Pioneer Generation (PG) card because she was not physically able to get to the polyclinic, walk in the door, register as a subsidised patient, make use of that subsidy and the PG additional subsidy too. Minister Ong Ye Kung, last year, thanked my Clementi residents and I for pointing out "that healthcare subsidies should not be tied to services being delivered in brick-and-mortar facilities". The Minister also said, "This will naturally have to be reviewed as we shift our paradigm". Can the Minister share what is the progress of the review and what improvements are being looked at to support less mobile patients and seniors at home? Because healthcare is changing. Care is moving "beyond hospital to community", the Ministry of Health's (MOH's) own words from half a decade ago. The Healthcare Services Act (HCSA) recognises that healthcare goes beyond places of brick-and-mortar. The National Electronic Health Record (NEHR) also recognises that patients move between different places of care and so, there has to be continuity of medical records as part of the continuity of care. And, therefore, it makes sense. It is a natural policy progression to look at how subsidies can be made more portable with the appropriate processes and safeguards, so that care follows the patient, including to the home for patients who are less mobile. Traditionally, MediSave was tied to the inpatient hospital setting. But over the years, we now allow MediSave to be used for outpatient care of chronic diseases in the clinic. But more can be done because some patients at home have medical conditions and it is very hard for them to move around, very hard to go out of the home, to a clinic.”
“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 medical doctor in a public hospital and I am the son of a cancer patient. Today, I will speak on our patients and our healthcare workers, our healthcare system and our pandemic defence. On our patients. Our people want to live at home, and sometimes, when a patient has an incurable terminal illness, that patient may want to die at home as well. So, the care must follow the patient. And if the policy intention is to subsidise the care, it is important to look at whether the subsidy and support follow the patient as well, including into the home. It is important in end-of-life care, palliative care. It is important when patients are less mobile because each trip to and fro for a less mobile senior can mean expenses on a taxi trip, a private hired vehicle or even a private ambulance for some of the sickest patients who are based at home. As family sizes get smaller, with fewer children to share the filial duties of caregiving, accompanying a parent to a clinic, each visit, each trip to and fro, means cutting into family care leave, annual leave from work. And, sometimes, that leads of friction with the employer. It is often the less well-off workers, with less bargaining power, who face difficulty being a caregiver because we know that while some employers are kind, some employers are "one kind". Last year, during the debate on Healthier SG, I shared about one of our Clementi seniors. Ah Ma was bedbound, not able to get out of the home, not able to physically get to the polyclinic nearby. Her home visit doctor wrote a prescription. But when the prescription was brought to the polyclinic, she had to pay unsubsidised rates for her medicine.”
“I thank the Minister and Senior Parliamentary Secretary for recognising the importance of the last mile and the journey of fellow Singaporeans, in particular, litigants-in-person, self-represented persons. Can the Ministry assure us that even as there are new measures which are digital, which are online, that these processors will remain accessible to older Singaporeans who may not be as English literate as their younger counterparts?”
“Chair, I have met Clementi residents who were litigants-in-person in family law proceedings; did not have a lawyer; and represented themselves. They found it very hard to find their way through the system. Last year, I shared about my Clementi resident who wanted to vary a maintenance order after her divorce; litigant-in-person; did not have a lawyer. She told us that to submit a security deposit, she needed to go through VITAL, a department under the Ministry of Finance (MOF). This took time to process. By the time the certificate of security deposit was issued, she had missed the deadline for appeal – we were told. She told us she had to liaise with CrimsonLogic, a service bureau which handled some of the transactions. Can the Minister tell us what is the role of these additional intermediaries? Do they make it more complicated for laypersons who do not have resources of a law firm, especially persons who have limited resources, from the older generation, who might not be fluent in English? What has been done since last year to make the journey less difficult for litigants-in-person in family law proceedings, especially Singaporeans who do not qualify for legal aid but do not earn enough to engage a lawyer? Chair, in the implementation of our system, we must make sure that due process does not present undue difficulties or undue obstacles because justice delayed, justice disrupted, justice complicated may become justice denied.”
“Chairman, I have met Clementi residents who are ex-offenders. Some were in prison for many years, and upon release, find that the job market has changed from the days before. Some are older, having been in and out of incarceration and now are dealing with health conditions, even as they are trying to find work. Finding work, finding a job – it is part of the recovery journey, the rehabilitation journey, rebuilding a life while coming back into society. What is MHA doing to improve the employability of ex-offenders who are rebuilding their lives, and how are we recognising employers who are inclusive, employers who lean in to give someone that second chance in life? Yellow Ribbon and Criminal Records”
“I thank the Minister of State for her answer. Mr Speaker, I have met residents who interrupted their careers, gave up their existing jobs in their 40s and 50s, to look after a terminally ill parent – dedication, devotion in their parents' time of greatest need. When they try to get back to the workforce, they find that because of the gap on the curriculum vitae, there are some employers whose human resources (HR) departments write them off, even before being considered for interview. Can I ask the Minister of State what is being done to work with HR practitioners to encourage inclusive and enlightened HR practices that recognise a worker who has interrupted their career and may have done so for family reasons and/or for caregiver reasons, and to help these workers have the best possible opportunity for a fair chance at getting back to the workforce?”
“We need to work with youths and the community. Essentially, while we continue to engage via online means, we also do not forget the face-to-face. That is where we engage parents – we share with them what they should do, some of the signs and symptoms of when their child is taking drugs and so forth. It is hard work but meaningful and worthwhile, to keep Singapore safe and secure.”
“If you look at the Misuse of Drugs Act in 2019, where we introduced new offences that aim to address the acts of contamination, where any person who disseminates or publishes information on the cultivation, manufacturing, consumption, trafficking, importing and exporting of controlled drugs, may face an imprisonment term of up to five years or fine up to $10,000 or both with harsher punishments for repeat offenders. So, this is where we target persons who share harmful information regarding drugs, particularly online to influence others towards the commission of drug activities. We will continue to navigate this because we also look at issues, not only in the upstream, but we are also looking at the operational and intelligence angle, and we continue to improve and be ahead of what the cartels or syndicates are doing. The Member asked a question about the most commonly abused drugs among youths. Essentially, it is methamphetamine, or in short, meth, cannabis and new psychoactive substances. This is the trend that we have been seeing in the last five years and we will continue with our preventive drug education at the various platforms. At the end of the day, we also want the youths to feel empowered. We have been working with them to co-create not only to produce the information materials but co-create the feeling of being empowered to stay drug-free. They also engage their counterparts from overseas. Recently, we had youths from Hong Kong visiting us. So, we also involve our youths in this process. As a whole, it is not only about Singapore. We want to make sure that our youths also understand why drugs are so harmful, not only within the Singapore context but also beyond and how they can play a part in this effort. We cannot do this alone.”
“I thank the Minister of State for his answer. I have met Clementi parents who are worried about foreign drug cartels and foreign influence and sponsorship that may be leading to a proliferation of drug lifestyle, media and related contents that may find its way into the handphones and mobile devices that their children are using. So, can I ask the Minister of State two supplementary questions? Firstly, how is CNB looking out to prevent, detect and take down content that facilitates access to or acquisition of controlled drugs? Secondly, can the Minister of State also tell us what are the most commonly abused drugs among youths under the age of 16 in Singapore at the moment? Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, I thank the Member for the supplementary questions. We are aware of online platforms being an opportunity for the drug cartels or even people in the different lines of drug supply and trafficking who may share on online platforms. So, as such, we engage social network services, e-commerce businesses, Internet service providers and technology companies to seek their cooperation. We work with them to detect and prevent the advertisements of controlled drugs. So, we do that. And this involves taking down the advertisements, banning the account from being used to peddle drugs and publishing anti-drug advisories on their platforms. That is something, from the operational perspective, that we do.”
“Mr Speaker, I thank the Minister for her detailed answer. I have Clementi residents, some who worked for Keppel in the early days of Singapore's developments, and they and their families are saddened and distressed to hear about what happened with Keppel Offshore & Marine. Can I raise two supplementary questions? Firstly, Mr Speaker, can I refer to what the Prime Minister said on 18 September 2012 on the 60th anniversary of CPIB. The Prime Minister said, and I quote, "We will never tolerate corruption. We will not accept any slackening or lowering of standards. Anyone who breaks the rules will be caught and punished." In conjunction with this, can I confirm with the Minister that every effort will continue to be made internationally through MLAs as needed, working with other overseas authorities, to obtain additional facts as needed that may be required to bring persons responsible to justice as far as it is possible within Singapore's laws and legal ambit? Secondly, can I also highlight the speech by the current Attorney-General (AG) at the Singapore Law Review Lecture 2017 on "prosecution in the public interest". In particular, the current AG said, and I quote, "If we are convinced that a serious offence has been committed, we will not hesitate to act, simply because securing a conviction may be an uphill task." Can I ask the Minister if we are aware of the assessment by the AG and the Public Prosecutor – the Minister said it did not reach the threshold for beyond reasonable doubt – was it assessed that the prosecution would be an uphill task in and of itself or outright impossible given the available facts?”
“I thank the Minister of State for her answer. I have Clementi residents who read the news of this and were concerned. I have two short supplementary questions. First, can the Minister of State share why these errata are happening and is it more often? Secondly, when was the last check of this particular exam paper and was the final check on an actual print copy that was going ahead to the exam?”
“I thank the Deputy Prime Minister for his comprehensive answers. Sometimes, in these situations, the mood among investors and investment-related decision-makers can change as the narrative shifts. Can I ask whether the Deputy Prime Minister foresees the possibility that investors and investment entities will shy away and have a chilling effect on their appetite for high potential, long-term investments that, nevertheless, have good fundamentals? Because in the Science and Technology sector, there have been investments and developments with a long horizon that bore fruit many years later – whether it was the vaccines that allowed us to fight COVID-19, whether it is monoclonal antibodies that took years to become viable treatments for diseases and so on.”
“Mr Speaker, I thank the Senior Minister of State for his answer. My Clementi resident told me that she signed an exclusive agreement with an estate agent, but she was not told about the option of other types of agreements, including non-exclusive agreements. Sir, can I ask the Senior Minister of State two supplementary questions. Firstly, I note that the Senior Minister of State mentioned the phrase "it is a contract between a consumer and an agent". So, can I ask the Senior Minister of State if MND has studied best practices from other Ministries. For example, under the Consumer Protection Fair Trading Act, the Second Schedule, Part 1, item 23, mentions omitting a material fact might be considered an unfair practice. So, can the Senior Minister of State tell us: is the option of a non-exclusive agreement a material fact when a customer is going to sign an exclusive agreement? Secondly, can I also ask the Senior Minister of State to elaborate on how MND sees the fiduciary duty of estate agents regarding sellers? Does it include some measure of requirement for informed consent when signing an exclusive contract, especially for first-time sellers who are not experienced and may require additional support and clarification?”
“Mr Speaker, I thank the Senior Minister of State for his answer. I have Clementi residents who are delivery riders with platform companies; some have been injured on the job. The General Insurance Association (GIA) recently proposed expanded use of prolonged medical leave insurance and group personal accident insurance instead of Work Injury Compensation Act (WICA) framework. Can I ask the Senior Minister of State, why did the insurers and platform companies not suggest this earlier, especially when they already knew that there were riders who were dying on the job? Second, does it mean that the GIA proposal will need every company to buy 24-hour insurance coverage for their workers, even if the platform worker is only doing a few hours a day with that particular company? And if so, who is going to pay under the GIA recommendation? Thirdly, if the GIA proposal is taken up, is it going to weaken the role of WICA? Will it encourage employers in other sectors to convert their employees into contractors so as to avoid the responsibilities and compensation that come with WICA protection for workers?”
“I thank the Minister of State for her answer. I have Clementi residents who are following the news of this. I have got one supplementary question. The Minister of State mentioned that the IHL ascertained the cause of the mistake as human error. Can I ask whether there has been a deeper dive into whether there were measures to intercept human errors before it led to an impact for many exam candidates? For example, did the web portal have safeguards so that an online exam needed to be uploaded in an encrypted or password-protected format? And likewise, whether there were other processes to reduce the risk of one human error affecting an entire cohort of exam candidates?”
“I thank the Minister of State for her answer. I have Clementi residents who saw what happened at these tragedies elsewhere in the world and were concerned as well. I have two supplementary questions. The first question is, do our agencies look for situations where there may be multiple events, multiple gatherings that individually do not cross the threshold for notification but which may actually lead to a substantial crowd, either by coincidence or by just the organic growth of the crowd around these events and gatherings? Secondly, does our MHA Home Team also look at how the flow of the crowd may go after a major event is completed and dispersed? I say this because I have had Clementi residents who were able to attend F1 this year and they felt that the crowds were quite substantial after the race ended and when people were heading home, heading off in multiple different directions through different thoroughfares.”
“I thank the Senior Parliamentary Secretary for her answer. I declare that I am a medical doctor at a public hospital. Sir, in The Straits Times Forum on 7 October 2022, an insurer was reported to have rejected a genuine claim on a technicality because the wording did not match a keyword, even though laypersons, healthcare professionals and the customer's own legal advisor felt the claim was correct. The company eventually admitted the claim. I have met Clementi residents and fellow Singaporeans facing similar difficulties. Can I ask the Senior Parliamentary Secretary, first, when such wrong decisions are overturned on appeal, is there any requirement for the insurer to look back at earlier cases to see if there were other legitimate, valid claims that were incorrectly denied? Second, I have met fellow Singaporeans whose IP insurers said the hospital bill needed particular words or phrases in order for a genuine claim to be allowed. This became a problem for some patients using their private insurance at a public hospital, because the public hospital billing format is standardised and may not match the insurer's technicalities and technical requirements. What recourse do these patients have and would MOH be willing to look at this further to see if these are isolated cases or reflect a more systemic concern? Because, Mr Deputy Speaker, we must not have a situation where a genuine claim cannot go through just because the customer is less literate, less eloquent and does not have access to their own legal team.”
“And, in fact, prior to this incident, ICA had already planned to enhance the power resiliency at Woodlands and Tuas Checkpoints by building a secondary electrical infrastructure by 2028. The works will be carried out in phases because of the complexity of the nature of the works and we also want to carefully plan it, so that we can minimise disruption to ICA's ongoing operations.”
“Mr Speaker, I thank the Minister of State for his answer. I have Clementi residents who were concerned at the news of what happened during the power outage. I have got two supplementary questions. Firstly, would the Minister of State consider, in hindsight, that the generator in use at the time constituted a single point of vulnerability? Because when a back-up generator is deployed as the main ongoing power supply, it is no longer a back-up system. Secondly, can the Minister of State advise the House on whether there will be a dedicated after action review (AAR), incorporating red team analysis of modes of vulnerability for our key infrastructure at checkpoints and that this will also look at areas, such as cyber risk, electrical supply risk, as well as network cable connectivity risk? Because a system may be compromised through many different possibilities and we have to secure our key infrastructure and checkpoints. Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, I thank the Member for the supplementary questions. Yes, we will have the AAR to be undertaken. The risks that were highlighted by the Member are things that we look at, as part of our business continuity plan. In order to do that, agencies work with the critical infrastructure stakeholders and we do have monthly drills that not only look at the issue of power outages. We look at issues that affect our security and incidents that may go beyond power outages. I thank the Member for reminding us on this aspect. And about the generators, to prevent a recurrence of that incident, ICA will deploy additional generators as further buffers to the existing back-up generators for all subsequent scheduled maintenance work.”
“Mr Deputy Speaker, I thank the Minister for Health for his support and statement, supporting our healthcare workers across Singapore, who continue keeping Singapore patients safe and looked after, even as the COVID-19 pandemic winds down and the BAU load continues apace. I also want to thank Minister for recognising the challenge that my Clementi resident, Ah Ma, went through, the family had asked me to tell her story and I am glad that the difficulties she and her family went through, have been recognised and will be looked at by MOH. I have a clarification to ask about how we support residents and patients who are in the frail stage of their health. These are residents who may have a number of medical conditions, who are not quite so ill that they may need to be admitted or have to go to a care home, but not quite in the pink of health. And they often have many medical conditions, with many, many follow-ups. In a Parliamentary Question earlier this year that I asked, and which I raised in Committee of Supply, there are Singaporeans today who may have 20 or even 30 outpatient visits in a single year, each of these visits poses challenges for the caregivers, especially caregivers who may be daily rated and cannot get time-off from their employer. As part of Healthier SG and strengthening coordination of care, can the Ministry also help look at ways to reduce the number of visits, by giving care providers, doctors and healthcare workers additional time and bandwidth, to help further coordinate and streamline the care for such patients who face frailty and many medical issues? 5.45 pm”
“I thank the Minister of State for his answer. I have raised PQs on this topic before. I have two supplementary questions. Firstly, does MAS track the response time from notification to a Government agency or the bank till the time the illegal transfer is interrupted in cases where residents discover an illegal transfer in progress? Secondly, for this equitable risk-sharing framework, will the agencies continue to consider the point I raised previously, that is, the idea that there can be a continuum between an unforced error and a forced error, depending on the sophistication of the scammer?”
“There has been progress, but we must continue giving this much deliberate attention, whether it is flexible work arrangements (FWAs) so that healthcare workers who are parents, who are caregivers to an elderly relative who need more flexible arrangements at work, that they can continue training, developing, growing, progressing on their journey. Likewise, going upstream to ensure that no matter where you start in life, no matter your background, no matter whether your journey took longer or a detour, that your starting point never deters you from stepping forward on that journey. Mr Speaker, in conclusion, as I said two years ago during the debate on the President's Address, healthcare is about all our lives – your life and mine, the lives of our loved ones, the life of every Singaporean. I call upon MOH and this Government to provide the resources, energy and imagination to do what is necessary to keep our healthcare system fit for purpose today, for tomorrow and for a generation to come. I stand in support of this Motion. [Applause.]”
“And people will benchmark ease of use, elegance, against what the big firms do as well. Mr Speaker, some healthcare workers and family doctors worry about the paperwork and administrative overheads from Healthier SG. The White Paper mentions submission of patient data. Will MOH look at how the software is designed, how long it takes to fill up a form, whether existing clinic software may become slower and more cumbersome once it connects with the public sector IT network? Has MOH assessed whether small clinics will need additional headcounts to address the compliance requirements of joining Healthier SG. Will the subvention consider this as well? For capitation, Mr Speaker, MOH has said there will be a shift to capitation funding where clusters get a pre-determined fee for every resident assigned within a geographical area. Can I ask the Ministry: will capitation consider that different patients have different needs, some patients having more medical conditions, more illnesses, more complex needs and thereby, more attention and more funding needed to achieve the same healthcare outcome? Sir, systems and enablers in the healthcare process, it depends ultimately on our workforce, our people. Our people are what enables us to deliver care. Healthier SG means that the role of family doctors in the community will be ever more critical – doctors drawn from the community, serving, caring, looking after the community. So, we need to ensure a diversity of backgrounds and journeys in our healthcare workforce, in our medical profession, at every level and in every generation. Much work has been done.”
“Will MOH also apply these important lessons to our public healthcare system too so that polyclinic doctors and healthcare workers can also be given more time, space and support to deliver that holistic preventive well-rounded care that we continue to work on and aspire to? I want to speak on enablers. The Healthier SG White Paper mentioned system enablers. We enable by making systems better, but this must also mean easier access, easier to navigate, fewer obstacles. I want to talk about medical IT, Mr Speaker. Earlier this year, I spoke on how across the public healthcare system alone, we have 14 million consultations each year. Imagine if we save one minute on waiting for computers and apps and technology-related time spent — less time spent waiting for technology or grappling with technology. That would mean 14 million minutes saved every year – 10,000 workdays, or about 27 years of someone working 24 hours a day. It is not a small matter. And with more family doctors coming on board, connecting with the public sector IT system, it is all the more important that the IT continues to improve – enabling, empowering, not getting in the way. Even as the healthcare IT is enhanced, there must be attention to ease of use. Sometimes, people prefer paper records, manual processes, not because they are afraid of technology, but because they find that existing technology platforms are more cumbersome, that it takes more time. And in our design and implementation, we must continue looking at this. I previously called upon MOH to give this the same attention and focus, as the big firms do, like Apple and Google, because today, every patient, every healthcare practitioner knows how a well-designed IT platform from a major tech firm can do things.”
“Can MOH confirm that patients will not face uphill hurdles – financial or administrative – if they wish to see a specialist at a different public hospital from the Healthier SG cluster near their home? Sir, let me speak on helping family doctors to help patients and residents. I want to talk about care and how it takes time. Preventive care, chronic care, holistic care, it takes time. Some of these discussions are as much conversation as consultation. Talking with a patient that you have gotten to know over the years, understanding why they took up smoking, why it is hard to kick the habit, persuading them to make that change, for better health and to save their life. Talking with a senior who has just been discharged from hospital after an illness, helping that senior find hope and confidence again to go back to exercising and leading a healthy lifestyle. Or making that time to be with a patient and a family through a difficult illness that may be getting worse, working through with the patient and family on what might be best in the difficult months and weeks or even days ahead. All these take time. And so, it is so important for MOH to continue looking at what happens in the real world, understand how much time is needed to deliver holistic care and to support our healthcare workers and family doctors on that journey. Paying family doctors to this important work, recognising the time needed is an important step. It sends a message that the work must be done, is being done and needs to be recognised.”
“Look more closely at patient journeys, deeper at the challenges faced by caregivers, healthcare providers, seeing through the eyes of our people. Sir, I want to talk about Healthy 365. MOH has designated the Healthy 365 app as the "digital window" to programmes by PA, HPB, SportSG and other programmes as well. But what happens for seniors who do not have a smartphone, who are not digital savvy, who are not quite comfortable using a smartphone app? We must make sure the digital window does not become a digital bottleneck. There must be careful attention to ease of use, understanding what our seniors and elderly need and find easy to use. Technology must serve, adapt and bend to the person, rather than getting people to bend to the technology. Seniors who feel left behind by digital change should not be treated as having fallen by the wayside, or not able to adapt. Just because a senior is not on a digital dashboard does not mean the senior is not there. Sir, Healthier SG also mentions residents having individual choice of healthcare provider. This must be in practice, not just in theory. I have met Clementi residents asking about what will happen at our national specialist centres that treat heart disease or cancer, for example. A cancer patient might have lived in Tiong Bahru for many years but chooses to stay with a loved one in Jurong who can be caregiver while they undergo treatment. So, she might want to see a specialist in the west, rather than in central Singapore. Some Clementi residents have asked: will it become harder to seek specialist care in a hospital outside your own geographical cluster? Will there be obstacles to patients choosing which public hospital they can go to, to receive their subsidised specialist care, once capitation kicks in?”
“So, for medically necessary treatments, Mr Speaker, we should look at how to bring the subsidy to the patient, if it helps prevent hospitalisations, reduce the burden of suffering, if it reduces the number of visits and the load on caregivers. Because when subsidy is tied to a physical venue, to a place of bricks and mortar, it can become accidentally regressive because the less well-off – patients and families who are less mobile, they find it harder to get to the place of care, harder to access to the subsidy. And it is these families who also find it harder to apply for private medical transport, to foot the bill, to get to the place of care. So, I call upon MOH to look closely at this because if the policy intent is to provide subsidy where help is needed, then we have to keep a lookout for physical or systemic barriers. There is a broader point, Mr Speaker, how do we better support residents, and particularly, long-term patients, who continue living in the community and want to minimise visits to and from hospitals – patients with advanced neurological conditions like motor-neuron disease? I asked a Parliamentary Question in Parliament yesterday but unfortunately; time ran out and I could not ask my supplementary question. For patients with advanced neurological conditions, later-stage kidney diseases or dementia – can we find ways to better empower family doctors who have known these patients for years, family doctors who hope for better support from the hospital clusters, to care for patients in the community? I call upon MOH to look at forming a workgroup as part of Healthier SG, to look at the issues faced by long-term patients with serious medical conditions living in the community.”
“In contrast to an able-bodied Singaporean able to go to a polyclinic, walk in the door, access polyclinic care without means testing, and apply the PG card without means testing. The family engaged a home doctor from an established voluntary welfare organisation (VWO) for house calls, writing medicines, prescriptions on a piece of paper, a paper prescription. The family would then bring the paper prescription to the nearby polyclinic and pay unsubsidised rates for the medication. Had Ah Ma been physically mobile and able to get to the polyclinic in person, there would have been no such administrative hurdle. So, we need to look at cases like this, see if there are ways to deliver care closer to patients' homes, and even have some medically necessary consultations in patient's homes, if needed. And likewise, to see if the funding journey can be more straightforward for such home medical visits, where they are assessed to be medically necessary. There are also some Clementi seniors who have regular medical appointments at hospitals, needing blood tests. They are wondering if some of these medically necessary tests can be done closer to home, or on occasion, at their homes, while still receiving some level of subsidy. It saves time waiting for some blood tests that may take several hours and it saves a trip back and forth, for blood tests that need to be done a few days before the medical appointment. Because when a caregiver has to accompany a patient back and forth, the burden, the stress, the worry, does not just fall on the patient. It falls on the caregiver who may have to take time-off from work and often it is the less well-off caregivers who have less bargaining power with the employer, less able to take time-off without worrying for the safety of their jobs.”