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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“So, it is an important step to fully subsidise nationally recommended screenings and vaccinations for Singaporeans, to remove the need for cash co-payment when using MediSave to treat chronic disease under the care of a family doctor – as part of an MOH programme. In short, the behavioural nudge needs to be towards prevention and health, rather than a sludge that makes it harder to do what is necessary to prevent greater problems down the road. We should make it as easy as possible for people to do the right thing. Nudge, not sludge. Sir, on subsidy, the place of subsidy matters too. In our early days, with a young population, subsidy was very much centred on the acute hospitals. Over the years, subsidy has become more and more decentralised so that care can be delivered with subsidy in the community, for chronic illness, closer to home. But with our ageing population, with seniors becoming less mobile, some finding it harder to go out, we also need to look at how care and, where needed, subsidy is delivered to patients and residents in the community – seeing through the eyes of our people. Sir, I visited the funeral wake of my Clementi resident, spoke with her family who told me their story. Ah Ma had been ill for some years – ill with a major stroke, bedbound, could not get out of the home. She was a PG Singaporean with a PG card but because she was not mobile, bedbound, she physically could not get to the polyclinic near her home. That meant she could not access the polyclinic care without a means test. It meant she could not apply her PG card subsidies towards the remainder of the bill without having to go through a means test.”
“Mr Speaker, I declare that I am a medical doctor in a public hospital looking after cancer patients. It has been 57 years since Independence, six decades since MOH was set up during British colonial days – nearly a lifetime. So, we should take stock, and ask ourselves, not just what comes next, but what if. What if we reimagined our healthcare system today, anew? What would we keep? What would we change? What we would we transform? Healthier SG is an important first step in this reimagining. It is an opportunity for a healthcare transformation, and I dare say, a healthcare revolution. Earlier this year, during the debate on MOH's Budget, I called for change – a change agenda. Today, speaking on Healthier SG, I will speak on helping residents and helping family doctors to help residents. Let me start on co-payment. It was a central dogma for public healthcare financing in Singapore for many years, but we must judge policy – not based on dogma but whether it gets the job done, whether it achieves the desired goals. The original idea for co-payment was to shape behaviour so that people look at the bill, consider what is value for money. But what happens if co-payment discourages some residents from going for medically recommended screenings, medically recommended vaccinations, medically recommended treatments for chronic disease, even if the illness might become a bigger problem some years down the line and cause suffering that you cannot even put a price tag on? The less well-off might well be affected the most.”
“I thank the Minister for his comprehensive answer. I have one supplementary question. Does the Government have plans to study more deeply the impact of socioeconomic status as well as housing type on the excess mortality risks from COVID-19?”
“I thank the Senior Minister of State for his answer. Mr Speaker, I filed all three of my oral Questions on this topic and I seek Speaker's indulgence for supplementary questions. Let me first declare that I am a healthcare worker at a public healthcare institution. I had Clementi residents contacting me – some were affected and saw how hard it was on the doctors and nurses, who nevertheless rose to the occasion and made efforts to help despite the outage. Some healthcare workers living in Clementi also contacted me and were concerned about the reliability of the system. I have the following supplementary questions for MOH. First, how do we benchmark our systems' reliability and usability? Do we take reference from best-in-class examples elsewhere? How do we benchmark? Secondly, the Senior Minister of State mentioned that there were issues with a hardware item from a particular manufacturer. Do we know whether this hardware item has given similar issues elsewhere in the world? If not, what is being done to look for other as yet, undiscovered potential vulnerabilities?”
“I thank the Minister and the Senior Minister of State for their answers. I have three supplementary questions. Mdm Deputy Speaker, as background, yesterday, in the US journal, Proceedings of the National Academy of Sciences (PNAS), a peer-reviewed report was published by the Cambridge Centre for the Study of Existential Risk. Entitled "Climate end game: exploring catastrophic climate change scenarios", it proposes serious consideration of worst-case scenarios in climate crisis. My three questions are as follows. Firstly, the Minister mentioned that the temperature projections might reach peak daytime temperatures of 40 degrees Celsius in Singapore by the year 2040. Can I ask if this a median scenario or have worse, more severe scenarios been considered and are we getting ready for those as well? Secondly, is the Government considering the possibility of low probability, high-impact situations? For example, if extreme climate situations affect energy resilience, and thereby, the ability of households in Singapore to maintain air-con across the island during a heat wave. And thirdly, I am not sure if I had missed the answer, but has the Senior Minister of State from MND mentioned what is the data on the temperature of HDB dwellings across different times of the day, and in particular, whether HDB flats will continue to be safely habitable amidst very high temperatures, even in the absence of air-con?”
“I thank the Minister for her detailed answer. I have got one supplementary question. Sir, some of my Clementi residents have observed, that sometimes the GSTV – U-Save rebate for a particular month, might not be credited in time for the SP group invoice for that month. For example, we have met Clementi residents, who, for the April invoice by SP group received the April rebate, but for the July invoice, had not yet seen the July rebate in that July invoice. Can I ask MOF whether the Ministry tracks that the GSTV – U-Save rebates are distributed in a timely manner and in particular, implemented in the service providers such as SP Group so that they arrive in a timely way for families who need that help? I ask this because some Clementi families have observed that when a family is facing cash flow problems in a difficult time with a rising cost of living, when the rebate that they expected to see in that particular month does not show up in the SP Group invoice, it comes as a surprise and a worry. We will help these families on the ground, but we hope agencies can close the loop with SP Group as well.”
“I thank the Senior Minister of State for his answer. I have a number of Clementi residents who work as delivery riders. They and their families, as well as some of their customers, are troubled every time a delivery rider dies on the job. I have filed two Parliamentary Questions (PQs) and I hope Mdm Deputy Speaker will allow me three supplementary questions. First, can the Senior Minister of State confirm that the Work Injury Compensation Act (WICA) policy intent is to cover persons on flexible working arrangements and, if so, why not cover flexible workers in the gig economy? Second, does the Senior Minister of State agree that there is policy space to improve protection for these delivery riders, to close what may be a perceived policy lacuna, to ensure a fairer outcome when a delivery rider dies on the job, working for a gig platform? Thirdly, does the Senior Minister of State also agree that this policy improvement has broader implications for workplace safety in Singapore? For example, what happens if, tomorrow, a marine, manufacturing or construction company decides to gazette their Singaporean workers as self-employed or independent contractors? They would need protections, too. In summary, Mdm Deputy Speaker, as one resident said, "No company should ever be allowed to send the message that when a worker dies, it is 'you die, your problem'." Because if a worker dies on the job, it is everyone's problem.”
“I thank the Minister for his detailed Statement. Some of my Clementi residents have asked about the ventilation of prison cells that the inmates stay in. The Minister mentioned that there is natural and mechanical ventilation for these cells. Can I ask two questions? Firstly, what has been the Singapore Prison Service's experience of COVID-19 in our prisons, especially compared with other jurisdictions. And secondly, has there been any review or study regarding the risk of transmission of airborne diseases within our prisons, especially in the COVID-19 era.”
“I thank the Minister of State for his answer. Can I ask if MAS coordinates with other agencies in the Government to look at the exposure of households to unsecured loans provided by retailers, or consumer retailers since this would be part of the broader landscape of exposure, especially with concerns about economic shocks coming from outside?”
“I thank the Minister of State for her follow-up reply and my resident's feedback is being submitted to MOE and I can verify this.”
“I thank the Minister of State for her answer. Sir, I was approached by a Clementi resident who gave feedback that one of her sons' classmates encountered some difficulty with the school that they went to. My resident told me that because a medical certificate (MC) was not submitted, the son's classmate was informed that the WA might not be deemed absent with valid reason, but instead be deemed absent without valid reason. Can I ask the Minister of State what avenues are available to students or parents who may, for whatever reason, be encountering such difficulties and how best may they take this up?”
“Mr Chairman, we have seen around the world challenges from the pandemic and what has been at stake. What has happened to those healthcare systems that broke under pressure. And thankfully, we did not. And some of this is through the policies and effort of the MOH team – the civil servants, the Director of Medical Services (DMS), everyone working, policies that lay the groundwork for healthcare workers to be able to do their best as far as possible. The Healthier SG announcement is significant and will be an important part of the next bound for Singapore healthcare. It will shape us a generation from now. So, I would like to thank Minister Ong, Second Minister Masagos, our two Senior Ministers of State, Senior Minister of State Dr Koh Poh Koon, Senior Minister of State Dr Janil Puthucheary, Parliamentary Secretary Rahayu, our Permanent Secretaries, our DMS – the whole team at MOH. And in particular, I want to again thank every single healthcare frontliner, whose effort and sacrifice has kept Singapore afloat and in one piece through this pandemic. Mr Chairman, I beg leave to withdraw my amendment. [Applause.] 5.30 pm”
“(proc text)] Ageing and Chronic Disease Management”
“There is also a much heavier load of electronic records, electronic messages, administrative loads as well for our young junior doctors. So, we need again, Mr Speaker, to seek truth from facts. We know in America, their house officers, their interns are more likely to have a motor vehicle accident at the end of a long shift. In 2007, 15 years ago, in SMA News, I asked whether we should do more research into how the performance of healthcare workers is shaped by long shifts and sleep deprivation. Are hospital near-misses more likely to happen towards the end of the shift? Does a night shift system change the pattern of near-misses? The aviation industry, militaries around the world have studied the impact of sleep deprivation for many years. We can learn from this and see how we can improve safety and patient care in Singapore. I also want to speak up for healthcare workers who are caregivers at home, nurses who, after a long shift looking after very ill patients, return home and have to care for a parent who is ill with dementia, a parent who is herself or himself needing care. Young doctors who worry if becoming a mother will have implications for their traineeship journey. We must keep on looking at how to make our healthcare workplaces more family-friendly, because that is how we build more inclusive workplace for healthcare workers across a diversity of backgrounds, a diversity of personal journeys. Sir, as I said during the debate on the President's Address, healthcare is about our people's lives – your life and mine. The lives of our loved ones, the life of every Singaporean. We owe it to our fellow Singaporeans to keep our healthcare system fit for purpose, not just for today, but for tomorrow. [(proc text) Question proposed.”
“Last year, then Finance Minister Heng Swee Keat announced improvements, but there is still room to look further at raising the remuneration of our nurses and our allied health workers because what our nurses and allied health sisters and brothers do is essential work, deep skills, physical, mental, emotional labour, reducing the burden of suffering for patients and patients' families. It is important work. And so, I call upon this Government to do a deep review – see what more can be done, because how we budget, how we formulate manpower policy, it is not just a question of market forces. It speaks to the values we have, what we hold dear and to the direction and message we want to send for our society. Sir, I want to speak for our outsourced healthcare workers. In Parliamentary Questions and in last year's Budget debate, I asked about outsourced healthcare workers serving on COVID-19 frontlines, in our COVID-19 wards, same patient care area, same risk, facing the same virus. Can MOH provide an update on what is being done to better support our outsourced sisters and brothers in healthcare? Because every worker matters, including outsourced workers, because in a pandemic, the virus does not ask to read your contract terms and conditions before deciding whether to infect you. We need to continue looking at this and continue improving. I also want to speak up for our young doctors who do long hours, long shifts on call. This can mean working a full day, sometimes starting at 6.00 am, sometimes earlier, working the whole night and working for a significant part of the next day. Today's patients are more sick, more complex than when I was a houseman many years ago.”
“Some Clementi residents have asked: "Why are IP insurers’ panels of doctors so different from one company to another?" In May last year, the Singapore Medical Association (SMA) News reported that one IP insurer for their panel of breast surgeons only had male surgeons, which meant a female patient, if needing a female breast surgeon in the private sector would have to co-pay more. But surely if a doctor is fit and proper for Company A, presumably they are fit and proper as well for Company B? Unless the different insurers have made these decisions due to business considerations, rather than clinical performance – in which case, the insurers should be upfront and transparent with patients. I call upon MOH to continue looking at this to see how we can make the journey better for patients who have invested many years of their CPF, MediSave savings or personal funds in IP Plans. On better medication prices, I also asked how we can ensure affordable access to new treatments, like cell-based therapies? Whether we can have cheaper, equally effective medications competing in the Singapore market amidst our Free Trade Agreements and intellectual property regulations. Can MOH provide an update? Sir, I want to speak on supporting our healthcare workers who have held the healthcare system together amidst the pandemic. More than two years, working guts out – day in, day out. On our nurses and our allied health sisters and brothers, I previously called upon MOH to look at paying our nurses more.”
“Building a care relationship to help someone stop smoking, or forging that trust through a healthcare journey, that trust which is needed in a mental health situation or when there is a life-changing diagnosis, a health crisis. It matters in a pandemic too. Every minute matters when there are many, many people sick, needing urgent care. So, work spaces, IT user interface – not a small matter. We must give it the same attention and focus on policy and implementation that the big firms, like Apple and Google do. We have seen that GovTech can develop best-in-class user interface: simple, elegant, gets the job done. Parking.sg – a small app but it shows we do have these capabilities. Should we also have a higher ambition, designing and building our own homegrown national IT healthcare platform, best-in-class, competitive or better than what is available internationally? As easy to use as an Apple or Google app, built by Singaporeans, for Singaporeans? And if we build something that good, we know that we can sell it to the world as well. Sir, on access to treatments, we know that by improving access to subsidies and MediSave, we help patients and doctors manage chronic illnesses upstream before they grow into a bigger healthcare crisis. Can CHAS and Outpatient MediSave be streamlined further, access improved? On Integrated Shield Plans (IP Plans). In September 2020, I had spoken about this, how individual patients, individual consumers do not have the bargaining power to take on an insurer, even when there are asymmetric terms and conditions. How the invisible hand of the market can become unbalanced and sometimes, you need the visible hand of the regulator to put things right on an even playing field.”
“Quitting smoking, lifestyle changes, challenging conversations in a health crisis. These are not just KPIs or targets or policy. It takes time. Each healthcare worker has but 24 hours a day. Yet, our time is one of the most precious gifts we can give to a patient. And decision makers and planners need to get even better at understanding how much time it takes to deliver quality care – whether face-to-face in clinic; on the telephone or through video-conference, including after hours; connecting with different patient care stakeholders, different medical teams; coordinating, improving a patient's journey. Because it is only when decision-makers deeply understand what is needed, that planning and policy can be implemented in a way that does the most good. It is like flying an airplane. Even the best pilot needs to know what is the air speed, what is the altitude, how much fuel in the tank. Sir, let me speak about technology and IT. In 2019, the last year before COVID-19, from public available figures, there were 14 million consultations across the public healthcare sector. Today, there are computers everywhere in healthcare but we know that the computer systems can be improved, made easier to use. 1.15 pm Imagine: if healthcare workers spent just one minute less waiting in front of a computer, waiting for a computer app to load, working with a mouse, data entry, or grappling with technology. That alone, Mr Speaker, would mean 14 million minutes saved in the healthcare system; a quarter-million hours, 10,000 work days, or 27 years of someone working 24 hours a day – that is how much time could be saved. Those 14 million minutes could have helped our healthcare workers connect better with patients.”
“And it would have been even harder without the help and support of our family physicians and our GPs in the community, on the community frontlines, supporting patients, helping patients recover in the community, to help reduce the brunt of the COVID-19 wave at our acute hospitals. I know some family physicians, including in Clementi, some are themselves not young and faced significant personal risk in looking patients in the early days the pandemic especially, before there were vaccinations against COVID-19. Some have also asked about support, closer collaboration with our hospitals, in peacetime and in crisis. Can it be easier for family doctors to link up with the hospital team, to keep updated on the mutual patient's condition, or even to mobilise the resources of a hospital cluster, working with family doctors to help support patients in the community? We need to keep our healthcare system fit for purpose, amidst Singapore's ageing population. And this means we need to find ways to support and empower our family physicians and GPs better, help healthcare clusters and family doctors connect to work together more closely, make it easier for information to flow and be shared to build that understanding of how best to care for a patient – so that care can be better coordinated even amidst an ageing population and patients with more complex medical conditions. Sir, let me speak on the healing power of therapeutic time because empowering healthcare workers also means understanding the work, how much time it takes to deliver quality care. Sir, imagine sitting down with a friend, encouraging them to stop smoking; listening to their story – how they started, the challenges they face; persuading that person to change their lifestyle. It takes time.”
“And yet, without enough time, space, opportunity to fully coordinate the care, it is hard to reduce and simplify the number of visits and appointments and journeys across multiple medical teams when a patient has multiple medical conditions. Let me speak on the value of care coordination. I raised this back in 2009 in the Singapore Medical Association Newsletter – the SMA News. Sir, in Cabinet, there are Coordinating Ministers. It recognises that coordination is important, adds value in and of itself beyond a single specialisation, beyond a single Ministry. Likewise, there is a role for the coordinating physician, someone who has walked with you for years, knows the ins and outs of your medical journey throughout your journey as well. And when the situation is complex, someone that can be a bridge between different specialists, different medical teams, not taking the place of individual experts, but bringing that holistic view, working with you, for you, for your health and your care. Sir, in some cases the coordinating physician might be a doctor who has known the patient for years – a specialist, a family physician or general practitioner (GP). But ultimately, it is a role that requires deep knowledge of the patient, deep understanding of the patient, a certain breadth of medical experience and, most importantly, depth of wisdom. It is high-value work, it takes time, it takes effort and it should be appropriately recognised and supported throughout the healthcare system. Sir, COVID-19 has been very, very hard on our hospitals.”
“Mr 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. In the Budget debate, I spoke on "stress tests" for Singapore. COVID-19 is testing us today. But we also need to prepare our healthcare system for tomorrow, test our plans for the future before the future tests us. I will speak on three areas today: better care for an ageing population, amidst better care coordination, better access to treatments and better support for our healthcare workers and frontliners. Sir, today Singapore is ageing – more chronic diseases; patients with multiple medical conditions. I asked a Written Question in Parliament early this year: how many Specialist Outpatient Clinic (SOC) visits a patient might have in a single year in our public hospitals? Here are MOH's figures from 2019, before COVID-19. Over 7,000 patients each had 24 or more clinic visits a year. That is 7,000 patients averaging two or more clinic visits a month. Over 2,000 patients each with 36 or more clinic visits a year. That is 2,000 patients, each averaging three or more clinic visits a month. Each visit means travelling to and fro. If you are less mobile, it might mean having to take a taxi. If you are still working, it might mean time away from work. For caregivers, time commitment, too, and not every employer is supportive. And for some low-income, daily-rated workers, each clinic visit means loss of income. I have met Clementi residents, worried about this. But they also see how busy our healthcare workers are across Singapore.”
“Sir, I have met Clementi residents facing divorce proceedings. Some feel disadvantaged, especially if the other spouse is better educated and controls the family's finances. Even where the Court has issued orders in favour of one party, there are cases of maintenance orders not being followed. The spouse can be a litigant-in-person who finds the legal system complex and difficult to navigate. Residents struggling to make ends meet, single parent, single income, looking after elderly grandparents and the children at the same time. Some do not earn enough to engage a lawyer, but earn too much to qualify for legal aid. One Clementi resident shared about her journey as a litigant-in-person. She wished to vary a maintenance order. She had to navigate the various intermediaries – VITAL, which is a department under MOF, as well as CrimsonLogic – an entity that apparently handles some of the payment transactions. In February 2021, a Singapore Academy of Law blog, in an excerpt of a book by NUS professors Jaclyn Neo and Helena Whalen-Bridge stated, and I quote: "The legal system itself may limit the litigant-in-person’s access to justice, particularly in terms of equality of access, due to complex procedural rules". Despite this, some spouses still proceed to deal as a litigant-in-person for divorce proceedings. Has MinLaw studied why and done a deep dive into this issue? Can the system be streamlined for litigants-in-person of limited means? Is MinLaw considering additional enforcement mechanisms against errant spouses who do not attend or comply with maintenance orders and timely payments because justice delayed is justice denied?”
“My Clementi resident came looking for help sometime back, just released from prison, nearly, 60 years old. When he was in Changi Prison, his medical care and follow-ups were at a hospital in the east of Singapore. But upon release home to Clementi in the west, he had a referral letter to the polyclinic listing 11 medical conditions. His medication card had 13 different prescriptions. He had eight medical appointments over the coming months at medical centres in the east of Singapore. Eleven medical conditions, 13 medications on prescription, eight appointments which he would have had to cross the island to attend. Each trip for medical care and back, from west to east, would have cost him money; transport costs. He shared he was living alone upon release from prison. Not yet found a job, no income. He was on the verge of giving up. We reached out to the healthcare teams and agencies which were able to come together and help him coordinate his medical care in the west of Singapore near Clementi. But there will be other older Singaporeans with multiple medical conditions just released from prison trying to rebuild their lives. Can the Minister tell us what is being done to improve handover medical care when prisoners with multiple medical conditions are released and returned to the community, especially if their are existing follow-up is far from home? We know our agencies tried their best. We know our agencies mean well, but let us continue looking at ways to improve and do even better.”
“Mdm Chairman, previously, I had spoken on how a Yellow Ribbon "Inclusive Hiring" mark can provide a way for fellow Singaporeans to support businesses with inclusive hiring practices to recognise and channel their custom and businesses towards employers that help lift up our ex-offenders through providing job opportunities and training. Can the Minister share what progress has been made on improving the job search process for ex-offenders and how can progressive and inclusive human resource practices towards ex-offenders be recognised, incentivised and encouraged further? Future Plans for Police Cameras”
“Mr Speaker, today I will speak on the climate crisis, our climate ambition, our energy security and our survival. Last year, I spoke about Singapore's burning platform, a world on fire with COVID-19. With natural habitats being destroyed, we must expect more pandemics, some worse than COVID-19. But climate change is a graver challenge than any disease. So, we need to stress-test our assumptions, test our plans for the future before the future tests us. So, we need to move quickly and boldly. An earlier generation spoke of mudflats to metropolis in one generation. It happened. And now we face a new ambition, again, born of necessity and survival. Can we go from carbon-positive to carbon-neutral? From what is unsustainable to what is sustainable within one generation? Because that is the implication of reaching carbon net-zero by the middle of this century. There is not much time and we need to be seriously bold because the climate crisis is about Singapore's survival, whether we stay above water. In 2019, a research paper in the journal, Nature Communications, showed very vividly, with maps, how hundreds of millions of people around the world would be underwater by the end of this century and that is just assuming a low-carbon emissions scenario. It is our economic survival, too. In a world where carbon border adjustment taxes are being talked about; in a world where consumers choose what to buy, where to work, how to invest based on sustainability; in a world where narratives can shift from free trade to sustainable trade. We need to be ready and it means Singapore needs to raise our ambition to stay above water, to survive and to thrive. We can only do this fast enough, within one generation, by moving boldly and ahead of the market.”
“Mr Speaker, I thank the Ministers for their Ministerial Statements. I have two questions and one suggestion. Sir, many of my Clementi residents were very worried to hear about what happened and it is important that MAS has recognised that there needs to be equitable sharing of losses when an incident happens. My first question is, will this proposed equitable sharing look at the difference between an unforced error compared to a forced error, where a customer was led or pressured into making an error, as appears to have been the case with the OCBC phishing scam? The second question, Mr Speaker, will this proposed framework for equitable sharing of losses also consider the speed of the bank response when a consumer is trying to get help? One of my Clementi residents described it thus. He said, "Imagine you got tricked, someone copied your house keys, they are looting your house now, you call for help and you are put on hold. You wait to press a number or get to the right department." That is what my resident said and they are worried what happens if this is their experience in a scam. Sir, for the suggestion, may I suggest to the Ministries, if they have not already done so, there can be Red Teams looking at not just fighting the last scam war, but the next one because, today, we know there are deepfakes for voices, deepfakes for video calls as the technology improves. We have to be ready for the next character of scams. Likewise, is there a role for white hat scammers, just like there are white hat hackers – white hat scammers actively testing the bank's procedures to look for vulnerabilities before fellow Singaporeans suffer avoidable losses?”
“I thank the Minister for his answer. I would like to draw reference to a Parliamentary Question (PQ) I filed early in July 2021 about detection of COVID-19 in the built environment because better sensing of virus in the air and on surfaces may help us to find new vulnerabilities ahead of new clusters. I have an SQ for the Minister for Transport. The Minister has spoken about what has been done to clean the air filtration better, to try and sterilise surfaces better with UVC. But can I ask the Minister how are we evaluating the effectiveness of these measures? Are we checking whether there is viral detectability in the ambient air? Are we checking for detectable virus on surfaces that members of the public or members of staff may come into contact with? And if I may put a second SQ to MOT, can the Minister confirm that there is ongoing attention to making sure that existing security protocols in the airport also interlink safely with safe management measures? So, for example, where staff are required to have their faces validated against photo IDs, that this is done in a way that does not undermine the safe management processes against COVID-19.”
“I would like to thank the Minister of State for her answer. Sir, my Clementi resident told me she has just been retrenched, with her last day of work in December. Her Primary 6 daughter is on school-based FAS and she is worried about what will happen in the new school. My resident told me that when she sought to apply for MOE FAS for the upcoming school year, she was told she had to wait till she had served the last day of her job, which would then take place in December, possibly towards the later part of December. Can I ask MOE two supplementary questions? Firstly, for school-based FAS, is there any way to facilitate handover of school-based FAS needy students between the old and new school, especially when these postings happen? Secondly, for MOE FAS, is there any way for MOE to consider pre-application requests from parents who have already received notice of retrenchment just before the end of the school year?”
“I thank the Minister for his answer. Sir, these are serious revelations. A Clementi resident told me that when he disputed a credit card transaction with his bank, he was told because there was an OTP record in his phone number's name, the transaction must be genuine and therefore, cannot be challenged. He appealed a number of times; the case was resolved. But how many more consumers would have given up before attaining a resolution? Sir, I have got three supplementary questions for the Minister. First, prior to September 2020, how many reports were there of fraudulent card transactions in recent years where the victim said they did not perform the transaction nor receive the SMS OTP? Has the trend been going up, prior to the latest findings? Second, will MAS consider looking into these earlier cases too? Cases, which based on earlier assumptions, might have been deemed clear-cut open and shut, but given the latest revelations, might warrant repeat scrutiny? And thirdly, can MAS reassure the public, including our Clementi residents, that agencies will continue keeping an open mind when a customer is concerned about cyber fraud affecting their credit card, involving the SMS OTP?”
“I thank the Senior Minister of State for the answer. I have met a number of brothers and sisters in Clementi who work in the gig economy, including as delivery riders. Sir, I have two supplementary questions. First, Mr Speaker, can MOM share whether MOM will consider requiring the gig platforms to report instances of injuries, when the worker is injured in the course of their gig economy work? Although the fatalities are documented, as in the Minister's answer, for every fatality, there may have been a serious injury, a near-miss, some time before. This data would be useful. The second question pertains to the workers who have lost their lives in the course of doing their gig economy work, as the Minister mentioned in his answer earlier. Does the Ministry have information on what compensation and support were provided to the families of these workers, who lost their lives? And was that support comparable to similar accidents taking place in delivery firms where the worker had an employee relationship with the employer?”
“Yes, Sir. Let me ask the two supplementary questions. First, can the Minister share whether there have been any cases of Multi-system Inflammatory Syndrome documented so far in Singapore among our paediatric COVID-19 patients? Secondly, given the very different experience of paediatric patients across some countries in the West, for example, in the US, there is an NBC news report on 14 August that stated "North Texas runs out of pediatric ICU beds amidst COVID surge", but at the same time, the British Medical Journal on 16 August mentioned that the UK experience is not as serious as what has happened in the US. So, can the Senior Minister of State also share, given the different experience on both sides of the Atlantic, what lessons can we learn from studying other countries' battles with COVID-19 to safeguard and support our children?”
“Mr Speaker, I thank the Senior Minister of State for his answer. I have got two supplementary questions. Sir, as background, a number of Clementi parents have reached out, sharing about their worries for their young children, children who are too young to be vaccinated, parents who are watching the case numbers in the community go up. Some parents have been watching what has happened overseas in some other countries: long COVID as well as the Multi-system Inflammatory Syndrome in children reported in some countries where COVID-19 is widespread; some parents also look at what happens in some advanced economies —”
“I thank the Minister for his sustained exposition on the topic. And if I may sustain a couple of supplementary questions as well on this issue. Let me start, first, by declaring that I am an adviser to the Shipbuilding and Marine Engineering Employees Union. And my supplementary questions are as follows. On the first point, the Minister spoke about how there are currently significant constraints regarding the deployment of clean hydrogen and its transport. Some of these constraints appear to be specific to the origin, as well as the destination – the liquefaction and then the subsequent gasification at the destination. However, I would like to ask the Minister whether he sees, at some point, opportunities arising further in the transport of liquid hydrogen. I understand that there are some prototype developments from the Japanese in this sector and even as we explore opportunities for the Offshore and Marine Engineering sector, I wonder if the Ministry is looking at ways to keep our industry ready in the event that some of these new modalities and technologies start to become commercially viable. Secondly, I would also like to ask the Minister, in terms of the changing environment regarding sustainability practices around the world, we see a situation where sustainability is, increasingly, a criterion for access to markets. How will these developments he has outlined maintain Singapore's competitiveness and access to markets around the world?”
“I thank the Ministers for their Statements. By way of clarification, I would like to raise three questions. A number of Clementi residents feel very much affected by the recent outbreak. Our central market has had to close. Many worried parents, seniors, families are concerned about the way forward. The first question is relating to the Jurong Fishery Port cluster. What measures can we take to better identify workplaces that may have a higher risk of transmission compared to elsewhere? Three weeks ago, I filed a Parliamentary Question on detecting COVID-19 virus in the built environment. Can I ask the task force what efforts are being made to look for other areas and workplaces that could be potential hotspots but which have not yet come to surface, but which are still at higher risk? Second question is on our schools. A number of parents in Clementi have been watching the reports of some schools having students infected, possibly by transmission at home and they want to know, given the Delta variant, what measures are being taken to maintain the safety of students, especially younger children, who are not yet able to be vaccinated? For example, how soon can we roll out breathalysers and tests, which are easy enough for a child to do it themselves? Third question, Sir, even as we open up and transition, I ask the Ministries that we must maintain many of the capabilities built up during this pandemic and internalise the lessons learnt because we know that a worse variant of COVID-19 or even a future Disease X, a worse pandemic, is just a question of "when" rather than "if". So, I thank the Ministers and our public servants for their efforts and I seek these questions as clarification.”
“I thank the Senior Minister of State for his answer. A number of Clementi residents with family who transit through or go through that interchange have expressed concern about what happened. I understand the investigations are still ongoing, but if I may raise three supplementary questions more generally. Can the Ministry share if the agencies have kept track of the number of accidents at this particular interchange over the past few years? Secondly, how many near misses have been reported at this interchange over the past few years. And thirdly, with regard to human factors, has it been studied whether a driver towards the end of the shift, may be more likely to be in an accident and what measures are there to better support our brothers and sisters in the transport sector who may be facing fatigue or challenging circumstances at work?”
“Mr Speaker, I thank the Ministers for their detailed statements. I am a healthcare worker, with brothers and sisters in the Labour Movement in the Healthcare Services Employees' Union (HSCU). I have got brothers and sisters on the TTSH frontline. Sir, it has been very hard for many healthcare brothers and sisters at TTSH. I hear of nurses who have been told by their landlords to move out at short notice. I know of a young mother of a newborn at home, her husband works at TTSH. He has had to move out of the home to keep her and her fellow healthcare workers working at another hospital safe from COVID-19 transmission between hospitals. Can I ask the Ministers what is being done to help affected TTSH workers: nurses who cannot find a place to stay, healthcare workers who cannot find a Grab or a taxi to bring them to the hospital or to take them home after a shift; families which have been separated by necessary COVID-19 precautions who need help with childcare, help with getting the kids to continue in school? Is there a hotline for affected TTSH staff to call? Can the Ministry set up a care team connecting the different Government agencies to provide help to affected TTSH healthcare workers, especially for challenges that may be beyond the reach of individual hospital management?”
“I thank the Senior Minister of State for his further clarifications. I want to put on record as a declaration that I am a medical doctor, looking after patients in the public sector, for avoidance of ambiguity. I thank the Senior Minister of State again and I very much support any further analysis of this issue by the Ministry and look forward to updates in due course.”
“Because once you have a mechanism in policy to protect patients when an insurer exits the market, to allow these patients to transit in a way that is non-discriminatory, not unfavourable, to another insurer, I put it to the Ministry that that can be the beginning of a mechanism to allow patients to transition between insurers. And I suggest to the Ministry that once patients have the option of transiting with the potential for having pre-existing conditions covered to some extent, as is the case in other regulatory jurisdictions like Australia, there is better bargaining power for the consumer and that leads to a better functioning market as well.”
“Mr Deputy Speaker, I thank the Senior Minister of State for his detailed answer. I would like to raise supplementary questions along two themes: patient voices and patients' ability to negotiate in the market. On the issue of patient voices, Mr Deputy Speaker, can the Senior Minister of State assure us that MOH's proposed dispute resolution mechanism will actively involve the patient's perspective and the journey experienced by patients, whether as existing policyholders navigating the IP system or potential policyholders or former policyholders who may feel excluded. My Clementi residents who are on Integrated Shield plans (IPs), some of them, they tell me of the challenges involved in making a claim, despite having been with the same firm for many years, despite the full support of the doctor looking after them, whether the doctor is in the private or public sector. On the second question, Mr Deputy Speaker, that of the bargaining power of patients, policyholders and consumers. The Senior Minister of State earlier spoke about the scenario of what happens if an IP insurer exits the market. He said that there would be a negotiation or discussion between the agencies and the insurance provider about ensuring that patients are covered. But I ask the Ministry, in the event of an IP insurer exiting the market, is there a mechanism to ensure that patients who already have existing conditions will be appropriately covered and recognised in a way that does not disadvantage them if the insurer exits the market? I furthermore would like to ask MOH, whether MOH would consider establishing some kind of regulatory backstop to protect patients?”
“Mr Chairman, I thank all Members for their cuts and I thank our Ministers, Senior Ministers of State, Parliamentary Secretary at MOH for their responses and sharing. The COVID-19 virus does not sleep. It does not rest and so are our healthcare frontliners, our agencies, our MOH officials have also had many sleepless nights because of this COVID-19 pandemic. Presumably, with implications for sleep health as Parliamentary Secretary shared earlier. So, a big thank you to all who keep us safe, and in doing so, keep Singapore going. I beg leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $17,355,401,300 for Head O ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $1,489,629,300 for Head O ordered to stand part of the Development Estimates. (proc text)]”
“Thank you, Mr Chairman. By way of clarifications, I have one observation and one question. First, regarding the Senior Minister of State, Dr Janil's observation that relooking healthcare needs to be through the lens of longer term issues in a COVID-19 world and looking at the larger social eco-system. I agree with this approach. It is essential in our approach to society and healthcare. I have a follow-up question for the Senior Minister of State, Dr Koh, regarding the earlier point in my speech on the approach to outsourcing hospital cleaners and hospital attendants. I do not expect an immediate resolution to this question, but I will urge a longer term rethink once the COVID-19 crisis is over. After all, COVID-19 has raised many questions of countries around the world. If it is supply chains, countries are looking, "at just in time" as compared to "just in case". And may I suggest that on issues of workforce, we also may want to look at economies of efficiency, but juxtaposing this and considering as well the resilience of solidarity across the entire healthcare team. And I hope MOH will consider this as part of a longer term review for the COVID-19 world, and what comes next.”
“In my Meet-the-People Sessions in Clementi, I have met older workers who have been retrenched, who are looking for job placements in healthcare institutions nearby. We should look at ways for hospitals to generate employment for residents living nearby as well. I call upon the Ministry to consider this outsourcing issue as one of the issues which COVID-19 is forcing societies around the world to re-think. Chairman, healthcare is about "health" and "care" supporting our patients, supporting our care-givers, supporting our healthcare workers –our sisters and brothers on the healthcare frontline. It is about keeping all of us safe, keeping all of us safe together. And so, may we continue building a healthier Singapore as we fight this COVID-19 pandemic as we emerge from the COVID-19 pandemic together. [Applause.] [(proc text) Question proposed. (proc text)] COVID-19 Vaccination Operations”
“These are some of our outsourced healthcare frontline workers. Our hospital cleaners, our healthcare attendants are an integral part of the health care workforce. They are integral to the hospital. Facing the COVID-19 risks together, serving on the same front line as medical nursing and allied health staff serving together. Once upon a time all these brothers and sisters were directly hired by the hospitals and not outsourced. Today, a growing number of cleaners and healthcare attendants have been outsourced. But, Sir, the rationale for outsourcing hospital cleaners and hospital attendants is not compelling. It is not compelling. First of all, the demand for hospital cleaners and hospital attendants is the same throughout the year. There is no seasonal component involved. It does not vary much throughout the year. And in a COVID-19 world, it makes sense for team members to stay based within the same healthcare institution rather than moving from place to place amidst a pandemic. We are already providing outsourced cleaners with protective gear during COVID-19. It recognises that they are part of the same healthcare frontline. And there is something to be said for treating all our hospital cleaners and healthcare attendants as part of the in-house staff, making them feel more fully like part of the team, supporting resourcing, uplifting these workers together accordingly. Because, Sir, when we are fighting on the COVID-19 frontline, we are all in this together. We should think about hospital cleaners, our hospital attendants as part of the whole healthcare team and not as a service to be outsourced. Furthermore, Sir, direct hiring also makes it easier for hospitals to create additional jobs and job opportunities to hire directly from the community nearby.”
“We can apply the same care and attention and passion to re-imagining the design of healthcare facilities, re-imagining the user experience so healthcare workers can do the job even better, care for patients even better. Whether it is a hospital computer system, the healthcare workplace, or the patient journey. Seeing through the eyes of our people. Sir, I want to speak about our healthcare frontliners. In particular, I want to salute our nurses and allied health workers. Every doctor knows this instinctively, even before they become a doctor from their days as a medical student. The impact our nurses have, lifting up the lives of our patients making a difference for every patient. Every patient, every care-giver understands this too. And I say this both as a doctor and as the son of a patient. We see the impact that our nurses have, that care, that dedication, that heart. Nursing is also deeply skilled work, deeply skilled work and essential work. Last year during the debate on the President's Address, I called upon MOH to look at paying our nurses and allied health workers more and I am glad the Finance Minister has announced better salaries for our sisters and brothers in nursing. Some years ago, I attended a healthcare conference. One of the speaker was the President and CEO of the Duke University Hospital in the USA. He is a nurse, trained as an Oncology nurse, rose up through the ranks to lead the hospital, to lead an entire healthcare system in the USA. We should continue looking at ways to further empower our nurses in Singapore to create more opportunities for upskilling and advancement, as we all work together to lift up the lives of our patients. Sir, I also want to speak on another group of healthcare frontliners who are key to keeping us safe.”
“Comfort the patients, especially in a world with COVID-19, where everyone is wearing a mask and that eye contact becomes even more important. Does it help that eye contact happen? Or is it sometimes a different experience? And if so why, and how can we make it better? So, I ask the Ministry, has MOH done any recent studies on the design of healthcare facilities, healthcare IT and the patient experience? Some designers talk about time-movement studies. How much time it takes to get a task done? How much movement is needed to make something happen? Has there been any recent ergonomic research to see what brings more comfort to patients and better performance for healthcare workers? Sir, these studies may not be easy to do. But what we do not study, what we no not look at, what we do not search for, we do not know. We must seek truth from facts. Sir, Steve Jobs was co-founder of Apple, and well known for his sense of design and aesthetics. Every iPhone user everyone who uses a modern multi-touch smartphone, sees the impact of his influence and legacy on industrial design. His younger sister Mona wrote in the New York Times shortly after he passed away. She wrote about how Steve Jobs, from his hospital bed, as a patient battling terminal cancer, wanted to make the hospital better. Sketching devices to hold an iPad in a hospital bed, designing new fluid monitors and X-ray equipment, re-drawing the design of a hospital unit. Not every one of us can be Steve Jobs, but every patient brings an important perspective to the healthcare journey. And when we see better through the eyes of our patients, when we see better through the eyes of our healthcare workers on the ground, we continually see better and better ways to improve our healthcare system.”
“They asked, "What is this gap in your CV? Why were you out of the workforce?" They did not see the dedication and devotion to duty. Sir, I call upon MOH to work with MSF and MOM to look at how we can better support care-givers – both during the journey of care-giving, and especially when a care-giver is trying to get back into the workforce. Together, across the Ministries, together with industry, and with our brothers and sisters in the Unions, we can find ways to build awareness among employers and even go the extra mile to recognise inclusive employers, who hire fellow Singaporeans who are returning to the workforce having spent time as care-givers showing that dedication and devotion to duty. 2.15 pm Sir, my fourth point on IT and design in healthcare. Chairman, when we empower our healthcare workers, when we look at what is happening on the ground and empower workers on the ground to do their jobs better, it helps patients as well. It improves the quality of care. It improves the patient experience. Sir, Information Technology, or IT, has transformed healthcare around the world, but we also must continue looking at how IT is implemented and designed. For example, digital ordering of tests today. Is it faster, easier, than ticking boxes and signing a piece of paper? If it is not, we must ask ourselves why and how can it be improved? Electronic records today. Do they speed things up, so healthcare workers can spend more time, more quality time with patients? Or is there still room for improvement? And if so, why and how can we make it better? Computer workstations today, the design of workstations today, computers, do they help doctors and nurses maintain eye contact with the patient?”
“With an ageing population and shrinking family sizes, this poses a challenge for many seniors in the community. In some cases, the son or daughter cannot take leave or has used up all of their annual leave, or the family member may be a low-wage worker, daily-rated, which means time away from work becomes loss of income. Many patients today are older, with more medical conditions—more complex medical conditions. Sometimes three, four, five – even more – medical teams look after the same patient. Sir, there is a role for more patient navigators and more care coordinators linking up across different care teams to help coordinate the care better, to help reduce the multiplication of medical appointments, to help make it easier for appointments to be brought onto the same day, where possible. We can look at reimagining our healthcare so as to support this better. Sir, I am told that IMH has a team of patient care coordinators and, over the years, their experience has been that this reduces the number of patients needing admission. There are lessons we can learn for coordinating care across other medical conditions as well. Sir, my third point on supporting care-givers. Some years ago, as a young doctor, I looked after an old lady with advanced cancer. She was very, very sick and not getting better. Her 50-year old son quit his job to look after her. He quit his job to look after his mother. Later, she passed away. Her son's duty was done. But he had a lot of difficulty. He found it so hard getting back into the workforce in his fifties. Yet this man, this filial caring son, had shown dedication and devotion to duty, day and night, looking after his mother who was terminally ill. Dedication, devotion, duty, but unfortunately, potential employers did not see it that way.”
“Mr 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. Sir, in the Budget debate, I spoke about preparing for the next pandemic. Today, I will speak on delivering healthcare to our fellow Singaporeans and supporting our sisters and brothers working on the healthcare frontline. I will speak on five areas today: (a) seniors' access to care; (b) care coordination; (c) care-givers; (d) IT and design in healthcare; and (e) our healthcare frontliners. Sir, on seniors' mobility and access to care. In an ageing society, we have more Singaporeans with mobility needs. Some stay in older flats with multiple steps at the doorway, flats where the steps are too high for the usual Enhancement for Active Seniors (EASE) programme organised by HDB. Has MOH studied whether seniors in such households are more likely to miss medical appointments? Has MOH looked at how to better support such seniors so they can more easily get to the clinic so that chronic diseases can be brought under control better and so that hospital admissions can be reduced by going upstream? Can MOH look into better support for home delivery of medications? Because this too will reduce the need for seniors with limited mobility to make multiple outpatient trips. Sir, my second point on care coordinators. On my Clementi home visits, I have met residents who have many, many medical appointments. One old lady told me she has 10 clinic visits in the upcoming, next three months. Each of them will mean her daughter has to take time off from work to accompany her to and from the clinic for the appointment.”
“Mr Chairman, I have met Clementi residents who have serious medical conditions. Sometimes, this means having to move in with family members. But this has implications for means testing. One of my residents is ill – visually impaired, on dialysis. Because of his condition, he moved in with a family member, for care-giving support. The family member is still working. But because of this, he does not qualify for legal aid. The means test looks at household income. My resident told me he faces an invidious choice – stay with a family member who can provide care-giving support or choose to stay separately without the family member as care-giver in order to maintain his means test access to legal aid. Sir, each case turns on its merits, on its details. But I am sure there are other families in Singapore facing the same dilemma. They should not have to choose between having a family member as care-giver staying together and falling on the wrong side of the means test assessment. Our agencies mean well and I hope we can continue finding ways to support families in such challenging unfortunate situations. Law Awareness and Enhancing Accessibility”
“Mr Chairman, I propose that MHA work with MOM to help recognise firms which practise inclusive hiring, including the hiring of ex-offenders. A Yellow Ribbon Inclusive Hiring mark can be a way for fellow Singaporeans to recognise such firms and to show support. People can make the extra effort to support such firms, do business with such firms, contribute attention and profile to such firms. MHA can also work with MOF so that good inclusive HR practices are supported during the evaluation of Government tenders. For example, if two bids are of equal quality, inclusive HR practices should be considered as a tie breaker. Work for Short-term Prisoners”