[(proc text) \"to amend the Goods and Services Tax Voucher Fund Act (Chapter 117C of the 2013 Revised Edition)\", (proc text)]
[(proc text) presented by the Second Minister for Finance (Mr Lawrence Wong) read the First time; to be read a Second time on the next available Sitting of Parliament, and to be printed. (proc text)]
[(proc text) Order read for consideration in Committee of Supply [5th Allotted Day]. (proc text)]
[Deputy Speaker (Mr Charles Chong) in the Chair]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head W (Ministry of Transport)","subTitle":null,"sectionType":"OS","content":"The Chairman: Head W, Ministry of Transport. Mr Sitoh Yih Pin.
Mr Sitoh Yih Pin (Potong Pasir): Mr Chairman, I beg to move, \"That the total sum allocated for Head W of the Estimates be reduced by S$100\".
Mr Chairman, in my kick-off speech for the Committee of Supply Debate for MOT, I would like to address two key developments in our transportation industry in Singapore. The first, a recent unanticipated development – the first, a recent unanticipated development, the COVID-19 outbreak and its effect on the industry; and the second, MOT's strategic long-term plan for our rail network.
I start with the recent virus outbreak. As we know, Singapore has been under the cloud of the COVID-19 outbreak since the end of last year.
We have been working extremely hard collectively to battle against the spread of the virus in Singapore. Our healthcare team rightfully deserves our admiration and gratitude for their efforts on the frontline, looking after patients who have fallen ill because of the virus.
However, Sir, there is also another team that has been on the frontline, bravely continuing to provide essential services to Singaporeans amid the ongoing virus outbreak. I am referring to our public transport team.
I joined Senior Minister of State Janil Puthucheary and NTWU Executive Secretary Brother Melvin Yong last month to visit the Bedok Integrated Transport Hub and Tanah Merah MRT Station and we observed our public transport team doing their part to step up cleaning routines which are over and above their usual duties. They work very hard every day, putting themselves on the line in the fight against the virus outbreak so as to ensure that precautionary measures are taken to protect Singaporeans on our public transport network.
I wish to take this opportunity to salute them for their efforts!
We also know that the virus outbreak has adversely affected the entire transportation industry. Travel numbers are down, whether in the air, on water or land. Transport operators and workers are concerned not only about bottom lines but also their own health as they go about their daily work.
I am therefore extremely glad to see the various measures that the Government has put in place to support the transportation industry.
To better protect our taxi and private hire car drivers from COVID-19, 300,000 surgical masks have been provided for them to offer to passengers who are unwell. Both taxi and private hire car operators have also set up temperature screening protocols for their drivers.
The Point-to-Point Support Package totaling S$77 million dollars was announced to support our drivers whose livelihoods have been adversely affected by the virus outbreak. There are three components: the Special Relief Fund (SRF), the Government and NTUC Driver Care Fund for drivers and the Waiver of the Operator Licence Fee for Point-to-Point Transport Operators.
Various other measures to support our aviation and marine transportation sectors were also announced at the Budget Statement earlier by Deputy Prime Minister Heng.
These measures will go some way in alleviating the hardships and difficulties that the transportation industry is facing as a result of the virus outbreak.
However, while we all hope that the virus outbreak can be contained quickly, in the past few weeks, we see worrying signs of further outbreaks in Japan, South Korea, Iran and Italy. If this continues, or worse if more countries get affected, it will inevitably have a further adverse effect on Singapore’s globally inter-connected economy. We must therefore confront the possibility that the worldwide spread of the COVID-19 virus could continue for some time to come and further affect our transportation industry.
In the premises, I would like to invite the Minister to share with us further plans or measures that MOT could implement to support the transportation industry, in the event that the situation is drawn out over a prolonged period of time.
Sir, I move on now to our rail network. On this front, we have much better news to share.
As we are all aware, the Government has made and are still making significant investments to our rail network. Minister Khaw Boon Wan had recently announced that the multi-year programme to renew the North-South and East-West lines, which are Singapore’s oldest and most heavily used lines, will cost more than S$2.5 billion dollars.
The rapid expansion of our rail network continues over the next two decades. Announced projects include the Thomson-East Coast Line, Jurong Region Line, Circle Line extension and the Cross Island Line. Once the Cross Island Line is completed – currently scheduled for 2031 –Singapore will have doubled its rail network to 360 km.
Our extensive efforts to renew, expand and improve our rail network has clearly paid off! I remember Minister Khaw, in 2017, setting a target of 1 million Mean Km Between Failure (MBKF) by 2020. This means that our trains, on average will travel about 1 million km before a delay of more than five minutes is recorded. We achieved this ambitious target by August 2019! Ahead of time.
It was no mean feat. We will recollect that as recently as 2015, our rail reliability was at 133,000 MBKF, at about one-tenth of current reliability levels. In 2017, this number had increased to about 400,000 MBKF and finally, to current levels of above 1 million MBKF.
The renewal of our rail network has led to higher reliability and shorter waiting times. The expansion of the rail network will lead to better accessibility, more convenience and comfort for commuters in the future. These are all positives and MOT should be lauded for achieving and indeed, surpassing, the herculean targets and tasks set.
Sir, as an accountant, however, I also worry about the bottom line. Investments made in the renewal and expansion of our rail network need to be funded. The operating costs of maintaining rail reliability at current levels need to be sustainable. The large losses recorded by both SMRT Trains and SBS Transit reported in 2019 provides us with an insight of the costs involved.
Sir, I think that at the end of the day, for our public rail network, it is a fine balance between financial sustainability of the rail network, affordability for consumers and the reliability and efficiency of the trains.
I therefore invite the Minister to share with us the Ministry’s long term strategic plans on sustaining and securing Singapore’s future public rail transportation needs as the Government continues to invest in expanding and renewing our rail network, while concurrently maintaining current reliability and service levels.
[(proc text) Question proposed. (proc text)]
Mr Ang Hin Kee (Ang Mo Kio): Mr Chairman, the aviation sector has been adversely affected by COVID-19. Many airlines and their crews are feeling the brunt because many flights have been cancelled and the passenger numbers for other flights have been reduced. I have been to the airport several times over the last two or three weeks. The situation is very tough – very few passengers. Consequently, even taxi drivers share with me that they wait for about three hours for passengers. That has never happened before in the past.
The Government announced a slew of packages involving training and support assistance. I would like to ask how has our airlines and staff, including the ground crew and cabin crew, responded to the help? Has it cushioned the impact and whether measures such as sending workers for upskilling have been implemented and well-subscribed?
I know we are asking for some things to be sped up in the midst of these recent announcements, but indeed, the income and the flight hours have been shortened tremendously; and the help needs to be very imminent and fast.
Both local and foreign crew also operate as effective teams. We do not just need the Singapore crew. A lot of times, we need our foreign workers and our partners who fly and service the planes, and do all the necessary work at the airport. It is indeed critical that we retain and ready the core team for the upturn, following COVID-19. Are there concerns among workers in the sector that remain unresolved and what more can we do to cushion and mitigate the impact?
Mr Ang Wei Neng (Jurong): Chairman, I would like to declare my interest as the CEO of ComfortDelGro Taxi Business.
COVID-19 hit Singapore suddenly and spread quite rapidly. We appreciate MOT's swift actions to announce plan to help our P2P drivers even before Budget day. Such move was greatly appreciated by the P2P drivers, because it is such a big improvement as compared to the time of SARS, when the help was given later.
However, the Special Relief Fund (SRF) of $10 per day is really not enough. Taxi operators have provided a top-up, by providing rental rebate of up to $26.50 per day, over and above the SRF of $10 per day. By doing so, taxi operators are in the red but taxi drivers and P2P drivers are still suffering. Many P2P drivers met me at the coffeeshops, in the course of my work, to appeal to the Government to increase the quantum of SRF. Alternatively, LTA can help to provide tax rebates to P2P operators so that the operators can pass the savings to the P2P drivers.
The Minister has openly said, many times, that the Government is willing to provide more help, as and when it is needed. Minister, the “when” is now.
The Senior Parliamentary Secretary to the Minister for Home Affairs and National Development (Ms Sun Xueling): Mr Chairman, with tourist arrivals plummeting and an increasingly number of companies allowing their staff to work from home to reduce the risk of infection, cabbies have reported a drop in earnings of over 25%, while private hire drivers have seen a drop of over 30%.
To address this, LTA announced a $77 million point-to-point package to help taxis and private hire businesses. The relief package gives about 40,000 eligible drivers $20 per day per vehicle for three months to ride through this difficult time.
Some taxi drivers have shared with me that the assistance is not sufficient as the drop in their earnings have been substantial.
I would like to understand the Ministry's thinking behind the relief package. Changes in ridership patterns could also be longer term in nature. What are the training packages available to help drivers move on into other sectors?
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): I have been approached by a number of elderly residents who hold Taxi Driver's Vocational Licence (TDVL), highlighting the following two matters and requested that this be brought to Ministry's attention.
First, the issue on the mandatory medical examination or health check-ups. It is a requirement for Qualified Driving Licence (QDL) holders aged 65 and above to go for health check once every three years for them to be allowed to continue driving. I also understand that for TDVL holders of the same age group, they are required to have their health checked on yearly basis.
Based on these two requirements, an individual age 65 years old and above has to attend medical examination once every three years.
Sir, it is understandable for TDVL holders in this age group to find it inconvenient to go through two separate medical examination within a year. First, they have to fork out additional amount of money for their health check, and second, it affects their income since they have to sacrifice their driving hours to attend this medical examination.
I do hope the Ministry will consider to allow elderly TDVL holders to undergo a single comprehensive medical examination, instead of two separate sessions, as mentioned earlier.
Second is the issue on the statutory age limit for vocational licence. Currently, the statutory age limit for vocational licence is 75 years old. I would like to convey a request to have the statutory age limit increased for another few more years, as long as the medical examination result permits. This extension will allow elderly TDVL holders who still need to sustain themselves to continue driving for few more years. And for those who just want to earn some income or remain active, they can do a part-time or relief driving. Hope Ministry will look into the matters raised.
The Chairman: Mr Png Eng Huat, you can take both your cuts together.
Mr Png Eng Huat (Hougang): Thank you, Sir. The first cut. Sir, I have spoken about making signalised pedestrian crossings safer for all in 2013, 2015 and 2018. In particular, I have called for the discretionary right turn junction to be phased out.
If one were to Google the term \"discretionary right turn\", a list of accidents will pop up on the screen. There is even a petition asking LTA to ban such junctions all together.
LTA was reported to have taken steps to address the safety concern of pedestrians over the years. I have noticed that more traffic light junctions are being re-programmed. I spoke on the same subject time and again, because I strongly believe those horrible accidents that happened at such junction could be avoidable.
Fast forward to 2020, 6 January, to be precise, a student, with the right-of-way and hidden by a vehicle waiting at the discretionary right injunction was sent flying through the air by another vehicle who did not see the young man crossing the road. That was the last straw for me. The discretionary turning on green rule is the recipe for accidents to happen because there are two green lights in operation at the same time: one for the vehicle to turn right and the other for the pedestrians to cross. How is that not dangerous to begin with? Imagine pedestrians and drivers hesitating at the discretionary right turn junction, second-guessing whether it is safe to proceed even though the lights are both in their favour.
If a pedestrian could be assigned 15% blame in an accident, even though the lights were in his favour in the court of law, what is the proportion of blame for the Ministry for giving pedestrians a false sense of security a discretionary right turn, when the Green Man signal does not necessarily mean it is safe to cross any more?
Sir, we all know that policies, rules and regulations cannot cover every situation. I am not asking the Ministry to design a perfect traffic junction. I am asking the Ministry to take the guess work out of crossing a simple junction. Anything else, the pedestrians and motorists will have to take responsibility for. And if we are talking about cultivating patience on the road, would a split traffic junction not been ideal training ground for that? You wait for your turn to proceed.
Sir, I strongly urge the Ministry to do something about those discretionary right turn junctions wherever possible because the safety of pedestrian must be at the forefront of everything in a car-lite pedestrian-centric city.
Sir, it was reported in the news that there are 553 pedestrian overhead bridges or POBs here in 2017. Last November, LTA announced that by 2022, 103 of them will be retrofitted with lifts. That is about 19% of all POBs that will have lift access by next year.
Many Singaporeans welcome the idea of having lifts retrofitted to POBs, especially the elderly people with mobility issues, couples with baby on pram and anyone who finds climbing overhead bridges a challenge.
I have written on behalf of many residents request for lifts for the overhead bridge in Hougang, in particular, the one at Holy Innocence High along Upper Serangoon Road. LTA has patiently replied to those residents, sharing about the high cost of retrofitting lifts to POBs and the priority being given to overhead bridges within 400 metres from polyclinics and hospitals.
Retrofitting lifts to POBs is a challenging process in itself. Plots of land on both sides of the road would have to be acquired to make way for the lift shafts. The construction along the narrow stretch of the foot path is challenging and the whole process may take quite a while to complete. The lifts at the overhead bridge along Hougang Avenue 2 have been under construction for almost two years and they are still not ready.
But having lift access for all which may not be an ideal solution for an ageing society like ours. If the lifts were to break down or to undergo servicing, everything would be reverted to leg power again. Sir, as we are transiting to a car-lite city, I hope the Ministry will shift the focus of our road and transport planning to be more pedestrian-centric. The rationale of having POBs to serve a car-lite and ageing society may need a rethink.
I hope the Ministry can study into the possibility of converting those heavily used POBs in HDB heartlands to signalise pedestrian crossings. This will allow pedestrians with mobility issues or special needs to cross the road, come what may, even if the traffic lights are out of order.
Maybe the Ministry can share what is the cost of implementing and maintaining a signalised pedestrian crossing versus retrofitting an existing overhead bridge with lifts. The issue of having too many signalised pedestrian crossings along a stretch of the road, can be easily overcome with synchronised traffic light control. And if we are talking about a pedestrian-centric and car-lite city, getting drivers to exercise a little patience would fit the overall objective quite nicely.
Assoc Prof Walter Theseira (Nominated Member): Sir, in order for our public bus system to break even, fares would have to double or costs would have to be cut in half. Our MRT system is also facing an operating cost deficit which will grow with new rail lines that may well redistribute existing passengers rather than grow new ridership.
While the fare formula has added the network capacity factor to address rising operating cost deficits, cost management is also important. Could the Ministry update us on efforts to optimise public transport services to manage costs?
Some commuters will also be affected when service frequency and availability is optimised. This makes it hard for the public and hon Members to support cost management. Could we consider \"win-win\" solutions where we issue targeted, transitional public transport vouchers to commuters who have to bear the brunt of any service changes?
Mr Yee Chia Hsing (Chua Chu Kang): Chairman, Singapore acts as a regional air and sea transport hub. We have managed to use Singapore's geographical location to our advantage, and over the years we have become a major regional and international hub through bold vision and thorough planning.
The opening of Jewel at Changi Airport has definitely upped the attractiveness of Changi as regional air hub. We are also relocating our container terminal to Tuas. But our status as a regional air and sea hub cannot be taken for granted and there are many regional countries also eyeing the pie. As such, I would like MOT to give an update of the measures that we are taking to stay ahead of the pack and how we are also preparing our workforce in the air and maritime transport industry to keep up with the changes ahead.
The Chairman: Mr Dennis Tan, you may take your three cuts.
Mr Dennis Tan Lip Fong (Non-Constituency Member): Thank you, Mr Chairman. I declare my interest as a member of the shipping community in Singapore. Last month, I filed a Parliamentary Question (PQ) asking (a) whether any investigation is being carried out in respect to the piracy incidents in the Singapore Strait in and after December 2019; (b) has the Government identified the persons or groups responsible for the reported incidents and where they originated from; (c) what action has been taken by any of our Government agencies to date; and (d) what are the Government's plans to prevent similar acts of piracy?
Minister Khaw Boon Wan replied that there were 12 incidents involving piracy and robbery in December 2019 and January 2020, and as none of those incidents happened in our territorial waters, no investigations were required of our agencies. He said that as the Singapore Strait does not only include Singapore territorial waters, the fight against piracy requires collaboration among all partners. According to him, the Republic of Singapore Navy conducts joint coordinated patrols with Indonesia, Malaysia and Thailand through the Malacca Straits Patrol (MSP) in the Strait of Singapore as well as in the Strait of Malacca; that the MSP hold regular meetings to enhance coordination, review conduct of operations and share intelligence and information.
On a same sitting in February two hon Members in this House also filed questions relating to the piracy incidents to the Minister for Defence. Minister Ng Eng Hen in his reply to one Member talked about RSN's cooperation with neighbouring counterparts under the MSP.
I had filed the PQ to the Minister for Transport instead of the Minister for Defence, as MOT is the domain Ministry for maritime transport, and in my view, this goes beyond the issue of security or security arrangements with our neighbouring countries. Minister Khaw's answer confirmed that no investigation was carried out by Singapore on the incidents reported and we are none the wiser about the cause of these piracy incidents – why there was a sudden spike in the number or who were the culprits behind the incidents?
Minister Ng's answer also shed no light on the same. The port of Singapore is one of the busiest ports in the world. Many ships pass through the Strait of Singapore every day for which a large number comes through to the port of Singapore and is anchorages and even its Outside Port Limits (OPL) waters for a variety of commercial shipping, bunkering and ancillary activities. It does not matter to shipowners or uses that the Straits of Singapore is not entirely subsumed under our territorial waters.
Many shipowners and users associate the Strait of Singapore with the access and passage between the Malacca Strait and the South China Sea and with access to the Port of Singapore and its OPL.
It is therefore in the interest of MOT, MPA and indeed all stakeholders in the Port of Singapore and our maritime hub, that the Strait of Singapore and its adjacent waters are kept safe and free of piracy activities. In fact, in my view, it is in the greater interest of Singapore, as compared to our neighbours, that piracy activities are minimised or curbed.
We have seen from the piracy problems off the coast of Somalia and the Gulf of Aden, not so long ago, and more recently off West Africa, how piracy result in increase in insurance and other operating costs for shipowners and operators, and shipping costs for shippers. Many ships also avoided these waters. Well, the piracy situation in the Strait of Singapore and the Strait of Malacca is thankfully far better than what we have seen in the waters off Somalia or West Africa. This is something we should not take for granted.
In July last year, the Chinese government raised the security level on Chinese flagged ships transiting the Strait of Malacca.
I hope MOT and other Singapore Government agencies involved will work actively with our counterparts in neighbouring countries to (a) understand the causes of all piracy incidents regardless of the locality of each incident; and (b) help bring all culprits to justice or encourage neighbouring authorities to work towards that end.
By doing the above, I hope all parties and all countries can work to minimise or curb piracy activities in the region.
MOT announced in November 2019 that e-scooters will be banned from footpaths but will be allowed on cycling paths; and MOT will extend the network of cycling path from 440 km to 1,300 km by 2030.
Last month, at the Second Reading of the Active Mobility (Amendment) Bill, I had some questions on the proposed extension of the cycling path network. But Senior Minister of State said that MOT will only be touching on the extended cycling power network during the COS debate today.
I would like to ask again, whether as part of the extended cycling path network, cycling paths will be directly linked to every HDB block, condominium, private landed house, shop house, office building and industrial building, so that there is a direct access for e-scooters, other PMDs, e-bikes and bicycles from each of these type of building, without the rider having to alight and push these devices on footpaths at all.
Direct access to the extended cycling lane network cannot be a half-hearted attempt, for example, having cycling paths circling a number of HDB blocks, but with no direct link from each block; or having cycling paths circling around clusters of private residential estates, expecting e-scooter or other users to alight and push en route to cycling paths. Similarly, people going to work in office buildings or industrial estates, must have direct access without having to travel on surfaces on which their mode of devices are barred.
In fact, going one step further towards utopia, if our cycling path network were to become sufficiently extensive such that PMD riders do not need to alight and push. It may in turn do away with the need for cyclists to share the use of foot path, which is still currently allowed. And this prospect will be welcomed by many footpath users who may not think that sharing footpaths with cyclists is a safe idea at all. It is not a safe idea because we still have a riding culture problem.
On the other hand, if the extensive linkage between cycling paths in our homes and offices seem too expensive, impractical or ambitious, then MOT may have to reconsider e-scooters, other PMDs and even e-bikes as a serious option for first and final mile connectivity.
If there is no direct link between the extended cycling network and the homes or workplaces of Singaporeans, e-scooter users would technically have to alight and push their e-scooters when on roads or footpaths and e-bike users must push their e-bikes when passing through footpaths. How confident are we that all riders will comply accordingly?
The new cycling lanes with a more extensive network alone will not solve all the problems we have seen with e-scooters before the footpath ban. Most of these problems, I submit, had to do with a poor riding culture, inadequate public education and inadequate enforcement.
With the new mandatory competency test certification for all users, I hope the public education situation with riders will improve considerably. However, for the non-riding public, I hope the Government will take steps and review how it can improve its public education. The Government must think of how to push such information to people who do not seek it, and such efforts should be carried out in all our four official languages.
On the issue of enforcement, people may take their chances and continue to use their devices illegally or in unlawful ways if they think that the chances of meeting enforcement officers are slim. Even now, I still see e-scooters being ridden on the road or on footpaths, albeit in a limited way. I still see illegal specs e-bikes being used and e-bikes on footpaths.
May I ask the Minister, while we await the building of the extended cycling paths, what efforts will be taken to enhance enforcement as well as public education beyond the current efforts?
I have also in the past suggested that the Government should consider mandatory safe riding certification courses with disqualification rights. The competency test certification process adopted last month is a big step forward. I believe that with disqualification rights, people will take greater care to use their e-scooters safely and considerately. So, I would again urge MOT to incorporate disqualification rights in our law.
My third cut. Last month, in response to my Parliamentary Question, MOT affirmed that under the Active Mobility (Amendment) and the Shared Mobility Enterprises (Control and Licensing) Acts, food delivery companies should be responsible for ensuring that their riders ride safely.
The new Acts do not provide details on this. Will the Minister confirm that these regulations will be included in the subsidiary legislation?
Meanwhile, I would also like to suggest that such regulations must include imposition of penalties on the food delivery companies in the event of any failure on the part of their riders to comply with the law, for example, pertaining to the use of devices with correct specifications, use of devices on paths allowed for the relevant devices, riding safely, and so on.
It is important to ensure all food delivery companies will take ownership of the issue of their riders using lawful devices or riding lawfully and safely during their deliveries.
On the very day the Government banned e-scooters from footpaths, Deliveroo announced that they would stop working with e-scooter delivery riders on footpaths. However, I continue to see GrabFood delivery riders using e-scooters on footpaths or roads even in the last two weeks. I am shocked that GrabFood still allow their delivery riders to carry out delivery in an unlawful manner and I hope that MOT will take action.
Separately, in respect of the delivery companies’ obligations to ensure that their active mobility riders have third-party insurance, will MOT take steps to ensure that all third party liability insurers will not be able to exclude or repudiate policy liability for accidents which take place while the riders are in breach of the law? For example, PMDs being used on the road, rider using an illegal specs e-scooter or PAB rider using footpaths. I am concerned that if allowed, claims by injured parties may be frustrated when accidents take place in such scenarios, which may defeat the very purpose of requiring such insurance coverage, particularly when the rider is self-employed and own his own device.
Mr Yee Chia Hsing (Chua Chu Kang): Chairman, early this year, Senior Minister of State Lam Pin Min mentioned that the Government will spend more than $1 billion to accelerate the completion of the island-wide cycling network.
While we have always mentioned that cycling is a good mode of transport for first and last mile connectivity and the focus has been to increase intra-town cycling network, can I also suggest that the MOT look at the possibility of cycling being a viable mode of transport for the entire journey?
Singapore is a small island and cycling is a good form of exercise. For someone working within 10 km of their workplace, cycling could be a good alternative if there are good inter-town cycling paths.
My hope is that it would be possible for my residents to cycle from Jurong West to Raffles Place on designated cycling paths in the future.
The Chairman: Mr Ang Wei Neng, you can take both your cuts.
Mr Ang Wei Neng (Jurong): Chairman, I am glad that MOT is accelerating the construction of Singapore’s network of cycling paths by a few years. It was previously announced that the network would be expanded from the 440 km currently, to 750 km by 2025, and up to 1,300 km by 2030. Does it mean that we are really trying to accelerate? We hope that MOT will give a firmer update on the timeline? Does it mean that we are aiming to build 1,300 km of cycling paths five years earlier, that means by 2025?
In determining exactly how the cycling paths should be laid out, to what extent does MOT consult with the local community? For instance, as cycling paths are typically carved out of existing footpaths for the more mature estates, who decides if the cycling paths are to be located on the left or right of the footpaths? Who decides the footpath were to be sandwiched between the cycling path and the road or the cycling path be sandwiched between the footpath and the road?
Also, from past experiences, we encounter problems with mature trees blocking the potential new cycling path or shared path. How is MOT coordinating with the various Ministries to expedite the construction of these cycling paths?
Chairman, my next cut is on Operating Train Services Overseas. This morning, there is a breakdown in the train service from Bishan to Yio Chu Kang, so that prompted me to change my speech. Let me declare my interest as part of the management team of ComfortDelGro before I continue my speech.
Singapore's train system has surpassed 1 million train-km between delays of more than five minutes. It is not a small feat. I do not know whether this morning's breakdown, how will it affect the 1 million mark.
However, nothing is perfect, just like when Police say Singapore has low crime, it does not mean there is no crime. When Singapore Airport is ranked the best airport in the world for a few years, it does not mean there is no lost luggage in Changi Airport.
Likewise, it is unreasonable to expect the train system be perfect and no breakdown at all. It is more important to build resilience within the train system; and the Circle Line and Downtown line have added resilience and some redundancy with the train system.
Similarly, the upcoming Thomson Eastern Line as well as Cross Island Line will build more resilience within the system. So, train passengers then can have alternatives when one line is down – like the London train system. To this end, I would like to ask the Minister when is a good time for LTA and Singapore train operators to join forces to bid for management of train services overseas?
By operating train services overseas, it will enable us to learn the best practices first hand and also bring the best to Singapore. This will benefit our Singapore commuters.
Train operators like Hong Kong's MTR has been operating overseas for quite some time. They have been operating 1,000 km of track in London, Stockholm and Australia. Similarly, French state-owned public transport company RATP operates in 14 countries and they have deep knowledge in how to operate the train system.
At some point of time, I would like to ask the Minister when will the Singapore fraternity, the train fraternity, consider operating the train system overseas, share our expertise overseas and bring the best to Singapore?
Mr Dennis Tan Lip Fong: Mr Chairman, the Bukit Panjang LRT system, dogged by reliability issues, is now undergoing a $344 million overhaul that is due to be completed in 2024. Yet, we should not forget that parts of the Sengkang-Punggol LRT system (SPLRT) are also reaching a critical point in their lifespan where concerns on reliability may begin to surface.
Indeed, both LRT lines were upgraded to two-car operations in 2016 and load on the systems would surely have increased. SPLRT did see some preventive maintenance and asset renewal works between 2017 and 2018. However, if past experience with the MRT system is any indication, should we expect that more works ought to be done to maintain and improve on the reliability numbers of the LRT system? I would like to ask the Minister when can the residents in both Sengkang and Punggol expect such renewal and overhaul works to happen?
Mr Melvin Yong Yik Chye (Tanjong Pagar): Mr Chairman, I am heartened to see that the efforts of our extensive multi-year, multi-billion dollars rail renewal projects are now bearing fruit. Reliability of Singapore’s overall rail network has continued to improve steadily, reaching an impressive 1.08 million MKBF in the first nine months of 2019.
But as we applaud the good work done thus far, we must not become complacent, or else, we risk undoing all that we have managed to achieve thus far. I would like to ask the Ministry to provide an update on the respective on-going rail renewal projects.
I would also like to ask if the Ministry has any plans to renew and refurbish our older MRT stations, in particular, along the North-South and East-West Lines, some of which were built more than 33 years ago.
Rail maintenance workers are our unsung heroes in Singapore’s journey towards better rail reliability. They have been working hard day and night, including on weekends and public holidays, to carry out both maintenance and renewal works. Some have raised issues regarding the lack of sufficient lighting and ventilation when carrying out their work in the MRT tunnels. With an increasing network of tracks underground, it is important that we take care of the welfare of our workers.
I have been into the tunnels on several occasions to observe track renewal as well as tunnel cleaning work. Rail maintenance is back-breaking work, and I hope that the Ministry can look at improving the work conditions for our rail workers.
Mr Arasu Duraisamy (Nominated Member): Chairman, I would like to declare my interest as the General Secretary of Singapore Port Workers Union.
The development of Tuas South is picking up pace. Sembcorp Marine shifted its HQ to Tuas in 2019, bringing along a large number of its workforce from other parts of Singapore office as they consolidated operations in Tuas.
PSA Tuas Mega Port will start operations next year. While the initial workforce numbers remain small, it will grow over time as more container berths become operational over the coming years.
In my engagement with workers and union leaders, one of the main concerns was the distance between home and work. Based on SMRT's website, a commuter will take around 90 minutes to commute between Pasir Ris and Tuas Link, and approximately 72 minutes he stays up-north from Yishun to Tuas Link. The complete journey does not factor in another half hour of travelling time to his actual workplace along Tuas Boulevard. This worker will be spending a minimum of 15 to 16 hours per day just for work and travel, assuming he is on a 12-hour shift roster.
Together with the sectoral tripartite partners, interim transport solutions have been put in place to cater to the workers' travelling needs. It is just a temporary solution and not a permanent solution.
At last year's Committee of Supply debate, I proposed to MOT to consider an MRT line down-south to reduce travelling time and the idea was dismissed due to projected low ridership. Can MOT reconsider the proposal for an automated people mover system in light of workforce growth in Tuas South?
Can the Minister also share what would the projected ridership numbers be for Tuas South in five and 10 years' time? What are the long-term transport plans for Tuas South and how does MOT intend to address workers' concern on reducing their commuting time, especially for those staying in the eastern part of Singapore?
Mr Lim Biow Chuan (Mountbatten): Sir, the 2019 poll on public transport showed that satisfaction with rail reliability has improved substantially as compared to a few years ago. Most commuters who take the MRT will notice that there have been marked improvements in train capacity, train reliability and comfort.
As a regular MRT commuter, let me thank the Transport Minister and the team at MOT and all the people who have helped make improvements to the rail network system.
As we continue to push for a car-lite society, may I urge MOT to consider having more public bus services to shuttle private estate residents to and from their homes to MRT stations during peak hours. Currently, whenever I request for a bus service, the usual response from LTA is that there are adequate options. But if adequate options means to walk a distance in the hot sun or rainy weather to the bus stop, then most residents will stick to driving their cars to their office.
Hence, I urge MOT to make an extra effort to make public transport more convenient for residents. Offer them a shuttle bus service to bring them to the nearest MRT station. If that extra effort is not made, it is unlikely that we will be able to persuade the residents to give up the comfort and convenience of their cars to walk a longer distance in the hot sun or rainy weather, just to take public transport. Make it so convenient that it is a no-brainer to take public transport as compared to their private cars.
Next, may I ask Minister for an update as to the completion date for the eastern sector of the Thomson East Coast Line (TEL). I have four stations in my constituency and many of my residents are very excited about having a new train line near their homes. Is it possible that completion of the TEL may take place earlier than 2023?
Mr Louis Ng Kok Kwang (Nee Soon): Sir, there is no doubt that the Cross Island Line is needed and I also have no doubt that we can reduce its impact on our biodiversity. People are concerned that the clearance and construction work at worksite A1W1 will have a major impact in breaking up wildlife habitats.
It would mean that tree-dwelling animals like the Raffles' Banded Langurs might not be able to get from one forest patch to another and this will threaten their survival. There are only 61 Raffles' Banded Langurs left in Singapore. The stakes are extremely high. These highly threatened monkeys are only found in the Central Catchment Nature Reserve. This is one of their last strongholds. If the forest is cleared for the worksite, the Langurs who rely on tree canopies will be forced to come down to the ground to use the roads to cross and they will likely get injured or killed.
We know through the work of Dr Andie Ang that a bachelor group of four male Langurs – Leonardo, Michelangelo, Donatello and Raphael – need the forest at the worksite A1W1. While mitigation measures have been proposed, Dr Andie feels that these measures will not work. She personally told me that she fears for the survival of this species.
Will MOT consider moving worksite A1W1 further into Singapore Island Country Club (SICC) where the forest that the Langurs need will not be impacted?
Miss Cheng Li Hui (Tampines): Sir, I am heartened to note that the rail reliability has improved in 2019. The overall MRT Mean Km Between Failure (MKBF) was over 1 million km from October 2018 to September 2019. MOT has successfully achieved bold target of 1 million km between failure, as set by Minister Khaw in 2017. Our trains are now as reliable as the Taipei Metro and Hong Kong MTR. I applaud the team for their resilience, determination and hard work in achieving the target.
Beyond ensuring timely renewal and maintenance of assets, we also need to build a pool of ever ready and competent rail engineering and maintenance crew to cope with a rapidly expanding rail network.
Can the Minister share details of the training and upskilling programmes available for rail engineers? How have these programmes led to the recent improvement in rail reliability and whether these programmes would be further enhanced?
The Chairman: Mr Melvin Yong, you can take your three cuts together.
Mr Melvin Yong Yik Chye (Tanjong Pagar): Chairman, our rail network will grow significantly over this new decade. The addition of three new lines – the Thomson-East Coast Line, Jurong Region Line and Cross Island Line – will increase the length of our rail network by about 130 km, bringing the total network length to about 360 km in 2030.
As our rail industry grow, we need to upskill existing workers and recruit more rail professionals to run the expanded and more complex train network. The $100 million Rail Manpower Development Package, announced by Minister in November 2019, will help accelerate this transformation of our rail workforce.
Can the Ministry provide an update on the initiatives under the Rail Manpower Development Package? Additionally, how many workers are expected to benefit from these initiatives?
Chairman, my next cut will focus on the future of our land transport system, which will be electric, connected and autonomous.
First, I applaud the Government for its ambition to phase out Internal Combustion Engine vehicles by 2040 and to embrace Electric Vehicles (EVs). Can the Ministry provide an update on the growth of EVs in Singapore over the past five years?
Fleet vehicles, such as our public buses, will be key in driving critical mass for islandwide EV-adoption. Does the Ministry have plans to replace all public buses with electric buses and what will be the timeline? Will our island's charging infrastructure be sufficient for the mass adoption of EVs?
Sir, the future land transport system will also be autonomous. Could the Ministry provide an update on the various Autonomous Vehicle trials and whether the plan to pilot autonomous buses in Punggol, Tengah and the Jurong Innovation District in the early 2020s is still on track?
Chairman, my final cut will be on the Bus Contracting Model (BCM). The introduction of BCM in 2016 has indeed transformed our public bus industry to become more competitive. Today, we have four public bus operators operating 14 bus packages. Commuters are enjoying better service reliability and reduced wait times, resulting in bus ridership hitting an all-time high of over four million daily rides in 2018.
I would like to ask the Ministry for an update on how the BCM has benefited the public bus industry, in terms of bus captain wages, quality of service and commuter satisfaction.
But as I highlighted in last year's Committee of Supply debate, BCM is not without its drawbacks. Bus captains have informed me that their jobs today, are now more stressful than ever, as they have to meet new stringent KPIs imposed. Could the Ministry share how it intends to mitigate this additional stress faced by our frontline bus captains?
Additionally, I would like to ask if the Ministry has learnt any lessons from the tendering of the first four BCM packages and if there will be any changes to the future tenders.
Lastly, I would like for the Ministry to update on their plans to enhance our public bus infrastructure to keep up with the increase in our public bus fleets and to cater for the introduction of electric buses.
Mr Ang Wei Neng: Chairman, the push by the Government to phase out the internal combustion engine vehicles in Singapore by 2040 is a very ambitious plan. This means that more than 600,000 diesel and petrol vehicles today will be replaced by full electric vehicles or other green vehicles in 20 years' time unless the Government is thinking of shrinking the vehicle population very drastically.
Before I proceed, I will like to declare my interest as the CEO of ComfortDelGro Taxi business. I have explicitly supported the plan to roll out more clean and green vehicles last week in the Parliament. However, I will like to make a few clarifications today.
Firstly, how is the Government going to realise the plan of increasing the charging points from the current 1,600 points to 28,000 points in 2030? What kind of incentives will Government provide for real estate owners, car park owners or operators or new players to install more new charging points?
Today, we have about 1,125 electric vehicles (EVs) supported by 1,600 charging points. Come 2030, how many EVs can be supported by 28,000 charging points? If most of the EVs are charging at about the same time, say in the evening, do we need to upgrade our Power Grid?
The current Vehicular Emissions Scheme (VES) allows fleet owner to enjoy up to $30,000 of rebate off the Additional Registration Fee (ARF) but the EV Early Adoption Incentive (EEAI) is only capped at $20,000 rebate off the ARF. In short, EEAI alone is not as attractive as VES. Does MOT have plan to continue with VES next year so as to supplement and compliment the EEAI?
We will like to seek clarity so that fleet owners can better support Government's green initiative.
The Senior Parliamentary Secretary to the Minister for Home Affairs and National Development (Ms Sun Xueling): Mr Chairman, one of the biggest challenges to EV ownership currently is the network of public EV Chargers. SP Group has committed to operate a public charging network with 1,000 charging points by 2020. Other providers include Greenlots and some car dealers.
Private property owners can install a wall box which are charging units, especially installed by the dealer at the electric vehicle owners' place of choice. However, the vast majority of consumers live in high-rise buildings. Greenlots, for instance, is installing charging stations at a small number of Condominiums and requires MCST approvals to do so.
I would like to inquire, what is the Ministry's roll-out plan to get from 1,600 electric charging points now to 28,000 by 2030. What potentially are some of the bottlenecks and what is the plan contingent on? How does the Ministry envision building charging points in public places and for private property owners?
Miss Cheng Li Hui: Sir, the bilateral agreements on the Kuala Lumpur-Singapore High-Speed Rail the Singapore-Johor Bahru RTS projects were signed in 2016 and 2018 respectively. When ready, the RTS link will allow 60,000 additional commuters to cross the Causeway during peak hour. The project benefits both countries by easing causeway congestion, reducing travelling time and facilitating business and tourism.
On 4 November 2019, it was announced that a suspension of the RTS project will be extended until 30 April 2020.
With a new government in Malaysia and the April deadline approaching, can the Minister provide an update on our bilateral transport projects. What is the status of RTS? Will progress commenced after April? If there is no progress, what other options are there to improve connectivity between the two countries and improving the Customs, Immigration and Quarantine (CIQ) facilities at our border.
The Chairman: Minister Khaw Boon Wan.
The Minister for Transport (Mr Khaw Boon Wan): Thank you, Chairman. Sir, my Ministry has prepared a simple folder, may I ask permission for the Clerks to distribute some of them.
The Chairman: Yes, please. [Handouts were distributed to hon Members.]
Mr Khaw Boon Wan: Mr Chairman, COVID-19 is still wreaking havoc around the world. In Singapore, Changi Airport took the first hit. Airlines have cancelled over 20% of their scheduled flights. Passenger volume at Changi has plunged by 25% and is likely to fall further. Both the cruise and ferry sectors are devastated. As China locks down, global supply chains are also disrupted. As fear grips, people telecommute more and go out less. Along with reduced tourist arrivals, our bus, rail, taxi and private hire car riderships have fallen by about 20%. This has taken a toll on the livelihoods of our taxi and private hire car drivers.
We are also tracking the impact on our transport infrastructure projects. For now, the delay to project timelines is still manageable. But if the outbreak drags on, it could disrupt the supply of construction equipment and materials. This could impact the timeline for Terminal 5, Tuas Port, new MRT stations and the next-generation ERP system. For example, our new trains are being built in China.
With support from our tripartite partners, the Government reacted swiftly with a robust Unity Budget 2020.
For the transport sector, MOT worked closely with NTUC and our transport operators to put in place relief measures to support our workers, while providing assurance to our commuters. Let me join Mr Sitoh Yih Pin to thank all frontline transport workers for keeping Singapore moving amidst this outbreak.
The COVID-19 outbreak will burn out. Sooner or later, our economy and our industries will recover. While we attend to the immediate needs, we should also focus on the eventual recovery and make full use of this lull period.
First, position our companies and workers to ride the eventual upturn. Use this opportunity to transform and grow. We have the road maps, the air, land and sea transport Industry Transformation Maps, to show us the way forward. Let us carry them out.
Second, press on with our infrastructure plans. Over the next five years, we have an extensive line-up of construction projects in the transport sector.
On the aviation front, we are expanding Changi Airport. The third runway will be operational by the middle of 2020s. The development of Terminal 5 is well underway.
On the maritime front, Tuas Port Phase 1 will be fully operational by 2027. When fully completed in the 2040s, Tuas Port will be the world’s single largest fully-automated container terminal. Together, these investments will grow our external connectivity to seize growth in the global transport of goods and people.
Another international link is the proposed RTS Link with Malaysia. Miss Cheng Li Hui asked about the progress. The project remains suspended until the end of April this year. Recent political developments in Malaysia will further impact the project. While we remain committed to working with Malaysia to find a way forward, the project cannot be suspended indefinitely. We, therefore, look forward to hearing from Malaysia soon. Are there other options to address the Causeway jam? Expanding the immigration facilities will help as the current capacity is inadequate to handle the peak traffic. Better distribution of traffic between the Causeway and the Second Link will also help. Likewise, a better distribution of traffic between peak and off-peak periods. We have been trying to pursue all these options, but to move the needle meaningfully, the RTS Link is the answer.
On the domestic land transport side, we stand ready to speed up over $100 million worth of cycling path and road construction projects by up to three years.
But beyond the immediate, our vision is a clean and green transport system for Singapore. This will raise the quality of life for generations of Singaporeans to come. We will make three strategic moves.
First, phase out vehicles with internal combustion engines (ICE) by 2040. In other words, no more ICE vehicles by 2040! We have 20 years to phase them out. Senior Minister of State Dr Janil Puthucheary will explain how we can achieve this and replace them with cleaner vehicles.
Second, speed up the construction of our cycling infrastructure. Senior Minister of State Dr Lam Pin Min will explain how we can get more Singaporeans to Walk-Cycle-Ride for first-mile and last-mile connectivity.
Third, keep our public transport among the best in the world. As noted by Mr Ang Wei Neng, Mr Sitoh Yih Pin, Miss Cheng Li Hui, Mr Melvin Yong and Mr Lim Biow Chuan, we have turned the corner on rail reliability. So, let me join these Members to thank our transport workers – LTA, SMRT, SBST and the National Transport Workers’ Union – for their hard work and dedication. But remember, maintenance is a continuous effort. Never lift your eyes off the ball. And, certainly, never be complacent. Let me also thank our commuters for their patience and understanding. But remember, a highly reliable MRT line may still experience some occasional hiccups. We do our best to reduce such inconveniences to the absolute minimum.
I note Mr Ang Wei Neng’s suggestion that our rail operators should seek to venture abroad, as our bus operators have done. This is something for the operators to decide. But if they do, my advice is that their foreign ventures should not distract them from their domestic operations in Singapore. Their priority must always be to ensure safe, smooth and reliable journeys for our commuters in Singapore.
In any case, our two rail operators will be fully engaged with our domestic network. There is plenty of work to be done. Over the next decade, we will be spending over $60 billion to expand and renew our rail network – $60,000 million of works to be done. Let me elaborate in response to Mr Sitoh Yih Pin, Mr Melvin Yong and Mr Dennis Tan.
First, we will be completing the Thomson-East Coast Line (TEL). Stage 1 has already opened. Stage 2 will follow within the next few months – single digit months. Mr Lim Biow Chuan and his residents in Mountbatten will benefit from Stage 4 of TEL by 2023. Can we expedite further? \"Jing kang kor\" – I think very difficult. First, it is a very complex project. Every time I meet the team, my message to them is \"safety first\". Do not be hasty. Deadlines are there to meet. Certainly, you want it done as soon as possible. But never compromise on safety.
Second, we will be completing the extensions to the North East Line and Downtown Line by 2023 and 2024 respectively – within the next term of Government. We will see four new stations added to our rail network. This includes the opening of Hume Station by 2025, which Mayor Low Yen Ling has actively lobbied for in previous COS. This year, I did not find her \"cut\".
Third, we will be completing the Circle Line when we complete the circle. This final stretch at Keppel is the most challenging to build and also the most costly. But when completed in 2025, it will significantly raise the resilience of our MRT network and the travelling experience of our commuters.
Fourth, we will be completing the Jurong Region Line by 2028. Like Mr Arasu Duraisamy, we want our Tuas port workers to have good public transport to Tuas. JRL will benefit them. This is in addition to the Tuas West Extension and bus services 247 and 248 in the Tuas South area which we had put in over the past few years.
Fifth, we will be completing Phase 1 of the Cross Island Line by 2029. This will contribute towards the subsequent growth of our rail network to 360 km from the current 230 km. In fact, a Singaporean student studying in Geneva, Faiz Basha, was so excited by the plan for our rail network that he produced a revised MRT map for 2030 and beyond. Mr Cedric Foo referred me to this map. He was intrigued by it and he described it as a beautiful map and, indeed, it is. Senior Minister of State Dr Janil Puthucheary told me of another Singaporean, architect Cliff Tan, based in the UK who has offered LTA many similar design suggestions. Both are overseas but their hearts are firmly anchored in Singapore!
Indeed, by 2030, around 80% of Singaporeans will live within walking distance of a train station. We would have achieved or exceeded the level of train connectivity enjoyed by the residents in Hong Kong, Tokyo and New York today. As Mr Cedric Foo remarked to me about our plan: “This is our commitment to build a liveable city in Singapore and this is MOT’s contribution to reducing traffic jams as well as carbon emissions!”
Apart from expanding our rail network, we will finally complete the renewal of the North-South Line and East-West Lines (NSEWL) by around 2023. Actually, 2023 is not too far off. This year is 2020; so, in only two to three years' time, Mr Lim! By then, we would also be able to see the benefits from the renewal of our oldest LRT line, the Bukit Panjang LRT. Ageing train stations, too, will be suitably refurbished and upgraded, especially the toilets and escalators. In time, we will also need to renew the next oldest lines – North East Line and Sengkang Punggol LRT – in good time.
The hard lesson learnt from the problems earlier faced by SMRT is that we must invest in good operations and maintenance. As noted by Miss Cheng Li Hui, this means engineering capabilities, as well as the timely renewal of old MRT and LRT lines. There is no free lunch.
As we pursue these projects, let me assure Mr Melvin Yong that we will continue to work with operators and unions to ensure optimal working conditions for our transport workers. Mr Yong knows that these are my top concerns. Every time I visit a depot, I would check in, talk to them, take a good look at their lounge, the furniture, the toilets. Those are signs whether the operators are paying attention.
They form the backbone of our transport system. We must support them well so that they can perform to their maximum potential.
Mr Chairman, transport is both capital-intensive and skills-intensive. That is why MOT’s budget is among the biggest in the Government. I think we are at number four this year although, in terms of the number of \"cuts\", we are at the bottom four, I think. I think it says something.
To ensure sustainability, we need taxpayers and commuters to co-fund it. The question is how to share the burden fairly. As posed by Mr Sitoh Yih Pin just now, it is how to strike a balance between financial sustainability, affordability, reliability and efficiency. It requires hard-headed calculations and a heavy dose of empathy. It requires political honesty and also sound judgement. That is why, among other things, we have a process comprising an objective fare formula and an independent Public Transport Council.
I agree with Assoc Prof Walter Theseira that fare adjustments must be accompanied by serious cost containment. We will continue to look for cost-cutting measures and productivity improvement solutions. We will also regularly benchmark our operators’ costs with their counterparts elsewhere. A recent NTU study gave us some reassurance that our operators’ costs are well within normal range. But we must also have the discipline to deploy public transport services prudently. That is why we have to sometimes turn down Members’ requests for new bus services – shuttle service, maybe we can negotiate – or shorter headways.
In the coming years, the expansion of rail and cycling lane infrastructure will add greater connectivity to the system and benefit more commuters. A highly interconnected transport network, supported by real-time information, will provide commuters with more route and mode options. Good mobile apps will empower commuters to choose the option that best meets their needs. As travel patterns change, we must be nimble to optimise the provision of public transport services. Assoc Prof Walter Theseira raised the idea of a transitional voucher for commuters affected by such optimisation. I am not so sure if it is easy to design such a scheme. But in a way, our cheaper off-peak rates are one such idea. In any case, we always ensure that commuters affected will have reasonable travel alternatives so that they will not be left in the lurch, and our Members do understand the need for cost management.
One such considerate Member is Mr Lim Biow Chuan. I have heard his request for additional public bus service for his private estate residents. LTA will evaluate his request seriously, carefully and fairly. We do have shuttle rides. I live in a private estate where there is a shuttle bus going around. In fact, it was the first private estate shuttle that runs on electricity – electric bus.
Mr Chairman, over the years, we have progressively transformed our land transport sector to better serve Singaporeans. It has not been a smooth journey but we never let difficulties discourage us. Mr Ang Wei Neng referred to McKinsey’s 2018 report ranking Singapore’s public transport as amongst the best in the world. More recently, there was a Business Insider France (11 February 2020) report on urban mobility, in which consulting firm Oliver Wyman joined forces with the Berkeley University of California to rank the top 10 advanced cities in the world based on the quality of their public transport systems. Singapore came out top. Credit must go to successive generations of MOT and LTA officials who put their heart and soul into this venture. But we know we are far from perfect. We still have a lot of things to do, including to complete the $60 billion strategic long-term plan for our rail network which I have outlined earlier and I look forward to Members’ continuing support.
My other MOT colleagues will now elaborate on our other plans moving forward.
The Chairman: Dr Lam Pin Min.
The Senior Minister of State for Transport (Dr Lam Pin Min): Mr Chairman, Minister Khaw spoke about the impact of COVID-19 on our transport network and our strategies for eventual recovery. He also laid down the vision of a clean and green transport system in Singapore. I will now elaborate on our efforts in the aviation and maritime sectors, and share how we can develop our cycling infrastructure to complement our vision for a clean and green transport network.
COVID-19 has hurt the aviation and maritime sectors. Passenger traffic at Changi Airport and cruise and ferry passenger numbers have declined significantly. Our priority for the coming months is clear: first, help industry tide over this difficult time; and second, position for recovery so that we emerge from this even stronger.
First, we will help the aviation and maritime sectors tide over this difficult time. On top of economy-wide measures, we have rolled out a $112 million assistance package to help the aviation sector defray cost and ease cashflow pressures. For the maritime sector, we have provided a 50% port dues concession to passenger vessels, on top of all existing concessions. We will also provide targeted assistance to affected ferry operators and other enterprises located at Marina South Pier and West Coast Pier.
We are also helping companies reduce their costs so that they can help Singaporeans keep their jobs and use this time to go for training. Take, for example, airline crew, which Mr Ang Hin Kee asked about. Due to the adverse impact of COVID-19, the SIA Group has temporarily suspended more than 9,000 flights, or nearly 15% of all its scheduled flights from February to end of May. Notwithstanding this, SIA is committed to helping its crew keep their jobs.
The Government is supporting this, through rebates on landing and parking charges, waivers of regulatory fees and the Jobs Support Scheme. These measures will help ease the financial pressure and support the retention of local employees. Early this week, SkillsFuture Singapore (SSG), Workforce Singapore (WSG), the Civil Aviation Authority of Singapore (CAAS) and NTUC announced an enhanced training funding and support package for air transport companies; we will work with airlines to facilitate their staff, including cabin crew, to attend training courses and will monitor the take-up rate.
We are watching the situation very closely and stand ready to do more if the situation worsens. Our commitment to our aviation and maritime sectors is this: we will get through this together. Working together as SGUnited, we can overcome COVID-19.
Second, we will work with industry to position for recovery so that we emerge from this even stronger. Mr Yee Chia Hsing asked how we can keep our air and sea hubs competitive. To stay competitive, we will invest in the three Cs – Capacity, Capability and Connectivity – and at the same time, develop sustainability as our new priority.
Current challenges notwithstanding, air passenger numbers are expected to double from four billion to eight billion globally in the next 20 years; one in two of this growth, or 50% of this growth will be in Asia. For the maritime sector, the growth outlook is likewise positive. These translate to huge demand for capacity, capability and connectivity and offer tremendous opportunities for Singapore. But how do we respond to this?
First, on capacity, we will press on with the development of Changi Terminal 5 and Tuas Port so that we are in time with new infrastructural capacity to meet future demand. We are not done building our air and sea hubs. Our efforts will not be hampered by COVID-19.
Second, on capability. We cannot meet the new demand just by growing manpower; we need to leverage technology and raise productivity. We will help companies transform and capture new opportunities.
Take, for example, CAAS will extend the $280 million Aviation Development Fund for another five years, from 2020 to 2025. Since 2015, the Fund has already helped nearly 80 organisations raise productivity through over 200 initiatives. Real value-add per worker has increased by over 7% between 2015 and 2018. One such initiative is SATS' smart glasses. It uses augmented reality technology to track the real-time location of baggage and cargo units and helps workers cut loading time.
The Maritime Port Authority of Singapore (MPA) and IMDA have also launched the Digital Acceleration Index to help maritime companies self-evaluate their digital maturity. MPA and the Singapore Shipping Association will take this a step further to launch the Maritime Innovation Playbook to help companies develop their digitalisation plans. Companies can also tap on MPA's Maritime Cluster Fund and the Sea Transport Industry Digitalisation Plan to support their digitalisation efforts.
We will also equip workers with new skills to take on new and better jobs. We will train up a younger generation of Singaporeans so that they can benefit and grow with the air and sea industries. Come April, together with ITE, we will launch two new Work-Study Diploma courses in Airport Operations and Maritime Business Management respectively.
Third, on connectivity. While demand may be down now, we will continue to maintain connectivity so that we can bounce back quickly when recovery returns. We will continue to push for air services liberalisation, to strengthen existing connections to cities and to build new ones. We will also go beyond physical connectivity to build digital connectivity. MPA's digitalPORT@SG™ will streamline digital port clearance processes for ships calling at Singapore and improve the efficiency of vessel calls. Likewise, digitalOCEANS™ will link us up to other maritime-related digital platforms globally to improve efficiency in the global supply chain.
The safety and security of our sea-lanes is fundamental to maritime connectivity. Mr Dennis Tan asked what more we can do to address piracy and armed robbery incidents in the Strait of Singapore.
I would like to reassure the House that our maritime security agencies, the RSN and PCG, will deal with any suspicious vessel entering Singapore waters robustly and take actions against perpetrators of crimes conducted.
However, as the Strait of Singapore does not only include Singapore territorial waters, the fight against piracy and armed robbery requires strong collaboration among all regional partners and Singapore cannot tackle it alone.
This is why there is the Malacca Straits Patrol (MSP) involving our military and the militaries of Malaysia, Indonesia and Thailand. The MSP includes air and sea patrols in the Straits of Malacca and Singapore. And as the Minister for Defence had shared with the House during MINDEF's COS debates on Monday, MINDEF has reached out to its counterparts in Malaysia and Indonesia to propose that MSP be extended to other areas in our surrounding waters. Discussions are on-going. The RSN's Maritime Security Task Force will also be enhancing their capabilities to deal with maritime threats.
Other actions are also taken to combat piracy and armed-robbery. MPA advises commercial vessels to stay vigilant, keep a lookout for pirates and take anti-piracy measures, such as holding training drills. Singapore is also part of a region-wide initiative called ReCAAP (Regional Cooperation Agreement on Combating Piracy & Armed Robbery against ships in Asia), which facilitates timely and accurate information sharing so that the respective littoral States and the shipping community can take prompt remedial actions.
While we position ourselves to seize the growth opportunities in aviation and maritime, we will do so sustainably. Singapore will not just be a competitive international transport hub but also a sustainable one. Let me lay out some of our strategies.
On the aviation front, we will play our part to contribute towards the International Civil Aviation Organization’s (ICAO)'s aspirational goals of 2% annual fuel efficiency improvement and carbon neutral growth from 2020 onwards.
First, Singapore is ready to participate in the voluntary phase of the Carbon Offsetting and Reduction Scheme for International Aviation (CORSIA) that starts next year. Under the scheme, our airlines will freeze their carbon footprint at current levels by reducing emissions and purchasing carbon credits.
Second, Singapore's aviation community will work together towards greener aviation. Singapore Airlines has invested in the latest aircraft models that are more fuel efficient and has an average fleet age that is nearly half that of the industry. CAAS, our Air Navigation Service Provider, will continue to invest in new technologies and air traffic management processes to improve flow and cut delays. In 2019, these processes reduced about 130,000 tonnes of carbon emissions. Changi Airport Group will continue to invest in environmental sustainability initiatives, such as energy-efficient cooling systems, infrastructure for charging electric vehicles and renewable energy options.
Third, we will study the use of sustainable aviation fuels (SAFs) in Singapore. SAFs can reduce emissions by up to 80% over their life cycle compared to conventional jet fuel, but they are two to five times more expensive today. Singapore houses key global aerospace companies and fuel producers, such as Rolls Royce, Shell and Neste. The Government and the industry players are studying different business and technological models to enable economically viable and sustainable SAF supply chains in Singapore.
On the maritime front, Singapore is committed to environmentally sustainable international shipping under the leadership of the International Maritime Organization (IMO).
On 1 January 2020, Singapore, together with the rest of the world, implemented the IMO 2020 regulation that reduces the permitted sulphur content in the fuels used by vessels from 3.5% to 0.5% outside designated Emission Control Areas. Beyond this, the IMO has set a longer term target to reduce the total annual greenhouse gas (GHG) emissions caused by international shipping by at least 50% by 2050, from 2008 levels.
Singapore will play our part under IMO2050. While IMO2050 is still 30 years away, we will start making plans now so that our companies and workers are equipped to seize new opportunities that arise from the shift. I am happy to announce today three new initiatives to position Singapore for the long-term maritime sustainability.
First, MPA will launch the Maritime Singapore Decarbonisation Blueprint 2050 next year. The blueprint will chart out strategies to achieve a sustainable maritime Singapore and establish Singapore as a responsible hub port and international maritime centre.
Second, the Singapore Maritime Foundation will set up an International Advisory Panel to garner inputs from local and international leaders from the industry and academia for this effort. The panel will convene for the first time in April this year.
And third, MPA and its partners will set aside $40 million under the Maritime GreenFuture Fund to be used for the research, test-bedding and adoption of low-carbon technologies.
Mr Chairman, this is what we do to help our aviation and maritime sectors compete, always looking beyond the horizon, planning for the long term, working in close partnership with workers and companies, and this will distinguish Singapore from other competing cities.
Our land transport system also plays an important role in securing a sustainable future for Singaporeans.
We will continue to work towards our car-lite vision and promote public, shared and active modes of transport as they are the most environmentally sustainable. I will touch on our efforts to promote active mobility, which has a low environmental footprint and complements our public transport system in moving towards a car-lite Singapore.
In cultivating a sustainable active mobility landscape, we have enhanced our regulatory and enforcement regimes. With the recent ban on e-scooters on footpaths and enhanced regulatory regime on active mobility devices, path safety has improved.
As Mr Dennis Tan said, businesses have a role to play, which is why LTA has introduced regulations on companies and continues to work closely with companies to encourage responsible behaviour by their riders. One requirement is that companies must ensure that all riders they hire in the course of work have third party liability insurance. LTA will specify minimum requirements for these insurance policies.
Mr Dennis Tan also pointed out the importance of public education and enforcement. That is why we are introducing a mandatory theory test for all e-scooter and power-assisted bicycle (PAB) riders to educate and raise awareness. We have also enhanced the penalties to strengthen deterrence against offences like speeding and reckless riding. LTA will not hesitate to take errant riders to task. Regarding Mr Dennis Tan's suggestion to disqualify riders who commit serious offences from riding, we will work with the Active Mobility Advisory Panel (AMAP) to study if it is necessary to do so, depending on the safety situation going forward.
Several Members have asked about our infrastructure plans. They will be pleased to know that we are accelerating the development of cycling paths. We have previously announced that there would be 750 km of cycling paths by 2025. We will bring this milestone forward by two years, reaching 800 km of cycling paths by 2023, which is not that far away – about three years away. The Government plans to invest over $1 billion as part of the Islandwide Cycling Network (ICN) programme to bring the cycling path network closer to Singaporeans' doorsteps.
By 2023, all HDB towns will have cycling paths. All HDB residents will have direct access to a wider cycling path network that is almost double the existing network. Residents can look forward to the cycling path plans for their towns within the year. LTA is working closely with Government agencies and local communities to ensure that the cycling path network meets the needs of the residents.
Towns which currently lack cycling paths or have many active mobility device users will have cycling paths built first. For towns with cycling path networks, we will continue to enhance connectivity, so that residents can enjoy more seamless access to key transport nodes and amenities like the town centre, MRT stations, eateries and malls.
And as Mr Ang Wei Neng has highlighted, constructing cycling paths in mature towns require trade-offs, especially in densely built-up mature towns. In some cases, we may have no choice but to reclaim grass verges and affect trees. In others, we may need to re-purpose roads.
By 2026, Singapore's cycling path network will be expanded to 1,000 km. With this, eight in 10 HDB residents will be a few minutes away from the cycling path network. Most HDB residents will be within 250 m from the nearest cycling path. This cycling path density is comparable to cities such as Amsterdam or Copenhagen. HDB Residents can expect to reach their nearest town centre within 20 minutes using active mobility modes.
By 2030, we would have trebled the cycling path network to 1,320 km.
Singaporeans will benefit from a comprehensive cycling path network connecting all HDB towns. The expanded cycling path network will allow more inter-town journeys to be carried out entirely on cycling paths. Active mobility device users can look forward to a safer and more seamless riding experience, with fewer interruptions. In addition, residents in Queenstown, Geylang, Jurong West, Sembawang, Yishun and Ang Mo Kio can rely on the Queenstown-City and Geylang-City routes, the Round Island Route, and North-South Corridor for journeys from their homes to the city before 2030.
With these developments, more journeys can be carried out entirely on the cycling path network, as Mr Yee Chia Hsing has pointed out.
Lastly, we need to develop the right culture of graciousness. This is critical in densely populated Singapore, where users of different modes of transport are constantly in close proximity.
The Active Mobility Advisory Panel (AMAP) will continue to promote greater acceptance of active mobility in Singapore by focusing more on engagement and educational measures, and calling on all path users to be safe and considerate.
Going forward, how can we do better, together? I would like to suggest a simple way, which is to look out for each other.
On roads, motorists should practice good road safety habits and be vigilant and look out for other road users. On paths, device users should watch out for other path users and ride safely and considerately. Pedestrians should also be alert to their surroundings and keep to the left unless overtaking. They should walk on footpaths wherever they are, located adjacent to cycling paths.
We will also continue to monitor the environmental impact of our other land transport projects.
Take, for instance, the Cross Island Line. We have engaged stakeholders extensively since 2013 and will continue to do so even as the project enters the Advanced Engineering Studies phase. Concerning the proposed worksite near the Singapore Island Country Club (SICC) that Mr Louis Ng mentioned, LTA is committed to exploring how the worksite's footprint can be optimised and is in discussions with SICC to make use of its non-playing areas.
Mr Chairman, we will stay resilient in this challenging period of COVID-19 and together, we will weather this storm. As Mr Yee Chia Hsing said, we did not become a major international aviation and maritime hub by chance, but through having a bold vision and thorough planning. We will continue to invest for the future, and sow the seeds for sustainable and competitive transport sectors. I will now hand over to Senior Minister of State Janil Puthucheary, who will explain our strategies for a sustainable land transport system.
The Senior Minister of State for Transport (Dr Janil Puthucheary): Mr Chairman, several Members have asked questions or provided suggestions that I will address in my response.
Mr Ang Wei Neng, Ms Sun Xueling, Mr Melvin Yong and Miss Cheng Li Hui have brought up issues such as COVID-19, taxi and private hire car (PHC) drivers, the transition to the Bus Contracting Model, the push for electric vehicles and the necessary incentives and infrastructure. They have also asked about our plans for autonomous vehicles and the future professional development of our transport workforce. I hope to address their questions.
COVID-19 has affected the public transport and point-to-point sectors. Compared to about a month ago, ridership on our MRT, our public buses and point-to-point transport sector has fallen by around 20%. The taxi and PHC drivers' livelihoods have been badly affected. They need help so that they can continue to provide sustainable services for Singaporean commuters.
Together with the operators and the driver associations, we launched a $77 million Point-to-Point Support Package last month. This will help to partially defray business costs incurred by about 40,000 eligible drivers. Taxi operators such as ComfortDelGro, SMRT, TransCab and Premier have committed to further help and will lean forward to provide additional rental rebates to their drivers, on top of matching Government's contributions to the package. This brings the total support committed by Government and operators to over $90 million over three months.
Eligible drivers have started receiving rental rebates or cash grants of up to $36.50 per day. Drivers who do not meet the eligibility criteria can seek help via the Government-NTUC Driver Care Fund. We hope that this will help the drivers through this difficult period.
But COVID-19 could have a longer term impact, so we are working closely with the operators and the driver associations to monitor the situation. If necessary, we will consider further support.
Even as we deal with COVID-19's immediate impact, we must push on with our plans for a future-ready land transport system. The Land Transport Masterplan 2040 (LTMP 2040) sets out this long-term vision that we have for our land transport system. It was developed in consultation with over 7,000 Singaporeans. And many participants recognised that Singapore is running up against tighter land, manpower, fiscal and environmental constraints. Long-term sustainability has to be a key planning consideration for our transport system.
There are three critical strategies for us to achieve this long-term sustainability of our land transport system.
First, we have to make Walk-Cycle-Ride (WCR) the preferred modes of transport here in Singapore. Walking – connecting us to the transport nodes, to the MRT, to the buses, and also to the amenities. Cycling – for those who can, as a very efficient and healthy way of getting around town. And riding – whether it is the MRT, the bus or shared vehicles, in preference to private car ownership.
The second key strategy is to move comprehensively to cleaner and greener vehicles – dealing with the emissions, dealing with resource utilisation and the issues around carbon.
Thirdly, we have to optimise our land transport system for the future. Every little bit of marginal gain – whether it is safety, whether it is efficiency, whether it is cost, whether it is the experience of the commuters – is important; and the best way to do so is to appropriately and correctly use technology to optimise our land transport system.
First strategy on making Walk-Cycle-Ride the preferred modes of transport.
It is sustainable, and Minister Khaw spoke about our ambitions for a world-class public transport network, our investments over the next decade to renew and expand the rail network. Senior Minister of State Dr Lam Pin Min spoke about how cycling and active mobility can play an appropriate role in this landscape.
Buses will also play an important role. Today, they already connect millions of Singaporeans to their homes, their schools and their offices on a daily basis.
The Public Transport Council's annual Public Transport Customer Satisfaction Survey (PTCSS) shows that commuter satisfaction in our public bus services continues to be high. The Bus Contracting Model (BCM) played an important part in achieving this. We have injected additional capacity through the BCM for more than 100 bus services. We have also built, replaced or upgraded 16 bus interchanges island-wide to keep pace with this larger bus fleet. Peak-hour bus waiting times for trunk services have come down from 20 minutes or less in 2016 to 15 minutes or less today. These improvements would not have been possible without the hard work, the dedication and the commitment of our bus captains.
The BCM was a major change for our bus industry and tripartite partners worked closely together to ensure a smooth transition. In particular, the National Transport Workers' Union (NTWU) played a key role in the development of tripartite guidelines to protect the welfare of bus sector employees and our bus captains. Bus operators competing for contracts under the BCM have to abide by these guidelines, which ensure that bus employees will be treated fairly and will be no worse off when a new operator takes on a contract.
Through this close partnership with NTWU, we have seen improvements to the working conditions for bus captains, such as upgraded staff canteens and more rest areas. The starting monthly pay for new local bus captains has also increased by over 25% since 2014, higher than the national wage growth of 18% over the same period. All of these would not have been possible without the NTWU's leadership and active participation, and we very much appreciate their contribution to this effort.
Our second strategy – to encourage cleaner and greener vehicles. It appears self-evident and has been discussed at great length in other parts of this Committee of Supply (COS) and also in the debate on the Budget. It is important and it is vital as we continue to grow our land transport system.
As mentioned in Deputy Prime Minister Heng Swee Keat's Budget speech, all vehicles will run on cleaner energy by 2040. This means that after 2030, we should see no new purchases of internal combustion engine (ICE) vehicles. Today, we have close to 900,000 ICE vehicles, and this will require an extensive transformation of the fleet, significant changes in commuting and consumer behaviour, and development of the necessary supporting infrastructure to achieve this vision.
Today, Electric Vehicles (EVs) are the most promising cleaner vehicle technology. Car manufacturers are developing new models that are energy efficient and increasingly cost effective. Other technologies such as the hydrogen fuel cell vehicles, could be viable in the future, but today they are currently less suited for mainstream use. We in Singapore lack a supply of green hydrogen to power hydrogen fuel cell vehicles. So, if we choose that path there will be a higher cost associated with the technology, infrastructure and refuelling. Nevertheless, we will continue to monitor developments and we will move in a way towards this vision for 2040 that will allow us to adapt to other technologies in the future.
It is an ambitious undertaking and there are serious challenges that we will need to overcome. The Government will make four moves to achieve this vision.
First, we will ensure that there is enough charging infrastructure accessible to EV owners. It will not be easy, but this is very important. Because if you are considering purchasing an EV over an ICE vehicle, you have to be convinced that you have access to a charger which is as convenient as access to a petrol station.
As a first step, we will prioritise the charging provision at carparks, starting with public carparks.
We will also work with the private sector to improve charging provisions at private carparks. We encourage charging providers to partner private developers and building owners, as many of them are keen to increase the availability of EV charging on their premises.
Greater EV adoption will result in an increase in electricity demand and we will be able to manage this because we will build new power generation capacity and we will reinforce our grid network. We will also incorporate innovations such as smart charging and energy storage solutions that store energy from the grid during off-peak periods. We are conducting studies to better understand the different factors that affect the demand for charging and we will also study potential solutions. This will guide our planned roll-out of the infrastructure needed.
The second move that we will make is to incentivise demand for EVs. Today, the upfront cost of EVs is about 78% higher than equivalent ICE vehicles. It is a large cost gap for a prospective EV owner. EV sales accounted for less than 0.1% of all new private car sales over the last five years. Today, we have about 1,000 EV cars.
This is why Deputy Prime Minister announced the EV Early Adoption Incentive at Budget this year. With this, the upfront cost difference between an EV and an equivalent ICE vehicle will be narrowed by up to $20,000. With further adoption and new models, this cost gap will close further. We expect EVs to reach cost parity with ICE vehicles by the mid 2020s. In the meantime, we hope that this incentive will serve as an early signal to encourage more prospective car owners to consider EVs. We also hope that car dealers will be encouraged to bring in more EV models. This will provide more choice for consumers and cater to the increase in demand.
Taxi companies will benefit from this incentive. Mass market EV taxi models will only need to pay the minimum Additional Registration Fee of $5,000. As fleets like taxis stand to benefit more from the lower per mile cost of EVs, we hope this incentivises more taxi companies to expand their electric taxi fleet. I am happy to hear that SMRT Taxis has already indicated their intention to trial more electric taxis in the near term.
Although existing EV owners are not eligible for the EV Early Adoption Incentive, they will benefit from the technical revision to the variable component of their road tax from 1 January 2021 onwards. As a special transitional arrangement, we will exempt them from the additional flat component of the new EV road tax that was introduced at this year’s Budget. This component was introduced to partly account for the loss in fuel excise duties that EVs do not incur. It will be waived for a three-year period from 1 January 2021 to 31 December 2023 for all EVs registered before this period.
So, in future, going forward there will be an incentive for new purchasers of EVs. And owners of existing EVs, prior to 1 January 2021, will all see a reduction in road tax during this period.
The third move is that the Government will take the lead to green our fleets. Last year, I shared that all public buses and taxis will run on cleaner energy by 2040. We will go a step further: all new public bus purchases from now on will be cleaner energy buses, including electric or hybrid buses.
Since last March, we have deployed 50 diesel hybrid buses on the roads. We have also bought 60 fully electric buses and will be deploying them progressively this year. New bus depots will be designed to support electric buses. As we gradually replace our existing diesel buses with cleaner energy ones, Singaporeans will enjoy quieter commutes and cleaner air.
The fourth move is that we will update our regulations to keep pace with technology. As one example, we will allow high-powered e-motorcycles into Singapore from 1 April 2020. This is in addition to the low-powered e-motorcycles which are already allowed today, and will add to the cleaner vehicle options available. Motorcyclists can now do their part for the environment by choosing an electric model.
We will also approve CHAdeMO; it is a fast charging method for EVs, an optional EV public charging standard. This means that public charging points in Singapore can include these CHAdeMO chargers from today onwards. Prospective car owners will then be able to choose from a wider range of EV models, including those that use these CHAdeMO chargers.
We will continue to review and refresh our regulations on EVs to ensure that these keep pace with industry developments.
To recap, four moves to drive the strategy of EV adoption in Singapore: build up charging infrastructure, incentivise the purchase of EV vehicles, Government will take the lead with our fleet and updating our regulations.
For our third strategy – harnessing technology to optimise land transport for the future. We have always relied on new technology to improve our transport system and deliver better transport outcomes. There are examples such as how today, you can plan your journey by looking up bus arrival times through the MyTransport app. Commuters can sign up for SimplyGo, allowing you to pay for public transport using your contactless bank card, so you no longer have to top-up your stored value cards.
A further use of technology is Autonomous Vehicles (AVs). These have the potential to improve connectivity by more efficiently offering dynamically-routed forms of shared transport.
Our AV trials have come a long way since one-north was designated as the first site for AV public road testing in 2015. Today, about 30 AVs are authorised for public road trials in a testbed that has expanded to include areas such as the National University of Singapore and Jurong Island. These trials have allowed developers to enhance their technology through real-world applications, and helped LTA learn how to safely introduce AVs to improve our transport network.
The trials have also created opportunities for the public to interact with AV technology. Around 6,000 visitors tried out the on-demand driverless shuttles in Sentosa last year. The feedback was positive, with most visitors indicating that they enjoyed the ride, mostly because for them it is really no different from a usual bus ride.
We aim to progress to the next stage of trials with pilot deployment in the early 2020s. We have launched a Call-For-Collaboration last year and there has been keen interest from more than 20 companies. We are currently assessing and looking through their proposals. Safety and public acceptance will continue to be top priorities as we progress to pilot the deployment in other areas.
These are exciting developments. But even as we continue to study and adopt new technologies, we have to ensure that this benefits our people through better jobs.
AVs will transform the transport sector and create new jobs. Today, some of our public transport operators have already taken steps to familiarise our bus captains with AV bus operations. So, these bus captains then become confident of working with AV technologies in the future.
To further prepare our bus captains for AV buses, LTA will work with stakeholders such as NTWU and Public Transport Operators (PTOs) to develop a skills and training roadmap to be launched by the end of this year. This will identify emerging skills and new job roles arising from AV deployment. On-the-job training and courses on AV safety protocol and operations will also be developed. We plan to train about 100 bus captains as a start.
These efforts are part of the Land Transport Industry Transformation Map 2.0. The Government will continue to work closely with the unions and industry to prepare our workers for new job opportunities in the sector.
Another initiative borne out of this close tripartite relationship is the Rail Manpower Development Package (RMDP). The RMDP aims to expand the rail workforce and accelerate workforce transformation over the next five years. A key component of this is a set of incentives for rail operators to expand and accelerate their training in key technologies and skillsets such as data analytics and condition-based maintenance. We expect the first batch of workers to start training in these areas from the second quarter of this year, with over 3,000 expected to benefit over five years. RMDP will also attract, retain and raise the profile of rail professionals through the launch of new SGRail Industry Scholarships and Sponsorships. These will be open to fresh graduates and in-service staff to pursue further studies at Institutes of Higher Learning. By investing in our rail workers, we are also investing in the future of rail reliability.
Beyond bus and rail workers, we will also continue to provide retraining and upskilling opportunities for taxi and PHC drivers, including allowing them to move laterally into adjacent sectors. The taxi and PHC operators have worked closely with the driver associations, with support from SkillsFuture Singapore, to develop training programmes for the drivers. For example, as of the end of 2019, about 4,600 ComfortDelGro taxi drivers have completed the SkillsFuture for Digital Workplace training programme, learning new skills to use e-payment technologies. Earlier this year, Grab and National Private Hire Vehicle Association (NPHVA) also launched the Grab Driver-Partner Training Kit that includes courses on safety and digital skills. Over the next three months, drivers can also benefit from the Self-employed Persons (SEPs) Training Support Scheme, which the Minister for Manpower had announced in this House earlier.
We will continue to work with operators and unions to equip our land transport workforce with the necessary skills and capabilities for the next phase of development.
So, Mr Chairman, we have three major strategies today to move towards the land transport system of the future. We emphasise \"Walk-Cycle-Ride\" to deliver on the vision that we have for a 45-minute city and 20-minute towns. We want the system to be clean and green, and for every part of the system to be optimised through the use of technology and across all of these strategies, throughout all of our efforts, we have to keep our focus on making sure that there are good jobs, that we look after the workers and we provide them the opportunities to retrain and re-skill themselves, to take advantage of these new opportunities.
There is a lot of work ahead of us to achieve all of this. We invite Singaporeans to partner us on this journey. Together, we can build a sustainable land transport system that brings Singapore together, one which future generations of Singaporeans will enjoy and feel proud of.
The Chairman: Mr Baey Yam Keng.
The Senior Parliamentary Secretary to the Minister for Transport (Mr Baey Yam Keng): Mr Chairman, the COVID-19 situation over the past weeks has reminded us of the importance of safety and inclusivity in Singapore’s transport system. During this difficult period, it is even more important that we ensure that no one is left behind, especially the elderly and vulnerable.
In fact, safety and inclusivity have been priorities for transport, way before COVID-19 outbreak. Over the last five years, we have invested about $200 million on various safety and inclusivity-related transport initiatives. Let me highlight a few.
In 2018, we announced plans to implement the Red-Amber-Green (RAG) arrows at all feasible traffic junctions to replace discretionary right turns and improve pedestrian safety. Mr Png Eng Huat will be pleased to know that we have implemented these RAG arrows at more than 300 junctions and target to have the arrows at a total of 1,200 junctions by 2023.
We continue to strive towards a \"Vision Zero\" environment with fewer land transport-related fatalities, through regulations at the vehicle, driver and operator levels. This includes stringent medical examinations for drivers. Not only will this give confidence to commuters, this is also for the drivers' own safety.
Mr Muhamad Faisal Manap asked about streamlining the medical examinations for elderly taxi drivers. As shared in the House last week, by the end of this year, elderly taxi drivers who have passed the medical examinations for their Taxi Driver Vocational License (TDVL) can use them to renew their Class 3 personal driving licences.
On the statutory age limit, we need to bear in mind that taxi driving is physically and mentally demanding, and can have serious impact on commuters and other road users. This move will bring greater convenience to our elderly taxi drivers. It is important to ensure that vocation drivers are fit to drive as they perform a public service. However, we are aware that with improve healthcare, drivers may be able to drive longer. We are studying the possibility of raising the statutory age limits of our elderly vocation drivers together with the Singapore Medical Association.
Mr Png Eng Huat also asked about Pedestrian Overhead Bridges (POBs). Indeed, our preference is to build crossings at-grade, rather than POBs, as they are all barrier-free and can be more easily accessed by the elderly and people with mobility challenges. However, there are instances where such at-grade crossings are dangerous, for example across major roads with fast-moving traffic, or when they may cause serious traffic congestion. In such cases, we will provide POBs. Even then, we will do our best to meet the needs of our elderly and the less ambulant. We plan to install lifts at all new POBs near major transport hubs and other existing POBs, if possible. As these lifts are costly, priority is given to the POBs which will most benefit the less mobile.
Since March 2015, we have gradually introduced priority queues at transport nodes, so that individuals with special needs can board buses and trains more easily. Building on this effort, we will also start trialling the use of priority cabins on the North East Line trains towards the end of this year. Commuters in these cabins, which will be located near station lifts where possible, are encouraged to give way to the more vulnerable commuters, such as the elderly, wheelchair users and families with young children. The idea for this initiative came from the various public engagements done to better understand commuters' needs. So, thank you for the suggestion.
As Singaporeans' mobility needs change, our transport system also needs to keep pace. Where suitable, the Government will continue to make our transport system even safer and more inclusive.
To enhance road safety for senior pedestrians, we have introduced 17 Silver Zones since 2014 with 18 currently in progress. These zones have narrower roads, speed humps to reduce traffic speed and two-stage crossings for senior pedestrians to pause and rest, making road crossing safer for them.
Over the past six years, accidents involving the elderly have reduced by almost 80% within these Silver Zones. With these encouraging results, we will continue with our plans to build a total of 50 Silver Zones island-wide by 2023. We are also constantly looking to improve upon existing results, for example, we will be trying lower speed limits at specific Silver Zones in the coming months to enhance road safety for our senior pedestrians.
To help the visually impaired navigate through our transport system, we piloted the mobile application, Mobility Assistance for the Visually Impaired and Selected Users (MAVIS). The app was piloted on selected buses since January 2019. MAVIS alerts bus drivers when commuters with special needs are boarding and alighting and allows visually impaired commuters to activate an audio announcement at the boarding bus-stop to guide them to their arriving bus. This might not mean a lot to able-bodied commuters, but to the visually impaired, these functions help them get around more conveniently and safely. We have received heart-felt feedback from commuters on how MAVIS had made a difference in their lives, giving them more confidence to take the bus, especially when there is no one around to help.
I am happy to share that towards the end of this year, we will expand the MAVIS trial progressively to all the buses on services 139 and 141, which serve the Enabling Village and the Singapore Association of the Visually Handicapped. Members would have also read about LTA's upcoming hands-free ticketing trial, which supports our effort to make it even more convenient for commuters with special needs to travel on our buses and trains, without the need to tap their fare cards.
Mr Chairman, the Government's efforts alone are not enough to make our land transport system safe and inclusive. For example, even if we build more lifts at existing train stations, it will not help vulnerable commuters if others compete to use the lifts.
Commuters play a very important role too. We will continue to encourage individual commuters to be more understanding about those with different needs from ours, be more gracious in putting others' needs before ours, and even better, be more caring by going the extra mile for fellow commuters, especially the elderly and those with special needs.
Let me share this story on how some commuters have done so. Mr Lester Wong was on the train when an elderly woman fell with her groceries and could not get up. Lester went out of his way to accompany her home, to make sure that the elderly was alright. Upon reaching home and taking a rest, the elderly was still not feeling well, so Lester insisted on sending her to the hospital to make sure that she got the medical care and attention she needed. Lester was the winner of the first Caring Commuter award last year.
Over the past years, we have heard many stories like Lester's and there are probably many more that we do not know of. We can harness these individual acts of care into a national movement and build a culture where showing care for fellow commuters becomes a way of life.
Hence, to galvanise commuters and other key stakeholders into action, the Public Transport Council has set up a new Caring SG Commuters Committee to help grow this movement:
Firstly, the Committee will help to facilitate greater awareness of the challenges faced by commuters and show commuters how to care for others. It is not always easy to know what kind of help others need, or if and when we should even offer help. Sometimes, we feel quite \"paiseh\"! This is why one of the Committee's first goals is to help commuters better understand other commuters' needs. We will encourage commuters who need help to ask for help too, so that it is easier for their fellow commuters to step up and provide the necessary care.
Secondly, the Committee will engage commuters and other stakeholders to explore ways we can grow the caring commuting movement further, as part of the broader SG Together movement. Over the next six months, the Committee will organise two series of engagements. To begin, we will engage widely to gather ideas and views on how we, as commuters, can contribute to this cause. Then, we will engage commuters in targeted ways to pilot and co-create solutions that can help to grow the movement.
The Committee will submit a report to the Minister for Transport in a year's time on its findings and recommendations on how we can continue to work with commuters and other stakeholders to build and sustain a caring commuting culture in Singapore.
Mr Chairman, the industry will also need to lean forward to play their part in making our land transport system safer and more inclusive for all Singaporeans. There may be some initiatives that are difficult for the Government to mandate and implement alone. An example would be the provision of child seats in taxis. This was discussed extensively during our public consultations for the P2P regulatory review and had mixed views from drivers, operators and the public. Today, I am pleased to announce that SMRT will be leaning forward to pilot the provision of booster seats in all its taxis, at no additional charge to commuters. This will enhance safety for children in taxis and provide parents of young children with a safer transport option.
Over the past weeks, we have seen even more instances of the industry stepping up to partner the Government, coming together during these difficult times.
For example, Grab and Gojek have rallied their drivers to step up in this time of crisis to provide on-demand transport services for our healthcare professionals. This had helped to provide peace of mind for the frontliners of our battle against COVID-19, to know that they can have a much needed, more comfortable ride home after a stressful day at work caring for fellow Singaporeans.
While COVID-19 would eventually run its course, the partnerships forged during this difficult time cannot end. We will continue to strengthen these ties and forge new partnerships as we build a transport system that is safer and more inclusive for all Singaporeans.
Such partnerships are pivotal in the next phase of Singapore's development. The Government cannot and should not do this alone. We will need to tap on synergies across sectors and harness the strength of our entire community. As a whole, we are greater than the sum of our individual parts. Working closely together with commuters, the industry and the community, we will achieve our vision of a safe and inclusive transport system for all.
The Chairman: Clarifications. Mr Ang Hin Kee.
Mr Ang Hin Kee: Chairman, I have a clarification for the Senior Minister of State Lam.
Beyond monitoring the take-up rate of training for aviation crew. I know that the Senior Minister of State takes a personal interest in many transport workers. I would like to invite the Senior Minister of State, together with SSG, WSG and CAAS to have a dialogue and attend a training class. Hopefully, the class can start within the month so that we can get a sense of whether the $112 million support to the aviation sector is reaching the workers and what has the workers' response been.
I believe the training programmes are available. We have a Skills Framework and the Industry Transformation Map. So, delivering training to the workers should be something that the training bodies and the various partners can deliver. And I would like to invite the Senior Minister of State to do that visit soon.
Dr Lam Pin Min: I would like to thank Mr Ang for that supplementary question. And I understand that he is equally concerned about the welfare of the workers.
The announcement of this enhanced training and support package was just made less than a week ago, on Monday. As I am aware, it is already quite well-received on the ground. Definitely, we will be working with SSG, e2i, WSG, CAAS and NTUC to see how we can jump-start some of these training courses for the air transport industry, especially the cabin crew that Mr Ang Hin Kee asked about in his cut.
I would also like to update Mr Ang that the SIA Group, for example, will be taking up around 6,000 training places under this enhanced training and support package. And we understand that this package will benefit up to 8,000 air transport workers. And SIA Group also planned to schedule the crew for training, hopefully from April onwards, taking into consideration things like the network and rostering requirements. But rest assured, I will be happy to accept the invitation by Mr Ang Hin Kee to visit them once you are ready.
The Chairman: Mr Dennis Tan.
Mr Dennis Tan Lip Fong: Chairman, I thank Minister Khaw, Senior Minister of State Lam and Senior Minister of State Janil for answering some of the questions I have raised. I have a clarification for Senior Minister of State Janil.
In my Budget debate speech, I raised the issue of the Government's handling of the foreign internal combustion engine (ICE) vehicles issue in Singapore. I also had some suggestions. I would like to just ask Senior Minister of State Janil: at this moment, how does the Government intend to handle the issue of foreign ICE vehicles in Singapore?
I am saying this because I think we all know that there are plenty of Malaysian lorries, buses motorcycles and passenger vehicles that come in and out of Singapore almost on a daily basis. I am sure that the Government would have to factor the presence of this large number of foreign ICE vehicles in Singapore as we work towards the plan in 2040. So, I will be grateful for the clarification.
Dr Janil Puthucheary: Mr Chairman, I thank the Member Mr Dennis Tan for his question. Certainly, the presence of foreign ICE vehicles is going to be an important consideration going forward. We are just getting started on our journey. If you look at what we are doing with the incentives, the waiver of some of the tax structures and some of the changes that we have to make, our regulatory space has not quite settled.
But when it does and as it does, one of the things we will have to look at is the relationship between what we do for Singaporean vehicles and then how that impacts what happens to non-Singaporean vehicles that are ICE vehicles when they come in. So, it is a factor but a it is a little bit premature to be absolutely settled on how it should be treated at this point.
The Chairman: Mr Sitoh Yih Pin.
Mr Sitoh Yih Pin: Sir, Senior Parliamentary Secretary Baey Yam Keng mentioned about the $200 million that was spent on safety, but he has not touched on safety of AVs. I know there are trials on AVs in NUS and NTU. But can he elaborate more because the public wants to be absolutely sure that AVs are safe on the road.
Dr Janil Puthucheary: Mr Chairman, I thank Mr Sitoh for the question and I am going to answer the question even though he directed it to my colleague, Mr Baey Yam Keng.
Absolutely, public safety is a key consideration in how we develop our AVs. It is part of our phased and gated approach in the AV development. But it is also part of how we hope to have opportunities for the public to experience Autonomous Vehicles in a safe and controlled manner; and for the developers and operators to then learn about what is the public experience on Autonomous Vehicles so that the experience can be improved.
The Chairman: Mr Melvin Yong.
Mr Melvin Yong Yik Chye: Thank you, Chairman. I follow-up on that question on autonomous vehicles, beyond safety, I am asking about job security. Autonomous Vehicles can potentially disrupt the livelihood of more than 50,000 workers who depend on driving to make a living. I am heartened to hear the efforts are already being made to familiarise our Bus Captains with AV technology. The union has been working very closely with LTA on that.
But there are others such as taxi drivers, private hire drivers, heavy vehicle drivers, school bus drivers, and recently, I even visited and found that even driving instructors will be impacted and eventually displaced by AV technology. We must not forget them in our push towards AVs.
May I asked the Ministry and the LTA to work with NTUC for similar AV familiarisation and transition programmes for the respective workers groups?
Dr Janil Puthucheary: Mr Chairman, absolutely, we would be very happy to work with NTUC and our tripartite partners. I will go a step further. I think it is essential that we do so and we would not be able to address the space adequately if it were not for the strong partnerships that we are able to develop.
I would assure Mr Melvin Yong and his union colleagues that there will be plenty of jobs. The one thing we cannot be assured of is that everything will stay the same. But there will be plenty of jobs and if we take the right approach in terms of thinking ahead, developing these roadmaps around retraining and re-skilling, and then having our workers and our unions actively engage in that process of retraining and re-skilling, then everybody will be well looked after.
The Chairman: Mr Louis Ng.
Mr Louis Ng Kok Kwang: Thank you, Sir. I have two clarifications on the Cross Island Line (CRL). I thank Senior Minister of State Lam Pin Min for sharing that they are exploring the non-playing areas in SICC so that we can move the worksite A1W1. But can I check whether we are looking into moving just a partial worksite of A1W1, or moving the entire worksite into the non-playing areas in SICC?
The second question is with regard to the establishment of the Environmental Advisory Panel that we are setting up to provide independent assessment of the implementation of the environmental monitoring and management plan. Can I just check who is LTA going to select to be part of this Panel?
Dr Lam Pin Min: I would like to thank Mr Louis Ng for his supplementary questions and his interest in the Central Catchment Nature Reserve (CCNR). Before I dwell into the questions that he has asked, I would like to assure the House that LTA, as well as MOT, have been working very, very closely with the nature groups in this journey. We have been engaging the nature groups and various stakeholders very intensively over the past six to seven years. I myself have met the nature groups' leadership on many occasions; even my predecessor, Minister Josephine Teo had done the same.
And this trust that we have built between MOT, LTA and the nature groups (NGs), is a very strong one. Therefore, I would like to reassure Mr Louis Ng as well as the rest of the nature groups' leadership, that we continue to work with them, even after the announcement of the alignment of CRL.
In fact, post-announcement, LTA has already engaged has already engaged the advanced engineering study consultant to look into the design of the alignment of the stations for CRL Phase 2 and that includes the optimisation of the worksite at A1W1. We shall wait for the report of the study before we can ascertain exactly how much we can optimise A1W1. But rest assured that we are also in a discussion with SICC to see how we can use some of the non-play sites within the golf course, so that we can minimise the impact of the the engineering works to the environment.
At the same time, we have also engaged an environmental impact study sub-consultant who will work with the advanced engineering study consultant to study the environmental impact of Cross Island Line Phase 2 on key biodiversity areas along its alignment.
I understand that Mr Louis Ng is also quite concerned about the Raffles Banded Langurs. LTA has also enlisted the help of our local primate specialist, Dr Andie Ang – we all know her very well – to study these together with the EIS consultant. There has been actually quite a number of mitigating measures suggested by Dr Andie Ang and we are currently working very closely with her.
With respect to the Member's specific question on the worksite, like I have mentioned, we will await the study, but definitely we will see how we can optimise the site in order to minimise the impact on the primates that he has mentioned – Leonardo, Michelangelo, Donatello and Raphael. We will make sure that the impact will be kept to a minimal, as much as possible.
As to the Member's second question on the Advisory Panel, I think we shall wait for LTA to make the necessary announcement.
The Chairman: Mr Pritam Singh.
Mr Pritam Singh: Thank you, Sir. Just two questions for the MOT office-holders. The first question pertains to a point I raised in my Budget debate speech about private bus drivers in Singapore and some of their concerns arising out of the COVID-19 situation. Does MOT have a perspective or position on how they can be helped and reached out to, in this time of need?
The second clarification arises from Senior Minister of State Janil's sharing on the purchase of public buses. I think 60 buses were purchased. What initiatives does the Ministry have in mind for the earlier adaptation for electric buses for the private sector? There are a lot of buses that are used to transport workers in Singapore, for example, and that can only support the Government's mission of the transit to electric vehicles in general.
Dr Janil Puthucheary: Mr Chairman, on Mr Singh's first point. The best help for the private bus drivers is going to be when business is usual is returned to and the tourists come back and workers need to be transferred and the current crisis is over. They will benefit from some of the measures that are in the larger support package for businesses in general and for Singaporeans in general. We have not gotten a specific package for private bus drivers, but as business entities in general, they will be assisted. But it is something we were looking at. And if there is an appropriate way and appropriate opportunity to do so, it is something that we can consider.
There are differences though, through the taxi operators, for example. There are ways in which we make sure that it goes down to the individual worker and so forth, and that is, the outcome that we would like to achieve.
For the electrification of private sector buses, the changes around vehicle emission schemes would be one of the key measures through which we hope they would be incentivised to then think about transition to electric platforms. The difficulty, of course, is that there are not quite as many models and platforms of that size today. There will be, as the technology improves, but we hope to be able to incentivise this from the emissions perspective.
The 60 buses that Mr Singh mentioned – 50 diesel hybrid – they demonstrate some of the difficulties that we have. We are exploring how to deploy and operationalise this technology and see what we need in terms of maintenance or depot reconfiguration, changes to the skill sets in our workers. And that is something where we have the entire network to deal with. I think for the smaller operators, it may take a little bit longer before they are able to make these changes. So, we do have some time to do it to meet our targets, but we will find ways to incentivise and encourage them to develop the skills and ability to do so.
The Chairman: Mr Yee Chia Hsing.
Mr Yee Chia Hsing: Thank you, Chairman. I hear from Senior Minister of State Janil that in 10 years' time, almost 100% of the new cars sold will be electric vehicles or clean energy vehicles. But now we are at 0.1%. How do we move from 0.1% to 100% in 10 years?
Like I have mentioned in our Budget speech, I think we need a five-year target rather than shoot for a 10-year mark. If in five years, we are not even hitting 5%, I think we will miss our target.
The other feedback is that there are a lot of car models, EV models which are available in the UK, but the dealers do not bring them in. What is MOT doing to push all these dealers to bring these models in? That is one feedback from consumers, that they have very limited EV choices.
Dr Janil Puthucheary: Mr Chairman, indeed our strategies that I have discussed – the four moves – are to reduce the cost differential between an electric vehicle and an internal combustion engine vehicle, encourage consumers to take this up as a choice, both because of the aspiration to be cleaner and greener, then hopefully it makes increasing economic sense to do so. Over the lifetime of a vehicle, an electric vehicle, hopefully, should incur less maintenance cost, the mechanisms are easier to maintain, and also less energy cost.
So, the short answer is we hope consumers will make the choice and we are trying to incentivise consumers to make the choice, as a result of which dealers should respond.
Internationally, many manufacturers are developing new models and have committed in some cases, to only develop electric models past a certain date. That should also help to lower the price of these vehicles.
Put together, we hope that over the next 10 years, there are increasing reasons for Singaporeans who choose to buy a car to choose to buy an electric car. And then, we hope that somewhere around 2030, we will have the last sale of an internal combustion engine vehicle and then, over a 10-year cycle by 2040, we will have an entire cleaner and greener fleet here in Singapore.
The Chairman: Mr Sitoh Yih Pin.
Mr Sitoh Yih Pin: Mr Chairman, I thank all Members for their speeches and contributions. In particular, I would like to thank the MOT team for their hard work and support. Sir with that, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $1,992,837,500 for Head W ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $9,484,729,700 for Head W ordered to stand part of the Development Estimates. (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head O (Ministry of Health) ","subTitle":null,"sectionType":"OS","content":"The Chairman: Head O, Ministry of Health. Dr Chia Shi-Lu.
Dr Chia Shi-Lu (Tanjong Pagar): Chairman, I beg to move, \"That the total sum to be allocated for Head O of the Estimates be reduced by $100\".
This year's Budget aside from the understandable focus on the evolving COVID-19 situation, has emphasised the importance of staying united and advancing forward as one people, to meet the challenges of the next decade and beyond. This is a strategy that should be applied to healthcare planning as well. And we have to come together as one people to think, to talk, to act and to prepare our country for the health challenges we face as we move towards 2030 and beyond.
The human body works well if all of its various component parts – the cells, the tissues and the organs – work together. Disease and illness occur if one or more of these parts lose their close cooperation and their balance with other parts. The traditional model for the practice of medicine involves a close but often exclusive doctor-patient relationship, although not always with the same unity of purpose.
Health and healthcare policies in the past have also often proceeded on a typically prescriptive and directive approach, presumably because there is often a fair degree of information asymmetry, and also because admittedly, many of us could not always be relied on to make the right choices for our personal health.
The Healthcare 2020 Masterplan that was enunciated by MOH in 2012 outlined clear goals in terms of healthcare quality, affordability and accessibility, and put forward concrete, quantitative objectives in terms of manpower, infrastructure and financial targets.
But health is not simply a numbers game and I was very supportive of more recent announcements by MOH that encouraged a mindset and strategic shifts. Just as whole-of-Government actions are needed to tackle complex issues confronting our country, a whole-of-society approach would be needed to cover that last hundred yards in our healthcare journey. And in order to do this, we really need the unity of purpose amongst all Singaporeans. This is certainly something that is not easy to achieve and certainly very difficult to budget for.
Singapore's response to the COVID-19 situation is a timely illustration of the importance of societal unity to meet medical shocks. Many commentators have commented favourably on the quality of our disease preparedness planning, healthcare facilities, medical manpower, contact tracing, border controls and so on, and allow me to join my Parliamentary colleagues to put on record my sincere appreciation for the sacrifices that all frontline personnel, whether medical or otherwise, have made since the situation unfolded from the start of the year.
But one of the key elements to the success of the strategy is community involvement and how the whole of Singaporean society has come together to face this challenge. This is one critical element that Prof Dale Fisher, who was part of the WHO-China mission to Wuhan, noted as one key reason why China seems to be succeeding in controlling this outbreak and why Singapore is likewise having some success in managing the outbreak thus far. And such community involvement would likewise be critical if we are to succeed in winning other wars we have, for example, the war on diabetes, on controlling dengue, bringing smoking rates down and getting everyone to eat better, sleep better and exercise more.
At this juncture, I would like to ask the Minister for an update of whether it is \"mission accomplished\" for Healthcare 2020. Further to this, I would like to ask the Ministry what updates have been made to our national vision for healthcare in the coming decade and beyond? How can we work together to encourage each and every one of us to work together towards common health objectives?
Some of the major shifts that the Ministry had announced were to shift care from hospital to the community and to move from healthcare to health. I believe that this can be facilitated by rethinking some of our basic models of healthcare delivery and I hope that the planning of future healthcare facilities like polyclinics and hospitals will consider new models of care, with better integration and interaction between healthcare and community stakeholders.
The newly established Alexandra Hospital, which serves many of my residents from Queenstown, has piloted new care delivery models where patients are looked after by a team of healthcare professionals grouped functionally rather than by medical specialty. The hospital also provides novel community outreach programs, for example, we have a free, regular bus shuttle services from the nearby neighbourhoods which they serve to the hospital. The hospital itself may be old and some parts are even heritage properties, but the way it functions is very much at the cutting edge of healthcare service provision.
I foresee that there will be increasing disruptions to the way healthcare is delivered and consumed. Hopefully, these disruptions would mostly be beneficial by improving efficiency and improving quality and accessibility and in this way, reducing costs as well as manpower requirements.
I have previously asked about progress on integrating data analytics and perhaps even personalised medicine into our healthcare ecosystem and would like to ask if the Ministry has any updates on this front.
I believe that fostering a united, whole-of-society approach to health, would require better health information accessibility and integration. The excellent system of information dissemination during the COVID-19 crisis by battling disinformation and misinformation has certainly contributed much to controlling the outbreak and maintaining societal confidence in the measures the Government is taking.
Does the Minister have any updates on the roll-out of the National Electronic Health Records system?
Next, an ageing population portends that a greater proportion of the health seeking population may have physical or cognitive impairments that makes it difficult for them to physically access health services. If you are old, your eyesight is not so good, you have trouble moving, it may be more difficult for you to go to your nearby polyclinic or hospital. Outbreaks like COVID-19 also bring into stark relief the benefits that telemedicine or remote medicine and remote consultation can bring.
I would like to ask whether there any updates on how telemedicine or remote medicine can be promoted and facilitated in Singapore?
Finally, as a nation, we have made great strides in our healthcare system and indeed, in our health, over the past decade. Our excellent performance by most measures, paradoxically means that it becomes harder and harder to make meaningful improvements in the future, as quality of our health is a more nuanced assessment than looking at crude rates like life expectancy or disease burden.
Nonetheless, I believe that a united society will be a key piece to this puzzle, and I look forward to the Ministry of Health's stewardship in this regard. May we all live long, live well and grow old together as one people. Thank you, and I beg to move.
[(proc text) Question proposed. (proc text)]
Mr Christopher de Souza (Holland-Bukit Timah): The Healthcare 2020 Masterplan aimed for improvements in accessibility, affordability and quality of healthcare. These included plans to build new, general and community hospitals, increase the number of subsidised drugs and to make primary healthcare more affordable and accessible through the Community Healthcare Assist Scheme (CHAS) and also the building of new polyclinics.
Indeed, the COVID-19 outbreak has put into focus the high quality of healthcare system. Our healthcare workforce has truly shown courage and determination. Would there be further investment needed in the healthcare system, over and above the 2020 goals so as to have the extra capacity needed to deal with a future outbreak, if one was to occur?
Ms Tin Pei Ling (MacPherson): MOH has achieved progress in many aspects of our public healthcare in the past decade. During my nine years in Parliament so far, I have witnessed many measures introduced to enhance senior care capacity and capability, improve public healthcare affordability, increase healthcare manpower, enhance healthcare accessibility, war on diabetes and many other schemes to promote healthy living.
And of course, in most recent times, a very successful campaign against COVID-19. And I hope that we can continue in this aspect.
With so much done and taking stock, I would like to ask the Minister if we have achieved what we set out to achieve at the beginning of the Healthcare 2020 masterplan? Now that we are in 2020, what is the Ministry's vision for the next decade? How hopeful can we be in moving from \"curative\" healthcare to \"preventive\" healthcare?
Mr Chen Show Mao (Aljunied): Sir, a year before the Minister of Health declared War on Diabetes, four years ago, the International Diabetes Foundation reported that Singapore had the second highest proportion of diabetics among developed nations. Our children and young people were increasingly overweight. One in three Singaporeans had a lifetime risk of developing diabetes, with serious and costly consequences.
Following the declaration of War on Diabetes, the Prime Minister spoke of diabetes as one of the three key long-term issues for Singapore.
Sir, the importance to Singapore of the War on Diabetes cannot be overstated. Could the Minister give us a report of progress from the front? What are the results and lessons? What are our new and continuing efforts and plans; strategies and tactics?
Dr Chia Shi-Lu: Sir, our efforts in tackling the COVID-19 outbreak have shown good results and won plaudits from around the world. WHO had shared that it was \"very impressed\" with our measures. Dr Zhang Wenhong (张文宏), Director of the Infectious Diseases Department at China's Fudan University, even drew parallels between our healthcare strategies with the famed Wudang (武当) martial art fighting techniques.
Would the Ministry provide an update on the COVID-19 situation? What are our contingency preparations in readiness for possible scenarios ahead? Specifically, what are our plans should community transmission within Singapore become more widespread or the evolving pandemic worsen, increasing the risk or reported infections once again. Have we considered the scenarios in which the virus becomes endemic? How then can we learn to leave with the virus?
Globally, many healthcare workers at the frontline have been infected while caring for patients and some have even lost their lives though fortunately, not to the same extent as was seen with SARS. What actions are being taken to enhance protection for our frontline healthcare workers.
Finally, I note that contact tracing is a key pillar in our containment strategy and recent studies have also suggested that early detection improves survival from the disease. I know recent cases in Singapore where individuals have been charged for being evasive about the movements.
Is the Ministry considering expanded powers to access location and other related data from mobile devices of patients and close contacts for contact tracing? South Korea for instance has enacted laws after the MERS crisis in 2015 on managing the information of patients in an infectious disease outbreak.
Ms Sylvia Lim (Aljunied): Sir, I have several residents who are COVID-19 patients and our thoughts are with all patients for strength and a speedy recovery.
On the treatment front, a resident who was a SARS patient told me that a medical team visited her recently to obtain some blood samples to aid the COVID-19 cases. Some medical experts overseas have opined that using convalescent blood plasma from former SARS patients could assist very sick COVID-19 patients but was unlikely to be deployable on a larger scale. Could Ministry elaborate on the thinking and efforts on this front?
As for containment, the World Health Organization has opined that it would take 18 months to develop a safe vaccine. As the virus is assessed to be spread by droplets at close range, containing the spread via separation measures like quarantine appears to be appropriate. What are the preliminary assessments of the effectiveness of the Government's strategy so far?
Mr Christopher de Souza: Singapore has a formidable healthcare force – the manner in which the COVID-19 outbreak is being dealt with reflects the dedication and professionalism of our healthcare workers. How is a precedent – a standard operating procedure of sorts – being presently developed by the Ministry such that the current operational experiences can be referenced by future healthcare workers in the event of a future outbreak of similar or different magnitude? This will bolster our fight in any future outbreak.
Dr Chia Shi-Lu: Chairman, our healthcare spending is expected to jump 16.2% this year. The increase of $1.9 billion will go to fund higher subsidies and contingency measures for the COVID-19 outbreak. With our ageing population and the increasing burden of chronic diseases, will Government subsidies be able to keep pace with ever rising medical expenditures? At $13.4 billion this year, healthcare is the second highest expenditure after defence. How will MOH ensure that our healthcare expenditure remains sustainable?
MediSave, which is one of the central pillars of our healthcare financing system, is meant to provide for bigger medical expenses such as hospitalisation, day surgery and also outpatient expenses. However, very often, surgeries and hospital stays could be averted with early detection and intervention. If we could encourage more Singaporeans to work closely with their primary care providers, take preventive measures and actively monitor their medical conditions to arrest or slow their progress, we would be able to cut our healthcare expenditure significantly.
Hence, would the Ministry consider implementing measures to further reduce out-of-pocket expenses for primary care costs, including liberalising MediSave for more categories of outpatient expenses or fine-tuning, tweaking some of the existing Flexi-MediSave systems?
The principle of co-payment underpins our healthcare financing system. It was meant to encourage prudent and responsible use of healthcare resources to motivate Singaporeans to stay healthy. However, for the elderly, it is more challenging for them to keep illnesses at bay. Many of them worry that even with Government subsidies, they might have difficulty affording the co-payment component of some of the medical expenses. How does MOH plan to keep healthcare affordable for Singaporeans, particularly for senior citizens? Thank you.
Mr Pritam Singh (Aljunied): Out-of-pocket expenses for medical care when our seniors enter their 60s can be a source of significant insecurity. Sir, I have previously called for the Ministry to consider a differentiated ceiling for MediSave withdrawals.
In 2018, about 16% of individuals fully utilised their Flexi-Medisave limits. Sir, this percentage appears small but it translates to about 136,000 Singaporeans who have fully utilised their yearly $200 limit. We also know from previous Parliamentary replies over the years that elderly patients above 60 years of age with chronic conditions visited polyclinics and CHAS clinics an average of six times a year, with an average annual bill of $200 after subsidies.
Those without chronic illnesses visited these healthcare facilities on average about three times a year, with an average annual bill of about $60 after subsidies. I believe there is scope to increase the Flexi-MediSave limits, particularly those who have larger outpatient bills.
Sir, calls for greater liberalisation of MediSave withdrawals have been made by my colleagues including Mr Faisal Manap. The Workers' Party acknowledges that higher withdrawal limits based on MediSave balances must be carefully considered as it may result in some Singaporeans having less MediSave savings through retirement. However, each senior Singaporean's situation is different, particularly in view of differing MediSave balances across seniors in the population.
In addition, Sir, a differentiated ceiling for seniors has been replicated for other MediSave schemes. For example, from this year, a differentiated MediSave withdrawal scheme has been introduced for Singaporeans with long-term care needs. Individuals with $20,000 or more in their MediSave account will be allowed to use $200 each month or $2,400 per year from MediSave for long-term care. Singaporeans with balances of between $15,000 and above are allowed to $150 per month, and so forth.
Apart from increasing the Flexi-MediSave limits for outpatient treatment, the additional flexibility in the form of a differentiated ceiling should also be considered to allow for inpatient co-payments that have to be paid in cash after MediSave deductions, particularly as our seniors grow older.
While MediShield Life and existing MediSave withdrawals can be utilised for inpatient bills, many patients are still required to make out-of-pocket payments in cash because of existing MediSave limits.
Sir, seniors should not be prevented from relying on their MediSave again to settle the cash component of their bills provided their MediSave amounts are healthy.
Just this Monday at my Meet-the-People Session (MPS), I saw a resident who asked me to write to the authorities to allow his 75-year-old brother – unemployed and living alone – to utilise around $1,400 from his MediSave to settle his hospitalisation bills. He showed me his brother's CPF statement and the amount stood in excess of $51,000. Sir, this is a man in his mid-70s and unemployed. Surely, there is further scope to further assist our seniors and reduce their out-of-pocket expenses for healthcare-related expenditure.
This is not a call for additional subsidies that impact the healthcare budget but a better calibrated MediSave regime that allows our seniors to better manage their cost of living concerns and give them a greater peace of mind.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Sir, MediFund Scheme is meant to financially assist Singaporeans who have difficulties with their medical expenses for both inpatient and outpatient treatments. It is made available at polyclinics islandwide as well as the restructured hospitals.
I would like to call upon MOH to allow the use of MediFund for reimbursement of transport fare for needy Singaporeans, who need to travel by taxi or private hire car to and fro their medical appointments due to their poor health conditions. A good example is stroke patients.
I have encountered residents who defaulted their medical appointments especially those who have multiple appointments in a month, as they are too weak to travel by bus or train, and they do not have the financial means to take a taxi or private hire car to ferry them.
Sir, this segment of our fellow Singaporeans are usually those who are unemployed due to their medical conditions and they depend heavily or solely on financial assistance, such as ComCare, and handouts from relatives and friends, which amount they received is only sufficient, and in some cases, not even enough for their monthly sustenance.
I do know of Voluntary Welfare Organisations (VWOs) that offer subsidies for private ambulance fee to needy individuals. However, this subsidised fee is still too high and unaffordable for some.
Sir, MediFund Scheme is to ensure that needy Singaporeans are not being deprived of their rights to medical treatments due to their financial standings. Allowing MediFund Scheme to be used for reimbursement of transport fare will surely ease the financial struggles and, more importantly, will enhance the accessibility of medical treatments for this group.
The Chairman: Ms Tin Pei Ling, you can take both cuts.
Ms Tin Pei Ling: In my cut earlier, I mentioned that public healthcare affordability has improved over the years that I have seen in this House. It has. But in the course of my constituency work, I still meet many middle-age and senior residents who continue to worry about healthcare costs.
One of the issues they face is not being able to use more of their MediSave to pay for their medical bills, forcing them to make out-of-pocket payments. This poses a cashflow challenge to them. A common argument I have heard from affected residents is that they still have savings in their MediSave, so why can they not use more of their own money for their own treatments? Attempts to explain how CPF works cannot be the same as how a private bank account works were futile as they have immediate needs to solve.
I have a resident, Mr Tay, who has a strong sense of self-pride and self-reliance. He needs to seek heart treatments regularly. While his wife and children are financially independent and he has a good relationship with them, he is highly reluctant to ask them to support his medical expenses. He argues for more use of his MediSave beyond the current annual cap so that he can pay for his own needs.
While I personally believe that children who can afford it, should support parents, I respect his fierce sense of self-reliance. Therefore, can the MOH consider increasing the flexibility of and annual cap on the use of MediSave?
Can we also conscientiously target our publicity and social outreach to encourage children with means to take the initiative to top up parents’ Medisave and Ordinary savings so that their parents need not feel the burden of having to ask their children for money? There is no guarantee that the children will comply but it is a social signal that we should actively send.
Also, the community can play a role in raising resources to support seniors who need help with their medical expenses. Would MOH consider a matching fund to boost the funds raised for this purpose?
Finally, I urge the Ministry to consider expanding the list of chronic diseases that are eligible for use of MediSave.
I once met a relatively young resident during my block visit, about my age or younger. He suffers from severe eczema, highly uncomfortable, and has difficulties finding or holding down jobs. His parents are working but they are just typical 3-roomers and they worry about how they could continue to finance his skin treatments as they age. It is a struggle for them and certainly tormenting for the young man himself. Statistically, an estimated 13% of Asians suffer from eczema.
Therefore, could the Ministry review the list of chronic diseases under the Chronic Disease Management Programme and consider including chronic conditions such as eczema?
I serve in the MacPherson SMC, a 52-year-old community. Together with the Marine Parade GRC and Mountbatten SMC, the Marine Parade Cluster has seen an average increase of 11% in our senior population from 2016 to 2019. This is a significant rise.
As such, healthcare demand will also rise. Studies have shown that the elderly are four times more likely to be hospitalised than younger Singaporeans. Therefore, what is MOH’s plan to expand capacity in eastern Singapore to cope with the anticipated increase and demand for healthcare? With a rapidly ageing population across Singapore, what are MOH’s plans beyond 2020 to keep care accessible for all Singaporeans?
The Chairman: Dr Chia Shi-Lu, you can take both cuts.
Dr Chia Shi-Lu: Thank you, Chairman. One-third of the patients admitted into hospital here in Singapore were aged 65 and above and this ratio is set to rise year on year. By 2050, almost half of our population will be in this age group. As the elderly are four times more likely than younger Singaporeans to be hospitalised, there will be much greater demand for hospital beds.
Would the Ministry share an update on how it will ensure that we have enough capacity in our hospitals, the corresponding number of healthcare professionals and other necessary medical resources?
I would also like to ask the Minister if he has the capacity projections for our various healthcare institutions in the next 10, 20 and 30 years. These include general hospitals, community hospitals, nursing homes, hospices, day care and eldercare centres and, very importantly, day rehabilitation and dementia day care centres. What are MOH's plans to keep this care accessible?
Another one of my concerns is how we can better regulate and balance the capacity growth in public versus private healthcare institutions. Is there room for closer collaboration and greater permeability between our public and private sectors to optimise healthcare resources, particularly in times of emergency and crisis?
Presently, the Ministry already has such a partnership with Raffles Hospital for patients with non-critical medical conditions sent there by the Singapore Civil Defence Force emergency ambulances. These patients will benefit from subsidised care at rates similar to those at our public hospitals. What is the progress on the areas of cooperation with the private sector to expand our national capacity?
Next cut. It has been demonstrated that health systems with a strong primary care sector produce better health outcomes by improving access to comprehensive care services. They also keep medical expenditures lower in the long run. Our primary care professionals are indeed the bedrock of our healthcare system here in Singapore.
MOH had earlier announced that it would be building 10 to 12 new polyclinics by 2030, thereby expanding the total number to be between 30 and 32. Ten of the polyclinics' locations have been confirmed, with at least three scheduled to be opened by 2025. Are the other seven clinics on track to be ready by 2030? Would the Minister share details of the types of services each polyclinic will offer?
Besides expanding our public sector primary care capacity, we should continue to strengthen our private sector as well. Our vast network of private General Practitioner (GP) clinics has the benefit of delivering the personal \"one patient, one doctor\" service. How will MOH support GPs in providing better holistic care? How close are we to the ideal of \"one patient, one doctor\" in Singapore?
Under the Primary Care Networks (PCN) scheme, GP clinics can organise themselves into networks to provide team-based care. Would the Ministry provide an update on the progress of the PCN scheme? Are there any new models for primary care delivery that the Ministry is considering?
The Public Health Preparedness Clinics (PHPCs) system has also proven its value during this recent COVID-19 outbreak. Are there plans to expand and strengthen this very useful initiative?
Mr Chong Kee Hiong (Bishan-Toa Payoh): Chairman, MOH announced that it would expand the number of polyclinics from the current 20 to about 30 to 32 by 2030. Three will be located in Serangoon, Kaki Bukit and Tengah and are slated to be ready by 2025. The other seven will be located in Bukit Panjang, Eunos, Kallang, Sembawang, Khatib, Tampines North and Yew Tee. Is MOH on track to reach the target of opening these seven clinics by 2030?
With the locations of these 10 polyclinics confirmed, there remains two more possible sites. I strongly urge the Ministry to build one of these in Bishan.
Over the last few years, a few condominiums were built in Bishan. In the next few years, HDB will be adding many blocks too. The profile of Bishan will be changed significantly with many more households and an increasing population of older residents. As of today, the proportion of senior citizens in Bishan is already higher than the national average.
Presently, due to the lack of a polyclinic in Bishan, my residents have to travel to the polyclinics in Toa Payoh and Ang Mo Kio. As part of the journey, some of the elderly need to cross a pedestrian overhead bridge not served by elevators.
A polyclinic is a facility many residents are looking forward to. It is also a necessity, so that the new households moving into Bishan will not overwhelm the polyclinics in Toa Payoh and Ang Mo Kio.
Besides expanding public sector capacity, what are MOH's measures to support private GPs in providing better and holistic primary care for Singaporeans?
Dr Lily Neo (Jalan Besar): Sir, WHO once reported that depression was poised to become the second largest cause of disability worldwide after heart disease by 2020.
According to the Singapore Mental Health Study conducted in 2010, 5.8% of our adult population in Singapore suffered from Major Depressive Disorder some time in life. There is a stigma attached to mental conditions that stops people acknowledging them and seeking medical help. It is important to note these afflicted persons need medical care and treatment that can relieve them from their predicaments and bring them back to normality and happiness.
May I ask MOH what plans are available in detecting and treating mental illnesses and especially for depressive disorders? As good community mental health provision will enable us to have better outreach to those afflicted, may I ask how MOH is ensuring this adequacy?
Raising awareness and educating more people about depression, especially on the symptoms of depression, such as suicidal thought, sleep disorder, feeling of hopelessness and loss of interest in daily activities, will prompt family members or friends to intervene earlier. Seniors especially those living alone or those with no family support are more prone to having depression. May I ask MOH whether there can be a targeted approach to reach out to these vulnerable seniors.
Depression occurs in the young too. Last year, IMH said that stress-related anxiety and depressive disorders are common conditions seen at its Child Guidance Clinics which treat children aged six to 18. Our youths have long precious journeys in their lives. May I ask MOH whether there can be a holistic support for youths-at-risk to detect, to prevent and to provide early medical assistance, when necessary, to ensure their mental well-being?
A majority of those with mental disorders do live at home. Even those with major disorders are usually not hospitalised. It is always a drain on the care-givers to look after those afflicted family members, especially those with major disorders. May I ask whether there is any scheme to better support such care-givers?
Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Chairman, Sir, the 2016 Singapore Mental Health Study found that one in seven Singaporeans have experienced a mental disorder in their lifetime. Depression is the most common disorder, with around 6.3% of adults suffering from major depressive disorder at some point in their lives.
The good news is that people are now more aware and more willing to seek treatment. Thus, the years of delay in seeking treatment for major depressive disorders have dropped from four in the 2010 study to one in the 2016 study.
The Government's efforts to ramp up mental wellness promotion are starting to bear fruit. Indeed, the increased prevalence rates in the 2016 study could be attributed to greater awareness and willingness to seek treatment. But this also means that we are really only catching up to the true extent of mental health disorder and there are a lot more Singaporeans who remain undiagnosed.
Sir, the Government and many community initiatives have been doing well in generating awareness about mental well-being. I want to focus instead on three other As – availability, accessibility and affordability.
On availability, MOH announced in Budget 2017 that one in two polyclinics will have a mental wellness clinic, or a dementia clinic, or both, by 2021. There were already such clinics in seven of the 18 polyclinics in 2017. I believe the Government should aim higher now and make mental wellness clinics available to Singaporeans in all 18 polyclinics. The other issue is the availability of psychiatrists and psychologists, especially in the public health sector, as the 2016 study noted the low rate per 100,000 residents here compared to higher income countries. Are there plans to improve on this front?
On accessibility, five of the seven wellness clinics in the polyclinics only see referred patients and the two Community Wellness Clinics run by IMH allow for consultation by appointments. Persons suffering from mental disorders are already finding it hard to come forward for treatment due to social stigma, thus we need to make the clinics as accessible as possible. Would the Ministry make all mental wellness clinics at polyclinic open to consultation by appointment?
Lastly, on affordability, patients can withdraw from MediSave up to $500 a year for outpatient mental health treatments, but estimates for subsidised treatments ranged from $220 to $380 a month. I believe there is a need for the limit to be raised to at least $1,000 a year to make mental health treatments more affordable.
Mr Chairman: Ms Anthea Ong, you can take your four cuts together.
Ms Anthea Ong (Nominated Member): Chairman, how do we ensure that the quality of mental healthcare is on par with what Singapore is known for in healthcare? Implementing a measurement feedback system (MFS), adopted in countries such as England, could is one way.
In the public consultation on mental health that my team and I conducted, 26 responses indicated feedback on treatment could improve their health outcomes. Could the Ministry clarify what measures are in place to ensure that there is regular feedback given by clients to their mental healthcare professionals?
[Deputy Speaker (Mr Lim Biow Chuan) in the Chair]
It is recommended by WHO and National Health Service (NHS) England that treatment for mental health conditions should be supported by talking therapies including counselling. From the consultation, 29 respondents described the importance of psychological support alongside medication in treating mental health conditions. One elaborated that her husband did not fare well on medication alone, as \"no trust was established (and) he did not open up\". Would the Ministry consider measures to ensure that individuals requiring mental healthcare be supported not only by psychiatrists and medications, but paired with psychotherapy and counselling?
WHO encourages engaging stakeholders in the evaluation of mental health initiatives. In a similar vein, could the Ministry share what measures have been undertaken to involve stakeholders, including people with lived experiences of mental health conditions, in evaluating initiatives launched under the Community Mental Health Masterplan?
In expanding mental healthcare into community settings, personnel including social workers and community counsellors now interact with issues of mental health, and steps should be taken to ensure they are appropriately qualified and competent. In continuity with a whole-of-Government approach, would the Ministry consider instituting a code of practice for non-medical personnel involved in mental healthcare, including psychologists, therapists and those within community settings such as social workers and community counsellors?
Next cut, which was initially directed to MSF. WHO suggests that the LGBTQ+ community should be considered as a vulnerable group in mental healthcare, with the double stigma of homophobia and seeking help for mental health issues. In a recent public consultation on mental health that we conducted, 13 responses referenced such a double stigma. One lamented that \"it doesn't help too with social stigma against mental health and LGBTQ+ that push more away from the care they need, like me.\"
For the LGBTQ+ community, specific issues include discrimination by mental healthcare professionals as well as disclosing one's sexual and gender identities to family without consent. Given the Government's commitment to mental healthcare in community settings, we now have social workers and counsellors who support mental health, in addition to mental healthcare professionals such as psychiatrists and psychologists. Would the Ministry consider adopting a whole-of-Government approach in ensuring that personnel working in mental healthcare, including those within community settings, are trained and competent in LGBTQ-related issues?
Diversity officers supporting minorities is a common practice in the business sector. Would the Ministry consider appointing diversity officers, sited within respective agencies, across the healthcare and social services sectors? They can serve as a resource for professionals to tap on to better understand LGBTQ-related issues, help to develop competencies in serving LGBTQ individuals and ensure dissemination of LGBTQ-specific resources.
We have come a long way in recognising mental health as an integral part of our total health, but still a long way to go in giving this priority and parity to physical health in our policies. Barriers to mental healthcare are significant issues facing many Singaporeans.
First, affordability. Through the public consultation, more than 65% of the respondents felt that costs for mental healthcare was high, prompting some to stop treatment. One shared, \"I stopped my therapy at the hospital because I just couldn't afford it even at $17 twice a month. It caused me to be more depressed instead.\"
There exists a significant disparity between claim and withdrawal limits under MediShield and Medisave for physical and mental health conditions, which is incongruent with the increasing prevalence of mental illness. I am sure the Ministry wants to assure Singaporeans that there is no discrimination against those with mental health conditions. Could the Ministry please clarify when this overdue parity in MediShield and MediSave limits for physical and mental health treatments will be rectified?
Obsessive Compulsive Disorder (OCD) and substance abuse are currently excluded from the list of mental health conditions covered under the Chronic Disease Management Programme (CDMP) for MediSave withdrawals despite the increasing and high prevalence of these two conditions according to the Singapore Mental Health Study 2016. Will the Ministry consider including these conditions?
Given the high co-morbidity between those suffering from chronic physical health conditions and those with mental health conditions, how does the Ministry ensure this group of patients benefit from sufficient Medisave withdrawal limits for outpatient treatments?
In line with the spirit of the Community Mental Health Masterplan to shift mental healthcare from medical institutions into the community, would the Ministry consider allowing patients to tap on their MediSave for mental healthcare provided by community mental health services such Shan You Counselling Centre, Clarity, and Counselling and Care Centre?
Lastly, to remove the first cost hurdle and encourage help-seeking behaviour, would the Ministry consider piloting programmes that provide free initial mental health consultations with a psychiatrist or psychologist?
Second, accessibility. We have 4.4 psychiatrists and 8.3 psychologists per 100,000 population. Overall, the median waiting time for new subsidised appointments is 27 and 28 days to see a psychiatrist or a psychologist respectively. Can the Ministry clarify on what plans are in store to improve these numbers so as to increase accessibility?
Seventy-one respondents shared that lack of clear, trusted and consolidated information on how to seek help limited their help-seeking behaviour. There are more than 10 helplines available under NCSS' Mental Health Resource Directory. Would the Ministry consider setting up a centralised helpline – maybe 991 or something – to make it easier for a person in distress to call for help? These helplines could even be manned by peer supporters, given the many community efforts to promote peer support training.
Would the Ministry also consider a centralised platform for mental health services to include information about service providers and treatment options available, estimated costs of treatment and available subsidies for treatment?
Building on the Ministry's community outreach efforts, would the Ministry consider expanding the modes of referral for community mental healthcare, including text or web-chats, phone calls, walk-ins, referral by friends and family, and also self-referral? As subsidised referrals for public healthcare can only be made through public healthcare institutions, would the Ministry consider allowing professionals in community mental healthcare to make these subsidised referrals?
Last cut. This was initially directed to MCI. The Tripartite Alliance for Fair and Progressive Employment Practices' (TAFEP) recent declaration that stating one's mental health history on job application forms is discriminatory is very welcomed, especially as 48 respondents or 12%, from this public consultation cited confidentiality issues as a prohibitive factor against seeking help.
Although we have robust laws governing confidentiality in the Personal Data Protection Act (PDPA), there continues to be worries about access to one's mental health history within the public healthcare system, especially by employers. A respondent from the consultation shared that within the Public Service, a colleague's mental health condition was accessed through the public healthcare system and was shared as office gossip by supervisors.
Additionally, respondents have shared with me their worries on the sharing of their personal information by mental healthcare professionals, including one who was threatened by her school counsellor that her parents will be informed of her same-sex relationship.
There are also instances of unnecessary declarations of mental health information, with a respondent indicating that she was unable to donate blood due to her mental health history.
In light of these issues, would the Ministry consider establishing a framework on rightful instances requiring mental health information declaration, accessibility of patient's mental health information within the public healthcare system and better processes for breaking of confidentiality, for example, professionals to discuss with individuals on which information continues to be kept confidential?
Ms Yip Pin Xiu (Nominated Member): Chairman, for persons with disabilities (PWDs), medical rehabilitation is always available. What is neither routinely recommended nor provided is any kind of mental health rehabilitation and support. Discrimination and abuse add their own weight to the already present guilt and shame many PWDs experience. It prevents the PWD from speaking out against it or seeking external help to cope with it. Can there be more information on where PWDs can seek access to mental healthcare if necessary?
The idea persists that PWDs are disabled, not mentally challenged, and therefore do not require mental health support. This view serves only to perpetuate the stigma around mental health concerns and makes it extremely challenging for PWDs to access mental healthcare.
Access to mental healthcare for deaf persons is one such example. Given that mental health support is typically given through oral consultation, whether in counseling or therapy, can the Ministry share what measures are in place to ensure that those who are hard of hearing or deaf are adequately supported by our mental healthcare professionals, both in public hospitals and community settings?
Mr Melvin Yong Yik Chye (Tanjong Pagar): Chairman, in addition to providing better support for mental health issues at our workplaces, we also need to do our part to provide better mental health services at the community level, particularly for our youths and young adults.
According to a 2018 study by the Institute of Mental Health (IMH), young adults are most at risk of suffering from mental health issues in Singapore. If left unaddressed, this could significantly affect the mental well-being of the next generation of our workforce.
I am therefore glad that the Government has announced that it will create the Youth Mental Well-being Network, which will bring young Singaporeans together and look at ways to promote mental wellness for their generation. I would like to ask if the Ministry has any further plans to make mental health more accessible at the community level, particularly for our youths.
The Labour Movement will also do our part to foster better mental wellness among youths through our Young NTUC arm. Young NTUC has since begun engaging with youths and young working adults to better understand the mental wellness issues that affect them as they transition from school to working life.
A recent study that Young NTUC conducted with over 120 youths found that close to 60% ranked mental well-being as their top workplace concern. Young NTUC is working to put together peer-to-peer support systems for our youths and I hope that the Government can partner with the Labour Movement to make mental wellness services more readily accessible to our young adults and youths.
Mr Murali Pillai (Bukit Batok): Sir, it seems to me that there are still challenges on the ground in ensuring that people suffering from mental health issues get timely access to appropriate treatment. I wish to illustrate some of these challenges through three cases I dealt with in the recent past.
The first challenge is difficulty in detecting these cases.
Recently, I met a lady who sought some assistance to repair a water pipe in her kitchen. I arranged for a community volunteer to visit her. When he attended at her home, he observed, to his shock, that the entire hall of her home was filled with rubbish by the lady, who appears to be suffering from Obsessive Compulsive Disorder (OCD). No one, even her immediate neighbour, knew of hoarding. Not only that, the lady was staying with her daughter who was later identified as suffering from depression. She used to receive from IMH but defaulted.
Quite clearly, the lady and her daughter are unable to seek help on their own. If not for the chance meeting between the mother and I, this case would not have been detected.
The second challenge we see on the ground is lack of cooperation on the part of care-givers, mostly because of lack of trust.
A few months back, I received a complaint from a resident of noise disturbance from his neighbour. I asked my community volunteer to help mediate.
The family residing at the unit in question consists of three persons: father, mother and their young son. My volunteer could immediately tell that the son was mentally unwell. He was not able to look at my volunteer in the eye. He was muttering to himself and pacing to and fro. The parents related that he has a habit of shouting and banging on the walls, too.
My volunteer tried to convince the boy’s parents to admit him to IMH. The father was, unfortunately, dead set against sending his son to IMH because of some unrelated incident that happened in the past.
In the meantime, the poor neighbours continue to put up with the disturbance which happens in the wee hours of the night.
Without the parents’ consent, there was no way even for the IMH Crisis Team to attend at the scene to intervene to help the boy. In addition, because the boy's actions were not deemed to be a danger to himself or others, he cannot be arrested under the Mental Capacities Act and brought to IMH, too.
The third challenge is ignorance on the part of care-givers.
I recently met a couple at their home. Their daughter, now in her 20s, has been holed up in her bedroom for years. She simply refused to come out from her room since she was in Secondary 3. When I asked them why they decided not to ask for help earlier, they told me that they were worried that her daughter may end her life. Hence, they kept quiet.
They were plainly anguished by their daughter's condition but simply did not know what to do for years. Not only that, they were undergoing serious stress themselves and would have suffered mental meltdown, if not for subsequent intervention.
Sir, as can be seen from these cases, mental health cases are sometimes presented as social issues that have arisen in the community. Hence, it may be useful to consider engaging the representatives of organisations involved such as the grassroots organisation, Police, SSO, FSCs and so on in an integrated way so that a plan may be drawn up for each patient who has been identified as needing help.
In particular, we should keep an eye and follow up on patients who are suffering from serious mental illnesses who have defaulted in their treatment. This is because treatment for such cases is focused on containing the situation, not to cure the patients. So, if they are not receiving treatment, one can reasonably expect these patients to be in trouble.
Mr Muhamad Faisal Bin Abdul Manap: Sir, the use of complementary and alternative medicine (CAM) is widespread in Singapore, with a study showing that as high as 76% of Singaporeans are utilising at least one form of CAM. This is not only includes traditional medicine practices, such as Traditional Chinese Medicine, Jammu and Ayurvedic medicine, but also includes practices such as Chiropractic and Homoeopathy. However, not all types of CAMs are treated the same under our existing laws and regulations.
Currently, only Traditional Chinese Medicine practitioners are regulated under separate legislation and Chinese proprietary medicines are regulated by HSA. However, regulations do not cover the Jammu or Ayurvedic practitioners or the product they sell.
Chiropractic practices popular amongst office worker has also seen an increasing number of complaints against practitioners in the field as reported by The Straits Times in 2016. This has led to a call by the Chiropractic Association for Government regulation. The lack of regulation, particularly concerning the unregulated use of CAM practices, may lead to detrimental outcomes of patients who simultaneously see western-trained doctors alongside CAM practitioners.
A 2017 Straits Times article reported that CAM is widely used by patients doing chemotherapy which sometimes increases the side effects of chemotherapy. The same article also reported that the use of CAM also delayed a patient seeking western treatment by an extra six weeks as compared to non-CAM users, exacerbating their conditions.
With the pitfalls that patients could suffer from CAM being left unregulated, I propose that MOH considers studying the possibility of a regime that can regulate CAM practitioners in the same way TCM practitioners are being regulated now, which can fall under the ambit of a potential Complementary and Alternative Medicine Act. The Act can help to set regulations that imposes a minimum standard of protection against consumers.
Such a regime should consider requiring mandatory registration for all CAM practitioners and mandatory information given to the patient about the underlying risks of using CAM. This also should include the mandatory disclosure of usage of CAM treatment to healthcare medical practitioners when patients seek medical treatment. Such a regime should ensure regulation is in place for both CAM practitioners and patient that otherwise need to seek recourse elsewhere.
The Chairman: Minister Gan.
The Minister for Health (Mr Gan Kim Yong): Mr Chairman, several Members of Parliament have asked about COVID-19. Let me provide an update on the situation.
As of 4 March 2020, yesterday, we have 112 confirmed cases, 79 have been discharged while 33 patients remain in hospital. Of these seven are in critical condition. Contact tracing is on-going. Dr Chia asked about contact tracing, we are indeed strengthening our capability on contact tracing efforts. I want to thank Singaporeans for their cooperation and support for the various measures we have implemented, without which, our efforts will not be effective.
Globally, the number of cases outside mainland China continues to grow at an alarming rate across continents and regions. This is worrying as they pose a high risk of importation of cases into Singapore. Therefore, we must expect to see significantly higher numbers of new cases in time to come.
In line with our risk assessment of the situation, we have implemented precautionary measures, including travel advisories and restrictions, temperature screening, contact tracing, quarantine, among others.
Ms Sylvia Lim and Mr Christopher de Souza asked about the effectiveness of our current strategy and how we can better prepare for the future. We have to appreciate that every outbreak is different. COVID-19 is different from SARS and different from H1N1. Even as we do our best to learn from each outbreak and prepare for the next, we must always expect the unexpected.
To mount a swift and effective response, we have to adopt a whole-of-Government approach and mobilise the resources of all the relevant agencies. This will allow us to assess, decide and execute our response quickly.
It is important to be transparent, too and share the information we know as soon as possible. This will help to preserve the trust between the people and the Government so that we can have the support of the public as we work together to fight COVID-19. It is also crucial to counter and respond decisively to fake news to avoid diversion of our resources and prevent disruption to our efforts.
The international scientific community has been working hard to study the virus, share new findings and develop solutions. We are sharing our best practices, research and knowledge on COVID-19 with other countries. For example, scientists from China published the genetic sequence of the COVID-19 virus quite early on, on 12 January 2020. Within just over a week, Singapore’s National Public Health Laboratory (NHPL) developed a specific PCR diagnostic test. Shortly after, A*STAR produced a PCR test kit, which has been used locally and shared with international partners to help identify patients and contain the disease. Our scientists are also participating in international clinical trials for treatment and vaccines.
Ms Sylvia Lim asked about using blood plasma for treatment. We are indeed planning to do so and NCID is collecting blood plasma from patients but there are limitations and constraints.
It may take some time before effective treatments and vaccines become available. As the global situation evolves, many countries may become infected. It will become increasingly difficult to stop the virus at our borders as we cannot ban visitors from every country and shut ourselves out from the world.
Even amongst our closest neighbours, the situation is also evolving. Therefore, it is likely that we will continue to see more cases and this disease will stay with us for quite a long time. We will have to continuously adjust, fine-tune our measures to deal with the disease so that life can go on while appropriate precautions are put in place.
I am glad to see the SG Clean campaign picking up momentum and I would like to thank Minister Masagos for leading this important effort. More initiatives will be announced later. All of us have a role to play and we must continue the good practices that have proven effective in reducing the spread of infectious diseases – such as staying home when unwell, practising good personal hygiene. I am beginning to sound like a broken record, but sometimes broken records are good.
We should also maintain high public hygiene standards in our food centres and public toilets. This will strengthen our collective resilience against COVID-19 as well as other infectious diseases, while allowing us to go about our daily lives as normally as possible.
Our healthcare workers are critical in our efforts in managing and containing this outbreak. I want to assure Dr Chia Shi-Lu that they are well-trained on infection control and prevention, and are provided with the appropriate personal protective equipment (PPE) for their safety. I would like to take this opportunity to thank them for their contributions and their dedication.
As Deputy Prime Minister announced, we will be giving them a token of appreciation through a Special Bonus for healthcare workers in our public hospitals and institutions, who are directly involved with treating COVID-19 patients. The senior management of our three healthcare clusters have informed me that as a gesture of solidarity with our healthcare workers, they will donate their own Special Bonuses to the staff welfare fund of their respective clusters.
The details of the Special Bonus for our healthcare workers will be released in due course, but for now our focus is to keep up our fight to contain the spread of COVID-19.
Mr Chairman, even as we tackle the COVID-19 outbreak, we need to continue to plan forward and build our healthcare system. MOH first introduced Healthcare 2020 in 2012 to increase accessibility, raise quality and enhance the affordability of healthcare services.
We are now in 2020, Dr Chia Shi-Lu, Mr Christopher de Souza and Ms Tin Pei Ling have all asked how we have fared with regard to Healthcare 2020. Mr Chairman, I must say I did not expect to still be Minister for Health in 2020. But I am still Minister for Health and I am happy to share that MOH has delivered on what we promised. [Applause.]
We have invested significantly in infrastructure to add capacity. In 2019 alone, we opened the National University Centre for Oral Health Singapore and Outram Community Hospital. The Sengkang General and Community Hospitals, which first began seeing patients in 2018, were also officially opened in 2019. Of course, we also opened the National Centre for Infectious Diseases (NCID) in time for this COVID-19 outbreak.
We stepped up building of long-term care facilities too like nursing homes and daycare centres to meet the needs of our ageing population.
We continued to improve the quality of care, with significant expansion in medical school and nursing intakes to ensure sufficient healthcare manpower. We expanded our polyclinic and GP networks, and further integrated patient care through the introduction of team-based care, and strengthened referral pathways to our Specialists Outpatient Clinics (SOCs).
We have made healthcare more affordable for all. Over the years, we have progressively enhanced and expanded the Community Health Assist Scheme (CHAS) to make primary care more affordable and for all Singaporeans. We also introduced the Pioneer and Merdeka Generation Packages in 2014 and 2019 to help our senior generations. Since then, almost one million Pioneers and Merdeka Generation seniors have received over $2.5 billion in benefits.
We rolled out the MediShield Life and will be launching CareShield Life (CSHL) later this year together with other changes to make MediSave usage more flexible which many Members of Parliament have asked about. Senior Minister of State Tong will go into greater details later on.
Most importantly, our overall healthcare outcomes have improved, with longer life expectancy and Health Adjusted Life Expectancy (HALE). This means that Singaporeans are not only living longer but living longer in good health.
However, this is the bad news. There is still room for improvement. Singaporeans are still living about 10 years in ill health. Several factors have contributed to this. Based on National Population Health Survey 2017, for example, approximately one in three of residents aged 40-69 has hypertension, one in seven has diabetes and two in five have hyperlipidaemia. To combat chronic diseases, we declared War on Diabetes in 2016. Let me give an update on the War on Diabetes that Mr Chen Show Mao has asked for.
To overcome this fearsome adversary, we have to start at the ground level, to build a strong foundation by shaping an eco-system that encourages healthier choices like living healthy lives and staying physically active. While healthier lives for Singaporeans will take many years of effort to realise, some of our efforts have yielded early progress.
For example, we have created more options for healthier meals. As of 2019, one in two stalls across hawker centres and coffeeshops listed at least one healthier option on their menu, as part of the Healthier Dining Programme (HDP). The number of healthier meals sold also grew to 205 million in 2019, up from 158 million in 2018. The prevalence of regular leisure-time exercise has also increased by about six percentage points from 29% to 35% between 2017 and 2019.
We will be launching a public campaign later this year to increase awareness on regular diabetic foot and eye screening. With greater awareness, we hope to reduce the incidence of lower limb amputation and give our patients better quality of life. These are just some of the many efforts we are taking on preventive healthcare that Ms Tin Pei Ling has asked about. Senior Parliamentary Secretary Amrin will be sharing more on our efforts later.
Besides prevention, we are also providing greater support for individuals living with diabetes. Under our Patient Empowerment for Self-care Framework, we have developed the National Diabetes Reference Materials on HealthHub, as a comprehensive resource for patients and their care-givers. This is helpful for patients and families as they can \"self-help\" themselves to information about their condition and what they can do for better disease management. For example, patients who wish to start exercising can learn simple, safe and practical ways to do so. These materials can also be customised by healthcare professionals for their own patients.
Our healthcare clusters will also be commencing pilot programmes from the second half of 2020 to increase patients' ownership of their care journeys. For example, one of the programmes will empower newly diagnosed patients with diabetes to initiate and sustain lifestyle changes through group health coaching and greater peer support.
To win the war on diabetes we will need concerted, multi-year efforts and many of these efforts will only bear fruit in the long-term. However, we will continue to monitor the intermediate outcomes, like physical activity and dietary practices to better track the progress of our various initiatives.
Going forward, I would like to assure Dr Chia Shi-Lu and Mr Christopher de Souza that we will continue to invest in new healthcare infrastructure and facilities to ensure care continues to be accessible to meet the needs of the ageing population.
We will be opening four more new polyclinics in over the next two years. Senior Minister of State Lam will share more about the expansion plans for our polyclinics later on. Woodlands Health Campus is scheduled to open progressively from 2022. We had experienced some challenges during the construction due to soil conditions, but we have mostly caught up. Now, with COVID-19, we are discussing with our contractors and suppliers to assess the impact and we hope to minimise delays.
Other upcoming facilities include a new community hospital in Novena and the redevelopment of two national specialist centres, that is, the new National Cancer Centre and the National Skin Centre.
MOH had previously announced that National University Health Systems (NUHS) would design new and innovative care models and test them at the Alexandra Hospital (AH) as part of AH's future development. The master planning exercise of AH was completed in 2019 and we will be calling tender soon for Medical Planners for this project. The first phase of redevelopment is scheduled to be completed by 2030.
Ms Tin Pei Ling has asked about healthcare capacity in the east. Changi General Hospital (CGH) is currently the only hospital in the east. While we have added significant capacity in CGH through expansion over the years, the healthcare demand has grown substantially as a result of population growth and ageing. Ms Tin will be pleased to know that we have commenced the planning of a new integrated acute and community hospital in the east, targeted to be ready around 2030. While the hospital will include the normal range of hospital services, we also want to hear what the community would like to see in this new hospital. As such, SingHealth, which will be operating this new hospital, will be engaging the community to co-create ideas to better meet the needs of the residents there. SingHealth will reach out to the community leaders when they are ready to do so.
Expanding our healthcare system will also mean that expenditure on healthcare will grow, both in the development cost of building new facilities, and later on, as the cost of operating these facilities.
Overall, our national health expenditure increased from $13 billion in 2012 to $22 billion in 2017, or about 11% per annum.
Of this 11%, about five percentage points of this 11% increase was due to increased utilisation. Let me explain.
As our population ages and grows, demand for healthcare services also increases, as some Members of Parliament observed earlier.
We are also utilising more healthcare than in the past, even after accounting for ageing and population growth. This is partly the result of making care more accessible and affordable to all, and partly due to earlier diagnosis, closer monitoring and follow-ups for medical conditions, that means, more frequent consultations and treatment. The range of treatment options has also expanded as the frontiers of medicine advance, increasing utilisation, but at the same time, improving lifespans and the quality of life.
That is five percentage points of the 11%.\tApproximately, another four percentage points of the growth in national health expenditure can be attributed to higher manpower costs. On the one hand, our healthcare workforce expanded significantly between 2012 and 2017. On the other hand, our healthcare workers' salaries also increased as we implemented pay adjustments to attract and retain our healthcare workers. So, that is four and five, that, is nine percentage points out of 11%. The remaining two percentage points have largely been due to increases in the costs of drugs, medical devices and other overheads.
And as Deputy Prime Minister highlighted in his Budget 2020 round-up speech, we can expect that the overall national health expenditure will continue to increase as our population ages and we step up our investments in facilities and services. But we must continue to be prudent in our healthcare expenditure to ensure that it is directed towards where it gives us the best outcomes.
Therefore, to answer Dr Chia and Ms Tin Pei Ling's questions on what our strategy is going forward, we must continue on our transformation journey for healthcare to ensure we have a good and sustainable system. We must press on with our efforts to go beyond healthcare to health, beyond hospital to community and beyond quality to value.
Patients too can play a role. We can make wise decisions and choices and have a trusted family physician to turn to for advice. Only then can we ensure that our healthcare system is sustainable and remains affordable for our patients.
Information technology (IT) will continue to be an essential enabler for our healthcare system, and we will continue to strengthen our governance and safeguards on our data. This will be essential to maintain the public's trust.
Over the past year, we have been taking concrete steps to implement the recommendations of the Committee of Inquiry (COI) on the SingHealth cyber attack. These steps will help to raise the cybersecurity posture of the public healthcare system. Close to 80% of the control measures recommended have been implemented or mitigated. The more complex measures require careful implementation to avoid disrupting essential healthcare services and impacting patient safety. These will be progressively completed by 2022.
Various enhancements have also been made to strengthen the security of the National Electronic Health Records (NEHR). Work is still on-going and the enhancements are being implemented. Mandatory contribution to NEHR will be deferred until all enhancements are completed and we are satisfied that the system is assessed to be sufficiently robust. We will further updates at the appropriate juncture.
[Mr Speaker in the Chair]
While we secure our systems, we continue to explore new technologies, such as telemedicine, how they can improve care. To-date, 25 public healthcare institutions and 39 community care partners have started video consultation pilot services. We will also leverage technologies, such as Artificial Intelligence, machine learning and robotics to support the work in public healthcare, which Dr Chia has asked about in his cut.
One example we are already deploying is the Singapore Eye Lesion Analyser Plus (SELENA+). This is a deep-learning artificial intelligence software system which can detect three major eye conditions: diabetic eye disease, glaucoma and age-related macular degeneration. SELENA+ highlights areas with potential vision threatening eye disease and refers abnormal cases to human graders, allowing them to focus on the more complex cases. SELENA+ has proven to be more efficient in delivering fast and accurate results. Building on SELENA+'s capabilities, a predictive risk assessment model for cardiovascular disease will be developed to help doctors accurately identify high-risk patients and conduct more timely interventions to save lives and achieve better outcomes.
To conclude, shaping better healthcare in Singapore is not something that MOH and our healthcare providers can do alone. Everyone will have a role to play in this.
We can start by taking care of our own health – by taking responsibility to keep ourselves healthy, we can live better, longer and healthier lives. Mr Chairman, if I may, let me speak in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] To battle COVID-19, we must be calm and not panic. As long as we take the right precautions, pay attention to personal hygiene, we can carry on with our day-to-day activities. I would like to take this opportunity to urge Singaporeans to exercise more and stay healthy. I am happy to see that many of our exercise programmes have resumed, after putting in place the appropriate safety measures.
Last Sunday, together with Minister Masagos and a few colleagues, I went to the Teck Whye Garden in Choa Chu Kang to take part in their community morning exercise that was just resumed. I am heartened to see that so many of our residents are committed to staying healthy and actively participate in activities.
(In English): Sir, keeping everyone healthy is a team effort and we are all part of that team. So, let us all play our part to keep Singapore and Singaporeans in good health. [Applause.]
The Chairman: Mr Melvin Yong.
Mr Melvin Yong Yik Chye: Chairman, our healthcare workers have been working tirelessly since the onset of the COVID-19 outbreak to combat the spread of the virus. Many have suspended vacations and put in extra hours. I commend all healthcare workers – nurses, doctors, medics, and more – for putting your lives on the line to serve Singapore.
Indeed, healthcare workers are a special group of professionals and I urge our tripartite partners to come together to do more for them.
One, let us recognise them not only when we have a crisis. Two, let us ramp up recruitment efforts and bring in more local talents. And three, let us reduce attrition and address the reasons why some leave service.
Sir, with our ageing population, our healthcare system will require more workers, especially nurses. While I commend the Ministry's \"Care To Go Beyond\" campaign, which profiles the work of nurses to attract locals into the industry, more needs to be done. I would like to ask what are MOH's plans to meet the increasing demand for healthcare workers, particularly in community care.
Perhaps the Ministry can consider recruiting more mid-career nurses in their 50s and place them in wards that are less intense. Mdm Wan Sok Meng, a staff nurse at the National University Hospital, is one such example. At 59 years old, Mdm Wan finally achieved her childhood ambition of becoming a nurse. More details of her story and other inspiring stories of those who have found nursing to be their calling in life can be found on my blog post today – because I only have limited time here!
Sir, in addition to recruitment, we also need to retain more healthcare workers and encourage more to return to nursing. About 850 local nurses leave our public healthcare sector yearly for a variety of reasons. Despite best efforts to attract them to return to nursing, only around 400 return to practice annually.
Some do not return because they feel that their skills are out of touch. To address this, our Healthcare Services Employees' Union (HSEU) is in partnership talks with Homage, a technology platform that matches trained and qualified care professionals to those in need of care, to explore providing nurses and care-givers who resign with opportunities to freelance as a care professional and keep their skills relevant. The union is also discussing how to provide training to these nurses through its Healthcare Academy – training that are relevant and timely.
I hope that the Ministry can work with the Labour Movement to improve retention of nurses and to encourage those who have left service to return to nursing.
Assoc Prof Daniel Goh Pei Siong: Chairman, Sir, even as we honour our frontline healthcare workers in this COVID-19 situation, we should make sure that we protect them in three ways: physical health and safety, mental wellness and social well-being.
On physical health and safety, the most heartbreaking COVID-19 news are those on doctors and nurses getting infected and succumbing to the disease. The SARS outbreak saw about one-fifth of the cases occurring among healthcare workers. A recent article by Dr Gan Wee Hoe and Dr Chia Kee Seng published in The Straits Times gave details on some measures taken to protect the health and safety of our healthcare workers. Would the Minister share the key measures implemented to protect our healthcare workers' own health and safety?
On mental wellness, again, based on the SARS experience, frontline healthcare workers suffer from high levels of burn-out and post-traumatic stress. Would the Minister please share whether any mental health resources are made available to our healthcare workers in this crisis, and whether free counselling and mental health resources can be made available to our frontline healthcare workers for the years after this crisis has blown over?
On social well-being, reports of healthcare workers in uniform being ostracised in public bring back ugly memories from the SARS epidemic, where about half of local healthcare workers experienced some form of social stigmatisation. I think it is amazing to see how many Singaporeans are fighting back to show appreciation to our frontline workers in concrete ways.
Nevertheless, I want to raise two points here. First, are healthcare workers afforded any legal protection from being abused when they are in uniform, whether at work or in public? Second, in a recent Straits Times report on the ostracisation of nurses in uniform, healthcare leaders reassured the public that the uniforms do not pose any risk of infection.
After this crisis has blown over, it may be timely to rethink whether uniforms are important for nurses or they should, like doctors, go to work in office attire and change to professional scrubs at work.
I am ambivalent about this as I grew up watching my mum go to work in her nurse uniform and I am still immensely proud of her. She related to me some of the obstracisation she experienced during SARS and how it forced her to change out of uniform to return home. Thus, I would rather see a change in public attitude. Nevertheless, a public conversation on the uniform will be useful, if anything, to see whether the public attitude can be changed.
Ms Joan Pereira (Tanjong Pagar): It has been three years since Community Nursing (CN) teams were set up as part of the Ministry's nationwide plan to bring healthcare closer to communities and homes, especially for the more vulnerable elderly residents. These personalised, coordinated and fully-subsidised care services play a crucial role in preventive care for the less privileged seniors.
As the nurses visit their patients in their homes, they are better able to detect the environment, social and other factors affecting their health. This enables them to have a more holistic understanding of their patients' needs. Over time, patients build trust in their nurses and this makes it easier for them to open up and accept their nurses' advice.
With our rapidly ageing population, more Community Nursing Posts (CNPs) will be required in our neighbourhoods all over Singapore. Would the Minister share an update on the number of such Community Nursing Posts to date and how many more does it intend to set up in the next 10 years? The posts are currently located at Senior Activity Centres. Will MOH partner with other organisations such as other Voluntary Welfare Organisations (VWOs) to expand the location options for future posts, as this will bring care closer to home for seniors.
How many nurses are working under this scheme and how many more will MOH recruit to cope with the increasing number of elderly persons in the coming years? What is the ratio of community nurses to residents under their charge? How has the retention rate of the nurses been so far?
Mr Christopher de Souza: Allied healthcare workers such as physiotherapists, speech therapists, nurses, medical support staff all play a significant role in the overall care for the patient. Methods to increase opportunities and training for their career and wage advancements are also key. This will ensure that a strong, core body of well-trained allied healthcare workers can pass down their experiences and knowledge to successive cohorts. How has the MOH prioritised their career and wage advancement and training?
The Chairman: Ms Irene Quay, you can take your two cuts together.
Ms Irene Quay Siew Ching (Nominated Member): Mr Chairman, I declare my interest as the President of the Pharmaceutical Society of Singapore and the Assistant Director of Allied Health Office at KK Women's and Children's Hospital.
I would like to speak on how MOH can empower our allied health practitioners, AHPs in short, and collaborative prescribing practitioners, or CPPs in short, to combat chronic diseases in Singapore by giving them the right tools through specific policy changes.
I spoke during the Employment (Amendment) Bill debate in 2018 on allowing AHPs and CPPs to issue recognised medical certificates (MCs). Currently under the Medical Registration Act, only qualified medical practitioners are able to issue medical certificates.
As our ageing population increases along with the surge in chronic diseases, we need to change our approach towards long-term follow-up for chronic patients to ensure healthcare and financial sustainability. AHPs and CPPs need to have the right tools to step up in their roles to care for these patients. At the moment, it is reassuring to see more of them taking over follow-up appointments for chronic cases as well as being equipped to manage them.
However, they are handicapped for reasons pertaining to regulatory restrictions. Patients often require MCs after consultation and they will have to be directed to medical doctors for issuances of MCs. This results in unnecessary delays to patients and is disruptive to the AHPs and CPPs as well as the doctor who might be seeing another patient.
I request that MOH consider permitting this group of healthcare professionals to issue MCs which are limited to two days per patient visit, starting with restructured healthcare institutions where AHPs and CPPs are taking on more in the management of chronic disease patients. This can be piloted through a regulatory sandbox approach. Perhaps, Public services can also take the lead to recognise time sheets and reimbursement for minor ailments and medication from retail pharmacies to relieve our polyclinics from their heavy workload.
In a similar vein, I understand that MOH has been attempting to right-site chronic disease patients to be cared for in the community by AHPs. Can the Minister provide an update on the success of this shift so far and the projected targets for the next five years?
I am concerned that the current financial gradient may not be steep enough to facilitate this shift from acute to the community. May I ask if MOH is looking at porting more subsidies for AHPs in the community settings to facilitate this transition? If done right, I see potential to effect an even more efficient and financially sustainable healthcare system for our citizens.
Mr Chairman, in this COS speech, I would like to address the need to direct support towards pharmacists in tackling medication-related issues within the community.
One such issue is polypharmacy, which is the concurrent use of multiple medication. It is a growing and persistent issue in Singapore as our population rapidly ages alongside with an increase in the number of patients with chronic diseases.
In the previous committee hearing, I talked about the different types of medication waste. Some examples include expired drugs, drug hoarding, drugs prescribed without indication, or duplication of drug therapy. I quoted a study from a local hospital on the estimated drug wastage cost detected during hospital pharmacist visits, at any time point, to be a staggering figure of $663 per patient.
For this year's committee hearing, I would like to highlight another grave medication-related problem in our healthcare system – medication non-adherence or compliance. This issue is especially prevalent among the elderly.
In late 2017, researchers from the National Healthcare Group Health Services and Outcomes Research department reported that seven in 20 newly diagnosed diabetic patients do not adhere to prescribed medication. This makes up about 35% of newly diagnosed diabetes patients in Singapore. There are many reasons for medication non-adherence, which include a lack of understanding or knowledge of diabetic medicine, difficulty in managing their complex medication regimen, concerns about medication side-effects and cultural beliefs.
Another study by the Saw Swee Hock School of Public Health and the Department of Pharmacy in NUS shows that pharmacists play an important role in educating patients on how their medication work. This can help to prevent long-term complications by explaining to patients the potential side-effects and how to manage them.
However, to address the many concerns that patients may have is very time-consuming. Currently, pharmacists working in healthcare institutions are beset by high patient load on a daily basis. They are unable to tailor individualised care for the needs of each patient and to follow-up to ensure that their concerns are addressed.
For instance, according to the Well-being of the Singapore Elderly (WiSE) study led by the Institute of Mental Health (IMH) in 2015, one in 10 persons aged 60 and above may have dementia. This translates to almost 82,000 people in 2018, and the number is expected to exceed 100,000 in a few years' time. These patients requiring multiple medications will most certainly be at high risk of polypharmacy and non-compliance.
I would therefore like to propose to MOH to set aside and expedite funding to support pharmaceutical services, particularly in the areas of medication review and reconciliation, de-prescribing efforts and related health literacy education, medication delivery services to facilitate instalment collections to avoid medication hoarding and waste, subsidies for adherence toolkits such as pill boxes and medication packaging instructions to fill these pillboxes, and multi-dose drug sachet dispensaries to improve drug compliance.
A recent report from the MOH Health Manpower Development Plan (HMDP) visiting expert, Dr Catriona Bradley, pointed out that the resources of the current community pharmacists are not optimised, and that there is an uneven spread of work leveraging on the capabilities that exist within primary care. She recommends increasing the deployment of community pharmacists in the areas of medication management and pharmaceutical care, which is in line with directives from the World Health Organization's (WHO) Patient Safety Challenge of \"Medication Without Harm\".
I quote verbatim, \"Where multiple prescribers treat the same patients across primary and secondary care, there is a need for a central point of review for medications\".
I understand that MOH is currently piloting studies to explore the benefits and cost effectiveness of such pharmaceutical services, but in view of the ageing tsunami, expedited efforts are necessary to galvanise our healthcare professionals to oversee this urgently.
Regardless of how much funding our Government pours in to subsidise drug treatments and improve access to medication, a patient's treatment cannot be optimised if he or she does not swallow a pill that is tailored to their needs.
Mr Chairman, I would like the Committee to consider my proposal to increase funding towards pharmacists with regard to the above-mentioned points. This will enable them to provide more individualised care for patients and at the same time, reduce medication-related problems and long-term healthcare cost in the community.
Dr Lily Neo: Sir, may I ask MOH what further plans are in place to enhance the care of our seniors? Many seniors express the desire to age in place for as long as possible. What are the measures provided to facilitate them to achieve this aim? It is a known fact that keeping seniors socially, physically and mentally active early on when they are mobile will assist them to have healthier and happier lives as they age. This will enable them to lead independent lives, ageing in place in their own homes and in the community for as long as possible.
Will MOH implement a baseline service model for all our eldercare centres to have programmes that will help achieve the above targets?
Preventive healthcare, such as preventing premature mobility difficulty or disability, will enable our seniors to live independent lives for as long as possible. Thus, the aim is to limit and delay the onset of disabilities in old age which more often than not are due to diseases. The most common causes of disability among older adults are chronic diseases, injuries, mental impairment and visual impairment. Early detection and having good control on chronic diseases can prevent disabilities such as strokes and heart diseases. Physical activities and keeping active can make our seniors stronger and lower their chances of falling, reduce their fracture rates and prevent injuries. Regular eye checks to diagnose cataracts and other visual impairments for early treatment can also prevent disability in seniors.
Our eldercare centres can support our seniors in this area by paying attention to their health, by checking their hypertension, monitoring their diabetes, arranging yearly eyes check and when necessary, referring them for medical help.
As seniors live till ripe old age, frailty may inevitably set in. But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes.
The Agency for Integrated Care (AIC) of MOH has in place such a program that presently looks after about 500 frail seniors living alone at HDB rental flats in the Chin Swee and Kreta Ayer precincts. It is an excellent scheme that should be extended to other constituencies. AIC has a team of two nurses and eight healthcare aides, who attend to the seniors; supervising their medical conditions and daily living essentials. This team also arranges for the grassroots volunteers and various voluntary care groups on assisting the social needs of these seniors in a coordinated effort. This has enabled residents to have lesser frequency of hospital visits and has enabled them to stay in their own homes despite their illnesses and immobility.
Ms Tin Pei Ling: In Singapore, we see a rapid rise in elderly population and smaller families. On the ground, it is not uncommon to meet elderly parents who shared that they wish not to burden their children or who are struggling to get by because their children simply have too many life priorities but they are sadly not one of them. This shift in demographics, family structure and individual attitudes has a profound impact on our society and how we organise ourselves in time to come.
At present, we see a network of community partners offering a range of services to our seniors. There are also efforts to better coordinate efforts across the different partners. Could the MOH share how effective has this approach been in engaging and serving the needs of our seniors? We have about 3,000 Silver Ambassadors now, how successful are we in reaching out to the different corners of our community? It is important that we reach the frail and lonely, every senior counts. How else can we better engage our seniors to avoid social isolation and better support them to age in place and with grace?
How can we leverage technology to coordinate our community networks and resources better and to engage our seniors better?
With so much done and will be done, I wonder when and how will we know if we have succeeded in achieving our vision of ageing in place and with grace. Could MOH articulate how Singapore has progressed in terms of caring for our seniors over the past decade? What is the state of physical and mental health of our seniors in Singapore and how has this changed over the years? Are there indicators that MOH uses to monitor our seniors' social well-being and how engaged they are in Singapore?
Assoc Prof Daniel Goh Pei Siong: Chairman, Sir, the Government has been preparing for the ageing society that is already upon us. Intermediate and long-term care, or ILTC as it is known, will become a critical sector in our healthcare system. This year Singaporeans will see the introduction of CareShield Life and MediSave withdrawals for long-term care.
A severely disabled Singaporean, who is unable to perform three or more activities of daily living, will receive a payout of $600 for life, and if the Singaporean's Medisave balance is $20,000 and above, he or she can withdraw another $200 a month. If we add in the Home Caregiving Grant, there is another $200 in cash assistance to receive. This adds up to a potential $1,000 in cash withdrawals to support the financing of the long-term care needs of a severely disabled Singaporean. If the affected person is from the Pioneer Generation, there is another $100 in cash assistance.
Sir, my concern is with the financing needs of middle-income households, especially those whose wage earners are from the sandwich generation facing the cost of raising school-going children and supporting ageing parents. The latest figure for 2019 from the Department of Statistics for median monthly household income from work per household member is $2,925. This suggests that about half of Singaporean households will not get any subsidies for their elderly household member accessing ILTC non-residential services, since cut off for subsidies is $2,800.
A Long-term Care study by Aviva in 2018 suggests that one would need around $2,300 a month on average for care, medical and everyday expenses. Sandwiched middle income wage earners could be facing the additional financing burden of around $1,300 a month to support an elderly parent needing long-term care.
I believe this burden will become widely felt in the near future, if it is not already being felt. Already, for the Home Caregiving Grant, there is a note on the AIC website that says it will take about three months to process applications due to the high volume of applications received. Has the Ministry done any study to ascertain the long-term care financing needs of middle-income households in the next five to 10 years? What more can be done to support the long-term care financing needs of middle-income households who fall outside of the Government subsidy threshold? Would opening CareShield Life to additional private insurance enhancements regulated by MOH like the Integrated Shield Plans of MediShield Life, with premiums payable by MediSave within limits be a possible answer?
Ms Yip Pin Xiu (Nominated Member): Chairman, Sir, in the last few years, the number of households with at least one member aged 65 years and above who hired a foreign domestic worker has been increasing. It seems that more families are relying on the help of a domestic worker to care for their elderly family member. Does the Ministry expect a growth in this number over the next few years?
Overall, does the Ministry view foreign domestic workers as a long-term measure in supporting our aging population? What is the Government's overall strategy to the role of foreign domestic workers in providing eldercare? Will this extend to the government's management of foreign domestic worker employment agencies?
Emerging data from AWARE's research on foreign domestic workers' role in eldercare suggest that domestic workers experience the lack of training in providing eldercare as a source of work stress. Would the Ministry consider mandating training for domestic workers who are hired to care for older persons or persons who need assistance with a certain number of Activities of Daily Living?
Mr Christopher de Souza: A lot of strain and pressure is felt by care-givers,especially those who are caring for an elder in the family while working. These responsibilities sometimes fall on a sibling who is single and staying with a parent or both parents. They need to work at the workplace, come home to care for their elderly and make significant decisions for the person they care for. As such, what measures have we put in place to provide respite care and how effective have these measures been?
Ms Joan Pereira: Sir, the Ministry announced last year that it was working with MND and HDB to pilot an assisted living development in public housing for the elderly. Seniors would be able to select a HDB flat with senior-friendly features and choose from a menu of care packages with optional add-on services to suit their needs and preferences. Examples of these choices include health screening, exercise classes, personal care, housekeeping and round-the clock emergency support. The development would even come with communal facilities and programmes to encourage social interaction.
It is an exciting development and I am glad to note that Singapore's first Assisted Living Public Housing for seniors will be launched in Bukit Batok in May. I strongly believe that this will help our seniors age in place. May I ask the following: how has the progress been thus far? Which service providers have been shortlisted as partners? How much will such a unit and the care packages cost? Will there be enough assisted living flats for all seniors especially with our ageing population. What other initiatives is the Ministry considering to support active ageing and to help our seniors age in place?
The Chairman: Senior Minister of State Dr Amy Khor.
The Senior Minister of State for Health (Dr Amy Khor Lean Suan): Chairman, ageing should not be regarded as a Silver Tsunami to be feared but rather as Silver Equity to be drawn upon. Longevity is also not a disease! It is a gift to celebrate, so long as we stay healthy. With the gift of time and health, we can pursue the things we enjoy.
Minister Gan shared that Singaporeans have a life expectancy of 84.8 years, of which 74.2 years are lived in full health. How would we seize the opportunities of at least 74 good years?
Since we launched the Action Plan for Successful Ageing in 2015, we have made significant strides in building a caring and inclusive home, centred on 3Cs – care, contribution, and connectedness. From scaling up the Community Networks of Seniors nationwide, to promoting learning and volunteering opportunities, we have sought to enable seniors to age in a caring environment, pursue the activities they enjoy and contribute to others in the way they wish.
We are also helping our seniors stay connected by capitalising on man's best friend. No, I do not mean a dog or cat – Member Mr Louis Ng is not here – but, you might have guessed it. I mean the smart phone.
Together with Smart Nation and Digital Government Office and Public Service Division, we have developed the Active Ageing module in the Moments of Life (MOL) app. As one of the 250,000 Merdeka Generation members that the Silver Generation Ambassadors have reached out to to-date, I found it really easy to access information about the various active ageing programmes via the MOL app and pick the one nearest home.
From next month, not only can I browse information on the MOL app, I can also sign up and \"chope\" a spot for active ageing programmes by the Health Promotion Board (HPB), such as health talks, cooking demonstrations and more!
This January, we launched the Healthy Longevity Catalyst Awards in partnership with the United States National Academy of Medicine, to spur bold, innovative ideas and technology to extend healthy longevity. This could include assistive devices, smart-enabled homes or job redesign solutions. We received more than 100 applications and I look forward to leveraging these innovations to help seniors stay active and engaged.
With all our efforts, I am glad to inform Ms Tin Pei Ling that the 2019 Ageing Survey showed that Singaporeans generally had a positive outlook towards ageing. Across all age groups, those who were still working or volunteering were also less likely to describe themselves as old. However, 96% of Singaporeans cited health as the top concern in old age and three in four retirees wished they could have worked longer.
As we plan for both seniors of today and tomorrow, we must respond to changing needs and aspirations. As part of the SG Together movement, the Government will engage Singaporeans across all ages to refresh the Action Plan for Successful Ageing, so as to co-create a future where generations of seniors may thrive in. Health and employment will be key focus areas in the Action Plan, to address our seniors' top concerns.
Of course, while we strive to make the best of our golden years, most of us will eventually come face to face with creaky knees and back pain. But if we prepare ourselves and plan ahead early, we can better cope with the uncertainty and lengthen the good years of our lives.
To that end, we have partnered the Centre for Seniors (CFS) to pilot bite-sized life-stage conversations, with the aim to reach out to some 5,000 mature workers, especially those in their early 50s, through collaborations with companies, union leaders and community organisations over the next two years. The conversations will touch on a wide range of topics such as employment, health and family, to help mature workers prepare themselves early for the transitions in their senior years. As of December, CFS had organised some 63 lunch-time talks for over 2,000 participants.
Chairman, speaking from experience, I will now like to urge all younger Singaporeans in their 20s and even younger to prepare early for their golden years, which could so easily come upon us in the blink of an eye. Just like me – Members of this House on the right side of 50, I think would surely understand.
Bone health, in particular, deserves our careful attention. With an ageing population, the number of hip fractures has nearly doubled, from 1,500 cases in year 2000 to nearly 3,000 in 2017. About 14% of those with hip fractures pass away within a year of fracture – a sobering statistic. Of the patients who survive, 20% require assistance with activities of daily living. Fractures can have a debilitating effect on our quality of life.
To reduce the risk of fracture when we age, we must start \"saving up\" calcium from young, before we reach maximum bone density at around 30 years old, after which, we can only maintain the density at best. To inculcate the importance of proper nutrition and a healthy lifestyle, HPB will be conducting a pilot outreach to 10 schools on bone health. Besides \"saving up\" calcium in our youth, we must also continually upkeep and prevent depreciation of our assets. In this case, depreciation refers to bone loss.
HPB will be working with Osteoporosis Society Singapore to train 300 Bone Health Ambassadors to reach out to more Singaporeans on the importance of a healthy lifestyle and diet, starting in the second half of this year. These ambassadors will help to run public educational sessions, particularly in the area of fall prevention.
Dr Lily Neo, Ms Tin Pei Ling and Ms Joan Pereira asked about our progress in supporting seniors to age-in-place. Since 2015, MOH has expanded the number of home and day care places by 70% to support seniors to age-in-place. For nursing homes, we have expanded bed capacity by 30%, we now have sufficient capacity nationwide.
Besides expanding capacity, we are also enhancing the scope of services to better address the spectrum of care needs. I announced last year that we will enhance the scope of eldercare centres, to go beyond aged care to social support and preventive health. Currently, MOH funds 82 Senior Activity Centres to provide wellness programmes and social support to residents in rental flats. In the next four years, we will progressively level up and fund at least double the number of eldercare centres to provide an expanded suite of baseline support services for all seniors nationwide and not just those living in rental blocks.
Services include active ageing programmes for the well, befriending services for the lonely, and information and referral for care services for our frail seniors.
In addition, about half of the eldercare centres will also provide higher level care services, such as day care and community rehabilitation services, to cater to those who are more frail.
We also echo Ms Irene Quay’s view that community pharmacists play an important role in ensuring medication adherence in the community. In 2017, of some 517,000 seniors, more than 43% were prescribed five or more regular medications and seen by three or more healthcare providers. Seniors who have multiple co-morbidities often struggle with making sense of many medications from many clinics and the risk of medication error then increases.
Thus, MOH conducted a small proof-of-concept for a pharmaceutical care service for 150 seniors at eight eldercare centres last year. Community pharmacists from both private and public healthcare institutions worked with the centres’ care teams to optimise seniors' medications. Through one-to-one sessions with their pharmacists, seniors and their care-givers received tips on managing their medications, including medication packing and management of side effects, so that they may take their medications safely and independently at home. Feedback from participants of the pilot has been positive. Hence, over the next three years, we will be extending the pharmaceutical care service to another 2,500 seniors at more eldercare centres. This will allow us to establish scalable solutions to help seniors manage their medications safely.
Besides pharmacists, community nurses pounding the ground complement the role of eldercare partners. To Ms Joan Pereira's question, we have expanded the number of community nursing posts from about 70 a year ago to about 120 community nursing posts today. These are sited at senior activity centres, community centres and religious sites, just to name a few. We now have a pool of 245 community nurses, exceeding our target to recruit 200 community nurses by end 2019. As feedback has been positive, we target to expand our pool to 300 community nurses by 2021. Kudos to our nurses from the Regional Health Clusters, who have attended to 86,000 residents in the community, up from just 33,000 just a year ago. I am glad that not only do our residents cherish our community nurses but nurses, likewise, found their job meaningful, and nearly all of them have stayed on the team since the pilot started. In fact, only one left.
This year, as earlier announced by Minister Lawrence Wong, we will also be rolling out another HDB housing type – assisted living flats – to expand the housing options for seniors. The first one will be launched in Bukit Batok. These new assisted living flats are meant to provide seniors with a housing option for independent living, with care available if needed, and a gotong royong spirit amongst neighbours.
We co-designed the flats with Singaporeans. In the past year, MOH and MND conducted 14 Focus Group Discussions (FGDs) with seniors, service providers and healthcare professionals.
Chairman, may I display a few slides, please?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Dr Amy Khor Lean Suan: The FGDs were conducted at these specially constructed mock-up flats and communal living room to help participants better imagine the assisted living experience. It was helpful as participants could give us very specific feedback: a moveable partition between kitchen and sleeping areas, room for a full-sized fridge, and more. We took in all the feedback and improved the design of the housing units, communal living room and basic service package. We are also exploring additional care service options to support frail seniors, such as after-hours care.
So, what is the difference between assisted living flats and the range of senior housing options today, such as 2-room flexi-flats? Unlike 2-room flexi-flats, these assisted living flats will be sold, twinned with a service package. Elderly residents will benefit from 24/7 emergency response, as well as the assistance of an on-site community manager.
The community manager will monitor the health status of residents and link them up with relevant care services according to their needs. The community manager will also curate programmes to foster a strong sense of neighbourliness, and residents can look forward to mingling at the communal space on every floor – much like the good old kampong days.
The first Assisted Living flats in Bukit Batok will be reserved for seniors aged 65 and above. In addition, we will set aside some units where priority will be given to seniors with care needs. More details will be shared in the coming weeks. Planning for a private Assisted Living pilot is also underway. MND and MOH have consulted developers and care operators on this and will announce details later.
MOH continuously seeks to wrap care and support around Singaporeans. Dr Lily Neo, Ms Anthea Ong, Mr Daniel Goh and Mr Murali Pillai highlighted the importance of taking this approach for not just physical health but also mental health. I agree and we are embracing this approach. For instance, the HPB promotes both physical and mental health in its preventive health programmes organised in the community and at workplaces.
Like a migraine or backache, we should seek help for mental health issues early, so as to avoid problems that are more challenging to address later on. To that end, we have set up 43 community outreach teams and trained over 24,000 frontline staff from Government agencies and community partners across Singapore to identify persons with mental health needs in the community and refer them for appropriate support. As of December 2019, we have reached out to over 300,000 persons and provided assistance to more than 23,000 persons who were at risk of developing mental health conditions or dementia.
IMH and the National Council of Social Service (NCSS) have also been driving the “Beyond the Label” national campaign to facilitate more conversations about mental health. This way, we hope to chip away at the stigma associated with mental health and encourage those with mental health issues to seek help promptly.
Ms Anthea Ong should also be assured that physicians are bound by duty and ethics to protect patient confidentiality and to ensure data sharing and use for patient care purposes only – for all medical conditions, not just mental health. Healthcare institutions are also required by licensing conditions to safeguard confidentiality of medical records. Specifically, our public healthcare institutions have implemented safeguards to ensure access by authorised users on a need-to-know basis. Severe disciplinary and enforcement actions are taken against users who wilfully breach patient confidentiality. Organisations must also comply with the Personal Data Protection Act.
Chairman, over the years, we have expanded our network of partners to ensure that persons with mental health issues can access the support they need. For example, the Institute of Mental Health operates a 24-hour Mental Health Helpline. NCSS has also recently launched a Helpbot named \"Belle\" to provide 24/7 access to consolidated information about helplines and mental health resources, according to what users are looking for. To date, Belle has supported 1,000 users.
Community intervention teams have also been established to support partner General Practitioners (GPs) and service providers with allied health services, such as psychotherapy and counselling. Over 26,000 persons have been supported by these teams. In addition, persons with mental health issues who face social and family issues may approach Family Service Centres for counselling support.
To date, more than half of our polyclinics provide mental health and dementia services. In addition, over 210 GP partners have been trained to diagnose and support persons with mental health conditions.
These services are available to all Singaporeans, irrespective of their specific risk factors, such as disability or gender identity. However, we agree with Ms Yip Pin Xiu and Ms Anthea Ong that care providers need to take into account specific care needs and risk factors.
For example, for persons with hearing loss, sign language translators will provide counsellors with the necessary support. The Singapore Association for the Deaf also provides counselling services.
Over the next year or so, MOH and the Agency for Integrated Care will be engaging our stakeholders, including disability associations, to identify ways to improve mental health support.
As highlighted by Ms Anthea Ong and Mr Daniel Goh, Singaporeans can tap multi-layers of financial support, such as Government subsidies and CHAS, MediShield Life, MediSave and Medifund, for treatment of mental health conditions.
MOH reviews the amount of financial support regularly to ensure that they are adequate. For example, the MediSave and MediShield Life claim limits differ across inpatient treatments to reflect different bill sizes. As the bill sizes of inpatient psychiatric treatments are comparatively lower than other inpatient treatments, the MediShield Life and MediSave limits are also correspondingly lower, to cater to different treatment types.
Based on the latest available data, fewer than one in 10 subsidised patients exceeded the MediSave yearly withdrawal limit for inpatient psychiatric stays, while fewer than three in 10 subsidised bills exceeded the MediSave daily withdrawal limit. As for MediShield Life, we have been reviewing the claim limits and more details will be announced later this year.
For outpatient treatment of mental health conditions under the Chronic Disease Management Programme (CDMP), which includes depression, anxiety, including Obsessive Compulsive Disorder (OCD) – so, that is included in CDMP – bipolar disorder and schizophrenia – CHAS cardholders may tap on subsidies of up to $500 per year for treatment at CHAS GPs, and more for our Pioneer and Merdeka Generation cardholders. Patients can also withdraw up to $500 per year from their MediSave for outpatient treatment for conditions under the CDMP. In 2018, only about two in 10 patients who withdrew MediSave for their outpatient mental health treatment reached the yearly withdrawal limit. To further defray the costs for patients with complex chronic conditions, say, a patient with OCD and osteoporosis, we will be raising their MediSave withdrawal limit. Further details on this will be shared by Senior Minister of State Mr Edwin Tong. Singaporeans who still require financial support after tapping these schemes can apply for MediFund from our public healthcare institutions.
We must also not forget that the well-being of persons with mental health conditions often rests on the care-givers, and they are at risk of burnout.
Hence, we will be piloting a structured system of support for care-givers of persons with mental health conditions. Under this system, upon first diagnosis of their loved ones, hospitals and community partners will provide care-givers with information, such as disease progression and expected care needs and link them up with the necessary health, financial and social support services. With this, we hope that care-givers will know upfront that they are not alone, that there is an entire network of support for them.
Even as we expand our suite of care services for persons with mental health, we must strengthen our multi-pronged strategy to better address mental health and this extends beyond medical care. Hence, in the coming months, we will be undertaking a whole-of-Government review of our mental health strategy, to identify gaps and strengthen existing inter-agency efforts. Besides enhancing support for the mental well-being of seniors, we will also focus on youth mental well-being, which Senior Minister of State Lam will elaborate on.
Chairman, in recent months, our healthcare workers are at the frontline, battling against the spread of COVID-19.
I will also like to take this opportunity to thank all our healthcare workers who have gone above and beyond their duty to keep us safe. We are grateful, and we will do our utmost to support all of them.
I share Assoc Prof Daniel Goh's pride in our nurses. It is unfortunate that some of our nurses were shunned and even berated for wearing their uniforms in public recently. Our nurses wear their uniforms with pride, and I hope members of the public can appreciate and trust their professionalism and affirm their efforts
The work of our healthcare workers is not any easier in \"peacetime\". Healthcare workers sometimes, inadvertently, bear the brunt of patients' and their families' emotions. Under the Protection from Harassment Act, the Government adopts a zero-tolerance policy against the harassment of public healthcare workers performing their official duties. The same Act also protects them as private citizens if they are harassed when off duty. All our public healthcare clusters also have counselling services and hotlines for our healthcare workers if they need help.
But the best way to support our healthcare workers is not to react after harm is done but to refrain from taking out our stress on them. I urge Singaporeans to take a moment to recognise their efforts, and I am heartened by those who have rallied behind them.
Chairman, our healthcare workers are truly the backbone of our healthcare system. Battling COVID-19 is but the latest example. Their role will only continue to grow in importance. As care needs increase in our ageing population, we will need a steady pipeline of dedicated healthcare workers. Manpower is a perennial challenge, but on the flipside, it is also an opportunity for Singaporeans who seek a meaningful career.
We have made some headway in growing the number of healthcare workers. For instance, the number of practising nurses has grown by 3.3% per annum in the past five years. In comparison, Singapore's total employment grew by 1.1% per annum over the same period.
With the expansion of services, we could see up to around 6,000 additional jobs in the healthcare sector in the next two years. This is on top of hiring to replace attrition. We will continue our efforts to attract and recruit Singaporeans to build a strong local core in our workforce.
However, with shrinking birth cohorts, the labour market will become much tighter in the decade beyond 2020. To meet our growing manpower needs, we must rethink our current approach and find creative ways to attract and retain people in the sector, particularly in the growing community care sector.
First, we need to diversify our hiring sources. Besides attracting fresh graduates, we will continue our efforts to bring mid-careerists into healthcare. Mid-careerists play a valuable role as they bring with them unique expertise and fresh perspectives from their previous careers. In the last two years, about 2,000 local mid-career PMETs transited into the healthcare sector, and about one-third of them are mature workers aged 40 and above.
Besides healthcare staff, there are many administrative positions available in the healthcare sector too. Take, for example, Ms Noraini, who joined Ren Ci Hospital after spending more than 20 years as a special needs educator and then as a business executive. Ms Noraini's experience placed her in good stead for her role as a resident care manager in Ren Ci Hospital.
Nevertheless, to support her transition into the community care sector, Ren Ci Hospital placed Ms Noraini under the Senior Management Associate Scheme (SMAS). When she completes her induction programme this year, Ms Noraini can continue to attend leadership programmes to support her development.
Second, we must invest in our people, especially in the community care sector, to enable the shift of care beyond hospital to community.
To support the attraction and retention of manpower in this sector, MOH previously funded a total of $350 million between 2012 and 2017 to community care institutions to raise salaries for their staff. Around 90% of MOH-funded institutions participated in this exercise.
Over the next three years, MOH will set aside another $150 million to support community care institutions to further improve the competitiveness of salaries. We project that this will benefit up to 4,000 local nurses and support care staff, if it is fully taken up. After these three years, MOH will factor in the higher salary levels in our funding to community care providers.
We strongly encourage employers to take the opportunity to enhance salaries of nurses and support care staff and continue to improve career prospects of our care staff in the community.
We are also eager to bring non-practising nurses back to our healthcare family. Over the past four years, about 500 local nurses have returned to practice annually. Returning nurses may undergo a refresher course under the Return to Nursing scheme, and those who return to the community care sector are eligible for a retention bonus of up to $5,000. In response to Mr Melvin Yong, MOH has been actively working with the union and employers on the retention and development of our healthcare workforce.
I also echo Ms Joan Pereira and Mr Christopher de Souza's call to continue supporting professional growth and development for nurses and allied health professionals.
Last year, we launched the Skills Frameworks for allied health workers and medical social workers, just to name a few. This year, I am pleased to launch the Community Nursing Competency Framework, which can be used by community nurses and employers as a guide to identify skills gaps and pursue development opportunities.
From this year onwards, fresh school leavers and in-service staff may apply for the new Community Care Scholarship to take up programmes relevant for the community care sector, such as in the disciplines of Occupational Therapy and Social Work.
Besides training, we must also create opportunities for our healthcare workers to take on leadership positions in the sector.
Nurses, in particular, play a leading role in care delivery in the community care sector and we must nurture those with strong clinical skills and leadership potential.
Let me share the story of Assoc Prof Edward Poon. He started as a staff nurse at Singapore General Hospital (SGH) before joining the community care sector early in his career. Over time, he took on various leadership positions and he is now Director of Nursing at St Luke's Eldercare (SLEC).
Assoc Prof Poon's impact extends beyond SLEC. In addition to upholding and maintaining the quality of care at SLEC, he also conducts training for the sector and collaborates with public hospitals on geriatric research.
We hope there will be more budding professionals who will go on to take on nursing leadership roles in the community care sector, just like Assoc Prof Poon. Hence, we will be introducing a new Community Care Nursing Leadership Programme this year, to groom the next generation of nursing leaders for the sector. Regardless of their current place of practice, all experienced Registered Nurses who want to take on leadership roles in the community care sector are welcome to apply.
The programme will provide nurses with opportunities in clinical training, leadership development, attachments and mentorship.
Lastly, all of us must find ways to eliminate unnecessary workload and adopt best practices to work smarter. This would include process and role redesign as pointed out by Ms Irene Quay.
Collaborative prescribing is one example. Since 2019, 34 advanced practice nurses and 31 clinical pharmacists in 11 healthcare institutions have been trained and empowered to prescribe drugs to their patients. We hope more institutions and professionals will come on board in the near future.
In response to Ms Irene Quay, employers may already choose to go beyond the minimum provisions in the Employment Act to accept medical certificates or time chits issued by allied health professionals.
In respond to Mr Faisal Manap, the regulatory scope of the new Healthcare Services Act (HCSA) includes traditional and complementary medicine services. MOH will monitor the prevalence of use and risks to patient safety, before considering whether to license these services under HCSA. Nonetheless, traditional and complementary medicine practitioners are already subject to relevant provisions under the Medicines Act and the Sales of Drugs Act, just to name a few.
Chairman, even as we face shrinking birth cohorts, we are also presented with the gift of longer health-adjusted life expectancy, which we can capitalise. Singaporeans are living longer and healthier and we should allow them to continue contributing, if they wish to.
This is a win-win scenario for both employers and employees. In 2019, around 99% of public healthcare workers aged 62 and beyond were offered re-employment and 95% of them accepted the offer.
To support our mature healthcare workers who are able and willing to continue working, MOH has worked with the Healthcare Services Employees' Union and public healthcare institutions to raise the retirement age to 63, and re-employment age to 68 from July 2021 onwards – one year ahead of the national schedule. Those who wish to retire or stop working at 62 may still do so whilst those who want to keep working now have the choice to work even longer.
In closing, it is our unending pursuit to find ways for each of us to age healthier, happier and in a fulfilling manner. I want to urge all Singaporeans – young and old – to help us achieve this.
The Chairman: Ms Irene Quay.
Ms Irene Quay Siew Ching: Mr Chairman, I refer to the nationwide curbing of antimicrobial resistance (AMR), an issue which I have also spoken on before on the need for us to curb AMR through legislative changes.
AMR is a major global threat that persists and will continue to worsen if left unchecked. I do not speak this lightly, but the potential fatal consequences of AMR will surpass that of SARS, H1N1, Ebola, MERs-CoV and COVID-19 combined.
A quote from England Chief Medical Officer, Dr Dame Sally Davies, \"The threat of antibiotic resistance is as great as that from climate change.\" This imminent danger is a result of antibiotic overuse, misuse and the lack of regulation.
A local study reporting a 10-year review of AMR in Singapore noted a marked difference in the community rectal carriage of ESBL-producing Enterobacteriaceae, that is, 6.3% in 2006 versus 26% in 2016 between two dissimilar surveys, appearing to signify an increasing trend despite the differences in methodology.
It is therefore with all urgency that I ask if MOH has any data to share on antibiotic usage in the community?
I understand that the antimicrobial stewardship programme has been well established in our public institutions. May I ask if MOH has considered funding for such antimicrobial surveillance programme in the community, where the majority of our primary healthcare is provided by private practices?
I would also like to request for an update on the progress of the National Strategic Action Plan on AMR.
Dr Lily Neo: Mr Chairman, I want to start by commending MOH as well as other Ministries in their efforts in tackling COVID-19 and limiting its spread, that has impressed WHO.
Healthcare workers' calling and dedication are at the greatest committal situation presently; knowing that while looking after the sick, there is possibility that they and their family members may also get sick as a result of COVID-19. May I also encourage all our healthcare workers in both the public and private sectors, especially those in the frontline, to keep up their good work and keep their spirits high. May I also thank all other frontline workers that help us in limiting the transmission of COVID-19.
I hope MOH will spare no effort in sharpening its future preparedness by enhancing this episode’s good practices and registering and correcting its shortfall. There may be areas that need attention, such as being self sufficient with locally manufactured preventive and protective items, for example masks, and enhancing our health scientist sector capability to fight viruses.
Adherence to a healthy lifestyle is associated with a lower risk of mortality. It reduces the risk of chronic diseases such as type-2 diabetes, hypertension, hyperlipidaemia and disability. May I ask MOH if there are new initiatives to assist more Singaporeans to achieve healthy living?
Diabetes and hypertension can cause heart disease, renal failure and so on. Compliance on diet and medication are key factors on the outcome on war on diabetes. Can MOH promote and motivate more healthcare providers and patients themselves to achieve it?
A local study found that the proportion of older adults with three or more chronic diseases nearly doubled from 2009 to 2017. If diabetes and hypertension are detected earlier, there will be lesser morbidity and disability amongst the seniors. All senior care centers can be tasked to assist detecting and maintaining good control for these two chronic conditions.
Breast cancer remains the most frequent cancer among women in Singapore, and approximately 6% of all women will be diagnosed with invasive disease in their lifetime. The underlying premise for breast cancer screening is that it allows for the detection of breast cancers before they become palpable. Small tumors are more likely to be early stage disease, having better prognosis, and are more successfully treated.
May I ask MOH on the percentage of women screened yearly and the percentage in detecting smaller treatable breast cancers? And how to improve its take-up rate?
Colorectal cancer is now the commonest cancer in Singapore. The average population risk for developing colorectal cancer in Singapore is among the highest in the world. Most colorectal cancers develop from adenomatous polyps, thus its early detection and removal reduces the risk of colorectal cancer. Pre-malignant period of the adenoma-carcinoma sequence makes it ideal to screen for colorectal cancer and such screening has been proven to save lives. Will Minister consider subsidised colonoscopy screening, as it is more accurate and is also preventive in nature by removing polyps early, compared to present occult blood testing?
Cervical cancer is the sixth most common cancer among Singapore women. The human papillomavirus (HPV) is the causative agent of essentially all cervical cancer cases. Because of this fact, and the fact that there are HPV vaccines that protect against infection with HPV, some countries like Holland and Australia are adopting a HPV DNA assays as primary screening methodology for cervical cancer prevention. Will MOH adopt the same strategy for better cervical cancer prevention?
Stomach Cancer is the seventh most common cancer in men and the ninth in women here. Every year stomach cancer takes more than 300 lives in Singapore. Chronic infection with Helicobacter Pylori (H. Pylori), a bacterium that lives in the mucous lining of the stomach, may increase the risk for stomach cancer. H Pylori infection is a common infection in Singapore affecting about 31% of the population, and infection increases to 71% in adults above 65 years. H Pylori is an important pathogen that can be treated with antibiotics and should be eradicated if detected.
A recently published report of a working group of the International Agency for Research on Cancer (IARC) of the WHO concluded that-randomised clinical trials have found that H pylori treatment is effective in preventing gastric cancer, and models indicate that H pylori screening and treatment strategies would be cost-effective. Will MOH raise the awareness on this finding and look into the feasibility of population based screening and prevention of stomach cancer?
Mr Leon Perera (Non-Constituency Member): Mr Chairman, Sir, based on the reply to my Parliamentary Question (PQ) last month, after the launch of the National Adult Immunisation Schedule in 2017, the take-up rate for adult vaccination rose, but is still way below that of some other developed countries. For example, for flu vaccines among seniors, our take-up rate may be around 24% versus 70% in the UK, US and Australia.
Can we do more to promote adult vaccination? For example, the Government works with employers to conduct health screenings, can those same platforms, events and working relationships be used to offer on-the-spot vaccinations to workers and companies?
Can we also do more to nudge GPs to display material in their clinics that prompts patients to ask for vaccinations. Of course, price is always a consideration, as many would want to conserve their MediSave for other future needs. I would repeat my call made in Parliament for the level of subsidy given for adult vaccines to take into consideration the downstream fiscal cost savings to the state from fewer diseases as a result of vaccines.
Finally, our child vaccination coverage for measles, for example, is high at around 95%. But in 2019 there were 152 measles cases, which was the highest number of cases since 1997. MOH figures also showed that there were several hundred cases of mumps every year since 2012.
In response to a PQ about measures to prevent measles outbreaks, the Minister for Health opined that passivity could explain most of the cases of children not being vaccinated.
However, the growth of anti-vaccination beliefs worldwide should not be under-estimated. I would like to ask for an update on what measures MOH is planning to reduce the numbers of children not receiving these essential vaccinations.
Do all childcare centres require vaccinations certificates before enrollment? Can we do more, for example, working with pre-school centres and private enrichment programme centres to flag out cases of non-vaccinated children?
Mr Charles Chong (Punggol East): Mr Chairman, in October last year, MOH announced new measures which would affect the marketing of high sugar drinks. Now, I applaud this move, as consumption and availability of highly sugared drinks continue to be a great impediment on our war on diabetes. In announcing the new measures, MOH said that more details about the measures affecting highly sugared drinks would be released in 2020. I would, therefore, like to ask the Minister if MOH has crystallised its policy on highly sugared drinks and if he can provide an update on this?
Sir, on smoking, I would like to ask the Minister about measures which are available to assist persons to quit smoking. Smoking's popularity has been in decline, as more people understand the health risks associated with smoking. I hope we can do more to discourage people from smoking and even more to encourage smokers to quit. Could the Minister provide us an update on the measures which have been put in place to assist smokers to quit and how successful has this been?
In 2018, the Senior Parliamentary Secretary for Health said that MOH was aiming to bring the smoking rate to below 10% by 2020 – this year. Could the Minister provide an update on how successful we have been at reducing the smoking rate?
And finally, Mr Chairman, I would like to ask the Minister about what we can do or what has been done to encourage Singaporeans to take preventive measures for the sake of their health such as getting regular health screenings done and having vaccinations performed when they are needed. Could the Minister let us know how successful MOH's \"Screen for Life\" programmes have been and how many Singaporeans have taken advantage of the subsidised screening under under the programme? Are there any plans to expand \"Screen for Life\" to beyond what they really are, just basic level tests?
Mr Leon Perera: Sir, the Government has introduced mandatory front-of-pack nutrition labels for less healthy pre-packaged sugar-sweetened beverages (SSBs), and advertising bans for the least healthy SSBs on local mass media channels. More than 30 countries have introduced such labels. In Chile, the sales of drinks with the unhealthy labels fell by 25% after one-and-a-half years. However, with the daily sugar intake of Singaporeans more than double that of the level recommended by the World Health Organization, could we go farther?
Could MOH consider reviewing the results of these moves and if these are not effective consider adopting to some degree and in a tiered and calibrated fashion the measures that have been adopted for tobacco products, such as more graphic warning labels and packaging?
A study by researchers at Harvard in 2018 suggested that graphic warning labels on sugary drinks reduced purchases more than text-based labels.
Research funded by the UK's Department of Health also suggests that removing products from choice locations within a retail outlet – for example, at the check-out counter where impulse buying is common – can reduce sales. While product placement is negotiated in contractual agreement between the sellers and the retailers, it may be necessary to explore nudging retailers to move in this direction in time though, of course, not without industry consultation and piloting.
Industry buy-in for such moves may be facilitated by the fact that many of the firms producing high sugar food and beverage products are gradually seeking to shift revenue share to healthier products over time, as they see the writing on the wall globally.
The Chairman: Senior Minister of State Dr Lam Pin Min.
The Senior Minister of State for Health (Dr Lam Pin Min): Mr Chairman, for Singaporeans to continue to have good access to quality and affordable healthcare, we must press on to transform our healthcare system in the long-run, even as we face threats like COVID-19.
With Singaporeans living longer, primary care plays increasingly crucial roles in maintaining one’s health throughout their lives. Our Vision, “One Singaporean, One Family Doctor”, remains relevant while we provide all Singaporeans with affordable and quality care, near their homes. Mr Chairman, may I display some slides, please.
The Chairman: Yes, please. [Slides were shown to hon Members.]
Dr Lam Pin Min: I announced in 2018 that our network of polyclinics will be expanded to 30-32 polyclinics by 2030, from 20 today. Since then, we have announced 10 new polyclinics, six of which will open by 2023.
In response to Mr Chong Kee Hiong's feedback for a polyclinic in Bishan, as well as Mr Sitoh Yih Pin’s suggestion to build one in Bidadari, I am glad to say that your prayers have been answered. We will be developing a polyclinic in each of these areas by 2030. With Bishan and Bidadari polyclinics, we will achieve our target of having 32 polyclinics by 2030.
To Dr Chia Shi-Liu's query, the new polyclinics will offer similar services as existing ones, including medical treatment for acute conditions, chronic disease management, women’s and children’s health services, and radiological, laboratory and pharmacy services.
Dr Chia also asked about our primary care transformation journey. This involves promoting a regular family doctor, which is important for continuity of care, especially for patients with chronic diseases who need long-term follow-up.
To work towards this goal, we shared last year that polyclinics are scaling up team-based care, where patients with chronic diseases see a regular care team.
We are not far from achieving this goal in the private primary care sector too – two-thirds of Community Health Assist Scheme (CHAS) cardholders with chronic diseases have a regular doctor. This demonstrates how integral private sector General Practitioners (GPs) are to our primary care transformation efforts, which brings me to Mr Chong’s and Dr Chia's queries about support for GPs in providing better and more holistic care.
Besides supporting them in their professional development, I will share more later, we have been partnering them to anchor and provide holistic chronic disease management through the Primary Care Networks (PCNs). Similar to polyclinics, PCNs are embracing team-based care.
Thanks to their support, we are on track to have at least half of CHAS GP clinics participating in the PCN by end 2020. More than 500 PCN GP clinic partners are caring for over 100,000 patients with chronic conditions, up from about 70,000 last year.
One of these patients is Mdm Lam. She was diagnosed to have diabetes and hypertension in 2007 and started visiting Jurong polyclinic to manage her chronic conditions. In 2015, she switched to Frontier Family Medicine Clinic (FMC) as she wanted to have one regular doctor to help manage her medical conditions holistically. She has also enjoyed having Frontier FMC closer to her home.
Since then, she has been regularly consulting Dr Thia, whom she is now very comfortable with and who is familiar with her medical conditions. With Frontier FMC joining the PCN in 2018, Mdm Lam also benefited from team-based care, including nurse counselling, and diabetic foot and eye screening. Now, Mdm Lam does not have to run around for multiple appointments as the PCN clinic coordinator ensures her screenings are done conveniently at the clinic on the same day as her consultation with Dr Thia. She is grateful her care team has helped her understand her medical conditions better, and that has helped her improve and keep her medical conditions in check
With the continued expansion of the PCN, more patients like Mdm Lam will benefit from this scheme.
Like chronic diseases, early detection and management of cancer can make a world of difference in health outcomes. We would like to thank Dr Lily Neo for her suggestions to improve screening and follow-up.
The screening rate for breast cancer is about 39% and the rate of late-stage breast cancer diagnosis has remained around 28% between 2008 and 2017. There is therefore room for improvement. Oftentimes, all that is needed is a change in mindset. Misconceptions and fears are common barriers – thinking that screening is not necessary when one feels healthy, that \"it is better not to know\", and that mammograms are painful, are just some of the examples.
To counter these, the Health Promotion Board (HPB) holds annual breast cancer awareness campaigns, conducts on-the-ground activities and uses social media to expand their reach. They will continue to work with partners to encourage more women to go for screening regularly.
To enhance the take-up rate, breast cancer screening must also be made accessible and affordable. In this regard, the Singapore Cancer Society (SCS), Breast Cancer Foundation (BCF) and the National Healthcare Group Diagnostics (NHGD) introduced the Community Mammobus programme, where the first mammogram is free of charge and subsequent ones are $10 for Singaporeans. About 9,300 individuals have benefited from this programme since its launch in 2018.
Mr Charles Chong asked whether there are plans to expand Screen for Life to include additional tests, and Dr Lily Neo also suggested alternative screening tests for selected cancers such as colorectal cancer and also mentioned about the Helicobacter pylori (H. pylori) test for stomach cancer. MOH and HPB refer to the Screening Test Review Committee's (STRC) recommendations in deciding which screening tests to provide at a population level. These are based on robust scientific evidence to ensure that they are safe, effective, suitable and cost-effective.
On colorectal cancer, both the Faecal Immunochemical Test (FIT) and the screening colonoscopy are recommended for population-level screening. However, the screening colonoscopy has risks due to its invasive nature. Conversely, the FIT kit can be safely and conveniently administered by the individual at home.
Under Screen for Life, subsidised FIT is available at all CHAS GP clinics and those who test positive are referred for subsidised diagnostic colonoscopies. Screening colonoscopies are still available at Public sector hospitals and are MediSave-claimable should one choose to go for them instead.
On cervical cancer, HPV-DNA testing for women aged 30 to 69 was introduced in mid-2019, following STRC's recommendation due to its higher sensitivity and lower frequency required, compared to the Pap smear.
MOH and our partners will keep on striving to encourage more Singaporeans to go for early screening and follow-up, and update our strategies when new evidence arises.
Mental well-being continues to be a top concern based on recent engagements with youths, which highlights the need to do more. Mr Melvin Yong and Dr Lily Neo, amongst many others, have recognised this and have asked how we can improve youth mental health services and make them more accessible.
Minister Indranee Rajah has announced MOE's efforts to further support student well-being through mental health education and peer support cultures in schools. Complementing MOE's efforts, we announced last year that we will work with the Institute of Mental Health (IMH), the Agency for Integrated Care (AIC) and our community partner, Care Corner, to develop an Integrated Youth Service (IYS), where youths at risk can access coordinated mental health and social support services in the community.
I am glad to update that the Integrated Youth Service will be starting in Woodlands this year. Care Corner will reach out to youths at risk and raise awareness on mental well-being and resilience. They will also provide individualised emotional support, needs identification and peer support services, and refer those who require further intervention to appropriate health and social services.
Moving forward, we will continue to take a whole-of-society approach and work with other Ministries to address youth mental health needs. This includes MOE, MSF, MCCY, including their National Youth Council (NYC), on the recently announced Youth Mental Well-being Network.
As mentioned by Minister Gan, we must continue to move beyond quality to value. He shared that about 50% of the rise in healthcare costs is due to higher utilisation and another 15% partly due to increases in costs of drugs and medical devices. We are therefore employing a suite of strategies to increase value and lower costs so that all Singaporeans can access care without experiencing financial hardship. Let me elaborate.
One of these strategies is the introduction of surgeon fee benchmarks for common surgical procedures in the private sector last year. Anyone, including doctors, patients and payers, can refer to them on the MOH website. I am glad to share that since its publication, surgical fees have generally converged, with the majority falling within range and more than 80% below the upper limit. We also saw a slight reduction in the average fees.
Our work does not stop here. We will keep monitoring the charges, seek feedback from stakeholders, and review the benchmarks with the Fee Benchmarks Advisory Committee (FBAC), so that they remain relevant and effective.
Building on this, the committee is studying expansion to surgical fees for less common procedures, doctors' inpatient consultation fees and other fee components like anaesthetist's fees, and plans to submit its recommendations later this year. With these efforts, all of us will be able to make more informed decisions and benefit from greater transparency of fees.
We have also implemented measures to reduce drug costs, including switching to generic drugs where possible. Generic drugs or biosimilars are medicines which are clinically equivalent to branded or originator drugs and typically cost much less. If used appropriately, both patients and our healthcare system can benefit from enormous cost savings without compromising safety and quality of care.
To encourage Public healthcare institutions to use more of such drugs, MOH works with the National Pharmacy and Therapeutics (NPT) Committee every year to select a basket of drugs which can be switched, and reviews their utilisation annually. In 2018, the usage of generics in the basket increased to more than 90% by volume. We will continue to work with the committee and Public healthcare institutions to increase uptake and therefore cost savings.
We have also set up the Agency for Logistics Procurement and Supply (ALPS) in July 2018 to pool together supply chain functions and resources across our three healthcare clusters to achieve greater economies of scale. With ALPS, 85% of drugs used in clusters were purchased on national group contracts in 2018. Today, this proportion has increased to 95%, resulting in clusters saving at least 5% in drug costs, benefiting our patients in turn. For example, the cost of drugs for epilepsy was reduced by up to 85%.
Building on these efforts, ALPS will work with relevant agencies to encourage greater entry of generics and new sources of drugs in Singapore and launch different approaches in strategic sourcing and procurement to keep drug prices competitive.
We must not only reduce costs, but ensure that our limited resources are spent on care that is of value.
The Agency for Care Effectiveness (ACE) conducts health technology assessments (HTA) to facilitate clinically-effective and cost-effective care, and negotiates with manufacturers to attain fair prices for selected health technologies. Their work has improved access and affordability for over 50,000 patients. Of note, they managed to cut down the prices of medicines such as those for Hepatitis C by more than half.
ACE is on track to deliver savings of $75 million over five years, and will work on benefiting even more Singaporeans.
MOH also introduced the Value-Driven Care (VDC) programme to deliver good health outcomes in a value-conscious manner. We are extracting value for the 17 high-volume, high-cost and therefore, high-impact conditions under this programme.
Since May last year, we have been sharing data across providers to identify areas of improvement and facilitate sharing of best practices. As we are still at early stages, we will continue to monitor the programme's impact. At the same time, we are expanding our scope by identifying additional conditions and increasing the period of analysis.
MOH and healthcare providers will work together on these on-going efforts to contain costs and ensure that all Singaporeans can access quality care. As individuals, we can also play our part too, by discussing with our healthcare providers on appropriate treatments for our conditions, and financial support available, if needed.
MOH is committed to supporting the development of healthcare professionals. Today, ACE publishes Appropriate Care Guides (ACGs) to help healthcare professionals optimise patient outcomes. To support them further, ACE will be launching a national educational visiting service known as ACE Clinical Update Service (ACE CUES) in the second half of this year.
While educational visiting may be a new term to many of the Members here, it has been made available in a number of countries, including Australia, US, Canada and Norway, and is shown in many studies to improve patient care and outcomes. Through educational visiting, best available evidence and information materials on patient care are brought to healthcare professionals at their workplace, where one-to-one, focused and customised discussions are held at their convenience.
A range of clinical topics will be covered over time, the first being asthma, which affects many people of all ages, most of which are being managed in primary care settings by GPs. As there have been recent major developments in asthma treatment, it is timely for ACE CUES to bring these updates to GPs nationwide to benefit their patients, starting with those in the PCNs.
Dr Chia Shi-Lu asked for an update on integrated personalised medicine into our healthcare eco-system.
In Singapore, healthcare demands are changing fundamentally, driven by a rapidly ageing population and increased chronic disease prevalence. MOH is examining ways to be future-ready to ensure that healthcare delivery evolves to address these demands and adopts innovative approaches to transform healthcare while mitigating costs.
Precision medicine is one such promising area. Work on the national strategy for precision medicine research and implementation has been on-going. It aims to accelerate health research and develop peaks of research excellence for Singapore, and, ultimately, to improve health by identifying clinical applications that are cost-effective, sustainable and relevant.
The official launch of the precision medicine strategy and research programme is currently planned for the third or fourth quarter of this year, and more details will be made available later.
Let me come to antimicrobial resistance (AMR). Ms Irene Quay asked for an update on the National Strategic Action Plan (NSAP) on antimicrobial resistance and the measures MOH is taking to optimise antibiotic use and enhance surveillance.
Following the launch of the action plan in 2017, we set up the Antimicrobial Resistance Coordinating Office (AMRCO) under the National Centre for Infectious Diseases (NCID) to oversee its implementation. To enhance surveillance, AMRCO is extending AMR surveillance and tracking of antimicrobial utilisation, already in place for public hospitals, to private hospitals and primary care. Guidelines for healthcare professionals on the management of infections and antimicrobial use are also being developed.
In addition, AMRCO, together with MOH and partner agencies such as the Singapore Food Agency (SFA), National Parks Board (NParks), NEA and PUB, is examining an integrated approach to surveillance.
As a first step, the First Joint Report of Antimicrobial Utilisation and Resistance in Singapore will be published this year. Singapore also enrolled in WHO's Global AMR Surveillance System (GLASS) to contribute surveillance data and learn from other countries' experiences.
All of us have a role to play in preventing antimicrobials resistance too by using antimicrobials appropriately. HPB will continue its \"Use Antibiotics Right\" public education campaign to address common misperceptions, increase awareness and encourage patients to discuss appropriate antibiotic use with their doctors.
We generally take a collaborative approach for public health programmes. We have benefited from close cooperation with the public and our stakeholders, and will continue to work together to improve public health for all. While much has already been done, our healthcare transformation journey does not end here.
As we continue to move beyond Healthcare to Health, beyond Hospital to Community and beyond Quality to Value, we need to keep in mind that success goes beyond having the right policies in place – the backing and invaluable cooperation and contributions of healthcare providers and citizens are paramount. With that said, let’s continue to work towards achieving our shared goal of accessible, affordable and quality care for all, so that we can remain a healthy nation for generations to come.
The Chairman: Mr Gan Thiam Poh.
Mr Gan Thiam Poh (Ang Mo Kio): Chairman, while all of us are preoccupied with COVID-19, it is important for us not to forget about another health risk – diabetes. Diabetes can lead to health complications such as kidney failure, heart attack and stroke. One in nine Singaporean adults were affected by diabetes in 2010. As our population ages, the prevalence of this disease will increase as the risk increases with age. Rising obesity also contributes to the prevalence of diabetes in our population.
Unfortunately, Singaporeans face many sugary temptations in their food and beverage choices daily. We may be able to resist snacks and so on, but most people will get a couple of drinks in the course of the day which are often loaded with sugar. These include coffees, teas, soft drinks and even purportedly healthy beverages such as freshly squeezed juices and herbal drinks. Will the Ministry share an update on the measures to control sugar-sweetened beverage consumption?
The Senior Parliamentary Secretary for the Ministers for Culture, Community and Youth and Transport (Mr Baey Yam Keng): Mr Chairman, good health is not something we can buy, nor can it be taken away by people. One golden rule to good health is regular exercise, which can be free of charge, for example running. The other is a balanced diet. Food is not free, but the best and healthiest choice is home-cooked food. Buying fresh produce and cooking at home is generally cheaper than eating out.
I have come across low-income families who do not cook. One common reason is lack of time, because some have more than one jobs to make ends meet. I especially worry for their kids who might resort to convenience food like instant noodles, which offer little nutrition. I have also met some seniors who live by themselves in rental flats. It is too much of a hassle for them to cook for themselves or he could be a widower who does not cook.
So, I would like MOH to share if it has done some studies on this issue and how it plans to help low-income Singaporeans.
The Chairman: Assoc Prof Dr Muhammad Faishal Ibrahim. Take your two cuts together.
The Senior Parliamentary Secretary to the Ministers for Education and Minister for Social and Family Development (Assoc Prof Dr Muhammad Faishal Ibrahim): The phrase \"prevention is better than cure\" is often used to encourage people to adopt preventive health measures in their lives. I commend the Health Promotion Board and other stakeholders who have passionately and persistently engaged Singaporeans to take on preventive health measures at the community and national levels.
As we move forward, I would like to ask how will MOH encourage Singaporeans across all ages to take on preventive health measures, such as doing timely health screening, vaccination and quit smoking?
Healthcare is not one size-fits-all, and often community providers are best able to customise services to fit the needs of local populations or vernacular groups.
Over the years, we have seen many community providers coming forward to play a part and contribute towards a healthier Singapore. These community providers have helped to empower Singaporeans to lead a more active lifestyle and taking ownership of their health.
As good health and active lifestyle are expected to continue to be an important national agenda, I would like to know how the Ministry is supporting these community providers, especially during this COVID-19 period?
Mr Charles Chong: Mr Chairman, the speaker before has already said all the things that I wanted to say. So, I shall not repeat them, other than to say that I support what Assoc Prof Dr Faishal Ibrahim has said. [Laughter.]
The Chairman: Senior Minister of State Edwin Tong.
The Senior Minister of State for Health (Mr Edwin Tong Chun Fai): Mr Chairman, as the Minister for Health has shared, we have delivered on our Healthcare 2020 objectives, including having Minister Gan remain as the Health Minister till now.
Today, Singaporeans live longer, healthier lives than when we made these goals in 2012. We enjoy some of the best healthcare in the world, and this remains affordable and also accessible to all. But the future will bring new challenges, and we cannot afford to rest on our laurels. It will take bold steps – from Government and the community in partnership – to ensure that we can continue keeping these commitments to our citizens.
Our healthcare financing system has weathered the test of time. Each financing scheme plays a unique role in ensuring that no Singaporean will be denied appropriate care because of an inability to pay.
First, Singaporeans enjoy means-tested subsidies across public healthcare settings, covering up to 80% of the costs of treatment. Singaporeans are also covered by MediShield Life for large hospitalisation bills and costly outpatient treatments. Coverage starts from the moment one is born, and is for life. Next, MediSave helps Singaporeans set aside some income towards future healthcare needs. It can be used to offset out-of-pocket expenses and also pay for health insurance premiums. Finally, MediFund provides a safety net for those facing financial difficulty.
This framework has worked well for us. Seven in 10 subsidised hospitalisations by Singaporeans do not incur any out-of-pocket expenses or payment, while eight in 10 incur payments of less than $100. Still, we regularly review each pillar of healthcare financing to give Singaporeans peace of mind in seeking the care they need.
As our population ages, we can expect more Singaporeans to face chronic conditions. Ms Tin Pei Ling asked how we are supporting chronic disease patients, and Dr Chia Shi-Lu asked specifically about what we can do to encourage them to seek early intervention in the community.
In June 2018, we raised MediSave withdrawal limits for conditions under the Chronic Disease Management Programme or CDMP, from $400 to $500. We also expanded CDMP to cover ischaemic heart disease and pre-diabetes. Today, CDMP covers 20 conditions, including four mental health conditions: schizophrenia, major depression, bipolar disorder and anxiety. We regularly review the list of CDMP conditions in consultation with clinical experts, and will include conditions such as eczema in our review.
Last November, we introduced higher subsidies for complex chronic conditions for CHAS Blue and CHAS Orange card-holders, and also expanded CHAS Orange to cover common illnesses. We also launched the CHAS Green card – part of a wider initiative to shift healthcare beyond hospitals and into the community. All Singaporeans are now eligible for subsidised CDMP treatments at CHAS GP clinics, regardless of income levels. This represents a fundamental shift in primary care financing, with universal subsidies for GP treatment.
Ms Irene Quay asked for an update on the success of these measures. Let me just outline the broad parameters with reference to a few facts. I am happy to share that around 200,000 Singaporeans received their CHAS Green cards in 2019, entitling them to the programme that I have just outlined a moment ago. Altogether, 1.7 million Singaporeans have received their CHAS cards, seven times more than when CHAS was first launched in 2012.
With our continuing efforts to bring more clinics onto the scheme, CHAS card-holders can now receive subsidised treatment at close to 2,000 GP and dental clinics island-wide. In 2019, we disbursed more than $160 million in CHAS subsidies, significantly alleviating the cost of outpatient treatments for Singaporeans.
This year, we will be further expanding the use of MediSave for CDMP treatments in outpatient settings. Currently, Singaporeans can tap on the MediSave500 scheme for CDMP treatments, for approved vaccinations and screenings. From 2021, we will increase support for patients with complex chronic conditions by raising their annual withdrawal limit from $500 to $700. Patients with complex chronic conditions include those who have visits for two or more CDMP conditions, or one CDMP condition with complications, within a year. This is aligned with the higher CHAS subsidies we implemented for complex chronic patients in November. In effect, rather than MediSave500, these patients will in fact benefit from an extension of the scheme, or MediSave700.
Administratively, we will align MediSave500 with all other MediSave schemes, shifting from a per-account to a per-patient limit. Overall, we expect more than 176,000 patients to benefit from the enhanced MediSave700 scheme.
Ms Tin Pei Ling asked us to consider greater flexibility in the MediSave withdrawal limits, especially for seniors with significant balances. I believe Mr Pritam Singh also raised the same issue. We have been working to increase flexibility under MediSave in a few key areas. Let me outline them.
First, covering new treatments and services. We are expanding MediSave to cover severe disability under the upcoming MediSave for Long-Term Care scheme. With cash withdrawals, patients will also have greater flexibility to choose appropriate care options, relevant for themselves and their particular circumstances. Second, increasing flexibility within existing schemes. So, first we cover new schemes and new treatments, and second, we look at increasing flexibility within the scheme itself. One example is lowering the age threshold for Flexi-MediSave in 2018 from 65 to 60. Another example is the MediSave700 scheme I have just outlined. The higher withdrawal limits increase flexibility for patients with complex chronic conditions, as they are likely to incur higher costs for their CDMP treatments.
Overall, these enhancements are designed to strike a balance, as we have to continue to do, between current medical expenses and of course, future healthcare needs down the road. We will continue to take on board the suggestions, review our MediSave withdrawal limits in light of our overall financing framework, to introduce greater flexibility where possible, and to ensure that they are adequate for the majority of patients in subsidised settings.
Dr Chia Shi-Lu asked how we can plan to keep healthcare affordable for elderly Singaporeans. The three pillars of our long-term care financing framework – CareShield Life, MediSave Withdrawals for Long-Term Care, and ElderFund – mirror the \"3M\" schemes that we have for acute care, and that has worked well for us. They complement existing subsidies of up to 80% for long-term care services, such as day care and home care.
The first two pillars represent significant changes. CareShield Life provides better protection for severely disabled policyholders with lifetime payouts. MediSave Withdrawals for Long-Term Care, or MediSave Care for short, will allow Singaporeans to withdraw directly from their MediSave in cash, providing flexibility for long-term care expenses. Both schemes will be launched later this year.
Assoc Prof Daniel Goh asked how we are supporting families who might fall outside of the subsidy thresholds. So, we have those within the framework, that I have just outlined. What happens to those who might fall outside the subsidy thresholds? First, let me clarify that the current income criterion of $2,800 for long-term care subsidies covers close to two-thirds of resident households in Singapore. The median household income per member quoted by Assoc Prof Goh includes the employer CPF contributions, which we exclude in assessing the eligibility for subsidies.
The figure is also based on all employed households, and does not consider households with no working persons. Elderly households, or households with elderly members, tend to have a lower income per household member. Hence, a larger proportion of such households will qualify for subsidies, with many qualifying for the maximum rate of subsidies.
Together with CareShield Life and other schemes highlighted by Assoc Prof Goh, most Singaporeans will be adequately covered for basic long-term care needs. In addition, as I mentioned to the House last year, we will allow private insurers to introduce additional severe disability coverage on top of CareShield Life, with premiums payable from MediSave.
The third pillar is ElderFund, a safety net for lower income and severely disabled Singaporeans. It supports those who are unable to benefit from schemes like ElderShield with monthly cash payouts, and opened for applications on 31 January.
Mr Faisal Manap asked if patients with physical impairments can obtain support from MediFund for transportation costs. This is an area where new measures complement the existing schemes to provide multiple layers of support. We provide means-tested subsidies of up to 80% for patients requiring transport for centre-based services, dialysis or medical appointments at polyclinics and also at SOCs. Patients who need additional assistance may tap on cash payouts under ElderFund or other schemes, to defray the costs of travel to and from medical appointments. So, we look at the overall framework and these are the schemes that sit outside that supplement and work with the existing framework.
Financial concerns represent only some of the challenges that Singaporeans face when loved ones encounter disease or disability. Beyond being able to afford care, we want Singaporeans to feel supported in caring for each other as well.
Ms Yip Pin Xiu has asked about our long-term plans for eldercare. Over the years, we have improved the accessibility of aged care services and also deepened the range of services and options available in the community and residential care settings.
Last year, for instance, we launched the Care-giver Support Action Plan to support those caring for seniors on their care-giving journeys. Since then, we have been working with the Agency for Integrated Care (AIC) and various community partners to roll out new initiatives.
Some initiatives focus on care navigation and care-giver training. Care-givers can obtain information and access referral services at four new AIC Links touchpoints in Toa Payoh, Nee Soon, Pasir Ris and also Choa Chu Kang, which complement the eight existing touchpoints already existing in our heartlands. We have also worked with healthcare professionals to introduce a course on the \"ABCs of Care-giving\", with customised components to help care-givers with the different mobility needs of their loved ones.
Within the eldercare landscape, there is a range of care-giving options. Many families engage foreign domestic workers (FDWs) to provide care and Ms Yip Pin Xiu asked if care-giver training initiatives will be extended to them as well.
There are, indeed. merits to training FDWs and families can decide on how best equip them. We have initiatives to support those who choose formal training for their FDWs, such as the Eldercarer FDW Scheme which we have run since 2016. Training is done before placements in the households that they serve and includes both classroom theory and as well as on-the-job practical training in managing the day-to-day care-giving needs of an elderly person. Care-givers can tap on an annual $200 subsidy under the Care-givers' Training Grant to offset the costs of training for their FDWs or other approved courses.
Mr Christopher de Souza has asked about our measures to provide respite care and how effective they have been. Mr de Souza will be pleased to hear that we have respite care options at more than 20 eldercare centres and 40 nursing homes, where more than 3,700 so far have benefited.
We have recently expanded the range of respite care options as well, starting with a respite care pilot in September 2019 for care-givers of cancer patients on home palliative care and a night respite care pilot in December 2019 for care-givers of persons with dementia, who experience behavioural and sleep issues at night. And sometimes, these difficulties cause the care-giver not to have his or her own rest. So, that option is available.
We have also been helping care-givers access respite care at short notice. Care-givers under our Go Respite pilot launched in April last year were able to pre-enrol for these services and activate the respite care at short notice. To-date, 450 care-givers have been pre-enrolled.
Beyond expenses for home and community-based services, care-giving expenses can take many forms and we recognise that.
So, in October 2019, we launched the Home Care-giving Grant, which replaced the previous Foreign Domestic Worker Grant with an enhanced quantum of $200 per month. By providing cash support directly to care recipients with permanent disability, care-givers have greater flexibility as to how best to deploy these resources.
We have since approved more than 4,900 applications for the Home Care-giving Grant, bringing the number of beneficiaries under the scheme to over 16,000.
Allow me to share the story of one care-giver, to illustrate how our schemes address the care-givers' different types of needs.
Mr Shahril lives with his wife, three children and a 79-year-old father, who is bed-bound after a stroke and heart attack. In October 2019, Mr Shahril needed a break from care-giving duties, as his helper had left the country for home leave. He shared this with the AIC Link staff at Changi General Hospital where his father was treated. Within two weeks, they enrolled Mr Shahril's father in AIC's Go Respite programme at the NTUC Health Nursing Home, across the road from their home, across the road from where they live, and he began his three-week stay there. This arrangement made it easier for Mr Shahril to continue to provide for his own family, with the assurance that, at the same time, his own father was being cared for during this period.
At the same time, Mr Shahril also applied for the Home Care-giving Grant. Today, his family receives a monthly payout of $200, which they use for essential items, such as diapers, milk supplements and other disposables, as well as for his father's medical expenses. All in all, our schemes have given Mr Shahril the flexibility and the assurance to care for his father in the long term.
I have shared how the Ministry is taking important steps to help address the cost of care, both financially and otherwise.
These will support Singaporeans in seeking the necessary care. But at the same time, we must take bold steps to encourage healthier lifestyles. I think Members have heard that narrative from the speakers before me. This will delay the onset of disease and reap downstream savings for our healthcare system.
Members will also be, nonetheless, familiar with our efforts on this front. Minister had previously described some of our efforts to promote healthy living under the war on diabetes initiative.
Although we have made progress in encouraging Singaporeans to exercise more and eat healthier, our daily sugar intake, as some Members have pointed out, remains high. In particular, beverages contribute to more than half of the sugar intake.
Both Mr Charles Chong and Mr Gan Thiam Poh asked for an update on our plans to control the consumption of such beverages. The same issues and questions have been raised by Dr Intan Azura Mokhtar in the House last week, while Mr Leon Perera also made suggestions what else we could do should these measures not prove to be effective.
As a start, let me outline what we will do. As a start, we will implement two new regulatory measures for pre-packaged beverages: a nutrient-summary label and an advertising prohibition for beverages with high sugar and saturated fat content. So, two elements – sugar and saturated fat. We want to provide Singaporeans with the right information to make their own healthy choices and also, at the same time, encourage the manufacturers to reformulate their products and create healthier options, a point that Mr Perera also raised.
Under this new regulatory framework, all pre-packaged beverages will be given a colour-coded nutrient-summary label, called the ‘\"Nutri-Grade\". With your permission, Mr Chairman, may I display an example of the label for Members?
The Chairman: Yes, please. [A slide was shown to hon Members.]
Mr Edwin Tong Chun Fai: On the screen, Members see an example of the label: Grade A, corresponding to the lowest sugar and saturated fat thresholds, is in dark green; while Grade D, corresponding to the highest sugar and saturated fat thresholds, is in red.
This provides a quick, at-a-glance summary of the nutritional quality of the beverage, allowing consumers to compare across products at the point of purchase. Besides the grade, we will indicate the sugar level of the beverage as a percentage of the total volume. So, if you see 12% on the label, it represents 12% sugar of the total volume in that particular product.
This provides Singaporeans with more information so that they can compare sugar levels across beverages within the same grade. With your permission, Mr Chairman, may I display a slide summarising the grading system?
The Chairman: Yes, please. [A slide was shown to hon Members.]
Mr Edwin Tong Chun Fai: Thank you, Sir. Pre-packaged beverages will be graded on a single set of nutrient thresholds, based on their sugar and saturated fat content. For example, beverages with more than 5% sugar content will be graded C, while beverages with more than 10% sugar content will be graded D. But beverages may subsequently be \"downgraded\", at the point in time, be downgraded to D, if they also contain a high amount of saturated fat.
We encourage all manufacturers to label their products with the Nutri-Grade, but the label will only be mandatory for beverages in Grades C and D.
The label is intended to facilitate Singaporeans' decisions when they go and purchase these products at the point of purchase. It will therefore not only be displayed on the front of product packaging, but also at points-of-sale the where customers do not have direct access to the product. For example, at e-commerce websites, vending machines, drink fountains, they will be displayed at the point-of-sale as well.
In addition to labelling requirements, we will prohibit advertising for Grade D beverages on all media platforms, including traditional and new media platforms across all time belts. This will reduce the impact of advertising on consumer preferences and encourage manufacturers to reformulate.
We will continue to allow advertising of Grade A to C beverages, as well as all brand advertising, as we want to encourage manufacturers to reformulate. The point is not to deprive Singaporeans of their favourite drinks, but to encourage manufacturers on their journey towards reformulation to create a wider and broader range of healthier options for Singaporeans to enjoy.
The new regulations will be published at the end of 2020, coming into effect a year later.
If manufacturers start today, they will have almost two years to reformulate their products in line with these regulations and avoid being in groups, Grade C or D where they have to compulsorily put on the label.
The Health Promotion Board (HPB) will continue to support industry reformulation efforts through initiatives such as the Healthier Ingredient Development Scheme. And HPB will also launch a campaign to educate consumers on using the Nutri-Grade labels to guide purchase and consumption decisions.
At the same time, we have heard strong calls from all quarters to also regulate – beyond just the pre-packaged – the freshly prepared beverages, such as herbal drinks and bubble teas. It is clear that they are a substantial and growing source of sugar intake for many Singaporeans. Dr Intan Azura Mokhtar, in particular, asked whether there are plans to extend our regulations to these drinks.
Over the past few months, I have met representatives from the freshly prepared beverage sector to hear their views on how we can work with them as well to help consumers make that transition to healthier choices.
Most understand the need to inform consumers about the nutritional quality of their products and they support our objective of reducing Singaporeans' overall sugar intake.
After a careful review of the local landscape, we have decided to extend the labelling and advertising measures to freshly prepared beverages. As a start, these measures will apply only to the larger chains, which are more likely to have consistent recipes, as well as significant reach and impact locally. We will study the local landscape to determine the appropriate criteria for what comprises a \"large chain\".
Other jurisdictions with mandatory labelling in F&B settings have, in their own countries, adopted thresholds of 10 to 20 outlets as being the definition of \"large chain\". But we will study this in our own context. We will take reference from what has been done in other countries, which means that small businesses with one or two stalls, such as those in hawker centres, would not be affected in the first instance. Nevertheless, we will monitor the impact of these measures, and may gradually seek to extend them to more establishments – along the vein of what Mr Perera had mentioned earlier.
Concurrently, we encourage F&B outlets not considered \"large chains\" to voluntarily adopt these measures. We will continue to engage the industry in the coming months to finalise details of these measures, including how to implement them in a cost-effective manner. More details will be shared when they are ready.
All these initiatives are part of a longer term approach to reshape consumer behaviour towards healthier living, not just in the choices that they make, but in consumption.
Some have suggested stronger measures, such as an excise duty or an outright ban. These will require further study, like those suggestions that Mr Perera raised. In the meantime, we will work closely with industry partners to support Singaporeans in making those healthier choices.
Finally, as a complement to our regulations, we also want to encourage Singaporeans to just go for more plain water instead – zero calories and very healthy on the overall grading scale.
So, on that front, we have been working with agencies like NEA, HDB, LTA and also NParks to increase the availability and accessibility of drinking water in the community.
Water dispensers are available in 30 hawker centres – Members might be pleased to know – and are also easily found in parks across Singapore. By mid-2020, more water dispensers will be installed in the remaining 82 hawker centres.
In addition, 14 bus interchanges and terminals already have water coolers and we will work with LTA and public transport operators to install water points in bus and MRT stations where suitable. In mid-2020, HPB will launch a nation-wide campaign to promote plain water, as part of their nutrition literacy campaign. Whether you are exercising in our public parks, enjoying a meal at the hawker centres, taking a bus, about to take a bus, or in the MRT station, we encourage you to choose plain water and we will make the options available as much as possible.
Mr Chairman, to conclude, the Government will continue to enhance the affordability of healthcare and expand support for care-giving. Policies such as the enhanced MediSave700 scheme will provide additional peace of mind for those with chronic illnesses.
At the same time, we will pursue downstream savings for our system by encouraging healthier living and supporting Singaporeans in making healthier and we believe, therefore, wiser choices in what they consume. Better health for us all is a vision and responsibility we must all share. We urge Singaporeans to partner with us as we strive for a healthier Singapore not only in 2020 but beyond. Thank you, Mr Chairman.
The Senior Parliamentary Secretary to the Minister for Health (Mr Amrin Amin): Beyond Healthcare to Health – going upstream and supporting healthy living. This is part of our ongoing transformation. To push this transformation, we will do three things which I will cover in my speech.
First, better financial support. Second, better community partnerships. Third, better use of technology.
On better financial support, we want Singaporeans, regardless of income or social background, to enjoy good health. We will do so in a fiscally sustainable, targeted and effective manner. I am happy to announce three initiatives.
(a)\tFirst, full subsidies for nationally recommended childhood vaccinations and developmental screening.
(b)\tSecond, subsidies for nationally recommended adult vaccinations.
(c)\tThird, subsidies for nicotine replacement therapies for eligible participants at smoking cessation pilots.
The effective dates for the vaccinations subsidies and child developmental screenings will be before the end of 2020 – exact dates will be announced later.
Today, only recommended childhood vaccinations against infectious diseases with high outbreak potential such as measles and diphtheria receive full subsidies, and this is only available at polyclinics in the primary care setting. There are currently no subsidies for adult vaccinations and smoking cessation in the primary care setting.
Full subsidies will be given to Singaporean children for all vaccinations recommended under the National Childhood Immunisation Schedule or NCIS. These also include pneumococcal and HPV vaccines. Subsidies will be available at polyclinics and at CHAS GP clinics across Singapore.
For Singaporean children up to the age of six, full subsidies for child developmental screenings will be extended from polyclinics to include CHAS GP clinics. We are doing this to ensure early detection and timely intervention for developmental delays for all Singaporean children. This measure is part of our ongoing efforts to ensure Singapore remains one of the best places to raise a child. So I urge parents to take advantage of the free vaccinations to give our children the best possible start.
All eligible Singaporean adults will enjoy subsidies for vaccinations under the National Adult Immunisation Schedule or NAIS at polyclinics and CHAS GP clinics. The NAIS covers seven types of vaccines that protect against 11 diseases, including influenza and pneumococcal disease. NAIS recommends vaccination to two main groups of adults: The first group, persons with certain medical conditions such as diabetes, chronic heart diseases and chronic respiratory diseases; and the second group, seniors aged 65 and above.
Subsidies will be means-tested. At polyclinics, eligible lower to middle income Singaporeans will get 75% subsidy. This corresponds to CHAS Blue and Orange cardholders at CHAS GP clinics. Other eligible Singaporeans will get 50% subsidy for the vaccinations. Pioneer Generation get an extra 50% subsidies and Merdeka Generation get an extra 25%, off the remaining co-payment amount.
Let me illustrate. Now Singaporeans pay about $70 to $80 for PPSV23 pneumococcal vaccination at a polyclinic. Assuming you fall within the NAIS recommendations and qualify for the subsidies, you can expect to pay about $20 to $40, depending on means-test. Pioneer and Merdeka Generation gets additional subsidies.
Singaporeans can continue to pay out-of-pocket amounts using MediSave. Singaporean adults will receive similar levels of means-tested subsidies for these vaccinations at CHAS GP clinics. We will share details when ready.
To ensure vaccination subsidies are passed to eligible Singaporeans at CHAS GP clinics, MOH will introduce fee caps for NAIS and NCIS vaccinations done at CHAS GP clinics. It is quite tongue-twisting. MOH have also worked with vaccine manufacturers so CHAS GP clinics can get these vaccines at favourable prices. We are studying ways to help those who may have difficulties going to polyclinics and CHAS GPs, such as nursing home residents, to benefit from these subsidies.
I mentioned earlier about providing the subsidies in a fiscally, sustainable and targeted, effective manner. Let me explain.
First, the NAIS scopes the group of people whom the Expert Committee on Immunisation (ECI) has assessed to be more vulnerable to certain diseases and are therefore recommended for the vaccinations. So, targeted group based on need.
Second, our aim is to reduce the number of people who fall ill from vaccine-preventable diseases. Singaporeans with chronic medical conditions are particularly vulnerable and fall sick more easily. If diseases can be prevented, we can gain system-wide savings in the long run. Essentially, this is what we are doing: keep out vaccine-preventable diseases through vaccinations, keep our people out of hospitals and keep them healthy.
Mr Perera asked about the coverage of childhood vaccinations and how we can raise adult vaccination coverage in Singapore. Coverage for childhood vaccinations in Singapore is high, with most vaccinations exceeding 95% coverage in the past five years. This is due to efforts in health promotion, comprehensive childhood immunisation services and a robust school health service. All childcare centres and kindergartens require immunisation certifications for compulsory vaccinations under NCIS before enrolment. Parental inertia and lack of awareness are some of the reasons a small minority of children are not vaccinated.
We have a two-pronged approach to increase children and adult vaccinations. The first is to make vaccinations affordable through subsidies and the second, public education. Public education has taken on renewed importance with misinformation from the anti-vaccination camps. We aim to increase vaccination coverage among adult Singaporeans to over 50% by 2025.
Smokers will get more support to quit. Subsidies will be given for nicotine replacement therapy, if found suitable, in smoking cessation pilots. New smoking cessation models will be piloted in our public healthcare institutions such as hospitals, polyclinics and our national specialty centres.
Singaporeans can benefit from intensive behavioural support, follow-up for up to a year and a 3-month nicotine replacement therapy, if found to be suitable.
MOH is evaluating the pilot proposals. The pilots will target 10,000 smokers. We plan to start the pilots after Public Healthcare Institutions (PHIs) resume normal operations. This will depend on how the COVID-19 situation develops.
Mr Charles Chong asked about existing measures to assist smokers to quit and their efficacy. Success rates for smoking cessation programmes in Singapore have ranged from 10% for telephone-based interventions to 20% for programmes that combine intensive counselling and pharmaco-therapy.
Smoking is one of the biggest risk factors for poor health. Standardised packaging for tobacco products will start in July 2020. The minimum legal age for smoking will be raised to 21 next year. This will set a good momentum to drive down our smoking rates further.
I shared in 2018 our stretched target of reducing our smoking rate to below 10% by 2020. Smoking rate in Singapore dropped to 10.6% in 2019. We will do our best to reach that stretched target.
SPS Faishal asked about community health promotion activities. Indeed, cultural connections and understanding are strengths we are tapping on to mobilise the community towards a healthy cause.
HPB's Jaga Kesihatan, Jaga Ummah (JKJU), which means take care of health, take care of community is one good example. JKJU started in August 2017. JKJU brought together MUIS, 28 mosques and Malay Activity Executive Committees. I am proud that they have reached out to over 35,000 Malay participants in 2019. This is important, involving the community and powering community institutions to take ownership and mobilise people to action. Truly a healthy development.
Masjid Maarof organised piloxing, zumba, a skit on coping with dementia and urged congregants to give up a cigarette puff for a less calorie curry-puff (\"A Puff for a Puff\"). Masjid Al-Ansar offered circuit training and stretch-band exercises for seniors.
We are stretching out to involve more partners and people. Our Regional Health Systems (RHSes) will partner JKJU to bring more quality programmes and deepen outreach. This will help greatly, it is a promising partnership. Because RHSes treat patients who are residents in the area, they know the local ailments and the common problems within the community. RHSes can help local partners like JKJU shape programmes, provide targeted interventions customised to local needs and offer medical expertise to raise awareness on community trending topics.
I am also proud of the excellent work of Chinese and Indian community groups, 27 churches and 10 temples have worked hard to organise health promotion programmes. From health screenings, national step challenge roadshows to physical activity workouts.
The Hindu Endowment Board, SINDA and Narpani and various places of worship partnered HPB and reached out to 5,000 people in 2019. The Hindu Endowment Board partnered National Healthcare Group to conduct health screenings for 1,500 people at Sri Perumal Temple in 2019.
Senior Parliamentary Secretary Baey Yam Keng asked about helping lower income Singaporeans stay healthy. HPB will pilot the \"Healthy Living Passport\" in mid-2020, beginning with five sites located in Boon Lay, Woodlands, Jurong Spring, Chua Chu Kang and MacPherson. We aim to reach at least 15,000 residents, about 5,000 families, over a three-year period.
Healthy Living Passport seeks to improve health literacy and promote healthy lifestyles, customised to the needs of lower income residents. Lower income residents have specific concerns. They shared with us about working shifts, not having enough sleep and missing out on various community exercise programmes. They shared that healthier food such as vitamins, vegetables and low-calorie options tend to be more expensive. They raised stress as a concern and many, unfortunately, turned to smoking to unwind. We cannot brush these concerns aside. We should try to address them and hear them out.
Healthy Living Passport is a modest effort, a sincere outreach to help our fellow Singaporeans lead healthy lives. Let us work together.
We are still working out the exact parameters of Healthy Living Passport. Broadly, we are focusing on equipping participants with knowledge on shopping for budget, healthier ingredients and prepare healthier, tasty meals and promote physical activity, oral health and mental wellness.
We are targeting to impart health tips to both parents and children in a fun and interactive way. Volunteers from HealthySG Buddies will encourage and support families to use this Healthy Living Passport and embark on a meaningful and fulfilling journey.
Mr Charles Chong asked how MOH empowers and supports community care providers. We are committed to supporting community partners deliver better care to Singaporeans. One way is through funding support. An example is the Tote Board Community Healthcare Fund. This fund helps non-profit organisations pilot and scale innovative projects in preventive health and community care. The Tote Board Community Healthcare Fund has committed approximately $230 million since FY2009.
The Tote Board Community Healthcare Fund funds the Wellness Support Package. This package supports nursing homes to upskill their manpower and implement senior-friendly activities such as table-top gardening and wheelchair taichi. Seniors enjoy these activities and homes reported improvement in seniors' mood, well-being and self-esteem. Twenty-five nursing homes have benefited from this.
We are working more closely together. For instance, the RHS-HPB Integrated Volunteer Network and the Shared RHS-HPB Learning Hub. We recruit, train and deploy HPB Health Ambassadors and RHS volunteers together to promote health in the community.
Since April 2019, volunteers in the Integrated Volunteer Network reached out to over 4,000 patients and residents in areas such as rehabilitation, health screening and quit-smoking programmes.
In 2020, we aim to bring volunteers from all public hospitals on board the Integrated Volunteer Network.
Advances in technology present opportunities to better tailor programmes and messages, and engage residents and deliver effective programmes to the right person, at the right time, at the right place.
In the next few years, HPB will develop a Population Health Data Hub. This will be a national data hub containing information such as demographics, lifestyle and health information.
The Hub will help us better understand Singaporeans’ lifestyle, behaviour and health. Interventions and nudges may be customised to individual’s needs and lifestyle, empowering behavioural change and driving health outcomes. This will help us to better address the causes of ill health early, and reduce incidence of chronic diseases.
We are developing a virtual Health Booklet (vHB) that can send personal reminders, empowering individuals to better manage health. We expect to launch the virtual Health Booklet in end-2020.
We are making good progress with HPB’s National Steps Challenge. Now in its fifth season, more than 850,000 participants have taken part. Participants have grown more active with more step counts and higher intensity physical activity.
Mr Chong asked about screening rates. Screening rates have gone up from 45.1% in 2010 to 66.3% in 2019. Under Screen For Life, over 62,000 individuals aged 40 years and above have gone for cardiovascular screening at CHAS GP clinics. Of those with borderline and abnormal screening results, 84.4% have gone for medical follow-up as at 9 January 2020.
We want more Singaporeans to attend screening and follow up on their screening to reduce risk of developing chronic diseases. This year, we will pilot tele-coaching for people found to be at risk of cardiovascular diseases through the Screen for Life programme. HPB's health coaches will reach out to selected individuals and invite participants to work on health goals through HPB or other programmes. Mr Chairman, in Malay, please.
(In Malay): [Please refer to Vernacular Speech.] Please allow me to put on record our highest appreciation to our frontline officers battling against COVID-19 and I would like to give a reminder on the importance of staying healthy through two poems.
This first poem is an ode to our healthcare workers who are the heroes that we admire and respect. The second poem is a reminder to everyone to wash their hands with soap and to practise this good habit daily.
Our primary objective is a healthy society. Regardless of income or background, we want all Singaporeans to enjoy good health and a good quality of life.
I am happy to announce that MOH will introduce three new subsidies this year: first, full subsidies for nationally recommended childhood vaccinations and childhood developmental screening; second, subsidies for nationally recommended adult vaccinations; and third, subsidises for nicotine replacement therapies (NRT) for those selected at smoking cessation therapies.
First, subsidies for childhood vaccinations. They will receive full subsidies. In other words, all vaccinations recommended under the National Childhood Immunisation Schedule (NCIS), including pneumococcal and HPV vaccines, will be provided for free to all Singaporean children. These subsidies will be available at all polyclinics and CHAS clinics in Singapore.
Full subsidies will also be provided for childhood developmental screenings for Singaporean children aged six and below, at all polyclinics and CHAS clinics. Early detection and recovery will result in better outcomes.
To quote a Malay proverb – bend a bamboo while it is still a bamboo shoot. We want our children to start their lives healthy. This is an on-going effort to ensure Singapore remains one of the best places to raise children and have a family.
Second, subsidies for vaccinations recommended for adults. This subsidy will be given for vaccinations recommended under the National Adult Immunisation Schedule (NAIS) for some groups of adult Singaporeans. First, seniors aged 65 and above; and second, those with chronic medical conditions.
NAIS covers seven types of vaccines that protect against 11 diseases, including influenza and pneumococcal disease. The subsidies will be means-tested. At polyclinics, lower to middle income Singaporeans will get a 75% subsidy. In general, these are the CHAS Blue and Orange cardholders. Other Singaporeans will get a 50% subsidy. The Pioneer Generation receives an additional 50% subsidy while the Merdeka Generation receives an additional 25% off the remaining co-payment amount.
I urge all Singaporeans, especially parents and seniors, to take advantage of this subsidy. Prevention is better than cure.
Singaporeans can continue to pay out-of-pocket amounts using Medisave. For instance, the pneumococcal vaccination (PPSV23) now costs about $70 to $80 at polyclinics for seniors. With the subsidies, Singaporean seniors pay only about $20 to $40. It is even lesser for the Pioneer and Merdeka Generation. Singaporean adults will receive similar subsidies if they go to CHAS clinics. We will share more details next time.
Third, subsidies for nicotine replacement therapies for those undergoing smoking cessation therapies. One in four Malay Singaporeans are smokers. We will commence the smoking cessation pilot programme in public healthcare institutions after the COVID-19 situation subsides and normal operations resume.
This programme will target 10,000 smokers and will offer counselling, nicotine replacement therapy if suitable and follow-up consultations up to a year. Do not wait until it is too late. Do not wait until you fall ill to quit smoking. We have done so much together. These include the \"Kita Dah Cukup Manis\" campaign to reduce sugar consumption, the \"Puff for a Puff\" programme to quit smoking, and the \"Get Fit for Haj/Umrah\" and \"Move and Be Happy\" programmes to invite everyone to be more active.
I thank the community for their strong support. I am heartened and confident that there is a noticeable change. I have experienced it myself. When I was out for Hari Raya visits, I was often served plain water and reminded that \"We are already sweet enough, aren't we?\" Yes, definitely sweet enough.
Let us enhance our efforts together to stay healthy and have a sweeter life.
(In English): Mr Chairman, truly, health is wealth. We are reminded of how quickly things can change and how fragile life is with COVID-19. Let us support one another to stay healthy.
The Chairman: Clarifications. Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Thank you, Chairman. I just have two clarifications for Senior Minister of State Lam and two for Senior Minister of State Edwin Tong.
For Senior Minister of State Lam, besides building new polyclinics, are there any plans to redevelop or refresh existing polyclinics, given that many of the polyclinics are growing long in the tooth.
Secondly, I asked the question whether there were any enhancements to the PHPC system. I may have missed his answer but I was wondering whether there are any plans to improve the system or to strengthen the system.
For Senior Minister of State Edwin Tong, I think I am very heartened to hear about this new Nutri-Grade labeling system. But I saw on the slide that the label was \"subject to change\". I was just wondering whether Ministry has tried it out or done some test-bedding of these labels to see how effective they are, how clear they are.
And my second question is, I note that he said that 70% of these pre-packaged drinks would be classified as C or D. I was wondering of that percentage, how many are actually under D.
Finally, does this information also extend to those dispensed drinks, at soda fountains or at drink machines?
Dr Lam Pin Min: I would like to thank Dr Chia for those supplementary questions. With regard to polyclinics' development, in addition to those that we have announced for new developments, which is up to 32 polyclinics by 2030, we do have existing polyclinics that are being redeveloped, one of it was Ang Mo Kio Polyclinic which was redeveloped some time back. And moving forward, we are also going to redevelop Toa Payoh Polyclinic. Of course, we will review and look at the requirements on the ground and for those polyclinics that can be redeveloped to cater to the increased capacity, we will do so.
As for PHPC, currently, we do not have plans to enhance it. We feel that with the current 800 to 900 PHPC clinics on the ground, in fact, it is serving its purpose well but having said that, I think we will see how the COVID-19 situation evolves. If need be, we can enhance it as and when necessary.
Mr Edwin Tong Chun Fai: On Dr Chia's two questions, the Nutri-Grade label, yes, it is subject to change as we look at the design. But he will be heartened to note that we have already looked at it very closely. We had about 12 focus group discussions and also studied with the food science people, people who looked at it from a behaviourial perspective. In fact, after this we will be putting up on our website the report of the findings that we have gathered from these focus group discussions.
And so, generally, the label is designed, having in mind simplicity, giving fullest of information in terms of the choice, but also easy to recognise so that those who are not so conversant, the elderly, may be able to distinguish them.
The Member's second point about the 70%, the figures approximately are 70% will fall into C and D. And of that, about 25, 26% will be D. Looking at these numbers, you can see why we have said earlier that there is a strong desire for us to encourage the market to reformulate on their own. Because much as you design the Grading system, what we also want to ensure – and we do not ban the items – so what we want to ensure is that the market, on its own, corrects it, and – I think, it is a point that Mr Perera made – manufacturers do appreciate that the market is looking out for healthier options. This is one of the ways, along with the advertising ban, that we want to push market in a particular direction.
On the Member's final point about the soda fountains, yes, I mentioned that to the extent that we are not able to have the consumers review the product grading – the Nutri-Grade – before it is actually purchased, then at the point of sale, in other words, perhaps at the cashier or at the place where the orders are taken, that summary label will also be available.
The Chairman: Dr Lily Neo.
Dr Lily Neo: Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?
Mr Gan Kim Yong: Mr Chairman, I thank Dr Lily Neo for this very important question. As I mentioned in my speech, we do expect to see more cases coming in, given the emerging cases all around the world. Many countries are beginning to see confirmed cases of COVID-19. In quite a number of countries, there are already significant community spread within the country and, therefore, there is a high risk of exportation of these cases to Singapore. We have raised precautionary measures: as you have seen, in recent days. We have introduced new travel advisories as well restrictions and we have also introduced a swab practices for those passengers or travellers who are showing signs of being unwell. These will help us to prevent or to minimise the number of imported cases.
But some of these cases may still be imported because it is not possible to stop every case. Many of them may enter without symptoms because it is still within the incubation period. They may begin to fall sick while they are in Singapore. And there may also be Singaporeans returning from these areas – they may also develop symptoms, after arrival in Singapore.
Therefore, we do expect to see a significantly higher number of cases in time to come. With a higher number of cases in Singapore, the risk of community spread will also increase. Therefore, it is important for us to re-emphasise the need for us to pay attention to public health and personal hygiene.
That is why I mentioned that the SG Clean campaign is very important. Through this campaign, we hope to build a strong foundation of public health, raise the standard of public health – whether it is in our food outlets, in our public areas, in our public toilets – and at the same time, also entrench a higher standard of personal hygiene, and look at how we can improve some of the social practices like common servicing spoons and chopsticks in our restaurants.
These will go a long way in helping us to minimise and reduce the risk of widespread community transmission.
As of today, we still do not have evidence of widespread transmission in our community here, but we cannot allow our guard to come down. We have to continue to be mindful and to exercise and practise high levels of personal hygiene.
The Chairman: Ms Irene Quay.
Ms Irene Quay Siew Ching: Thank you, Chairman. Senior Minister of State Lam shared about this national antimicrobial surveillance report. I just wanted to ask if the results are ready and how are we faring in terms of our antibiotic utilisation in the community? What are our national targets and what are we doing about it?
Dr Lam Pin Min: I would like to thank Ms Irene Quay for the supplementary questions. As I have mentioned, the first joint report of antimicrobial utilisation and resistance in Singapore will be published later this year. So, I would not be able to let Ms Irene Quay know what the initial results are. Please be patient. The report will be released for public viewing.
The Chairman: Ms Joan Pereira.
Ms Joan Pereira: I have got two clarifications for Senior Minister of State Amy Khor. Earlier, she mentioned the Community Care Nursing Leadership Programme, or CCNLP. May I know how this complements the Community Nursing Scholarship that was earlier announced in 2017 to develop the pipeline of nursing leaders in the community?
The second clarification is on assisted living. Though the Senior Minister of State shared that the Government is rolling out assisted living flats to expand housing options for seniors, I still wonder whether there will be enough assisted living flats for all seniors, especially with an ageing population.
Dr Amy Khor Lean Suan: With regard to the Member's first question about the Community Nursing Scholarship and how this relates to the Community Care Nursing Leadership Programme. The Community Nursing Scholarship is for fresh school leavers, whether they are \"A\" Level or existing nursing students. So, they are fresh. What we are doing is trying to inject fresh talent into the community care sector – those with leadership potential and who have a passion to serve in the community care sector. As the Member has said, that started in 2017. Between 2017 and 2019, we have got 17 of these scholars. Although, of course, the class sizes in the Polytechnics are bigger, but those under this scholarship programme, there are 17 now.
For the Community Care Nursing Leadership Programme, this is a talent development programme. It is leadership development for the existing cohorts who are already registered nurses. They do not have to be in the community care sector. So, any registered nurse with good, strong clinical skills as well as nursing experience, and who are interested to join the sector, could apply for this. They will have an individual development plan for them to become leaders, take leadership positions in the sector.
Regarding assisted living, the Member's question was whether there will be enough. Firstly, let me say that there is already a range of housing options for seniors. One of them, of course, would be 2-room flexi flats. They can also choose to stay in their existing flat and get the Home Improvement Programme (HIP) and the Enhancement for Active Seniors (EASE), and then, get services like home care, day care and so on, and with the support of family. Or they can sell and use the housing grant of up to $30,000, the Proximity Housing Grant, to stay near their children or stay with their children.
What we have done is work with MND, and also based on feedback to look at another housing option for seniors – assisted living, which is not just the hardware, the physical space, but is actually the flat twinned with a basic service package that will be sold to the seniors. It is really to meet different preferences, needs as well as lifestyle aspirations. This might be useful for a group of seniors who want to be independent, live independently, may not have very strong family support, who feel that as they get more frail, they will need more services. In addition, they want to prevent themselves from being socially isolated, they want to have some kind of communal living and yet have some privacy. So, that is what this assisted living housing form is for.
We will monitor the demand for this. This is a pilot. We will monitor the demand and decide if we will build more of this housing form. As I have said, we are also looking at a pilot in the private housing market.
The Chairman: Ms Anthea Ong.
Ms Anthea Ong: Thank you, Chairman. I first want to thank Senior Minister of State Amy Khor for announcing to the House that there will be a whole-of-Government and multi-Ministry effort to address mental health as a national priority. It is very sweet, D grade-worthy news, I think. But I hope that it is not just the elderly and the youths that we are looking at, because the sandwiched ones are the very ones who are playing a big role in the mental well-being of our youths, and they are also the care-givers of our elderly.
So, if the Senior Minister of State will indulge me, I have four clarifications and one comment, from the four cuts.
I understand the Ministry is not intending to bring to parity the limits for MediSave and MediShield in terms of physical and mental health conditions, which, to me, would be the loudest anti-stigma signal, with that parity. Can I urge MOH to conduct its own public consultation or studies to examine the many affordability issues that were raised in our own rudimentary public study that I shared both in the Budget debate speech and earlier.
I know because I think we all understand that the treatment process for mental health conditions is a lot —
The Chairman: Ms Anthea Ong, given the number of clarifications we have, could you keep it to just clarifications, please?
Ms Anthea Ong: Sure. Thank you. So, a lot more nuanced and protracted, so there is a cost implication.
The Senior Minister of State also confirmed that Obsessive Compulsive Disorder (OCD) is now included in Chronic Disease Management Programme (CDMP), but I just checked the MOH website and it is still not there. Earlier, Senior Minister of State Edwin Tong also only listed four mental health conditions that are covered but not OCD. So, can Senior Minister of State Khor please confirm that.
I asked the Ministry about the plans to improve the waiting times, which is right now 27 to 28 days to see psychiatrists and psychologists. Can I please ask Ms Amy Khor to respond to this ask?
The next ask that I also filed in my cut, which has not been responded to, is – I asked the Ministry to consider MediSave to be used for community organisations that are providing mental healthcare services. Can I please have a response to that?
Last but not least, Senior Minister of State Khor assured that the Ministry will look at specific needs of the differently-abled in public mental healthcare. Can the Senior Minister of State also assure that the LGBTQ+ community, that their specific needs will also be looked at, as I had outlined in the dedicated cut on this.
Dr Amy Khor Lean Suan: I think it is more like six follow-up questions, not four. I will try and answer them.
First of all, this thing about parity between MediSave and MediShield Life. As I have tried to explain, when we set the withdrawal limits for MediSave or MediShield – say, inpatient, for the different types of treatment, different types of conditions, not just mental health but other conditions, we look at the bill sizes.
To give you an example, in 2018, the average daily bill size for inpatient psychiatric treatment at IMH is $90. But for acute hospital, the average bill size, taking out the cost of surgery procedures, is $480. So, if you talk about parity, we are talking about parity in terms of making sure that the withdrawal limits will cover a majority of the cost of the treatment for subsidised patients. Therefore, for MediSave daily withdrawal limit, it is $150 for psychiatric treatment.
And as I have said earlier, for inpatient MediSave withdrawal limit, less than one in 10 actually exceed their $5,000 yearly withdrawal limit and less than three in 10 exceed their daily limit. So, that is what the parity is. It is not the absolute amount but what is the bill size.
I assure the Member that we will and we have always continued to monitor to make sure that the withdrawal limits are adequate, to make access to healthcare affordable to our subsidised patients. And, as I have said for MediShield Life, the MediShield Life Council is reviewing the MediShield Life limits for the different conditions. So, the same thing with MediSave withdrawal for outpatient treatment.
The next question is on OCD. The word is not there. It is under \"Anxiety disorder\". So, if a doctor says under anxiety, it is OCD, it is covered. Dr Chia Shi-Lu is nodding his head. So, it is covered. The word is not there. I only listed a few, because I did not have enough time.
For wait time, as in for access to many other treatments, we are always mindful of the wait time. What we are doing to try and reduce the wait time is that for the hospitals and polyclinics, they are trying to see how they can review their work processes to optimise the appointment slots. For instance, you try to tighten the triaging, so, they call the patient before the appointment, to try and optimise these slots.
We are also looking at tiering of services to provide the appropriate level of care, because not everything has to go to the specialists. When it is possible to get care in the community or in primary care sector, then we will refer them to the primary care sector or community care sector.
For the Member's information, as I have said over the years, we have tried to increase access to treatment and we have now got about 210 GPs who are trained to provide mental healthcare. If they do not need to go to a specialist, they can be treated or cared for in the primary care sector. And, actually, there is no wait time, and they still can get a subsidy, through CHAS as well as through CDMP.
If they access care through the community intervention teams, the first referral is within two weeks – 14 days – a lot shorter.
That is what we are trying to do. And then, only for the more complex cases, they go to the specialist – to try and shorten the wait time.
Besides that, if urgent medical mental health assistance is needed or they need to see the doctor immediately, they can contact IMH through the 24-hour Mental Health Helpline or show up at the IMH 24-hour Emergency Services. Having said that, we are working on how we can reduce the wait time. So, I hope that answers the Member's question.
Regarding mental health of the LGBT community, as I have said earlier, healthcare providers who are caring for all persons with mental health conditions, are trained and they are supposed to provide these patients with empathy, sensitivity and due consideration to their specific care needs as well as risk factors. What we have done is to adopt a team-based approach to healthcare and ensure that different perspectives are considered. If need be, they can get the experts to come in to provide holistic care.
In addition to that, let me say that in 2017, the Institute of Mental Health set up the Gender Care Clinic. This clinic provides counselling and psychiatric treatment for persons experiencing emotional difficulties pertaining to gender identity, including the people who are diagnosed with gender dysphoria. And approximately 50% of these patients have a co-morbid psychiatric diagnosis. Majority of them will have anxiety and depressive disorders, and they are actually treated there. So, there are various avenues that we help this group of people.
I think I have answered all the queries. Oh, one more. If the community care provider is working together, say, with the GP or with the polyclinic and they are referred to them, then I think they can access MediSave. But, of course, the community care provider must be qualified.
The Chairman: Mr Melvin Yong.
Mr Melvin Yong Yik Chye: Sir, my first question is for Senior Minister of State Amy. Besides raising the retirement and re-employment age ahead of schedule, what else is MOH planning to do to support older healthcare workers and maximise their employment at the workplace?
My second question is for Senior Minister of State Lam. He announced the introduction of the Integrated Youth Service in Woodlands with Care Corner. Could the Senior Minister of State share more details about what services are provided under this Integrated Youth Service?
Dr Amy Khor Lean Suan: The public healthcare institutions welcome older workers or mid-careerists to work in the public healthcare sector.
For us, manpower is a perennial challenge. So, we are doing everything we can to attract as well as to retain our mid-careerists and to re-employ older workers. Some of the things that we have done is firstly, to design age-friendly workplaces as well as put in place age-friendly employment measures. So, redesigning the job roles, flexible work arrangements, part-time, for instance. The nurses now have access to part-time work, more flexible work arrangements, as well as even preparing, what we call, pre-retirement preparatory training to prepare them to be re-employed again or to encourage them to be re-employed again.
And then, in the community care sector, we are also working to redesign jobs so that they can be broken up and seniors or older workers can do part-time work. A very good example is NTUC Health. They break up care roles so that seniors could be escorts to bring the patients to the senior care centre or care for them through active ageing programmes in a care centre.
Another one would be to reduce the manual burden or workload on the senior workers. So, patient uplifters, transfer aids and so on, which are really helpful to our healthcare workers, including nurses. Lastly, even within the healthcare institutions, we have got jobs that help to take some of the workload, say, from the nurses so that nurses can focus more on their clinical work, so \"Basic Care Assistants\", for instance. And we have got 100-odd of them now and more than half are actually above 50.
Dr Lam Pin Min: I would like to share Mr Melvin Yong that the new Integrated Youth Service (IYS) has been developed to provide holistic support for social and mental health services to at-risk youths. There are basically four services that IYS provide. First, which is to outreach for prevention which is to increase awareness and encourage help-seeking behaviours. This is done through activities like roadshows, talks and workshops on mental health topics.
The second service they provide is to identify needs and to provide a one-stop service for care coordination.
The third service will be for peer facilitation and mentoring. So, at IYS, we will look for model youths who will provide that kind of a role model for these youths at-risk as well as to look for youth volunteers who can actually better engaged these youth during activities like roadshows and outreach programme.
And the last service that IYS provides is to provide emotional support and monitoring. It can be done in the form of group sessions to improve resilience as well as coping skills.
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling: Thank you. I have two questions. Firstly, I would like to ask whether the Ministry will consider setting up a matching fund to boost the funds raised by community organisations, including grassroots with the aim of supporting seniors who need help with their healthcare financing. I declare my interest because in MacPherson, we have a MacPherson Care Fund since 2012. So, obviously, such a fun will help us stretch that dollar to help more seniors.
The second question is about bone health. I fully agree with this. The statistics about the risk of hip fractures to the health of seniors were very alarming. I would like to ask: what is the Ministry doing more upstream, perhaps what HPB is doing to help encourage Singaporeans to take care of their bone health earlier, perhaps even targeting women who are at higher risk because they may have given birth to children, prolonged nursing and so on? I think these are all factors that may contribute to calcium loss.
Mr Edwin Tong Chun Fai: I will address Ms Tin's first point. On the matching fund, MOH has set up the Community Silver Trust in 2012. That is to encourage donations and also additional resources to providers in the intermediate and the long-term care (ILTC) health space. And that is done by providing a matching grant, every dollar for every dollar, for eligible ILTC providers.
The Trust's matching grant supports providers in building capabilities, enhancing the quality of care. The matching grant also frees up charity dollars, which organisations can then channel towards defraying the costs of healthcare for their seniors.
Dr Amy Khor Lean Suan: Let me say personally that I also felt that many people may not realise they only have a very limited amount of time to build up bone health. And for women, I am told is actually even before 30 years old. You will maximise your bone health and after that, either you try and keep it or you are going to lose it. And from menopause onwards, it is a steep decline if you do not do anything.
For seniors, we have been working with seniors on bone health. But as the Member has rightly pointed out, what we want to do now is to go upstream. We are not the first. In the US, they provide a guide to the parents about how to build up strong bones in their kids from young. So, what we are doing is to work with HPB and Osteoporosis Society to trial this, to pilot this in 10 schools. We want to try and do it in a fun way. So, they are developing the curriculum as well as putting up videos to get students to understand and have a healthy lifestyle, good nutrition as well as exercise and so on.
The Member is right that one of the things is, under our Women Health Advisory Committee, we are also looking at how we can reach out to get more to understand that if they do not do this, fracture is really a very debilitating condition.
Mr Edwin Tong Chun Fai: I would also like to let Ms Tin know that the Trust is made up initially of a $1 billion injection by the Government. And Ms Tin might remember that in 2018, it was topped up by another $300 million. Since the inception of the Trust, it has matched up to $700 million in terms of donations from the eligible organisations.
The Chairman: Would Dr Chia like to withdraw his amendment?
Dr Chia Shi-Lu: Chairman, I wish to thank all Members who have taken part in this debate and, of course, Minister Gan, Senior Ministers of State Amy Khor and Dr Lam Pin Min and Mr Edwin Tong and also Senior Parliamentary Secretary Amrin Amin, together with all the staff at MOH for their replies and the work they have put in for the healthcare system for the benefit of all Singaporeans. On this note, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $11,696,866,200 for Head O ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $1,713,083,800 for Head O ordered to stand part of the Development Estimates. (proc text)]
The Chairman: I wonder whether we are suitably inspired by MOH to skip tea-break, eat less and be healthier? So, I will pose the question to you. The question is, we are inspired by MOH to skip tea-break, eat less, be healthier and happier. As many as are that opinion say aye. To the contrary say no.
Hon Members: No!
The Chairman: I think the noes have it, the noes have it. I propose to take a break now.
[(proc text) Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mr Speaker: Order. I suspend the Sitting and will take the Chair at 5.00 pm. Order. Order.
Sitting accordingly suspended
at 4.40 pm until 5.00 pm.
Sitting resumed at 5.00 pm
[Mr Speaker in the Chair]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head I (Ministry of Social and Family Development)","subTitle":null,"sectionType":"OS","content":"Mr Seah Kian Peng (Marine Parade): Mr Chairman, I beg to move, \"That the total sum to be allocated for Head I of the Estimates be reduced by $100\".
Today, there are many community agencies on the ground providing a variety of support services to those in need, from family matters to financial aid and also healthcare. Local Community Development Councils (CDCs) have schemes in place for both short-term and long-term assistance.
As social needs become more complex, individuals in need will require multiple forms of social support, which are being provided by different community agencies today. This can be an advantage – that agencies specialise in order to help individuals with specific problems. It increases efficiency and reduces transaction time on the part of people seeking help.
At the same time, problems do not respect bureaucratic borders – individuals that need help may not necessarily have the time and effort to \"code-switch\" across these agencies, whether it is about filling up forms or registering for means testing. Instead, they may delay their applications, sometimes causing their own situation to worsen by the time they seek help. This is certainly far from ideal. We do not want our social safety net to fail where it is most crucially needed.
On the other hand, there are also many different Singaporeans who want to contribute their time and money, but may not be able to commit for the long term, or at regular intervals. We should not ignore this important group of volunteers which add up to a significant number of volunteer hours. Again, the complexity exists on the supply end of this issue.
We need some special, specific and granular mechanisms to bridge complexity at both ends – coordination, planning and organisation. We can all do better if there are plans to help direct these efforts and other community efforts through better coordination and sharing of information about individuals and families in need in the community. Can Minister give an update on these plans?
If we fail to coordinate, there will be continued frustration, unmet urgent needs and a general sense of helplessness among many communities. But if we succeed, the outcome is both powerful and simple – a stronger, more beautiful fabric of Singapore, woven by all of us together.
[(proc text) Question proposed. (proc text)]
Chairman, the Government has put in place many schemes and services to support Singaporeans in building strong families including various marriage preparation programmes for couples looking to get married. But some young people looking to get married get caught up in the romance and the emotions of the moment. They do not have the time nor the inclination to plan and prepare.
One useful way is to review the marriage courses available on the Registry of Marriage's website. I note that some of them cost about $300 and the titles include one called \"Evidence-based Marriage Programme\". Another is titled \"PREP\" or Prevention and Relationship Enhancement Programme. All this sounds like a cautionary tale. I am not sure, even after reading the syllabus, exactly what it is that the course is trying to prevent.
But some of the classes, \"Negotiation and Conflict Resolution\", for example, it is very useful indeed, especially like how the website said that the course was \"proven to sustain up to five years\" after the programme. I wonder what happens after five years.
I must assure Members of the House that I support these courses and I do think they are useful. But we must not approach them in the same benefit-and-cost analysis manner that we do in courses.
There is no KPI. If a marriage is abusive and unhappy, surely the best outcome is to step out of it. Divorce should not be seen as a failure but an option in human relationships.
Strong marriages are important to a nation as well as to couples themselves. We must start conversations about what strong marriages mean as well as how to build it. This, to me, is the true benefit of preparation courses.
Some of these courses cost a few hundred dollars and I understand that the Government provides a subsidy of $70. How can the Government make these programmes more accessible and affordable to better support couples in building strong foundations for their families?
Ms Denise Phua Lay Peng (Jalan Besar): Mr Chairman, Singapore's social challenges are turning complicated and complex. The new normal is the recognition that Government can no longer do it alone.
Even the supposedly simple issue of \"feeding the hungry\" is, in truth, not as simple as it appears. The recent CNA documentary on \"Food Insecurities\" showed up problems such as overlapping of help efforts; reluctance of donors to work with each other; and wastage of donated items.
I myself have been involved in issues such as coordinating senior services and helping cardboard collectors in my constituency and district – not easy. MSF Minister Desmond Lee himself has personally led in bringing together groups to solve social concerns such as rough sleepers and also food distribution to the poor. We have to find a formula that goes beyond the interest, passion and intervention of a heroic Minister.
Tackling social challenges together, especially more challenging wicked ones, calls for several critical success factors: a strong sponsor who can back with the right links; a systems thinking approach; clarity in problem statement; an understanding of the overall landscape, driving and restraining forces; a strong facilitator; and implementation discipline for results.
MSF should be given resources to start an establishment that is nimble and competent enough to facilitate and pull in the right internal and external resources to address identified prioritised social challenges – a SWAT team of sorts.
I seek the Ministry's inputs on how it intends to lead and facilitate the imperative of tackling social challenges together with others in the community. What are the outcomes and obstacles to date?
Assoc Prof Walter Theseira (Nominated Member): Chairman, Singapore was ranked by the Economist Intelligence Unit as the fourth most food-secure nation in the world. Yet nearly half of a sample of 236 families in Singapore reported moderate to severe food insecurity. These were the findings of the 2018 report \"Hunger in a Food Lover's Paradise\" by the Lien Centre for Social Innovation at SMU. The report finds no lack of help. There were some 125 food support groups operating in Singapore, in addition to food support from ethnic self-help groups and community organisations.
A basic question is how much food is enough. But the question is, enough for what?
The 2019 Minimum Income Standards study led by Dr Ng Kok Hoe of the Lee Kuan Yew School of Public Policy found that a single elderly household requires about $400 a month for food, about 29% of their budget. More importantly, that study reveals that Singaporeans consider food to be more than calories for the body; it is nourishment for the soul. It includes having meaningful choice and variety, the opportunity to eat healthily but also enjoy the occasional indulgence and the chance to meet friends at the hawker centre or to invite others to a home-cooked meal. It is not three restaurant meals a day. It is three meals with dignity.
Despite good intentions, charity struggles to meet these varied needs. Esther, a retiree, told CNA Insider in a report on food insecurity published this month, and I quote: \"We can’t give feedback because the food is free… It feels like we are beggars, what they give, we must eat.\" But Esther has diabetes and high blood pressure. She needs a healthier diet for her health conditions. She does not always have a meaningful choice. Chairman, with your permission, may I display a slide on the LCD screen.
The Chairman: Yes, please. [A slide was shown to hon Members.]
Assoc Prof Walter Theseira: Thank you, Sir. Ms Diana Ong from the Chinese Development Assistance Council (CDAC) conducted a study under the mentorship of Dr Ong Qiyan from the Social Service Research Centre at NUS. The purpose was to understand consumption of food in 77 low-income Chinese families with young children. They found that families who ate a healthier diet – more fresh fruits, vegetables and meat, less processed food – spent significantly more each month than families who did not – $204 per capita, per month, instead of $168. The big difference in spending is not in eating out. It is in trying to eat a healthier home-cooked diet.
These results are consistent with the food insecurity-obesity paradox: that in a rich country, food insecurity manifests not as starvation, but as an inadequate and unhealthy diet that exposes the poor to risks of obesity and malnutrition. And when children are affected by a less healthy diet, as in the CDAC study, then these consequences can last a lifetime.
What can government food aid achieve? Research from the United States has found that government food stamps reduced food insecurity, increased birth weight, improved children’s health, and even reduced metabolic linked diseases such as obesity, high blood pressure and diabetes, many years down the road, for people who benefited from food stamps when they were children.
So, Budget 2020’s initiative to grant $100 in grocery vouchers, for two years, for needy Singaporeans is a step in the right direction. But much more can be done if addressing food insecurity is made a priority of government policy, rather than left to voluntary groups.
Mr Mohamed Irshad (Nominated Member): Chairman, this cut concerns food insecurity in Singapore. Individuals are food insecure when they are not confident of having economic and physical access to sufficient acceptable food for a healthy life. CNA recently did a feature on food insecure families as cited by Members previously, and I have three specific questions.
First, above the $100 in grocery vouchers between FY 2020 and FY 2021, is the Ministry implementing any long-term programme to reduce the number of food insecure households in Singapore?
Secondly, with regard to our \"Many Helping Hands\" approach, has (a) the Ministry identify any gaps in our food insecure population currently not served by any Ministry or NGO; and (b) has the Ministry identified areas for improved coordination and efficiency, which require further funding or investment?
Thirdly, what efforts are being taken by the Ministry to ensure that our food insecure households are able to afford healthy and nutritious food? What additional investment is required to improve access to nutritious food? Does the Ministry intend to make these investments?
Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Chairman, Sir, last year's Household Expenditure Survey revealed that between 2013 and 2018, Singaporeans living in 1-room and 2-room flats have increased their monthly spending by 3.7% on average, while families in private apartments saw expenditure fall by 0.1%. Households living in landed property, who spent nearly 5% more on average every year between 2008 and 2013, tightened the purse strings to spending just 0.2% more every year between 2013 and 2018.
Singstat also reported that households in the lowest 20% income group experienced an expenditure increase which was more than their income growth. If this trend continues, it does not bode well for the financial well-being of lower income households even when income inequality is mitigated.
Does MSF have a programme to track the income, expenditures and financial well-being of lower income HDB residents? Tracking such data can help MSF provide better and targeted assistance.
Sir, according to Household Expenditure Survey, expenditure on Housing and Utilities make up 14.4% of total expenditure for households living in 1-room and 2-room flats. This is much higher than the 8.1% on average for all HDB households. In absolute terms, the average household expenditure per household member on Housing and Utilities for those living in 1-room and 2-room flats is higher than those living in 4-room and 5-room flats. This is quite anomalous and warrants study, as housing costs should be a progressive burden and not tax the lower income more.
Mr Darryl David (Ang Mo Kio): Mr Chairman, the past two years have seen the production of several media shows that highlighted the complex social issues that Singapore faces, and in that process, offered us a deeper glimpse into the challenges and struggles that some Singapore families have to grapple with.
Channel News Asia’s thought-provoking documentaries, \"Don’t Call Us Poor\", \"Inside the Children’s ICU\", and \"Inside the Child Protective Service\" have highlighted the crucial point that there will never be a simple solution, there will never be a simple solution to tackle social issues because of the inherent complex inter-dependencies that reside in them. Indeed, these could be what philosopher and management scholar, C West Churchman, referred to as \"wicked problems\".
Classic examples of wicked problems include economic, environmental, political and social problems whose solution requires a great number of actors to come together to deliver a holistic whole-of-the-problem solution. Wicked problems are impossible to resolve in a piecemeal manner as the inherent complex inter-dependencies that exist between the variables in these problems will render any effort to solve one aspect of the problem to reveal or create other problems.
Singapore has always adopted the \"many helping hands\" approach when it comes to community assistance. Many community agencies on the ground provide a variety of support services to those in need, from family matters to financial aid and even healthcare. As social needs become more complex however, individuals and families in need may require multiple forms of social support, which could be provided by different community agencies today.
I would like to ask the Government are there plans to help these individuals and families through better coordination and sharing of information across Government agencies, NGOs and VWOs?
Dr Lily Neo (Jalan Besar): There are many families who are in need in our society. They face many issues, such as financial inadequacy, poor health, low education, unemployment, single parenthood, many members to support, physical or mental disability and so on. According to a survey, there are least 20% of Singaporeans who are earning less than their monthly expenditure. Many families, when faced with multiple problems and stresses, become overwhelmed and ill equipped to care and provide for their children. These children will not enjoy the same fighting chance as their better-off peers, and thus may grow up to be in the same predicament as their parents if intervention and help are not rendered in time or in a sustainable manner.
These families require intensive, holistic and coordinated assistance. Would MSF look into the following issues of such families?
One, how do we identify such families? Has there been any survey done to see how many of such families who are in need? We need to know who they are before we can reach out to them. Can MSF provide the resources for good outreach to touch base with these families, to understand their needs, to assist them with their urgent needs and to coordinate and follow-up with them in a sustainable manner? These families need intense hand holding, because just informing them on the many assistance schemes that they can tap on will not work for them.
Two, do we have plans and effective programmes in place that are able to collectively solve the needs of these families in areas such as financial, education of children, medical health referrals, childcare placement, re-employment and so on. More social workers who can understand the needs of each family, sorting out the families' issues; by tapping into the various Government schemes, by working and coordinating with social service agencies (SSAs) to benefit these families.
Three, do we have an upstream measure in place to handhold such families? Many of these families have disadvantaged children that need longer follow-up, especially the young children. The reason is that such families may have entrenched problems that cannot be solved overnight. Priority must be given to their children in their well-being as they grow up especially in their education, health and character development. Our system must be robust to ensure that these children are on track to get out of their families' predicament and the chance to climb the social ladder or to break the poverty cycles.
Four, a higher percentage of the children of these families is not in pre-schools when it is even more crucial for them to do so. Can MSF ensure that all of these children are placed in pre-schools? Evidence shows that the developmental years, especially the first few years of a child's life are fundamentally important. Special attention and assistance given to the first few years of children's lives lead to better economic, social and emotional benefits later on.
In disadvantaged families, many parents are unable to support their children's education due to limited resources and their own educational level. Others tend to be permissive and take a hands-off approach. This results in higher absenteeism from schools. These families and children need closer follow-up and supervision by MSF.
Five, many community agencies on the ground can be roped in to provide a variety of support services to those families in need, from family matters to financial aid and even healthcare. As social needs become more complex, individuals in needs may require multiple forms of social support, which could be provided by the different community agencies today.
Are there plans to help direct these efforts through better coordination and sharing of information about individuals or families in need in the community? Comprehensive assistance can be facilitated by data and digital technologies, on implementations and on follow-up. I hope MSF can facilitate the adoption and wider use of such technology. This will enable good coordination and good outreach to families in need by the various agencies, but more importantly, it is to spread the resources for better coverage and to prevent duplication or uneven distribution of help.
Social service agencies are critical partners in providing such support programmes and services to help individuals and families overcome their difficult circumstances. The social service sector will have to adopt more productive and innovative processes, as well as continually build up new competencies. What are the Ministry's plans to strengthen capability development amongst social service agencies, to meet growing social needs?
Six, there is higher chance of those from low-income single parent families of being disadvantaged. Can there be priority given to these families to assist their children better?
Seven, there are more transnational families who belong to the families in need. Apart from assisting their children's education and well-being, the spouses of these families also require hand holding assistance in finding employment.
Mr Murali Pillai (Bukit Batok): Sir, the reasons why people may sleep in public places instead of their homes are manifold and be complex. I quote the hon Member of Parliament, Dr Lily Neo on a speech during the COS debates in 2018. She said, \"Many of them may have a variety of problems, such as family feuds, HDB housing issues, mental issues, employment and financial issues\".
In response, the hon Minister for Social and Family Development, Mr Desmond Lee stated, \"We need a more coordinated, whole-of-society approach to address the underlying issues and needs of these individuals. MSF works closely with other frontline agencies and the community to reach out and coordinate the help that they need.\" This approach makes eminent sense.
Currently, however, the issue still persists. In the LKY School of Public Policy report published in November 2019, it was revealed that there are about 1,000 rough sleepers on the streets of Singapore. The report also identified that a good number of rough sleepers have residences but decided not to stay at home for one reason or another.
I recently came across one such case. I tried to persuade the rough sleeper, who refused to go back home owing to a combination of family and mental health issues, to go to a shelter instead. However, he refused. Over time, he became more and more frail. This was obviously concerning. Now he is missing and that is doubly concerning.
I would like to suggest that MSF be given more legislative support to enable it to intervene and help these rough sleepers to ensure their well-being. As currently worded, a \"destitute person\" under the Destitute Persons Act is defined as, inter alia, \"any idle person found in a public place, who has no place of residence\". Based on this definition, there is no ability to require a rough sleeper who has a residence to take shelter in welfare homes for the sake of his health and welfare under the Destitute Persons Act.
I believe there is a case to remove the residency requirement. With the rough sleeper brought into institutionalised care, I would think there will consequently be a better opportunity to resolve the underlying issues that gave rise to him not returning to his residence.
I wish to stress though that any exercise of power under the Act must be done with the health and welfare of the rough sleeper in mind.
Assoc Prof Walter Theseira: Chairman, the \"Break the Silence\" campaign which you launched when you were Minister has brought crucial awareness to domestic violence issues. While many domestic violence cases fall within traditional family contexts, vulnerable groups, such as LGBTQ+ persons, face specific challenges.
The NGO Sayoni found that LBTQ women are at increased risk of facing domestic violence, but they do not often seek help, due to the fear of disclosing their stigmatised identity and a lack of understanding that state institutions will protect them. Initiatives like \"Break the Silence\" often do not explicitly include LGBTQ+ persons in the campaign resources. If vulnerable groups are not represented or acknowledged, they are less likely to seek help as they may not believe their specific needs will be addressed.
In 2016, The Straits Times reported that social workers \"feel ill-equipped to deal with LGBT clients\". Sayoni's research found LBTQ persons face additional challenges in seeking help because social workers may lack a sensitive understanding of their identities.
For instance, Jamie, who was experiencing psychological violence from her family, approached an area-based counselling service for anger management issues. The counsellor did not directly address Jamie's anger management problem, but instead, offered to address the, I quote, \"gay problem\", thereby framing being gay as the cause of Jamie's distress. The possibility of being misunderstood or discriminated against by social workers deters many LGBTQ+ persons from seeking help.
Could the next Break the Silence campaign be made more inclusive, by explicitly recognising the vulnerabilities of LGBTQ+ persons and other marginalised groups? Could the Ministry provide in-depth sensitivity training for social workers and other first responders to address the specific needs of these marginalised groups?
Prof Lim Sun Sun (Nominated Member): Hon Members, it is my right today to speak to you for four minutes and no longer. Just as it is our right as Singaporeans to contest elections to enter this House or in my case, to be appointed. Fundamentally, rights are legal, social, or ethical principles of freedom or entitlement, stipulating what is allowed of people or owed to people according to legal doctrine, social convention or ethical theory.
In Singapore, the rights of children are protected by the Children and Young Persons Act. I am glad to have been in the House when we passed the amendments to extend identity protection for young people involved in court proceedings to children aged 17 and 18. Identity protection for all our children is critical in a digitalising age. For today's young people, the digital world is ripe with opportunity but fraught with risk. I would thus like to highlight the issue of the digital rights of children.
When I started researching into young people's media use 20 years ago, I was speaking to teens. In my most recent research, some of my interviewees reached just above my knee. Indeed, with device use creeping ever lower, we must think of more concerted protection for our children from commercial and sexual exploitation on online platforms.
Commercial exploitation is stealthy and widespread. Children are the target of media content that shows the unboxing of attractive toys they cannot afford and the allure of fast food, fast fashion and unhealthy habits such as vaping. Young people's data is being collected and used for commercial purposes and they are aggresively marketed to across all platforms, including movies, internet connected toys, apps, online games and social media. Even in the face of COVID-19, I believe our children are under greater threat of from influencers than from influenza!
More egregiously, young people are also the target of sexual grooming in online platforms and exposure to sexually explicit content.
In Singapore, we have done well to ensure children's rights to access digital devices, services and digital literacy education to children from all socio-economic backgrounds. But there is much more we can do to expressly protect children's digital rights, especially in the areas of the privacy and data protection. We must take more active measures to ensure that their personal data is processed fairly, lawfully, accurately and securely, for specific purposes and with the free, explicit, informed and unambiguous consent of children and their parents. One key issue is that the terms and conditions of digital products and services are couched in obtuse language that adults cannot understand, let alone children.
Given MSF's significant efforts in advancing the welfare of children, I would like to ask the Ministry to lead the charge in driving a whole-of- Government effort to recognise, concretise and protect the digital rights of children. Importantly, we should also involve our young people in the process of identifying what they believe their digital rights currently are and should be. For differently-abled children in particular, we must also develop more schemes to pioneer innovation so that they too can enjoy greater access to digital devices and services.
Mr Melvin Yong Yik Chye (Tanjong Pagar): Our children are the future capital of our nation. It is therefore important that we provide them with the resources to achieve their maximum potential in life, regardless of the starting point that they are born into.
However, not every child is fortunate enough to be born into an environment filled with love. To help this group of vulnerable children, Parliament amended the Children and Young Persons Act in 2019, to strengthen support for children who have been neglected or abused. Can the Ministry provide an update on the new initiatives that have been implemented since the Act's amendment?
Various studies on at-risk youths in Singapore has found that peer and family influence may have an impact in influencing youths' attitudes towards gangs and juvenile delinquency. We should therefore work towards identifying early signposts that would identify a child to be at-risk, and adopt a more preventive and integrative approach towards helping them and their families.
Beyond the Government’s effort, I also urge community groups to come together to rally our youths and help them stay out of trouble. One good example of a community initiative targeting at-risk youths is the Delta League programme. Created in 2011, Delta League engages our youths through football during the long June and December school holidays. To keep them meaningfully occupied and away from crime, besides attending football clinics and playing matches, the youths also participate in crime prevention and other activities to enhance their awareness of crime and its consequences. Delta League marks its 10th year this year, with over 20,000 youths benefiting from its programmes in the past nine years. Some of our Delta League boys have since gone on to fulfill their dreams of becoming professional footballers. With support from MSF, I hope to see more of such initiatives from the ground to help our at-risk youths in this new decade.
Chairman, we can and we must, help our vulnerable groups of children and at-risk youths to achieve their maximum potential in life, regardless of their starting point. Because in Singapore every child matters.
Ms Sylvia Lim (Aljunied): Singapore ratified the UN Convention on the Rights of Persons with Disabilities in 2013. The Government has also issued Enabling Masterplans and the leadership of some colleagues in this House towards realising this vision is well-known.
Recently a disabled resident asked me to raise the topic of training and employment prospects for persons with disabilities.
The Government has had schemes to boost the hiring of persons with disabilities, including the latest announcement of the Enabling Employment Credit, to provide stronger wage support for open employment. Non-governmental organisations also have initiatives such as sheltered workshops to provide training and employment.
In a recent Parliamentary answer, MOM stated that the resident employment rate of persons with disabilities in the working age of 15 to 64 was about 29%, with the resident unemployment rate at 13%. What is the Government’s assessment of how far Singapore has implemented the UN Convention, particularly Article 27 on Work and Employment?
Ms Rahayu Mahzam (Jurong): My son Ayden has Down Syndrome. He will be three years old in April. Time really flies but I remember vividly the emotions I felt when my husband and I were figuring out how to support his developments. We have a challenging start but found most of the information, guidance and support we needed online, through talking other parents and people in the sector.
SG Enable was one of the agencies which my husband and I became familiar with very earlier on in our journey. We were informed about SG Enable through the social worker at the hospital and she helped us apply for the Early Intervention Programme for Infants and Children (EIPIC) through SG Enable. In the course of my work as Member of Parliament, I found out more about the work that is done by SG Enable, especially in providing information and referral services of various schemes and providing employment support for persons with disabilities (PWDs).
I believe that over the years, SG Enable has started to establish itself as a trusted partner to PWDs, their care-givers and social service agencies. It is important to build on this and make the infrastructure and services more pervasive and accessible to families.
Parents sometimes find that the services and spaces that are conducive for their children with needs are not located to where they live. It would be ideal if more spaces like Enabling Village, for example, could be replicated all around Singapore.
I am appreciative of the efforts that have been put in to provide support to families with children with special needs. However, what else can be done to bring greater convenience to PWDs and their care-givers in accessing social services.
Ms Denise Phua Lay Peng: Sir, the latest Enabling Masterplan for persons with disabilities (PWDs) will be expiring in 2021.
Several pieces in the Masterplan have progressed. Two workgroups, for instance, were commissioned – one to look at employment and the other on independent living. SPD President Ms Chia Yong Yong, a PWD herself and me in my volunteering capacity as ARC President and a parent of a PWD co-chair the workgroup with Minister of State Mr Sam Tan.
Many Singaporeans, especially PWDs and their families are not aware of the progress of the latest Enabling Masterplan. Can the Ministry provide an update on the progress of the Masterplan and what has so far been done by the two workgroups?
I would also like to focus on three other issues which are not covered by the two workgroups.
First on life of PWDs after their parents' death. One common grievance by families with children with disabilities is the question of, “What would happen to my child when I am no longer around?” I have heard this at many focus groups for the last 20 years. Their worries range from financial, legal, housing, healthcare and other issues.
In recent years, there are books, portals and even agencies to help families plan for the future. However, if these families are still living with worry and fear, then there is more to be done in this space. The question ought to be shifted to, “What is going to happen in the future when I am gone, and how can I shape it?”
I urge MSF to assemble a team to improve the current state of future planning for families with disabled children.
Next, on residential options of adults with disabilities. The current options of where adult PWDs can live and be supported appropriately, are too limiting. PWDs are expected to live with their families, with whoever relatives are left or in costly residential homes for those with higher support needs and less family support.
The existing models do not cater sufficiently to a continuum of adult PWDs with varying support needs and abilities. Some interesting models like the TOUCH Ubi Hostel for PWDs are some of the best kept secrets in the community.
Singapore is unique in itself in the social eco-system. Public housing is the pride of the nation and every Singaporean is encouraged to own a home. Yet, at the same time, taxation on personal income and corporate taxes are low, contributing to lower public spendings on social services, especially for PWDs compared to other countries.
I urge MSF to develop our uniquely Singapore continuum of housing and support choices for PWDs depending on: the level of family support and financial ability; the level of ability of the PWD himself in independent daily living and work; and the level of support services needed by them in care supervision, healthcare, daily living and work.
This will empower PWDs and families to make their choices and become part of the solution.
Lastly, on community access and inclusion. Research has shown that although most people in Singapore welcome the idea of an inclusive society, not everyone is willing to or feel comfortable interacting with PWDs.
Both the disability community and the rest of Singapore need to organise ourselves better for better outcomes in community access and inclusion. Can Government streamline Government-linked agencies so that there is less overlap and greater clarity to the public on the \"who\", the \"what\" and the \"how\" in disability support and inclusion?
Can more \"mainstream\" services be tapped upon to increase the presence and inclusion of PWDs? For instance, can the community clubs and the grassroots movement identify PWDs and include they and their families in their midst of their activities and their plans?
Can a continuum of housing options for PWDs be designed into all new and existing public housing estates so that PWDs can live with the appropriate support there, seeing and be heard and felt? Can every Government ministry appoint Disability Champions or teams to look out for and include PWDs in both their work and other parts of life?
Mr Desmond Choo (Tampines): It is a basic societal tenet that we should provide all children with opportunities to learn, grow and contribute to society. We need to further enhance support for children with special needs and disabilities, especially those who have early childhood intervention is especially critical.
For example, the Government-subsidised Early Intervention Programme for Infants and Children (EIPIC) helps to pay for therapy and intervention programmes that typically offer up to 12 hours of intervention a week. But this is less than half of the lower bound of the range of between 25 to 40 hours a week, that some experts postulated is needed for effectiveness. Moreover, EIPIC programmes are usually not integrated with mainstream childcare programmes, where educators are largely not trained to teach children with special needs. As a result, the children may feel excluded and be deterred from interacting or participating. Such disjointed arrangements also exact a toll on working parents who have to shuttle their children back and forth from EIPIC centres to childcare and it also wears the children out as well.
I will like to suggest a couple of approaches to improve the system capacity. One, we need to have more inclusive pre-schools. The initial slower pace is only to be expected because we need mainstream acceptance. Alternatively, we can consider widening the eligibility for pre-school/childcare subsidies to more private operators of schools for students with special needs under the Enhanced Pilot for Private Intervention Providers scheme. Currently, only 10 operators are listed under the scheme.
Two, we can leverage on the childcare anchor operators by providing subsidies to train their educators, hire specialist therapists and upgrade their facilities to be inclusive schools.
Three, we can also consider having special needs care as one of the components of teachers’ basic training.
Mr Seah Kian Peng: Special Student Care Centres (SSCCs) offer subsidised before and after school care services for students with special needs aged seven years to 18 years. They are key to providing care-giving and educational support and skills for independent living for these Special Education (SPED) students.
With the support of SSCCs, parents have more options and time available to them. SPED students are also given more opportunities to interact with their community and plan for their future. However, the number of such SSCCs remains small. The fees at $832 a month are not low.
We need to ensure that such services remain affordable. Although subsidies are available for those who need them, the fees quickly run into the hundreds of dollars, with surcharges during school holiday periods.
Subsidies are generous now for low-income families – those with income of less than $1,500, they get 90% subsidy. However, for those who earn more than $3,500, they get a subsidy of only 10% – leaving them to pay more than $700 each month.
Families with special needs children already face many challenges. Surely, we can support them better, especially when the systems are already in place.
So, I like to ask the Minister what measures are in place to ensure that SSCCs remain affordable for families who require these services, especially for those with multiple needs?
Ms Irene Quay Siew Ching (Nominated Member): Mr Chairman, Sir, I would like to address the challenges of teenage health, both physical and emotional, and the necessary roles that parents can play in providing a nurturing and loving environment to secure a bright future for their offsprings.
Teens in Singapore face a multitude of issues ranging from body image, struggles to find their place in society, peer influence, parental pressure, physical health changes, school-related stress, bullying, substance abuse, just to name a few.
Healthcare professionals caring for school-aged children and adolescents are also seeing an increased cases of eating disorders, a form of psychiatric illness with significant, life-threatening medical complications as well as teenage suicide cases.
Although there are many contributing factors to these problems, I believe that parents can do more to help and support their teenagers in this challenging journey.
Parenting is a complex balancing act, which requires both making hard decisions between giving the child freedom to grow and being there for them when needed.
I noticed, with regret, that data from MSF showed a gradual rise in the number of children referred to MSF for various forms of abuse.
Hence, there is a need for us to work on and improve parenting skills of our adults in Singapore because I believe that all parents want the best for their children. However, we should acknowledge that not all parents may be equipped with the right skillset and mindset to raise the child.
Hence, I would like to propose to MSF to consider making parenting courses mandatory for all new parents and incentivise parents to attend such courses by making it a prerequisite to receive their Baby Bonus entitlements.
I am sure that all parents in this Chamber, myself included, will agree that parenting is one of the most complex jobs out there. There is a widely held and unfounded perception that parents should or naturally know what to do to parent their children and everything will be fine as long as we love them enough. But I am sorry to say that this is not always the case. As such, I find it quite perplexing that we are not using available science, expertise and valuable experiences from those who have gone through the journey to better prepare new parents.
Parenting courses will be useful to help new parents eliminate unnecessary fears of unknowns while bringing awareness to what may be expected when raising a child. It will also help them understand and learn different parenting styles for different personalities and how to engage their kids to create a supportive family structure through mindfulness and conscious parenting. At the end of the day, we should prepare our kids for what lies ahead by providing them with a strong mental, emotional and moral foundation. We cannot just leave this to MOE or MSF alone because no one can be a better role model to our children than us, parents.
As a working mother with four children, I can fully understand that this is not easy. We cannot be perfect but we must keep trying and keep working on it, using the right parenting skills – like speaking to my kids sitting in the Gallery today. [Laughter.]
Coming back to my speech, sorry, Chairman. They are quite a distraction.
The Chairman: I can throw them out if you want me to. [Laughter.]
Ms Irene Quay Siew Ching: I understand that MSF has implemented the Triple P Positive Parenting Programme nation-wide in schools and I would like to find out more about the attendance and success rates of these courses.
I have attended such courses at my children's schools and a common remark from the teachers at the start of the course is that, often, the parents who do not make time or do not have the time for these programmes are the ones that the teachers need to reach out to.
Sir, I believe that there are two extreme types of parents that we need to be mindful of – those that are ignorant or do not have enough time for their children, and the overly-concerned parents who subconsciously impart unnecessary stress to children, teachers and the people around them.
This brings me to an enlightened quote from Dr Shefali Tsabary, a renowned clinical psychologist and writer of the award-winning New York Times bestselling book, \"The Conscious Parent – Transforming Ourselves, Empowering our Children\". Her revolutionary wisdom focuses on a parent-centric way of upbringing, rather than on the child.
And I end with a quote, \"To be an awakened parent who is aware that traditional paradigms of parenting, where parent is seen as greater than the child are obsolete in the modern world, producing dysfunction and disconnections in families. When parents are aware in the present moment, learning and growing alongside their children, the entire family thrives. Free to actualise their individual destiny, each family member lives unencumbered and unafraid. Empowered with self-awareness, boundless in self-belief, liberated in self-expression, each feels free to explore, discover and manifest their authentic being.\"
Ms Rahayu Mahzam: We often hear of how children become embroiled in your parents' acrimonious divorce proceedings and are made emotional pawns. I am a lawyer in family practice and I see that happening often. In such situations, I often ask my client to think about the child's best interests. Divorcing parties are, however, often caught up in their emotions and are not able to think rationally.
One area that is particularly challenging relates to arrangements of custody, care and control and access of the children. It would help processes in the family justice system better support divorcing parties and encourage more positive outcomes and arrangements.
Last year, the Committee to review and enhance reforms in the family justice system submitted its recommendations to make various processes less acrimonious for families undergoing divorce, particularly for those with children. I am happy to note the announcement last week that there has been support from the public and stakeholders and that the Government has accepted the wide-ranging recommendations.
Could the Ministry provide an update on this matter and the specifics on the key proposals which should be adopted and implemented?
The Chairman: Mr Louis Ng. Both cuts, please.
Mr Louis Ng Kok Kwang (Nee Soon): Sir, last year I asked the Ministry to consider requiring divorce rulings to specify which parent can list their child as an essential occupier in HDB flat applications. The reply was that parents with shared care and control arrangements have equal rights to list their child as an essential occupier and they should come to a mutually agreeable decision themselves.
That is ideal but the reality is that a divorcing couple might find it hard to cooperate on an issue as contentious as housing. Divorce rulings already decide on custody, care and control and division of matrimonial assets, which are equally contentious. Why not housing?
Can MSF clarify what each parent awarded care and control is expected to provide in terms of housing for the child? Is a parent's ability to provide housing a factor in awarding care and control to that parent?
For the welfare of the child, can MSF require divorce rulings that award shared care and control to also state which party is allowed to list the child as an essential occupier in their application to buy a subsidised HDB flat?
Next, the parent who needs the cash component of the Baby Bonus the most is the one who does not qualify for it. Why? With a median salary of only $600 a month, single unwed parents under 35 years old clearly need the cash.
They can get the cash if they marry the father or mother of their child and then file for a divorce. But why do we want fellow citizens to marry someone they do not want to marry and jump through so many hoops to get something they should get?
They already receive the CDA component of the Baby Bonus, so why not the cash component? Let us end the discrimination and provide single unwed parents with a cash component of the Baby Bonus.
Mr Seah Kian Peng: Over the years, the Government has been providing generous pre-school subsidies to support working parents with young children in their care-giving duties. This has allowed many women to re-join the workforce after becoming mothers.
Surveys have shown that 72% of mothers here take some form of break after childbirth. So, helping these women return to work is a significant and worthwhile effort.
Many women already know of the platforms that are in place to help them, including subsidies from MOM as well as social enterprises who link them up with employment opportunities.
These women may already have strong social networks. However, there is a gap for low-income mothers who do not have alternative care-giving arrangements. For those who do not work, they may not know of these platforms and opportunities. And this may, in turn, affect their ability to look for paid employment opportunities that are flexible enough to accommodate their need to care for their young children. This sets up a vicious cycle of missed opportunities and lack of mobility.
Do we know how large this group is and what are the main obstacles to their re-joining the workforce? This is the group that needs more help from us. So, I would like to ask the Minister what other measures are in place to better support this group of low-income mothers who do not have alternative care-giving arrangements.
The Chairman: Mr Ang Hin Kee. Both cuts, please.
Mr Ang Hin Kee (Ang Mo Kio): Mr Chairman, I would like to speak in Mandarin for my first cut.
(In Mandarin): [Please refer to Vernacular Speech.] \tBecause of COVID-19, some of our expatriate pre-school Chinese teachers must be quarantined and cannot return to Singapore to resume work. Their colleagues who continue working and their students all miss them. They are being told not to worry as the pre-school centres are working hard to ensure that students can attend lessons as usual. During this critical period, everyone is working together to overcome difficulties.
I would like to know, currently, how many pre-school teachers specialise in teaching Chinese and, among them, and how many are foreigners? How many of these foreign teachers have been affected by the outbreak?
Using this outbreak as a learning point, will MSF consider adjusting the ratio of foreign and the local pre-school teachers to prevent the recurrence of a similar situation where there is a sudden drop in teaching staff?
I understand recruiting Singaporean pre-school Chinese teachers is a challenge. I would like to know how many pre-school Chinese teachers we need to meet future demands and whether we are close to achieving this target.
I have met many Singaporeans who are passionate about the Chinese language and some of them are mid-career individuals. Does MSF have new plans to attract more Singaporeans and mid-career individuals to join the pre-school education sector?
We must also provide schemes for upskilling, as well as education resources, to help Chinese language teachers gain new knowledge and deepen their teaching capabilities to help nurture students' interest in the Chinese language.
In 2018, MSF announced a new Mother Tongue teaching certification programme jointly launched by ECDA and the National Institute of Early Childhood Development. The programme was launched last year with the aim of enhancing the oral skills of pre-school teachers and deepening their understanding of the relevant cultures and traditions. The programme will cater to Malay and Tamil teachers initially. May I know whether there are similar plans for the Chinese language teachers?
(In English): Dual-income families are becoming the norm and, naturally, demand for more full-day pre-school and after-school student care services. It was announced in last year's Committee of Supply that all Primary schools would have after-school care facilities within the school compound by the end of 2020.
As we ramp up capacity to meet demand, how do we ensure that fees across all school-based Student Care Centres (SCCs) are fair? Does the Ministry also track the pricing of fees by all registered centres and publish this information for comparison by parents?
In a recent response from MSF to my Parliamentary Question, it was noted that close to half of parents' feedback concerning SCCs are related to issues, such as hygiene and child management. The rest relates to affordability, capacity and issues, such as enrolment process, to the requirements imposed on registered SCCs.
Currently MSF only provides SCC operators guidelines in aspects, such as staffing, layout, programme, hygiene and safety, recommended educational qualifications and training for their supervisors and staff. All SCCs are also required to meet standards in the areas of supervision, physical environment, operating hours, safety, health and hygiene and provide a structured daily programme.
Will the Ministry consider mirroring the approach taken in the pre-school sector?
Childcare centres and kindergartens are licensed under the regulatory framework. This helps to enhance the affordability, accessibility and quality of our pre-schools. Consequently, there are also clear skills frameworks and mandatory training programmes to ensure that there is uniformity in how pre-school centres deliver their care and supervision programmes. I believe this can serve as a useful guide to the SCCs to provide a positive and developmentally appropriate physical environment for our students.
With a better trained workforce and clearer career progression, it can also seek to improve the professional image of the student care sector and attract more Singaporeans to join the sector.
Will the Ministry consider having funding support to assist the centres invest in staff training so that we can have a sound and reliable after-school care support system?
The Chairman: Mr Darryl David, take your two cuts together.
Mr Darryl David (Ang Mo Kio): Mr Chairman, a research on neurology and developmental psychology found that the early years of a child's learning experience plays an important role in the child's future physical, cognitive, emotional and social development. Early childhood education, therefore, has a direct impact on the child's overall development, the type of adult that he/she will become and the society that a country will develop accordingly.
In his research, Jack Shonkoff of the Harvard School of Public Health went as far as to suggest that early childhood education is the most important investment that a country can make because it forms the foundations for a prosperous and sustainable society. This is because a stable, responsive, rich and nurturing learning experience in the formative years of a child will have a lifelong impact on his/her mental and physical health, as well as the human capital potential.
At the National Day Rally in 2019, Prime Minister Lee announced that the Government would be increasing Government-supported pre-school places to improve accessibility to affordable and quality pre-schools. Measures to be adopted include the extension of the Partner Operator (POP) Scheme, which will improve the affordability, accessibility and quality of POP services through Government funding and support.
Beyond the Government's plans to expand the Anchor Operators (AOPs) and POPs in the early childhood sector, how else is the Government intending to support other pre-school operators, especially the smaller independent ones in this sector?
Next cut, please.
The Government has made significant investments in recent years to enhance the quality and accessibility of early childhood education. In last year's National Day Rally, as I have mentioned earlier, Prime Minister highlighted the broad plans to \"more than double\" the current spending on early childhood education over the next few years.
Part of this increase in spending is to raise the number of families that are eligible for additional means-tested subsidies by raising the household monthly income ceiling from $7,500 to $12,000, thereby helping an additional 30,000-odd families.
However, there remains a care-giving gap. Under the current framework, a larger subsidy quantum is given to working mothers to support their child care-giving needs when they are at work. In contrast, a smaller subsidy quantum is given to non-working mothers with the understanding that they provide home-based care-giving to their children as an alternative to full-day childcare services. This has resulted in a somewhat unique situation sometimes where dual-income families could receive a higher level of pre-school subsidies than single-income families.
Mr Chairman, I would like to state for the record that I am very grateful for all the hard work that my wife does as a full-time mum, a non-working mum, and I agree that non-working mothers could provide the home-based childcare giving that working mothers are unable to. I am very grateful for that.
However, the reality is that not all working mothers are able to provide effective home-based care for various reasons such as having to meet the demands of caring for elderly family members, who are old or who have special-needs; or in fact, caring for their other children whom might have special needs as well.
I would like to enquire what measures are in place or can be put in place to better support this group of non-working mothers?
Ms Rahayu Mahzam: As much as we would like to believe that every child has the potential to succeed and do well in life, in reality, the circumstances in which the child is in at the start of his or her life, could dictate this trajectory of the life journey. His or her future could be impacted even as early as when the child is in the mother's womb. The mother's nutrition during her pregnancy will have an effect on a child's health and development. As soon as the child is born. The child's well-being and development will be affected by stimulations the child receives.
We have now identified the importance of early childhood education and how crucial the early years are in shaping his or her development. I have always been excited about KidSTART and the potential it brings to change the lives of many children from low-income families and those who have challenging backgrounds. This programme provides holistic and comprehensive support to these families and gives these children a fighting chance to seize the same opportunities as children from better-off families.
My biggest concern with this programme is whether it can be scaled up faster. I am therefore heartened to hear the recent announcement on the expansion of KidSTART and the launch of growing together with KidSTART at the Early Childhood conference last year.
Could MSF share more about this? Perhaps one way to scale the programme is to have more involvement from corporate and community partners who can help replicate the programme and support more families. Could this be something MSF could consider? Further, in this regard, could MSF provide any updates on the types of partnerships with corporate and community partners forged thus far and whether we could build on these partnerships?
The Senior Parliamentary Secretary to the Ministers for Foreign Affairs and Trade and Industry (Dr Tan Wu Meng): Mr Chairman, at one of our Clementi coffeeshops, on weekends you can find a very special group of uncles and aunties. Some stay in Clementi or nearby. Some come from all over Singapore to meet. Some from the Pioneer Generation, some from the Merdeka Generation. Each one a veteran artist with a lifetime of experience. Many nationally, even internationally acclaimed. A number have even won the Cultural Medallion. All these luminaries and legends – and you can find them at one of our Clementi coffeeshops on a weekend.
Last year, as part of our National Day celebrations, these veteran artists helped organise an exhibition at our Clementi Community Centre. It was a very special gathering, but what made it extra special, even more special, was how our residents came together, across from all walks of life, with the artists for this community art exhibition. Exhibiting artworks together, even making impromptu artwork on the spot together. Young parents, youths, children from all walks of life, including families, starting with less, families living in our rental blocks in Clementi.
I spoke with a young boy, who was deeply moved that his drawing was being exhibited alongside the work of these famous artists. It boosted his confidence. He had found new friends, new networks. The artists also shared, that by connecting with the community, including some of our children who were starting with less, they had also found ways to introduce their heritage, their life stories to another generation of young Singaporeans.
Sir, it makes a difference in our communities when we give time, energy and heart. When people come together, creating moments, creating memories, creating opportunity. We see this too, in our tuition mentoring programmes in Clementi Town. Young professionals, as well as students still in higher education, young people working together, volunteering as homework mentors for children who are starting with less. Again, sharing time, energy and heart. And with each friendship forged, each moment shared, it lifts up each child even as it changes, touches, transforms the life of each volunteer.
Mr Chairman, what these stories tell us, is that community partners can play a very special role in helping to lift up our children, in helping to lift up communities, in helping to lift up our fellow Singaporeans and especially children, who are starting with less. It tells us that how we multiply social capital is an important complement to the traditional fiscal measures that can found in any Budget. Because, Mr Chairman, in a fair and equitable society, fiscal redistribution is an important part of policy. Fiscal redistribution in a progressive way, giving more to people who start with less.
But there are also many kinds of sharing, many kinds of sharing which go beyond dollars and cents which cannot easily be measured in terms of hard numbers, but these forms of sharing are also deeply important. The sharing of life experiences, the sharing of networks, the sharing of mentorship, the sharing of social capital.
Sir, the magic of social capital is that sharing is not a zero-sum process. When we share social capital, it multiplies and it lifts up everyone even as we connect together, grow together, grow closer together as one Singapore family together, as Singapore together. And Sir, it is my belief that this element of social capital can and must be part of how we continue building and uplifting our communities and our societies because, whether in Singapore or around the world, much of the research on the role of neighbourhoods, on the role of communities, implicit in that, is the idea that in that in the role of places and neighbourhoods, there is also the role of social capital.
Whether you are looking at the research by Raj Chetty and his colleagues in the US, whether you listen to the stories by researchers such as Angus Deaton, all these researchers who have looked at inequality in society, who look at the role of neighbourhoods and how people's lives change over time – my belief is that a key question in all this, is the role of social capital and we must continue looking at it closely, developing it, growing it further.
Mr Chairman, to bring that social capital together in our society, it also helps to bring different stakeholders together to bring corporations and community partners together. And as we heard recently at the Early Childhood conference in September last year, the Minister for MSF announced the expansion of KidSTART and growing together with KidSTART.
So, if I may ask the Minister, can MSF share any updates on the types of partnerships with corporates and community partners forged so far, because it takes all of us to make Singapore better and part of that journey to building a more fair and more equitable society is how we grow that social capital among us, how we grow the networks among us and how through that we uplift one another. Because, Mr Chairman, as we said earlier when we share social capital it multiplies. So, let us grow our society and multiply the good within us to touch others.
The Chairman: Minister Desmond Lee.
The Minister for Social and Family Development (Mr Desmond Lee): Mr Chairman, I thank Members for their thoughtful and heartfelt speeches.
Over the last few years, we have been working with many community partners and stakeholders to transform our social sector, better enable Singaporeans to seize opportunities and uplift those who have encountered setbacks, at every stage of their lives. MSF will continue to push ahead with efforts to transform our social safety net in three significant ways.
First, we will go upstream and intervene early, where possible. Intensive downstream measures or casework remains necessary to support those who have fallen behind. But I think we all agree that prevention is better than cure.
Second, we will continue to put individuals and families at the centre of our work. Not agencies and organisations but people and families. The needs of families and individuals can be complex and inter-locking. They can seldom be addressed by a single organisation on its own. Yet, as we bring in more partners, we also need to make sure that it is simple and intuitive for families to access help and resources. So, we will continue to streamline structures and processes, tighten coordination across partners and organise services around families and individuals.
Third, we will reach out and work with even more partners to transform our social safety net together and to address the challenges in the social sector that Deputy Prime Minister mentioned in his Budget Statement. In order to achieve greater impact, we have to reach out, build relationships, earn the trust of our partners, collaborate and draw on the diverse strengths of the people, private and public partnerships. To facilitate such partnerships, we will build capability, tap on technology to strengthen links between partners and grow organic local community networks.
So, let me share some details about how we are pushing ahead in some of these areas. First, expanding our early intervention efforts, to give every child and every family a good start. The early years are critical for a child's development. Over the past decade, we have made significant progress in making quality preschools more accessible and affordable for Singaporean families.
In January, we increased the preschool subsidies for low- and middle income families and enabled more families to benefit from the Additional Subsidy by raising the monthly household income ceiling from $7,500 to $12,000. We also support our Anchor and Partner operators to keep their fees below the caps set by ECDA and invest in improving the quality of their programmes.
We will do more. To enable more families to access affordable and quality preschool, we will extend the Partner Operator scheme for another five-year term, starting from January 2021. We have 250 Partner Operators today. In the new term, we intend to appoint more. When we do so, we will further lower the fee caps, so families with children attending these centres can pay lower fees for quality preschool education.
For low-income families, we provide upstream support to them and their children through KidSTART. Since 2016, KidSTART has benefited over 1,000 children. With the positive feedback, we will expand KidSTART to reach 5,000 more children and their families over the next three years.
In conjunction with this, we launched the \"GROWING TOGETHER with KidSTART\" movement where individuals and organisations can contribute directly to the growth and development of children from lower income households. If you join us, you can partner families, the community and the Government to provide extra resources and support and watch these children grow up.
We hope more of you will step forward and work with us to give our children the best possible start in life. This is again one of the social sector challenges that Deputy Prime Minister referred to in his Budget Statement – to grow a whole-of-society effort to better support children from lower income families.
Our efforts to give every child a good foundation go beyond pre-school. Working parents may not have time to supervise their children after school. For some parents, student care services can fill this gap by providing a structured and conducive after-school environment. This augments the foundation built in school. Therefore, we will increase subsidies to make student care more affordable and accessible for lower income families.
My colleague, Senior Parliamentary Secretary Muhammad Faishal Ibrahim, will share more details later.
Sir, giving every child a good start also means protecting children who are vulnerable. Last September, Parliament amended the Children and Young Persons Act. The raising of the age limit for children and young persons from 16 to 18 years will enable more children to benefit from care, protection and rehabilitation, if needed.
MSF has been working with community partners and agencies on implementation and capability building. We aim to bring the first set of amendments into effect in the second quarter of this year. Senior Parliamentary Secretary Muhammad Faishal Ibrahim will elaborate on this in his speech.
I will now touch on what we are doing to go upstream, to strengthen and support families.
A strong marriage is the foundation for a strong family. Marriage preparation programmes help couples build a strong foundation for their married life and pick up useful skills such as communication and conflict management.
Mr Seah Kian Peng asked how we are making these programmes more accessible and affordable. To encourage more couples to take up such programmes, we have been providing generous rebates and will continue to do so.
When couples start a family and become parents, they will face a new set of challenges. Evidence-based parenting programmes, such as the Positive Parenting Programme or Triple P, have helped parents to pick up skills to manage difficult behaviours exhibited by their children and to reduce their parenting stress.
Ms Irene Quay asked for an update on Triple P, in front of her children. In 2014, we piloted Triple P in Primary and Secondary schools. After we saw how it helped parents, we expanded it to more schools. Today, Triple P is offered in 295 Primary and Secondary schools in Singapore, and over 20,000 parents have attended. An online option for Triple P, or Triple P Online, is also available for the convenience of parents.
Last year, we decided to put in more structure to our upstream family support and anchor upstream support at the regional and community level. And so, we appointed 10 social service agencies as regional Parenting Support Providers or PSPs. Besides working with schools in their regions to deliver Triple P to more parents, these providers also serve as a one-stop shop offering a wider range of programmes. This allows PSPs to provide more customised support for each family.
These moves incorporate feedback that we have received – that early support is important to help parents pick up skills for more effective parenting. As families get smaller, and increasingly both parents work, it can be challenging for families to strike a balance between work and family life. So, we will do more to give families early support in their parenting journey.
Ms Rahayu Mahzam asked about the status of the recommendations made by the Committee to Review and Enhance Reforms in the Family Justice System. We have accepted the Committee's recommendations, which include more upstream pre-divorce support for couples. The feedback and our assessment have been uploaded on the Internet. They are quite detailed. The Member can find more details there.
Over the course of marriage, there will be couples who face significantly more challenges. Some may consider divorce as an option. We will develop an online portal to support these couples.
The portal will make it easier to access marriage counselling. We hope that this will help couples to make better decisions and to give their marriage another chance.
But for those who decide to proceed with the divorce, the portal will consolidate information and resources on housing, finance and other important issues that will significantly impact the family's lives after divorce. This helps couples to better understand the practical implications of their decision and reduces the need for couples to approach multiple agencies for information.
Children are often the most severely affected in a divorce. The portal will help couples understand the immediate as well as long-term impact on children, learn how to co-parent effectively and point them to relevant services, if needed.
Currently, divorcing parents with minor children, who are unable to reach an agreement on divorce are required to attend the Mandatory Parenting Programme (MPP) where counsellors from the Divorce Support Specialist Agencies (DSSAs) help them better understand the practical issues of divorce.
We will ride on the online portal to introduce an enhanced Mandatory Parenting Programme. This will help divorcing parties better understand their specific circumstances and needs through an e-learning module, and have a more personalised discussion with their counsellor. Both this enhanced programme and the online portal will be ready in the later part of next year.
However, some couples are hesitant to use face-to-face counselling services or prefer online avenues. To overcome this, MSF will implement a two-year pilot with the Community Psychology Hub to provide online counselling through live chat or email later this year. This pilot can reach out to 200 clients a year. We hope that this online channel will encourage those who are hesitant about face-to-face services to seek help earlier. We will assess the demand and the response to this service, before making it available on the online portal itself.
To ensure that the online portal is truly useful, relevant and sensitive, we will engage Singaporeans in focus group discussions in the third quarter of this year to seek honest feedback and develop various aspects of the portal such as design, content and flow.
Mr Louis Ng asked whether MSF could require divorce rulings to specify which parent can list their child as an essential occupier when applying to buy an HDB BTO flat. I think the Member asked the same question yesterday during MND's COS and also got his answer.
Sir, it is better for couples to work out arrangements between themselves. It involves their children and they will be co-parents for the lives of their children as they grow up. This is where the initiatives I just described – the portal, online counselling – could help them work out the best care arrangements for their children.
Having said that, the Member is right that not all divorces are amicable. HDB is prepared to consider waiving the mutual agreement requirement if there is clear evidence that one party has already moved on. And the Courts ultimately have the power to make care and control orders and impose conditions. Parties may return to Court for detailed rulings, if necessary.
Mr Louis Ng also asked about single unwed parents. We recognise the challenges faced by single parents. This is why benefits to support the growth and development of children are given to parents of all Singaporean children, regardless of their marital status. Besides the Child Development Account benefits, we have also extended 16 weeks of maternity leave to unwed mothers.
Sir, I move on to the second key thrust of our transformation – putting individuals and families at the centre of our work.
Last year, we announced that we would be integrating the oversight of early intervention services for children with special needs, with mainstream pre-school services, under one body – the Early Childhood Development Agency (ECDA). ECDA will have a holistic view of the developmental needs of children below the age of seven. They will be able to coordinate early childhood development and early intervention as one integrated continuum.
As a next step, we will further streamline the administration of disability functions. Through our conversations with the community, we recognise that it can be challenging for persons with disabilities (PWDs) and their care-givers to approach different agencies for different needs and different issues.
To better support persons with disabilities and their care-givers, SG Enable will be the single touchpoint for disability services and public education efforts.
Accordingly, disability service-related functions and programmes currently under MSF headquarters and the National Council of Social Service (NCSS) will be transferred to SG Enable. This will strengthen the delivery of services for PWDs and their care-givers across different life stages and needs. MSF's Disability Office will retain policy oversight over disability matters.
We will continue to work closely with our stakeholders to see how we can better meet the needs of persons with disabilities. Last year, we formed three Enabling Masterplan workgroups to look at Employment and Employability, Independent Living and Inclusive Pre-schools. Minister of State Sam Tan will provide updates on these three cross-sectoral workgroups in his speech later.
In our community engagements, we often hear the worries and concerns of care-givers of persons with disabilities. For students with special needs, care-givers tell us that special student care service is essential. Besides helping care-givers to balance work and care-giving responsibilities, the service also helps to reinforce what is taught in school.
To better support persons with disabilities and their care-givers, we will make special student care service much more affordable. We will increase the subsidy quantum across all income tiers to reduce what parents have to pay out of pocket and raise the income cap so that more families can qualify. Minister of State Sam Tan will provide you the details later.
Sir, we have also adopted this approach of providing wrap-around, client-centric support to families with young children living in rental housing. Assoc Prof Daniel Goh asked whether we track the financial health of families at the bottom income quintile as their expenses seem to be growing faster than their incomes. Lower income families also seem to be spending more on household and utilities. There are two reasons for these observations.
First, some of these families are retiree households who tap on other sources of income, including savings, allowances from children, CPF payouts and so on. Second, in calculating household expenditure and utilities, rent is included, but mortgage repayment for owner-occupied property is not. Many 1- to 2-room HDB flats are public rental flats. That is why families living in these flats seem to be spending more on housing.
In any event, for low-income families experiencing hardship, we provide financial assistance, along with the support from our community partners and agencies, to help them with daily expenses and household bills, including utilities, public rental fees and mobile data plans. We regularly review the assistance to account for changes in the prices of essential items as well as changing needs.
Assoc Prof Walter Theseira and Mr Mohamed Irshad asked how we will assist families who face food insecurity. Our assistance to low-income families through ComCare covers basic needs such as food. For families facing immediate needs, our Social Service Offices (SSOs) offer interim assistance such as cash and supermarket vouchers. We also connect them to community-based support such as free cooked food. Families who are unable to buy or prepare their own meals are also linked up with food rations and meal delivery services offered by social service agencies.
We recognise that low-income households may face challenges in eating healthily. The Health Promotion Board (HPB) works with donors to encourage them to donate healthier and more nutritious food products.
The community, too, plays an important role in supporting vulnerable households with food provisions. MSF has been working with food support organisations and charities since 2018. Last year, we convened a workgroup with food organisations and charities, volunteer groups and Government agencies to look at how to reduce food waste and inefficiencies in distributing food, in order to ensure that beneficiaries receive healthy and nutritious food. We have made some progress and will continue to work on these issues together.
But we want to go beyond providing financial assistance and addressing immediate needs.
For families with young children, we want to proactively reach out to provide Comprehensive, Convenient and Coordinated support. We want to empower them to overcome their challenges, achieve sustained stability and possibly even purchase their own homes. And we want to bring the community together to do this.
At last year's COS, I announced that MSF will be launching Community Link, or ComLink, at four locations – Jalan Kukoh, Marsiling, Kembangan-Chai Chee and Boon Lay. In each location, we wanted to bring partners together to address the community's needs in a proactive and customised manner. Mr Seah Kian Peng, Mr Darryl David and Dr Lily Neo asked how we work with different community agencies to support individuals and families in need in a more coordinated manner. Our approach is to work with these agencies as equal partners right from the get go.
Over the past year, local implementation workgroups comprising social service agencies, schools and pre-schools, Government agencies, and the grassroots went door-to-door to engage all families with young children, and conducted focus group discussions to understand their needs, worries, strengths and aspirations. Backend, the workgroups held regular case discussions to link families to the right agencies for additional support, coordinate the interventions provided and track their progress closely.
For areas that existing programmes may not fully address, the workgroups roped in new partners to bring new programmes to the community. For example, we noticed that families in Boon Lay lacked conducive study spaces at home. Often, parents are also not able to guide their children academically. To address this, the local implementation workgroup created a home work café at the Residents' Network, with South West CDC contributing funding and NTU students volunteering as tutors.
In Jalan Kukoh and Marsiling, we have dedicated ComLink centres to run these programmes. We also make full use of existing community resources. So, in Boon Lay and Kembangan-Chai Chee, where the centres are being set up, we maximise existing spaces like the Residents' Network and RCs to operate these community programmes.
Not only Government and community partners are involved. Corporates and volunteers have stepped forward to offer their expertise and time. For instance, Etonhouse Community Fund donated more than 800 Boxes of Joy with brand-new toys and educational materials to families living in all four ComLink areas in December last year. Doctors and lawyers have stepped forward to provide free health screening and legal advice to residents. Students from Polytechnics and Universities run tuition and enrichment programmes for the children.
ComLink is a good example of the type of cross-sectoral partnerships that can bear fruit when we come together to address specific needs in our local communities. ComLink is a microcosm of how our future social safety net will look like – proactive, upstream, integrated and with individuals and the families placed at the centre of what we do.
Sir, during this time, we are also paying particular attention to those affected by the COVID-19 situation. MTI's assessment, as you heard during their COS, is that the economic impact of COVID-19 could be worse than SARS. The Government has introduced measures to help businesses with cash flow, help workers remain employed and provide additional support for specific sectors directly affected.
For MSF, our priority is to support vulnerable families and individuals who are unable to meet their basic needs because they are unable to work or because the sector they are working in have taken a big hit.
First, we provide financial assistance for persons under Quarantine Orders or Stay-Home Notices, if they are in financial need. We are also tapping on The Courage Fund which now stands at $3.6 million to provide additional support for lower income families who are affected by COVID-19. For social service agencies, ComChest will also be providing support to help them cope with additional expenses.
Beyond the challenges it poses to our economy, COVID-19 is also a test of our social resilience. I am encouraged to see people stepping forward to help one another. Many have signed up to volunteer and donated generously to The Courage Fund. Last Sunday, volunteers in the Families for Life Council launched the \"Share-the-Care\" movement, which encourages families to look beyond themselves to show appreciation to our frontline and their families.
All 1,000 Share-the-Care baskets have been adopted and I hope families continue to pay the care forward. In fact, I got a message from one of the families. Their son, who is in Secondary school, after playing the games with his parents, packed the basket with new things, went to one of the clinics, after it closed to give it to the doctor and said, \"This is for you and your family and children\". It moved the doctor to tears. So, let us continue to stay vigilant, take the necessary precautions, take care of our families and keep a look out for one another and give each other a pat on the back, especially our frontline workers.
Ms Denise Phua asked how we are tackling social challenges together as a society. The third key thrust of our transformation is indeed about collaborating more intensively with different partners across all areas of our work. Earlier, I spoke about how we are involving the community through partnerships such as \"GROWING TOGETHER with KidSTART\" and ComLink. Members might also recall the PEERS network or the Partners Engaging and Empowering Rough Sleepers network. Launched in July 2019, the PEERS network is a diverse group comprising Government agencies, charities, religious organisations and community groups.
Mr Murali Pillai asked about how we assist those who have homes but are sleeping in public because of family problems. Sir, Government agencies join community partners in the PEERS network on their regular night walks to reach out to rough sleepers, befriend them and understand their circumstances. For those who are willing to receive help, we address their immediate needs, work on underlying issues, and support them towards eventual longer term housing.
It was not easy initially. There were concerns among our newfound partners that Government agencies would forcibly move the rough sleepers off the streets. But as we continued to work with them, to look after the rough sleepers' well-being, our relationship strengthened. Because of this trust and understanding, we were collectively able to support more rough sleepers in finding longer term solutions than if each of us were to work alone. I would like to thank all our partners for your trust, your partnership and for coming together. We welcome more partners to join us on this initiative.
Another area that we want to partner the community more rigorously is in enhancing youth mental well-being. The latest Singapore Mental Health Study noted that young people between 18 and 34 years of age had a higher prevalence of mental health conditions, compared to older people. Mental health issues are complex but prevention, early detection and intervention can go a long way to help.
This is not a new area. We are keenly aware of the many issues and struggles faced by those with mental health issues. You have heard from my colleagues in MOE, MOH and MOM on the measures that they have taken and are taking. The community and practitioners on the ground have also done a lot of good work. By bringing a social lens to this issue, however, we can further synergise our efforts and increase our overall impact.
A person's mental well-being affects their families neighbours, colleagues and friends. It is more than a medical issue faced by a person. We want to address the social determinants of health – and consider what kinds of holistic support a person needs to stay healthy. Hence, there is more that we can do together. Last month, we made an open call for persons interested in the topic of youth mental well-being to step forward, connect with us to contribute ideas, and work with us to turn some of these ideas into reality.
This is yet another challenge that Deputy Prime Minister mentioned, that we are issuing to the social sector. We are very encouraged by the enthusiasm of all who have reached out to us. In total, as of this time, more than 700 individuals and organisations have responded and the number continues to grow. Many are young people who are concerned by this issue and want to do something about it. Some have struggled with mental health issues. Some are care-givers or therapists of persons with mental health issues.
We will be establishing a Youth Mental Well-being Network. Everyone who stepped forward during the open call, will have an opportunity to be part of this network. We will get to know one another, identify areas to collaborate and work together to deliver programmes and interventions, to better support our youths. And this work is just beginning. In a way, how we intend to proceed is uncharted waters.
But some early ideas have already emerged. For example, providing information and raising awareness about available resources so that people know where to go for help and to do so earlier. This is just one of the points raised in the conversations we have had thus far.
I hope many Singaporeans will partner us to jointly develop solutions for a happier and healthier society. Our young people deserve the best start in life possible.
Sir, the social service sector is a major partner in our endeavour to build a society of opportunities for all. Demand for social services will increase in both scale and complexity as our social challenges evolve. We therefore need social service professionals with deep skills and capabilities.
In April last year, we set up the Social Service SkillsFuture Tripartite Taskforce to bring together academics, professional associations, Social Service Agencies and policy-makers to look at how we can enhance the capabilities and effectiveness of the professionals in the sector. Since then, the taskforce has initiated various manpower development projects, which we will share more on in the coming months.
Besides skilled and competent professionals, we also need social service agencies with the capability and capacity to deliver outcomes sustainably, effectively and efficiently. Donors generally prefer to support programmes and services that directly benefit service users and those in need – understandably so.
However, resources are needed to build capability and capacity in our social service agencies. As announced by Deputy Prime Minister during Budget, we will introduce the Community Capability Trust (CCT). This is a dedicated, long-term fund of up to $480 million to strengthen our social service agencies capability and capacity to do more and to do so better.
This fund will be made up of contributions from the Government, Tote Board and the community. Government and Tote Board will provide an initial $200 million in capital. To encourage donors to contribute to capability building, the Government and Tote Board will match $2 to every dollar donated by the community for five years, from FY2020 to FY2024. Thereafter, donations from FY2025 to FY2029 will be matched dollar-for-dollar.
The Community Chest will also provide an additional $30 million in capital and spearhead fundraising initiatives to unlock the matching grants. So, let us grow this fund together and use it to prepare our sector for the challenges of the future.
Capability and capacity building may sound very abstract, so, let me illustrate how our efforts to build up our social service agencies capabilities can have a real and lasting impact on the people that we serve.
There are many examples, but we have chosen a very \"techie\" one where the benefit is very clear.
Angsana Home is a Welfare Home managed by Thye Hua Kwan Moral Society in Pelangi Village. Under the Tech Booster project by the National Council of Social Service, it has implemented the SoundEye monitoring system. The system makes use of smart sensors with AI-enabled sound recognition and motion detection technology to identify abnormal sounds or movements that could give early warning of distress from residents.
Angsana Home staff can be more quickly alerted when residents require attention or help, even during night shifts when there may be fewer staff are on duty. This allows the Home to monitor residents' safety more effectively and provide better care to residents. This is an example of the kind of work that the CCT will support, enabling the social service agencies to do their work better, serve beneficiaries more effectively, have better outcomes and make the work better for social sector professionals.
We know that building capability and capacity is a long-term effort that requires sustained investment. The CCT will give the sector the time and resources needed to build stronger and more productive social service agencies that are ready for tomorrow's challenges.
To serve clients in a coordinated manner, we also need to strengthen the links across social service agencies, as well as between them and Government agencies. Earlier, I spoke about how we work with community agencies as equal partners so that we can operate in concert. Besides working collaboratively, technology is also a key enabler to help us coordinate better. Today, we harness technology to enable our clients to access services more conveniently. Besides financial assistance, all SSOs offer access to employment and housing services. Some also offer access to family and legal advisory services.
Most of these services are provided at the SSOs through video conferencing to other agencies, making it more convenient for clients who need not make multiple trips to receive support from agencies such as HDB, Workforce Singapore (WSG) and the Legal Aid Bureau. We will grow this video conferencing network by offering access to more of these services at all our SSOs, and by bringing partners such as Agency for Integrated Care (AIC) and hospitals into the network, over the next year.
Besides using video conferencing, we want to harness technology to provide more comprehensive and coordinated support to clients and beneficiaries.
Today, officers may ask clients to submit documents, so that they can better understand their circumstances. This may sometimes include documents that clients had already submitted to other agencies previously. And when one agency needs to make referrals to another, officers often do so over emails for each and every case. After the referral is made, officers may also need to check in with their counterparts to keep track of progress.
To streamline these efforts, we will make significant system enhancements.
First, the enhanced system will allow frontline officers to make faster and more comprehensive assessments about their clients' needs, through digitalisation and data sharing across multiple agencies. Clients will also experience greater convenience without having to repeatedly submit documents to multiple organisations.
Second, the enhanced system will make it easier for agencies to refer cases, share assessments, coordinate how they are supporting their clients and monitor the clients' progress.
This way, all parties can monitor progress and coordinate follow-up actions better, to improve a client's situation. This will also reduce the bandwidth tax on families as they seek to tackle the challenges they face.
These enhancements will be rolled out from the second half of this year. We will bring agencies on-board this system progressively. In steady state, about 5,000 frontline officers from both Government and community agencies will be able to tap on the enhanced system to provide comprehensive, convenient and coordinated support to the Singaporeans that we serve.
Technology is important, but it is no substitute for the human touch. This person-to-person connection is critical in the social service sector, because it builds trust and understanding. With mutual trust, we are comfortable calling our counterparts in another organisation and mobilising support on multiple fronts to address issues quickly.
To strengthen these personal connections, we organise SG Cares Community Network sessions every year in each and every town, all across the island, to bring together partners from the social, health and community sectors in each town. Through this platform, partners get to affirm and build new relationships. We also invite partners to exchange ideas and best practices on addressing needs in the community. The sessions spark discussions that turn into collaborative projects.
We completed the first wave of 19 SG Cares Community Network sessions island-wide in 2019. Through these sessions, we brought together more than 3,500 participants from 160 Government and community help agencies.
The Community Network sessions from the first wave catalysed 60 collaborative projects. \"Stories About Us\", started by community partners in Hougang and Serangoon, is one such project. These community partners saw the need to listen to the voice of those with mental health issues when designing solutions for them. They then engaged recovering mental health patients to understand the challenges they face in navigating social and healthcare services and asked them how agencies can better support them.
In the second wave, which we have started in November last year, our SSOs will jointly organise these sessions with community partners and volunteers, and develop and implement their ideas together with them. Mr Chairman, allow me now to speak briefly in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] \tChairman, in the past few years, MSF has been collaborating with the community to strengthen our social safety net, in line with the SG Together movement.
Moving forward, youth mental well-being is another important area in which we will continue with this partnership approach.
Studies have shown that young people between 18 and 34 years of age have a higher prevalence of mental health conditions as compared to older groups.
Last month, I made an open call for Singaporeans interested in the topic of youth mental well-being to step forward with their ideas. In total, more than 700 individuals and organisations have responded, many of whom are young people who are concerned about this issue and want to do something about it.
We will set up a youth mental well-being network and invite those who are passionate about this topic to share their views. We will identify areas to collaborate and work together to develop more holistic support for our youth's mental well-being.
Through such partnerships, we can synergise and amplify our efforts to better support Singaporeans in need.
I hope more Singaporeans will step forward and partner us to build a caring and inclusive society together.
(In English): Chairman, we are committed to nurturing resilient individuals, strong families and a caring society. We are intervening early to give every child and every family a good start. We are continuing to put those we serve, at the centre of what we do. We are partnering the community, building sector capability and strengthening networks to work better together.
Our society is stronger and more resilient when all Singaporeans come together, when we look out not only for ourselves, but our families, neighbours and fellow Singaporeans in need.
As Deputy Prime Minister mentioned in the Budget Statement, the Government has identified specific challenges that we are bringing partners across the public, people and private sectors together to address. I also spoke about several initiatives that we will work together with Singaporeans on. These include GROWING TOGETHER with KidSTART to support low income families with young children; an online portal for those facing difficulties in their marriage; ComLink to uplift families living in rental housing; the PEERS network to assist rough sleepers; the Community Capability Trust to build capability and capacity in the sector; and the Youth Mental Well-being Network.
I hope more Singaporeans will step forward to join us in these initiatives, participate in our Community Network sessions or join a Volunteer Centre set up by MCCY in their town.
Let us work together to make Singapore a place where those in need are better supported and where Singaporeans have the chance to pursue their dreams, regardless of their starting points and what they may have encountered as they progress in life. [Applause.]
The Chairman: Minister of State Sam Tan.
The Minister of State for Social and Family Development (Mr Sam Tan Chin Siong): Mr Chairman, we are building a more caring and inclusive Singapore. One where individuals are valued for who they are and also enabled to achieve their potential.
The Enabling Masterplans aim to support persons with disabilities (PWDs), recognise their abilities and help them to participate meaningfully in our community and also in our society.
As part of the Masterplans, we set up SG Enable in 2013 to better support them. Since then, SG Enable has become a trusted partner to PWDs, their care-givers and Social Service Agencies (SSAs).
Minister Desmond Lee spoke about placing citizens at the centre of our work and also the consolidation of disability support services under SG Enable in his speech earlier. Please allow me to explain further.
Over the past three years, we have spoken to PWDs, care-givers, social service operators and many stakeholders, to understand the challenges and needs that they face.
From their feedback, one common challenge is the need to work with different agencies and SSAs at different life-stages to get help, and sometimes having to submit the same documents multiple times. To them, having a single touchpoint to support them at all life-stages would make life easier. Many SSAs in the disability sector also told us that the sector could be better coordinated. For example, they have to work with different agencies to get approval and funding for different programmes and activities.
We are grateful to our partners and stakeholders, and have been making efforts to streamline service delivery for the disability sector based on their feedback.
So, I am pleased to announce that from 1 October 2020, SG Enable will become the single touchpoint for the disability sector. It will take over the administration of disability programmes currently run by MSF and the National Council of Social Service (NCSS). In addition, people who are willing to serve and contribute towards creating an inclusive society will be able to identify SG Enable as the single touchpoint to volunteer their time and services.
Ms Denise Phua and Ms Cheryl Chan made an important point on promoting inclusion and also correcting misperceptions about PWDs. This begins with building positive attitudes and improving understanding through public education.
To make our public education messages stronger and clearer, SG Enable will lead public education efforts related to disability. This includes reaching out to the broader community through the \"See the True Me\" campaign and also coming up with resources on how people should interact with PWDs, and how they can be supported at the workplaces.
Bringing different functions under one roof will improve efficiency, oversight and coordination of services. In addition, it will also provide clear direction for the many helping hands involved.
This new single-touchpoint structure is the next big step forward for the sector to bring stakeholders under one umbrella to co-create and co-deliver services and solutions for PWDs.
Sir, last year, we formed three cross-sectoral Enabling Masterplan workgroups on Employment, Independent Living and Inclusive Pre-schools.
The workgroups have worked with Government and community partners over 13 engagement sessions. We consulted more than 200 PWDs, care-givers and over 40 different SSAs from the disability sector.
With their input and suggestions, we are now working across the whole-of-Government, together with private and community partners, to co-create and co-deliver solutions to address the problems identified and raised during the 13 engagement sessions.
Ms Denise Phua and Ms Sylvia Lim asked about what we are doing to help PWDs in terms of training and employment. As announced earlier by MOM, the Government has introduced new initiatives ,such as the Enabling Employment Credit and the enhancements to the Open Door Programme.
That said, we are also aware that Government measures alone are not enough to meet all the needs. We need to bring the public, private and people sectors together to advance inclusive employment. A good example of how we do this is through the partnership between SG Enable and SSAs to provide training and job support services and their partnership with inclusive employers, such as UOB, to run initiatives such as \"The Unlimited\", which helps them reach out to even more employers who are willing to employ PWDs. But of course, there is always more that we can do together.
So, under the employment workgroup, which I co-chair with Ms Denise Phua, we put ourselves in the shoes of PWDs looking for a job and we tried to understand the challenges that they face and also we have tried our best to identify the areas where they need more help. Through this exercise, we have identified four key areas where we can and we will do more to help them.
Let me use an example to elaborate this further.
Take for example, Mark, who is about to graduate from a SPED school and will be looking for a job. First, to enhance Mark's work capability, we will help him to improve in areas that employers have identified as crucial. These areas include soft skills, such as communication, teamwork and problem-solving skills. Second, we will create alternative supported employment models and job opportunities for Mark, as he may not be ready to work in an open employment environment yet. Third, we will enhance employment services to match and place Mark in a job. Fourth, we will enable Mark's colleagues to better understand and support him on the job, and we will strengthen education and awareness on working with persons with disabilities.
There are initiatives planned for each of these areas. One such initiative is the development of a soft skills curriculum for students with disabilities, which MOE is working with employers and SSAs on.
Ms Denise Phua and other care-givers also raised concerns about a gap in terms of continual education and training. The workgroup is working with relevant people and also private sector partners to address this concern.
All these efforts to support persons with disabilities in terms of training, work and employment are in line with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), something that was mentioned by Ms Sylvia Lim earlier.
Besides employment, independent living is another issue raised by persons with disabilities and their care-givers. The workgroup on independent living, which I co-chair with Ms Chia Yong Yong, is looking into how we can help persons with disabilities live more independently in the community. While we recognise that there is a broad spectrum of disability types, allow me just to illustrate with the example of Amanda, who is visually impaired.
By stepping into her shoes, we better understand the challenges that she faces along the way to access public transportation and what can enable her to overcome that. First, Amanda needs to cross the road from her house to the train station. She can activate the Green Man Plus at the pedestrian crossing. Not only does this function give her additional time to cross the road safely, the beeping sound also helps to orientate her in the right direction. At the train station, Amanda needs to find her way to the gantry. Here, she relies on the tactile flooring to guide her to the gantry, but she needs to take out and tap her EZ-Link card. By using radio frequency identification or Bluetooth technology that LTA is testing, she can, in the future, pass through the gantry hands-free, without any difficulty.
At this point, let me also extend my appreciation to Mr Cheong Kwek Bin and the Singapore Association of the Visually Handicapped (SAVH). Working with visually impaired persons like Kwek Bin as a member of our workgroup has been immensely helpful. He and SAVH members have provided invaluable insights on how things can be improved.
Collaborating with them has enabled us to gain insights, to use smart design and assistive technology to further help persons with disabilities to get around the built environment and also public transport.
Another example of such a collaboration was the Mobility Assistance for the Visually Impaired and Special Users (MAVIS) pilot project, earlier shared by MOT.
Sir, we also aim to increase public awareness and understanding on how to lend a helping hand to persons with disabilities if they need assistance, and also ensure that they have better access to information and online services.
Many of these improvements will not only benefit persons with disabilities, but also all of us.
The third Workgroup on inclusive preschools, which Senior Parliamentary Secretary Muhammad Faishal Ibrahim and Assoc Prof Kenneth Poon co-chair, is studying models for inclusive preschools that will allow children with severe developmental needs to receive Early Intervention and Early Childhood services. Senior Parliamentary Secretary Muhammad Faishal Ibrahim will elaborate more on this later.
All the three workgroups have taken in findings from the engagement sessions and will put up their recommendations later this year.
Chairman, we are also doing more to provide support for care-givers of persons with disabilities. Mr Seah Kian Peng noted that Special Student Care Centres (SSCCs) are key to supporting care-givers. They are particularly essential for care-givers who need to work or care for other dependents and themselves.
I am therefore happy to announce that MSF will improve funding and subsidy support for families of SSCC students and extend the subsidies to more families of Special Education (SPED) students. From 1 July 2020, we will raise the eligibility criteria for means-tested subsidies from $4,000 to $9,200, and we will also lower out-of-pocket expenses for SSCC services. This reduces the out-of-pocket cost for a child from a family with a combined household income of $4,000 by around 75%, or from currently $582 to $142 a month, starting from July.
However, beyond the reduction in fees, these enhancements also provide much needed support and respite for care-givers like Mdm Valerie, who fell ill and could not take care of her daughter, Kylie. Before joining MINDS SSCC, Kylie had to be placed in institutional care. The SSCC helped Kylie learn to be more independent in her daily living skills and also facilitated her return home to her family when her mother recovered.
Ms Rahayu Mazam asked how we could make it more convenient for persons with disabilities and their care-givers to access the support they require. Besides making services more affordable, we are also making information more accessible.
To this end, SG Enable launched a new online website called \"The Enabling Guide\" in July last year. As a one-stop resource for persons with disabilities and care-givers to find help easily, it pulls together information and resources on various disability schemes and services, and guides users to make informed decisions about service options across the life stages. Sector professionals from the disability sector can also use information in the Enabling Guide to help their clients.
Ms Denise Phua and Miss Cheryl Chan also asked important questions about the support available for persons with disabilities as care-givers age, and how we can help care-givers prepare for a future where the care-givers themselves are no longer able or around to take care of their children.
Care-givers of persons who lack mental capacity can make financial arrangements such as setting up trust accounts with the Special Needs Trust Company. They can also apply to Court to be appointed as their child's deputies and have a successor deputy appointed to take their place when the need arises. MSF has also introduced the Assisted Deputyship Application Programme (ADAP) to make the deputyship application process simpler and cheaper.
Sir, we want to assure care-givers that there is a continuum of support and residential facilities, and programmes for persons with disabilities.
Those who can live independently can tap on Government funds for Assistive Technology devices to make their lives easier. Others who require some care-giving support can consider residential options in the form of Government-funded Community Group Homes and Adult Disability Hostels.
But we also know that there are some who need greater care-giving support. When their care-givers pass away and if no one can take over the care-giving responsibilities, the Government will step in to take care of them in Government-funded Adult Disability Homes as the last resort. Sir, we will not leave them alone to fend for themselves. We will not.
In line with the suggestion by Ms Denise Phua, we will continue to work with other relevant agencies to develop the continuum of housing options for persons with disabilities, as well as to make other community services more inclusive. Chairman, I would like to speak in Mandarin now.
(In Mandarin): [Please refer to Vernacular Speech.] Mr Chairman, we are committed to building an inclusive society where everyone can play their part, participate actively and contribute.
From 1 July 2020, MSF will enhance subsidies to make Special Student Care Centres (SSCCs) services more affordable for families of Special Education (SPED) school students and will extend the subsidies to more families.
We will raise the eligibility criteria for means-tested subsidies from $4,000 to $9,200, and lower out-of-pocket expenses for SSCC services. The reductions will range between 30% and 80% for most families. This means that out-of-pocket cost for a child from a family with a combined household income of $4,000 will be reduced by around 75%, from $582 to $142 a month.
Let me also share that from 1 October 2020, SG Enable will be the single touchpoint for disability services, and take over the funding administration and management of disability programmes currently administered by MSF and the National Council of Social Service (NCSS). SG Enable will also take the lead on public education efforts related to disability and will take over the running of the See the True Me campaign from NCSS.
The changes will allow SG Enable to enhance their efficiency in coordinating resources and project planning, and reduce duplications, so that they can provide more efficient and effective services for persons with disabilities and their care-givers.
In July 2019, SG Enable also launched a new online website – the Enabling Guide. This is a one-stop online platform for persons with disabilities and care-givers to find help more easily. It pulls together information and resources on various disability schemes and services, and users can make more informed decisions about different service options across life stages. Sector professionals and social service agencies can also use the information in the Enabling Guide to better help their clients.
MSF will continue to work with our people, private and public sector partners to build a more inclusive society. Under the third Enabling Masterplan, the Government has formed three cross-sectoral Workgroups to look into how we can better support persons with disabilities through their different life stages. This includes providing better support for children with developmental needs through an inclusive pre-school model, improving the employability of persons with disabilities and helping them live independently through the use of technology and design. The Workgroups will release their recommendations later this year.
(In English): Mr Chairman, in closing, everyone has a part to play in building a caring and inclusive society. Inclusion is not just a vision. It is action. It is about people coming together, enabling each other to create a Singapore where every individual can achieve his or her potential.
We want to build a Singapore that we are all proud to call home. So, at this moment, I would like to turn over the floor to Senior Parliamentary Secretary Muhammad Faishal Ibrahim, to speak about other MSF programmes and services.
The Chairman: Order.
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Mr Speaker: Order. Pursuant to Standing Order No 91(3)(d), I propose to extend the time of this day's Committee sitting for a period of up to 30 minutes.
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The Senior Parliamentary Secretary to the Minister for Social and Family Development (Assoc Prof Dr Muhammad Faishal Ibrahim): Chairman, I thank the Members for their valuable suggestions and continued support of my Ministry's work. I would like to start with a few words in Malay.
(In Malay): [Please refer to Vernacular Speech.] The Malay proverb – bend a bamboo while it is still a bamboo shoot – underlines the importance of educating children while they are still young. Quality early childhood education helps to provide them with strong developmental foundations to succeed in life. The Government is committed to ensure that every child has a good start in life regardless of their background. We have implemented various measures to enable more families to place their children in affordable quality pre-schools.
More Malay/Muslim families are now enrolling their children in pre-schools. The cohort enrolment of Malay/Muslim children aged five to six years old in pre-schools is comparable to the overall pre-school cohort enrolment for children aged five to six years old. This is an encouraging trend. I hope that more Malay/Muslim parents will enrol their children in pre-schools. Through the various measures by the Government to improve access to affordable quality pre-schools, cost should not be a barrier for children from low-income families to receive quality early childhood education.
To help low-income families further, we will streamline subsidy support under Special Approval for children living in public rental flats or receiving ComCare Short-to-Medium Term or ComCare Long-Term Assistance. From August 2020, these families will qualify for maximum pre-school subsidies automatically until the next fixed point of assessment, regardless of the mother’s working status. This is because they had already been means-tested for those schemes. For new enrolments from these families, we will also speed up the processing of Start-Up Grants. This grant helps to defray the initial costs of pre-school enrolment, such as uniforms and deposit.
We will extend more upstream support to children from low-income families, even before they enrol in pre-school, through the KidSTART programme. We have received positive feedback on the KidSTART pilot. Thus, we are expanding KidSTART to another 5,000 children over the next three years. We will also raise the KidSTART income eligibility criterion from a monthly household income of $1,900 to $2,500 from April this year, so that more families can benefit from it.
My Ministry works with many agencies and community partners to give every child a good start. One example is our partnership with M3. Under Focus Area One of M3 to support marriage, parenthood and early childhood development, we partner MENDAKI on the Preschool Outreach Programme. Apart from promoting awareness about the importance of pre-school, this Programme also helps Malay/Muslim families to enrol their children in pre-school. I am happy to share that two-thirds of children enrolled in pre-school with MENDAKI’s help are now attending pre-school regularly. Last year, MENDAKI and M3 partners also launched the KelasMateMatika@CC programme to help Malay/Muslim parents learn techniques to support their children aged four to six years old develop skills in Mathematics.
Chairman, I have shared about the efforts by us and our community partners to provide a good start in life for all children. The responsibility of developing and educating children is a shared duty of the whole community. We will become stronger if we help each other and stay united as the Malay proverb goes – like the bamboo and the river bank . So, please come join us in creating a better future for ourselves and our future generations.
(In English): Quality early childhood development helps our children build strong foundations for life. The Government is committed to giving every child a good start in life, regardless of their background.
At the National Day Rally last year, the Prime Minister announced that the Government will continue to make quality pre-schools more affordable and accessible.
Since 2012, we have doubled the number of full-day pre-school places to 180,000 today. This will increase to over 200,000 by 2023.
Today, 50% of all pre-school places are provided by Government-supported pre-schools. We aim to increase this to 80% by 2025.
Over the medium-term, we aim to lower fee caps at Government-supported pre-schools so that working families with a child in full-day childcare will pay around $300 per month. This is the equivalent of primary school fees plus after-school student care fees. After means-tested subsidies, families will pay less.
Let me explain how we will get there. First, we have enhanced pre-school subsidies. From January this year, we have raised the monthly household income ceiling for the Additional Subsidy from $7,500 to $12,000, and increased subsidies across all eligible tiers.
Second, we will be extending the Partner Operator (POP) scheme for another five-year term from 2021 to 2025 and lowering the fee caps. We aim to appoint more POP childcare centres in the new term.
They will have to meet lower monthly fee caps of $760 for full-day childcare, compared to $800 today. With this, we expect industry median fees to go down. Fee caps for infant care will also be lowered.
Mr Darryl David asked how the Government intends to enhance support for pre-school operators. Besides expanding the POP scheme to support more quality pre-school operators, ECDA and IMDA will launch an Industry Digital Plan for the early childhood sector later this year to provide broad-based support to help pre-schools adopt digital solutions.
In addition, I am glad to announce that ECDA will extend and enhance the Support Schemes to help eligible non-Government supported pre-school operators defray various expenses.
First, the \"Kindergarten Conversion Grant\", \"Enhanced Workplace Childcare Centre Scheme\" and \"Enhanced Social Service Agency Development Grant\" help qualifying pre-school operators defray start-up costs of infrastructure development, and furniture as well as equipment. Moving forward, ECDA will enhance the funding amounts and streamline the three schemes into a single Infrastructure Support Grant.
Secondly, the Community/Sports Facilities Scheme (CSFS) incentivises building developers to set aside spaces for new childcare centres. Moving forward, centres under the scheme may also qualify for support to defray their start-up infrastructure and furniture and equipment costs.
We will also increase the funding amounts for the Portable Rental Subsidy and the Teaching and Learning Resource grants which help pre-schools defray rental costs and support their quality improvements.
Our educators are at the heart of quality pre-schools. Several efforts have been put in place over the past five years to attract more local educators and raise the quality of early childhood educators.
These efforts help to raise the resilience of our early childhood workforce. Mr Ang Hin Kee asked about the impact of staff on Leave of Absence due to COVID-19 on pre-schools. I would like to assure Mr Ang that educators certified to teach Chinese Language who were issued Leave of Absence or Quarantine Orders formed less than 6% of early childhood educators certified to teach Chinese Language.
We will continue to grow the pool of local Chinese Language Teachers, as part of our overarching strategy to make early childhood teaching a career choice. Today, locals can pursue the Early Childhood Chinese Language teaching track at NIEC at highly subsidised rates. Next month, NIEC will launch a new Professional Conversion Programme allowing mid-career entrants to complete the course in half the time.
We are also doing more to raise the standing of the profession. I am pleased to announce that we will make it mandatory for all pre-schools to close on Teachers’ Day from this year onward. So, from this year onward, it will be mandatory to close and teachers can have a good holiday. This move further signals our recognition and appreciation for our pre-school educators.
While we work to enhance the affordability, accessibility and quality of pre-schools for our children, we recognise that certain groups of children need additional targeted support. Mr Desmond Choo spoke about children with developmental needs. We agree with him and are doing more to support this group.
The Early Intervention Programme for Infants and Children (EIPIC) provides young children at risk of moderate to severe developmental delays with early intervention (EI) support. The intensity of subsidised intervention is tailored to the child’s needs and is comparable to other developed countries. EI centres also provide care-giving training to family members so that they have the skills to ensure that intervention can continue for the child beyond the centre for more sustained outcomes.
Beyond EI centres, many pre-schools strive to adopt a more inclusive approach and enrol children with varying needs. To support inclusion within pre-schools, the Government has introduced various EI programmes at pre-schools. Currently, about 550 pre-schools, offer the Learning Support (LS) and Development Support (DS) programmes for children with learning and mild developmental needs respectively. Pre-schools that are DS-LS providers receive Government funding to train their Learning Support Educators and procure therapy services. The new DS-Plus programme allows children who have made sufficient progress under EIPIC to receive intervention within the pre-school setting instead.
Early childhood educators are also taught the basics of identifying and working with children with development needs during pre-service training.
The cross-sectoral Inclusive Pre-school Workgroup, which Minister Desmond and Minister of State Sam referred to, is co-chaired by Assoc Prof Kenneth Poon and I. We are studying how to better support children with moderate and severe developmental needs in pre-schools, including the need to enhance pre-school teacher training and the role of programmes such as EIPIC and the Enhanced Pilot for Private Intervention Providers (PPIP). We are more than halfway through our work and will share our recommendations by the end of this year.
Besides children with developmental needs, children from low-income families is another group for whom we are providing additional targeted support. We have the Pre-school Outreach Programme to reach out to low-income families to encourage them to enrol their children in pre-school. We will also be doing more in three ways.
First, we will ensure that pre-school fees is not a barrier. Our recently enhanced subsidies will enable more low-income families to pay $3 per month at Anchor Operator (AOP) childcare centres, or $1 at AOP or MOE Kindergartens. We also made applying for subsidies easier.
Mr Darryl David asked about support for non-working mothers. Last year, we enhanced support for non-working mothers under Special Approval. Under the scheme, mothers who are not working for reasons such as taking care of a younger child, studying, undergoing pregnancy, or medically unfit to work, can receive the same subsidies as working mothers. Mothers who are looking for work can also qualify for Special Approval as a transitory measure.
Mr Seah Kian Peng also asked if we can do more for non-working mothers from low-income families. I am glad to announce that with effect from August 2020, we will streamline subsidy support under Special Approval for all children from low-income families living in public rental flats, or receiving ComCare Short-to-Medium-Term or Long-Term Assistance.
As these families have already been means-tested, we will automatically qualify them for maximum pre-school subsidies under Special Approval. Families will not have to submit additional documents when they apply for Special Approval. The subsidies will also remain unchanged until the next fixed point of assessment, as opposed to the current process where they may have to re-apply for support every few months.
For new enrolments from these families, we will also facilitate Start-Up Grants, which defray the initial costs of enrolment such as uniforms and deposit.
Allow me to illustrate how this supports families. Consider Lisa, who lives in a public rental flat. Her husband is the sole breadwinner and they have a son, Caden, who recently turned two and enrolled at an AOP pre-school. As Lisa is looking for a job, ECDA provided her with working mother subsidies for six months under Special Approval, and she only pays $3 per month for childcare. Previously, Lisa would have to re-apply for subsidies once her Special Approval expires in six months. With our enhanced subsidy process, Lisa will receive maximum subsidies and continue to pay $3 per month until Caden completes Nursery 2. With this, Lisa can have peace of mind while she seeks employment. She will not have to worry about her subsidy support expiring.
Mr Chairman, this also demonstrates the Government’s efforts to better coordinate the delivery of social services, by linking assistance schemes across pre-school, housing and social domains for families.
Second, we want to ensure that children from low-income families can access developmental opportunities at their pre-schools. These activities, such as field excursions, may incur some costs to families. All AOPs are required to set aside funds to help low-income children access such opportunities. For all other pre-schools, I am pleased to announce that ECDA will extend the Pre-school Opportunity Fund (PSOF).
The PSOF provides funding support for children from low-income families to participate in these developmental activities. The number of children who had benefited from PSOF has increased from about 900 in 2014 to 2,400 in 2019. Over the next three years, we expect this to go up to about 2,700 children per year.
Third, as Minister Desmond shared, we will extend more upstream support to children from low-income families, even before they enrol in pre-school, through KidSTART.
We have received positive feedback. Parents felt more confident in parenting. Health and development issues were detected earlier, and younger children on KidSTART enrolled earlier in pre-school.
This is why we are expanding KidSTART to another 5,000 children over the next three years. We will first expand to the Woodlands and Bedok regions this year, which have ComLink sites. From April onwards, we will also raise the household income ceiling from $1,900 to $2,500 to benefit more children.
As the Government increases support for children from low-income families, we have also received active interest from many community and corporate partners wanting to do their part. This was why my Ministry launched the \"GROWING TOGETHER with KidSTART\" initiative together with ComChest last September. This will enable us to deepen partnerships with interested parties to provide support in a more impactful, meaningful and sustainable manner.
Dr Tan Wu Meng and Ms Rahayu Mahzam asked for an update on the partnerships that we have forged thus far. Allow me to share some examples.
Since we launched the \"GROWING TOGETHER with KidSTART\" initiative last September, we have received over $800,000 in donations. This includes a sum of $600,000 which the Real Estate Developers’ Association of Singapore (REDAS) had collectively raised from its members. Singaporeans such as Ms Joanne Lim, Founder of the Right PerspectiveSG, have also stepped forward to raise funds for KidSTART with the launch of her children’s book.
Last year, Kimberly-Clark Corporation sponsored about 12,000 diapers for 420 KidSTART families. Over the next three years, they have pledged another 100,000 diapers for families on KidSTART.
Besides donations, we currently have about 250 volunteers from all walks of life. They partner our officers in running activities for KidSTART families.
One example is Mr Simon Loh, who is the Risk Management Director and the Chairperson of SP Heart Workers – H-E-A-R-T Workers – which is Singapore Power’s Corporate Social Responsibility Committee. Beyond stepping forward to volunteer when he heard about KidSTART, Simon also mobilised 30 Heart Workers to volunteer weekly at our KidSTART group sessions over four months. Besides assisting with programme delivery, they provided some very helpful suggestions to improve our activities, which we took in.
We appreciate the strong commitment by all our partners and welcome more to join us.
When children enter Primary school, we recognise that some parents may require after-school care. Mr Ang Hin Kee spoke about enhancing the accessibility, affordability and quality of student care centres, or SCCs in short.
Overall, fees for registered SCCs, including those in the community, have remained stable. The current median fee is about $295 per month, close to the median of $290 per month in 2015. So, it has been quite stable.
For school-based SCCs, MOE puts in place measures to keep fees affordable. Operators are selected via a competitive procurement process where they are required to state any proposed fee increases throughout their six-year contract upfront. This is taken into account as part of the bidding evaluation criteria. Contract specifications also limit the types of fees that operators can charge.
We want to ensure that student care remains affordable, especially for low-income families. Therefore, I am pleased to announce that we will increase the amount of subsidies under the Student Care Fee Assistance (SCFA) scheme from 1 July 2020. Eligible families will receive up to $60 more subsidies each month. To benefit more families, we will also raise the income criteria from $4,000 to $4,500, and the per capita income from $1,000 to $1,125. Around 9,000 students will benefit from these enhancements this year.
Currently, SCCs registered with MSF provide sufficient capacity to meet public demand. Moving forward, we want to make sure that we regulate the sector in a manner that is conducive. And we feel that needing to regulate the sector more tightly will have to be weighed against the increased cost and manpower requirements, on the part of both Government and SCC operators, of doing so. Nevertheless, we have the framework in place.
We will continue to monitor the student care landscape and review the requirements for SCCs as needed to ensure that they remain relevant and appropriate.
As Members of Parliament, we might have encountered families with children who have been abused or neglected. They need strong intervention to ensure that they have the best shot in life. This is why Parliament had passed amendments to the Children and Young Persons Act or CYPA last year.
Mr Melvin Yong had asked for an update on the implementation efforts. I am pleased to announce that from second quarter this year, the Court will be able to grant Enhanced Care and Protection Orders, or ECPOs in short, so that all children facing abuse and neglect can benefit from enhanced protection.
With an ECPO, MSF and designated care-givers can make day-to-day and more substantive decisions for a child whose family struggles to provide a safe environment. An ECPO will minimise disruption to the child, as it can last till the child turns 21 years old.
We had earlier announced that childcare leave benefits will be extended to foster parents. Today, I am pleased to share that from second quarter this year, these benefits will be available to 530 foster families. Foster parents will be able to use the leave when they, for example, bring foster children under their care to visit a doctor.
We hear Prof Lim Sun Sun's concerns about the need to safeguard the digital rights of children. There are various legislative, regulatory and public education measures in place. For example, new offences related to the distribution and advertising of child abuse material were introduced through the Criminal Law Reform Act. Another example is the Personal Data Protection Act which all organisations must comply with when they collect, use or disclose personal data, including that of children.
We will not be able to completely insulate our children from online dangers. It is therefore important that children learn to use the internet safely and responsibly, such as through Cyber Wellness programmes in schools. Parents also play a role in keeping their children safe.
Assoc Prof Walter Theseira asked if the Break the Silence campaign could be more inclusive. We recognise that it is not easy for persons facing violence to seek help. Their concerns are varied, such as whether it would lead to the arrest of the perpetrator who might be a loved one, and the stigma or fear about being judged.
The Government’s stance is very clear. Violence against any person – LGBTQ or not – should not be condoned. We are very clear about it. The Penal Code and the Protection from Harassment Act protects all victims from domestic violence, regardless of their sexual orientation, gender identities or marital status.
As a policy, social services must be accessible to all, without discrimination. For example, our Family Violence Specialist Centres have supported LGBTQ persons who faced violence after \"coming out\" to their families. In fact, I have spoken to a few of them and it is heartening to note that even when we engage the social work community, increasingly, they talk about it and see how they can look at the needs of everyone, including the LGBTQ community, friends and families in Singapore.
The Singapore Association for Social Workers has a Code of Professional Ethics, which is covered and reinforced throughout a social worker's training and practice. This code binds social workers to strive towards a culturally sensitive practice that acknowledges all diversity, including sexual orientation and gender identities.
We will continue our efforts to be inclusive and make social services available to all persons who require them. For example, MSF is exploring the setting up of a one-stop dedicated national hotline to make it even easier for victims to seek help, regardless of the type of abuse or violence they face.
A new inter-agency taskforce, which I co-chair with Senior Parliamentary Secretary Xueling, will address domestic violence regardless of family and social forms.
At the same time, we continue to encourage social service agencies and social workers to deepen their capability to support all victims with empathy and sensitivity.
Chairman, my colleagues and I at MSF will continue to work hard to build a society of opportunities for all Singaporeans, at every stage of their life. We will continue to transform our social safety net. We will enable Singaporeans of all abilities to participate fully in our society. We will give every Singaporean a good start in life.
We cannot do this alone and must continue to partner Singaporeans in this national journey. Together, we are stronger than the sum of our individual parts. On that note, I thank Chairman and all the Members here for working with us at MSF to make life better for all Singaporeans. [Applause.]
The Chairman: Clarifications. Mr Seah Kian Peng.
Mr Seah Kian Peng: Mr Chairman, just a short clarification to Minister of State Sam Tan. I know he has been leading Government's effort in engagement of the disability sector. Just want to ask him what is the community's feedback to this engagement? And secondly, are there any specific areas that the Government is focusing on and looking to improve?
Mr Sam Tan Chin Siong: I thank the Member for the clarification. In the course of almost four months, MSF, together with partners and also the two co-chairman of the Enabling Masterplan 3 (EMP3) workgroups – Ms Denise Phua and Ms Chia Yong Yong – together we have engaged, we have conducted 13 engagement sessions with more than 200 persons with disabilities, the care-givers as well as the social service agencies from the disability sector.
Through these sessions, we had the opportunity to really hear for ourselves first-hand information and sharing from them. To many of these participants at this engagement sessions, they told us that this is the first time where they really sit down with a Ministry, Senior Management, Ministers, Mayors and all that to share their inner feelings, their frustrations, their aspirations as well as the challenges that they face. They also told us what they want the Government to do in order to help them.
Through these engagement sessions, we have currently identified 12 new initiatives under the workgroup for Independent Living as well as 14 initiatives for the workgroup for Inclusive Employment. We now have 26 initiatives that we are working on together with 19 Government agencies and Ministries. Personally, I think this is a very useful engagement, very productive one.
Once we work out all the mechanics and schematics of all these 26 initiatives. We plan to go back to the community to engage them again to co-create and also to co-refine all those programmes and services, so that together all these activities and initiatives are not just merely coming out from the Government, Ministries and all, but it is a joint product between the Government, the people and the private sectors.
I think if we can do this, Singapore will truly be an inclusive society. I thank the Member for raising that question.
The Chairman: Ms Rahayu Mahzam.
Ms Rahayu Mahzam: Just building on that effort that MSF is doing that Minister of State mentioned, I wanted to just find out about the parent groups. Because I think that is another group that you may want to also continue to build on. Because I am part of some of these organic groups and they can, I believe, augment the support structure if you empower them and also be the ambassador.
So, I am just wondering with all the efforts of streamlining, having SG Enable as the one-stop point and also overseeing the See the True Me campaign, perhaps the parent groups could also be engaged and empowered to be the advocates.
I have a second clarification to Senior Parliamentary Secretary Faishal. He mentioned earlier that there is a sum of about $800,000 that has been donated to the KidSTART efforts through \"GROWING TOGETHER with KidSTART\". I am just wondering how would that donation be channelled through the beneficiaries as well as what are the volunteering opportunities? If we are able to share about this more, people would be more interested and we could scale up this programme.
On that note, what is the objective of actually growing aside from just getting the support because I think there is potential to scale up KidSTART and potentially help more families.
Mr Sam Tan Chin Siong: I thank the Member for raising this very important question. Care-givers, the parents, form a very important key pillar in holding a family together. To the question of what we do to help our care-givers, particularly parents with children with disabilities or special needs, SG Enable has set up a dedicated place called Care-givers Pod which serves as a meeting place for parents with special needs children or with disabilities to meet regularly.
So far, I was told that more than 1,600 care-givers have utilised a place to conduct sharing sessions, training and interaction sessions. So far, 222 care-givers have registered for personal access to the Care-givers Pod.
This is only the beginning, because if we can reach out to the parents, we are able to help them chart out the plans for their children for the future. Then, their children who either have special needs or disabilities will have a brighter future going forward.
Minister Desmond Lee and I have separately engaged, parents who are care-givers to better understand their situation, challenges and the needs that they need from the Government. So, all those engagements sessions proved to be very useful because they established trust and confidence between both sides. We will continue to organise such engagement sessions to make sure that parents of children with disabilities or special needs will not be left alone to fend for themselves.
The Chairman: Senior Parliamentary Secretary Dr Muhammad Faishal Ibrahim.
Assoc Prof Dr Muhammad Faishal Ibrahim: I just want to thank the Member for the Supplementary Question and thank the Member for the interest in \"GROWING TOGETHER with KidSTART\". The donations that we receive, we can use it for essentials such as milk, diapers as well as to help them with transport costs going for KidSTART programme as well as to pre-school. At the same time, there are also opportunities where we can help to top up their CDA account. And that is one area that we can also empower them to be able to use that.
With regard to the opportunities available, in fact, the first basic thing is, as part of the outreach to get them on board in KidSTART. So, that is very critical, we must get them on board first. Secondly, we can also look at how these volunteers can participate in some of the KidSTART activities like home visit, group sessions and they can become befrienders and also, at the same time, organised activities for the KidSTART recipients and their families.
So, beyond doing all this is not only about having that donation as well as the activities. It is also about developing the relationship between the donors, volunteers and the families as well as the children.
We want to give the best start in life for every child and when we invest in such activities together, we not only give them the opportunity to have a good future, but I feel more importantly, it is also how we can get closer and we do this as part of the Singapore Together movement – where we want to do things together and build Singapore together.
I am very happy that the Member is very interested in this and if any individual or donors who are interested can contact ComChest or can even approach Minister Desmond Lee, Minister of State Sam Tan as well as myself at any point in time.
The Chairman: Let us take one last question, Dr Lily Neo. Please keep it short.
Dr Lily Neo: Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it? And what are the schemes in place to help them overcome this challenge?
Mr Desmond Lee: The Member is referring to Community Link or ComLink. We have set up Community Link in four locations for a start. In the north, Marsiling; in the south, Jalan Kukoh; in the west, Boon Lay; and in the East, Kembangan-Chai Chee. We have visited 650 families with young children door-to-door. We aspire to reach out to 1,000 in these four locations. We have a better understanding of the needs of each and every one of these families but also the assets and strengths of each family to pull themselves up, especially to make sure that poverty does not translate to the next generation. They have young children.
So, this programme is not in and of itself targeted at achieving home ownership, though that is one of the many indicators of progress in these families' lives.
When we identify that they have an aspiration for home ownership, then we will work with them to ensure that there is stability in family, stability in their work, support them with financial literacy if they wish to enhance their capabilities on that front, accumulate the savings; and then, when they are ready to pursue home ownership, there is a range of schemes available by HDB to support them.
Fresh Start, for example, is one programme, but the enhanced Step-Up Grant, recently adjusted last year, will also better enable these families to leave rental housing and get back into stable housing. There is a housing support team set up by HDB that will work closely with the ComLink agencies to support these families on the homeownership journey, when they make that decision.
The Chairman: Mr Seah, would you like to withdraw the amendment?
Mr Seah Kian Peng: Mr Chairman, on behalf of all Members who filed cuts, I would like to thank Minister Desmond Lim, Minister of State Sam Tan and Senior Parliamentary Secretary Muhammad Faishal Ibrahim for their considered responses, which I found very assuring.
I cannot help but notice that I have been filing cuts to MSF and the former MCYS for the last 14 Committees of Supply. The number of cuts has been progressively coming down. It is a good sign. I think it shows that the Government has been resolving more issues even as new ones cropped up.
It leaves me now to thank all the men and women at MSF and all those in the social service sector for their good work, their consistent work all these years in our on-going journey to make Singapore more caring, more compassionate and a more inclusive society. With that, Mr Chairman, I beg leave withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $3,170,071,900 for Head I ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $102,581,800 for Head I ordered to stand part of the Development Estimates. (proc text)]
The Chairman: Leader.
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The Chairman: I give my consent.
[(proc text) Resolved, \"That progress be reported now and leave be asked to sit again tomorrow.\" – [Ms Grace Fu Hai Yien]. (proc text)]
[(proc text) Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
The Leader of the House (Ms Grace Fu Hai Yien): Mr Speaker, I beg to report that the Committee of Supply has made progress on the Estimates of Expenditure for the financial year 2020/2021, and ask leave to sit again tomorrow.
Mr Speaker: So be it.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Adjournment","subTitle":null,"sectionType":"OS","content":"[(proc text) Resolved, \"That Parliament do now adjourn to 10.00 am tomorrow.\" – [Ms Grace Fu Hai Yien]. (proc text)]
Adjourned accordingly at 7.59 pm.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Plans to Expand Green Bond Grant Scheme with Stricter Regulations","subTitle":null,"sectionType":"WA","content":"1 Mr Louis Ng Kok Kwang asked the Prime Minister whether there are plans to expand the Green Bond Grant Scheme with stricter regulations to ensure the adherence to the Scheme's definition of eligible expenses.
Mr Tharman Shanmugaratnam (for the Prime Minister): The MAS' Green Bond Grant Scheme was launched three years ago to catalyse the green bond market in Singapore. To-date, more than SGD 6.5 billion of green bonds have been issued in Singapore.
Over the years, we monitored the take-up of the grant, reviewed and refined the scheme. In February 2019, MAS lowered the minimum issuance size from SGD 200 million to SGD 20 million to support more issuers, including medium-sized enterprises. MAS also expanded the scope of the scheme to include social and sustainability bonds and renamed it the Sustainable Bond Grant Scheme.
Even with changes to the scheme, issuers of green bonds are still required to have in place a green bond framework based on internationally accepted principles – governing the use of proceeds, the evaluation and selection of projects, and reporting on the allocation of proceeds to eligible projects.
Issuers are also required to obtain independent external reviews1 to assure investors that their frameworks are robust and not subject to \"greenwashing\", where unsubstantiated or false claims on the environmental contribution of one's products, services or business activities are made. To further reduce greenwashing risks, more work needs to be done globally to develop common standards and definitions, as well as to enhance disclosure and reporting.
Beyond green bonds, having access to a wider range of sustainability financing options would facilitate SMEs' adoption of sustainable business practices. MAS is thus looking into developing a grant scheme for green and sustainability-linked loans, which could potentially be more relevant to SMEs as the loan proceeds can be used for general corporate purposes so long as borrowers meet relevant sustainability metrics. MAS will calibrate the minimum qualifying loan amount to better meet the needs of SMEs.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":["1 : External review may be second opinion, verification, certification or rating done to support a green/social/sustainability bond status."],"footNoteQuestions":["1"],"questionNo":"1"},{"startPgNo":0,"endPgNo":0,"title":"Study on Impact and Mitigation Factors of Climate Change on Low-income Groups","subTitle":null,"sectionType":"WA","content":"2 Mr Louis Ng Kok Kwang asked the Prime Minister (a) whether the National Climate Change Secretariat has conducted a study on the impact and mitigation factors of climate change on low-income groups; (b) if so, what are the results of the study; and (c) if not, whether it will consider conducting such a study.
Mr Teo Chee Hean (for the Prime Minister): Our strategies for climate action take into account the needs of all stakeholders, including the low-income and the vulnerable.
Our range of adaptation and mitigation measures is designed to be inclusive. The measures aim to minimise the adverse effects that climate change could have on the economy, society and on our daily lives.
For example, the Government has been improving the liveability of our public housing estates through novel ways of weaving greenery into our estates and towns, which reduces temperatures while improving air quality. HDB flats are also designed to maximise cross-ventilation, thereby reducing reliance on air-conditioning which is a large contributor to household utility bills. The recently announced HDB Green Towns Programme will further enable reduction in energy consumption and cool our HDB towns. These sustainability measures ensure that the impact of climate change on all residents, including low-income groups, are minimised.
The Government also ensures that cost of mitigation measures is minimised for households. As recently announced, the Government will introduce incentives to support lower-income households in purchasing more energy efficient appliances. To help households adjust to the impact of the carbon tax on their electricity and gas expenses, eligible HDB households are given an additional $20 GST Voucher – U-Save on top of the regular U-Save rebate each year from 2019 to 2021. Eligible households living in smaller HDB flats benefit more as they receive a larger quantum of U-Save rebates, and typically have smaller annual utilities bills.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Singaporeans Under 21 Years of Age Residing in Singapore with Non-PR Foreign Parent","subTitle":null,"sectionType":"WA","content":"3 Ms Anthea Ong asked the Minister for Home Affairs (a) how many Singaporeans who are under 21 years of age reside in Singapore currently with a foreign parent who has not been given PR status; and (b) since 2016, how many of these non-PR foreign parents are (i) women (ii) sole supporters of their Singaporean child, having been separated, divorced or widowed from their citizen spouse and (iii) persons who have left Singapore with their Singaporean child to reside elsewhere following the expiry of their Long-Term Visit Pass or other visit passes.
Mr K Shanmugam: As at 31 December 2019, about 13,400 Singapore Citizen (SC) children under the age of 21 had foreign parents who were residing in Singapore on either a Long-Term Visit Pass (LTVP) or a Work Pass.
Based on ICA's records from 2016 to 2019, there were around 14,400 unique non-PR foreign parents with SC children under the age of 21 who applied for LTVPs.
Of these 14,400 parents, around 12,100 of them were female. Among this group, only 1.5% or 177 of them were widowed, divorced or separated. Seven did not eventually qualify for long-term stay through an immigration or employment facility. As at 24 February 2020, the SC children of these seven were still residing in Singapore.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Children Granted Singapore Citizenship Born to PR Mothers and Non-PR Mothers Each Year Since 2016","subTitle":null,"sectionType":"WA","content":"4 Ms Anthea Ong asked the Minister for Home Affairs in each year since 2016, how many children granted Singapore citizenship have been born to (i) mothers with permanent resident (PR) status and (ii) foreign mothers without PR status respectively.
Mr K Shanmugam: From 2016 to 2019, an average of around 4,280 citizen children were born in Singapore each year to mothers who were Permanent Residents (PRs). For the same period, an average of around 2,210 citizen children were born to foreign mothers who were not PRs.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Court Applications Involving Spouse Refusing to Comply with Court Orders on Sale of Matrimonial Home in the Past Five Years","subTitle":null,"sectionType":"WA","content":"5 Mr Louis Ng Kok Kwang asked the Minister for Law for each year of the past five years (a) what is the number of court applications involving a spouse who refuses to comply with court orders pertaining to the sale of the matrimonial home; (b) for these applications, what is the average and mean duration of the application from the date of the initial order requiring the sale of the matrimonial home; (c) what is the average and mean number of previous applications also involving such non-compliance by the spouse; and (d) if such data is not currently collected, whether the Ministry will consider collecting such data.
Mr K Shanmugam: Currently, the data referred to in (a), (b), and (c) are not collected.
In relation to (b), the time between the making of the initial order and the enforcement or variation of that order depends on the facts of the case, including the terms of the initial order, the circumstances of that case, and when the party concerned decides to make the application.
We will explore with the Courts if they are able to collect such data.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Cases Requiring an Assistant Registrar to Sign Documents for Sale of Matrimonial Property due to Refusal by Spouse to Sign Sale Documents","subTitle":null,"sectionType":"WA","content":"6 Mr Louis Ng Kok Kwang asked the Minister for Law for each year of the past five years (a) how many cases has an Assistant Registrar been required to sign on documents for the sale of the matrimonial property because of refusal by the spouse to sign the sale documents; (b) for these applications, what is the average and mean duration of the Assistant Registrar's signing from the date of the initial order requiring the sale of the matrimonial home; (c) what is the average and mean number of previous applications also involving such non-compliance by the spouse to sign the sale documents; and (d) if such data is not currently collected, whether the Ministry will consider collecting such data.
Mr K Shanmugam: Currently, the data referred to in (a), (b), and (c) is not collected.
In relation to (b), the time between the Registrar's signing of documents to effect the surrender, sale, or transfer of the matrimonial property and the making of the initial court order depends on the facts of the case, including the actual terms of the initial court order. Where the application is approved, the relevant documents are signed on the same day.
We will explore with the Courts if they are able to collect such data.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Licence Fee Payments made by Dog Farms and Pet Shops in 2018 and 2019 Under Animals and Birds (Dog Licensing Rules)","subTitle":null,"sectionType":"WA","content":"7 Mr Louis Ng Kok Kwang asked the Minister for National Development for the nine licence fee categories in Part II and Part III of the First Schedule of the Animal and Birds (Dog Licensing Rules), how many (i) dog farms and (ii) pets shops respectively, have paid the licence fee in (i) 2018 and (ii) 2019 respectively under each category.
Mr Lawrence Wong: Table 1 provides the number of dog farms that paid annual licence fees for dogs kept for breeding at their premises under Part II of the First Schedule of the Animals and Birds (Dog Licensing and Control) Rules.
Table 2 provides the number of dog farms and pet shops that paid annual licence fees for dogs kept for sale at their premises under Part III of the First Schedule of the Animals and Birds (Dog Licensing and Control) Rules.
8 Ms Anthea Ong asked the Minister for Manpower in each year of the last three years (a) how many households have hired at least two domestic workers, disaggregated by the number of domestic workers; and (b) of these households, how many consist of at least one person above the age of 65.
Mrs Josephine Teo: From 2017 to 2019, an average of 14,000 households per year hired at least two foreign domestic workers (FDWs). Half of these households have at least one person who is aged 65 or older.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Grounds of Rejection in Request to Hire Foreign Domestic Worker","subTitle":null,"sectionType":"WA","content":"9 Ms Anthea Ong asked the Minister for Manpower what are the grounds that the Ministry uses to reject (i) an employer's request to hire a foreign domestic worker and (ii) an employment agency's application to place a foreign domestic worker.
Mrs Josephine Teo: The reasons for rejecting foreign domestic worker (FDW) applications are the same whether they are made by employers or their employment agents. The main reasons are unacceptable accommodation for the FDW, the employer having no or unstable income or the FDW being over the age limit.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Requiring Association Support for Companies' Applications to Recruit Process, Construction and Maintenance Work Permit Holders","subTitle":null,"sectionType":"WA","content":"10 Mr Zainal Sapari asked the Minister for Manpower what is the rationale and intent of requiring the Association of Process Industries (ASPRI) to support a company's application to recruit Process, Construction and Maintenance (PCM) work permit holders.
Mrs Josephine Teo: Contractors in the Process Construction and Maintenance (or \"PCM\") industry require specialised skills and expertise to build and maintain process plants.
In January 2000, MOM enlisted ASPRI's help to verify the business nature and activities of PCM contractors so that only suitably qualified contractors are granted access to foreign workers. The association is well placed to do so given its specialist knowledge of the sector. Upon successful verification, the contractors submit work pass applications directly to MOM without ASPRI's involvement.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":"1","footNotes":null,"footNoteQuestions":null,"questionNo":null}],"writtenAnswersVOList":[],"writtenAnsNAVOList":[],"annexureList":[],"vernacularList":[{"vernacularID":3682,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Assoc Prof Dr Muhammad Faishal Ibrahim","filePath":"d:/apps/reports/solr_files/20200305/vernacular-5 Mar 2020 - SPS Faishal Ibrahim - Reply to MSF cuts (Approved by MSF).pdf","fileName":"5 Mar 2020 - SPS Faishal Ibrahim - Reply to MSF cuts (Approved by MSF).pdf"},{"vernacularID":3722,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Gan Kim Yong","filePath":"d:/apps/reports/solr_files/20200305/vernacular-Gan Kim Yong MOH 5March2020 -Chinese（moh).pdf","fileName":"Gan Kim Yong MOH 5March2020 -Chinese（moh).pdf"},{"vernacularID":3723,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Amrin Amin","filePath":"d:/apps/reports/solr_files/20200305/vernacular-5 Mar 2020 - SPS Amrin Amin - Reply to MOH cuts (Approved by MOH).pdf","fileName":"5 Mar 2020 - SPS Amrin Amin - Reply to MOH cuts (Approved by MOH).pdf"},{"vernacularID":3724,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Ang Hin Kee","filePath":"d:/apps/reports/solr_files/20200305/vernacular-Ang Hin Kee Budget MSF 5March2020-Chinese.pdf","fileName":"Ang Hin Kee Budget MSF 5March2020-Chinese.pdf"},{"vernacularID":3725,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Desmond Lee","filePath":"d:/apps/reports/solr_files/20200305/vernacular-Desmond Lee MSF 5 March 2020-Chinese (MSF).pdf","fileName":"Desmond Lee MSF 5 March 2020-Chinese (MSF).pdf"},{"vernacularID":3726,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Sam Tan Chin Siong","filePath":"d:/apps/reports/solr_files/20200305/vernacular-Sam Tan MSF 5 Mar 2020 -Chinese (MSF).pdf","fileName":"Sam Tan MSF 5 Mar 2020 -Chinese (MSF).pdf"}],"onlinePDFFileName":""}