The following question stood in the name of Ms Anthea Ong \t–
1 To ask the Minister for Social and Family Development (a) how we are doing with our target for 20% female representation in Statutory Boards and listed companies by 2020; (b) what steps are being taken to close the gender salary gap of about 20%; and (c) in view of the upcoming International Women's Day theme of #BalanceforBetter, what are existing imbalances in our gender equality pursuit that we must balance for a better Singapore.
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\tAssoc Prof Walter Theseira (Nominated Member): Question No 1, Sir.
The Senior Parliamentary Secretary to the Minister for Social and Family Development (Assoc Prof Dr Muhammad Faishal Ibrahim) (for the Minister for Social and Family Development): Mr Speaker, a few of the issues being asked in this Parliamentary Question (PQ) are similar to the issues being raised by Members Prof Fatimah Lateef and Ms Rahayu Mahzam in the COS cuts for MSF. May I have your permission to address the issues together when I make my reply during the MSF COS? I have spoken to the Member Ms Anthea Ong and she is agreeable to this arrangement.
\tMr Speaker: I am agreeable also.
\tAssoc Prof Dr Muhammad Faishal Ibrahim: Thank you, Sir.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Children from Transnational Families Receiving Learning Support and Enrolled in Special Education Schools","subTitle":null,"sectionType":"OA","content":"2 Ms Anthea Ong asked the Minister for Education (a) how many children from transnational families are currently receiving additional learning support or are enrolled in special education schools; and (b) whether language interpreters are engaged to support both the Singaporean and foreign spouse in their understanding of their child's additional learning needs.
\tThe Senior Parliamentary Secretary to the Minister for Education (Assoc Prof Dr Muhammad Faishal Ibrahim) (for the Minister for Education): Sir, our schools provide additional support to all students who need them. However, we do not monitor the number of students from transnational families who receive the support from schools. As at February 2019, 129 students from transnational families out of a total of about 6,000 students attend our 19 SPED schools.
Partnering parents is an important part of delivering the customised curriculum and programmes in all schools. Schools have not reported difficulties connecting with parents even in the minority of cases where one parent may not speak any of our national languages. Where language is a barrier, they find ways to overcome it, such as enlisting the other parent, other family members, or school personnel who may know the family’s home language.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Government Assistance for CHAS-registered Clinics to Better Advise Patients","subTitle":null,"sectionType":"OA","content":"3 Ms Joan Pereira asked the Minister for Health what assistance does the Ministry provide to Community Health Assist Scheme-registered clinics so that the doctors and clinic staff can better advise patients on their options.
\tThe Senior Minister of State for Health (Dr Lam Pin Min) (for the Minister for Health): MOH partners participating general practitioner (GP) and dental clinics under the Community Health Assist Scheme (CHAS) to provide CHAS, Pioneer Generation (PG), and in future, Merdeka Generation (MG) cardholders, with subsidised medical and dental care.
MOH provides clinical and claims guidelines to all CHAS GP and dental clinics, such as on the eligibility of items for CHAS subsidies, to ensure appropriate clinical care and utilisation of subsidies. MOH regularly reviews these guidelines to ensure they remain in line with best practices.
The Agency for Integrated Care (AIC) works closely with MOH to support CHAS clinics in scheme participation. To help GP and dental clinics understand the guidelines and how CHAS can help their patients, AIC conducts individualised on-site training sessions for doctors and clinic staff, and organises outreach efforts such as regional lunchtime talks, on CHAS. AIC also publishes articles in professional newsletters, and issues regular mailers to CHAS clinics, to highlight key updates on matters of relevance to GPs, and alert them to potential practice pitfalls. CHAS clinics can also contact their AIC account managers for assistance and clarifications on the scheme.
\tMs Joan Pereira (Tanjong Pagar): I thank the Senior Minister of State for his reply. With a higher number of Singaporeans who will be eligible for CHAS moving forward and for us to better serve them, would the Ministry consider providing clearer guidelines to these CHAS clinics on the specific subsidies for specialist referrals?
\tDr Lam Pin Min: Indeed, Mr Speaker, with the rapidly ageing population and when CHAS subsidies are extended to all Singaporeans with chronic conditions, the number of Singaporeans utilising CHAS benefits will inevitably increase. The CHAS agreement states that CHAS clinics can refer CHAS patients who require specialist care to the Specialist Outpatient Clinics (SOCs) at public hospitals as subsidised patients as long as their referrals are unnamed referrals. Such subsidised referrals can be made for any medical conditions.
At the SOCs, patients receive prevailing SOC subsidies based on their per capita household income. CHAS subsidies, however, do not apply on SOC visits. This information is available to CHAS GPs through AIC's various engagement platforms and we will continue to outreach to CHAS GPs to inform and update CHAS GPs and dental clinics on clinical and claims guidelines, especially so when there are new initiatives being rolled out.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Statistics for Top 10 Scams","subTitle":null,"sectionType":"OA","content":"4 Mr Ang Wei Neng asked the Minister for Home Affairs (a) what are the crime statistics for the top 10 scams in Singapore for the past five years; and (b) what are the current resources in the Singapore Police Force that are dedicated to (i) solving online and phone scams as compared to the past five years and (ii) detecting and preventing online and phone scams.
\tThe Senior Parliamentary Secretary to the Minister for Home Affairs (Mr Amrin Amin) (for the Minister for Home Affairs): In the past five years, the top scam types include e-commerce scams, loan scams, internet love scams and credit-for-sex scams.
For these top types of scams, the number of reported cases has gone up from around 2,600 cases in 2014 to around 5,800 cases in 2018.
The Member asked about Police resources dedicated to online and phone scams.
First, better organisation of resources. Since 2016, cybercrime investigation, digital forensics training, liaison and policy matters have been integrated under a single Cybercrime Command. This has allowed SPF to achieve better coordination between the different units involved in cybercrime.
Second, better training of officers. All frontline Police officers and investigation officers have been trained in basic cybercrime investigations. In addition, officers with the aptitude for cybercrime investigations and digital forensics are given specialised training.
Third, better use of technology to help solve crimes, such as digital forensics, malware analysis, and video analytics.
Fourth, formation of specialised units. The Police set up the Transnational Commercial Crime Task Force (TCTF) in October 2017 to tackle transnational online and phone scams. We have seen good results. The TCTF has closed over 600 bank accounts and recovered more than S$1.5 million.
The Police also set up an E-Commerce Fraud Enforcement and Coordination Team (E-FECT) in November 2018. Within two months of its formation, the E-FECT arrested 26 e-commerce scammers and solved more than 230 e-commerce scams.
To prevent scams, the Police have been working very closely with stakeholders such as convenience stores, remittance agencies and banks, to raise their awareness and develop suitable prevention measures. This includes training frontline counter staff to spot scam victims, and displaying crime advisories prominently at the counters and Automated Teller Machines. These efforts have resulted in heightened awareness and vigilance amongst their staff, which helped prevent at least 80 scam cases involving close to $300,000 in 2018.
In the online space too, the Police have engaged major online shopping platforms to implement measures to safeguard consumers. An example is Police’s partnership with Carousell to remove suspicious advertisements on their platform, introduce a secure payment system, and feature scam advisories.
The Police have also been working with the National Crime Prevention Council (NCPC) to step up public education on online and phone scams. The Police have also set up an Anti-Scam Helpline (1800-722-6688) and the www.scamalert.sg website. Members of the public are encouraged to visit the website to learn about the various types of scam and take steps to avoid becoming a victim.
\tMr Ang Wei Neng (Jurong): I thank the Senior Parliamentary Secretary for the comprehensive reply. It is quite clear that the cybercrime trend has been going up. The Police not only need physical strength to catch the culprit, they also need cyber strength and cyber technology to help them better detect and solve the cyber crimes.
I have two supplementary questions. First, are there dedicated resources at the front line in the Police Division, in the investigation team? Are there people dedicated to solve and take care of cybercrime and phone scams? Secondly, can the Senior Parliamentary Secretary elaborate how many counter staff in the banks and other remittance outlets have the Police trained and gotten in touch with? We know that the turnover for counter staff is high. So, what are the efforts to continue to educate them, especially new staff?
\tMr Amrin Amin: The Member asked about training of frontline officers. In my reply, I mentioned about the training of frontline Police officers and investigation officers, that they have been trained in basic cybercrime investigations. In particular, officers with aptitude for cybercrime investigations and digital forensics are given digitalised training. In addition, we have various specialised units that tackle cybercrime.
On the issue of banks and the other stores and the turnover of staff, I think that is a valid point. I do not have the exact numbers in terms of the number of staff that have been trained. This goes to show that on-going training and continuous outreach is very, very important given the turnover of staff. But it is something that we have to keep doing and do better.
The key thing is the role of individuals to take precautionary measures to understand that some things are just too good to be true and so, to take prevention measures at their end. I think that is the ultimate solution. Other than that, the other measures are something that we will keep doing and trying. But the individual is the best defence to cybercrimes.
\tMr Ang Wei Neng: One more question: is there a dedicated unit at a Division to investigate cybercrime, or it is just part of their general duties? If there is no dedicated unit in the Division, will the Police consider setting one up in the near future?
\tMr Amrin Amin: Cybrecrime investigations are consolidated under a single cybercrime command. We have consolidated all the resources within the Divisions into a single cybercrime command, where we can pool all the resources together. I think the thrust of the question is whether there is capability on the ground to address cybercrime issues. The answer is yes, there is capability and there is concerted effort on our part to tackle this problem, and these are the various measures which we have introduced – from having a single cybercrime command, ensuring training of our officers on the ground as well as forming specialised units and involving the community.
So, it is a concerted, comprehensive effort, a multi-prong approach towards tackling this issue.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Employment Rate of Differently-abled in Public Service","subTitle":null,"sectionType":"OA","content":"5 Ms Anthea Ong asked the Prime Minister (a) what is the current employment rate of the differently-abled, including persons-in-recovery from mental health conditions, in the public service; (b) what support structures are in place to ensure upgrading and retention of these employees; and (c) how can the public service as the largest employer change the mindset amongst employers to take advantage of the Open Door Programme and employment credits to support more employment of our differently-abled.
\tThe Minister for Trade and Industry (Mr Chan Chun Sing) (for the Prime Minister): Mr Speaker, Sir, as at 31 December 2018, there are more than 300 persons with special needs employed in the Public Service. We do not track the number of officers who are recovering from mental health conditions.
As an inclusive employer, the Public Service is committed to supporting the employment of persons with special needs to take on meaningful jobs in accordance with their abilities. Public agencies have been working closely with SG Enable to drive the hiring of persons with special needs in the Public Service. Our efforts include advertising suitable vacancies on SG Enable's job portal and participating in career fairs and programmes such as job shadowing, internship and mentorship organised by SG Enable. Agencies can also tap on SG Enable’s Workplace Disability Inclusive Index, advisory and consultancy services, attend disability management workshops and training, or access SG Enable's online resources.
Once these individuals are in our employment, public agencies also work with SG Enable to train and integrate them into the organisations through employee training, workplace modifications and job redesign. For instance, MCCY had installed magnifier software and equipment to help two officers with special needs read documents on the computer screen and in hard copies more clearly and easily. MOM had also modified its workplace to improve wheelchair accessibility for an officer with limited physical mobility and provided a modified telephone and headset to enable her to make and receive phone calls with greater ease.
Beyond tapping on the support schemes provided by SG Enable, the Public Service is also committed to providing opportunities for our officers with special needs to develop their skills and enhance their ability to perform work in different areas. One good example is Vital, which employs a number of persons with special needs in the Payroll and Claims division. Initially, these officers were assigned duties in claims verification. Once they were familiar with claims verification, they were exposed to payroll processing and eventually were able to take on work in this area as well.
Our officers with special needs are also given a fair chance to be considered for promotion, if they demonstrate good performance and the ability to take on a larger role. In fact, more than 70% of the officers with special needs in the Civil Service had been promoted at least once.
We hope that our commitment to supporting the employment of differently-abled individuals, and the positive experience that we have had doing so, will encourage other employers to come on board in this effort. To this end, some of our public agencies like MOM and GovTech have worked with SG Enable to feature some of our officers with special needs in their outreach efforts.
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\tMs Anthea Ong (Nominated Member): Speaker, I thank the Minister for the clarification. I am very heartened to hear that we have 300 differently-abled persons within the Public Service. Can Minister share a little bit about some of the challenges that the Public Service may face in having more of such differently-abled persons to join the service? Because I understand that the Service is 170,000 strong and 300 is an amazing effort but I am wondering if there are challenges that are preventing the Service to bring in more? That is one. The other question is, if you could share some of the successes. So, success stories of working with the differently-abled within the Service so that the other employers can also take heed.
\tMr Chan Chun Sing: Mr Speaker, Sir, on the challenges that the Public Service sector faces, I think they are no different from any other in the private sector. Basically, we look for a job fit, and, in line with the Member's second question, the issue is really not to look at what the people cannot do, but to look at what the people can do; and then, to design the job scope to fit it with the abilities of the people. So, we look at the abilities rather than the disabilities.
\tMs Denise Phua Lay Peng (Jalan Besar): Sir, I thank the Minister for his answer. I know he is also very supportive of this community. I want to take this opportunity to honour the good Public Service agencies that are very progressive and very inclusive, like National Library Board (NLB), Vital, MOH Holdings and so forth. They have been doing good work. I ask the Minister and the Public Service to share some of these success stories as my fellow colleague, Ms Anthea Ong has mentioned.
I want to ask Minister, if he would consider putting in a more ambitious target. What we are seeing is only 300 out of more than 100,000 employees are persons with special needs. I know the Government is generally quite allergic to quotas in this aspect but I am hoping that at least the Public Service can set an example, a model. Perhaps install some targets, for example, 1% to 2% as a start, so that the rest of us in the country can look towards learning from what is possible. I feel strongly that when the Government puts its heart to something, it always gets done and done fairly well. So, I hope the Minister will consider my suggestion for at least a target in the public service to hire persons with special needs including those with mental health.
\tMr Chan Chun Sing: Mr Speaker, Sir, I thank Ms Denise Phua for her suggestion. This is something that is close to my heart and I have discussed this long and hard with my staff as to whether we should set a target. Today, we do not set a target, but we have something better than that. Let me explain.
If we set a target, people usually try to meet the target. But I really do not want people to meet the target for the sake of meeting the target. I want people to look at the people based on what they can do; to focus on their abilities rather than their disabilities and fit them into the job, redesign the job to fit the person.
The best incentive for the Public Service to do this in a manpower crunch situation is this: we have a separate quota; in a sense, we do not count in against the usual manpower headcount. So, you can employ more people that is not under your headcount. And every agency has great incentive to do this when there is a manpower tightness in the labour market.
\tMs Denise Phua Lay Peng: I am really heartened by Minister's sharing of that particular hiring scheme. I think it is one of the best kept secrets, and I want to honour the Minister for promoting that. But looking at the outcomes, which is about 300 out of more than 100,000 staff in the Public Service, I think that even the scheme must have been facing some obstacles or barriers to achieve the kind of results that we would like to see.
I would like to ask the Minister to consider actually setting a target and really also honoring and recognising those agencies, leaders and peers who actually adopt inclusive employment practices, to their peers. Even if the Public Service starts by saying, \"It might end up as tokenism\", there will be some who feel like they might as well make it worthwhile if they were doing it anyway. So, I would seek Minister's favourable consideration to at least set a soft target.
\tMr Chan Chun Sing: I think I did not use that word but Ms Denise Phua used the word. We do not want tokenism. That is not what we want. We want people to really focus on the abilities of what this community can provide. Today, as for the Public Service, it is not a secret as in nobody knows about it. Actually, they all know about it. But I think what we can encourage people to do is to see the examples of those who have embraced the community with special needs and how they have played a constructive and positive part in this whole journey. And that will encourage more people to come on-board.
Today, I looked at the numbers, they are not under any constraints. In fact, they are free from the manpower constraints. They have not hit anywhere near the, if you like, the pool of available quota that we have made available. This is over and above what the usual manpower quotas will be. So, I think there is great scope for us to do more and I will take the Member's suggestion that we can definitely do more to promote good practices and share some of the best practices in many of these jobs available.
Personally, I have visited some of the call centres including the private ones where people think that people with special needs are less efficient. But actually it is not true. Because sometimes when we have a disability in one of our faculties, we become much more focused in another, and they end up being even more productive than what we call normal people. So, I think, there is some stories that we can share to encourage our people to embrace them. At the same time, we all need to take some effort to redesign some of the jobs in our respective organisations. So, my assurance to the public is that, for the Public Service at least, they have the latitude to go forth in this, and they are not constrained by the manpower quotas in the usual sense.
\tMr Speaker: Ms Denise, I will permit this only if it is different from the points you have made earlier.
\tMs Denise Phua Lay Peng: I thank the Minister. I think we are sharing from the same side so I do not think it is an argument but really how far do we go. I think besides the good scheme that you have mentioned just now, I wonder if you could also install a recognition programme —
\tMr Speaker: I think you made the point earlier.
\tMs Denise Phua Lay Peng: When I was in some countries, in the public school system, for example, inclusive schools, were actually recognised. The schools who got awarded felt like they really made a difference, and I do not know if that feature or culture can be installed in the Public Service as well. It is not just having an extra headcount, it is doing something really right and doing it well and that they can be recognised and be seen as models.
Organisations like NLB, MOH Holdings, Vital and so forth, they are really doing a good job, and I think we should uphold them, raise them, let them be recognised and others in the rest of the sectors can learn from them.
\tMr Speaker: Ms Anthea Ong.
\tMs Anthea Ong: Thank you, Mr Speaker. Minister Chan earlier mentioned that he did not actually have the information on persons recovering from mental health conditions within the Public Service. I may be wrong and I stand corrected, I understand that the Public Service still requests for a declaration of medical history which includes mental health conditions. I wonder if that could also be a reason why that information is not known and whether the Public Service is also looking to prohibit that practice if it is actually still going on.
Can I also take this opportunity to formally apologise for being late, to the Speaker and also to Senior Parliamentary Secretary Faishal. Sorry.
\tMr Chan Chun Sing: Many of the declarations on medical things are in confidence, so when we ask people to let the organisation know, it is not with the view of a punitive action. It is in fact to make sure that there are some special needs that the organisation should be aware of, then to make sure that we can better take care of the person. Let us say the person, for whatever personal reason, decides not to declare medical in staff confidence questions, I think we can understand that.
But I also want to reassure the House that it is not for punishment or to blacklist anybody. In fact, if anybody declares a medical condition, it is so that we can better take care of the person and that we will not unnecessarily stress the person beyond the point of their capability.
Just to follow on Ms Denise Phua's point, I agree with her that we can do more to help our people be aware of the opportunities and the potential of the special needs community. I think the greatest rewards for our public servants who embrace such things is because they know deep in their hearts that they are doing the right thing. They are upholding the kind of values that we exemplify and this is much more important to them than any tangible, physical awards. I think that should be how we go forward as a society. It is the kind of values that we want to express rather than tangible rewards per se.
Mr Speaker: Assoc Prof Walter Theseira.
\tAssoc Prof Walter Theseira (Nominated Member): Mr Speaker, thank you. I thank the Minister for his reply. I think the concern that people may have when filling in these forms to declare their health conditions to their supervisors is that they are concerned they may be perceived as perhaps, not up to the task if they declare a pre-existing or past mental condition. Therefore, that may affect their promotion opportunities and advancement opportunities. So, what can the Public Service do to assure individuals that this should not be a concern, that they should declare everything so that they can be appropriately managed and that they will not be at any risk of not advancing as far in their careers as other people?
\tMr Chan Chun Sing: The greatest assurance is what I have just spoken. I am the Minister-in-charge of Public Service and I tell everyone that when we ask people for their medical condition, it is not to blacklist anybody or will this in anyway limit their progression. In fact, we want the person to be safe, we want the workplace that they work in to be safe, so we need to understand their medical conditions and we see how we can help them in that sense. I think that assurance come from me, down to every level in the Public Service. The safety of the individual, the safety of the team and the crew is of utmost concern to us when they conduct any jobs.
We always teach our people, even from my own organisation, I grew up in the SAF, that we must make sure that we know ourselves, know the capabilities of ourselves, know the capabilities of our team members so that we do not put each other in danger, so that we can all accomplish the mission together. I think that philosophy remains that we should not see their declaration of medical condition as a blacklisting exercise or in any way impeding the progress. It is an exercise to make sure that we know the capabilities of the respective members, the limitations of the respective members, so that we can put everyone's potential to good use.
\tMr Speaker: Ms Denise Phua.
\tMs Denise Phua Lay Peng: Last time.
\tMr Speaker: Only if it is a fresh perspective.
\tMs Denise Phua Lay Peng: Yes. Minister is usually very analytical, perceptive and strategic. I want to ask the Minister what he thinks are the factors behind the dismal employment rates of persons with special needs including for mental health in our Public Service.
\tMr Chan Chun Sing: I would put it down to job fit. The job fit requires us to understand the capabilities of the individuals concerned. The job fit also requires the organisations to have a clear understanding of what the individual is capable of. From my experience, in MSF, it is not just in the Public Service sector alone. I think many organisations can do much better than in our efforts to try to understand the capabilities, the abilities of the people that we are talking about and not the disabilities of the people we are talking about. So, that is the first part.
The second part, it does and it is true that organisations will need to take on a bit of work, responsibility to redesign some of the jobs from the type of tools that are being used to the workflow that is being used. That requires a bit of effort and that is another area that we can do much more together with SG Enable's help to see how we can redesign the job processes. Sometimes, it is not as difficult as we imagine it to be. So, I think these are the two key factors as to why it is so.
The third factor that I have come across is this. We also need to be able to do a much better job in helping our people with disability to profile what they can do to bring out the best in them. And this is something that we all can help, together with SG Enable. These are my own experiences of how we can lift the numbers of people with special needs in employment.
Ms Anthea Ong: I thank Minister Chan for giving the assurance to all that the practice of the declaration of medical history, including mental health condition, is not one that is exclusive, but one that is inclusive. However, in the job market, generally, that is being seen as discriminating to a large extent. It is both coming from a stigma that is in society as well, to self-stigma of the individual. Would Minister Chan be open to considering not having a practice as such but, once a candidate or applicant is employed, to then have the HR team work with the person to give him or her support once he or she comes forward to declare their conditions?
Mr Chan Chun Sing: First, I would like to reiterate that the exercise is one for the safety of the team and the crew and also to bring out the best from each. So, I think the correct way for us to do is that when someone comes into a job, the HR will work with them confidentially to see whether there are any limitations that that person might want to highlight, so that HR knows how best to put the person into the correct fit. It would be quite bad for us to put someone into a job that demands something from that person which is beyond what that person is capable of doing. We should be very careful to do that for the safety of the individual and the safety of the organisation.
So, I think these are things best for us to work confidentially between the HR and the respective individuals. But I just want to say that nobody should feel that by revealing your medical record you would in any way impede your career progression. The revelation of the discussion of one's medical history with the HR is for the purpose of the safety of the individual so that the organisation can extend the necessary help and design the appropriate job scope for the individual. And that is my assurance to the House.
\tMr Speaker: Order. End of Question Time. The Clerk will now proceed to read the Order of the day.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Estimate of Expenditure for the Financial Year 1 April 2019 to 31 March 2020","subTitle":"Committee of Supply – Paper Cmd 19 of 2019","sectionType":"OS","content":"[(proc text) Order read for consideration in Committee of Supply [5th Allotted Day]. (proc text)]
[Mr Speaker in the Chair]
[(proc text) Resumption of Debate on Question [5 March 2019], (proc text)]
[(proc text) \"That the total sum to be allocated for Head I of the Estimates be reduced by $100\" – [Mr Seah Kian Peng]. (proc text)]
[(proc text) Question again proposed. (proc text)]
The Chairman: Minister Desmond Lee.
The Minister for Social and Family Development (Mr Desmond Lee): Mr Chairman, I would like to thank Members for their thoughtful speeches yesterday evening. MSF will focus on three priority areas.
First, building a strong social compact, by strengthening family and community bonds and our collective resilience.
Second, building a more inclusive society, to enable people of all abilities to achieve their fullest potential. My colleague, Minister of State Sam Tan, will share more later.
Third, giving our children a good start in life, through affordable, accessible and quality preschool. My colleague, Senior Parliamentary Secretary Faishal Ibrahim, will speak on this later.
Sir, our social compact has evolved over the years. In the early days, there was a strong emphasis on self-reliance. Social assistance was minimal and community support was ground-up. As our economy developed, we experienced uneven income growth. We then introduced targeted social policies to give more support to those with less, and placed stronger emphasis on collective responsibility and the need for many helping hands.
As we face more challenges – an ageing population, shrinking family sizes and economic disruption and so on, individual and family efforts may sometimes not be enough. And so, over the last decade, we have shifted the balance decisively, with the Government and community shouldering a heavier responsibility. We now have broad-based transfers and subsidies that benefit the majority, as well as more targeted assistance for the low-income, vulnerable and those with specific needs. We have put in place trampolines to help people bounce back – in the words of Deputy Prime Minister Tharman Shanmugaratnam – and social safety nets for those who cannot care for themselves and who have little or no family support.
But even as our broad-based policies and schemes and our targeted means-tested support continue to uplift many low-income families, we need to do more to better support families who are bogged down by complex and often interlocking challenges. For such families, the consuming nature of their difficulties – addiction, incarceration, family violence, illness, divorce, mental health problems and so on, and often a combination of a number of the aforementioned – may make it difficult for them to access available opportunities, benefit from schemes and programmes, or respond effectively to help that is offered to them.
I know of a four-generation family – a teenage girl raised by her grandmother. She dropped out of school, had a son out of wedlock a few years ago when in lower Secondary. The girl’s son did not have any pre-school education until recently when social services intervened. Why is this girl looked after by her grandmother? Because her mother has been in and out of prison for various offences – out for a while and now in for a long-term imprisonment for a serious crime. Her father remains uncontactable for some time now and refuses to take responsibility for the family. Unfortunately, her grandmother is showing signs of dementia.
So, this is a family that faces very complex challenges which make it difficult for them to cope on their own despite many, many agencies and VWOs coming in to assist in different areas. The question is: how can we support such families with their existing needs and also ensure their next generation has a good start in life?
At COS last year, I shared that MSF would be partnering and working with other agencies and community groups to transform and integrate our social services and strengthen that important last-mile support for families, especially those with very complex difficulties, so that help can be provided in a more comprehensive, convenient and coordinated manner.
Ms Denise Phua and Mr Seah Kian Peng asked about our progress. At the Joint Segment on Opportunity yesterday, I described the ComLink that we will be setting up to support rental housing families and the Local Community Network pilot to wrap around support for at-risk youth and their families. MOE has also articulated the UPLIFT proposals to support students whose performance and absenteeism are worrying. All of these that we announced yesterday carry the DNA of integration and coordination – a different way of doing things in the social services.
So, let me now give this House an update on our broader level work across the entire social sector and, this is in a way, an interim report card.
Mr Chairman, in the course of the presentation, may I display some slides on the screens for Members' better understanding?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Mr Desmond Lee: Thank you. Sir, the centre is a family with complex challenges, like the kind that I described earlier. They sometimes face issues beyond those that they are seeking help for. For example, if a family seeks help from HDB because of HDB rental arrears, it could be because a breadwinner has lost his job and the family is in financial difficulty, hence, running into difficulties with arrears.
We want to ensure that these families get the necessary information and referrals to the relevant agencies’ services, regardless of which agency they first approach in the community. So, even if they approach only HDB in the first instance and it is in relation to arrears, when the officer speaks to the family and understands that actually because of this and that, although it is beyond his remit and he assesses them for assistance on arrears, what he ought to be doing is to refer the family to, say, Workforce Singapore (WSG) or NTUC’s Employment and Employability Institute (e2i) to help the breadwinner with potential job matching and also to the Social Service Office (SSO) for financial assistance in the meantime.
We want each frontline agency in the community to be a potential gateway for families with complex needs to receive assistance from other social services, including those in the community.
By the end of this year, we will train 2,500 officers from various frontline agencies to identify a client’s broader needs and link the client to the relevant agencies. They include our frontline colleagues from the People’s Association (PA), HDB, WSG, NTUC’s e2i, Singapore Police Force (SPF), Singapore Prison Service (SPS), the Silver Generation Office (SGO) and the Agency for Integrated Care (AIC).
Over time, we will expand to include more ground agencies as well as VWOs and community partners.
Next, because the solution to families’ problems may rest with multiple agencies, one needs to make some adjustments before the other can give approval, families also need to travel to multiple touchpoints. And clients with complex problems are often asked to submit multiple documents or repeat their circumstances when they need help. We should not let this be a barrier to them seeking help. We have therefore established a single touchpoint where they can access multiple services. We will start with the SSO.
Some of our SSOs are already physically co-located with complementary services such as employment assistance and family services. We are using technology as well, to provide some of these services via video-conferencing links. You can see that on the screen – a Social Service Officer working with a client, addressing the assistance that the SSO can provide, but also linking the client through video conference to officers in other agencies so that there is direct face-to-face contact. And if the documents need to be shared, they can send it across.
By end this year, clients will be able to access financial, employment and housing services at all our 24 SSOs, either through physical co-location of services or video-conferencing links with HDB, WSG and NTUC’s e2i career coaches. By the second quarter of this year, clients will be able to access legal advisory services through video-conferencing at Boon Lay, Taman Jurong and Queenstown SSOs. This is part of a pilot with the Legal Aid Bureau.
We also observed that because agencies and VWOs are currently approached separately for specific issues – a family will approach HDB for housing-related concerns, approach SP Power Services for utilities issues, approach other departments for specific areas of needs – these agencies sometimes end up with a compartmentalised understanding on the family's challenges, rather than a holistic overview.
To address this, we are improving information and data sharing across agencies. We have established protocols with HDB and MOE. Why? To enable ComCare clients to be automatically considered for reduced HDB rental rates and assessed concurrently for MOE’s Financial Assistance Scheme (MOE FAS) for their school-going children. By the second half of this year, ComCare clients with young children will also be automatically assessed for childcare subsidy and financial assistance. This is work in progress and we will continue to expand these arrangements to more agencies.
We are also using data and system interfaces to provide more coordinated and targeted assistance, especially if they can allow us to intervene early. I agree with Ms Tin Pei Ling that data can be used to tailor assistance to clients’ needs. SSOs and Family Service Centres, for example, use SSNet to share client information with consent, and we are looking at the possibility of more information link-ups.
Beyond systems and data sharing, there needs to be careful case coordination so that no Singaporean falls through the cracks.
I assure Mr Darryl David that our SSO officers work closely with the family and other agencies to understand the family’s circumstances and support them holistically. But we take his feedback and we will seek to do better.
At the same time, we need to better organise and coordinate all of this work, especially when so many agencies and VWOs may sometimes be involved in certain families' cases, so that families can achieve the best outcomes. We are therefore introducing a set of case coordination guidelines for agencies and case workers across the community. Agencies will discuss and coordinate around the needs of each family, with one agency maintaining overall oversight for each complex case. We call these Guidelines for Case Master Action Planning, or Case-MAP for short. The Case-MAP will guide agencies and caseworkers from different organisations, both within and outside government, so that they share a common understanding of the entire family’s needs, and align their interventions accordingly. And if they identify barriers, gaps, road-blocks or inconsistencies in policies, criteria or operational implementation, these will be surfaced to the relevant Ministries through our SSOs, to be looked into, and resolved. About 200 agencies and 400 officers across seven towns are being trained in these guidelines, which we have started rolling out this month.
The initiatives I have shared will strengthen our social service architecture and enhance the support which families with complex challenges receive. But going beyond systems, data and protocols, what we are really working towards is a strong, interpersonal network comprising our officers, social workers and partners across various agencies, in every town, embedded amongst our communities.
Our fellow residents, VWOs and partners on the ground know the local community and their needs best, and what local informal resources are also available to supplement formal support.
Just imagine a map, each and every town in Singapore covering the whole island. On this map, you can see many, many dots and each dot from a planner's point of view is a healthcare institution, a service centre, an SSO, a school, a Polyclinic, all embedded in the town. Each of these agencies is like a node that we seek to connect through the SG Cares Community Network. These community networks seek to share and tap on the collective knowledge of the communities' needs, explore collaborations to make a greater impact, and to align and organise our efforts to better support individuals and families in need.
Since May last year, we have started bringing together government agencies, VWOs and community partners at the town level; not the headquarters, but on the ground, the people who are actually running the centres in the communities. The first round of networking, involving about 160 agencies and 200 officers per town, will be completed by July this year.
The second round for some towns will start taking place from later this year. We will do this every year. As follow-up, the SSOs will – in between each of these sessions – lead deep-dives with relevant partners to tackle specific social issues, such as youth offending, disability, the needs of seniors in that specific locality. They will also create more opportunities for our ground officers to build professional people-to-people relationships with counterparts in other agencies and VWOs.
So, when we talk about systems theory, we talk about silos, we talk about people guarding their turf. What better way to address this on the ground than to let officers meet each other and know that actually they are all aligned to the same purpose, the same families you are serving and let us work together.
We are already seeing positive outcomes from the networking. Project Home Alone (PHA), for example, is an initiative that sprung up from the Hougang-Serangoon SG Cares Community Network session in September last year. The SSO at Hougang, the Ang Mo Kio-Hougang Grassroots and Xinmin Secondary School initiated an elderly befriending programme after they met during the session and it started last month. Secondary school students are befriending elderly residents living near the school, as well as in Thye Hua Kwan (THK) Nursing Home in Hougang.
We hope to see many more of such partnerships. A strong network of support within the community is crucial for those who need more help. And so, Community Link or ComLink, and the Localised Community Network pilot, which I announced yesterday, will complement and strengthen support for the vulnerable. Imagine each and every town having a local community network, agencies, all knowing each other – whether you are Government, people sector, whether you are a religious organisation, corporates who want to come on board, informal groups who want to play a part – but doing so in a co-ordinated way through the SSO who understands the landscape, able to galvanise the data. Each and every node in that town, with training, with kind of a relationship building, all aligned to say that, \"Well, yes i am doing my job. But in understanding my clients' needs, I understand the broader landscape of the challenges and I will bring in my relevant partners to make sure we work together as far as possible.\"
And within each of these community networks, you have your local LCN pilots, you have your ComLink, all working and plugging into the same motherboard.
Sir, let me now move on to youth offenders. The community support which I spoke about earlier, is also important to break cycles of offending for young people. Upon discharge from our MSF Youth Homes, young people may re-offend for various reasons – mixing with bad company, difficult family circumstances and so on.
But every young person matters, and we will do our utmost to help them overcome their challenges. Let me share Jervin’s story. Jervin is a young man currently serving national service. He was discharged from the Singapore Boy's Home last year and it is not easy to adjust back into the community after some time away. Jervin's case worker understood this acutely and went the extra mile. She checked in regularly on his progress for six months after his discharge, helped arrange his NS check-up for his enlistment and connected Jervin's family with the Family Service Centre (FSC) for additional support. Jervin was also placed on the Bettr Barista Holistic Training Programme and received his professional barista certificate before he started national service. The social worker and I are both proud of Jervin, and we hope that he continues his good progress.
To better support young people like him, after their discharge from MSF's Youth Homes, we have decided to lengthen post-care support from two months to one year. Post-care officers in the community will therefore have a longer runway to build rapport and a relationship and help link young people to community groups such as schools, employers, interest groups and other local community partners, to help keep them meaningfully engaged and envelop them with positive support and positive influence. And if issues arise, they can help these young people manage and resolve them early.
The nature and intensity of support will be tailored to the needs of these young people. Those with additional needs will be referred to partner agencies for support. In fact, if you speak to youth work agencies, youth workers and youth-at-risk, including those who have emerged from a crisis, they will share with you that relationship is critical. If you ask them to work with one youth-worker in one agency and say the programme is over, go to another programme in another place and have another youth worker, that relationship is just very hard to rebuild. And if you push them from pillar to post and say there are multiple people involved, it will be just very difficult to break through that barrier, that wall that they put up around themselves.
And so, this work of lengthening post-care builds on the work of National Committee on Prevention, Rehabilitation and Recidivism (NCPR), and Mr Melvin Yong had asked for an update on this work. We will help our youth re-integrate more smoothly into the community and reduce re-offending.
We are also strengthening statutory protection for children and young persons. Ms Sylvia Lim asked about the timeline of proposed changes to the age for protection under the Children and Young Persons Act (CYPA). We are consulting stakeholders on the proposed amendments, some of which are substantive and we look forward to Ms Lim's inputs as well. It is important to ensure that our partners are equipped to play their roles, and not unduly rush implementation. Our public consultations will run till mid-March and we aim to table the Amendment Bill in Parliament later this year or early next year.
Sir, close partnerships between the Government and community is crucial to tackle another serious social challenge – homelessness or rough sleeping. Both Mr Seah Kian Peng and Assoc Prof Daniel Goh asked about efforts to tackle emerging types of homelessness; different types of rough sleeping.
MSF works closely with Family Service Centres, HDB and other agencies to coordinate support for homeless persons.
Transitional Shelters offer temporary accommodation and social support to homeless persons who need intensive support to access stable housing, while Welfare Homes provide long-term residential care for destitute persons who are unable to support themselves and lack family support.
As Mr Seah Kian Peng and Assoc Prof Daniel Goh have pointed out, some individuals who sleep rough in public places may have homes, but do not, or are unable to go home for various reasons, such as conflict with family members, co-tenants and so on. They may also not be known to social service agencies, or have declined Government assistance.
Over the year, we have stepped up partnerships with community groups who are active in befriending and engaging persons who sleep in public places, so that we can better coordinate and strengthen our outreach to them. Better understand the precise circumstances they are in and then allow us to work with the relevant partners, both local community partners, VWOs and government agencies to try to resolve this challenge that they face.
Mr Chairman, what the House has heard earlier, and in fact yesterday, in terms of the ComLink and LCN work, was that the social services would play a bigger role together with ground Government agencies in a coordinated holistic approach to try tackle some of the most difficult challenges that complex families face. And by no means will this work be easy. But this work will be intensive, and our social workers and our VWOs will need all the support that they can get.
We cannot transform social service delivery or look forward to achieving this new social service landscape without our partners in the social service sector. As Mr Seah Kian Peng pointed out, the demands on the sector are increasing and social needs are growing in complexity. So, we must grow and develop the sector to meet these emerging challenges and better support vulnerable groups.
We will continue to provide resources, together with community partners like the Tote Board. Over the years, the Tote Board Social Service Fund, or TBSSF, has supported various social service programmes benefiting vulnerable families, children and youth, the elderly, persons with disabilities and persons with mental health issues.
For example, The Early Intervention Programme (EIPIC) for children with developmental needs, Family Service Centres (FSCs) for low-income and vulnerable families, and school social work programmes for at-risk youth are just some examples of programmes that have made a big difference in improving lives.
Sustained funding is crucial to ensure that vulnerable groups continue to receive the support they need. It also enables VWOs to focus on delivering services well, and expand, and develop new programmes to serve growing areas of need. It will also place them in a better position to operate in a network environment of social support.
I am happy to share that the Tote Board has committed $580 million to the Tote Board Social Service Fund, over the next four years – this is the largest tranche of funds put in, since it was set up in 2006. This would benefit many VWOs who serve the community.
Beyond funding support, we must also suppport and upskill our social service professionals, and develop their competencies to meet growing and changing social needs. We launched the Skills Framework for Social Service in January this year. This helps our professionals to map out career progression pathways, and guides organisations in training and developing their talent in the social services.
Mr Darryl David asked about further efforts on this front. How can we better support our social workers, and social service professionals to meet the challenges of today and tomorrow. Building on the framework, we will set up a Social Service SkillsFuture Tripartite Taskforce, to coordinate and drive skills development initiatives in the social service sector. The taskforce will comprise sector professionals. It will include academics, experts and policymakers. I counted four but I still call it \"tripartite\". They will explore further ways to build capabilities and strengthen professional practices. This includes reviewing the entry and training pathways for our social service professionals, ensuring relevance in curriculum, identifying improvements for professional practice, and working on joint projects to strengthen evidence-based practice.
Mr Chairman, I have spoken about our plans to provide Comprehensive, Convenient and Coordinated help, centred around our community networks across the island; and also our efforts to strengthen our social service networks in every town and community. And to also strengthen our social service sector and professionals.
Doing this will take time, we must commit to this if we want to better support and uplift the vulnerable in our midst. And we will work together with the community to do better, go further and make a greater difference. But at the same time, we must continue to support and strengthen our families, as families are the bedrock of our society.
So, now let address a couple of the cuts that Members have raised relating to family. Single parent families face more difficulties. Mr Desmond Choo asked if we could extend benefits, such as tax reliefs, to single mothers. Single parents comprise divorced, widowed and unwed parents. Most single parents are divorced or widowed, and enjoy the same benefits as married parents. Today, all Singaporean children receive government benefits that support their growth and development. These include education and healthcare subsidies.
Arising from our review in 2016, we extended 16 weeks of maternity leave and the Child Development Account benefits, including the $3,000 First Step grant, to unwed mothers and their children. Some benefits, such as the Baby Bonus Cash Gift, tax benefits and housing benefits are intended to encourage and support marriage and parenthood. Nevertheless, we will continue to see how we can better support single mothers and their children who face challenges.
Assoc Prof Daniel Goh and Mr Christopher de Souza asked if more could be done to support pregnant mothers contemplating abortion in coming to an informed decision, with the option of giving up their children for adoption instead.
The decision to terminate a pregnancy or carry a baby to term is deeply personal, and we must respect that. But it is important that an informed decision be made.
All women considering abortion are required to complete pre-abortion counselling, where a trained counsellor will share on the medical, psychosocial and emotional aspects of terminating pregnancy. She can only give her written consent to terminate pregnancy at least 48 hours after this session. Those who require further support will be referred to Family Service Centres or appropriate helplines. MSF and MOH will continue to review how to strengthen and enhance the counselling process.
Mr Faisal Manap asked about working elderly Singaporeans. According to the 2018 Comprehensive Labour Force Survey, 27% of residents aged 65 and above were employed. Among those who work, some do so for financial reasons, others do so to stay engaged, some for both.
Retirement adequacy is a concern for low-income elderly. We have assistance and support schemes to ensure our seniors age with assurance. We regularly review these schemes and introduce new ones when required. Much of this has been discussed yesterday at MOM COS and more at the subsequent MOH COS, I presume.
Broadly, seniors receive healthcare support through the Pioneer and upcoming Merdeka Generation Packages. The Silver Support Scheme and ComCare assistance provides further financial support. For seniors who continue working, they also receive employment support and assistance through the Workfare Income Supplement, which has just been enhanced, and the Special Employment Credit. And there are options for them to unlock value from their flats such as the Silver Housing Bonus and Enhanced Lease Buyback Scheme. If they need someone to kind of guide them, support them and link them to the relevant agencies, our Silver Generation Ambassadors and our AIC officers on the ground will lend the support.
Ultimately, helping our seniors age gracefully and with peace of mind is also about nurturing communities of care and support within their homes and community, from family members to volunteer befrienders.
Sir, MSF will partner Singaporeans to build a caring and inclusive Singapore, where we can live with dignity, raise strong families, and take pride in contributing to those around us.
Singaporeans need not face life’s uncertainties alone, and help is available to better support and uplift these individuals and families. This is possible only with the strong partnership of individuals, families, the community, the social service sector and government agencies. This is the essence of our social compact. Let us continue to strengthen the bonds that hold us together, as we collectively build a better Singapore and a better social service sector for all Singaporeans.
The Chairman: Minister of State Mr Sam Tan.
The Minister of State for Social and Family Development (Mr Sam Tan Chin Siong): Mr Chairman, Singapore has been working hard these past 12 years, to challenge ourselves to become a society with bigger hearts, where all, regardless of age or ability, have hope for a good future.
This is what the three Enabling Masterplans are about: charting our direction towards a more caring and inclusive society, where persons with disabilities or special needs are empowered to participate fully as integral and contributing members.
Members may well recall that we first laid the groundwork for an inclusive society by developing services under the first Enabling Masterplan in 2007. That was 12 years ago.
We then went on to enhance support and services, under the second Enabling Masterplan in 2012. Notably, we set up a dedicated agency, SG Enable or SGE, to support persons with special needs, and improved the quality of early intervention (EI) and education services.
It is on this foundation that we are continuing to push forward under the third Enabling Masterplan (EMP3).
Sir, Ms Denise Phua asked about the progress of EMP3. Under the EMP3, the Government is partnering the community to support persons with special needs and also their care-givers across different stages of life. So, we adopt a whole-life stage approach.
We want to give young children with developmental needs a good start in life. We shall do so by ensuring that they have timely access to quality EI, that is, Early Intervention services. My colleague, Senior Parliamentary Secretary Faishal, will share more details later.
For children of schooling age, we want to give every child access to learning opportunities, regardless of their abilities. From January this year, we have included children with moderate to severe special educational needs under the Compulsory Education Framework. In her COS speech on Monday, Second Minister for Education, Ms Indranee Rajah, already elaborated about support for these students in mainstream schools.
We know that transportation is a key enabler, and have put in place various schemes and subsidies to support persons with special needs. These include the VWO Transport Subsidy and the Taxi Subsidy Scheme. The Government is also continually improving the accessibility and inclusivity of public transportation.
Sir, we will continue to support students as they move from school to the next stage of life. One such example is the School-to-Work Transition Programme, which matches students who are able to work, to suitable training and employment pathways based on their strengths and interests.
For job-seekers with special needs, MSF and SG Enable will continue to work with MOE and MOM to enhance their employability, expand employment options, and also to promote inclusive hiring.
We will continue to help persons with special needs prepare themselves for the workforce. For example, SG Enable works closely with SPD, Autism Resource Centre (ARC), and the Movement for the Intellectually Disabled of Singapore (MINDS) to match individuals to suitable jobs, and help them adjust well into the workforce.
I am, therefore, heartened that efforts by the Government, community and corporate partners are bearing fruit. However, there is still a lot more that we can do together.
I, therefore, thank Ms Denise Phua for her suggestions to identify, individualise, integrate, implement and also inspect the care-giver support system. We know that a care-giver’s job is never an easy one. Indeed, support for care-givers is another key focus of the EMP3.
This is why we launched the Care-givers Pod at the Enabling Village last year. It is a place for care-givers to find peer support, and also to attend training sessions and organise sharing sessions among themselves.
Sir, we also know that care-givers need comprehensive and reliable information on the services available. To respond to this need, SGE is developing a new online portal that will enable care-givers to find relevant resources easily, including for respite care, as suggested by Dr Tan Wu Meng.
MSF agrees that formal respite services are needed to provide temporary relief for care-givers to prevent burnout. The Drop-in Disability Programme (DDP) is a day respite option for care-givers.
MSF-funded Disability Homes also offer residential respite care services to those who need it.
As announced by MOF, the age limit on children with special needs will also be removed for the Grandparent Care-giver Relief (GCR) scheme, from the Year of Assessment 2020. Working mothers who seek the help of grandparents to take care of their children with special needs can get tax relief of $3,000, regardless of the child’s age.
Although these measures will provide welcome support, we also know that many care-givers worry about what will happen to their loved ones when they are older. I will speak more about this later in my speech.
For now, I will speak on MSF’s forward plans to enable persons with special needs to maximise their potential.
Sir, Ms Denise Phua made a very passionate point yesterday on the importance of creating greater awareness on the EMP3. She also suggested that the Enabling Masterplans have to be \"living documents\", and more people and organisations should be co-opted to co-shape and co-implement solutions. I agree with her fully.
Sir, in 2019, MSF will deepen our engagement with various stakeholders, including persons with special needs and their care-givers, voluntary welfare organisations, employers, technology providers, and educational institutions. Doing so will not only allow us to better coordinate and provide targeted support to meet the varied needs of differently-abled persons across disability groups, but also increase awareness of the Enabling Masterplans. Together, we can co-create the hardware, software, and the heartware of an inclusive Singapore.
I am, therefore, very happy to announce that we will form two cross-sectoral workgroups involving people, private, and public sector partners, to focus on employability and independent living.
The first workgroup will look at preparing persons with special needs for the future economy, by enhancing access to lifelong learning opportunities and employment pathways. We must prepare our citizens with special needs for the jobs of today and also tomorrow. I am, therefore, very grateful that Ms Denise Phua has very kindly agreed to co-chair this workgroup with me to study this issue further with the relevant stakeholders in the public, private and the people sectors including WSG and e2i.
Sir, I will also co-chair another workgroup with President of SPD, who is also a former Nominated Member of Parliament, Ms Chia Yong Yong, to look into promoting independent living through technology and design, in the home setting as well as within the community.
Mr Chairman, all of us want to have assurance that the needs of our loved ones, and those of our own, will continue to be met when we enter our senior years.
Dr Tan Wu Meng asked about support for seniors who worry about their children with special needs. We have set up the Special Needs Trust Company (SNTC) to support parents and care-givers of persons with special needs in future care planning and financial security. This includes planning for their future expenses for accommodation, health and other care needs.
Mr Darryl David has asked about support measures for those who have lost their mental capacity. All Singaporeans need to plan for our own golden years. Having a Lasting Power of Attorney (LPA) will give us peace of mind, knowing that a trusted loved one is empowered to act for us, should we lose mental capacity. It will also enable our care-givers to act confidently in providing care for us.
I thank Mr Dennis Tan for his suggestion to do more to protect Certificate Issuers by amending the LPA form. We will consider this in our on-going review of the LPA form.
Yet, there are a number of seniors who may not have the support of family members. They may be single, or married but childless.
MSF has introduced two community support options to help these Singaporeans plan ahead in the event of them losing their mental capacity.
The first is the Professional Deputies and Donees (PDD) Scheme, which was launched in September last year. Under this scheme, individuals can procure the services of a registered PDD to make major decisions on their behalf, such as liquidating their property to finance their care.
To assure individuals that their interests will be protected, we have put in place a training course for PDDs, and also put in place very robust measures to ensure all the regulations and practices are monitored. Twenty individuals have registered as PDDs so far. MSF will continue to train more suitable persons to be PDDs, and raise awareness of PDD services.
Mr Chairman, with your permission, may I display a slide on the screen?
The Chairman: Yes, please. [A slide was shown to hon Members.]
Mr Sam Tan Chin Siong: Thank you. To complement the PDD scheme, MSF launched a two-year Community Kin Service (CKS). This is a pilot launched in 2018. The scheme allows partner-VWOs to manage the day-to-day expenses of a senior who has lost mental capacity, through the authority of a Court order, and also under the close supervision of the Office of Public Guardian. This could include passing the senior a fixed cash amount from his bank account so that he can buy food and groceries, and make payment for the senior’s utility bills so that he will not experience a disruption in the electricity and water supply.
With the help from a community kin, the senior can stay within the community that he is familiar with, while receiving dedicated care. So with these schemes in place, we hope that Singaporeans will be able to prepare for their future and also be supported through their golden years. Mr Chairman, allow me to now speak in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Our vision is to develop an inclusive society where every Singaporean is empowered to participate fully as integral and contributing members. We have been working towards this objective in the past few years, striving to build a society with bigger hearts, where every individual has hope for a good future, regardless of age and ability.
Members in this House may remember that we laid the groundwork for an inclusive society when we first launched the Enabling Masterplan in 2007. In 2012, we enhanced services and support for persons with special needs under the second Enabling Masterplan.
Under the third Enabling Masterplan, we will adopt a life-stage approach to provide further support for those with special needs at various stages of their lives, so that they are better able to live independently.
We know that care-giving is both physically and psychologically exhausting. Therefore, one of the priorities of the EMP3 is to help care-givers provide better care for themselves and their loved ones.
To ensure that these plans are implemented successfully, all of society, across the public, private and people sectors, must work as one.
Therefore, we will be introducing two cross-sectoral workgroups. The first workgroup will focus on improving the quality of life for persons with special needs through technology and design. I will be co-chairing this group with the President of SPD and former Nominated Member of Parliament Ms Chia Yong Yong.
I will also co-chair another workgroup with parliamentary colleague and President of ARC, Ms Denise Phua. The aim of this workgroup is to prepare persons with special needs for the future economy by enhancing access to lifelong learning opportunities and employment pathways.
Every one of us would like to live well in our golden years, and every Singaporean should prepare ahead for this stage in life. It is for this purpose that we established the Lasting Power of Attorney (LPA). By appointing an LPA, we authorise a family member or trusted friend to make decisions on our behalf in the event that we lose our mental capacity. With this clarity, we and our care-givers would have less to worry about.
At the same time, we are also aware that there are senior citizens with no one to turn to, and may not have any care-givers to take care of them should they lose their mental capacity. They may be married but childless or they may be single.
Therefore, MSF has introduced two community support schemes to help these Singaporeans plan ahead.
The first is the Professional Deputies and Donees (PDD) Scheme. This was launched in September 2018. Under this Scheme, individuals can procure the services of a registered PDD to make decisions on their behalf, for example, liquidating their property to finance their care.
To assure individuals that their interests will be protected, we have put in place robust safeguards. These include mandating PDDs to report regularly to the Office of Public Guardians, and record all decisions made on behalf of their clients. We also provide training for the PDDs, to ensure that they are trustworthy and able to support their clients.
To complement the PDD Scheme, MSF launched a two-year Community Kin Service (CKS) pilot in 2018. This Scheme allows partner-VWOs to manage the day-to-day expenses of a senior who has lost mental capacity through the authorisation of a Court order. This could include VWOs making monthly withdrawals from the senior’s bank account, passing the senior a fixed cash amount so that he can buy food and groceries, or paying for his medical bills.
The first case under the pilot programme is a 78-year-old man who lives alone in a one-room flat. Doctors have certified that he no longer has the mental capacity to manage his daily expenses.
Under the CKS pilot, a social worker from the authorised VWO helps him pay his utility bills, and visits him twice a week to give him an allowance, so that he can continue with his current lifestyle, for example, eating his favourite meals at nearby coffee shops.
With help from a community kin, this senior can age within the community that he is familiar with, while receiving dedicated care. This scheme is run by the Office of Public Guardian to ensure that seniors’ monies will not be misused.
With these schemes, we hope that Singaporeans will prepare ahead for their future and be supported through their golden years.
(In English): Mr Chairman, all of us can play a part in fostering a caring and inclusive society for all Singaporeans, regardless of their age and their ability. So, this is one journey where I hope Singaporeans, particularly those who are interested in and have concerns for persons with disabilities or different abilities, can partner us to walk this journey together.
The Chairman: Senior Parliamentary Secretary Muhammad Faishal Ibrahim.
The Senior Parliamentary Secretary to the Minister for Social and Family Development (Assoc Prof Dr Muhammad Faishal Ibrahim): Chairman, I thank Members for their valuable suggestions and support for MSF's work. Allow me to start with a few words in Malay.
(In Malay): [Please refer to Vernacular Speech.] We, in MSF, are committed to work together to improve the lives of Singaporeans. One of the main priority areas is ensuring that every child has a good start in life.
Children are our future. Pre-school education helps children develop skills in thinking, learning and socialising with other children, as well as self-confidence and independence. We will continue to ensure affordable and quality early childhood services that are easily accessible. Our goal is to ensure that every child has a good start to succeed in life.
Among the efforts implemented include funding for some pre-school operators to offer quality programmes at an affordable fee. We also provide subsidies to parents. Low-income families receive the most subsidies and thus need to pay only a few dollars a month in school fees.
We are reviewing pre-school subsidies to make it more affordable for parents. While this review is on-going, I am pleased to announce that MSF will provide more subsidies for mothers who are looking for a job and who need to place their children in childcare centres first, or mothers who are unable to work because they are caring for a young child.
We will also maintain the amount of subsidy received for a longer period, without requiring a review every year. We hope these enhancements will give families more certainty and peace of mind.
Through these enhancements, over 5,000 families will benefit from 1 March 2019. With more support available for our families, I urge more parents to enrol their children in pre-schools. Ensure your child has a good start in life.
As we continue to enhance pre-school services, some of our children may need more help. To help young children with developmental needs, early intervention is critical to help them achieve their full potential.
Currently, the Government provides subsidies for early intervention programmes to help children with developmental needs.
From 1 April 2019, most families will be paying lower fees, a reduction of 30% to 70% for early intervention services. More families will also be paying as little as only $5.
From July onwards, we will also enhance the early intervention programmes so that they are more customised to our children's needs. For example, children from the Early Intervention Programme for Infants and Children (EIPIC) who have achieved sufficient progress, can receive early intervention at their pre-schools without having to go to an early intervention centre. This enhancement is expected to benefit at least 4,500 children every year.
Mr Chairman, I have shared our efforts to give all children a good start in life. Please allow me to recite a Malay pantun.
Board the LRT at Fajar station
To Mandai Zoo we go
The young get an education
To be smart adults, they grow
Ladies and gentlemen, let us journey together to build a better tomorrow for us and our generations ahead.
(In English): Mr Chairman, quality early childhood development builds strong foundations for life. My Ministry strives to give every child a good start. Since National Day Rally 2012, we have significantly enhanced access to affordable and quality pre-schools.
We want to assure Members that the Government is committed to making pre-school affordable.
The expansion of Anchor and Partner Operator pre-schools, as well as MOE Kindergartens, ensures the supply of affordable pre-school services. In addition, the Government provides subsidies to help defray the fees borne by parents, especially those from lower income groups.
Last year, Minister Desmond Lee shared that we are further reviewing pre-school subsidies. While this review is still on-going, we will begin to enhance operational processes to improve access to pre-school subsidies.
We agree with Mr Louis Ng and Ms Anthea Ong that we can do more to address pre-school affordability concerns of non-working mothers. Therefore, I am pleased to announce that ECDA will provide more subsidies to non-working mothers who are looking for work, or who are unable to work because they are caring for a younger child.
Mothers like Mdm Lee Siok Hong will benefit from this. A mother of two children, Mdm Lee cares for her younger child at home, while her elder child is enrolled in childcare. Based on our prevailing rules, Mdm Lee may qualify for $300 Basic Subsidy for her elder child until her younger child turns 18 months old. With our enhancements, Mdm Lee will receive $300 Basic Subsidy for an additional six months, until her younger child turns two years old. Depending on her household income, Mdm Lee may also be eligible for up to $440 of means-tested Additional Subsidy.
Mothers who are looking for a job will also benefit from our enhancements. Under our prevailing rules, a job-seeking mother may qualify for $300 Basic Subsidy for three months. With our enhancements, she will receive $300 Basic Subsidy, and up to $440 of means-tested Additional subsidies, for six months. We hope this will give mothers greater peace of mind to secure a job.
To Mr Ng's query, non-working mothers can consider enrolling their children in kindergartens, which are generally more affordable than childcare services. For instance, today’s median monthly fees are $171 for kindergartens and $856 for child care, before subsidies. And with the Kindergarten Fee Assistance Scheme, or KiFAS, the out-of-pocket cost for low- and middle-income parents who enrol their children in Anchor Operator or MOE Kindergartens is a few dollars a month.
I am also glad to announce that ECDA will give parents greater certainty on the amount of child care subsidies they will receive. ECDA previously verified the working status of mothers annually. From this year, this will be performed at fixed points in the child’s pre-school years, which may be up to 2.5 years apart. The longer time-frame between ECDA’s re-assessments will give families more certainty on the amount of subsidies they receive, even if parents transit between jobs, or take on care-giving responsibilities.
Through these enhancements, more than 5,000 households like Mdm Lee’s will benefit every year, starting from 1 March 2019 this year.
Mr Leon Perera asked for an update of the Early Childhood Development Centres Act, which came into force from January 2019. This helps drive better standards across the pre-school sector.
Since 2015, ECDA has been engaging pre-schools to prepare for the Act. All child care centres are already licensed under the Act. Kindergartens, which are new to a licensing regime, have been provided another year to apply for a licence. We understand that no pre-schools has had to close due to the Act. In fact, closures of pre-schools have remained consistently low over the past few years.
Dr Lily Neo, Mr Darryl David and Mr Ang Hin Kee asked for an update of the Early Childhood Industry Transformation Map or ITM. Many pre-schools have implemented initiatives such as technology services, centralised services, and demand aggregation. These solutions help to free up our educators’ time from administrative work, so that they can focus on nurturing and teaching the children.
The Early Childhood ITM also aims to ensure that workers in the EC sector are well taken care of at their workplaces. In particular, we hope to do more for our mature workers, and enhance their career longevity.
I am pleased to announce that ECDA will be collaborating with the Health Promotion Board to commission an occupational health and safety assessment. They will appoint a panel of experts this year to holistically examine the well-being of pre-school staff, as well as recommend job redesign and workplace enhancements.
At the heart of quality early childhood development are our early childhood educators. We will press on to attract, develop and retain capable and passionate educators. The National Institute of Early Childhood Development will begin training its first batch of students in its full-time Diploma in Early Childhood Development and Education from April 2019.
I am also happy to announce that ECDA will soon introduce an enhanced centre management system, or CMS. The CMS will interface with all pre-schools and improve existing processes such as licence application and subsidy administration.
With CMS, pre-school administrators and parents will enjoy greater convenience. For example, through automation, pre-schools will have less data entry and no longer need to retain hard copies of birth certificates and NRICs for subsidy applications. Parents will be required to fill in just one form to apply for subsidies and financial assistance. This will smoothen the application process for about 20,000 new families annually, and halve the time spent on subsidy applications.
Ms Sylvia Lim asked about the KidSTART pilot. KidSTART supports parents to ensure that their children benefit from nurturing relationships, holistic child development, as well as a secure home environment. We are encouraged by the feedback that we have received so far. Children are speaking more and their social skills have improved. Their parents feel better supported in their parenting.
We will continue to closely assess KidSTART, and study the viability of scaling it up.
Even as we continue to enhance pre-school services, some of our children would need an extra helping hand. We agree with Ms Rahayu Mahzam that for young children with developmental needs, early intervention, or EI, is valuable, and helps them achieve their fullest potential.
Mr Perera asked about pre-schools and children with developmental needs. Today, there are 550 pre-schools offering the Learning and Development Support programmes, catering to children with mild developmental needs.
We understand that insurance coverage for operators is not a barrier to enrolment. There are insurers which offer group insurance coverage to pre-schools, without distinguishing between the developmental needs of their children.
Earlier this year, Minister Desmond Lee announced our plans to make EI services more affordable. From 1 April, EI fees will be reduced for most families, with reductions averaging between 30% to 70%.
From July, we will also progressively offer enhanced programmes that are better tailored to the different needs of children as they develop over time.
Let me share how this will benefit children like six-year-old Elijah Lim. Elijah was one of around 700 children who participated in our pilot of enhanced programmes. He used to receive intervention at an EI centre twice a week, in addition to attending pre-school. After making progress, Elijah transited to receive intervention in his My First Skool pre-school, where his speech therapist and pre-school teachers worked together to help him gain greater independence and confidence. Elijah is now settling in well in a mainstream primary school. His pre-school friends also benefited from being in a more inclusive place for learning. Elijah’s family appreciated the convenience of not having to shuttle between his pre-school and EI centre. During our two-year pilot, many other families and children gave positive feedback. I am optimistic that even more will benefit as we expand this offering.
May I also assure Ms Rahayu that we will continue to refine our EI services by learning from international best practices, building new capabilities, and enhancing standards.
We will work with our partners to continually improve, so that every child in Singapore can have a good start in life.
In our society, we aspire to provide opportunities for all. In MSF, the Office for Women’s Development, or OWD, was set up as the national focal point on gender policy matters and for international cooperation pertaining to women. There has been much progress in these areas. But, we believe more can be done.
The OWD champions the crucial roles that women play in our society. Ms Rahayu, Ms Ong and Prof Fatimah Lateef asked about how we can advance the representation of women on boards of organisations. Doing so not only helps women to advance, but benefits organisations as well. To me, It is a win-win outcome. This work is spearheaded by the newly-formed Council for Board Diversity, or CBD. The CBD takes over from the Diversity Action Committee (or DAC), and will take on a wider scope. The representation of women on boards of Top 100 primary-listed companies on SGX had increased from 7.5% in end 2013, before the DAC was constituted, to 15.2% at the end December 2018. This is a good achievement. DAC had suggested changes to the Code of Corporate Governance, which came into effect from January 2019. This Code requires companies to disclose their board diversity policies, objectives and progress. We should see benefits from this in the coming years. The CBD will continue to encourage companies listed on the Singapore Exchange to put more women on boards, but will also engage people and public sector organisations. Currently, we have 23% women’s participation on statutory boards. We are confident that the CBD can build on this progress.
Prof Fatimah also asked about the progress of BoardAgender. Their efforts are complementary to the work of the CBD. One of their key initiatives is the SG50 Champions of Change launched in 2015, which is a network of influential individuals who pledged to support the cause.
Ms Ong highlighted the 20% pay gap between genders, derived from a ValuePenguin report. From our understanding, the figures in this report is wider than is the case in Singapore because of the different base and definitions used.
MOM’s latest data estimates Singapore’s gender pay gap for full-time employed residents in similar occupation groups at around 10% instead. This 10% gap can be attributed to the fact that women are more likely to exit the workforce earlier, or have intermittent patterns of work, for reasons such as child-giving.
The Government’s goal is hence to empower women with choices to enter, remain in, or re-enter in the workforce. We want to support women’s desire to fulfil both their career and family aspirations. For example, MOM just announced an increase in the Work-Life Grant budget, and introduced various other initiatives. This will help jobseekers, including women planning to return to the workforce.
It is also critical for families to address gender equity at home. Men, like me, can take on more family responsibilities, so that women do not necessarily have to shoulder the lion’s share.
Ms Rahayu and Ms Ong also asked about other initiatives to empower women. The Government is committed to working with partners to cultivate a supportive environment for women in the workplace, community and at home.
We also want to ensure women feel safe and protected, and to come forward when they are not. In February this year, the Criminal Law Reform Bill was tabled in Parliament for the First Reading. The Bill will repeal marital immunity for rape. This will allow for all women to be better protected from sexual abuse.
To further support women, OWD actively engages the Singapore Council of Women’s Organisations, or SCWO. SCWO is the umbrella Women’s Organisation with over 500,000 women in its 50-member organisations. I am pleased to announce that OWD will introduce a seed fund for SCWO to administer. This will help women’s organisations to pilot or scale up women’s development programmes. More details will be shared by SCWO later this month. SCWO also recently launched a new “SCWO Insight Series”, which brings participants together with women leaders to discuss national issues. The SCWO will also roll out other initiatives, such as celebrating International Women’s Day this Friday. On that note, I wish all fellow Singaporeans a meaningful International Women’s Day in advance!
Mr Chairman, my colleagues and I at MSF will continue to work hard to uplift Singaporeans from all walks of life. We will strive to provide a good start in life for our children. We will nurture a more inclusive society where Singaporeans of all abilities can live well and have peace of mind as we grow older. We will strengthen family ties because we see the family as an important institution of our society. We will support fellow Singaporeans who are facing challenges to get back on their feet. We do all these because we take pride in building Singapore into a nation of opportunities where all can succeed.
Mr Chairman, we will press on with this important work. We urge all Singaporeans to walk together with us in this journey to build a better tomorrow for all and our future generation. Thank you.
The Chairman: Clarifications. Mr Darryl David.
Mr Darryl David: Thank you, Chairman. I just have two points of clarification. First point I believe would be to Minister. It is very heartening to hear Minister talk about the tripartite, or should I say, the quartripartite because it involves four parties task force. Can Minister, perhaps, share more regarding when we can expect more details on this task force in terms of, perhaps, a budget and opportunities and would there also be opportunities for mid-career professionals in terms of this task force's framework that is due to be set up to allow them, perhaps, to do a professional conversion programme as it were.
Another point of clarification is for Senior Parliamentary Secretary Faishal. The Centre Management System (CMS) would certainly help many parents to register for early childhood and so. Would it be compulsory for all early childhood centres to come onto this CMS programme? And when can we expect the CMS to be rolled out into the sector?
Mr Desmond Lee: Mr Chairman, I thank the Member for his interest in the Tripartite Taskforce. This Tripartite Taskforce brings together representatives from the entire eco-system – those who train our social workers, both pre-employment as well as mid-career; those who employ and work with social workers in our VWOs and agencies; and of course, the Government departments as well.
This ensures that building on top of the skills framework that we put in place very recently for our social work professionals, we have an eco-system where the tripartite partners understand the needs on the ground, including the new structures that we are setting up, the new kind of social safety nets that we are building, and the kinds of skill sets that our social workers will need to learn – both pre-employment and as part of continuing education – and to pick up in order to be able to meet social needs. For example, if he senses that we need more social work intervention, say in the geriatric field, and we will go on to work with our academic partners to see how curriculum can be adjusted in order to cater to this growing need, for instance.
And so, as to when we can start to expect some recommendations to come out from the tripartite task force, let us give them a bit of time to meet. There have been some preliminary sessions, but allow them to meet and discuss, and they will then come up with recommendations on the various issues I have talked about – pathway, career, transition, curriculum and so on.
Mr Darryl David: I had asked another question of the Minister: would there also be opportunities for mid-career professionals, in terms of this task force's framework, to do a professional conversion programme to make the switch. If the Minister could reply, before the Senior Parliamentary answers. Thank you, Mr Chairman.
Mr Desmond Lee: Yes, indeed this is one area that I am looking into with great interest. I recalled Mr Dennis Tan had asked me about childcare teachers and we know that the majority of pre-school teacher enrolment each year is from mid-career transitions. So, we are now looking with interest at the landscape for the social sector. Many come from pre-employment training, from Polytechnics and our Universities, but I am also seeing how we can further strengthen career transition for older workers with life experience who want to go into social work. There are many of them who do transit, they are graduate diplomas for some of these conversions. We want to see how this pipeline can be further strengthened, and part of the work of the tripartite taskforce is also to look at this.
Assoc Prof Dr Muhammad Faishal Ibrahim: Chairman, I agree with the Member that CMS would bring great benefits to the parents as well as the operators. All childcare centres and kindergartens regulated by ECDA under the Early Childhood Development Centres Act will come on-board the CMS and we are likely to going to roll out to all pre-schools later this year.
The Chairman: Prof Fatimah Lateef.
Prof Fatimah Lateef (Marine Parade): Thank you, Chairman. I have one clarification for the Minister. It is actually pertaining to single unwed mothers, and I know the principles and values we want to uphold in the society and all that. But many of the issues that they face and grapple with, I agree, can be solved at the constituency level through other networks that we have formed in the constituency and all that. But when it comes to policy – housing, Baby Bonuses and so on – that, we require intervention at the Minister or Ministry level. Usually, we will appeal and re-appeal, but then you know, it is a very long circuitous journey for these people, really.
Pertaining to that, taking that a little bit further, I have a couple of cases where we actually have Muslim women who are second wives to Muslim men, and they are also faced with this issue where they do not qualify for Baby Bonuses and other policy issues because they are the second wives of the men. That is another area as well.
Mr Desmond Lee: I thank the Member for her keen understanding of the challenges that single unwed mothers as well as women in the Muslim community face, specific to the cultural context.
On the former, as I said earlier, schemes that benefit all children – all Singaporean children – apply across the board regardless of the marital status of the parents. There are certain schemes which support and encourage marriage and parenthood, and these are schemes that we provide specifically for that purpose. That is the distinction.
But having said that, we all recognise, all Members of this House recognise that many of the single unwed mothers are not in the situation out of choice, but out of circumstance. They soldier on; they care for the child and they want the best for the child. And certainly, we too want to ensure that these children have every opportunity.
So, a lot of the work that we do involves ensuring that we understand fully the challenges of some of these women. Stoic though they may be, they may need more support, and let us weave that support around them, each and every community, building that kind of support platform that I talked about earlier so that we can address them using a variety of schemes and programmes, both national, community-based and local.
On the issue of Muslim wives who are second wives, there is family support that is provided to the entire family for the marriage and for parenthood, and for the children. And if these families as a whole face challenges, whether financial or social, again, let us have a good look at the situations of these families and see how we can address some of them.
As I said earlier in my speech, as a result of this tighter integration of support, when the agencies can fly through the challenges of these families, flying through different policies even on the ground, and how they interface and touch families. They will be able to identify where there are gaps, where there are kinks, where there are inconsistencies which on the ground we can see, and if the parent Ministries can then come together and see how best we can resolve them through policies, tweaks or schemes, or adjustments, or even new policies, we will certainly be prepared to look at them.
Mr Leon Perera (Non-Constituency Member): I thank Senior Parliamentary Secretary Assoc Prof Dr Muhammad Faishal Ibrahim for responding to most of the points in my cut speech. Just two quick clarifications. One is: could the Senior Parliamentary Secretary share with us the number of pre-schools that have been given the one-year extension and are still awaiting the licence he had referred to?
And secondly, in regards to my point about international rankings of Singapore in terms of early education quality, I refer to the Starting Well ranking report that was done in 2012. Is the Government aware of other reports that rank how well we are doing with respect to other countries? And is this something that the Government will monitor going forward? Unless I missed it; I do not think that was touched on.
The Chairman: The guillotine time is 1.00 pm, so I suggest every Member try to rush through your questions and responses.
Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, there are 400 kindergartens and all the 400 will have a year to get the licence. And about the study that the Member mentioned, from our understanding, that has been the only one study that had been undertaken. If you look from the time the study was undertaken to today, you cannot deny the fact that there has been a great leap in terms of the changes that we have undertaken in terms of affordability, the quality, as well as the accessibility that we have provided to our children and the families.
So, as a Singaporean, I feel very happy that we want to give every child a good start in life. This not only comes from the operators, but I think when we speak to parents, we speak to families and all the stakeholders, they feel that we are doing the right thing. We will continue this journey.
Mr Desmond Lee: Just to supplement my colleague's response, the Lien Foundation report benchmarked the early childhood in Singapore with that in a number of other countries. There were, amongst others, three major criteria: one was accessibility, another was affordability and quality – precisely the three indicators on which we are pushing very hard in Singapore.
On accessibility, I understand, we did not rank well because we did not legally mandate that every child go to pre-school even though our pre-school attendance rate is very high, even for those at the lower SES.
For those with the lower SES with KidSTART and with pre-school outreach – going door to door for each family – we endeavour to try to raise the low SES participation rate in pre-school. So, we did not rank well because there was no legal mandate it. In some countries they are legally mandated. But I think let us look at the results – look at the attendance rates.
On quality, again, I am told we scored not so well on that study, in terms of teacher-child ratio – that means how many children there are for each teacher. Wages, which, again, has been going up quite steadily since 2012, outpacing the general market in terms of wage increments. Pre-school teacher training, again, there is the National Institute of Early Childhood Development (NIEC) and the coming together of three institutes, so, great emphasis on quality, both pre-employment as well as the professional development that we have put in place for teachers, principals, as well as edu-carers.
And looking at the linkage between pre-schools and Primary schools which again now, we have strong interface because both MOE and MSF, looking after ECDA, look at the interface as well. So, we take the report at heart. It has been many years since. There have been no studies in between, but I think we look at our indicators where we stand and want to make sure that we invest heavily for our children to have the best start in life.
The Chairman: Let us keep clarifications short.
Mr Seah Kian Peng (Marine Parade): Sir, a quick clarification for the Minister. In a quest to provide more comprehensive, more coordinated, more convenient services to residents, I have asked in my cut yesterday and previously whether our Social Service Offices should also consider operating during the weekends. So, I would like the Minister's response.
Mr Desmond Lee: I take the Member's point. We have three Social Service Offices (SSOs) that are opened on Saturdays. If you look at the attendance at SSOs, most of our clients turn up on weekdays. And for those who have difficulty meeting our officers during the office hours, they make arrangements with our officers at our Family Service Centres to meet outside office hours. So, we accommodate them, including those who can go to our SSOs that are open on weekends. Otherwise, we make arrangements.
Dr Lily Neo (Jalan Besar): May I ask the Minister whether he knows the numbers of vulnerable families in the community? He mentioned earlier that he wanted to give more help to these families. May I ask him whether MSF has enough capacity to reach out to them, and how many is MSF going to help in these families, and whether we have any target on the outcome benchmark for these families?
Mr Desmond Lee: I do not have the figures, but if you look at the bottom 20% of the SES, I think that would be a group we would first be very concerned in ensuring that we support better, particularly if they face complex challenges. And so what I described yesterday and today, seeing how we can weave a closer social safety net and having better social health integration in the community.
In terms of ComLink which I articulated yesterday, for the four centres that we will open in the course of the next two years, we hope to outreach to 14,000 families in rental housing with young children, and work with them proactively.
In terms of resources, I am very appreciative of Members who have in this House openly sought more resources for MOM and MSF from the Finance Ministry in order for us to better strengthen this network.
But we cannot work on our own. We work very closely with our partners, with our VWOs, those in the Family Service Centres, child protection agencies, adult protection, family violence, as well as divorce support, and community groups including the grassroots. This last mile connection on the ground is not something that any single agency can do on its own.
Mr Louis Ng Kok Kwang (Nee Soon): Just a quick clarification for the Senior Parliamentary Secretary. I think him for saying that we saying that we will be providing more support for non-working mothers. Could I just clarify that the non-working mothers will now be able to get the full basic subsidy of $300, as well as the additional subsidies?
Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, I thank the Member for the question. As I mentioned earlier, there are two circumstances which I highlighted: the non-working mothers who are looking for work and non-working mothers who are looking after younger children.
Nevertheless, I would like to assure Mr Louis Ng that we would do our best to help every mother here. We want to see how we can facilitate care-giving, and at the same time, support them financially. So, if there are issues or things that matter that the non-working mothers are not clear about or would want to get support for, I would like to urge the families to approach any of the operators or ECDA where they can apply for special approval, and we will look at these circumstances on a case by case basis. So, our intention is to help them, support them so that we can give the best start for our children.
Ms Tin Pei Ling (MacPherson): I have a few clarifications. First, I would like to ask Minister, to what extent does the SSO access applicant's wealth and assets when determining how much assistance to provide. I am asking this in the context of data. With increasing availability of data, with the advancement of technology, how might the SSO make use of this to do so, to ensure social equity?
Second is the Community Kin Service (CKS) and the Professional Deputy and Donees (PDD) sounds quite similar. May I just ask, how are these two schemes differentiated, how do they complement each other? And therefore how do we position this to our residents and can the publicity towards this two schemes be increased just like Lasting Power of Attorney (LPA). A lot of them asked about LPA, but they do not know much about these.
Mr Desmond Lee: Maybe before I respond to Ms Tin Pei Ling, I also want to make a clarification in response to Mr Seah Kian Peng, it is not three SSOs, it is four SSOs that are opened on a Saturday, half-day, but again I reiterate that the key is we will look into this in terms of better service outreach while certainly making arrangements to accommodate the needs of our clients if they are unable to meet us during office hours.
In response to Ms Tin's query, she is right that with technology and data and with the proper linkages, we will be able to do a couple of things. One is to make sure that in relation to specific applications, say for ComCare and other forms of support by clients and beneficiaries, we should be able to have a more accurate triangulation to determine means.
Second, it should be more convenient and less of a hassle for clients to have to keep churning out documents, especially if we can get them from other agencies. So, these are the two things.
Third is that, this is work in progress. This is a piece of work that we need to undertake with a number of the agencies. As for CKS and PDD, I will let my colleague respond.
Mr Sam Tan Chin Siong: Mr Chairman, I thank the Member for the clarification. The difference between CKS and PDD is that, PDD helps persons who lost the mental capacity to make major decisions like liquidating the assets, bank accounts and all that, to provide institutional care or some other major financial needs. Whereas the CKS is to involve VWO partners in the community to help seniors who have lost their mental capacities to deal with the day to day living activities, like buying food, getting monies to pay for services likes utilities and so on. So, these are the two services.
For the second question of publicity with greater awareness on CKS, we just piloted this service not long ago. We are still in the pilot stage, once the project is piloted, when we decide it is a good scheme to roll out in the community then we will also roll out publicity. So, it is coming.
Mr Speaker: Mr Seah Kian Peng, would you like to withdraw your amendment please?
Mr Seah Kian Peng: I would like to thank Minister Desmond Lee, Minister of State Sam Tan, Senior Parliamentary Secretary Faishal Ibrahim for the replies and clarifications. I have been speaking at the MSF COS for the last 13 years. I cannot help but detect the number of cuts and the time allocated has been declining. This is one trend we like to see, but as the Minister had said, even though issues are fewer, they are becoming more complicated, more complex and it requires all of us in this sector to work more closely together.
I just want to, on behalf of all Members who spoke, extend our appreciation to everyone in the Social Service sector for their hard work, for their commitment, for their dedication. It takes all of us to make Singapore a more caring, more inclusive and a more giving society. It is my pleasure to beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $2,902,846,300 for Head I ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $115,657,400 for Head I 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\".
I know of a man, now in his 70s, who had been smoking since his teens. No amount of persuasion, threats, nicotine patches or counseling could make him quit. And then, he was hospitalised for a minor heart attack a few years ago, and he has not smoked since. That man is my father.
I know of a woman, also in her 70s, who cares about so many people around her, but despite her advancing years somehow never got around to going for health screening, despite the urging of her family, and although she herself would urge her family to go for regular health checks. And then, one day her group of friends decided to go for a health check at the nearby polyclinic, and because it was their regular meet-up for lunch, she decided to just tag along, had the very first mammogram of her life, which detected very early stage breast cancer, which was then quickly and safely removed. That woman is my mother.
Much has been written on how one’s attitudes to health and health seeking behavior can be changed. It can be due to some catastrophic event, such as the onset of disease but in the absence of such event, what else can be done to nudge someone towards better health practices?
You would think that any reasonable person would take the appropriate steps to stay healthy, but we smoke, we drink more than we should, we eat too much, exercise not too much, and so on. We emphasise health education, we try to \"game-ify\" healthy practices such as the 10,000 step challenge. We penalise poor choices with sin taxes. Against tobacco, we have cornered the industry at every turn short of an outright ban. But still, ill health in our society remains frustratingly, maddeningly sticky. Some years ago I was proud to mention that Singapore was the Healthiest Country in the World. Disappointingly this year we have dropped to eighth position from fourth position a year before.
In terms of healthcare, the system in Singapore remains affordable and accessible, and of very high quality. But rightly, over the past few years Singapore has shifted more and more resources towards health promotion and maintenance, rather than to costly medical services. Part of the three key shifts espoused by MOH.
I believe that choosing and maintaining healthy lifestyle choices can only be achieved if there is a community and whole-of-society approach – a support structure that positively reinforces such behavior. Just like recidivism among ex-offenders can only be drastically reduced by strong family and community support, many studies show that if we encourage each other at every opportunity then we will find it easy to live healthily. Hence, we have to be healthy together, as it is difficult to stay the course alone. We often go for health screenings on the encouragement of friends and loved ones, maintain our diets with the support of friends and family, and quit smoking when we want to do it for the betterment of both ourselves and our families.
It is vitally important that the Government supports this whole-of-society effort. I was very happy to learn of the new multi-agency task force that has been set up to drive health promotion. I understand that “it will coordinate and synergise efforts across multiple public agencies, to nudge Singaporeans towards adopting a healthy lifestyle”. Can the Ministry provide an update on the progress of this task force?
With regard to diabetes, we are now in the third year of a long and bruising campaign against diabetes. What milestones in our war on diabetes have been achieved? Sugar is indeed the enemy. From December last year till January this year, MOH sought views on four proposals: (a) a total ban on pre-packed high-sugar drinks; (b) single or tiered taxes on high-sugar drinks; (c) mandatory front-of-pack labelling on sugar/nutrition content; and finally perhaps even (d) a ban on advertisements for high-sugar drinks on all platforms.
Has a decision been reached following the public consultation on possible measures for pre-packaged sugar-sweetened beverages? Is the Ministry still considering a tax on sugar?
Singapore also hosted the inaugural Ministerial Conference on Diabetes in November of last year. The Conference brought together more than 300 international and local delegates, including health ministers, senior government officials, academics and thought leaders from 18 countries. What are the takeaways from the inaugural Ministerial Conference on Diabetes in November last year?
Moving on to alcohol, concerning alcohol intake, I would like to follow up on a recent Parliamentary Question (PQ) I filed concerning recommendations about alcohol consumption. MOH’s current recommended limit for regular alcohol consumption is two standard drinks a day for men and one standard drink a day for women. I think we should review this recommendation in view of the latest findings that there is in fact no safe level of alcohol consumption.
A systematic analysis of scientific evidence that was published about alcohol in the Lancet in September last year, concluded that: \"Alcohol use is a leading risk factor for disease burden worldwide, accounting for nearly 10% of global deaths among populations aged 15 to 49 years\", very young, \"and poses dire ramifications for future population health in the absence of policy action today. The widely held view of the health benefits of alcohol needs revising, particularly as improved methods and analyses continue to show how much alcohol use contributes to global death and disability. Our results show that the safest level of drinking is none. This level is in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks a day\".
Regarding dementia, I note that there have been cuts filed on mental health, but I would like to ask about our national strategy to deal with dementia. With longer lifespans and an ageing population, comes an increase in the number of patients with dementia. I would like to ask how can we prevent or delay its onset, increase diagnosis rates and provide the necessary support and long-term care for patients with dementia? What is the progress on the expansion of dementia-friendly communities?
Let me now move on to obesity. How are we tackling obesity? In Singapore, the percentages of overweight men and women are expected to increase to 36.5% and 21.7% respectively by 2025, according to the World Obesity Federation. In 2017, MOH figures showed that 36.2% of Singaporeans aged 18 to 69 years and 13% of children in mainstream schools are overweight.
In addition to measures to curb sugar intake that are alluded to earlier, are there also efforts to reduce fat intake in our diet? What about efforts to increase participation in regular exercise and sports?
Finally, let me touch on Health Screenings and Immunisations. The Screen for Life (SFL) programme I believe is a landmark initiative as early disease detection typically supersedes any medical treatment for established disease. I would like to ask how can we encourage more Singaporeans to take up the SFL programme for health screenings and post-screening follow-ups?
Although heavily subsidised, many older Singaporeans, and many of them live in my constituency of Queenstown, still maintain the attitude that it is better not to know about their health conditions, or are concerned that screening examinations are too inconvenient or too difficult or too onerous for them.
Since November 2017, adult Singaporeans can now use their MediSave to pay for vaccinations which MOH is recommending depending on their age and health status. It is the latest step in the push to encourage preventive care. The new National Adult Immunisation Schedule (NAIS), which lists who should be vaccinated and when, includes immunisation for diseases such as the flu and hepatitis B.
How has the response been? What is the proportion of adults who have had vaccinations since? Are we still seeing 100% coverage for children under the National Childhood Immunisation Programme? I know that there has been cases of parents who have refused due to misconceptions about potential side effects of vaccinations for the children. How can MOH reach out to them and convince them of the benefits? And finally, I would like to ask, are there more diseases of public health importance that can be addressed by a nationwide programme of immunisation? Thank you and I beg to move.
[(proc text) Question proposed. (proc text)]
Prof Fatimah Lateef (Marine Parade): Sir, we have a strong healthcare system, with strong, sound fundamentals. One of the most important characteristics that keep us at the forefront is the ability to robustly adapt and be dynamic. And this is unique in terms of healthcare because it is an area that is rapidly changing and developing. But this journey never ends. It is going to have to continue into the future. I have five areas that we have to focus on moving ahead.
Firstly, the balance of quality and affordability. We have been doing this a lot. We have been reviewing our policies, we have been liberalising, we have been doing all kinds of things and tweaking according to the needs of our population as we move into the future. We must continue to do this. We must review at regular intervals and we must make sure that we tweak accordingly and appropriately as well.
The second area is really to embark on new models of care. This must be more in terms of ambulatory, more community based, more home-based care, more step down care and more intermediate care needs as we move forward with an ageing population. There will also be a need to review more preventive services and to have these made more widely available and accessible.
Thirdly, manpower. We need an adequate projection of numbers into the future of the pipeline for provision of care of the types of different healthcare personnel that we will need. The demand will be high in an industry which is really labour intensive. Our graduates from our traditional schools and institutions will continue to churn out numbers but the numbers will need tweaking as well and this will have to meet our demands. Perhaps also tapping on the retired personnel, who are still healthy will be an option to consider moving into the future.
In terms of innovation and productivity, healthcare, as I said, is a labour intensive patient-centric so we need to review that appropriately as well.
Fifth, it is data-driven healthcare which is really a must moving into the future. This will help us formulate guidelines and policies. KPIs must be reviewed regularly as well.
With all that in mind, I would like to ask Minister: first, on our healthcare productivity – how are we doing and how are our targets set and how are we moving ahead with this? Secondly, what will be MOH regulating framework for adopting new models of care for Singapore moving ahead with ageing on top of our minds. And, thirdly, can we also have an update on the progress of the regulatory sandbox licensing experimentation and adoption programme ( LEAP).
Mr Murali Pillai (Bukit Batok): Sir, in 2017, I suggested that MediShield Life coverage be extended to patients who are directly admitted to Community Hospitals. The Ministry indicated that it would study my suggestion.
In Bukit Batok SMC, where I serve, residents have benefited from a range of in-patient services provided by St Luke’s Hospital, a community hospital dedicated to the elderly sick, over two decades.
The services extended by the Hospital have increased significantly and now includes, in addition to medical care, palliative care, rehabilitation care and dementia care. A change in MediShield Life coverage will help residents in paying for these \"cares\".
The hon Minister responded in 2017 by stating that MediShield Life was designed to provide coverage for large acute hospital bills and there is a need to guard against costs escalation. I would respectfully point out that there are benefits in right-siting the care of the patients at an appropriate healthcare institutions so that precious resources in acute hospitals are not stretched. I would be grateful for an update on this matter.
Ms Sylvia Lim (Aljunied): Mr Chairman, while SCDF ambulances attend to about 90% of emergency cases, consumers will call for private ambulances in emergency cases if they wish to send a patient to a preferred or private hospital and in non-emergency cases. For the consumer, however, the current lack of regulation has meant that there is patchy information on available services and vastly different consumer experiences. On the one hand, I have personally had good experiences with private ambulances. On the other hand, I hear less happy accounts from residents. Such feedback include high charges and a lack of advance disclosure or transparency about the costs of various services and equipment. others include asking the family to decide if certain equipment should be used en route which laypersons have little knowledge on.
Another concern is that private ambulances attending cases at HDB flats may not have the stretchers that can be manoeuvred into an incline position to fit the size of HDB lifts. The quality of the vehicles is also disparate with some ambulances apparently retrofitted from cargo vans. Some businesses insist on taking cash payments only which can be stressful if the charges come up to about $1,000 to be paid by the family in the middle of the night.
It was recently reported that regulation is coming in the form of the proposed Healthcare Services Bill. While this is welcomed by consumers as well as industry players, there are some concerns. One concern is the proposed distinction in licensing requirements between those operating emergency ambulance services and those operating medical transport services. The current proposal is that those licensed to provide emergency ambulance services would have more stringent requirements. For example, they will need to appoint a clinical director to maintain standards of comprehensive emergency care, to conduct audits, do training and protocol development.
In contrast, businesses who provide medical transport services in non-emergency cases do not need to meet the same standard but will have operational restrictions. For example, they will not be allowed to have blinkers and sirens. Operators have pointed out that patients who are initially stable cases can deteriorate suddenly en route to the hospital which will turn a non-emergency situation to an emergency one. When this happens, time is of the essence and blinkers and sirens may make all the difference. What is the status of MOH's review of the regulation regime?
Finally, to better facilitate consumer choice, could the Government arrange for a one-stop portal for consumers where they can evaluate the offerings and consumer feedback of private ambulance services? As for the reasonableness of the charges, will the Government consider publishing fee benchmarks so as to keep this essential service affordable.
Dr Chia Shi-Lu (Tanjong Pagar): Mr Chairman, the CHAS programme, I am happy to note, has progressed significantly since its inception. Today, the majority of General Practitioners (GPs) clinics support it. A new CHAS card for chronic disease management was announced by the Prime Minister last year and I would like to ask for more details about this new card.
As the new card will cover all Singaporeans for chronic conditions, regardless of income, we can expect greater demand for the services of participating GPs. Does the Ministry expect more GP clinics to join the network and can we look forward to a 100% participation rate? What are the obstacles that still prevent clinics from joining? What plans does MOH have to help them?
Given the rise in median household incomes over the years, I would also like to ask if the qualifying income criteria for the Blue and Orange CHAS cards will be revised and also, if the benefits can be revised upwards, in addition to the new benefits announced, that is, the increased subsidies for complex chronic conditions and the extension of subsidies for common illnesses to Orange cardholders.
MOH has also stated that it aims to strengthen the private primary healthcare sector. MOH started the Primary Care Networks (PCN) scheme in January 2018, where GPs come together to provide holistic team-based care for their patients. Would MOH please provide an update on this scheme? It was announced during the Budget Statement, that the Ministry “will be looking at how to help CHAS clinics better track their patients’ progress and outcomes”. Can this tracking process also be enabled at the PCN level?
Mr Low Thia Khiang (Aljunied): Mr Chairman, Sir, personalised medicine involves the customisation of medical treatments to specific patient groups based on genetic profiles.
At last year’s MOH COS, I asked the Minister whether MOH was on track with drafting the code of practice for clinical genetic testing. Minister replied that the Ministry was developing an integrated national strategy for precision medicine research and implementation; and would provide a thorough update at an appropriate time. It has been a year since, hence, I would like to ask for an update.
There have been reports that hundreds of patients have benefited from personalised medicine treatments at our public hospitals. I would like to know how many Singaporeans have benefited to date?
I have three concerns. First, precision medicine is a fast-developing field of clinical research and application. I am concerned that the longer we take in enforcing the code of practice and implementing the national strategy, developments in the field would have outpaced the code and strategy.
Second, if a substantial number of Singaporeans have already obtained personalised medical treatments, then the delay in enforcing the code of practice may expose these Singaporeans to the misuse of their personal and DNA data, medical risks associated with DNA-editing and other bio-ethical risks.
Third, last November a Chinese scientist used gene-editing technology in an experiment that led to the birth of the world’s first genetically modified baby. There was an international uproar and the Chinese Government is putting in a regulatory regime now in response. I am concerned that the longer we take, in regulating precision medicine and genetic testing, we may run the risk of such an incident happening here that will damage our reputation as a biomedical R&D hub.
Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Mr Chairman, the SingHealth's cyber attack and HIV Registry leak have shaken confidence in the security of our personal and patient information and health records. Learning from these events, how will the personal and patient data be kept in NEHR be better secured and protected against hacks and also leaks by administrators, doctors, finance staff and researchers.
In 2018, a joint survey on public sentiments towards the NEHR showed that over 11% of respondents said they would prefer to opt out of the NEHR and 56% said they would like to have their records maintained in NEHR but do not want any healthcare provider to access it without their explicit consent except during emergencies. This negative sentiment preceded the SingHealth's cyber attack and HIV Registry leak. Thus, the Government will need to get better buy-ins for the NEHR from the public now. Should the NEHR be minimally covered by the PDPA and the data protection regime that provides for additional safeguards and is patient-centric? Such a move can improve public confidence as many are now familiar with the PDPA framework. Small private clinics will need extra help to secure the data.
Ms Sylvia Lim: Mr Chairman, Singapore has been centralising patients’ health records through the National Electronic Health Record System (NEHR). The benefits of convenience are evident. Patients can go to any healthcare facility and receive treatment that takes account of their medical history. However, the recent MOH data leaks and the cyberattack on SingHealth, have shaken the public confidence in such centralised electronic health records. These incidents targeting patients’ personal records are reminders of the risks to privacy and security that accompany convenience, risks which we had not understood or taken seriously enough.
MOH has announced that primary care providers such as private GPs will be required to enter case notes into the NEHR. This has been held in abeyance while MOH does a thorough of cyber security. However, even before the recent breaches, some GPs in private practice told me they had grave reservations about the impending requirement for them to key in confidential data about their patients into the NEHR. They cited that they had a duty of doctor-patient confidentiality and were not comfortable keying in the medical conditions and drugs prescribed to patients, for review by unknown persons down the line. In view of the potential for unauthorised access or leaks, they would also be reluctant to put in sensitive information, however relevant to treatment.
Sir, we must acknowledge that even with the best fortifications, cyber defence is an endeavour that pits us against potentially the most technically advanced and resourced hackers in the world. There is also the risk of disgruntled or rogue employees who can exploit legitimate access for improper purposes. As it is impossible to completely prevent hacks and data breaches, one key concern would be to limit damage in the event of breaches.
To mitigate the risks and fallout from data breaches, common and effective measures include improvements in ways to store and access information, such as data compartmentalisation and restrictions on authority. For instance, it would be odd for persons responsible for macro-level policy to access personally identifiable information. It would also be unnecessary for staff not attending to a particular patient to access the patient’s records. There may be particular sensitivities if certain information gets into the wrong hands. In view of all this, I would like to ask what the Ministry of Health has done, or is doing, to compartmentalise data and limit who can gain access to data stored at MOH and at the healthcare providers it regulates.
Mr Christopher de Souza (Holland-Bukit Timah): Mr Chairman, patient data is often – and sometimes very – sensitive. It is personal as it may contain information relating to medical conditions and diseases that the patient may want to keep private. The release of this information could cause turmoil to the patient and his or her family – leading to serious stress in relationships. To ensure IT and cyber security specialists operating within the specialised sphere of medical information are trained well and that standards are kept high across health clusters and the many hospitals, would the MOH consider setting up a Medical Cybersecurity Academy to train a core group of medical cybersecurity specialists, share best practices between them and then steadily raise the industry standard such as to protect medical records and the related information contained in them?
Ms Tin Pei Ling (MacPherson): MediSave, MediShield Life and Medifund are the three pillars of our public healthcare financing system supporting the healthcare needs of all Singaporeans. These are on top of the universal Government subsidies available. On top of these, the Government introduced different schemes to help Singaporeans, especially the elderly, better cope in their old age.
Objectively, we know that public healthcare expenditure has more than doubled within a short span of five to six years. Singaporeans’ average out-of-pocket expenditure as a percentage of bill size has also trended downwards.
Still, worries about healthcare affordability persist. Some Singaporeans genuinely cannot afford it, some struggle to pay it off, and some do not even seek treatment because they do not know if they can afford it.
For the low-income, they can apply for Medifund or public financial assistance if they pass the means test. This will cover their medical expenses in public healthcare settings. In the course of my community work in MacPherson, I have met many low-income residents, especially vulnerable elderly, receiving full medical coverage under such schemes. This is assuring to observe. However, for the average Singaporean, the ability to afford or continue to afford is less certain.
Hence, I would like to ask the Ministry how ready is an average Singaporean in coping with his/her healthcare cost, especially in old age? Could the Ministry share the calculations and projections? Could the Ministry compare how an average retiree today and an average retiree in, say, 2030 or beyond, cope with their expected healthcare costs? Is our current public healthcare financing method sustainable?
Mr Leon Perera (Non-Constituency Member): Sir, Singaporeans are still concerned about the cost of healthcare. A recent REACH survey concluded incidents like the recent furore of MediShield Life not covering much of a certain bill, do not help. Some Singaporeans go to Johor Baru (JB) to purchase medication.
Other than other pocket expenses, there is concern that premiums for MediShield Life and IPs may rise in future. Thanks to healthcare inflation.
Going forward, can we find cheaper ways to deliver the same healthcare outcomes? Value-based healthcare (VBH) which was conceptualised in the University of Utah in the US is a healthcare delivery model in which providers, including hospitals and doctors, are paid based on patient's health outcomes. Value-based care differs from paying providers based on the amount of healthcare services they deliver. While it is hard to summarise how this works in practice in under two minutes, it involves practices like sharing of data across physicians, to prevent redundant testing and adjusting payments to hospitals based on good care practices.
While there have been trials by organisations, no national healthcare system has implemented VBH on a national level yet. But I understand that many companies are developing solutions for VBH in anticipation of an eventual VBH revolution in healthcare. Amazon, Berkshire Hathaway and JP Morgan Chase have a joint venture to champion elements of VBH as a disruptive healthcare solution.
I understand that NUHS has adopted a value-driven outcome initiative (VDO). NUHS states that the true ideas from VBH concept from University of Utah and has shared the concept with public healthcare clusters in Singapore.
I would like to ask the Government whether it would study the VBH approach, conduct pilots and move towards a comprehensive adoption of VBH or its equivalent across the entire healthcare system if results are positive. If so, when is the target date for a more broad-based adoption of VBH and would a roadmap be published?
Assoc Prof Daniel Goh Pei Siong: Chairman, from 2020, severely disabled Singaporeans will be allowed to draw up to $200 a month from MediSave for long-term care needs. However, this is very limiting for those with more than $20,000 in their MediSave Accounts. This is especially if the long-term care is the only medical cost that they have to deal with, and that which the care is effective and preventive, it will minimise additional medical expenses.
The current limit of $200 is prime for 100 months. However, the median duration of stay in a nursing home is 59 months. Why not peg the limit to the median duration instead? The Government should consider increasing the maximum quantum to $600, scale up according to the amount in the member's MediSave savings.
If the Member has $20,000 in his/her MediSave Account, he/she can draw up to $300 a month as $20,000 will cover 60 months of stay in a nursing home. If the member has $40,000, he/she can withdraw up to $600 a month. This may be a more efficient and effective way for severely disabled Singaporeans to make use of their MediSave savings to meet their long-term medical needs.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Sir, as Members of this House, I believe many of us may have been asked by residents, relatives, friends and acquaintances who are unhappy with the use of CPF, on why should there be a limit set for the use of all MediSave money and why is the allowable amount to be utilised annually so minimal.
Sir, for the first question on the limits set for the use of MediSave, I will share with them MOH's explanation, that is, the setting of the withdrawal limit is with the intention to ensure that Singaporeans have sufficient in their MediSave Account for their basic healthcare needs in old age.
For the second question, my reply would be, \"Sorry. I do not have the answer.\"
Therefore, Sir, I would like to ask the Ministry the following questions pertaining to MediSave withdrawal limits.
One, how is the withdrawal limit amount as well as the incremental amount being tabulated and arrived at? Is there any specific formula applied and if yes, can the Ministry share this formula?
Two, how regular is the review on the withdrawal limit conducted? Is there any specific cycle or is it on situational basis, for example, review will be conducted when there is an inflation in the healthcare cost?
Third, who are involved in this reviewing process?
Sir, the answers to the above questions may not be able to address or lessen the unhappiness. However, it will provide some clarity and transparency on the matter.
The Chairman: Mr Pritam Singh, you can take your two cuts together.
Mr Pritam Singh (Aljunied): Sir, this cut seeks to explore whether the Ministry can grant Singaporeans greater flexibility to use more of their own MediSave to pay their hospital bills. This is particularly for bills which are not covered by MediShield Life or because the amount owing is within the deductible limit and hence, must be settled solely by the patient in cash or MediSave.
In such cases, MediShield Life does not kick in because it is meant for larger hospital bills. While MediSave can be used, it is subject to limits and, in many cases, a few hundred dollars will still have to coughed up in cash. I believe there is scope for the Government to exercise some flexibility and give Singaporeans the choice of allowing the entire remaining amount after subsidies to be paid by a patient's Medisave instead of cash, bearing in mind the matter involves a hospitalisation.
For citizens with sufficient MediSave balances, and who are in their senior years from the age of 60, in particular, some additional flexibility in terms of choice, would bring significant peace of mind, leaving cash in their pocket.
I hope the Government can look into this to reduce the out-of-pocket expenses for this category of Singaporeans. For example, can the Government consider a tiered-withdrawal quantum for those above 60, not too dissimilar from the MediSave withdrawals for Long-Term Care announced in July last year to achieve a sustainable balance between the use of member's MediSave savings for the immediate term and the future respectively?
Chairman, Sir, CareShield Life and MediShield Life are both compulsory schemes with the former soon to become a central pillar of our healthcare system. The public cannot opt-out of either scheme and this fact alone brings into sharp focus the premiums of compulsory risk pooling schemes. It would follow that the adequacy ratios of such schemes and the Government's reasons and assumptions behind premium pricing should be made more transparent so that the public can understand the factors behind premiums calculation.
One of the pain points that was manifested through public discussions prior to the debate in this House on the CareShield Life White Paper last year surrounded the fact that from 2002 to 2016, ElderShield collected $2.6 billion in premiums, and only slightly in excess of $100 million was paid out. The importance of pre-funding for such schemes aside, a general lack of understanding contributed to the public dissonance on the issue, as the numbers suggest over-collection of premiums. I appreciate that the actuarial models that determine how premiums are priced are complex and multi-faceted. Some factors include disability mortality, recovery rate, claims continuance rate, improvements to mortality as well as the risk profiles of various cohorts amongst others.
However, complexity should not be a reason to avoid publishing these considerations and the weightage of the calculations behind them. With the upcoming legislation of CareShield Life, I hope these assumptions and considerations can be meaningfully communicated to all Singaporeans.
On a similar note, I would like to enquire about the frequency with which MediShield Life's adequacy ratio is reviewed by the MediShield Life Council and considered by the Ministry, so as to ensure that the greater transparency on reserve requirements called for in the MediShield Life Review Committee report are meaningfully operationalised. I understand the FAQ section on MediShield Life on the MOH website provides a helpful table, setting out the incurred loss ratio of the scheme each year.
Can the Minister share, in light of MediShield Life transitional subsidies ending this year and the incurred loss ratios over the years exceeding 90% so far, does the Council foresees an increase in premiums in the near future?
Sir, I believe transparency can help control healthcare costs by widening debate and scrutiny. It also helps create the peace of mind that all is done to ensure the affordability of these compulsory insurance schemes. In the absence of such knowledge regarding spending, insurance may be inaccurately perceived by some as a pure tax, rather than a risk-pooling scheme that is closely tied to each participating cohorts' expected benefits.
Mr Christopher de Souza: Mr Chairman, arising from feedback I received from Singaporeans who went through difficulties during and after giving birth to their baby, I had asked in October last year whether MOH could consider extending additional financial support for expectant mothers who find it difficult to obtain maternity insurance from private insurance companies due to previously-experienced pregnancy complications. MOH said then that a review was being conducted for serious pregnancy and delivery complications. Could MOH provide an update on the review, please?
Mr Mohamed Irshad (Nominated Member): Mr Chairman, from 1 April 2019, Singaporeans who purchase new Integrated Shield Plan riders will no longer be able to purchase \"full-rider\" policies and must be prepared for co-payment of at least 5% of the medical bill.
The Health Ministry explained that this change is aimed at \"full rider policies which encourage a \"buffer syndrome\" which leads to over-consumption, over-servicing and over-charging of healthcare services, which could, in turn, lead to higher fees and premiums over time. I support this but it looks like most of the abuse comes from patients in private hospitals.
The Straits Times reported that the average total in-patient bill in the private sector has increased by 9% each year over the last 10 years, from 2007 to 2017. This is almost double the 4.9% increase for bills in the public sector's Class A wards.
From the numbers, it looks like there is lower risk of over-spending in the public hospitals. The less financially savvy patients rely heavily on the hospital and their doctors to determine the course and cost of treatment. This risk is further mitigated by the implementation of cost benchmarks in public hospitals.
In that light, will the Ministry consider having co-payment on Integrated Shield Plan riders only for private hospitals and have zero or lower co-payment for claims relating to public hospitals?
Ms Joan Pereira (Tanjong Pagar): Sir, I would like to ask the Minister what measures the Ministry has in place to ensure that healthcare remains accessible to all, its costs affordable, and whether more subsidies for a wider range of generic drugs can be included.
First, one of the most effective ways to keep costs down is to provide transparency, thereby encouraging healthy competition among providers. Patients should have access to more information which include not only fees but also standard or quality of delivery.
Presently, fee benchmarks and bill amount information for common surgical procedures for both public and private hospitals are available on MOH's website. I hope it is also possible for MOH to provide more qualitative information.
Second, besides providing more subsidies for more generic drugs, additional assistance for needy patients for drugs should also be well-understood by all public hospital staff so that they can advise patients accordingly. This issue was highlighted in the newspapers recently by members of the public. It appeared that the affected patients and family members were not informed of the Medication Assistance Fund (MAF and MAF Plus), which is different from Medifund. MAF subsidises non-standard drugs prescribed for Pioneer Generation or Community Health Assist Scheme (CHAS) cardholders.
Finally, may I request for the Ministry to look into increasing our Seniors' Mobility and Enabling Fund (SMF) subsidies.
Mr Charles Chong (Punggol East): Mr Chairman, a number of speakers before me have already raised most of the points which I have so I will not repeat them and I will be very brief.
As Singapore's population ages, one of the issues which will be of increasing concern of our citizens is the affordability and the accessibility of healthcare. Given the importance and the relevance of this issue for most Singaporeans, I am sure the Minister will provide some updates on what is being done or can be done to ensure that healthcare remains affordable for Singaporeans. In particular, are there plans to use technology and medical advances to increase efficiencies, reduce doctor time and empower other professionals within the healthcare ecosystem such that costs can be contained?
Could the Minister also clarify the extent to which generic drugs are used as another means of reducing costs? I believe Ms Joan Pereira has already raised this. Could MOH also provide comfort to patients that generic drugs are just as efficacious as brand named drugs?
Dr Chia Shi-Lu: Chairman, the Merdeka Generation Package (MGP) is a wide-ranging and comprehensive package of measures that addresses concerns that the Merdeka Generation would have regarding healthcare affordability.
What are MOH's plans to reach out to the MG seniors to let them know about the MGP and support their aspirations for active ageing?
In particular, I note that the package includes a participation incentive of $1,500 to join CareShield Life on top of the previously announced $2,500. The total incentive of $4,000, together with the higher lifelong payouts, should be highlighted to the seniors during outreach activities, as they may be concerned about the higher monthly premiums.
With longer lifespans, the risk of more seniors facing severe disability in their latter years is higher. We can see for ourselves today, within our communities, many of the old-old, as we move from an aged society to a super aged society, and with the old-old defined as those age 85 years and above, needing help with at least three out of six Activities of Daily Living (ADLs) – washing, dressing, feeding, transferring, toileting and walking. This proportion is growing higher day by day. Affected seniors covered under CareShield Life will qualify for lifelong payouts, compared to only six years for the previous ElderShield400 system, and this will be very useful for paying for care assistance or necessary consumables.
Mr Leon Perera: Sir, on 2 March, Senior Minister of State Mr Edwin Tong announced that MOH will be doing a very comprehensive review of the entire medical regulatory landscape as overseen by the SMC, including reviews of disciplinary processes.
I have several questions and suggestions on how these disciplinary processes currently operate and what would be the parameters governing the pending review.
Firstly, the current process allows complainants to appeal to the Minister should they be dissatisfied with the ruling of the Complaints Committee (CC). I understand that MOH has signalled its intent to do away with this avenue of appeal in future. But that reform may take time to implement. For now, I would like to ask, how does this appeals review process operate within MOH? It would seem to be opaque to many in the profession. What expertise and skill sets and processes are brought to bear in considering such appeals within MOH and what sorts of personnel are involved?
Next, once a complaint is escalated to an SMC Disciplinary Tribunal (DT), it is my understanding that lawyers begin to play a key role in the process. What measures are being taken to minimise the legal fees incurred by the SMC for DTs which are paid by insurers, since this has the potential to elevate medical indemnity insurance premiums borne by doctors?
Next, will the review process yield changes to reduce the long time period often associated with the CC and DT processes? And can the Government consider if disciplinary action for more minor complaints can be addressed by a different form of committee than a DT, to reduce the considerable time and cost associated with the DT process.
Lastly, the Government currently appoints the majority of members of the SMC. What is the Government doing or will do to correct any perception now or in the future that the SMC is insufficiently independent of the Government? If any such perception took root, it may erode confidence among doctors of getting a fair hearing, which in turn could lead to things like defensive medicine, which can escalate costs and worsen efficiency.
Mr Christopher de Souza: Mr Chairman, allied healthcare workers such as nurses, physiotherapists and speech therapists play a key role in supporting the overall medical care of the patient. I had previously asked how we could formalise their continuing professional development, career progression, and the sharing of best practices within the allied health profession. Would MOH be able to provide an update on the steps taken so far to help achieve this outcome?
Mr Dennis Tan Lip Fong (Non-Constituency Member): Chairmain, demographics have only increased the demand for healthcare. In the Government's Healthcare Manpower Plan 2020, released in October 2016, the healthcare services estimated an addition of 30,000 healthcare workers by 2020. With more hospitals and polyclinics coming online in the communities to establish the key infrastructure for delivering healthcare needs to our people, it is time to look at the manpower available to operate and manage both new and existing infrastructure.
A strong local core is important as healthcare needs are better served with cultural understanding. I would like to seek clarification from the Ministry on the plans to build a \"strong local workforce\" in accordance to the Healthcare Manpower Plan 2020; how is the Ministry monitoring and ensuring that enrolment figures and local graduate figures translate to reinforcements to the nursing manpower, and then retaining the local graduates to meet the long-term plan of building a strong local workforce?
I ask as the number of local nursing graduates have been gradually decreasing since a peak of 1,744 graduates in 2012, to 1,479 graduates in 2015. During the COS debate in 2017, Dr Amy Khor stated that the foreign workforce for nursing is 33%. Even as we have learnt that the reduction in services DRC will not impact healthcare operations, how has this percentage shifted with the introduction of conversion programmes available at the tertiary institutions, such as SIT, and the push to increase intakes to the healthcare courses?
The retention rate of new healthcare workers will also be a key measure of sustainability of our healthcare operations. What is the attrition rate and average tenure of nurses and other healthcare workers? Is the suite of measures to retain the local graduate healthcare workers in the industry sufficient? And what are common reasons for healthcare workers leaving the workforce?
Dr Chia Shi-Lu: Chairman, besides doctors and nurses, Allied Health Professionals and TCM practitioners make significant contributions to our healthcare eco-system. In a rapidly ageing country like ours, there will be greater demand for their services, particularly for therapists, psychologists, audiologists, dietitians and medical social workers, just to name a few. They are an integral part of a healthcare system which delivers comprehensive and seamless care.
Sir, I have four questions. One, how is MOH ensuring that we will have a steady pipeline of Allied Health Professionals, given the need for holistic care; two, will there be measures to upskill and better empower of nurses to take on a greater role in our healthcare system, given our tight labour market and the heavy work burdens of our nurses; three, in addition to the training and development of these professionals through the traditional career progression pathways, would the Ministry elaborate on measures to attract those interested in making a mid-career change to these professions; and lastly, how would the Ministry ensure that the remunerations of those in the public sector remain competitive?
Mr Leon Perera: Sir, I declare my interest as the CEO of a research consultancy that undertakes work in the silver industry, among other sectors. Voluntary Welfare Organizations (VWOs) figure prominently in the Intermediate and Long-Term Care (ILTC) sector. It is in our interest to ensure that these VWOs flourish in the long-term and become sources of good quality care.
I have a few questions and suggestions for improving the intersection between the Government and VWOs in ILTC, though some of these points may apply to private sector developers and/or operators of ILTC facilities as well.
Firstly, the tendering process takes into consideration a range of factors, but by virtue of convention, public tendering tends to create pressure on bidders to bid higher or lower, if it is a tender for operating services and not land. And this is not a bad thing, value-for-money is an important consideration.
Nevertheless, the ILTC sector is a space where innovation and experimentation is still relevant. There should be space for facilities in our ILTC sector which are unorthodox, and which may come with a higher price tag, as it were. What is the consideration given to striking the right balance between quality and innovation on the one hand and cost on the other?
Secondly, what steps are being taken by the Government to further empower and help VWOs in the ILTC sector in terms of funding, manpower and organisational development? Capacity-building is one area where VWOs may face challenges.
Lastly, in growing the ILTC sector, the VWO sector may need to be augmented by the private sector, which has potentially a substantial capacity to invest financially, as well as, in some cases, to deploy relevant, cutting edge technology. What is the Government doing to engage and support good companies to invest in this sector and possibly to partner with our VWOs?
Prof Fatimah Lateef: Sir, advanced care planning is a sensitive area, and more so in our multi-religious and multi-ethnic society. Many lack the genuine understanding of what it is, and it also stems from the fact that it is a taboo subject many choose not want to talk about and they feel discomfort in discussing it. It cuts across all ages because talking about death and the end of our lives is really not the easiest thing.
As a result many lack the understanding and may be unaware of the important decisions and options they have or have to make, whilst they still can. In my work as an Emergency Medicine Specialist, people come in with critical and serious illnesses and presentations, many even stemming from many years of harbouring a chronic illness or diagnosis, and yet, not having an ACP done at all. We then have to discuss with them or the next of kin, at this critical juncture, in order to have a decision to be made pertaining to the level and depth of care and resuscitation they wish. Many grapple at this stage as they may not know what their loved ones wish for. They may never have broached the topic and have a sense of guilt can prevail.
Choosing to know, learn and decide on advanced care planning is really something we may need to do. How is the Ministry send out more educational messaging and campaigns, perhaps to be executed in a sensitive way and also perhaps working across Ministries – MOH, MSF and other partnering organisations, VWOs and NGOs; perhaps also getting our IROs and IRCC to talk as well in our society.
The Chairman: Minister Gan Kim Yong.
The Minister for Health (Mr Gan Kim Yong): Mr Chairman, I would like to thank the Members for their thoughtful comments. With your permission, may I share a slide at the end of my speech?
The Chairman: Yes, please.
Mr Gan Kim Yong: Dr Chia asked for an update on our overall healthcare system. Let me begin by reviewing our overall state of health. Singapore's overall health outcomes are generally good. The Global Burden of Disease 2017 Study (GBD) published in The Lancet ranked Singapore favourably as the country with the highest Life Expectancy. Our Life Expectancy at birth has risen from 83.2 years in 2010 to 84.8 years in 2017. Health Adjusted Life Expectancy (HALE) at birth also increased from 72.9 years to 74.2 years over the same period. But these figures also show that we are living about 10 years of our lives in ill health. For every 10 years we live, we spend more than a year in illness.
These findings are not surprising. The mortality rates due to cancer, stroke and heart diseases, have reduced significantly by 16%, from 2010 to 2017. This was made possible in part due to the early prevention, better treatment and disease management, which have contributed to our increase in life expectancy.
However, it is not time for us to celebrate yet. The recent Bloomberg report also reminds us that we need to keep up on our efforts. Data also shows that many of us are living with chronic illness. From 2010 to 2017, the prevalence rates of diabetes, hypertension and hyperlipidaemia among Singapore residents aged 18 to 69 years have increased by 4%, 14% and 33% respectively. This is partly due to an older population, but we cannot blame everything on an ageing population because it is also partly due to unhealthy lifestyles and habits. If these chronic conditions are not managed well, more serious conditions may result further down the road.
On capacity and accessibility, we have stepped up our building programmes. We have completed seven hospitals since 2010 which will add up to about 3,800 number of beds when fully opened. In 2018 itself, we opened the new CGH Medical Centre, Sengkang General and Community Hospitals, and earlier this year, the new National University Centre for Oral Health Singapore commenced operations.
We also injected a significant supply of aged care services, especially in home and community care to encourage ageing in place.
We have been training and recruiting healthcare professionals to meet our manpower demand. The number of registered doctors rose significantly, by 52% over the period from 2010 to 2018. Local medicine intake increased by some 60%, from about 300 to about 500 today. Together with Dentistry and Pharmacy, the total intake now exceeds 700 a year and contribute to a strong local pipeline, reducing our need for foreign-trained professionals.
Registered nurses have also increased significantly by 44%. While we had a record local nursing intake of over 2,100 students last year, we will still need more, especially in the critical community care sector. Senior Minister of State Khor and Senior Parliamentary Secretary Amrin will share more about opportunities for nursing and allied health professions later.
Our expenditure on healthcare has increased, too. Since 2010, Singapore’s national healthcare expenditure has almost doubled, from $11 billion to reach $21 billion in 2016. Government Health Expenditure (GHE) increased even faster, by 2.4 times, from $3.9 billion to $9.3 billion. We have more than doubled the amount of direct Government subsidies given to Singaporeans from about $2.6 billion to $5.6 billion over the same period. And this has helped to keep healthcare affordable, especially for needy Singaporeans.
However, it is unsustainable for us to continue increasing our national healthcare expenditure at this current rate. And I agree with Prof Fatimah Lateef that our healthcare system has to transform the way it delivers care and we must continue to refine our way of funding healthcare services. As individuals, each of us must also take responsibility for our own health.
Our healthcare institutions are doing their part to transform their healthcare models. Polyclinics, for example, have been experimenting with new ways to enhance chronic disease management. The National Healthcare Group Polyclinics (NHGP) have piloted a teamlet care model since 2015. By assigning patients with chronic diseases to the same team comprising family physicians, nurse care managers as well as care coordinators, there is better continuity of care. As a result, patient outcomes have improved, with more regular preventive health screenings done, and visits to the doctors and emergency departments reduced. SingHealth Polyclinics (SHP) and National University Polyclinics (NUP) are also rolling out team-based care models.
Private GPs are our key partners in primary care, too. The Primary Care Network (PCN) started as a ground-up initiative by GPs from the Frontier Healthcare Group to share resources and improve chronic disease management. Senior Minister of State Lam will share more about the progress of the PCN scheme.
Similarly, we are working towards transforming care at the community level to better integrate social and healthcare services. Community care providers are also doing their part. Some of them are piloting innovative ways to enhance patient care and safety. For example, several of our community care providers, such as All Saints Home, have introduced new sensor mats to monitor residents’ movements so as to prevent falls and to provide better care.
To catalyse efforts on care transformation, we set up the MOH Office for Healthcare Transformation (MOHT) in 2018. MOHT has been working with partners to design innovative healthcare pilots, such as the new Integrated General Hospital (IGH) model piloted at Alexandra Hospital (AH). This model particularly benefits patients with multiple active conditions, who would typically be attended to by a few specialists during each admission. Under this new IGH model, one care team will look after each patient for better integrated care.
Let me give Members an example of Mr Kang Swee Hiang. Mr Kang is an 81-year-old senior who lives alone and was recently admitted to AH for uncontrolled hypertension. He has a number of active medical conditions but he was looked after by one care team, without transfers across wards and doctors. The care team found that Mr Kang's cataracts made it very difficult for him to take his medications and may increase future fall risks. The team then reduced the pills he had to take, and counselled him on how to take them properly. He also underwent cataract surgery and received physiotherapy, too. They also engaged community partners to schedule befriending and home care services, and connected Mr Kang to the Social Service Office for post-discharge assistance and support. AH is now working to consolidate his outpatient care under one principal doctor.
About 4,000 patients have benefited from Phase 1 of the IGH model, which focuses primarily on inpatient care. While efforts under Phase 1 will continue, MOHT and NUHS have commenced Phase 2, which aims to better integrate hospital care with community services required by patients living around Queentown. Dr Chia will be very happy to know that this pilot will be in Queenstown. It is still early days, and these efforts will need to be fully developed and evaluated before scaling up.
MOH will continue our care transformation efforts, in line with our strategy to move Beyond Hospital to Community, Beyond Quality to Value, and Beyond Healthcare to Health. However, there are a few key challenges ahead of us.
First, we have to strengthen the robustness of our healthcare IT systems, including data privacy and security. As highlighted by Mr de Souza, IT and data play an important role in our care transformation journey as they help to better inform policy, ensure continuity of care, and allow innovative care models to evolve. The NEHR system, for example, is an important, large-scale national system designed to better support patient care. Prof Goh and Ms Lim asked about the safeguards in place for NEHR to ensure patient confidentiality. Broadly, there are three levels of safeguards.
The first is the protection against cyber-attacks and unauthorised access. There are several lines of defences before the NEHR database, with intrusion detection at each line. Regular security audits are conducted, with the most recent penetration test done in October last year. In addition, there are ongoing robustness tests conducted by CSA, GovTech and an independent third party PwC. At the user level, the NEHR should only be used for direct patient care. There are strict controls to protect against unauthorised access. The NEHR system also does not allow users to download records onto workstations.
As highlighted by Mr de Souza, having well-trained IT and cybersecurity specialists familiar with healthcare is key. MOH, with CSA’s support, is working to ensure that technical training for our cybersecurity specialists meet industry’s best practices and standards. Good cyber-hygiene practices are regularly shared with all public healthcare staff.
But we must assume that persistent attackers will not give up and they will eventually get through, despite the strongest protection. Therefore, the second level of safeguards is having proper detection and enforcement measures to pick up any breaches quickly and escalate to the appropriate level for prompt investigation and containment. All NEHR accesses are logged and subjected to monthly audits, using analytics to detect unusual usage patterns. IHiS plans to roll out a feature that will allow patients to view accesses made to their NEHR records so that they, too, can report any suspicious access.
The third level is deterrence. We must take stern action against anyone who is responsible for data breaches, including our staff who have failed their duties. This way, we can ensure a strong data protection system.
Sir, our next challenge, as highlighted by many Members, is to keep healthcare affordable. As Mr Charles Chong pointed out, all stakeholders must work together to ensure that our healthcare system will be sustainable not just for our current needs but also for the needs of our future generations.
As our Minister for Finance has announced in his Budget speech, we will be launching the Merdeka Generation Package (MGP) this year. The MGP is our way of honouring this Merdeka Generation for their unique contributions in shaping the nation during our formative years. The Package is designed to support MG seniors in leading a healthy and active life as they age, and to provide assurance that they will be able to afford their care expenses. Senior Minister of State Khor will share more details on MGP later.
Senior Minister of State Tong will update on our proposed enhancements to the Community Health Assist Scheme (CHAS) so that all Singaporeans will have access to affordable quality primary care, especially for their chronic conditions.
Healthcare providers and professionals, too, play an important role in keeping healthcare costs in check, through ensuring efficient operations and abiding by appropriate pricing and clinical practices. We had introduced fee benchmarks last year to provide all stakeholders with a useful reference on appropriate fee levels. We have also studied best practices and approaches on value-based healthcare in the US and elsewhere – which Mr Perera asked about – and adapted it to our local context. It is also difficult for me to explain value-based healthcare in two minutes. So, I will try to be brief.
Since 2017, MOH has appointed a National Value-based Healthcare (NVH) Workgroup to look into this. By comparing standardised clinical quality indicators and cost data across our public healthcare institutions, it will help our healthcare providers to identify best practices among them as well as identify opportunities to improve clinical outcomes in a cost-effective way. More work will need to be done and we are continuing to explore this.
Insurance allows risks and resources to be shared across all members in the pool, helping patients to cope with large and unexpected healthcare costs. This is why we have MediShield Life and, soon, CareShield Life. We will continue to explore how we can further strengthen the role of insurance as we move forward.
Lastly, individuals have the responsibility of saving for our own healthcare needs during our working years, including through MediSave, to meet our future needs when we grow old. We also have the responsibility to make well-informed decisions to choose appropriate healthcare services.
But the most effective way to keep healthcare affordable is to stay healthy. The next challenge is, therefore, to take more decisive steps to encourage healthy living. Three years ago, I declared war on diabetes in this House. This is probably the only war that the Parliament has ever declared. We have made some progress but we do need to push harder. We held a Ministerial Conference on Diabetes last year and one of the key takeaways is that to tackle diabetes effectively, we need a coordinated effort by all stakeholders, not just MOH.
In the year ahead, we will step up our efforts on several fronts, reducing diabetes-related amputations, empowering patients and healthcare professionals to better manage diabetes and minimise complications. In particular, we are also recommending the use of non-fasting screening test for diabetes to increase screening rates, and will make early screening more convenient for women with a history of gestational diabetes. My colleagues will elaborate more on these efforts later.
Smoking is another area that we need to move more swiftly and strategically on. Tobacco use is the second-highest contributor to Singapore’s disease burden. More than 2,000 Singaporeans die prematurely from smoking-related diseases each year, and the social cost of smoking in Singapore has been estimated to be at least $600 million annually. We will continue to work on reducing smoking rates.
However, despite our best efforts to stay healthy, we may still fall ill and become frail as we age. Care-givers will need greater support as they will play a key role in caring for the sick and frail among us. With an ageing population and longer life expectancy, care-giving needs will rise, with family and informal care-givers playing an increasingly important role. Many will have to balance their work and family responsibilities. There is, therefore, greater urgency for the society to come together and collectively support our care-givers, and ensure that adequate “hardware” and “heartware” are in place.
Sir, allow me to share the story of Mr Tang in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] \tMr Tang, who is 42 years old, heads the business development department of his company. In the past year or so, Mr Tang has been caring for his 81-year-old father with dementia, together with his mother, wife and siblings. While his mother is the main caregiver, the other family members also take turns to help care for his father. Although Mr Tang and his family faced challenges adapting to his father’s behavioural changes, it was fortunate that his wife works in the healthcare sector, and the family was able to identify various avenues of support and help.
Nonetheless, not all caregivers are equipped with such knowledge, or have other family members to share the caregiving burden. With our ageing population, caregiving needs will grow and we need to strengthen the support for our caregivers. We need to increase awareness of the resources that are available to caregivers, and more systematically match these caregivers to the help they require.
(In English): I have spoken about our progress, transformative initiatives that can change our care models, and MOH’s focus areas for the next three to five years. But at the heart of our healthcare strategies, is people – people like you and I. MOH and our healthcare providers can only do so much. For every “top-down” programme, we need many “ground-up” support and initiatives. Each of us must actively take charge of our health, and come together as a community, or just as a group of friends, to support one another.
This is why I find the example of “Team Strong Silvers” so inspiring. Team Strong Silvers is small, but mighty. It is a group of friends with a common interest in health and fitness who decided to form a senior citizens’ interest group in 2013. Just like its name suggests, the members build up their strength through calisthenic exercises. The team hopes to encourage more seniors to age actively, and to inspire younger generations to invest in their health from an earlier age. I am glad to see the team actively spreading the healthy lifestyle message via social media and even carrying out on-site fitness training sessions for other seniors. With more seniors like them, I am hopeful that we will add more years of healthy life to our growing life expectancy. And when we replace “I” with “We” and do it together, “Illness” can become “Wellness”.
The Chairman: Every Wednesday, we will have Parliament running in the evenings. So, join us as well. Dr Lily Neo.
Dr Lily Neo (Jalan Besar): MOH estimates that one in two healthy Singaporeans aged 65 could become severely disabled in their lifetime, and may need long-term care. About 7% of the population or about 83,000 individuals in 2030 will have deficit in one or more ADLs. This is about two-and-a-half times today.
May I ask MOH whether there is any postulation on the healthcare services required to meet the needs of an ageing population especially the disabled seniors requiring long-term care?
Are we building enough infrastructure such as acute hospitals, community hospitals, nursing homes, dementia-care, palliative-care and respite homes and so on? Can we also provide more day care centres, dementia, rehabilitation, and respite day care centres, and senior activity centres? Are we training enough medical personnel to cushion the impending explosion on the need of healthcare providers?
Last year, the social aged care functions, under the Senior Cluster Network, was transferred from MSF to MOH. What are MOH’s plans to better support an ageing population with its expanded functions?
One important form of preventive healthcare is allowing seniors to remain active and independent within the community, and living in their own homes. This is because being active and independent in the community will facilitate physical, mental and social well-being of seniors. As what Finance Minister said, “The best way of protecting ourselves is to lead a healthy lifestyle”.
What is MOH doing to support seniors who wish to remain independent in the community?
Many seniors have expressed that they prefer to live for as long as possible in their own homes, in the familiar environment and in the community with families and friends. We should have policies to enable this. We should also encourage the community to come together to make this work.
Every few HDB blocks should have at least one senior activity centre to promote physical, mental and social wellness of the mobile seniors and to facilitate them to remain active and healthy in the community.
For frail seniors, the Ageing Gracefully @ Home (AGH) programme carried out by full-time shared care-givers that include nurses should be expanded, especially at HDB rental blocks. Under AGH, home visits are provided for these frail seniors with the following services: daily supervision on meals, blood pressure checks, medicine intake, home cleaning services, bathing, identifying people who are sick, medical assistance, hospital transportation and so on. VWOs can be roped in to provide the assistance to the seniors to fill the gaps.
We need to expand homecare expeditiously to allow seniors with medical conditions to remain in their own homes and in the community. This is especially useful after discharge from hospitals. Homecare in Singapore is at its infancy. Under homecare, MOH can facilitate services such as medical care-giving, nursing, medication, nutrition, occupational and rehabilitation therapy. Physiotherapy at home is especially crucial to allow earlier regaining of mobility from reversible medical conditions, such as mild strokes and surgeries. At discharge from hospitals, patients can be dispensed with mobility aids to facilitate independent living at home. Homecare aides can be recruited and trained to provide specific job scopes.
Transitional Care Programme by acute hospitals to help care-givers look after their loved ones at home enhances homecare and should be expanded.
Seniors with ADL deficiency need care-givers for their daily living. Care-givers can assist seniors live with dignity. Many care-givers are family members who also hold employments. Could our Government facilitate flexible work arrangements for care-givers? Would our Government also consider paid \"Care Leave\" for care-givers? It can be two weeks per year, for a start, similar to \"Parental Leave\" for fathers.
Care-givers can suffer \"burnt-out syndrome\" from emotional and physical fatigue. Could we have more respite care centres that are accessible and affordable? Could there be a one-stop centre for information and respite care referrals for care-givers. Many care-givers also get domestic helpers to assist them with their care-giving roles. However, many foreign domestic helpers are ill equipped to take up this role. Could we improve the know-how and enforce this area of domestic employment requirement?
The number of seniors who will live alone will double to about to 92,000 by 2030. Could we provide more housing adaptability to accommodate seniors’ mobility to facilitate independent living, as well as having seniors’ friendly environment in the vicinity, such as food centres, health facility, and wellness centres? Examples of housing adaptability are, doors for motorised mobility aids, appropriate-height kitchen table tops, hoisting aids to get out of beds, emergency call points and so on. Technology adaptability such as smart home aids for seniors, fall sensors, emergency medical detection sensors can enhance quality of life.
Ms Joan Pereira: Sir, as MOH had taken over the responsibility for Senior Activity Centres (SACs) from MSF, would the Minister share the update on plans for our SACs? I would also like to take this opportunity to share some suggestions which I hope can be considered for SACs’ future development.
Firstly, I hope that MOH will scale up and expand the number of SACs in all our estates to meet the demands of our rapidly ageing population. As a communal space for social and recreational activities, the number and capacity of the programmes must be able to cope with the higher demand which will come with more seniors taking up active ageing.
Second, I hope all SACs will have sufficient attached day care, respite care and assisted living facilities to provide a seamless experience for the elderly. Imagine a healthy, active senior who has taken part in SAC’s activities, transiting into its respite and day care services, and subsequently assisted living facilities, as he grows older and more frail. The proximity of all these to his home, the familiarity of the environment, staff, neighbours, fellow participants and volunteers will provide him or her with a lot of comfort and peace of mind.
Ms Anthea Ong (Nominated Member): Mr Chairman, the additional funding from the Long-Term Care Support Fund and Home Care-giving Grant is likely to boost the use of formal home and centre-based services. There is a need therefore to improve the regulatory framework for homecare and day-care services. Lien Foundation reported that, as of 2018, only two out of 60 such private providers were receiving subsidies which came with mandatory minimum requirements by MOH.
Perhaps it is time to consolidate existing healthcare legislation into a holistic framework that covers the whole care spectrum. A strong regulatory framework should have at least three components: legislation, care quality auditing, and feedback and disputes. Independent bodies and a rating system could be set up for these purposes.
What plans does MOH have to regulate private homecare and centre-based services? Given the absence of mandatory minimum service standards, what is being done to ensure the quality and effectiveness of these services.
Ms Tin Pei Ling: As we enhance our healthcare, we can expect longer and more healthy years. Future work will also rely more of intellect and wisdom. Our population will become better educated and more savvy with the digital space and, therefore, less fear and deeper entrenchment of technology in our lives.
There is, therefore, much that we can do to help seniors age meaningfully. More importantly, we need to ensure that our seniors do not slip into isolation. We need to ensure that they are constantly connected to our larger social network.
I had spoken many times in this House about how to enable active aging and what seniors can do. I would like to ask the Ministry to give an update on what it is doing to encourage senior volunteerism, senior employment and socialising?
I would also like to highlight one point today and that is lifelong learning. Learning keeps our mind stimulated. It is exciting to explore new things and exhilarating to achieve what we did not know or have before. We should re-ignite that sense of curiosity in our seniors and offer many opportunities for them to learn new things.
SkillsFuture is an excellent scheme to promote lifelong learning. The National Silver Academy also offers a variety of courses tailored for seniors. Some of the seniors in MacPherson have actively utilised the credits and attend courses. Some have even depleted the credits. That is why we launched the Lifelong Learning Fund in MacPherson, so that they can continue to take on courses and acquire new knowledge and skills, especially in the digital space.
As such, for the earnest senior learners, will the Government consider a special top up to the SkillsFuture Credits for seniors? What plan does the Ministry have to encourage more seniors to embrace lifelong learning?
Mr Murali Pillai: Sir, year after year, we have seen an increase in our health budget, as mentioned by the hon Minister for Health, to cater for health and healthcare needs of Singaporeans. It may be timely to review our “investment” in health over the years and determine how we have fared thus far and what targets we should aim for the future.
My attention was recently drawn to a study published earlier this year in the Singapore Medical Journal by a group of 10 doctors and researchers entitled “Successful ageing in Singapore”. The study focused on successful ageing amongst Singaporeans aged 60 and older. Successful ageing is defined as having no major diseases, no disability, high cognitive functions as well as physical functions and active life engagement. The study revealed that 25.4% of our seniors have aged successfully.
What is the Minister’s view of the finding in light of the “investments” made in promoting good health over the years and against the backdrop of increase in lifestyle diseases, as hon Minister just mentioned? What are our targets for the future?
The Chairman: Ms Tin Pei Ling, take your two cuts together.
Ms Tin Pei Ling: Singaporeans aspire to age in place. This requires putting in place home and community care support, programmes to engage and promote active ageing, infrastructural investments, retrofitting and hardware maintenance to create an elderly-friendly environment where seniors can live independently.
We should apply elder-friendly designs into our hardware and heartware solutions. Make such designs mainstream. Share best practices and set standards and audit public and private projects across all sectors.
We should proliferate digital eldercare to supplement the shortage of manpower. Leverage technology and artificial intelligence to enable quality and personalised care for seniors. Continue to research, develop and invest in digital eldercare solutions so that more innovations can reach market faster.
We could do more to recruit and organise volunteers into a powerful network of resources in the community. Exploit physical and digital platforms to optimise the matching of regular and ad hoc volunteers to help seniors who may have differing needs at different times of the day.
In essence, we can still do more to enable independent living for seniors. I would therefore like to ask what is the Ministry and whole-of-Government doing to help seniors live independently. What is being done in terms of physical hardware and programmes? How is the Government actively utilising digital solutions to achieve our goals?
Care-givers play a very important role in our ageing landscape. They offer the human touch that Government policies or programmes cannot provide, no matter how brilliantly designed they can be.
For a long time, the Government was focused on addressing the direct needs of our seniors. But I am heartened that in the parliamentary debate on care-givers just last month, the Ministry responded very encouragingly with the introduction of the Care-giver Support Action Plan, comprising assistance such as the Home Care-giving Grant and night respite service.
I have no doubt that these assistance will alleviate the burden and stress care-givers face at present.
However, as we know from our ground experiences, the financial burden on a care-giver who has given up her job can be significant, higher than what the care-giving grant can offer on a monthly basis.
Not all care-givers who are still working can successfully negotiate for flexible work arrangement, or at least, not as easily, depending on the employer's attitude and nature of the job.
Even as the night respite care pilot is underway, there is still an army of care-givers embedded in different parts of our community, providing non-stop care to their loved ones and quietly enduring the inevitable fatigue.
As such, I would like to ask the Ministry if it will continue to engage care-givers to ensure that their needs are understood and that the support put in place will address them adequately. Would the Ministry also work towards accelerating the implementation of the action plan so that more care-givers can benefit sooner than later?
Mr Charles Chong: Thank you, Mr Chairman. One result of us having an ageing population is that more support will need to be given to elderly Singaporeans.
Apart from those who care for the elderly, there are also those who care for people with disabilities, for those with chronic or terminal illnesses. Very often, these care-givers are family members – children, parents or siblings.
The demands placed on care-givers must not be underestimated. Apart from the stresses involved with looking after persons under their care, they also have their own lives to lead. And while I believe that most care-givers embrace the caring responsibilities, they often face their own challenges and these could be professional, financial or psychological.
Care-givers play a vital role in ensuring the well-being of our older citizens and citizens with disabilities or chronic illnesses. And I think it is only right if we do what we can to support them.
I would like to ask the Minister if more could be done to support care-givers in their role. For example, what kinds of training can they attend to carry out procedures which they may need to execute and what resources are available to them to provide emotional and psychological support? Could the Minister also consider, if beyond the existing schemes, the financial needs of care-givers, something that we can look into supporting, as being part of the broader package of support for the person who is receiving the care?
Mr Murali Pillai: Sir, families whose members are diagnosed with mental health conditions often have difficulty managing these patients.
It is not unusual for such patients not to adhere to instructions to take their medication or even attend medical appointments. This would lead to relapses on the part of the patients. Often, their care-givers undergo quite a bit of stress as a result.
There are also families where the care-givers are older than the patients giving rise to uncertainty and worry on the part of care-givers as to how the patients, usually their children, would be taken care of once they pass on.
During the recent debate on the Care-givers for Seniors' motion introduced in this House by hon Member of Parliament, Dr Chia Shi-Lu, the Government announced a slew of measures to help care-givers of seniors- such as provision of the Home Care-giver Grant of $200 per month and care-giver support network.
The hon Senior Minister of State, Mr Edwin Tong, pertinently recognised in his speech at the debate that there is a \"broad range of care-givers who operate in a variety of different circumstances and a very broad landscape\". It is time to consider providing similar support for care-givers of mental health patients as announced for the care-givers of seniors.
Separately, there are a good number of cases of mental health patients who live alone or do not get any support from family members and are in sore need of medical intervention. From time to time, we hear of such patients engaged in behaviour such as hoarding materials in common corridors of HDB flats, quarrelling with neighbours based on perceived threats, throwing bags of urine and faeces, and so on. A good number of them cannot help themselves because they suffer from anti-social personality disorders whose prognosis is guarded.
Often, in the absence of supervision from families, there are practical difficulties in ensuring that these patients receive and adhere to their treatment. Even if the Police gets called in, and the patients are eventually referred to IMH, there is no guarantee that they would present themselves at scheduled appointments. Once they are off their medicine, the tendency is for them to go back to their anti-social behaviour and the entire cycle repeats itself. This raises a conundrum in the communities where they live. Not only that, these patients may harm themselves, especially if they plunge into depression.
I would like to ask the hon Minister what are his plans to provide more help to mental health patients and their care-givers, including those who are older patients? Also, how can the community and other partners help in this regard?
Mr Melvin Yong Yik Chye (Tanjong Pagar): Mr Chairman, there is an increasing need to ensure that we make mental health services more accessible to support those with mental health conditions. A distinction is often made between mental and physical health. But the mind and body are inextricably linked. The two are inseparable and we need to pay attention to both to achieve wellness and not fall into illness.
Our workplace can be a very stressful environment. A 2017 study by Willis Towers Watson found that 44% of local employers identified stress as their number one health issue, while 60% of the employees admitted to having above average or high levels of stress. Prolonged exposure to such stress can potentially lead to mental health conditions.
But there remains a societal stigma when it comes to dealing with mental health issues. Many are unwilling to openly talk about such issues. And a 2018 survey conducted by the National Council of Social Service revealed that over half of those surveyed were unwilling to live or work with a person with a mental health condition.
Mental health issues affect Singaporeans of all ages, in particular, our youths and millennials. Some have started calling them the \"burnout generation\". Yet, addressing such issues remain a stigma in Singapore.
I would like to ask how is MOH making mental health services more accessible to support persons with mental health conditions, especially among our youths.
Mr Christopher de Souza: Mr Chairman, staying engaged, being active and socialising are key to good mental health. If one has physical health but is not connected to a social network, then mental health can decline.It is one of the reasons why we have situated a childcare centre next to an active ageing centre in the constituency I serve – Ulu Pandan. The elderly and young can interact and bring joy to each other, across generations.
As an extra step, would MOH consider setting up Community Mental Wellness Conservatories in heartland areas to bring together care-givers of elderly Singaporeans who may have dementia or mental illnesses to share care-giving best practices on how to re-connect the elderly to a social network, with the mind to lift their spirits and re-energise them into joyful and active ageing?
Mr Alex Yam (Marsiling-Yew Tee): Mr Chairman, I first asked in 2014 if the Ministry will consider adjusting the threshold of gestational age for abortion from 24 weeks to 22 weeks based on the increasing viability of even extreme preterm babies. I have made the same request consistently since then.
As early as in 1991, the viability limit defined in the Motherhood Protection Act in Japan was amended from 24 weeks to 22 weeks based on medical advances. I am certain that if we look at the numbers in our own hospitals , there will be similar medical justifications.
In Mandarin, Japanese and Korean, the written word for the womb translates to \" the palace of the child\". In Hebrew, the word Rakh’am is used to refer to the womb and translates to compassion and protection from harm. And I do hope that unborn children of Singapore will truly find it a palace for them to develop well and a place of mercy for them who do not have a voice.
I therefore repeat my request for the Ministry's careful consideration, based on medical evidence, if a review of the gestational limit is due and an adjustment to the term limit be adopted.
Ms Tin Pei Ling: Women are living longer and have longer life expectancy than men. Women are also typically the main care-giver at home, caring for our young and old. Their health therefore not only concern herself but will impact the entire family's well-being. Moreover, women is a formidable source of manpower for Singapore, driving our continued growth.
It is therefore important that we ensure Singaporean women are healthy and vibrant. I would thus like to ask what is the Ministry doing to help women and mothers. What is in place to drive preventive health effort for women?
The Chairman: Dr Amy Khor.
The Senior Minister of State for Health (Dr Amy Khor Lean Suan): This House recently saw a lively debate on ageing. I was encouraged by the support for the Action Plan for Successful Ageing launched in 2015, when I shared about its progress.
As Minister Gan shared, our Life Expectancy and Healthy Life Expectancy are good. Nonetheless, through the Action Plan, we want to further help Singaporeans add more life to years, not just years to life. As we provide for seniors today, we will do more for seniors of tomorrow, who will live longer, be better educated and have different aspirations. MOH will conduct a public consultation later this year with stakeholders, including seniors, community and business partners to develop an updated Action Plan.
A study by the Duke-NUS Centre for Ageing Research and Education (CARE) showed that seniors who are supported by social networks and befriending can better manage their chronic diseases. Strengthening integration between social and healthcare is key to successful ageing. Let me elaborate on our efforts, which I call the \"3 Ps\" – People, Places and Programmes.
First, we want to further enable people in the social and health sectors to integrate care for our seniors. Since the beginning of 2018, about 3,000 Silver Generation Ambassadors (SGAs) have engaged around 280,000 seniors, identifying seniors with needs and working with stakeholders to link them to active ageing, befriending and care services. Seniors can have their social and healthcare needs managed jointly by the Silver Generation Office (SGO) and Social Service Offices (SSOs). More of these offices will be co-located where possible. SGO is recruiting more SGAs, to reach out to seniors, including the Merdeka Generation (MG). I encourage Singaporeans to come forward and join this endeavour.
MOH works closely with our community care providers and healthcare professionals to deliver quality care, ensuring good governance over our services, while allowing room for the sector to evolve. To Ms Anthea Ong's query, in 2015, MOH developed developmental guidelines for home and day care providers to work towards quality care. Healthcare professionals providing these services, such as doctors, nurses and therapists, must also be licensed by their professional bodies.
Looking ahead, MOH will review the need for more formal regulation, including licensing under the proposed Healthcare Services Act (HCSA), as Mr Louis Ng has also asked in a Parliamentary Question (PQ). We will adopt a risk-based approach, and subject services with higher patient risks to higher levels of regulation. Hence, we will start with licensing home medical services, and review the need to licence other services as the sector evolves.
Second, we will strengthen integration by providing places and programmes to address the social and health care needs of our seniors. Following the transfer of functions from MSF, as of end 2018, MOH oversees 127 Senior Activity Centres (SACs) providing wellness programmes to seniors living in studio apartments and rental flats; 118 Senior Care Centres (SCCs) providing day care and community rehabilitation services, and five Active Ageing Hubs (AAHs) serving seniors across a spectrum of needs.
Chairman, may I display some slides?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Dr Amy Khor Lean Suan: In response to Ms Joan Pereira and Dr Lily Neo, we aspire towards more age-friendly neighbourhoods, with accessible care and amenities. We are expanding aged care services capacity but must do so sustainably. MOH will partner our operators to enhance the scope and reach of services in our Senior Centres. For example, those currently providing day care services may offer additional wellness programmes. Services will be made available to all seniors, not just those living in studio apartments and rental flats.
We will work with operators, enhancing their capacity and capabilities, to implement this common vision of SACs, SCCs and AAHs as places where seniors can access a range of services from fiscal year 2020.
In relation to Mr Leon Perera’s question, since 2012, we introduced the Build-Own-Lease (BOL) framework to support efforts to increase capacity, encourage improvements in care quality while keeping fees affordable. Our tender process covers quality (including innovative care models) and affordable fees. AIC supports providers in capability development, including leadership development, manpower recruitment and quality improvement programmes.
To support preventive health, we grew the number of Community Health Posts (CHPs) to around 150. We will now expand the number of areas covered by Community Nursing teams, from 18 to 29 areas around Singapore. We will also partner more Senior Centres to make community nursing services accessible to more seniors by 2020.
Members, such as Ms Rahayu Mahzam, have called for Assisted Living options.
MOH and MND plan to launch a pilot where seniors buy a home bundled with a package of programmes and services that can be customised to suit their needs and preferences. For instance, healthy seniors could buy into basic services, such as light housekeeping. Additional services, like care coordination, can be layered on as their needs change. We have identified a possible location, and MND will share more on this.
The development could comprise flats with senior-friendly features, complemented by communal spaces like recreation-cum-dining rooms with light programming to encourage interaction. MOH and MND will start Focus Group Discussions over the next few months to better understand Singaporeans’ aspirations and fine-tune this new option for ageing-in-place before going to market.
As Ms Tin Pei Ling suggested, we are tapping on technology to benefit seniors, starting with MG seniors who are more IT literate. MOH is partnering SNDGO and PSD to include a new module under the existing Moments of Life app to support active ageing. I have seen a prototype and found it useful. The app will include an Active Ageing Programme finder that can show seniors programmes near their homes. Seniors can also use the app to check their eligibility for Government benefits like the Merdeka Generation Package and GST Voucher scheme. In a later phase, we will explore features, such as allowing bookings for active ageing programmes. The app will be piloted later this year, and I look forward to using and sharing it.
An ageing population raises demand for community mental health services. Someone once jokingly said to me, “The nice thing about ageing and losing your memory is that you make new friends every day!” Joke aside, in reality, dementia can be debilitating not just to patients but also care-givers. I agree with Mr Christopher de Souza and Mr Melvin Yong as well as Ms Ong that we must support persons with mental health conditions and their care-givers. In 2017, arising from the recommendations of the Inter-agency Committee on Community Mental Health, MOH launched the enhanced Community Mental Health Masterplan to further strengthen mental health care. We have made good progress since, in increasing outreach, early detection and providing care and support in the community.
Through a multi-pronged approach strategy, we bring the community together, to raise awareness and support for seniors with or are at-risk of dementia and depression. Thirty-nine community outreach teams have been set up and have reached out to over 210,000 people. We are on-track to meet our 2021 target of 50 teams. We established eight Dementia-Friendly Communities, building networks of support around those with dementia and their care-givers. Our Dementia Friends Mobile App has encouraged more than 4,100 people to sign up as Dementia Friends and assisted over 50 persons since its launch in October 2018.
Our Community Network for Seniors (CNS) has been expanded nationwide to anchor a strong community care system for seniors, including those with mental health conditions. Under the CNS, SG Ambassadors proactively reach out to seniors, referring those with possible mental health conditions to support services. Community befrienders visit lonely seniors regularly, providing them with emotional support to keep social isolation and depression at bay.
Furthermore, AIC has trained over 14,000 front-line staff from Government agencies and community partners to identify and respond to persons with mental health conditions. Over 2,700 individuals have been supported with medical care or social support according to their needs. We will continue to work with agencies like MHA and HDB, grassroots leaders and voluntary welfare organisations to identify and provide social and medical support for those in need, including persons who exhibit behavioural challenges in the community.
Addressing the stigma associated with mental health conditions is also a collective effort. NCSS and IMH launched the “Beyond the Label” campaign in September 2018. We hope this will catalyse more conversations about mental health and encourage those facing such challenges to seek help.
To strengthen care and support in the community, we increased access to mental health and dementia services in 12 polyclinics, up from eight in 2018 and also at our GP clinics. As of December 2018, over 190 GPs have been trained to diagnose and support persons with mental health conditions. Twenty allied health-led community intervention teams were established to support GPs and community organisations in managing persons with mental health conditions.
Beyond building on existing efforts and scaling up programmes, we are developing new initiatives to better address emerging areas. Following the NurtureSG Taskforce’s recommendation to better support youths, MOE and HPB have been establishing peer support structures in mainstream schools and Institutes of Higher Learning (IHL) to equip students to look out for signs of mental stress among peers and support and encourage them to seek help when needed. Since 2007, about 2,400 Allied Educators have received training to identify and support students who require referrals to mental health services. We will train more moving forward. The Community Health Assessment Team (CHAT) operates a mental health wellness centre for youths, which has reached out and provided mental health assessment to more than 3,100 at-risk youths as of December last year.
As social and mental health issues are interlinked, we will take a more holistic approach for at-risk youths. MOH will develop a new integrated youth service, together with community youth partners, IMH, AIC, NCSS and HPB. We will expand on the success of the CHAT model, to increase outreach and educate youths on resilience and mental well-being. Those who need help will be referred to social and health services for assistance and intervention in an integrated manner. MOH will update the enhanced Community Mental Health Masterplan and rally a whole-of-society effort to build communities of care around mental health patients and their care-givers.
The Merdeka Generation Package (MGP) is a major fiscal undertaking and is our show of appreciation and support for the Merdeka Generation (MG) in their silver years. After Prime Minister announced the MGP at the National Day Rally (NDR) last year, many of my MG cohort friends excitedly asked me “What, what, what are the benefits?” Following Minister Heng’s Budget speech, the constant refrain became \"When, when, when, when will I get these benefits?”
We want our MG seniors to benefit from the package as soon as possible. Implementing the MGP is a major effort involving multiple Government agencies and partners, and we are working closely to roll out the benefits quickly. The bulk of the MGP benefits will be available in two tranches – July and November 2019.
From July 2019, MG seniors will receive three benefits. One, their MediSave accounts will be automatically credited with their first $200 top-up, which they will continue to get once every year until 2023. Two, additional MediShield Life premium subsidies for MG seniors will take effect. MG seniors will receive subsidies starting from 5% of their MediShield Life annual premiums, and increasing to 10% after reaching 75 years old. Although system changes to automatically apply the additional subsidies will be ready only towards the end of this year, we will backdate the subsidies to 1 July, to allow more MG seniors to enjoy them. MG seniors with policy renewals between 1 July and 31 October this year will pay the full premium first, and receive the additional subsidies as a refund automatically by end December 2019. Three, the one-time $100 top-up to their PAssion Silver cards, we will share more details on how to redeem the top-up when ready. As you will have till 31 December next year to do so, and the credits do not expire, we would like to assure all our MG seniors that there is no need to rush.
Come 1 November 2019, MG seniors will receive additional subsidies for outpatient care, for life. Implementing the outpatient subsidies involves many healthcare partners, who need to train front-line staff and make necessary system changes. We need time to do this properly and correctly, so implementation can be as smooth as possible. When MG seniors visit polyclinics and public specialist outpatient clinics from 1 November 2019 onwards, they will automatically receive an additional 25% off their subsidised bills.
MG seniors can also bring their MG cards when they visit CHAS GP and dental clinics, to enjoy special subsidies of up to $23.50 per visit for common illnesses, $520 in annual chronic subsidies and $261.50 per procedure for dental procedures. Also, eligible MG seniors will pay only $2 for screenings recommended under the Screen for Life programme, compared to up to $5 today.
Finally, in 2021, when CareShield Life becomes available for existing cohorts, we will give an additional participation incentive of $1,500 to each MG senior who joins the scheme, on top of the $2,500 previously announced. MG seniors who join CareShield Life will hence receive participation incentives totalling $4,000 each, which will offset annual premiums for 10 years.
Eligible seniors will receive a notification letter for the MGP by April 2019. From the same month, SGO will start to proactively reach out to 500,000 MG seniors to share details of the MGP.
To Dr Chia Shi-Lu’s query, beyond home visits, SGO will employ new approaches, such as group engagements at workplaces, which may be preferred by MG seniors, among whom one in two are working. SGO will also conduct engagements at community locations frequented by MG seniors, like hawker centres. It will connect MG seniors to volunteering and learning opportunities, such as the Retire with a Purpose (RWAP) programme under the RSVP and National Silver Academy courses.
As mentioned by Minister Gan, Senior Minister of State Sim Ann and I will co-chair a Merdeka Generation Communications and Engagement Taskforce to ensure effective communications and outreach to our MGs and their family members. The taskforce comprises 23 members from the public, private and people sectors, which had its first meeting two weeks ago.
Ms Tin noted that women are living longer and we must address their healthcare needs. The Women’s Health Committee will continue to champion good health among Singaporean women at all stages of their life.
One focus area is cervical cancer. From 2011 to 2015, about 200 new cases were diagnosed annually and around 70 die of the disease every year. This cancer, which is caused by infection with the Human Papilloma Virus (HPV), can be prevented with vaccination and screening. To bring about more comprehensive coverage of HPV vaccination for cervical cancer prevention, MOH will offer fully subsidised HPV vaccination from April 2019 as part of our national school-based health programme, similar to countries, such as the United Kingdom and Brunei. Current and future cohorts of Secondary 1 female students will be offered the HPV vaccination, and a one-time catch-up programme will be progressively provided for current cohorts of Secondary school female students. All other female Singapore citizens and permanent residents from the same age-equivalent cohorts, including those studying in private education institutions, will also be eligible. The vaccination will be fully subsidised, as part of an opt-in scheme.
For women aged 30 years and above, we are introducing a more accurate HPV screening test for cervical cancer, which only needs to be done every five years, compared to the current recommended protocol involving Pap smear test which needs to be done once every three years. The better test will cost more, but the Government will provide more subsidies, so the cost to women will be the same in the long run.
We will also make early screening more convenient for women with history of gestational diabetes, who are at higher risk of diabetes later in life and need to start regular screening soon after pregnancy. They will be automatically eligible for subsidised cardiovascular risk screening under the Screen for Life programme, and will no longer need to take the online diabetes risk assessment tool to qualify.
For women intending to enrol in IVF, Mr Ng will be pleased to know that we will lift the requirement for purchase of Assisted Reproduction Programme (ARP) insurance from 1 April 2019.
This is because MediShield Life and MediSave now provide basic healthcare coverage for all Singaporeans from birth.
Mr de Souza and Mr Dennis Tan asked about attracting more Singaporeans to nursing, and supporting continuing development and career progression of healthcare professionals.
Over the last five years, we increased nursing intakes by around 30%. In 2018, we admitted more than 2,100 students, our highest intake to date, up from 1,600 in 2013. But it will be challenging to continually increase student intakes in view of falling cohort sizes, so we need to look at mid-careerists, too, beyond supplementing our local workforce with foreigners. For those looking for a second career in healthcare, our Professional Conversion Programmes (PCPs) provide sponsorship for course fees and an allowance. In 2018, about 130 mid-career individuals embarked on our nursing PCPs, our highest intake in 10 years. MOH will continue to work with healthcare employers to improve retention, provide meaningful job opportunities, and enhance careers through multiple progression pathways and entry points to ensure we maintain a strong local core of the nursing workforce.
In line with the SkillsFuture movement, we worked with Nanyang and Ngee Ann Polytechnics to create a new, faster progression pathway for Enrolled Nurses who did well during their ITE training, to upskill to a Registered Nurse. We now have a 2+2 Diploma in Nursing which will allow ITE Upgraders to complete the Diploma in Nursing course in two years instead of the current 2.5 years.
We will strengthen and better recognise workplace-based learning, to achieve the twin objectives of better care for our patients and professional growth for our healthcare staff. Assuring our staff of continued opportunities for professional development is key to retaining them in the healthcare workforce.
I am pleased to announce that we will set up the National Nursing Academy (NNA) to coordinate and support lifelong learning across healthcare institutions, schools and training providers. The NNA will oversee Continuing Education and Training (CET) efforts to develop future-ready nurses with the requisite skills and competencies to meet evolving healthcare needs. In line with the push towards digitalisation, the NNA platform will allow nurses and healthcare leaders to access a comprehensive suite of high-quality courses and learning opportunities online.
Today, many healthcare providers have in-house training programmes which are often not recognised and transferable across different institutions. The NNA will accredit and strengthen the quality of workplace-based training and develop a system to recognise the skills and competencies attained by a nurse at the workplace. This will make the skills portable and stackable to advance nurses’ careers and professional practice across healthcare institutions and settings.
To facilitate this, the NNA will articulate the skills and competencies needed for nurses' evolving roles as part of the larger Skills Framework for Healthcare. We will deepen this framework, starting with the Community Nursing Competency Framework, which will be completed by May this year. This will be followed by frameworks for palliative and gerontology care in 2020.
The NNA’s efforts will benefit all nurses and healthcare providers in the public, private and community sectors.
Mr Chairman, in conclusion, as MOH continues to empower all Singaporeans to take charge of our health, I invite everyone to work with us to add more life to years.
The Chairman: Order. I propose to take the 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 3.25 pm.
Sitting accordingly suspended
at 3.02 pm until 3.25 pm.
Sitting resumed at 3.25 pm.
[Mr Speaker in the Chair]
[(proc text) Debate in Committee of Supply resumed. (proc text)]
[Mr Speaker in the Chair]
Head O (cont) –
Dr Lily Neo (Jalan Besar): Sir, I have been an advocate on preventive healthcare all these years and I have spoken many times before in this House on this topic. Thus, I agree with the Minister for Finance wholeheartedly when he said, “The best way of protecting ourselves is to lead a healthy lifestyle, and take preventive actions”. This is the best approach as it will result in quality of life and a happier populace.
Preventive healthcare means adopting healthy lifestyles to stay healthy and to prevent diseases, especially chronic diseases. It also means detecting and treating chronic diseases early and consistently. The purpose is to prevent severe ill health and disability as a result of chronic diseases like diabetes, hypertension and hyperlipidaemia. Untreated, chronic diseases can lead to heart diseases, stroke, renal failure, foot amputation, blindness and so on.
We cannot carry on with just the traditional approach of healthcare systems on diagnosing and treating diseases alone, because this will lead to increasing demand on healthcare services, which can be daunting in an ageing population.
Preventive healthcare has to be expanded quickly and urgently, as the success of which will allow people to live healthily and happily, and will cushion the demand for increasing healthcare services.
I am glad that the Minister for Finance has announced that CHAS is now expanded to subsidise all Singaporeans in seeking treatment for chronic diseases at private clinics. This will encourage more people to seek treatment early for chronic diseases. Subsidising the treatment for chronic diseases is a good way to prevent the complications of such diseases, will reduce ill health and lessen the demand for acute care.
May I ask MOH on the detail of subsidy for the expanded CHAS scheme for chronic diseases for all CHAS holders? May I also ask MOH how it plans to ensure that the intent of preventive healthcare with regard to chronic diseases can be achieved with the expanded CHAS?
It will be a pity if we have such a good CHAS scheme but people do not make full use of it. This may be due to either insufficient information about the scheme or the patients are not bothered to go for early and continuous treatment of chronic diseases, due to a lack of knowledge of chronic diseases and their side effects. I urge MOH to raise awareness and campaign on the importance of early diagnosis and treatment of chronic diseases.
Could MOH provide an update on the war on diabetes, Healthy SG task force and Health Promotion Board (HPB)’s progress on healthy lifestyle promotion? Promotion of mental well-being is an integral part of preventive healthcare. Presently, MOH’s psychiatric and mental healthcare is insufficient, especially in the community setting. Could MOH expand and provide more resources in this area?
There is a saying “We are what we eat”. Singaporeans’ sugar intake increased from 59 gm a day in 2010 to 60 gm last year. The World Health Organization (WHO) recommends a daily sugar intake of 25 gm ideally. However, Singaporeans are already taking more than twice that. Sugar provides calories with no added nutrients. Excessive sugar intake may result in excessive weight, diabetes, heart diseases, fatty liver and so on.
Could MOH strategise more effectively to nudge Singaporeans to reduce their sugar intake? MOH will need to adopt a range of measures, including better information and a national campaign to facilitate better-informed choices. Labelling of the sugar and calorie contents should be made widely available in the food on sale here, even at our hawker centers. Such information will not only remind people to keep healthy but also give consumers an informed choice, to better plan their sugar and calorie intake for the day.
I favour to go for “half of your sugar intake or no sugar intake” campaign. Other measures should include sugar taxation and to reduce the sugar content in beverages. In our schools, we can go further in helping our children by reducing their palate for sweetness, by not selling beverages and other sugar-added food in school canteens. We should facilitate our young to achieve reduced palate for sweetness when they are in schools, so as to achieve better health when they grow up.
Mr Mohamed Irshad (Nominated Member): Mr Chairman, during the 2017 National Day Rally, Prime Minister Lee cited Diabetes as a health crisis for Malays and Indians. He pointed out that the main common causes of death like stroke, heart attack and kidney failure can be traced back to diabetes. Can the Minister share what efforts are undertaken to customise health promotional messages to Malay and Indian communities? Could the Minister also provide an update on the war on diabetes?
Mr Melvin Yong Yik Chye: Mr Chairman, it has been quite a few years since MOH declared war on diabetes. I would like to ask the Ministry to provide an update on the progress of our fight against diabetes, and what were some of the most effective initiatives that have been rolled out thus far.
Singaporeans spend a lot of time at the workplace. Therefore, promoting workplace health is a key battleground in our fight against diabetes. We are what we eat, meals with reduced salt and oil, and drinks with reduced sugar are some simple steps that workers can take towards forming healthy eating habits.
Employers too can play a vital role in encourage healthier eating habits. The National Transport Workers Union (NTWU) and SBS Transit (SBST) have collaborated to do just that. Today, 43 NTWU canteens today offer healthier brown rice meal options. As employer, SBST has contributed $150,000 to support this initiative. More than 10,000 SBST staff can get a stamp with each brown rice meal they buy. Every five stamps can be exchanged for a $2.50 meal voucher. Since we started this initiative, our transport workers have taken more than 50,000 brown rice meals at our NTWU canteens.
I hope the MOH can continue to encourage and support more such collaborations at our workplaces.
Dr Chia Shi-Lu: Chairman, MOH has introduced a series of tobacco measures to make it harder for smokers and to deter new ones. These include excise taxes, restrictions on smoking areas, a ban on point-of-sale display and a gradual increase in the minimum legal age. Very soon, cigarette packaging will also have to be plain and standardized, with bigger graphic health warnings.
Can the Ministry take one step further and reconsider a ban on flavored and particularly, menthol cigarettes, such as what Canada has recently done and which the USA is considering once again. Such products are particularly appealing to new smokers, especially youths.
The World Health Organisation (WHO) has also recently introduced the concept of a “best buy” policy. How aligned is Singapore with WHO’s recommended, cost-effective policy action for smoking? For example, should we increase the minimum legal age beyond 21 and is our tobacco tax sufficiently prohibitive? Can more be done to help smokers, particularly young ones?
The Chairman: Senior Minister of State Dr Lam Pin Min.
The Senior Minister of State for Health (Dr Lam Pin Min): With your permission, Mr Chairman, may I display some slides on the screens during my speech?
The Chairman: Yes. [Slides were shown to hon Members.]
Dr Lam Pin Min: Mr Chairman, with our high life expectancy, we are facing an increasing burden of chronic diseases, coupled with rising healthcare costs and emerging diseases. We need to be ready to meet these challenges. I will share more on the work we have done to keep Singaporeans healthy and safe, while keeping healthcare affordable for all.
Primary care plays a crucial role as the foundation of our healthcare system. It enables good quality, comprehensive and continued care for Singaporeans near their homes. We will continue to invest in our primary care to enhance facilities, and provide more resources for our General Practitioner (GP) partners.
MOH had previously announced plans to enlarge our polyclinic network from 20 currently to about 30 to 32 polyclinics by 2030. Currently, these are slated for Bukit Panjang, Eunos, Kallang, Sembawang, Khatib and Tampines North. I am pleased to inform Members that in addition to these, two more polyclinics will be developed in Serangoon and Tengah, which are expected to be operational by 2025.
Minister Gan earlier shared about our primary care transformation efforts, including the Primary Care Network (PCN) scheme, of which Dr Chia Shi-Lu has asked for an update. Please allow me to share more in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] In 2018, MOH launched the Primary Care Network (PCN) scheme. This is part of our strategy to transform primary care. This scheme aims to support private GPs to come together to form networks with the sharing of clinical and administrative resources, and provide more holistic care for patients with chronic diseases.
Last year, more than 300 GP clinics participated in this scheme to form 10 PCNs, and collectively are serving more than 70,000 patients with chronic disease. Through this scheme, patients with diabetes have enhanced accessibility to various ancillary services, such as eye and foot checks. To date, more than 5,000 patients with diabetes have benefitted from this.
This year, there are more than 450 GP clinics participating in the PCN scheme. This number is more than 40% of CHAS GP clinics. In order to benefit more patients with chronic disease, MOH targets to have half of all CHAS GP clinics participating in the PCN scheme by 2020.
(In English): Mr Chairman, let me now share a success story from United PCN. Like many Singaporeans, Mr Adrian Chia, who is 38 years old, loves food. He used to drink a 1.5-litre bottle of sweetened beverage daily, and ate fried and oily food. He was diagnosed with diabetes by his general practitioner, Dr Kelvin Goh, who practices in a clinic under United PCN.
Mr Chia took his diagnosis as a wake-up call. Working together with Dr Goh, the PCN nurse and care coordinator supported Mr Chia with managing his condition. He also received nurse counselling for his diabetes, as well as foot and eye screening checks through the PCN. Mr Chia began to take small steps, and started to exercise daily. Through much perseverance and self-motivation, he has progressed to participating in Iron Man races. He also changed his eating habits to include healthier food choices such as oatmeal and fruits.
Today, Mr Chia’s condition is now under control, and may not even require diabetes medicine if he maintains his new regime.
Dr Chia has also asked about our efforts to support PCN clinics in tracking and monitoring patients' progress. A key feature of the PCN scheme is the provision of resources to maintain a chronic disease registry that tracks the care processes and patient outcomes. By aggregating resources through PCN networks, GPs in the PCN scheme also stand to benefit from greater economies of scale.
For example, NUHS PCN in the Western region has worked with major laboratory providers to provide common laboratory tests for chronic disease management at reduced prices, and facilitate the electronic collation of laboratory results for the chronic disease registry, reducing the need for GPs to manually compile these. Such systematic data collection allows PCN GPs to reflect on their professional practice and work with the PCN HQ to implement quality improvement programmes and improve patient outcomes.
Learning from the experience of the PCNs, MOH will study how to help CHAS clinics better track their patients’ progress and outcomes.
MOH will also continue to encourage more GPs to join CHAS, though there are always some who chose not to, such as those who prefer not to take on additional load.
At the same time, we have continued our efforts in the War on Diabetes. Mr Melvin Yong and Mr Mohamed Irshad have asked for an update on this. We should recognise that our fellow Singaporeans with diabetes do not have to journey alone; we all play a part in supporting them to better manage their condition, and avoid long term complications from diabetes.
Patient empowerment has emerged as a new paradigm that can help improve medical outcomes while lowering costs of treatment. This concept seems particularly promising in the management of chronic diseases, including diabetes. As such, the Diabetes Prevention and Care Taskforce has developed a new Patient Empowerment for Self-Care Framework which aims to empower patients to co-own their care journeys for better care outcomes. It helps patients initiate and sustain lifestyle changes for better disease management, prioritising what is of greatest importance to them. This is done with the support of their families, healthcare professionals, community-based providers, as well as other forms of social support.
We have developed the national diabetes reference materials for patients, care-givers and the public. The first tranche of materials is largely pictorial and easy to understand. A beta version of the introductory section, which is mainly targeted at newly diagnosed patients, has been available on HealthHub since December 2018. The full set of materials will be published on HealthHub in four languages in the second half of 2019. We will also be seeking public views from mid-2019 on specific diabetes-related topics for more in-depth materials to be developed, and published online for reference.
Besides empowering our patients, our healthcare workers can look forward to more training and resources to improve their delivery of care. MOH will be developing a care team training framework to equip healthcare professionals, and lay volunteers in the community, with essential skills to empower their patients and care-givers more effectively. This will be developed in consultation with various stakeholders, and rolled out progressively from end-2019.
Last year, I shared about our high rate of diabetes-related amputations of the leg and foot. MOH formed the National Diabetic Foot Workgroup in April last year to develop a strategy to reduce such amputations. A key recommendation of the Workgroup is a risk-stratified diabetic foot screening, management and escalation framework, which aims to streamline diabetic foot care services across primary and tertiary care, and provide healthcare professionals with clinical guidelines for timely and appropriate care.
This framework will be progressively launched in our polyclinics and public hospitals from the second quarter of 2019. MOH will continue to closely track the rate of amputations among patients with diabetes.
Aside from equipping our healthcare professionals, MOH also seeks to uphold the standards of practice and public confidence in the medical profession. The medical disciplinary process is specified in the Medical Registration Act (MRA) and aims to protect both the public, and ensures fairness to the doctors. Mr Leon Perera has given some feedback, and asked about the review of the medical disciplinary process. MOH is currently looking into making amendments to the MRA, which was last amended in 2010. This will include looking at the issues raised by Mr Perera.
In addition, as announced over the weekend, my Ministry will form a Workgroup to undertake a comprehensive review of the taking of informed consent by doctors. The Workgroup will also review the medical disciplinary process with a review to enhance the regulatory framework. This ranges from the filing of complaints, to the structure, composition and processes of the Complaints Committees and the Disciplinary Tribunals, and the use of expert evidence.
The Workgroup will consult widely in evaluating the issues raised, and make appropriate recommendations to the Ministry. MOH will take into consideration these recommendations from the Workgroup.
To ensure consistency and fairness in the sentencing of disciplinary cases, a separate committee, which is the Sentencing Guidelines Committee, was also appointed by the Singapore Medical Council in January 2019 to develop guidelines on the appropriate sanctions to be meted out. My Ministry will continue to engage the medical community and carefully consider what steps are necessary to improve the medical disciplinary process.
Minister Gan highlighted the need for all of us to work together to keep our healthcare system sustainable for future generations. While MOH continues to provide subsidies, this will be unsustainable if we do not manage increases in healthcare costs. A significant part of managing such increases is to aid patients and providers to choose care which is appropriate to the patient’s medical conditions and needs.
Ms Joan Pereira has asked if we can explore having more subsidies for a wider range of generic drugs. Back in 2017, to encourage the use of generic drugs, we introduced a basket of clinically and cost-effective generic drugs which can replace the more expensive branded equivalents.
MOH reviews the generic drugs basket annually with the National Pharmacy and Therapeutics Committee. We will also actively monitor new generic drugs from overseas, and work with the Health Sciences Authority to introduce them locally.
By volume, the usage of the generic drugs in the basket has increased from 87% in 2013 to 99% in 2017.
Currently, clinically and cost-effective drugs are eligible for subsidies. When generic alternatives of these subsidised drugs become available, prescribing of generic alternatives is encouraged to provide more savings for patients.
Ms Pereira also asked about the Medication Assistance Fund (MAF), which was introduced to help needy patients pay for non-standard drugs which have been assessed to be clinically necessary.
Since October 2018, MOH has streamlined the MAF application process such that eligible patients, with the assistance of hospital staff, can receive the MAF assistance upfront, without a separate financial assessment by the medical social worker. The public hospitals will be enhancing their systems to support this simplified process.
To ensure costs are kept affordable, patients should also be informed of the estimated charges before making a decision. Mr Charles Chong has asked about the measures to empower patients to make informed decisions about private hospital fees. Since 2003, MOH has been publishing historical transacted hospital bill sizes. More conditions were covered over the years and in 2014, we further published total operation fees for common procedures to ensure transparency of healthcare charges. As shared by Minister Gan earlier, we have since introduced fee benchmarks in November last year for professional fees for common surgical procedures.
These fee benchmarks provide a useful reference to guide private healthcare providers in charging appropriately, and enables patients and payers to make more informed decisions. Both the bill size publication and fee benchmarks are available on MOH's website. Doctors should take reference from the benchmarks in setting their fees and advising their patients. They should also be prepared to explain to patients where their charges exceed the range, such as when addressing a highly complex case, or in exceptional circumstances. Patients are encouraged to use the benchmarks to have a conversation with their doctor on their treatment, the complexity of their condition and the fees charged.
We will monitor the bills and charging practice following the release of the fee benchmarks, and consider the approach for periodic updating of the fee benchmarks to ensure they remain relevant and updated.
Mr Mohamed Irshad has asked about having reduced co-payment for patients with Integrated Shield Plan riders who are treated at public hospitals. Co-payment is a tenet of our healthcare financing framework that encourages prudent and appropriate use of healthcare services, both in the private as well as the public sectors. This helps to ensure that healthcare costs and health insurance premiums remain affordable and sustainable for Singaporeans in the long term.
All new Integrated Shield Plan riders are required to have a co-payment of 5% or more. The co-payment amounts can be paid using MediSave, up to the applicable limits. Medifund is also available for those who require assistance with their healthcare bills.
Mr Low Thia Khiang has asked for an update on precision medicine research and implementation.
Work is on-going. However, I am glad to inform Mr Low that MOH's Health Regulation Group, together with the Genetic Testing Advisory Committee, introduced a Code of Practice for the Standards for the provision of clinical and laboratory genetic/genomic testing services in July 2018. The Code addresses key issues such as competency and training of personnel delivering the services, and the appropriateness in the ordering of genetic tests. An IT architecture is also being conceptualised to pull together, store, and analyse the information from healthcare institutions in a robust and secure manner.
Precision medicine has been deployed in our public healthcare institutions. For example, approximately 240 Singaporean and PR children with Acute Lymphoblastic Leukaemia have benefited from personalised treatment in the past 15 years.
Currently, gene editing involving human subjects is regulated under the Human Biomedical Research Act. Research of a nature similar to that of the cited case in China is strictly controlled, and cannot be conducted without the explicit approval from MOH.
As precision medicine is an emerging field, we will need to carefully consider many factors, such as ethical, legal and social implications, and weigh the investments required against the potential benefits, before systematically implementing the strategy to maximise the benefit to the population.
We will continue our efforts to keep our healthcare system sustainable for the long term and ensure that all Singaporeans can receive appropriate and affordable care.
Beyond keeping healthcare affordable, we need to keep Singapore and Singaporeans safe from infectious diseases. MOH regularly reviews existing legislation, policies and capacity to safeguard public health and prevent the spread of infectious diseases.
The Infectious Diseases (Amendment) Bill was passed in January 2019 and will come into effect in the subsequent months. Key amendments include strengthening processes for infectious diseases notifications and surveillance, powers to disseminate health advisories more expediently, and enhancing powers for national public health research.
In addition to enhancing legislation, we have also increased public health education and protection by providing guidance on recommended vaccinations through the National Childhood Immunisation Schedule and the National Adult Immunisation Schedule.
Dr Chia Shi-Lu asked about the vaccination take-up rates. Childhood vaccination rates remain high. Measles and diphtheria vaccination rates, at age 2 years, have been around 95% or higher in the last decade. The take-up of recommended vaccinations for adults has been encouraging, with more using MediSave for them. For example, MediSave used for influenza vaccinations has increased by about 60%, from about 32,000 between November 2016 and October 2017, to about 52,000 in the same period a year later. However, there is still room for improvement as the numbers represent a small proportion of the at-risk population for which vaccination is recommended. MOH will continue to educate the public on the importance and benefits of vaccination to encourage up-take but ultimately, we should all take responsibility for our own health by going for the recommended vaccinations.
Minister Gan mentioned that MOH has developed the National Centre for Infectious Diseases (NCID), a 330-bed national facility designed for containment of dangerous infectious diseases. It is expected to be fully operational by May 2019. During an outbreak, NCID will centrally manage the screening, isolation and treatment of infected patients. NCID also houses public health capabilities, such as the National Public Health Laboratory, to support the detection of infectious diseases. NCID will also conduct training and research to strengthen national preparedness against outbreaks.
In conclusion, my Ministry will continue to grow Singapore's healthcare capabilities while keeping costs affordable for all. We must work together as one to tackle the challenges, and ensure that Singaporeans can enjoy many more years of health to come.
The Chairman: Senior Minister of State Mr Edwin Tong.
The Senior Minister of State for Health (Mr Edwin Tong Chun Fai): Mr Chairman, Minister for Health has emphasised in his speech earlier our collective responsibility in ensuring better health for all Singaporeans. With a united front, I believe we can do much more, moving forward to ensure that healthcare remains sustainable, accessible and also affordable for all Singaporeans.
Let me elaborate on how MOH can help to strengthen our support for individuals, providers and the community in enabling us to achieve this together.
Ms Tin Pei Ling asked how can we keep our healthcare affordable and sustainable. Mr Pritam Singh also wanted to understand how we can pay for our hospitalisation bills that fall below the MediShield Life deductible.
As a starting premise, our healthcare financing system is designed to ensure that no Singaporean is denied access to appropriate healthcare because they cannot pay. We provide support through multiple, and often overlapping layers, each one playing an important but different role.
First, the Government provides means-tested subsidies of up to 80% for Singaporeans across all public healthcare settings.
In addition, all Singaporeans are covered by MediShield Life, for life. MediShield Life focuses on large bills and selected costly outpatient treatments to keep the premiums affordable.
Next, we then have MediSave to help Singaporeans set aside part of their income to pay for future healthcare needs. Singaporeans can also tap on MediSave to pay for MediShield Life deductible and co-insurance.
Finally, Medifund provides a safety net for Singaporeans who face financial difficulties with their remaining healthcare bills.
Overall, our system has worked well. In 2017, the majority of Singaporeans already pay little or no cash after subsidies, MediShield Life and MediSave for their subsidised hospitalisation bills. Seven in 10 subsidised hospitalisations by Singaporeans did not require any cash payment, and eight in 10 paid less than $100 in cash after subsidies, MediShield Life and MediSave.
Nonetheless, we must continue to constantly innovate, raise productivity, manage cost and also be responsive to changes in order to ensure the long-term sustainability of our healthcare financing model.
Ms Tin has also asked a broad question on how ready an average Singaporean might be, in terms of coping with his or her healthcare cost, especially in old age.
Projections on expenses give us some assurance but we have to remember that healthcare costs can vary and can vary quite easily with a myriad of factors such as personal health management, disease progression trends, medical technological advances and, of course, the effectiveness of our care model transformation. These are in turn shaped by the actions of individuals, providers and payers. We therefore take a calibrated approach to regularly review and take stock, see where we are, and ensure that our financing schemes continue to be relevant and adequate. We will continue to do so, to keep care affordable and accessible at each setting.
At the primary care setting, we have targeted subsidies at Singaporeans who need them more. CHAS enables Singaporeans from lower to middle income households to receive subsidies at participating GPs. In 2018, about 630,000 patients have benefited from reduced out-of-pocket medical expenses due to CHAS and are therefore better able to cope with their bills, especially for chronic conditions such as diabetes.
With an ageing population, we expect more Singaporeans will require assistance to help manage their chronic conditions.
Primary care, being the foundational bedrock of our healthcare system, plays a critical role in shifting healthcare beyond hospitals and into the community. We want Singaporeans to be able to obtain chronic are in the community, and to work with GPs in enabling that. We have therefore reviewed our financing structure, to better achieve this, with the whole primary care sector and our partner GPs.
As mentioned by Prime Minister at the National Day Rally last year, we will extend CHAS to cover all Singaporeans with chronic conditions. This is a major philosophical shift, as Singapore has never had universal subsidies for GP care, but we believe this will help Singaporeans as they grow old and also allow for a greater anchoring of chronic care in the community. And as Dr Lily Neo puts it, to facilitate the seeking of early treatment as far as possible.
This new tier – CHAS Green – will soon be available to all Singaporeans who previously did not qualify for CHAS Blue or CHAS Orange. This would consist of households with per capita household income (PCHI) greater than $1,800. It will provide up to $160 of annual subsidies for chronic conditions. In addition to keeping primary care affordable, CHAS will be another step towards transforming our primary care system to serve Singaporeans.
To better support existing CHAS cardholders as well in managing their chronic conditions, we will also be increasing the annual subsidies for complex chronic conditions for CHAS Blue and Orange cardholders. They will see an increase of up to $20 in their annual subsidies. This means that existing CHAS cardholders can now enjoy up to $500 in annual chronic subsidies.
We will also be introducing additional subsidies for CHAS Orange cardholders. They will be able to receive up to $10 in subsidy per visit for common illnesses, such as cough and cold, at CHAS GP clinics.
Collectively, we expect to pay out more than $200 million a year on CHAS subsidies.
These changes will take place from 1 November 2019 onwards. We will provide more details closer to that date.
To encourage more Singaporeans to tap on the scheme, my Ministry is also looking into ways to simplify the application process for CHAS. We are developing an online application, which we expect to be ready by September 2019. It will be more convenient for Singaporeans thereafter to apply and we hope that more Singaporeans can benefit from CHAS.
At the same time, as CHAS helps more Singaporeans manage their chronic conditions at CHAS GPs near their home, we will put in the measures to monitor that CHAS clinics are in fact delivering good outcomes.
MOH is also reviewing clinical guidelines for care provided at CHAS dental clinics, to ensure that the care delivered is appropriate, relevant and meets the needs of the patients.
Finally, as I have mentioned in this House last month, Dr Chia Shi-Lu will be pleased to know that we will continue to review the per-capita household income (PCHI) criteria for CHAS and other healthcare subsidy schemes, so that the appropriate target group of Singaporeans can continue to benefit from these subsidies.
Aside from Government subsidies, we also review our MediSave limits regularly to keep subsidised healthcare affordable for all Singaporeans.
Mr Muhamad Faisal Abdul Manap asked what are the considerations in determining the MediSave withdrawal limits.
MediSave withdrawal limits are set to be sufficient for the vast majority of expenses in each healthcare setting, after Government subsidies and MediShield Life pay-outs, where applicable, are taken into account. For example, for inpatient stays which MediSave is primarily designed for, we set different withdrawal limits to take into account the varying charges and also the different complexity of surgical procedures. MOH also considers the use of MediSave beyond withdrawal limits on a case-by-case basis, taking into account factors such as the need for more complex treatments, sometimes unforeseen circumstances or complications, and also financial difficulties which may make it hard for the family to pay the outstanding bill. Ultimately, we need to strike a right balance between present use of MediSave and its role as savings to cater for healthcare needs in old age.
Dr Lily Neo asked about the affordability of long-term care, and more specifically, Assoc Prof Daniel Goh proposed increasing the MediSave withdrawal limits for such care.
Let me first set the context. Today, around two-thirds of households qualify for means-tested subsidies of up to 80% for intermediate and long-term care services. We will be introducing CareShield Life, which provides a pay-out of at least $600 per month for persons who are severely disabled. In addition, we also enabled a cash withdrawal of up to $200 a month from MediSave to complement these schemes. Severely disabled individuals with $20,000 balance in their MediSave, can expect to withdraw MediSave up to about 70 months, after setting aside a minimum of $5,000, taking into account other MediSave users such as paying for medical expenses. And that is not too different from the median 59 months which is proposed by Mr Goh. Mr Goh's 60 months was premised on taking it out exactly, but we have to cater for individuals who might require the services beyond the immediate.
The amount of MediSave withdrawal has been carefully considered to strike the right balance between the long-term care and other medical needs of an individual, such as insurance premiums and also hospitalisation expenses. Those who require further assistance beyond what I have mentioned can seek help from Medifund, ComCare, and the upcoming Elderfund.
The long-term care needs of Singaporeans are therefore not solely reliant on a single measure like MediSave withdrawals. They are supported in fact by a robust long-term care financing framework that mirrors the current financing framework for acute care, which has worked well for us.
Let me now turn to MediShield Life, another key pillar of our healthcare financing system. To alleviate the concerns over healthcare expenses related to marriage and parenthood aspirations, we mentioned last year that MOH would review how to extend MediShield Life to cover serious pregnancy and delivery-related complications. These complications could give rise to large bills and become a worry for expectant parents. Mr Christopher de Souza, who raised the point last year, asked for an update on the review.
I am happy to say that we have completed the review after consultations with senior clinicians and have decided to extend the coverage of MediShield Life. From 1 April this year, MediShield Life will cover inpatient treatments for serious pregnancy and delivery-related complications such as eclampsia, cervical incompetency and postpartum haemorrhage, under the existing inpatient claim limits. There are a few more of such complications which will also be covered, and the full list will be found on the MOH website. This enhancement can potentially benefit up to 4,000 patients each year.
Besides providing greater assurance against large hospitalisation bills, we also regularly review how MediShield Life can stay relevant as the model of care evolves. Let me share two examples.
First, on direct admissions into community hospitals which Mr Murali Pillai asked about and raised a suggestion earlier in the House to allow patients who were directly admitted into community hospitals to tap on to MediShield Life and MediSave, similar to those who were transferred from the acute hospitals for continuation of care. I am happy to say that since 15 July 2018, MediShield Life coverage has been extended to patients directly admitted from the emergency departments of public hospitals into community hospitals.
Patients identified for such direct admissions have to be reviewed to be in a stable condition with a clear diagnosis, and require a period of medical, nursing or rehabilitation care. Reason for that is because they are stepping down to a community hospital. This is to ensure that patients are appropriately right-sited and care is safe for patients.
All patients in community hospitals can already tap on their MediSave, regardless of where they were admitted from. We will continue to review MediShield Life coverage for other direct admissions in to community hospitals, based on assessment that such admission is appropriate and safe for patients.
Second, on bone marrow transplants, patients undergoing an autologous bone marrow transplant for multiple myeloma used to be admitted for the entire transplant treatment. Presently, however, part of the transplant treatment including conditioning, stem cell infusion and post-transplant monitoring can be done in an outpatient setting for suitable patients. This potentially shortens the inpatient stays by up to three weeks.
To better support these patients in continuing their bone marrow transplant treatments in the outpatient setting, MediShield Life will be extended to cover these costs up to a claim limit of $6,000 per treatment at approved hospitals. This will apply to treatments performed on or after 1 April 2019. This enhancement can potentially benefit over 20 patients a year. Treatment received in the inpatient setting will continue to be claimable under the existing inpatient claim limits.
In addition to MediShield Life, we will soon introduce our second national insurance scheme, CareShield Life, next year. Mr Pritam Singh asked for more transparency on the adequacy ratios and the assumptions behind premium pricing for these schemes.
As a start it must be remembered that MediShield Life and CareShield Life are not-for-profit, long-term schemes. Collected premiums and the investment returns are solely used for the administration of the scheme and the benefit of policyholders – there is no other use of these funds. Premiums are priced by external professional actuaries based on established actuarial principles, taking into account scheme benefits, claims experience, and future changes in demographics, utilisation rates, and of course, the costs of medical treatment, amongst other factors.
For MediShield Life, the actual claims experience has been close to the projections used in the pricing of premiums. In 2017, for example, our actual claims amounted to 99% of expected claims.
But we have to bear in mind that these are current-year claims. As MediShield Life, however, is a long-term scheme, and part of the premiums collected are set aside as reserves to support long-term commitments and to buffer against adverse scenarios such as a worse than expected claims experience. Further, to help with the affordability of premiums in advanced years, policyholders also pay ahead during their working ages, so that their premiums rise by less in their older ages, when at that stage, they become less economically active.
Quite apart from that, we also regularly monitor the Capital Adequacy Ratio and the Incurred Loss Ratio of the Fund to ensure that the Fund remains healthy.
The Capital Adequacy Ratio reflects the Scheme's ability to meet its liabilities under adverse scenarios. MediShield Life's capital adequacy ratio for 2017 falls within the range of private healthcare insurers'.
As part of our on-going review of the MediShield Life claims limit, we will also be reviewing the Scheme's capital adequacy ratio in tandem with its impact on premiums.
The Incurred Loss Ratio of the MediShield Life Fund over the last five years was approximately 97% – sufficient to ensure the sustainability of the scheme but not excessive. This ratio compares the total premiums collected to the total monies required to ensure that the Fund is able to meet both current-year claims and also its liabilities into the future.
Total monies required for the Fund include immediate claims pay-out each year, and the change in required reserves for future pay-outs.
A less appropriate approach sometimes cited to assess the adequacy of the Fund's premiums collection is to compare total premiums collected to total claims paid in the same year. This approach, however, is not a holistic representation as it omits a large part of what MediShield Life's premiums are meant to support, namely future long-term claims and premium affordability in advanced ages.
For MediShield Life, the benefits are outlined in the information booklet issued to all members. Further information about the Fund size, the reserves and the Incurred Loss Ratio is published on the MOH website, and the MediShield Life financial accounts are audited each year by an external auditor and then submitted to the Parliament every year.
In addition, the independent MediShield Life Council also reviews premiums collection and claims experience amongst others, and thereafter provides recommendations to the Government to ensure that MediShield Life provides effective protection in an affordable and sustainable manner.
The CareShield Life scheme design was also discussed in this House in 2018. CareShield Life supports the long-term care needs of Singaporeans in old age. Premiums are paid during the working ages, for lifetime coverage should the policyholder become disabled.
Similar to MediShield Life, an independent CareShield Life Council will be set up to advise the Government on the sustainability of the CareShield Life scheme.
I turn now to address the questions and the cuts on care-giver support.
Even as we address Singaporeans' concern over healthcare expenses, we also recognise the need to consider accessibility to healthcare, which is critical for the timely management of the condition. This is especially so for elderly who needs long-term care, and we must also care for the care-giver. With this in mind, MOH announced a Care-giver Support Action Plan earlier last month to strengthen support for senior care-giving.
Ms Tin Pei Ling and Mr Charles Chong have asked what we intend to do to continue to support care-givers. We intend to do more in at least three areas – financial support, flexible work arrangements and options for respite care for care-givers.
Firstly, in terms of financial support, we have put in place several financial support measures to help defray the costs of care-giving, such as means-tested subsidies for aged care services, the Seniors’ Mobility and Enabling Fund which subsidises the costs of assistive devices and home healthcare items, and the Care-givers Training Grant which subsidises training.
In addition, we will be introducing a new Home Care-giving Grant (HCG) by end 2019, as further financial support to care recipients living in the community with permanent disability and require some assistance in at least three Activities of Daily Living (ADLs). The HCG replaces the existing Foreign Domestic Worker (FDW) Grant with an enhanced quantum of $200 per month. While the FDW Grant helps to offset the costs of hiring an FDW, the HCG provides greater flexibility to help offset more care-giving expenses, such as the costs of home and community-based services, and transportation to medical appointments. In some cases, some might prefer to hire an FDW to help; others might not; it does not matter. The HCD can be used in either scenario.
Secondly, MOM has shared their plans to increase the budget for the Work-Life Grant to allow more companies to benefit from the grant and implement flexible work arrangements for their employees. This will help working care-givers to manage their work and care-giving commitments, and is a key step to building a sustainable approach that balances the needs of both employers and employees.
Third, we will be expanding the existing respite care services. We currently have respite services at our centres and nursing homes to allow care-givers to take a break from their care-giving duties. Centre-based respite services cater to the needs of care-givers who need a few hours off, while nursing home respite services allow overnight stays from several days to a few weeks. To date, over 2,400 clients have benefited from these respite services. We will be piloting a new night respite service with selected nursing home providers in the second half of 2019 to support care-givers of seniors with dementia who experience behavioural and sleep difficulties at night. We will continue to explore new models of care to meet the needs of care-givers.
The Care-giver Support Action Plan complements the already existing suite of services and schemes currently available to seniors and their care-givers. MOH will be implementing the Action Plan over the next two years to better support care-givers, and will provide more details on other specific measures in the coming months.
Further to strengthening the financial and care-giving support, we also believe that having a reliable healthcare network is fundamental to every successful healthcare system. And this could be achieved through proper regulations.
Prof Fatimah Lateef has asked for an update on our regulatory approach and progress with regulatory sandbox. As a regulator, our priority is with ensuring patient safety and proper continuity of care, as new and innovative care models evolve to meet the healthcare needs of Singaporeans.
To do so effectively and safely, there is a need to review and replace the current Private Hospitals and Medical Clinics Act (PHMCA). The proposed Healthcare Services Act (HCSA), which will come before Parliament shortly, aims to enhance the regulatory clarity as to the types of healthcare services regulated, strengthen the governance of the licensees providing the healthcare services, provide the necessary safeguards to patient safety and welfare, and to ensure continuity of care and accountability.
To complement the change in our approach to regulation, we have also launched a regulatory sandbox in April last year to support the safe growth of new modalities of care and innovations within current care services – the Licensing Experimentation and Adaptation Programme or LEAP.
Doctor-led Telemedicine and house-calls were the first services to come under LEAP, and within the last year, we have 11 providers on LEAP. As providers and models mature, we are also encouraging a shift in the services provided, from managing simple acute conditions, such as cough and cold, to more complex chronic diseases such as diabetes, supporting MOH's \"Beyond Hospital to Community\" strategy.
Prof Fatimah Lateef will be pleased to note, and I think Mr Leon Perera also raised the point about encouraging innovation in the intermediate and long-term care sector, that we are constantly looking at how technology can help us create a sustainable healthcare future. We are also supporting our healthcare institutions to find solutions to increase productivity through the Healthcare Productivity Fund. We are seeing some early results. On the average, our productivity efforts have saved about 300,000 man-hours across public healthcare and community care institutions per year.
However, even with innovations in modalities of care and changes in the way patients can access healthcare services with technology, we are mindful that there are certain aspects of care that we should not or perhaps ought not to replace – for example, the human touch. One of our key strategies in supporting productivity is to continually explore how innovations can free up manpower from routine work so that they can go back to the business of caring for patients directly.
To conclude, Chairman, the Government will continue to support productivity and innovation for greater healthcare sustainability, affordability and accessibility. We hope that new policies, such as the enhanced CHAS scheme, will encourage all Singaporeans to seek help early and in the community. We will also be helping care-givers to continue to care for their loved ones in the community. Let us all work together and move away from healthcare to health. Help us, help you – with each and every one of us taking good care of our health, we can all be hopefully happy and active in our golden years.
The Chairman: Senior Parliamentary Secretary Mr Amrin Amin.
The Senior Parliamentary Secretary to the Minister for Health (Mr Amrin Amin): Mr Chairman, I will focus on three areas: removing trans-fat from our food supply; reducing smoking rates; and third, strengthening our health eco-system.
On the first area, artificial trans-fat is harmful to health. According to the World Health Organization (WHO), artificial trans-fat increases risk of heart disease and has no known health benefits. WHO has called for countries to remove artificial trans-fat from the food supply.
Currently, our law requires food manufacturers to declare and limit the amount of trans-fat in cooking oil and fats. Local trans-fat halved from about two grammes per day in 2010 to one gramme per day in 2018.
It is timely to build on this. We will be introducing a ban on partially-hydrogenated oil (PHO) in our food. Current trans-fat regulations only apply to fats and oil. This ban will also extend to pre-packaged food products such as snacks, baked foods, prepared meals and fat spread PHO is a major source of artificial trans-fat in these food.
Banning PHO will not have an adverse effect on Singaporeans' food options and cost. MOH has consulted the local food industry who are generally supportive. United States, Canada, and Thailand have also banned PHO.
The industry will be given time to make adjustments. Details will be shared subsequently.
Mr Chairman, turning to second area: reducing smoking rates. Dr Chia asked about efforts to help smokers quit. Smoking remains a concern in Singapore. I had announced in May 2018 that we are working towards a smoking prevalence of less than 10% by 2020. There are about 400,000 daily smokers today. One in six smokers tell us that they are thinking about quitting, but only three in 100 smokers actually take action. We target to get more smokers to go beyond thinking about quitting to actually taking active steps to quit smoking.
Successful cessation rates range from 10% for telephone-based interventions to 20% for programmes that combine intensive counselling and pharmacotherapy. This is comparable intentionally. It is difficult to quit smoking. That is why it is called an addiction, but it is not impossible.
One story inspired me. Mr Iskandar shared with me about how he successfully quit smoking, and he also helped his father to quit a 30-year smoking habit.
Mr Iskandar started smoking when he was 14. After smoking for about eight years, he started his quit journey last year. He wanted to save money for travel and improve himself. He quit cold turkey. He went to the gymnasium and jogged.
Mr Iskandar shared his quit journey with his father, Mr Muhamed Ibrahim, a smoker of 30 years. The son motivated the father and his father had also quit smoking. Mr Iskandar is now working on his brother, Mr Noor Muhamed, to cut back on smoking.
There are learning points from Mr Iskandar's story. First, personal motivation is important. Studies show that self-motivation and important milestones, such as the arrival of a new baby, or discovering a serious disease, are critical turning points. Second, supportive family and friends are critical. And third, it is never too late to quit smoking. Mr Iskandar's father is one example.
We will be speaking with more smokers this year to see how we can help. Details will be shared in HealthySG Task Force's recommendations.
There are some who have suggested e-cigarettes as smoking cessation aids. Members are aware that we disallowed the importation, sale, distribution, purchase, possession and use of e-cigarettes since February 2018.
Cessation products and programmes must first be effective and evidence-based. The current evidence for e-cigarettes as a smoking cessation aid is mixed, and we are monitoring studies that have been conducted. One concern we have is a \"substitution effect\". Some smokers substitute cigarettes with e-cigarettes instead of quitting or, worse, they use both. So it is hardly smoking cessation. It is more like swapping one nicotine/tobacco addiction in one's guise for another.
The other concern is the \"gateway effect\". Various studies have shown that e-cigarette users are more likely to become cigarette smokers compared to non-users. The experience with e-cigarettes in United States and Hong Kong are instructive. US' Sergeant-General has called alarming increase in new cigarette use an epidemic. Hong Kong reported a rise in Primary 2 to 4 students trying e-cigarettes in the last two years. And Hong Kong has recently banned e-cigarettes.
We are open to allowing a specific product to be registered and regulated under the Health Products Act as a therapeutic product for smoking cessation, but there must be good evidence and it must be effective.
Dr Chia Shi-Lu asked about help for younger smokers. Smoking rate among Secondary school, ITE and Polytechnic students dropped from 8% in 2011 to 2019, to about to 4% in 2014-2016. But this means that there are still 12,000 under-aged smokers. We are focused not only on preventing initiation, but also helping younger smokers quit, and this is our strategy.
The Health Sciences Authority (HSA) has stepped up ground surveillance and enforcement activities among tobacco retailers to reduce youth access to tobacco. In 2018, HSA suspended the tobacco retail licences of 23 first-time offender retailers and revoked four repeat offenders.
Youth smokers are referred to counsellors, Quitline, or Student Health Advisors (SHAs) at 50 Secondary schools or ITE Colleges and Polytechnics for cessation counselling. In 2017, 3,000 youths were counselled and 43% managed to reduce smoking, and about 10% quit.
In June 2018, we launched \"Better Things to Do\", a campaign for youths. We hope to encourage youths to tap on their network to promote a tobacco-free lifestyle.
And in January this year, we focused on harmful, emerging products – e-cigarettes in particular, which contain nicotine and benzene. And we will intensify our tobacco-free efforts.
Mr Chairman, turning to the third area of my speech, strengthening our health eco-system, I have three points to make.
First, growing our healthcare professionals, and traditional Chinese medicine practitioners. Second, making screening and follow-up more convenient. And third, the progress on war on diabetes and HealthSG Task Force.
On the first point, Dr Chia Shi-Lu asked about ensuring sufficient numbers of allied health professionals. MOH had worked with MOE and the Singapore Institute of Technology (SIT) to increase the intake of four Allied Health degree programmes in Physiotherapy, Occupational Therapy, Diagnostic Radiography and Radiation Therapy from 230 in 2016 to about 300 students in 2018.
There are also Graduate Entry Masters programmes in Speech Therapy, Clinical Psychology and Audiology at the National University of Singapore.
MOH regularly reviews our training pipelines, for example, to the growing need of dietitians in Singapore, SIT launched the first local four-year Dietetics and Nutrition degree programme. The first cohort will begin the programme in September 2019.
Earlier this year, we introduced an accelerated Professional Conversion Programme for Physiotherapists as an additional pathway for those keen to join the healthcare sector as Physiotherapists. This programme allows mid-career locals with a degree in science-related fields to complete physiotherapy training in less than three years, compared to four.
Mr Christopher de Souza asked about continuing development and career progression for allied health professionals. We are launching the \"Skills Framework for Healthcare\" for six professions – Nurses, Pharmacy Technicians, Physiotherapists, Occupational Therapists, Speech Therapists and Patient Service Associates.
The Skills Framework for Healthcare (SFH) is a common reference for skills and competencies for different stakeholders. MOH will work closely with the respective professions to identify training needs and build a future ready healthcare workforce.
Turning to Traditional Chinese Medicine (TCM) Practitioners, to raise professional standards of TCM practitioners, Continuing Professional Education (CPE) is compulsory when renewing practicing certificates. To defray CPE costs, TCM practitioners can apply for the TCM Development Grant, launched in 2018, at a cap of $200 per year. As of end 2018, we had given more than $70,000 to over 400 TCM practitioners. TCM practitioners can use their SkillsFuture Credit to attend eligible TCM-related courses. And we will continue to work closely with the TCM Associations to support TCM practitioners.
We will make health screening and follow-up more convenient. From May 2019, you can have subsidised checks for blood sugar and cholesterol levels at CHAS clinics without having to fast overnight or for 12 hours.
We will update our guidelines to recommend the use of glycated haemoglobin (HbA1c), and the non-fasting lipid tests, as alternative screening tests for diabetes and high blood cholesterol respectively. This has been endorsed by international and local medical professional bodies. A local clinic working group found that the HbA1c, if used correctly, was just as capable as the current test in detecting diabetes. The group also recommended the use of non-fasting lipid profiles for screening high cholesterol based on international guidelines and studies.
The non-fasting tests give Singaporeans a wider range of screening options to choose from. This will be helpful for seniors who are more prone to episodes of low blood sugar. We hope to increase screening uptake with this added convenience.
Singaporeans with eye conditions can now receive care closer to their homes. We piloted community eye clinics with Singapore National Eye Centre (SNEC), Tan Tock Seng Hospital (TTSH) and National University Hospital (NUH). At CECs, patients can have their eyes checked and managed. There are four CECs at Punggol Polyclinic, Keat Hong Family Medicine Clinic, Hougang Polyclinic and the Health Promotion Board at Outram. Later this year, there will be two more community eye clinics at Pioneer and Geylang Polyclinics.
Dr Lily Neo asked about promoting healthy lifestyles to prevent chronic diseases, and supporting Singaporeans to reduce sugar intake. Mr Melvin Yong asked for updates on the War on Diabetes and Dr Chia asked for updates on the HealthySG Taskforce.
Healthier eating is now more accessible. As of December 2018, more than 1,200 food and beverage (F&B) operators, hawker centres, and coffee shops, with 8,900 touchpoints island-wide, have joined the Healthy Dining Programme (HDP). Singaporeans consumed 131 million healthier meals in 2018, double that in 2017.
Lower sugar beverages are now within reach. We have more drink partners with about 200 outlets, as well as drink stalls in hawker centres and coffee shops with the \"H\", with the healthy dining programme.
HPB’s Eat Drink Shop Healthy Campaign nudges Singaporeans to earn points when choosing healthier options during grocery shopping.
We extended the Healthier Ingredient Development Scheme (HIDS) to include sugar-sweetened beverages, desserts and sauces. We partnered five dessert suppliers, three beverage suppliers, and one sauce supplier, and there are now healthier options available.
Exercise is another area. The National Steps Challenge Season Three helped 8 in ten participants who were previously inactive clock more than 150 minutes of physical activity a week. We are taking another step forward. We are encouraging higher-intensity physical activity, hence better fitness. 740,000 participants in Season Four of the National Steps Challenge were provided with a new step-tracker that can measure heart rate.
There were also many exercise programmes in the community, but there is more to do. The HealthySG Taskforce, which I chair, seeks to integrate, coordinate, scale up health promotion efforts across our social and infrastructure agencies and communities, and especially the under-reached and disadvantaged groups, such as the lower income. Public consultations will start in end March to early May, and we are targeting to release recommendations in early second half of the year.
Mr Mohamed Irshad asked about how health promotion efforts have reached our Malay and Indian communities. Let me give an update. Mr Chairman, with your permission, in Malay, please.
(In Malay): [Please refer to Vernacular Speech.] Our effort to develop a healthy Malay community focuses on three aspects.
First, by watching what we eat and drink. Second, be physically active. Third, undergo health screenings and seek early treatment.
Many initiatives introduced this year have refreshed the three thrusts mentioned earlier.
Let us talk about food. In 2017, there were only two halal Healthier Choice dishes at the hawker centres: Thosai and Mee Soto.
Now there are more choices with six halal dishes that are healthier. Halal Healthier Choice dishes now include chicken porridge, Penang asam laksa and mee bakso. Crowd favourites like briyani, nasi padang, chicken rice, rendang and many other kinds of dishes can also be modified into healthier versions.
Well-known Malay restaurants also began to serve a wider choice of delicious and healthy food. Rumah Minang, Hajah Maimunah, Sabar Menanti, and many more. These are some of the 1,100 food establishments that serve healthier halal dishes using brown rice, healthier cooking oil, vegetables and less coconut milk.
It is not just when eating out. If you attend religious feasts or weddings, healthier choices are also available. There are now 107 caterers providing halal healthy food, including 24 Malay wedding caterers like Jamil Catering and Istana Wedding Services. The feedback has been positive. The dishes taste the same and the flavour is not compromised. In January this year, we offered get-fit courses to those getting married at the Wedding Fair. One hundred and forty couples who are tying the knot participated in this pilot programme so that on their big day, they will be lighter, slimmer and more importantly, healthier.
Our “Kita dah cukup manis!” (We are sweet enough!) and “Korang OK?” (Are You OK?) campaigns, especially during the fasting and Hari Raya period, advise us to consume less sugar.
In November 2018, I launched the “Korang OK?” exercise video for pre-school children. To bend a bamboo, do it when it is still a bamboo shoot (Malay proverb meaning to cultivate good values while they are still young). From young, develop healthy habits, exercise, as these can be done easily and enjoyably.
Six dialogue sessions sharing nuggets of wisdom on health were organised with Berita Harian. It is always best to get medical advice from the professionals. Therefore, during these dialogue sessions, the public were able to obtain health tips from the experts like doctors from the Muslim Healthcare Professionals Association.
The dialogues did not end there, and in fact, it continued online. The “Korang OK?” social media site set up in June 2018 has more than 23,000 followers and the site is actively sharing healthy recipes and health tips.
Exercise is important. I was concerned when I saw many of our seniors experiencing leg pains when I performed my Umrah (minor pilgrimage) in 2017. Together with HPB and Umrah travel agents, we launched the “Get Fit For Haj/Umrah” in November 2017. The six-week exercise programme organised in mosques and stadiums attracted 900 participants. I was informed that, through this programme, our pilgrims were able to move quicker when performing their tawaf (haj ritual that involves walking).
After the Umrah season, there are also exercise programmes like the “Gerak Gelak” walking event organised by the MAEC from the community clubs. Four “Gerak Gelak” sessions were organised since 2018 by the Tampines, Marine Parade and Sembawang GRCs, as well as in Jurong last week, with a total of 2,200 participants.
Taking care of health is also encouraged in Islam. The “Jaga Kesihatan, Jaga Ummah” (Taking Care of Health, Taking Care of Community) programme launched two years ago began with five mosques. It has expanded to include 23 mosques, with various exercise programmes, health workshops and health screening sessions held at JKJU mosques, and it has benefited more than 4,500 congregants this year.
Good health is a precious gift. Let us take care of our health and our families together.
(In English): Let me now turn to the Indian community. I attended a dialogue with 20 Indian voluntary oganisations to talk about community health matters and programmes. We are partnering with various Indian groups such as Sree Narayana Mission, the Central Sikh Temple, and Narpani Pearavai, the Indian Activity Executive Council Committees.
We partnered with Suria, Vasantham and various Mediacorp artistes to run the Family Funival earlier this January. Over 5,000 people bonded over zumba and various workouts. We will do more this year.
In conclusion, Mr Chairman, Singaporeans are living longer, and my colleagues and I are working hard to ensure all of us can lead healthy, fulfilling lives. Let us grow healthier together! Let us build a healthy Singapore together.
The Chairman: I do not know about you but I feel very hungry after his speech. Clarifications? Mr Alex Yam.
Mr Alex Yam: Thank you, Chairman. My clarification is for the Senior Minister of State Dr Amy Khor. I hope she can address my cut on reviewing the medical evidence on pre-term viability.
The Senior Minister of State for Health (Dr Amy Khor Lean Suan): I thank the Member for reminding me about his cut. My apologies.
In response to the cut, the current cut-off of 24 gestational weeks for abortion was based on scientific evidence of foetal viability outside the womb. According to local experts as well as based on our hospitals' experience, foetal viability below 24 weeks remain low. Furthermore, morbidities such as neuro-developmental disabilities are very high among the premature babies who survived.
International studies and professional bodies also largely support the low foetal viability below 24 gestational weeks. In addition, in 2018, it is worthwhile to note that about 1% of all abortions performed were performed between 22 and 24 gestational weeks, of which more than half of these abortions were performed due to foetal anomalies and other medical reasons.
So, essentially, the number of abortions below 24 but between 22 to 24 is already very low, and quite a large percentage is really due to medical reasons. So, what we have done, really, is also to work together with MSF to strengthen pre-abortion counselling and to raise awareness among these women with unplanned pregnancies of the options available to them including adoptions. MOH will continue to monitor and review this issue as new evidence emerges.
The Chairman: Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Thank you. Just two clarifications. One is concerning the Agency for Care Effectiveness (ACE). I have been very supportive of it because it gives guidelines on what is the best practices. So, perhaps, I was hoping that MOH could share with the House the achievements of ACE thus far.
The second clarification is regarding MediShield Life. Earlier this year, there were some concerns about inadequate payouts for certain patients. I understand from previous replies that the MediShield Life Review Committee is looking at claims limits. But, in the meanwhile, to give better assurances to Singaporeans, is there any mechanism by which we can appeal for higher payouts from MediShield Life in certain of these bills?
Dr Lam Pin Min: Mr Chairman, I would like to thank Dr Chia Shi-Lu for the supplementary questions with regard to ACE. Just to give a brief background. ACE, which is the Agency for Care Effectiveness, was actually set up within MOH in August 2015 as a national health technology assessment agency, against this backdrop of rising healthcare costs and the need to drive clinically effective and cost-effective healthcare.
Over the years, there has been a lot of good work done by ACE. Just to name some of the achievements that ACE has done, which includes producing technology guidances on drugs and medical technologies. In fact, they have published almost 33 drug guidances, three medical technology guidances, as of 2 January 2019.
In addition to that, ACE also produces Appropriate Care Guides (ACGs) which are targeted and concise as recommended care practices and pathways that promote appropriate prescribing behaviours. As of 2 January this year, they have already produced nine ACGs.
ACE also conducts value-based pricing, or what we call VBP, in parallel with drug and medical technology evaluation. This is to ensure that the price of patented drugs or medical technologies recommended for subsidy commensurates with the drugs or medical technologies' value in Singapore's context.
So, suffice to say, ACE has done a lot of good work and it has also achieved its objective of driving healthcare costs down.
Mr Edwin Tong Chun Fai: Chairman, I will address Dr Chia's second question. At this point in time, we do not look at appeals for MediShield Life payouts. The reason for that, obviously, is the more you get the payout on an individual, that compromises the fund because you draw out from other persons who have put premiums inside.
But on Dr Chia's point, we can consider appeals for higher MediSave withdrawals or, if not, then the use of Medifund, in the meantime. But the MediShield claims limit is being reviewed.
The Chairman: Ms Joan Pereira.
Ms Joan Pereira: Thank you, Chairman. I have two questions for MOH. First, in my earlier cut, I mentioned that patients now have access to information on bills and fee information in the MOH website. But there is no information on the website on the standard or quality of delivery; basically qualitative information. So, would the Minister consider providing such information on the website, which I feel will be helpful? First question.
My second question: last year, MOH announced the formation of the Agency for Logistics and Procurement Services (ALPS) to pool together the supply chain functions and resources of the three health clusters. May I know what is the progress of ALPS and how has that benefited our patients?
Mr Gan Kim Yong: Sir, on the quality information of our healthcare institutions, I will take on the suggestion and will take a look and see what kind of quality information we can put up to help patients make informed decisions. It is a useful suggestion. I want to thank the Member for that suggestion.
Secondly, on ALPS, ALPS stands for Agency for Logistics and Procurement Services. It is quite a mouthful but it is an important initiative that we have introduced. The idea is to bring together the supply chain functions of all our clusters, so that we can achieve economies of scale, aggregate demand, and so on.
The first step is to better understand the procurement practices of the different clusters and see whether we can harmonise them – first, to achieve economies of scale by aggregating the purchases of the various clusters; then we have a higher leverage with our suppliers so that we can negotiate for better pricing.
Secondly, we are also looking at whether we can take the next step of standardising some of the products, instead of each one having their own prescribed specific products for the cluster, and whether we can find common products that we can further aggregate the demand so that we can optimise the supplies.
Beyond that, the agency is also looking into how we can reorganise our distribution network, our logistics arrangement, our entire supply chain management so that we are able to optimise resources. For example, if you can imagine that you store your pharmaceuticals in one warehouse and deliver them to another hospital, and you have another warehouse deliver to the other hospital, actually we can just have one warehouse to deliver to both hospitals. So, there is opportunity for us to optimise.
Lastly, having done some of these optimisation, we also want the agency to think out of the box to see whether they can have new innovative ways of managing the supply chain. For example, if you allow your imagination to run wild a little bit, you can think about whether we can deliver medication to the patients rather than having to collect it from the pharmacy. So, if you do a national kind of distribution network, that may be possible. Today, many of us purchase through e-commerce and they deliver to your house quite regularly. But, of course, delivering medication is quite different from delivering your food items and sundries and so on. It is more stringent. We will have to study it very carefully. But aggregating the supply chain and logistics function will allow us to think out of the box and develop new models of distribution which will in the long term benefit our patients.
Ms Sylvia Lim: Thank you, Chairman. I do not recall hearing a response to my cut on the private ambulance service industry. So, may I have a response to that and, in particular, what the Ministry is doing to improve outcomes for consumers?
Mr Edwin Tong Chun Fai: The Healthcare Services Bill (HCSA) that I talked about will regulate private ambulances and I think Ms Lim, in particular, spoke about the publication of rates for more transparency. That legislation will mandate the publication of common fees charged as well as give more transparency to the bill components to be paid by the consumers so they will know upfront what those costs would be. Further details would be set out in the HCSA Bill as we will put it up shortly.
Ms Irene Quay Siew Ching (Nominated Member): Mr Chairman, can I ask the Minister for his comments regarding the proposal in my Budget debate speech to acknowledge allied health professionals' and pharmacists' expertise in a national subsidy framework for cost containment as well as to keep patients in the community, such as the extension of drug subsidy schemes to community pharmacies as well as extension of CHAS scheme to allied health services in the community because we need a holistic approach to keep patients in the community?
Mr Amrin Amin: I thank Ms Irene Quay for the good suggestions. MOH is actually currently studying the models of care that will help patients access allied health services earlier, say, for example, the direct referral to community physiotherapists for agreed musculoskeletal presentations.
On the point about remuneration for public sector allied health professionals, a point that was raised by Ms Quay, beyond salaries, MOH works with clusters to enhance the value proposition of an AHP career in the public sector and these are things that I mentioned by providing learning and development opportunities. I mentioned in my speech also about the skills framework for healthcare that was launched in 2019 that will cover various training opportunities and career plans that they can have.
As for pay, it is something that we will review. We always want to make sure that it is competitive so that we can retain good AHPs in the public sector.
Mr Pritam Singh: Thank you, Chairman. My question is directed at Senior Minister of State Edwin Tong. This is with respect to my cut on Greater MediSave Flexibility for senior citizens, particularly those above 60. The Senior Minister of State mentioned in his reply that eight out of 10 patients pay less than $100 in cash as a result of their hospitalisation. Can I just get a sense of the average amount that patients pay for the remaining 20% of that category? In addition to that, what are the absolute numbers of hospitalisations we are talking about in that particular category – those who pay above $100?
Mr Edwin Tong Chun Fai: I do not have those numbers to hand out, but if the Member could file a PQ, I would have those numbers to hand.
Dr Lily Neo: Thank you, Mr Chairman. Two clarifications, please. May I ask whether there is sufficient aged care capacity to support our ageing population? Secondly, what is HPB doing to make healthier food options more affordable?
Dr Amy Khor Lean Suan: Since 2015, we have been significantly increasing aged care capacity in terms of nursing homes as well as community care, home and centre-based care facilities. In fact, we have added 2,700 day care places since 2015 so that seniors can access day care services near their homes. We have also added another 2,300 home care places over the same period.
In fact, the supply of home and day care places has actually stabilised. We see sufficient capacity at the national level. So, in fact, at the national level, there are more vacancies than wait-listed seniors, except that there could be an imbalance in demand and supply within certain local areas because of patient or family preferences and so on. So, in those areas where there is an imbalance, we are actually ramping up capacity in terms of new centres, as well as building new centres. Our focus now is on the quality and variety of aged care services available. Earlier on in my speech I said that we are actually looking at better integration of social and health services and, therefore, because the Senior Activity Centres have now come under MOH, together with the Senior Care Centres, we are now looking at a range of services that all these Senior Centres can offer within the community and, therefore, increasing access and availability of services for the seniors.
Mr Amrin Amin: Sir, to answer Dr Lily Neo's question on making healthier food more affordable, this is something that we are studying in greater depth under the Healthy SG Taskforce, but there have been some efforts going on. HPB collaborates, for instance, with the local retailers to offer price discounts for Healthier Choice symbol housebrand products and we have been working closely with retailers, such as NTUC, Cold Storage and Sheng Siong.
We will see what else we can do on this front. But it is also worth pointing out that on healthier food, it does not cost so much to eat healthy. You can actually prepare chicken in healthier ways.
Mr Leon Perera: Thank you, Sir. Just a quick clarification. I thank the Minister for addressing my cut on Value-based Healthcare. Is there a targeted timeframe for moving in a more broad-based way towards a value-based healthcare model in Singapore and will a roadmap be published towards that end?
Mr Gan Kim Yong: Sir, the value-driven care initiative started in 2017, as I explained in my speech. We appointed a national value-based healthcare workgroup. This workgroup already comprised representatives from the various public healthcare institutions, so it is already quite broad-based. To date, we have initiated a total of 17 conditions under value-driven care and we want to expand this over time. But we need to do it very carefully because, as the Member pointed out, we need a buy-in from both service providers as well as patients so that they are on this journey of value-driven care.
We will continue to press on with this effort. But it is already broad-based, involving most of our public healthcare institutions and they have a plan to gradually expand these conditions to more conditions. But we would prefer to focus on these 17 for the time being to make sure that they are done well so that the same methodology, the same model, can then be replicated. If we rush into it, I think it may create more problems and difficulties. So, we would prefer to focus on these 17, do it well and develop a dashboard so that we can get everybody on board and try to improve and optimise the care outcome and cost effectiveness. Later on, we can replicate to other conditions.
The Chairman: Dr Chia, would you like to withdraw your amendment?
Dr Chia Shi-Lu: Mr Chairman, as always, I would like to thank all Members for their active participation and for the very healthy debate and, of course, to Minister Gan, Senior Ministers of State Amy Khor, Lam Pin Min and Edwin Tong and Senior Parliamentary Secretary Amrin Amin and all staff of the Ministry of Health for the care they have given; you get explanations and the surgical precision of their responses. May we all live long and prosper. With that, I beg leave to withdraw my amendment.
Amendment, by leave, withdrawn.
The sum of $10,023,750,700 for Head O ordered to stand part of the Main Estimates.
The sum of $1,698,806,800 for Head O ordered to stand part of the Development Estimates.
","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 T (Ministry of National Development)","subTitle":null,"sectionType":"OS","content":"The Chairman: Head T, Ministry of National Development. Mr Alex Yam.
Mr Alex Yam (Marsiling-Yew Tee): Mr Chairman, I beg to move, \"That the total sum to be allocated for Head T of the Estimates be reduced by $100\".
As a Member of the Class of 2011 in Parliament, like me, many Members of this House would have personally experienced the volume of appeals by our residents regarding housing matters from 2009 through to 2013. Many were young couples, and even their parents, who came to Meet-the-People Sessions, anxious and perhaps also perplexed by the housing situation then. Many try and try but were constantly unsuccessful in their applications for a flat.
Fast forward today, I think we can mostly agree that the situation has gotten much better. Just by volume of cases, you can tell that the increase in supply and the multiple improvements that have been made and introduced by then Minister Khaw Boon Wan and, more recently, by Minister Lawrence Wong and the MND team have made a difference. This is a Ministry that has listened intently to feedback from the public and suggestions from backbenchers for a re-emphasis on the centrality of housing to the social compact that we have with fellow Singaporeans, and that there are housing options for Singaporeans at every life-stage.
While the appeals on purchased flats have dropped, there is still work required on the other end of the housing spectrum, and this is rental housing. At last year’s Committee of Supply, I spoke on the issue of co-living, as well as our public rental flat schemes. I am thankful that the Ministry has made improvements on many fronts, yet it is still an issue that vexes. I, therefore, welcome the Senior Parliamentary Secretary’s reiteration yesterday that public rental should be temporary.
To help households in rental housing to move to home-ownership is certainly not straightforward. There are multiple issues that rental families face. We have experimented with different schemes before, such as the HOPE Scheme (Home Ownership with Education) which I previously raised issues with. We now have the Fresh Start Housing Scheme which the Senior Parliamentary Secretary also updated the House that 74 families have now been emplaced.
Yet, with a scheme that has been in place since December 2016, the numbers seem to indicate a fresh but no so fast start. I took a look at the available numbers. In December 2017, 56 applied, 33 were successful. In December 2018, Minister announced that 70 were placed. Today, in March 2019, we have 74.
If we look at the figures of the number of families who have progressed from rental to home-ownership of 3,500 over the last six years, 74 seem very small indeed. And 3,500 households across 56,000 rental units seem to indicate that the journey, though encouraged, is honestly quite fraught.
[Deputy Speaker (Mr Charles Chong) in the Chair]
Most of us would have rental households in our constituencies. We are certainly proud and happy for our residents who have successfully progressed to purchasing their own homes. But do we also shed a tear for the many who are left behind? We have seen their struggles first-hand – to try to hold a job, to fight ill health, to balance family needs, to pay debts, and, for some of them, to stay on the straight and narrow. For us and many community partners, we do whatever we can to help them. Yet, often, challenges remain and continue to surface that keep them from completely lifting themselves out.
I am, therefore, heartened by Senior Parliamentary Secretary's announcement of a Home Ownership Support team to provide stronger personalised help for those with potential for home ownership. The work for the new team will certainly not be easy. Could the Ministry, therefore, update the House on the ambit of this new team and what are the conditions that the team will be looking at to identify households that can potentially become homeowners?
Based on the understanding of this criteria, could I also ask the Ministry how many of rental households today would potentially move towards home ownership in the next five years and what are the main barriers that would keep the rest from moving towards these aspirations?
While we address the issue of families progressing to home ownership from rental, there is also a group who faces even greater challenges. These are our elderly poor, often single, without family support. Last year, I raised the issue of joint-singles where co-tenants are unable to get along. Would the Ministry consider having more rental flats refurbished to provide for more privacy within the flats for co-tenants to have some semblance of their own space? This reduces the disagreements that may surface. Also, I would suggest for an adjustment period to be included for the benefit of both co-tenants so that they have time to adjust to each other before committing to a full rental contract. This could be for a month and come with certain pre-conditions.
From elders in rental flats to elderly homeowners, the Ministry has provided additional options over the years. One example is the Lease Buyback Scheme (LBS). After the enhanced LBS was first announced by Deputy Prime Minister Tharman in 2012, fellow Members and I have pushed for great adoption of the scheme and also for the scheme to be extended. Further improvements were then made in 2014, and I was most heartened when Minister Lawrence announced after last year's NDR that LBS will be extended to all flat types effective from 1 January this year.
I have actively promoted the LBS to my older residents and, as I have a high number of larger flats, the extension is welcome news for my residents. However, I also wish to point out that there are many who are still unaware of the details and grapple with issues surrounding leaving an asset for their children or should they live beyond the period under the LBS agreement. Would the Ministry, therefore, consider better communication on the scheme and perhaps offer a customised info-kit to home owners who qualify for the scheme so that they can be better informed of their options?
Related to this is, of course, diminishing lease and its impact on home prices. The Ministry had earlier indicated in August 2018 that it is studying the possibility of allowing liberalisation of the usage of CPF for older, shortest lease flats. I wish, therefore, to ask the Ministry for an update on the study so far and the parameters that the Ministry is looking at to make this work. I would also point out that while this will open up the market for older flats and allow younger home owners the option of purchasing an older flat using more of their CPF, we must not solve two problems and yet move the main issue of diminishing leases further down the line.
For younger aspiring home owners as well as second-timers, the Sale of Balance Flat Scheme and the Re-Offer of Balance Flat Schemes are often seen as the easier and quicker option to getting keys to your own flat. But I often caution younger residents who try for SBF that they are competing for a smaller pool with a bigger crowd, and yet they still try. Therefore, I welcome the Ministry's announcement that the ROF will now be extended all year round and made available online on a first-come first-served basis. However, I wish to ask how the Ministry intends for the system to work smoothly and avoid opportunistic applications rather than from those with genuine needs. Could the Ministry also clarify how the first-come first-served system will be fair for all?
If the ROF scheme under the new arrangement is proven to be a successful model, I would ask that the Ministry also consider extending it to the SBF scheme as well.
Over the years, I have also been making an appeal for better access to housing for singles and single parents. We have made big strides for singles and the extension of grants in the last two years have been helpful for many applicants. However, one feedback I have consistently received is that while the grants are attractive, often they are hard to qualify for, such as the proximity grant when the estates that singles wish to apply for close to their parents or child are of larger flat types that they do not qualify for. For single-parents and divorcees, the waiver of the wait-out period that was announced recently is a Godsend. However, the requirement for approval of the former spouse to purchase a flat often still serves as a major barrier. Could the Ministry, therefore, consider further relaxing this requirement?
Mr Chairman, we live in a fast-changing world. Singapore prides itself as a city that keeps pace with technology. Could the Ministry update on the plans to make our nation's built infrastructure future-ready? In doing so, can we also ensure that it continues to be a welcoming and liveable city where all Singaporeans can feel a part of?
What are the challenges that lie ahead of us? Last year, I had the privilege of accompanying President Halimah on her State Visit to the Netherlands. While there, I saw for myself the Dutch living out the Polder Culture in all aspects of their lives, especially in how they build and plan their city. Like us, we are a small country surrounded by water and at risk of global warming and rising sea levels. I watched a simulation there at the Research Institute of our city centre flooded as sea-waters rise. We can talk about it. But watching it really hits home quickly. The reality is that the risks are real. How can we plan in advance for this possibility and learn from the experiences of others?
Singapore, ultimately, is our home. It must be one that is endearing and enduring. Our homes must be places of comfort and safety, our communities built on trust and cohesiveness, our environment green and welcoming, our nation united and strong. At the root of it all is our compact with Singaporeans, a promise that we have kept and must continue to keep – come hell or high water.
[(proc text) Question proposed. (proc text)]
Mr Chong Kee Hiong (Bishan-Toa Payoh): Sir, many visitors remark on how rapidly Singapore's skyline is changing. Indeed, we are constantly building up, expanding out and tunneling down. As we develop and transform our city, how will the Ministry continue to ensure that housing, industry and business needs are met as we stay green, create space for agricultural development and take measures against the effects of global warming?
HDB flats will continue to be where the majority of Singaporeans make their home. As HDB is in the process of reviewing the Home Improvement Programme (HIP) 2 and the Voluntary Early Redevelopment Scheme (VERS), it is timely to also consider the redevelopment of entire precincts or estates, instead of making incremental changes.
The benefit of a \"whole-of-precinct\" or even \"whole-of-estate\" redevelopment project is a better integrated layout with improved accessibility and connectivity. Infrastructure could also be improved in a more holistic manner. Another plus is the viability of installing systems incorporating new technologies, such as the pneumatic waste conveyance system (PWCS). Redeveloping a precinct or a cluster of precincts may even be more economical and technically easier to carry out. Redevelopment also provides the opportunity for rejuvenation. For many older estates close to the Central Business District, the height of the new blocks can be increased to accommodate more young families who have members working in the CBD.
HDB is not only the main provider of housing. It also has to fulfill many social objectives. HDB estates must foster inclusivity through the distribution of household types as well as the design and layout of high-quality social and community facilities. Meeting the needs of different family compositions, the elderly, persons with special needs and other vulnerable groups require redesigning blocks, the precincts and surrounding facilities. It is far more feasible to have a total makeover than piecemeal renewal.
Infrastructure – the transformation of our infrastructure is necessary to enhance our ability to cope with climate changes, including higher temperatures and heavy rains, and to become more resource-efficient, such as through the installation of solar panels and other energy-efficient measures. Our city also needs to undergo infrastructural renewal to keep up with technological revolutions, such as the installation of charging points for electric vehicles. Would the Minister share with us an update on the major projects to make Singapore more resilient in the face of climate change? Will our city be sufficiently equipped to deal with or, better still, lead other cities, in technological advances?
To attract more investments, we need good infrastructure and buildings which provide reliable and seamless support to businesses and industries, particularly those in the innovative and cutting-edge sectors. Whether we are building homes, tunnels or roads, we must constantly check and enforce the high quality of our structures through construction oversight and strict audits of certification works. The lessons of Opal Tower in Sydney and its wider implications for buildings across Australia is a timely reminder of the importance of quality control. What measures does MND have in place to enhance the quality and safety of our building projects?
Aesthetics is also important. We should be a city which is not only efficient and functional, but also beautiful and interesting, with buildings reflecting our unique historical and cultural heritage. We should be a city attractive to visitors but, more importantly, a joy to live and work in for Singaporeans. In this aspect, I urge the Ministry to continue to provide support to HDB to create beautiful and practical homes and estates.
We want to become more independent in terms of our food supply. This is a great challenge in our land-scarce island. Would the Ministry share its plans for helping our farming communities through the creation of space and building of supporting infrastructure?
Finally, Singapore needs to protect her areas of greenery as this is an important component of a liveable environment. I would like to request for an update of our efforts in this area.
Mr Ong Teng Koon (Marsiling-Yew Tee): Sir, the URA has indicated that the updated Master Plan will be published this year. This time round, more so than for previous years, there will be intense public interest to see how URA will lay out its vision for the physical future of our country. I can also sense palpable excitement on the ground, with some calling this the Master Plan for underground space.
I think it is quite cliched to talk about how technology is changing our lives, but they are definitely new developments that could fundamentally change how we think about physical space. For example, the advent of autonomous vehicles could totally revolutionise land-use. One direct but profound outcome is less need for parking in each building, as fewer people will drive themselves. Commuters will arrive in AVs, which will then drive off and pick up other passengers. It is not uncommon now to have three to five storeys of every building dedicated to carparks.
Widespread adoption of AVs could free up several extra floors per building and create a 5% to 10% uplift in lettable area. Another issue of concern is the potential impact of climate change, such as rising sea levels. What impact would this have on low-lying coastal areas and on reclaimed land? I remember the Minister for National Development's reply to a PQ that I asked in 2011 in relation to rising sea levels that all new reclamation projects would have to be built to 2.25 metres. Does MND have any plans to raise this requirement further?
A Master Plan typically has a 10- to 15-year planning horizon, but buildings can easily last 30 to 40 years. How do we balance the long- and short-term needs and make optimal use of scarce land? At the same time, we need to balance commercial uses with recreational space and maintain greenery even within the central core. I would, therefore, like to ask the Minister how the URA will ensure that the Master Plan will effectively support our next phase of growth? Will there be opportunities for public input? How will this be done and what can the public expect to see?
I have noticed significant rejuvenation within the CBD over the last few years, as old buildings have been replaced or refurbished to meet future needs. Trends, such as the rise of co-working, have also helped to bring more vibrancy into the CBD, as smaller companies and start-ups can now afford space downtown. How does MND plan to also rejuvenate older areas of the city, within the CBD, as well as in the surrounding areas?
The Government shared plans about the Greater Southern Waterfront (GSW) last year. The opportunity to replace the existing port operations at Tanjong Pagar are exciting, given the prime location so close to both the CBD and to leisure zones, such as Sentosa. What can we expect to see at the GSW and what is the timeline for realising these plans?
Finally, I would like to thank the Ministry for doing important work to redefine our urban landscape for the next decade, and I look forward to the Minister sharing his exciting plans with fellow Singaporeans.
The Chairman: Mr Gan Thiam Poh, you have five minutes for your three cuts.
Mr Gan Thiam Poh (Ang Mo Kio): Sir, for young couples, many have to wait more than a couple of years before collecting keys to their new HDB flats. This is really not conducive for family planning. Most of these couples put up at their parents’ flats instead of renting in the interim to save money for their future. Considering that current flats are not big, it is quite a squeeze to house another new family member with babies on the way.
Because of this, most couples postpone having a child until they get their own flats, which is again, not ideal, as more and more couples are getting married when they are older, in their 30s. Hence, it would be really helpful if the wait can be shortened. Would the Ministry continue to build BTO flats ahead so that buyers can enjoy shorter waiting times of 18 months or less?
In addition, for families wishing to upgrade to a bigger flat, can priority be given according to the number of children they have? After all, the more children there are, the greater the urgency for more space. This will also encourage our young couples to have more children as they can be assured that they don’t have to wait too long when they need to upgrade to bigger flats to house more kids. May I ask how many such applications have been received and what is the percentage of success?
Lastly, will the Ministry consider additional measures to encourage first-timers to continue to live near their parents in existing mature estates? Can some form of additional rebates or incentives be provided? This is because first-timer young couples have to pay a premium for these locations, which are generally more centralised and have more amenities.
What measures will MND take to ensure mature estates remain vibrant and liveable, especially with the falling average household size? How about building more BTO flats targeted at young families? This will enable young couples to stay near their parents and their children will bring more vibrancy to a mature area with high numbers of elderly.
To optimise our car parks, would HDB and URA consider introducing another type of season parking, namely, for half a day, either day or night parking, at HDB, URA and heavy vehicle car parks to provide an alternative for those who do shift work and to ease their parking needs and optimise the parking space?
Mr Saktiandi Supaat (Bishan-Toa Payoh): Mr Chairman, Sir, the release of each BTO estate brings about better upgrades and facilities than the last one, reflecting the needs of the different demographics over the years. From the early days of no-frills living, to addition of playgrounds of fitness amenities, to green-living aesthetics, HDB flats have come a far way.
Yet this creates a significant difference between the mature estates and newer estates, and there are some concerns that mature estates will not catch up with the newer estates in terms of technology and liveability. Imagine living in a non-smart technology enabled estate, and then visiting a grandchild’s new estate and finding it too foreign to navigate. The state and appearance of one’s living environment projects a certain standard of living, so we do not want to create a situation whereby residents living in different neighbourhood estates have a different quality of life.
Moreover, estates should be upgraded regularly to maintain safety and inject freshness in the neighbourhood. What is the Ministry doing to ensure HDB estates and flats remain liveable and vibrant even as they age? Can the Ministry share how the timeline is decided for the implementation of upgrading projects in the older mature estates, so that they can catch up with the newer estates? Will rental flats benefit from these upgrades as well?
Er Dr Lee Bee Wah (Nee Soon): Sir, I was pleased to learn from last year’s National Day Rally that flats built between 1987 and 1997 will also be included in Home Improvement Programme (HIP). Half of Khatib homes were built in 1986 and the HIP have been completed or near completion. The other half of Khatib homes were built in 1987 where residents are still waiting for their HIP. May I know how soon can they have their HIP? Their flats would require repair in many areas. Despite the conditions of these flats, many residents are waiting and hoping. They want to save on renovation cost because many are elderly, retired or semi-retired.
In private estates, many residents look forward to the Estate Upgrading Programme (EUP).
Can we have EUP in more estates? Like HDB estates, amenities around the private estates too deteriorate with the years, and they too should be subject to renewal. renewal. We can serve the private estates better by introducing more community facilities, like playing fields, courts, carparks and so on. Create opportunities for the neighbours to come together, to facilitate community togetherness. I would like to request for a large-scale town-wide funding to be extended to private estates too.
Designated Smoking Points (DSPs) are increasingly popular among my residents. We have been relying on private funds to build the DSPs. Can we tap into the Community Improvement Projects Committee (CIPC) funding for maintenance and addition of new DSPs? With CIPC fund, more DSPs can be rolled out to other parts of Singapore too. Perhaps, HDB should be bold enough to pilot smoke-free new BTO block.
Buyers are informed upfront that there is no smoking allowed in the block including their own homes. I would like to volunteer to take up this pilot in Nee Soon South. I have residents who have been asking to sell their flats before five years MOP is up as they cannot stand the smokes from their neighbours.
Next, my residents who use heavy vehicles for work often face a long wait for heavy vehicle parking in Yishun Town. Many new residents who shifted into new BTOs are having difficulty in buying season parking.
Many have to wake up early and stop work till very late. Hence, they take the risk of parking along the service road near their homes and ended up receiving summons regularly. On behalf of my residents, I would like to plead to MND to increase the amount of parking space for heavy vehicles to match the demand. I have made such request many times in Parliament.
Next is the plight of divorcees. Although divorcees with care and control of children can now buy subsidised flats without the three-year restriction, when the ex-spouse is not cooperative, it becomes difficult to sell their matrimonial homes. So they do not have money to buy their next flat. I hope more can be done to facilitate the post-divorce sale of flat process.
Next, may I know how many 2-room flats has HDB built and how many singles are still waiting to buy 2-room flats? Will MND consider allowing singles to buy 3-room flats so that they can accommodate their elderly parents?
Finally, I would like to know how does HDB determine the TOL fee that they charge for essential services like ATM and AXS machines? I have been asking for an AXS machine to be installed at Block 507 where there are coffee shops and other shops. I was told that HDB is charging $200 per month.
Hence, the operating cost of an AXS machine is $500 to $600 per month. This makes service provider procrastinate. Can HDB waive the fee so that the service providers are more willing to provide such essential services?
I hope MND can address all the above for our endearing homes. The more we do, the more enduring our homes are.
The Senior Parliamentary Secretary to the Ministers for Foreign Affairs and Trade and Industry (Dr Tan Wu Meng): Mr Chairman, in our HDB estates, our void decks are anything but empty. They can be places of friendship and fellowship, when neighbours gather. The void deck can be a place of joy, a wedding venue for a community to celebrate. The void deck can be a place of sadness, when a resident has passed away, and family and friends and neighbours come to say goodbye. The void deck can be a place of potential – white space that can someday be used for a social service office, a senior activity centre, a kindergarten and more. Indeed, our void decks are not devoid.
But some residents worry about the shape of newer HDB blocks that do not have void decks. Some of my older residents may someday move in with their children. Some have en bloc SERS and move from old blocks to new blocks within Clementi. My older residents look upon newer precincts with some curiosity. The see the new pavilions, the new sky gardens but to these seniors, they feel it is quite different from the void deck. Maybe not so adaptable, not so airy, something different. Sir, infrastructure policy must have a long tail. What we build today must be future-proved to meet the needs of tomorrow and void decks and other wide spaces add to that flexibility for tomorrow.
So, can the Minister share with us, what HDB's plans are, to provision for sufficient shared common spaces in our newer estates? How is HDB designing newer estates, so that neighbours can gather together; so that children can play together; so that families can celebrate together and so that when there is a bereavement, people can say goodbye to loved ones near to home and among neighbours.
Mr Png Eng Huat (Hougang): Sir, it was reported in the news last November that the estate of Punggol was morphing into one of the largest housing estates in Singapore. However, residents there were reported to be suffering from growing pains as the infrastructure and services in the estate did not keep up with the growing population. Residents found themselves staring at growing congestion and longer commuting time with each new development sprouting up in the estate.
In another report, it was stated that the traffic congestion in Punggol has been a long-standing problem, stretching back to almost five years ago. Even when a new link road connecting Punggol Centre to the nearby expressways came into operation, one resident predicted that the traffic congestion would return in a few years’ time.
Amenities like childcare centres, healthcare facilities, and food outlets were also reported to be in need of improvement to meet the demands of the growing population in Punggol.
Sir, it is going to be déjà vu in the estate around Upper Serangoon Road, leading towards Hougang Avenue 7 and KPE. There are now new housing estates and condominiums sprouting up and the traffic on Hougang Avenue 7 enroute to KPE is also coming to a crawl every weekday morning. This part of the estate is also short on amenities like childcare centres.
Residents in Hougang can already predict what is to come in the not too distant future when more people start to move into the new developments in the estate. Would we be seeing a repeat of what the residents of Punggol were experiencing the past five years? Would other upcoming estates be facing the same problems as well?
Sir, when supporting infrastructure is playing catch up in a growing estate, the belated construction work will only add to the traffic congestion woes and exacerbate the misery of the residents living there. Some things can be hard to predict but we are living in an era of big data. Some trends and problems can be predicted and anticipated with a fair amount of accuracy.
I would like to ask the Coordinating Minister for Infrastructure how often do the various Ministries and authorities meet to share and address such mismatch of housing developments, transport infrastructure, and amenities.
The Chairman: Mr Muhamad Faisal, you can take both your cuts.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Thank you, Sir. Sir, I have residents who earn their living as a heavy vehicle driver who seek my assistance to appeal on their behalf for waiver of fine for illegal parking. The common presenting issue is that they are unable to find a parking lot for heavy vehicles, resulting in them parking their vehicles illegally. Many of them were issued fines while they were attending to their needs such as answering to nature's call and when buying packed food for lunch or dinner during their working hours. The fines imposed have a great impact on them financially. Sir, I feel and empathise with the plight faced by these heavy vehicle drivers being penalised due to a lack of parking spaces for heavy vehicles while they are trying to fulfill their humanistic needs.
Sir, I observed that there are existing heavy vehicle parking areas in some HDB housing estates, usually located in the proximity of neighbourhood centres which have dual vehicle parking lot. This dual parking lot has double markings; one marking with the dimension to cater for Class 3 vehicle while the second marking a bigger dimension is for heavy vehicle. Such dual parking lot will allow any type of vehicle to park on first-come-first serve basis. Sir, I would like to suggest for such dual vehicle parking lot to be introduced at roadside in industrial areas and as well as non-major roads which have high flow of heavy vehicles. Such implementation will definitely facilitate heavy vehicle drivers to park legally by fulfilling their needs.
Sir, HDB subsidised rental flat under the Public Rental Scheme (PRS) is meant to provide low-income families who are unable to afford home ownership and have no family support with a roof over their head. One of the eligibility criteria for an applicant to make is household income ceiling of $1,500.
Sir, during the Budget debate, Minister Heng announced changes in enhancing the current available support measures for two groups of Singaporeans: first, low-wage Singaporeans and second, Singaporeans who are permanently unable to work and have little family support, to support their living expenses.
Sir, for the former, one of the measures announced in the enhancements of Workfare Income Supplement (WIS) where the qualifying income cap will be raised from current $2,000 to $2,300 per month. As for the latter, the ComCare Long-Term Financial Assistance Scheme amount will be increased.
Sir, the revision enhancement to financial and support schemes from time to time are indeed necessary due to the ever increasing cost of living. On this note, can I urge the Ministry to conduct a review on HDB's subsidised rental flats' household income ceiling eligibility criteria. I do not have the information on when was the last time a review was done. However, I do believe that it has been a while since it was conducted. I do hope HDB will make this timely review.
Mr Lim Biow Chuan (Mountbatten): Sir, some years ago, when I was serving as a grassroots leader, I visited rental flats regularly. My experience visiting these flats are that many of the older rental flats face each other via a common corridor and there is little ventilation or light between the flats. As a result, the entire area smelt musty and the living environment is usually not pleasant due to the presence of hoarded items.
When I became a Member of Parliament for Mountbatten and visited the Dakota Crescent rental flats in the constituency, the living environment was much better as the flats were spacious and better ventilated. However, the building was almost 60 years old and one can see the wear and tear on the building and the facilities. The lifts were old and break down regularly due to their age and the lack of spare parts. These lifts could not be upgraded due to the smaller size of the lift shaft and any extra lift extension could not serve every floor because of the design of the building.
Older rental flats usually result in hoarding by long-time residents and the collected items would be placed at the common corridor. Sometimes, there would be infestation of bed bugs, cockroaches and other pests.
I urge MND to consider plans to gradually upgrade the existing older rental flats to make the living environment better for the residents. As an example, the new rental flats at Cassia Crescent is better ventilated with more facilities in the building so that the residents can gather together outside their flats. The lift also stops at every floor and this allows elderly residents or those on wheelchairs to travel out of their flat.
Can HDB consider doing a overall assessment of the needs of rental flat residents so that we can gradually upgrade the rental flats to better serve their needs? I was glad to hear Senior Parliamentary Secretary Sun Xue Ling speak yesterday about the setting up of the social service hub to offer services to the elderly. This is important because some of the elderly who are illiterate need help to understand official letters from Government agencies like HDB or Town Council. They need help to understand their SP Services bills and even police warnings about conmen cheating the elderly. They cannot understand the notices. So, the Social Services Offices would be of great help to help these elderly illiterate residents understand messages better.
I also urge MND to consider providing more facilities to support the elderly residents in the rental block of flats. Even simple things like having food stalls near the flats, bus stops near the rental flats would make life better for some of the elderly staying in the rental flats.
I was also delighted to hear of HDB’s plans to help rental flat families own their own homes. For example, some of the residents at the rental flats at Dakota,were offered the opportunity to buy their flat at Cassia Crescent, however, they did not take up the offer as they were concerned about buying a flat in a new and unfamiliar environment.
Having stayed there for a while, they found that the flat is suitable for their needs and wish to buy over the rental flat. However, they were told by HDB that they could not do so. Why should this be the case? We should encourage all sitting rental flat residents to buy over their existing flats whenever they wish to do so as we should promote home ownership among them. I urge HDB to have a more flexible scheme for rental flat residents to buy over their flat.
Mr Seah Kian Peng (Marine Parade): Public housing is one of the pillars of what it means to be a Singaporean, but it is also one of our most under-appreciated forms of welfare. Home ownership is a way for us to provide peace of mind, to give the lower income a disproportionately higher amount from our national budget, and also to communicate important values such as family togetherness, resilience and optimism about the future.
We do so with a complicated jigsaw of home proximity grants, means testing, and eligibility criteria to ensure that the most disadvantaged benefit the most. Human lives are complex – and our rules reflect this complexity. Over the years, the rulebook for the sale, purchase and rental of HDB has become very thick indeed.
Sir, I have spoken about “Officer X” in my cut on MSF. One of the most important areas where I think Officer X can be deployed is to help the lower income in rental flats. They also need to be able to help these families who want to move out from the Flexi-flats and into bigger ones – including bending the rules on the Minimum Occupation Period of 20 years. Indeed, if we do our job well, there may be many who see their lives improving substantially beyond 20 years.
So, I would like to ask the Minister the following three questions:
(a) An update on the Fresh Start Programme, including the problems encountered such as the complexity of rules, and the difficulty in understanding them.
(b) How does MND help public rental tenants to eventually own their own homes?
(c) How can MND help to ensure rents remain affordable and do not disincentivise progress among tenants?
Miss Cheryl Chan Wei Ling (Fengshan): Sir, among the estimated 50,000 households that are living in public rental flats. I believe it is MND’s intention to focus on a segment of these public rental tenants and help them improve their social mobility by eventually owning their own homes.
From my observations, the public rental flat occupiers are mainly the single parents with children, seniors with no extended family, families with foreign spouse, families with interim issues and singles co-tenants. I would like to point out three areas for MND’s consideration to enhance the primary objective of encouraging social mobility of this group and also to help those families that does not qualify under the current Fresh Start Housing.
The first area, enhance guidance on the home ownership process. We should consider a few aspects that will be helpful for the families who had low income for an extended period. First, to provide more financial planning and more detailed assistance in guiding them on their first purchase so that they can make more informed decisions of flats that are within their buying power. Second, their home loan eligibility limit with HDB has to be increased as it is unlikely they can qualify for a loan from the private banks. Third, as many of these public rental tenants are low-income workers, they are usually on freelance jobs which does not contribute much to their CPF. So, CPF should not be part of their mortgage payment plan until they are able to build some sufficient funds.
The second area, review rental rate based on more factors beyond household income. Rental rate review today takes into account all household income of the occupiers in the flat. Sometimes, the rate is increased as it is based on most recent payslip before tenancy renewal. I feel that this needs to be reviewed more holistically or taken into account with a different treatment for each condition. For example, families that have once off bonus, jobs that are commissioned based, odd jobs on project basis, families with sons that are serving National Service; these income cannot be treated in the same manner as a regular full-time source of income.
Moving forward, if we want to enable social mobility for them, we need to look at the efforts of these families in stepping up and over different periods of their life cycle.
The third area, invest in upkeeping of public rental flats. As we try to integrate public rental flats with regular flats in the newer housing estates, I would like to ask MND to also consider investing in upkeeping older rental flats. The exterior facades are now refreshed through the regular Town Council Maintenance Repair & Redecoration programmes. However, there are many seniors living in these rental flats who are not only unable to afford interior renovation of their units, they are most likely to live there for good as they have no next of kin. Existing programs like Enhancement for Active Seniors (EASE), spalling concrete treatment, leakage treatment; should be extended to these tenants readily without any difference compared to regular flat owners.
I hope that MND’s goal in helping these families and also would like to know how many target households we are looking at.
The Chairman: Mr Png, you have eight minutes for your three cuts.
Mr Png Eng Huat (Hougang): Sir, it was mentioned in this House in 2014 that HDB had cleared the backlog of first-timer applicants for HDB flats. A year before that, in a Committee of Supply speech, the Minister for Housing Development said. “A couple of months ago, HDB announced that they were planning about 23,000 Build-To-Order (BTO) flats. I decided to tell them to up the figure to 25,000 because I wanted to decisively clear the backlog of all married HDB first-timers this year.”
Sir, five years have passed, I am still hearing young couples, married or waiting to tie the knot, sharing about their difficulties of securing their matrimonial flat. I have a resident who has just made his sixth attempt to apply for a flat recently, having started the application process about two years ago, and he is getting married in a year’s time. Some first-timers were given queue numbers that far exceeded the number of flats available for booking, while others were not even given a queue number to begin with, especially when balance flats are put on sale. I can understand why some young couples are only interested in Sale of Balance Flats (SBF). If they have put off starting a family for two years trying to secure a flat, they may not want to wait another three more years for a BTO flat with their biological clock ticking away.
How can HDB help these young couples own their first matrimonial flats with less stress and more certainty as the future of our next generation depends on them? Some of them were told to spread their options further if they want to secure a BTO or SBF flat, but that will mean living further away from their parents who, more often than not, would be the first port of call to help when they are starting their own families.
Sir, first-timer married applicants are also encourage to live near their parents. And if their parents are living in a mature estate, who can fault these first-timer applicants for wanting to secure a new flat in and around the popular estate? Next, would HDB consider offering balance flats to young couples who were unsuccessful in previous attempts to secure their first flats, be it in the same development or not, so as to help them secure a flat sooner?
Sir, when the Minister announced that HDB had cleared the backlog of first-timer applicants, does it actually translate to shorter waiting time for new first-timer flat applicants?
The Lift Upgrading Programme (LUP) has benefited many households since the programme was launched in 2001. The LUP has allowed many senior citizens to go out and meet their friends or watch the world go by at the playground or at the void deck, even if they are on mobility aids. In short, the LUP has given these senior citizens a comforting and reassuring sense of independence at an age when they may have to be home alone.
From the last update we have in this House, there are about 150 blocks of HDB flats left without direct lift access for all floors. Six of these blocks are in Hougang. In my conversation with the affected residents living in these blocks of flats, I can sense their anxiety and despair about ageing in an environment with no direct lift access. To some of these residents, their flats are not built of concrete alone, but of memories. They would like to age in a place they call home. But without direct lift access, these residents may become prisoners in their own homes over time. Some residents told me they need to make special arrangement just to bring their aged parents to visit the doctor. Some elderly residents would prefer not to go out at all, and they would depend on their neighbours to help them with the errands.
I would like to ask the Ministry how long more must these residents wait for a solution to free them of this physical impediment to active ageing and quality of life? It is good to give these residents an indication of the time required to resolve the lift access issue. These residents need to make long-term plans. While some HDB flats are challenging to implement 100% lift access, some are relatively easy to resolve.
Take for example, residents of Blk 363 Hougang Ave 5 are just three additional lift shafts away from achieving 100% lift access. So, it is only a cost issue. For those HDB flats with complicated structures, can HDB look into solutions like vertical platform lifts, which are suitable for wheelchair use, and rather compact and inexpensive to implement for short level access?
Sir, the $5 billion LUP has brought relief to many residents residing in over 5,000 HDB blocks. In all fairness, residents living in the remaining 150 blocks should also get the benefits of direct lift access. I seek confirmation from the Ministry that effort is continuing to bring 100% lift access to these affected blocks in the near future.
My third cut. Sir, The Home Improvement Programme (HIP) has also brought much relief for many households suffering from water seepage and spalling concrete issues due to wear and tear over time. Some of these issues are long standing but such relief offered by HIP should not be short lived.
While residents can pay as low as about $300 to have their bathrooms completely upgraded with new tiles, piping and sanitary wares, they should not be made to correlate the low cost of upgrading with lower quality of fixtures or workmanship. The bulk of the costs of HIP is funded by taxpayers. The contractors are not subsidising the upgrading. These contractors are expected to deliver quality works and fixtures that commensurate with their winning bids at the very least.
While wear and tear can continue over time in an old flat which has undergone HIP, spalling concrete or leaks cannot possibly resurface at the same spot shortly after the one year Defects Liability Period (DLP). It does not make sense to the affected residents that HIP is meant to resolve such long standing issues for about a year at the very most.
Although there are not many such cases reported, it certainly lends weight to the fact that the upgrading works were not carried out properly for some of these flats in the first place. Thus, affected residents should not be made to pay again if such issues were to resurface at the same spot shortly after one year. I hope HDB can look into having a slightly longer DLP for spalling concrete and water seepage problems that HIP is supposed to resolve.
Next, I would like HDB to consult residents living on the ground floor before installing the new clothes drying racks in their units. The new rack compromises the safety of residents living on the ground floor as the structure will allow intruders to gain easy access into their units via the kitchen windows using the new rack as a support.
Residents living on the ground floor also generally do not use these designated areas to dry their clothes as they are located right next to the bin chutes. They would prefer to dry their laundry elsewhere.
There are a number of such ground floor units in the two HIP clusters announced for Hougang Avenues 2, 5 and 7 and they are about to go through polling soon. I hope residents living in those ground floor units can be consulted this time round before HDB proceeds to install those new racks by default.
Next, I do welcome the announcement of a new HIP2 for qualifying flats at the 60- to 70-year mark. I may not be around to enjoy HIP2 but I do have faith that technology would play a big role in making those aged homes more liveable in the future.
So, apart from the standard spalling concrete and water seepage issues, which will probably return with vengeance after another 30 to 40 years, I hope HIP2 can make these old flats more elderly friendly and smarter in energy consumption and safety. I hope these old flats can be rejuvenated with better connectivity to help the elderly access e-services easily with dedicated smart devices. More importantly, I hope all physical barriers to active ageing would be removed completely by then, inside and outside the flats.
Assoc Prof Walter Theseira (Nominated Member): Sir, public housing should play a role in integrating Singaporeans across all socio-economic groups. However, over time, substantial differences have developed between HDB estates. Chairman, may I have your permission to display a slide on the screen?
The Chairman: Yes, proceed. [A slide was shown to hon Members.]
Assoc Prof Walter Theseira: Thank you. Let us compare the third lowest and the third highest HDB town by resale price. In 1990, mean resale prices for a 4-room flat ranged from $60,000 to $95,000. By 2018, the equivalent range was from $340,000 to $650,000. As a percentage of the mean resale price that year, the range was from about 75% to 120% in 1990, and from about 80% to 150% in 2018. Similar figures hold for other types of flats.
Sir, the same HDB towns are still popular. Eight out of the top 10 HDB towns by price in 1990, are still in the top 10 in 2018. However, rising incomes and wealth among better-off Singaporeans appear to be driving prices up because these HDB towns are close to the city centre and well-connected to amenities.
Let us also consider the policy of favouring private development over public use, for high-value locations. Sir, I am not used to telling stories but here is one.
When the bus interchange at Yishun, where I live, was redeveloped, the HDB commercial centre there was demolished. The land was integrated into the private Northpoint City development. Hon Members will have seen similar examples in their own constituencies.
When I wear my economist hat I see why the private sector should maximise the value of that land. Otherwise, we would have to subsidise it heavily. But this is the heart of the problem. When value is assigned by the market, it is those with the ability to pay, who will get to live closer to MRT stations, closer to the city centre, closer to any amenity that people want.
I believe public housing should act as an integrator. Public housing must play a role in checking the forces of segregation that would otherwise put rich Singaporeans in the most desirable places, and poor Singaporeans everywhere else. Large BTO discounts cannot solve this completely because they just give windfall gains to those who can already afford a high-end HDB flat.
What is MND doing to monitor income stratification in HDB housing? Can we consider alternative forms of HDB ownership in high-valuation areas to ensure that public housing continues to integrate Singaporeans of all types, and lower-income Singaporeans have a wide choice of locations to stay? This may include equity-sharing with HDB or shorter term leases with guaranteed subsidised resettlement on lease expiry.
Mr Yee Chia Hsing (Chua Chu Kang): Chairman, I am sure every Member in this house would have come across two groups of residents at our Meet-the-People Sessions relating to BTO and resale flats.
The first group would be young couples asking us to write to HDB because they have not been lucky in getting their BTO flats. Some even told me that they are delaying having a child because they wanted to have a place of their own first.
I have always tried to persuade such couples to consider buying a resale flat instead. I will explain that resale prices have softened. HDB has increased the CPF Housing Grant for first timer buying resale flats in from $30,000 to $50,000, for couples buying 4-room or smaller resale flats, and from $30,000 to $40,000 for couples buying 5-room or bigger resale flats.
There is also the Proximity Housing Grant of $20,000 for young couples who buy a resale flat near parents – 4 km. I also highlighted to these couples that a resale flat often has a larger floor size so although the absolute price may be higher but the per square foot price may be lower.
Unfortunately, even after my \"sales pitch\", most couples still tell me that they still want BTO because the absolute price of resale flat is still much higher than BTO and they are also concerned about the high cost of renovation for a resale flat as well as the shorter lease period.
Chairman, the second group of residents are those who are unable to sell their current HDB flats. They may have purchased another BTO or upgraded to private housing and when the time comes for them to sell, they were unable to do so due to the weak market conditions.
So, we have a situation where there are too many buyers for BTO flats and too few buyers for resale flats. Having young couples move into a mature estate through buying resale flats is also good so that the estate does not grow old. Young families can bring vibrancy and diversity to older estates. It also lessens the pressure on childcare and other school facilities in the newer estates where there are too many BTO flats.
Chairman, I have a few suggestions to make today. For new BTO flats, I expect that the implied dollar value subsidy per unit is larger for a 5-room flat than for a 3-room flat but conversely, the CPF Housing Grant for first-timers buying resale flat is smaller for a bigger unit. I would like to suggest that the CPF Housing Grant be the same regardless of the size of the flat.
The current system is an indirect form of means-testing which is not done for couples buying BTO. CPF Housing Grant should not be subject to means-testing since the Additional CPF Housing Grant and Special CPF Housing Grant are already subject to means-testing.
I also hope that both the CPF Housing Grant and Proximity Housing Grant can be increased so that more couples would consider resale flats as an attractive option. In fact, there are many intangible benefits for young couples to stay near their parents. For children with both parents working, it is important that their grandparents are around to show them love and also pass down traditional values.
In summary, I hope HDB can do more to make the purchase of resale flats more attractive to young couples. It is a waste of resources to build ever more BTO flats to meet demand while there are many perfectly fine resale flats available for sale.
The Chairman: Mr Louis Ng, you can take both your cuts together.
Mr Louis Ng Kok Kwang (Nee Soon): Sir, parting ways with someone you used to love or perhaps still love may not be an easy process. When a child is involved, it could get even harder. Going through a divorce is an emotionally draining period and our policies might make it more acrimonious, especially for the lower income.
Couples know that if they get shared care and control of their child, they will have to fight each other for subsidised public housing. If one party gets sole care and control, then he or she is guaranteed subsidised public housing. Is it in the best interest of the child for their parents to have a more acrimonious divorce? If shared care and control is a court judgment, should not our housing policies make it possible to enforce the judgement to protect the best interests of the child?
Will the Minister consider waiving the mutual consent requirement when shared care and control is awarded by the court, especially in cases where parties are only able to afford subsidised public housing?
Sir, single unwed parents under 35 years old need our help. Unlike those above 35, who qualify for public housing under the Singles Scheme, those under 35 can only qualify on a case-by-case basis.
With a median household income of only $600 in 2017, lacking the cash component of the Baby Bonus, and often lacking family support, single unwed parents really need our help.
I am grateful that HDB has approved several housing appeals I have made for them. But this case-by-case basis approach adds unnecessary stress to an already stressed parent.
A safe and stable home is a fundamental need for every child, and our housing policy should be child-centric. For a start, can Minister consider providing rental housing to single unwed parents under 35 years old with a monthly household income below a certain amount and who lack family support? Can we accept their applications at the HDB counters like any other HDB flat application? Let us not tell the applicant that they do not technically qualify, that it is subject to a case-by-case review, and that they should see their Member of Parliament to submit an appeal.
Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Chairman, I asked the Minister last year about retirement village models that could be transplanted here to give our seniors diverse options for retirement housing.
For public housing, Minister to Kampung Admiralty, with its active ageing hub and placement amenities within walking distance. I would like to ask the Minister about the possibility of retrofitting our public housing estates to approximate the Kampung Admiralty model.
For private housing, Minister said that the Ministry is reviewing development control guidelines to provide more clarity on retirement housing developments. I would like to ask for an update on this review.
Future seniors who have different financial abilities needs aspirations about active ageing. In the Lien Foundation and NTUC Income study, our future seniors prefer retirement villages to nursing homes by a large majority. There is a need to diversify elderly housing options.
Assisted living facilities have become popular elsewhere. These facilities allow seniors to enjoy their independence and maintain an active lifestyle while staff help with chores and monitor their health. What are the possibilities and and limitations to introducing development of affordable privately-run assisted living facilities here in Singapore.
Mr Saktiandi Supaat: Sir, last year in Parliament, I expressed my concerns for minority ethnic group sellers, who are only able to sell their flats back to other minority ethnic groups under the Ethnic Integration Policy (EIP).
Failure to sell the flat is a genuine concern faced by some minority buyers, and for the elderly, this is of even greater concern when they need the money for their living expenses or illness. If they are not open to other options, such as renting and the lease buyback scheme. Already, the age of a flat in a mature estate could pose a challenge in selling the flat. And now, coupled with the limitations of the EIP, the difficulty of selling is doubled.
I have seen a number of above 65 years old residents having difficulty selling their bigger flats and to monetise them because of the EIP. To facilitate the sale of flats by seniors in older mature estates and, in the case of those not able to sell due to EIP, can HDB help facilitate by providing a grant or subsidy to same ethnicity buyers to consider buying the flats but only for seniors selling? This will help ensure there is no horizontal dimension of inequality setting in.
I would also like to ask for an update on the uptake of the various schemes for the elderly to monetise their flats. What are the challenges for the elderly in using these schemes? How will the Government be help to better-facilitate such schemes?
Mr Murali Pillai (Bukit Batok): Sir, in July last year, I suggested in this House that vacant school sites be considered for conversion into retirement homes. The Government agreed to study the suggestion.
The main reason behind my suggestion is to pass on to our seniors the savings arising from lower capital expenditure involved in converting schools to homes. Also, there are other advantages, as noted by the hon Minister in his written reply, such as the relatively large size of the school plot which can accommodate a good number of persons and the favourable location as, usually, schools tend to be located near neighbourhoods.
Yesterday, we heard from the hon Minister for Education on his plans to redevelop Junior Colleges (JCs) which will eventually result in more vacant schools. I would be grateful for an update on this matter from the Minister.
Mr Zainal Sapari (Pasir Ris-Punggol): Sir, in my Budget speech and my cut to MOM, together with hon Member, Dr Intan Azura Mokhtar, we made a call for provision of rest areas to outsourced workers. Minister of State Mr Zaqy Mohamad also shared yesterday that MOM will encourage building owners and service buyers to provide proper rest areas which are well ventilated and equipped with basic furniture for the outsourced workers to store their personal belongings, rest and have their breaks.
There are good examples of proper rest areas for outsourced workers provided in some buildings such as JTC Summit, Inland Revenue of Singapore, the seven new hawker centres and many others. However, there are buildings that may not have designated rest areas at the service buyers' premises, and these may not have been catered for when the premises were built.
In this aspect, I opine that the URA can play a critical role to make this happen if the Development Charge (DC) can be waived if the building owners set aside an area as rest areas. DC is a tax levied when planning permission is granted to carry out development projects that increase the value of land, such as rezoning to a higher value use or increased plot ratio.
DC can run into thousands of dollars depending on the geographical area and usage. With the hefty DC, it can explain why most building owners do not carve out a rest area which has no commercial or intrinsic value to the owners. Thus, I am proposing for the URA to include Rest Areas under the “List of Items not counted as GFA” and correspondingly be exempted from DC. This may encourage building owners to provide rest areas for the outsourced workers as well.
Er Dr Lee Bee Wah: Sir, I would like to declare my interest as a professional engineer in the construction industry. Many big projects continue to be awarded to foreign contractors. Many local contractors hope that our Government can walk the talk and support our local contractors. This can help them build up track records and also stay afloat during this difficult period.
The announcement of the increase in diesel tax comes as a shock. I appreciate the Government’s effort to ensure a more sustainable environment. But it is unfortunate that there is no grace period. Contractors are locked into very competitive existing contract prices and have to incur additional cost overnight. Could there be some form of rebate that could absorb some of the impact from the increase?
Additionally, contractors, architects and engineers face a lot of red tape in the process of their work. They told me that road openings, service diversions, LTA clearances cause them the most headaches. As an example, one developer paid a few hundred thousand dollars for services diversion. Subsequently, no existing services were found on site. The developer after several years and many rounds of appeal has yet to get back his money. Also, Plan approvals often take a long time. After dealing with one written direction, very often, agencies come back with another new set of written directions, and then it is back to the drawing board, and seeking approvals again. Where is the productivity here?
Contractors said due to recent strict audit check by AGC, many variation orders submitted by them were stuck. Work has already been done but nobody wants to approve the payment.
Another non-productive practice is individual 3D modelling. In a tender, if there are 10 tenderers, 10 contractors will build their own 3D modelling from scratch. Can the project architect not issue 3D model to all tenderers instead?
Workers remains a sticky issue. How does the Ministry arrive at the man-year entitlement allocation? Many contractors said the current allocation is insufficient for a project. Because of increasing safety demands, every potentially dangerous job requires a watchman, while the foreign worker quota is being tightened. How effective is this watchman scheme? Has the number of safety lapses decreased?
I hope the Government will re-examine all the above together with the MOM.
Mr Dennis Tan Lip Fong (Non-Constituency Member): Mr Chairman, park connectors are used by people for strolls, walking their babies or pet dogs, or for exercises such as brick-walking, jogging or cycling. They are also used by people to get to nearby MRT stations or bus-stops. Depending on the locations of these park connectors, they can be really busy at certain times of the days or week. Bicycles, e-scooters, mobility scooters, wheel-chairs, skate-scooters and strollers compete for use with people and pets on foot.
As a regular user, I have always been concerned about the safety of park connectors. I am particularly concerned about the uncertainty regarding the appropriate use of the lanes provided on park connectors.
Mr Chairman, with your permission, may I show a photograph so that people can have an idea of the lane marking I am going to refer to.
The Chairman: Yes, please.
Mr Dennis Tan Lip Fong: Thank you, Sir. Is the lane marked with the figure of a person walking only reserved for people on foot? Who is allowed to use the part marked PCN? Are people on foot allowed on it? If so is it not dangerous for other users such as cyclists and PMD users to use it while people are walking on it from both directions?
In practice, many people walk on both lanes and cyclists and PMD users are often left weaving through the traffic on both lanes frequently unsafely, especially during peak periods.
The lane marked with the figure of a person walking is narrower than the part marked PCN. It is too narrow for concurrent two-directional use when, say, someone is pushing a stroller or walking a big dog.
I first raised this issue last September during the Second Reading of the Land Transport Enforcement Measures Bill. I filed a Parliamentary Question with MND last month asking what actions have been taken to promote the safe use of park connectors by different users including safe and orderly adherence to the respective lane-markings for users on foot and for PCN users. The Minister did not address the issue of adherence to lane-markings. So, I would like to ask the Minister today: how are park users supposed to use the park connectors safely according to the lane-markings? Will the authority educate the public on the safe usage of park connectors?
I use the park connectors almost every day, and I have never seen any signage or advisory on this issue. I have never seen any enforcement being carried out, whether it is illegal usage, for example speeding by cyclists or PMD users, or cyclists or PMD users using the part marked of the figure of a person walking. I have, however, seen quite a few accidents and many near misses, and a recent accident involving a young child and a e-scooter on a park connector promoted me to raise this again.
The Chairman: Mr Louis Ng, please take your three cuts.
Mr Louis Ng Kok Kwang: Sir, in the context of recent discussion on the disamenities that come from irresponsible feeding, I would like to touch on a related topic: cat abandonment.
Cat abandonment is one of the reasons for an increase in the stray cat population. It is a heartless act. It also causes problems as cat feeders struggle with the sudden increase in numbers and residents also suffer disamenities. In one recent case, 11 cats were abandoned overnight.
We have strong legislation against pet abandonment. It is easy to enforce these laws with dogs as dogs are micro-chipped and licensed and we can trace the owner. But there is difficulty with cats as there is currently no licensing requirement or micro-chipping requirement.
We have fined a person previously for abandoning her cat. She left the pet carrier there with her details. But how many owners will abandon their cat and leave traces of their details? In other cases it is not so straightforward.
Can I ask the Ministry to look into plans to strengthen measures to deter cat abandonment for instance, by micro-chipping and licensing pet cats?
Sir, the launch of the Trap-Neuter-Release-Manage programme for dogs in 2018 signalled a fundamental shift in the way we manage the stray dog population in Singapore.
Can the Minister provide an update on the progress of the programme? Has there been strong public support and what kinds of concerns have been raised and how have we addressed them? Can the Minister also share whether we will be adopting a similar approach for wild animals where we focus on science-based approaches that tackle the root of the problem and address both residents’ concerns and animal welfare concerns?
Sir, Singapore has lost 90% of our original forest cover and we really need to protect what is left. Urgently.
Recently, there has been much concern about the environmental impact of the Cross Island Line and the Mandai developments. There will be similar developments in the future, and many have argued for mandating EIAs.
Earlier this month, I asked the Minister if EIAs will be made mandatory for construction works near national parks or nature reserves. The Minister replied that the Ministry will require developers to conduct further studies and implement more mitigating measures \"if the potential environmental impact of a project is assessed to be significant.\"
Can the Minister clarify how and who will assess the potential environmental impact of a project and how we ascertain that further studies are required? Can we also mandate that EIA consultants file their final reports to the authorities rather than the developers so as to ensure their independence? For construction works in or near sensitive security areas, can the Ministry make EIAs public after removing sensitive data related to national security?
Mr Ong Teng Koon: Sir, it has been more than four years since the infamous stick of fishballs led to the creation of the Municipal Services Office. The goal, to improve service delivery and coordinate across agencies, is the right one, and certainly welcome by my residents.
Given that it has been running for more than four years now, could MSO update on how it has improved the coordination and delivery of municipal services for residents? What are some specific and tangible benefits that residents have experienced, and what are can they look forward to in the coming years?
Equally important, how are MSO and the municipal agencies harnessing technology to respond more effectively and efficiently to residents’ issues?
We have all become spoilt by online service providers that cater to our whims with a few swipes of our smartphones. While we do not expect instant responses or solutions to every problem, service gaps will seem more painful for residents. What plans does MSO have to use technology both in the front end, for example using apps, and back end (for example using AI, automation of basic services) to improve service delivery.
Miss Cheryl Chan Wei Ling: Sir, since the OneService App was launched, I have heard residents’ positive feedback on its ease of use and found the single point of contact helpful.
In today’s context where people are pressed for time and have little patience in waiting for things to get resolved, can Municipal Service Office (MSO) provide an update on how wide the adoption of the OneService App has been since its inception and in which specific areas has the app assisted its users most effectively?
Why is this important as we continue to encourage adoption of the app for more widespread usage? It is not because we do it for the sake of becoming a digital nation, but truly to reap the benefits of big data, efficiency in response and to bring it further by involving community and agency resources in the vicinity. In that respect, I have a few areas to highlight for consideration.
First, focus resources on the critical or frequently raised topics. For example, today the lift is a common facility that is widely used in HDB. While it falls under the purview of the Town Council, the usual feedback route is through the town council service hotline. If there is a case of man-trap in the lift, it will take longer for support to arrive at site as it needs multiple calls at the backend. This as compared to if the app is already connected to the lift service provider or the rescue unit to seek help in case there are emergencies or medical conditions for the person trapped. The latter would have been more efficient.
To take this further, a lot of data that is collected based on the feedbacks through many channels can be more effectively analysed and applied for future designs, maintenance regimes or to reduce recurrence of incidents. I would like to ask MSO if it has not been done, whether it is possible to link the cross-agency information and have the data analysed to provide preventive maintenance or implementation of more effective solutions that fixes the root causes.
Second, expand the app’s capability beyond a feedback tool. Besides providing feedback on municipal issues observed on the ground, consideration should be made for the tool to also serve as a channel for ideas from the ground on how we can improve situations or designs. I have heard thoughtful feedback from residents on municipal matters due to their work expertise or experience in similar situations. While we understand not all ideas are feasible due to different constraints, but it can become a useful platform for the community and the agencies to share and evolve ideas which are practical for the local context.
And third, connectivity of app to community resources for the elderly. Today, a care-giver or the family member probably has to download many apps or search online for information on suitable services for their seniors in the community. The idea I am raising is to provide more convenience for the care-givers and for them to understand or be notified if there are upcoming municipal works or unintended disruptions which may cause difficulties for the seniors who are less mobile.
As a first step, I would encourage MSO to think of how we can put community resource information on the app based on regions. This has a two-fold purpose. One, to enable the community to know what services are available in the vicinity that are suitable for seniors. Two, to connect the Silver Generation Office, the neighbourhood community police post or other VWOs in closer connection with the care-giver or the seniors’ family members who are at work to provide the extended support if required.
Should this be successful and have more capability in future, we can connect our seniors to be a part of the app. Many would say it is difficult to get the elderly to be digitally inclined. This could be true for the Pioneers today, but this will not be the case in future for the Merdekas and the younger cohorts in future. It is useful for us to think on a longer horizon and more effectively utilise the technology space.
The Senior Parliamentary Secretary to the Ministers for Health and Home Affairs (Mr Amrin Amin): Technology, when applied correctly, can enable Government agencies to deliver smarter and more efficient services to meet increasing demand and rising expectations. How are MSO and the municipal agencies harnessing technology to respond more efficiently and effectively to residents' issues. Good municipal service delivery is about understanding the needs of the local community and ensuring that they are met.
Last year, MSO announced that it is transforming the OneService app into a one-stop community platform beyond being a tool for reporting feedback in order to meet the needs of the community. Could MSO provide more information on how it will further develop the app to meet the diverse and changing needs of residents.
The Senior Parliamentary Secretary for the Ministers for Culture, Community and Youth and Transport (Mr Baey Yam Keng): Mr Chairman, like fellow Members of the House, I get my fair share of feedback on municipal issues from residents, whether face-to-face or through emails and social media. Common ones include littering, bird and cat feeding, not cleaning up after their pet dogs, noise nuisance and so on.
I do appreciate these feedback because they help us understand the ground better and relevant agencies can target their attention and actions towards more specific areas. After all, residents are naturally more familiar with their own environment as they use the area on a daily basis. They are the best eyes, ears and CCTV cameras.
I would like to use the following examples to illustrate two points and ask MSO these two things: one, how do we encourage greater community ownership of the shared living environment; two, how have MSO and the municipal agencies been partnering residents to tackle municipal issues in the community?
Sir, when an area is clean and free of litter, it means two things: either the cleaner just swept the floor or there is no littering. In other words, an area is full of litter because of two possible reasons: the cleaner has not done his work properly, or the public are not disposing of their litter properly. For most common areas in the estate, sweeping is done once in the morning. Therefore, if someone throws a piece of litter after the cleaner has swept the floor, it will be there till the next morning. When I receive feedback on littering, I am interested to know whether is it not clean, not cleaned, or not cleaned yet.
Through the feedback data received by the MSO, I wonder whether MSO is able to help analyse the information to assess the situation and identify the main root cause of issues that are happening the ground. With the information, we can then decide on the necessary intervention. For example, in the case of littering, it could mean a closer monitoring of the work of the cleaner, or public education on responsible disposal of littering, or, perhaps, NEA should be putting up CCTV cameras to catch errant litterbugs of areas where littering is very prevalent.
Sir, when MSO was set up, it was to help the public report on a municipal issue without having to navigate through the system and identify the agency in-charge of taking action. I am glad that MSO with its OneService app, has made the process much easier, effective and hassle-free.
However, there are municipal issues which clearly warrant enforcement leading to prosecution, for example illegal parking, whether is it at season lots, handicapped lots, loading and unloading bays, along double yellow lines or at the void deck. There are also cases of motorcycles riding on pavements, sheltered linkways and void decks. For such cases, depending on the exact location, it could be HDB, LTA, Traffic Police or the Town Council, which has the power to issue summons against the errant motorist. This is equally confusing to the public. So, can MSO enhance the OneService app for public to provide conclusive evidence of the offence, whether in the form of photographs, or video? This could then help to alert the relevant agency to take necessary enforcement action?
The Chairman: Minister Grace Fu.
The Minister for Culture, Community and Youth (Ms Grace Fu Hai Yien): Mr Chairman, I would like to thank Members − Mr Baey Yam Keng, Mr Ong Teng Koon, Mr Amrin Amin and Miss Cheryl Chan for their questions on the Municipal Services Office, or MSO, and also earlier, Ms Denise Phua, for her positive mention of MSO in her speech on MSF.
The MSO was set up with the belief that public services should be focused on our residents. I am happy to share that the collective actions and efforts of Government agencies, Town Councils and MSO, have translated into tangible improvements for residents over the past four years.
Residents can now conveniently access the services they need with the OneService app. We now have 157,000 app users who have reported 288,000 cases. Today, about one in five municipal feedback received by Government agencies are reported through the app, double the one in ten over two years ago.
Residents can now expect more timely responses to their feedback. On average, cases are addressed within three working days. For cases that require multiple agencies to work together, we have improved case routing processes, and integrated agencies' feedback systems for greater efficiency in case management. With the inclusion of all Town Councils in September 2016, the number of cases referred between these systems has increased from about 5,000 cases per month then, to 14,000 cases per month last December. Today, 90% of such complex cases are closed within 13 days, while the average time taken has fallen from 8.5 to 6.5 days over the past three years.
Residents' issues are being addressed more effectively. Last year, we introduced the Local Infrastructure Projects scheme to enable MSO and agencies to assess residents' requests for small-scale infrastructure in a timely manner. For example, we jointly evaluated a request supported by the Citizens' Consultative Committee for a footpath with lighting under the Sengkang West vehicular bridge. For the safety of residents, PUB tapped on the scheme as the implementing agency to build the infrastructure. Their efficiency in meeting the needs of the residents won them compliments from the residents.
As Mr Ong, Miss Chan and Mr Amrin Amin have suggested, technology offers us great potential in achieving better services with high operational productivity. As part of the Smart Nation movement, we have been harnessing technology to deliver smarter municipal services.
We have started enabling residents to do more with the OneService app to meet their diverse needs. This year, we will progressively introduce new features to transform the app into a one-stop community platform – not just to report feedback, but also to perform transactions, engage one another and access information.
For example, residents will soon be able to book and pay for neighbourhood facilities such as the barbeque pits near your block through the app. Motorists will be able to obtain paperless Electronic Parking Systems (EPS) receipts for HDB and URA car parks through the app, which can be useful for tracking expenditure or claims. Residents can also receive alerts on happenings in their neighbourhood, such as roadworks and hawker centre closures for maintenance. We will be implementing these enhancements in the coming year. And I thank Miss Chan for her suggestions on how we can deepen connections and community involvement through the app. We will continue to engage our users and partners with these ideas as we transform the OneService app.
Next, we are working with our partners to respond better to residents, by using technology to re-engineer our processes.
First, we have implemented case routing using Artificial Intelligence. This enables cases to be routed automatically to the right agency, freeing up officers to focus their efforts on solving more complex problems.
Second, agencies can access one another's proposed and on-going projects through a new Infrastructure Works Dashboard. They can use system tools in the Dashboard to de-conflict overlapping works for better coordination. Hence, we can minimise inconveniences arising from infrastructure works to residents.
In the future, we want to bring about more service improvements through the Municipal Services Productivity Fund introduced in 2017. An example of a funded project is Parking.sg, developed by GovTech, HDB and URA. Besides making it more convenient to pay for parking, removing the need for the paper coupon system, Parking.sg has actually resulted in savings for motorists. Nearly half of parking sessions are ended early, and drivers have been able to get more than $3.3 million in total refunded to them for unused time so far.
So, we have extended the fund and set aside $25 million for agencies to tap on over the next five years. We have approved two new projects under the extended fund − drones by SLA for early detection of maintenance issues, and a trial deployment of compactor litter bins by NEA for more efficient waste collection.
In total, we have awarded $5.2 million for six projects, and expect about five times that in productivity gains.
Mr Baey and Miss Chan asked about the efforts of MSO and our municipal agencies in partnering the community in tackling issues and building greater ownership. They highlighted the value of residents' feedback, which MSO can study, using data analytics, to understand root causes and develop more effective and targeted solutions. We fully agree with them, and are progressively doing so as we build up our database to tackle complex issues. Mr Baey asked if we could enable residents to easily alert agencies through the OneService app for municipal offences that may require enforcement action, such as illegal parking. We are studying this carefully with agencies, taking into account the need to ensure responsible reporting for the purpose of enforcement.
Beyond giving feedback, when private individuals and groups come forward, we can tap on diverse ideas, deeper knowledge and stronger networks to solve our problems effectively. This is why agencies are collaborating extensively with grassroots organisations, Community Development Councils (CDCs), Institutes of Higher Learning (IHLs) and the public. These partnerships enable us to harness ideas, co-create and pilot solutions for issues with the local community.
Last year, MSO organised the OneService Innovation Challenge and the Love Your Living Environment Youth Challenge. Residents from all walks of life came forward to contribute suggestions and work with agencies to implement ideas to deliver better services or tackle municipal issues.
A group of NUS students participated in the Youth Challenge and designed rubbish bins that allowed people to have some fun in expressing their opinions. They call it \"PollBins\". For example, people could indicate their preference for roasted versus steamed chicken rice by throwing their litter into the corresponding bin. The students tested their idea and found that people are more minded to discard their trash in the bins. The students gained from understanding gamification and its impact on behavioural change.
We also want to encourage residents to do their part in improving their living environment. We launched the HelpBuddy app pilot last year, where residents can take part in activities offered by agencies. Checking if the gravitraps set up by NEA to monitor the mosquito population, whether they are in good condition, is an example. Going forward, we will enable residents to put up simple activities on the app. For example, residents can help spot missing pet dogs, or share household tools with one another. If the pilot is successful, we will incorporate it in the OneService app.
To conclude, in the coming year, we will work closely with our partners to enable more convenient, effective and efficient services for residents. But we also want to do this with residents, because municipal issues ultimately impact us all in our daily lives. By so doing, we can build a better home for all, together.
The Chairman: Minister Desmond Lee.
The Second Minister for National Development (Mr Desmond Lee): Mr Chairman, may I show some visuals at the appropriate junctures to illustrate some points I am going to make?
The Chairman: Yes, proceed.
Mr Desmond Lee: Thank you. Sir, I will speak on three areas that MND will continue to strengthen in the coming years. First, our infrastructure resilience; second, climate resilience; and third, social resilience.
Let me begin with strengthening our infrastructure resilience. We often take infrastructure resilience to mean how strong and durable our existing structures are, and how well we maintain them. This certainly is important as our buildings start to age. But resilience is also about designing and building better to meet tomorrow’s challenges, so that our buildings can accommodate higher-density living, changing lifestyle needs and also withstand tougher weather conditions. This means adopting innovative solutions in design and construction. That is why MND continues to invest heavily in Research & Development in the urban and infrastructure sector.
One example is the Housing Development Board. In recent years, it partnered A*STAR to develop the Integrated Environmental Modeller (IEM). The IEM is a 3D modelling software that predicts how environmental conditions interact with our town plans. The software can, for example, try to simulate how wind flows through different urban features and open spaces, and where solar heat is more likely to build up. This helps our town planners take some of the guesswork out of designing a more liveable and sustainable estate. Now, they can plan better for open spaces to enjoy good ventilation, and plant trees and greenery in the right places to help bring down ambient temperatures.
Singapore can be a thought leader in producing innovative urban solutions like IEM. We are both compact and well-connected which is an ideal living test-bed for new ideas. Innovations developed here have the potential to be useful in other dense, tropical cities. The team that developed the IEM recognises this. They are currently in talks with the industry to see how the IEM can be adapted for commercial use. I hear that they are even looking to bring it overseas.
We will continue to support promising research under the Cities of Tomorrow (CoT) programme, which builds on the success of the Land and Liveability National Innovation Challenge (L2 NIC). The projects we have funded are diverse. But all of them aim to develop practical solutions to the multifaceted challenges that exist in our built environment.
For example, in construction technology, we are investing in innovations such as 3D printing to build faster, safer, and more cost-effectively. In facilities management, we are studying how robots and data analytics can make the job of inspecting building facades safer and more efficiently. Ultimately, these innovations aim to improve the lives of people, and ensure that our city meets the demands not just of today but of tomorrow.
Let me now move on to climate resilience. Various Members have spoken about the importance of being responsive to the threats and effects of climate change. We fully agree. It is especially critical for small, low-lying states like us to act decisively to protect ourselves. We have conducted studies to examine the risks and impacts of sea level rise and invested in clean-tech solutions, so as to move towards becoming a more low-carbon society. Minister Lawrence Wong will speak more about this tomorrow.
Today, I will speak about an important response to climate change – protecting the diversity and resilience of our natural and urban eco-systems. This is a comprehensive effort that requires planning at different levels. First, at a design level, our colleagues at NParks have put in a lot of thought to embed climate resilience features into our urban green spaces.
At one-north Park, specially chosen wildflowers and grasses help to filter storm water runoff naturally. These plants then also serve as a habitat for various species of butterflies, birds, and aquatic wildlife bringing them into the city. Our Nature Ways – such as the one shown here in Tampines – replicate the tiered structure of a tropical forest with native trees and shrubs. So, these are not just streetscape but are grown in a particular way to replicate some natural structures. They provide important ecosystem services to people and facilitate ecological connectivity for some species.
Second, on a planning level, we work with our community partners to protect and strengthen our Nature Reserves and Nature Areas. We currently have six Nature Parks adjacent to our Nature Reserves to provide over 250 Hectares of protective green buffers. By 2020, we will add two more Nature Parks at Rifle Range and Thomson to increase our green buffers to over 370 Hectares. Over the next 10 years, we will do more to regenerate forests in our Nature Parks as well as Nature Reserves. As part of our Forest Restoration Action Plan, NParks will plant an additional 250,000 native trees and shrubs to restore our secondary forests.
Third, underpinning all this work are our continued efforts to conserve our native flora and fauna. NParks will continue to plant more trees. In the past five years, NParks has planted an average of 50,000 trees a year, twice what it used to plant in the past. It will restore and enhance more habitats, for example, restoring mangroves at Sungei Buloh and Pulau Ubin, and repopulating corals at Sisters Island Marine Park. We will implement more species recovery plans and have started this for 50 species of native plants and 10 species of native animals. What Members see on the video is the Neptune’s Cup Sponge, which is one of the species being carefully rehabilitated in Singapore waters. It was thought to be globally extinct since 1908. But it was re-discovered in Singapore in 2011 – the first known re-discovery of this species in the world. And so you see this work of NParks officers, relocating it to afford it better protection from the elements.
Another species in our recovery programme is the Harlequin Butterfly. It is rare and little is known about its biology. But NParks has been studying it closely in the field, and has been relocating it to new sites to establish more populations. Today, there is a healthy new population at Pasir Ris Park, and work is underway to introduce more at East Coast Park.
Members also pointed out that development should not come at the expense of greenery. We would like to assure Mr Louis Ng, Mr Chong Kee Hiong, Mr Ong Teng Koon and Mr Pritam Singh that maintaining and enhancing our greenery will continue to be a key pillar of our urban planning strategy. In our post-independence years, this was what set us apart from other cities with similar growth strategies. Indeed, as Minister Heng Swee Keat said in his Budget round-up speech, greening is part of our identity.
But our small size, as a city state, means that our land and resources are scarce and finite, and the tensions and trade-offs for us when it comes to land use are magnified many times compared to larger countries. This is a reality we live with every day, and our planners are always seized with these challenges. So, we have to continue to be judicious about how we use land to meet our needs as a city and as a country, while ensuring that we safeguard land for the aspirations of our children and our future generations.
In this regard, any decision to clear land and forest cover is not taken lightly. If we do, it is a decision we make after very careful deliberation and inter-agency discussion, taking into account Singaporeans’ needs and the many trade-offs involved. As was in the case of Tengah, which was needed to provide homes over the next two decades for 42,000 families, and jobs for more than 20,000 people as the town develops progressively. These are not just difficult trade-offs in the present day, between greenery and biodiversity on the one hand, and housing and jobs on the other. But trade-offs between the present and the future – between land use for today’s needs and keeping land for our children and grandchildren and generations not yet born.
At the same time, in response to Mr Louis Ng’s question, we work to ensure that when development does take place, proposals are thoroughly examined for any potential environmental impacts among other issues.
Our Environmental Impact Assessment (EIA) framework covers all Nature Reserves, Nature Areas, other sensitive natural areas, as well as marine and coastal areas. Those who propose development close to these areas are required to consult our technical agencies on their plans together with URA and MND. And these technical agencies include Nparks. We take a prudent approach to this consultation. If we have reason to believe that a project may significantly impact the environment, then the developer will be asked by technical agencies to conduct a further environmental study. We would like to assure the Member that studies are undertaken in an independent and objective manner,
By specialists who have every interest to maintain their professional standing. The Study reports are also carefully assessed by the technical agencies, such as NParks, AVA, MPA and NEA, to ensure their adequacy. In addition, to reiterate my previous answer to Members’ question in this House, we will make the findings of such Environmental Impact Assessments publicly available, unless specific considerations require otherwise. That said, our review of the EIA framework is ongoing. MND and the technical agencies are studying how best to strengthen our policies and processes, to ensure the framework remains robust for the future.
Now, this brings me to my third and final area of focus. Our green spaces not only contribute to our climate resilience, they also bring people together, and are an important part of our social resilience. Singaporeans have reason to be proud of our distinctive greenery and rich biodiversity. Our common spaces allow us to interact with one another, and bond with our family and friends. More and more citizens are stepping forward to care for our green spaces.
We are indeed fortunate to have over 45,000 volunteers who work closely with us to protect and enhance our greenery and nature areas. For example, our community gardeners tend to more than 1,400 Community-in-Bloom gardens across the island. Our Biodiversity Beach Patrol volunteers help monitor key stretches of our beaches. Meanwhile, NParks’ extensive Friends of the Park communities continue to see people from all walks of life and all interests coming together with a common love for nature and open spaces.
Mr Dennis Tan highlighted concerns about the safe use of our park connectors and showed us a photograph of that. NParks has installed more safety features to enhance the safe use of PCNs. Additional lighting, speed regulating strips, and advisory signs have been put up. NParks has also installed advisory signs at high usage parks and park connectors to remind users to stay on track and give way. And NParks conducts outreach programmes to promote the safe use of park connectors, including lane usage and appropriate speed limits. And NParks is working together with LTA on joint enforcement efforts.
But the Friends of the PCN have also been contributing to our efforts. Chaired by avid cyclist and nature lover Mr Woon Tai Woon, the Friends of PCN have led the charge on ground-up initiatives, reaching out to PCN users to promote safe riding, like helping with track painting and public signage; encouraging safe riding etiquette through the “Share the Track” programme; and most recently, creating a video promoting the responsible use of Personal Mobility Devices (PMDs).
We will also activate more community nodes for citizens to enjoy. In 2017, we announced the start of trail enhancement works along the Rail Corridor. The continuous green trail stretches 24 km from the north to the south of Singapore, and is used by many as a place to cycle and trek. Today, I am happy to share that we have plans to develop the former Bukit Timah Fire Station (BTFS) into an additional recreational node along the Rail Corridor. This former Fire Station is strategically located at the intersection of the Rail Corridor and the Coast-to-Coast Trail which we announced quite recently, too. And we envision it be a base for visitors to explore the nature and heritage attractions in the area, including Bukit Timah Nature Reserve, Dairy Farm Nature Park and the Former Ford Factory. It will also be home to a new Visitor Centre for the nature parks in the area, and will host other nature, heritage, and recreational uses and we will announce more details later this year.
Finally, we will reinforce social resilience in the places that Singaporeans call home. We continue to ensure that our residential communities are served well by high quality social and community facilities. This means ensuring that community facilities are right-sited and sized appropriately, to support cohesive and multi-generational neighbourhoods.
For example, the future Punggol Town Hub will feature a public library, community centre, hawker centre, and health services, all co-located for one-stop, convenient access for residents. It will also have a cycling path that connects to the larger Punggol cycling network around it. The mix of amenities was carefully planned so as to meet the needs of the current demographic of residents, and as Punggol evolves, so, too, will the offerings at Punggol Town Hub.
Let me briefly address the remaining cuts.
Er Dr Lee Bee Wah made a request to increase heavy vehicle parking options in Yishun. Public heavy vehicle parking is popular as it tends to be cheaper and closer to residential areas; and that is where the tension arises. These residents were concerned about heavy vehicles entering residential built up areas. But of course, it is usually more convenient for drivers to park near home, especially given the hours that they operate. Unfortunately, while we plan carefully to ensure sufficient heavy vehicle lots at a national level, it is not always possible to fully meet local demand, especially near heavily built up residential areas. These are in relation to site constraints, concerns of safety, noise and other disamenities.
We encourage drivers to look into private heavy vehicle lot options as well as alternatives in neighbouring areas, but also encourage employers to take responsibility and help their drivers find the right spaces to park their company vehicles. But we will certainly work with Er Dr Lee Bee Wah to look at the requirements in Nee Soon. I would like to thank Mr Gan Thiam Poh and Mr Muhamad Faisal Abdul Manap for their suggestions to optimise car park use.
Some car parks already allow day and night season parking. Since private cars, heavy vehicles, and commercial vehicles tend to need parking at different times, available space is often already used optimally, and separately, agencies have also allowed parking lots that do not have traffic and site constraints to double up as heavy vehicle spaces for short time periods. But we continue to look out for other carparks which can be further optimised to support dual use and will continue to explore the ideas that Members have raised.
We have come far together, but we have more to do to build a thriving and dynamic city, develop comfortable homes and neighbourhoods, and protect our natural and built environment. We look forward to the continued support of all our Members.
The Chairman: Minister of State Zaqy Mohamad.
The Minister of State for National Development (Mr Zaqy Mohamad): Mr Chair, at the appropriate junctures, may I show some slides?
\tMr Alex Yam asked about our plans to create a future-ready built environment (BE) sector that supports the nation's changing needs. In October 2017 and February 2018, we launched the Construction ITM and the Real Estate ITM (REITM), which target to fundamentally change the way we design, build, maintain, and rejuvenate our city, while creating good jobs for Singaporeans. Since then, we have been partnering the industry, the unions, and the institutes of higher learning (IHLs) to implement the ITMs. Let me elaborate on our progress and upcoming plans.
First, on the Construction ITM. To drive change at the workforce, firm, and ecosystem level, BCA set up the BuildSG transformation office last year, to partner the industry in growing progressive firms and preparing the workforce for the future.
BuildSG has been working with the Trade Associations and Chambers (TACs), to help them build expertise in the three transformation areas, namely Design for Manufacturing and Assembly (DfMA), Integrated Digital Delivery (IDD), and Green Buildings. Six TACs have developed their own action plans to support the Construction ITM, and three more are due to complete theirs by the end of the month. These plans underline the TACs' commitment to guide firms and individuals through the transformation journey.
BCA is also partnering industry stakeholders through the IDD Steering Committee to guide the development of IDD, and encourage greater integration across the construction value chain.
As Er Dr Lee Bee Wah and Dr Teo Ho Pin noted, Building Information Modelling (BIM) is not yet seamlessly adopted across different project parties. To address this, BCA and IMDA have launched a $4 million joint call to support construction and technology firms in developing digital platforms for the BE sector, as part of the IDD implementation plan launched in November last year. The intent is to facilitate the use of a single BIM model across the construction value chain, from design, to construction, and to operations and maintenance.
We have also undertaken various initiatives to upgrade and augment the BE workforce, who are key to industry transformation. Beyond the infrastructure, manpower capability is also something that we need to build. Last month, BCA set up the iBuildSG Tripartite Committee to oversee the implementation of leadership and talent development strategies. Let me share three key updates.
First, IHLs will be updating their curricula to better equip undergraduates with skills and competencies to support transformation. As a start, NUS will pilot an inter-disciplinary module on prefabricated prefinished volumetric construction (PPVC) later this year. With PPVC, components are pre-fabricated under controlled factory conditions, and assembled like Lego blocks, as you see on the screen. This can significantly speed up on-site construction, and save up to 40% manpower. The pilot module will not only familiarise students with this technology, but also expose them to real work conditions where different stakeholders work together to deliver a project.
Second, the Committee has developed internship guidelines to help companies structure more effective internships. Good internships offer students a valuable opportunity to get a taste of work in the BE sector. The hands-on experience also better prepares students for joining the workforce. For example, Ms Tan Zi Rui went on a year-long internship with Aurecon while studying at the Singapore Institute of Technology. She helped to retrofit buildings with energy-efficient cooling systems and gained engineering experience.
Aurecon was also able to assess Zi Rui's technical and behavioural competencies and offered her the iBuildSG undergraduate scholarship, and subsequently a full-time position. It is wonderful to see young women joining the BE sector, and in this case, the construction industry as well. The Committee's guidelines aim to help more firms and students benefit from such positive internship experiences. I encourage firms to refer to them on BCA's Building Careers portal when planning your internship programmes.
Third, the Committee will upgrade and augment the industry's competencies through enhancing continuing education and training. The Committee is developing (a) a skills framework to identify skills and competencies of the future and guide training programmes to help PMETs remain relevant; as well as (b) a leadership framework to groom a core group of industry leaders.
We will also continue to support firms in training and bringing in mid-career professionals through Professional Conversion Programmes (PCPs). Last year, we introduced the PCP for Building Information Modelling (BIM) Professionals. After learning about the promising career prospects of a BIM modeller, Mr Mohamad Saifullizan Bin Abd Rahman took up the PCP. He has been receiving structured training in essential BIM skills, as well as on-the-job training with his industry sponsor, Lum Chang Building Contractors. To help more people like Saiful enter the BE sector, BCA is now working with Workforce Singapore (WSG) to expand the PCP offerings to other BE transformation areas, such as for professionals supporting DfMA projects and off-site facilities.
We will also do more to improve the attractiveness of construction industry jobs.
The use of productive technologies already improves working conditions and can create attractive new jobs, such as prefabrication supervisors. As Mr Zainal Sapari pointed out, it is also important to provide rest areas for workers. I announced at MOM's COS session yesterday that we will be looking into companies' practices in this regard. MND will also look at how best to ensure adequate provision of rest areas from a planning perspective.
Another important aspect of good jobs is remuneration. With the move towards higher skilled jobs, wages should also keep up. I urge industry leaders to continue your efforts in enhancing pay and career prospect for employees, so as to build up a strong local core of PMETs to support sustainable industry transformation.
The Government will also do our part to ensure that wages remain competitive. Last year, we announced a Progressive Wage Model (PWM) for the lift industry. BCA is working with the industry to phase in implementation, while ensuring sufficient lead time for buyers and firms to adjust.
In the meantime, the Government will take the lead to drive early PWM adoption by procuring only from firms that have registered their PWM status, starting this May. So far, 21 lift companies have pledged their commitment towards the PWM, and I hope that more will join them.
I am heartened to see progressive firms adopt productive construction technologies like DfMA. Take for instance INSTAD Pre Fabrication Pte Ltd, which set up a facility for prefabricated Mechanical, Electrical and Plumbing (MEP) systems in 2017. Through automation, the firm has achieved higher construction quality, with up to 40% time savings and 60% productivity improvement.
Workers in the MEP factory also enjoy improved working conditions – similar to the manufacturing sector – compared to traditional construction sites.
We want to support more firms in their transformation journey, and shift the industry towards adopting productive technologies like DfMA. To do this, we will need to complement existing funding schemes and manpower development initiatives with changes to our foreign manpower policies.
Currently, construction projects are subject to the Man-Year-Entitlement (MYE) framework, which manages foreign worker numbers at the project level. MYE quotas are allocated to main contractors based on project type and value. Main contractors then decide how to allocate these quotas to their sub-contractors.
We have received feedback from the industry that such an arrangement is not optimal, as Er Dr Lee Bee Wah had also fed back in her speech. For example, a main contractor may only pass on a small proportion of the allocated MYE quota to sub-contractors.
DfMA facilities are also not allocated MYE quotas directly as they are not project-based. So, most workers in DfMA facilities are employed on the higher MYE waiver levy rates. This means that the manpower cost for off-site DfMA works is typically higher compared to on-site works at construction sites.
While we have received industry feedback, as Er Dr Lee said, about the allocation of MYE quotas, increasing our reliance on foreign workers cannot be the way forward. Instead, to better align our manpower policies with our transformation outcomes, we will have to review the existing MYE framework for the construction sector.
Our intent is to progressively reduce the MYE quota for on-site works, and eventually remove the MYE framework altogether. We want to replace the MYE with a system that better enables the industry to optimise their foreign workforce, be it on-site or at DfMA facilities. This will take time and BCA will consult the industry in working out these changes to the MYE framework.
Meanwhile, to encourage more off-site works in the interim, we will introduce a new voluntary Off-site Construction Special Scheme (OCSS) for DfMA facilities. Firms on the OCSS will be able to hire an allocated number of workers at MYE levy rates. This will lower the cost premium for DfMA, and hopefully encourage more firms to shift towards off-site work.
BCA will be engaging eligible companies to explain the details of the scheme, which will be implemented later this year.
Er Dr Lee and Mr Ang Wei Neng underscored the importance of efficient and streamlined regulations and processes for construction projects. We agree. The Inter-Agency Coordinating Committee (IACC) was established by BCA in 2011 to resolve cross-agency regulatory issues. Instead of meeting only when issues are surfaced, the IACC has started to hold monthly meetings this year to proactively engage the industry.
Where there are changes to regulations, we will do what we can to help firms transition. Specific to Er Dr Lee's feedback on the service diversion and others, we take those on-board and I will have a word with BCA to see how best we can help her.
Er Dr Lee asked about rebates to help absorb the diesel duty increase. As announced by the Minister for Finance, three years of road tax rebates will be provided for commercial diesel vehicles. The rebates will also apply to commercial vehicles used in the construction industry.
Er Dr Lee also provided specific feedback on services diversion works and the Workplace Safety and Health (WSH) regulations. As many of our projects are on brownfield sites, preparatory works, such as services diversion, may be required prior to development works. It is inefficient for Government to undertake all such land preparations before tendering out sites for sale. Instead, our approach is to make known in the tender documents, any encumbrances on-site, so that interested bidders can factor these accordingly into their timelines and tender price.
As for workplace safety, our WSH regulations adopt a risk-based approach for the supervision for high-risk construction works. Supervisors need not be present at all times if the risks are sufficiently addressed, for example, by adequately briefing workers on the potential risks, and the proper use of tools and safety equipment.
The WSH regulations have contributed to reducing construction workplace fatality rates, from 8.1 per 100,000 workers in 2007, to 3.1 per 100,000 workers in 2018. As I have elaborated in my MOM speech yesterday, one of the strongest links to many of these fatalities is inexperienced workers.
Er Dr Lee also asked about our efforts to support local contractors. We know that the industry has been experiencing a slowdown in recent years. We have introduced a number of measures to help. In 2017, we announced that we would bring forward $1.4 billion worth of public sector projects to boost construction demand over the next few years. To help local companies build up a track record, we have parcelled out large infrastructure projects into smaller contracts that SMEs can take on and allowed smaller consultancy firms to band together to bid for higher value projects.
So, to assure Er Dr Lee, we want to provide as much support as we can for local firms and, certainly, within our procurement guidelines. That is why we also have to continue to review our processes, policies and how we work with inter-agency regulations. This is one of the reasons why we are looking at the MYE framework as well.
Our longer term focus remains on helping firms build capabilities and strengthen their competitiveness. We currently provide funding support to firms in various areas, including construction productivity, manpower development and research and innovation. To help firms navigate the schemes more easily, we will consolidate our existing schemes under an umbrella BuildSG Transformation Fund (BTF) amounting to about $770 million. This includes top-ups to two existing schemes, namely, the Productivity Innovation Project (PIP) and the Public Sector Construction Productivity Fund (PSCPF).
More than 300 firms have benefited from the PIP, which co-funds capability development initiatives that improve site productivity. The good news is that we will add about $200 million to the PIP to support more firms in adopting productive technologies. The PSCPF supports Government agencies in procuring innovative and productive solutions for public sector projects. Since its launch in 2017, most of the $154 million fund has been committed. We will add another $95 million to the fund to sustain the effort.
Next, let me provide an update on the progress of the transformation efforts in the Real Estate industry. In April last year, BCA formed the tripartite Facilities Management Implementation Committee (FMIC) to transform the FM industry into one that is more productive and that leverages on data analytics, predictive maintenance and smart solutions. To this end, the FMIC, which comprises representatives from both the Government and the industry, has proposed recommendations in four areas, namely:
(a) Designing for maintainability;
(b) Enhancing maintenance productivity and quality through smart FM;
(c) Enhancing guidelines for FM procurement; and
(d) Ensuring adequate training and development of the FM workforce.
While implementation details are being worked out, the public sector will take the lead to uplift the FM industry through various initiatives, such as by adopting outcome-based procurement guidelines. This provides flexibility for FM service providers to focus on improving outcomes, instead of meeting headcount requirements.
On the property transaction front, we will continue to enhance and streamline the transaction processes for users through automation and digitalisation. A key thrust is to make it easier for industry players to access property-related Government data, thereby enabling the automation of time-consuming administrative processes. We have done this for data related to rental transactions since February. This means that checks, like whether a seller is the legal owner of the property, and whether a landlord is eligible to lease out a HDB unit, can now be done with the click of a button. I believe this will benefit many, as rental transactions account for about 60% of all residential property transactions.
I am happy to share that we will be doing likewise for data related to the sale and purchase of residential properties from the end of this year. We encourage the industry to take advantage of this to streamline processes and better serve your customers.
But we are not stopping here. Our long-term goal is to facilitate seamless and digitalised property transactions from start-to-finish. To chart the way forward, CEA is chairing a digitalisation workgroup with representatives from both Government and industry. By reducing the hardcopy documents and physical payments, consumers can spend less time on paperwork and queuing up at banks, and property agents, bankers and lawyers can focus on higher value-added services to customers.
As Mr Chong Kee Hiong noted in his speech, good infrastructure is essential in supporting our future economy. We have a rigorous framework to ensure that our buildings are safe. Developments involving structural works undergo checks to ensure that they have been designed and built according to the approved plans and building regulations. Developers are required to engage trained professionals known as Qualified Persons and Accredited Checkers at various stages of the project, from the building design phase, to supervising the construction works on-site, to certifying the works upon project completion. BCA also conducts sampling checks on building plans and targeted inspections on structural works, and will take enforcement action against any party that contravenes the regulations.
Going forward, the various ITMs under the Built Environment sector will strengthen the industry’s capabilities in continuing to build and maintain quality infrastructure. MND will continue to partner our stakeholders as we ride the waves of transformation to a high-tech and a more productive BE sector.
The Chairman: Leader of the House.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply Reporting Progress","subTitle":null,"sectionType":"OS","content":"The Leader of the House (Ms Grace Fu Hai Yien): Mr Chairman, may I seek your consent to move that progress be reported now and leave be asked to sit again tomorrow?
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 Deputy Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Ms Grace Fu Hai Yien: Mr Deputy Speaker, I beg to report that the Committee of Supply has made progress on the Estimates of Expenditure for the financial year 2019/2020, and ask leave to sit again tomorrow.
Mr Deputy 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":"Resolved, \"That Parliament do now adjourn.\" – [Ms Grace Fu Hai Yien].
Adjourned accordingly at 7.07 pm
1 Mr Louis Ng Kok Kwang asked the Minister for Health how does the Ministry calculate norm costs, defined as the Ministry's observed average costs of running Long Term Care services, which tend to be considerably lower than what Voluntary Welfare Organisations (VWOs) claim are the real costs of service delivery, as reported in Lien Foundation's 2018 \"Care Where You Are\" report.
Mr Gan Kim Yong: MOH partners Voluntary Welfare Organisations (VWOs) as well as private and public sector service providers in delivering long-term care services (LTC) for Singaporeans.
To estimate the costs of providing different LTC services, MOH works with the service providers to conduct regular costing exercises. The costs are determined based on service requirements set out for each care service. The average of the costs across the long term care provided by different service providers, the \"Norm Cost\", is then used as a reference to determine the funding for the services.
As care models, cost structures and productivity vary across service providers, some could have costs that are higher than the norm cost, while others could have costs that are lower.
MOH provides means-tested subsidies of up to 80% for long term care services. Singaporeans who require additional help after the subsidies can apply for financial assistance such as MediFund. Some VWOs provide additional assistance to their clients through charity dollars raised. Some may also choose to provide additional facilities and services using their charity funds. To support VWOs in their fundraising efforts and encourage Singaporeans to give generously, the Government funded Community Silver Trust provides dollar for dollar matching for donations raised in the long term care sector.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Neighbours with Behavioural or Mental Health Problems Who Cause Nuisance, Inconvenience or Pose Hazards and Dangers","subTitle":null,"sectionType":"WA","content":"2 Ms Joan Pereira asked the Minister for Culture, Community and Youth with reference to neighbours with behavioural or mental health problems that cause nuisance, inconvenience or pose hazards and dangers (a) what measures are in place to resolve the problems expeditiously; and (b) whether regulatory and enforcement powers need to be strengthened for the Community Mediation Centre and other related Government agencies, for the safety and well-being of residents.
Ms Grace Fu Hai Yien: The safety of residents is a priority for the Government, and the Police will not hesitate to intervene where there is a threat to life and property.
However, not all cases are of this severity, and there are other avenues to resolve these issues. Parties can seek mediation through a neutral third party, such as a grassroots leader, or approach the Community Mediation Centre (CMC) for help. Persons who suspect that their neighbours are displaying disturbing behaviours due to mental health issues can contact Agency for Integrated Care (AIC), which will assess and make the necessary referral for medical assistance and social support. Agencies, such as HDB and PA, grassroots leaders, voluntary welfare organisations and the AIC will come together to find a sustainable solution with the parties involved.
Where community-based solutions are not sufficient, we have other laws and procedures that allow parties to deal with persons with mental health conditions who are posing disruption to the community.
(a) If the person is becoming a risk to himself, or poses a danger to others, the Police can apprehend the person and take him to a doctor. The doctor will assess the person's mental health, and send the person to a psychiatric institution for treatment if necessary.
(b) For intractable cases where parties are unable to resolve their disputes through voluntary mediation, parties can file a case with the Community Disputes Resolution Tribunals (CDRT) as a last resort. The CDRT judge can order the parties to attend mandatory mediation or attend counselling, or fix the case for hearing if mediation and counselling are not suitable.
(c) If a respondent breaches the CDRT's order, his affected neighbour can apply to CDRT for a Special Direction (SD) for the respondent to comply with the order. The CDRT can order a third party, such as the respondent's family member, to enter into a bond with conditions that the respondent goes for psychiatric assessment or treatment. If the respondent breaches the SD and is convicted, the court can call for a psychiatric assessment to determine whether it would be appropriate to make a Mandatory Treatment Order for the respondent to undergo psychiatric treatment.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Salary Claims Filed with Employment Claims Tribunal","subTitle":null,"sectionType":"WA","content":"3 Ms Anthea Ong asked the Minister for Manpower in 2017 and 2018 respectively (a) how many salary claims were filed by (i) local employees and (ii) foreign workers at the Employment Claims Tribunal; (b) how many court orders were issued to errant employers to settle salary claims by (i) local employees and (ii) foreign workers respectively; and (c) how many orders remained unpaid one month after the orders were issued.
Mrs Josephine Teo: 85% of the claims filed under the Employment Claims Act (ECA) were resolved at the Tripartite Alliance for Dispute Management (TADM). The remaining 15% of the claimants were referred to the Employment Claims Tribunals (ECT), and of which 5% were withdrawn while 10% filed for adjudication. Two-thirds of the adjudicated claims resulted in money orders issued to employers to settle the salary claims; this proportion is similar for both local and foreign employees.
Of the ECT orders issued, about half of the claimants received full payment from their employers. Another 16% reported partial payment, while 36% reported no payment. Cases that resulted in partial or no payment usually involved employers in financial difficulty, or large accumulated salary arrears before the employee reported to TADM. In 12 cases (1% of ECT orders), the employer wilfully refused to pay despite having the means to do so. MOM is investigating and prosecuting these employers. 129 low income claimants who did not fully recover their salaries received additional financial assistance through the Short Term Relief Fund or Migrant Workers' Assistance Fund.
We encourage workers to approach TADM immediately when they have salary arrears. This improves the chances of full recovery, and prevents more workers from encountering the same problem.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Occupational Injury Cases Seen by Private vis-à-vis Restructured Healthcare Providers","subTitle":null,"sectionType":"WA","content":"4 Mr Louis Ng Kok Kwang asked the Minister for Manpower (a) what is the current percentage of work injuries or occupational injury cases that are seen by private compared to restructured healthcare providers; and (b) what are the patterns (types of injuries, severity of injuries, sectors, occupations) seen by private compared to those seen by restructured healthcare providers.
Mrs Josephine Teo: In the past three years, around 75% of work injury cases have been seen by public healthcare institutions, while the remaining 25% have been seen by private healthcare providers.
The industry and occupation profile of injured workers seen by the public healthcare institutions and private healthcare providers are similar.
Nonetheless, a larger proportion of the cases handled by the public healthcare institutions involve serious injuries such as fractures, dislocations and crushing injuries, compared to the private healthcare providers. Correspondingly, private healthcare providers have a larger proportion of less serious cases, such as bruises and sprains, compared to public healthcare institutions.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Employers Prosecuted for Failure to Report Work-related Injuries","subTitle":null,"sectionType":"WA","content":"5 Mr Louis Ng Kok Kwang asked the Minister for Manpower in each of the past five years (a) how many employers have been prosecuted for failing to report a work-related injury; and (b) how many of these employers who failed to report a work-related injury have been punished with a fine and how many have been punished with imprisonment.
Mrs Josephine Teo: Non-reporting occurs mostly because employers disputed that the injury was work-related, or was not informed of the injury. Before 2018, we focused on educating employers to have better systems to detect and surface injuries suffered by their employees, and to report injuries brought to their attention even if they believe the injuries were not work-related. Since the start of 2018, we have stepped up our enforcement efforts which led to an increase in the number of employers being taken to task for non-reporting.
In addition to the 40 composition fine cases, a site manager was convicted in 2016 for attempting to cover up a workplace accident by abandoning the injured worker along an alley. The manager was jailed six months for the offence. There has been no other case of non-reporting which resulted in imprisonment.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Most Common Methods Used by Employers to Avoid Reporting Work-related Injuries","subTitle":null,"sectionType":"WA","content":"6 Mr Louis Ng Kok Kwang asked the Minister for Manpower (a) what are the most common methods used by employers to avoid reporting a work-related injury; and (b) what are the most common ways that instances of non-reporting of work-related injuries by employers are detected.
Mrs Josephine Teo: Today, employers are required to report work injuries resulting in medical leave of more than 3 days, hospitalisation for at least 24 hours or death.
Common reasons cited for delayed or non-reporting are (i) the employer did not agree that the injury was work-related; and (ii) the employee did not inform the employer of the work injury.
Non-reporting of work injuries by employers are usually detected when an employee or his representative files an incident report to MOM.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null}],"writtenAnswersVOList":[],"writtenAnsNAVOList":[],"annexureList":[],"vernacularList":[{"vernacularID":2701,"sittingDate":null,"vernacularTitle":"Vernacular by Mr Sam Tan Chin Siong","filePath":"d:/apps/reports/solr_files/20190306/vernacular-Sam Tan MSF 6 Mar 2019 - Chinese_tracked v2.doc.pdf","fileName":"Sam Tan MSF 6 Mar 2019 - Chinese_tracked v2.doc.pdf"},{"vernacularID":2702,"sittingDate":null,"vernacularTitle":"Vernacular by Assoc Prof Dr Muhammad Faishal Ibrahim","filePath":"d:/apps/reports/solr_files/20190306/vernacular-6 Mar 2019 - SPS AP Dr Muhd Faishal - (vetted MSF) Reply to MSF cuts.pdf","fileName":"6 Mar 2019 - SPS AP Dr Muhd Faishal - (vetted MSF) Reply to MSF cuts.pdf"},{"vernacularID":2703,"sittingDate":null,"vernacularTitle":"Vernacular by Mr Gan Kim Yong","filePath":"d:/apps/reports/solr_files/20190306/vernacular-Gan Kim Yong MOH 6 March 2019 -Chinese.pdf","fileName":"Gan Kim Yong MOH 6 March 2019 -Chinese.pdf"},{"vernacularID":2704,"sittingDate":null,"vernacularTitle":"Vernacular by Dr Lam Pin Min","filePath":"d:/apps/reports/solr_files/20190306/vernacular-Lam Pin Min MOH 6 March 2019 -Chinese (mh).pdf","fileName":"Lam Pin Min MOH 6 March 2019 -Chinese (mh).pdf"},{"vernacularID":2705,"sittingDate":null,"vernacularTitle":"Vernacular by Mr Amrin Amin","filePath":"d:/apps/reports/solr_files/20190306/vernacular-6 Mar 2019 - SPS Amrin Amin - (MOH No Answer) Reply to MOH cuts.pdf","fileName":"6 Mar 2019 - SPS Amrin Amin - (MOH No Answer) Reply to MOH cuts.pdf"}],"onlinePDFFileName":""}