[(proc text) Order read for consideration in Committee of Supply [5th Allotted Day]. (proc text)]
[Mr Speaker in the Chair]
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[(proc text) \"That the total sum to be allocated for Head W of the Estimates be reduced by $100.\" – [Mr Sitoh Yih Pin.] (proc text)]
[(proc text) Question again proposed. (proc text)]
The Chairman: Minister Khaw Boon Wan.
The Minister for Transport (Mr Khaw Boon Wan): Mr Chairman, our excellent connections to the world provide huge advantages for our businesses, create good jobs for Singaporeans and raise our quality of life. They make Singapore a global city and a vibrant economic hub.
The role played by Changi Airport and PSA is well-understood. But remember these are not permanent strengths. As the Chinese saying goes, \"一 山 还 有 一 山 高\". There is always a taller mountain elsewhere. Many airports and seaports in the region are working hard to replace us. Changi Airport and PSA are working even harder to make sure we are not easily replaceable. The Ministry of Transport (MOT) is fully behind them, together with other Government agencies.
That is why we are expanding Changi Airport, even though we have just opened Terminal 4 (T4). This is not just about building another terminal in Changi. We are actually building a second airport, complete with a third runway, an extensive underground network of tunnels and a mega terminal to serve up to 50 million passengers per year in the first phase of development. By adjoining the current airport, it will almost double our overall airport capacity. More importantly, we can synergise both airports to make the entire Changi an unbeatable air hub.
Likewise, the capacity of our seaport at Tuas will be double our current container throughput. But more than physical size, the new seaport will leverage the latest technology and help create new innovative solutions. As the operator of the new seaport, this will set PSA apart from its rivals. It will help make PSA’s customers even more efficient and cost-effective in their operations.
While the external connectivity dimensions of Changi Airport and the seaport are obvious, the role played by land transport is also crucial. No point being able to fly or sail into Singapore easily, only to be stuck in traffic jams. This is a common phenomenon in many other cities around the world. Singapore must never be like that.
The key is to ensure our land transport matches the standard of Changi and PSA. Our approach is to make public transport the preferred mode of transport within Singapore. This is a continuing work-in-progress. As Mr Sitoh Yih Pin put it, there will be growing pains, but I am confident we will get there. Our target is to have 75% of all peak hour journeys made on public transport by 2030. We are on track to achieve this target. To answer Mr Ang Hin Kee's question, the peak hour public transport mode share last year was 67%: with bus at 34%, rail at 28%, and taxi and private hire car at 5%. With the introduction and growing popularity of personal mobility devices (PMDs), we can be increasingly confident.
We are clear that for public transport to be the preferred mode, it must be extensive, affordable, reliable and seamless.
First, an extensive public transport network. A well-connected and resilient rail network forms the backbone. Eight in 10 households will live within a 10-minute walk of a train station by 2030. That is why we are expanding our rail network to 360 kilometres (km). We will also increase the number of stations to 270. This will put our rail network density ahead of Tokyo and New York City today. This is hard work, patient work over many years and several Transport Ministers. When we fully opened the Downtown Line last year, we took a giant step forward.
The next giant step will be the opening of the Thomson-East Coast Line. The project is on schedule. We have also started planning the Jurong Region Line and Cross Island Line. These new Mass Rapid Transit (MRT) lines will help to catalyse the development of the Jurong Lake District and Punggol Digital District and transform them to enable an exciting car-lite lifestyle for more Singaporeans.
Besides the MRT, we have also enhanced bus services significantly, as noted by Mr Melvin Yong. Through the $1.1 billion Bus Service Enhancement Programme (BSEP), we have added 1,000 new buses to our fleet and introduced 80 new routes. Through the Bus Contracting Model, we have raised service standards by injecting additional capacity for more than 100 services. To support the expansion of our bus fleet, four new depots as well as seven interchanges and terminals have been built or upgraded over the past five years.
We have also incorporated an incentive-disincentive framework in the bus contracts. For the first service year, the operators have already earned incentives of about 1.5% of their total service fees. This is nearly $20 million of incentive payment. The more they improve their services to commuters, the more incentives they stand to gain. This has aligned their corporate objectives with ours. Together, these measures have contributed to greater bus connectivity, less crowded rides and shorter waiting time for commuters. Commuters have felt the difference. It showed up in the Public Transport Customer Satisfaction Survey. I see this as a vote of confidence by commuters for BSEP and the new Bus Contracting Model.
Second, an affordable public transport service. Our transport fares are affordable. To measure affordability, we track the percentage of income that lower-income Singaporeans spend on public transport. In other words, out of your monthly salary, how much do you spend on public transport? It is low, below 2%. So, if you earn $1,000, less than $20 is spent on public transport. While transport fares must be affordable, we must be careful that they are not priced too cheaply, as maintaining a high-quality transport system requires resources. Cheap fares are popular, but they are not sustainable.
The story of the New York City subway is instructive. A recent New York Times article, reproduced in our local media, which chronicled the woes of the New York City subway. It was once an engineering marvel. It is now a broken system with many safety issues. It is estimated that over US$100 billion is needed just to fix the subway’s most pressing needs.
The investments we are making to improve the transport system are huge. MOT’s budget is now the second biggest amongst Ministries, after the Ministry of Defence (MINDEF), and ahead of the Ministry of Health (MOH), the Ministry of National Development (MND) and the Ministry of Education (MOE).
Miss Cheng Li Hui has observed an alarming spike in public transport subsidies. She is right. And we should all be alarmed. She is in business. She knows that rising cost against declining revenue has only one outcome – a disaster. What are the facts? Over the past five years, improvements to public transport services have increased operating costs by about 60%. One major contributing factor is the huge increase in network capacity as we opened new lines and added more buses and trains. This huge cost increase has been borne by the Government, namely, taxpayers. Against such rising cost, fares have gone down by 2% over the same period. So, 60% rise in operating costs but fees reduced by 2%. That is the past five years.
But what about the future? Over the next five years, we will provide subsidies of about $5 billion for public bus services and $4 billion to renew our rail operating assets. Another $20 billion will be invested in infrastructure to further expand the public transport network. The Government will continue to subsidise public transport to keep fares affordable. However, every dollar spent on transport is a dollar less for other expenditure, like schools, healthcare and security. The Public Transport Council (PTC) is currently reviewing the fare formula, and I agree with Miss Cheng Li Hui that the current formula is inadequate. It can be improved to better track total costs. I am confident that they can work out a fair and sustainable arrangement. Please support the PTC when they make their recommendations.
Meanwhile, we need to be prudent about where and when to inject new services, especially in low ridership areas, so as to not overburden taxpayers. I hear Mr Zaqy Mohamad’s call, on behalf of Mayor Low Yen Ling, for better rail connectivity in Bukit Gombak. Mayor Low is a good Member of Parliament (MP). She is reflecting her residents’ demands. I have to be a good Transport Minister. I have to balance the needs of all Singaporeans in a fair manner. We are committed to opening Hume MRT station eventually. But the exact timing of this will depend on the pace of developments and ridership growth in the area. I seek Mayor Low's patience and understanding.
Third, a reliable public transport system. We do not need the story of the New York City subway to remind us of the importance of reliability. The Singapore Mass Rapid Transit (SMRT) has its own bad experience of past neglect and, hence, its fair share of reliability problems in recent years. Correcting these problems is a multi-year effort. But we will get there; we just need time. I asked for five years when I took over this portfolio two and a half years ago. So, I am at mid-point.
Mr Melvin Yong asked for an update. We are making good progress. I have set yearly targets. My target is for the MRT network to achieve a Mean Kilometres Between Failures (MKBF) of 400,000 train-kilometres (km) this year, 600,000 train-km next year and one million train-km by 2020. These are not soft, easy targets. They are very difficult targets to achieve. That is why very few metros in the world have achieved that.
After a painful 2017, the new signalling system in the North-South Line has finally stabilised. I am pleased to report that the MKBF of the MRT network, for January and February this year, has exceeded next year’s target of 600,000 train-kilometres. In fact, the North-South Line hopes to cross its 150th consecutive day of no disruption today. This is the good news. The bad news is that we will soon start testing of the new signalling system on the East-West Line with passengers. We have been testing it without passengers; that means, at midnight. We will soon be testing it with passengers on board. I will be spending many days and nights briefing the MPs along this stretch of East-West Line to explain to them what re-signalling is all about, why we need to re-signal, why it is good for Singapore and the commuters and what to expect, especially the unpleasant experience of the North-South Line. Do expect glitches and delays. So, please bear with us.
Extended engineering hours have been very useful to our engineering team. They allow us to speed up the renewal of ageing assets, as well as the installation of noise-barriers around the island. For residents living next to MRT tracks, this is a welcome development – my residents as well as residents of Er Dr Lee Bee Wah.
Extended engineering hours have also allowed us to step up preventive maintenance and repairs. To answer Miss Cheng Li Hui’s question, we require our rail operators to fulfil stringent Maintenance Performance Standards (MPS). If they fail to comply, we will impose regulatory action and financial penalties. More importantly, after several years of interacting with them, my sense is that our two rail operators themselves have already internalised the importance of maintenance and they have accepted their responsibility to regain public confidence in our MRT system. I am optimistic they will not fail us. They are ramping up the number of maintenance staff. Over the past five years, our maintenance workforce has grown by over 1,500 staff, a 50% increase, with plans to further increase this by more than 600 over the next three years.
I thank commuters for allowing us to close earlier and open later – Early Closure, Late Opening (ECLO). To answer Mr Melvin Yong’s question, ECLO will continue, especially for the older lines where we have to juggle limited engineering time between maintenance and the renewal of ageing systems.
We have learnt to manage such planned closures with an extensive shuttle bus arrangement so that affected commuters have convenient travel options. During the recent planned closures along the entire East-West Line, we mobilised 350 buses and 700 bus captains to support the shuttle services. I thank all our transport partners and the Land Transport Authority (LTA) for their commitment to this effort. It was Team Singapore at its best.
Many readily adjusted their work schedules to accommodate the additional works. Many made personal sacrifices. During one Sunday closure, this was in December, along the North-South and East-West Lines, many members of SMRT's track circuit replacement team were unable to attend the wedding of their teammate, Mr Mohammed Idris bin Zakaria. The team managed to send him a photo and message from the worksite, which read: \"Hi Idris, we are working at Jurong due to ECLO, hot sun and rain are a big challenge here. In fact, it is going to rain, but we know today is your big day, we all just want to say, Happy Marriage\". There are many such examples.
We are determined to make our system among the best in the world. It can be done. Until all the ageing assets are fully replaced and upgraded, we may still encounter some delays or disruptions. But we are doing our best to eliminate such risks and, should they happen, to minimise inconvenience to commuters.
To accelerate the renewal of the ageing assets, we will reinforce our bus network to provide some back-up capacity. We will be deploying 450 buses to bolster capacity along existing bus routes which support critical stretches of the rail network undergoing renewal. These are new buses. They were ordered to meet growing ridership demand and to replace our ageing bus fleet. We are opportunistically bringing forward their purchase and deployment to strengthen the resilience of our public transport network in the interim.
Like Mr Melvin Yong, we, too, are concerned about staff fatigue. Planned closures are generally over the weekends, when bus services are thinner, so we have been able to tap on the existing pool of bus captains for these shuttle services. To manage driver fatigue, bus captains are rostered to ensure that they have sufficient rest. We will continue to work closely with the public bus operators and National Transport Workers' Union (NTWU) to ensure that such shuttle services are sustainable, and that we maintain strong morale amongst our bus captains.
Besides our oldest MRT Lines, enhanced maintenance and renewals are also underway for all the other MRT and Light Rail Transit (LRT) lines, which are at different stages of their lives. The Bukit Panjang LRT, in particular, is reaching the end of its useful life. After evaluating all possible options, LTA has decided to work with the original equipment supplier, Bombardier, to renew the entire network. We will also try out a new service support arrangement whereby SMRT will engage Bombardier through a long-term maintenance contract for spares, training and technical expertise. Bukit Panjang residents can look forward to more reliable rides in due course.
Fourth, a seamless public transport experience. Commuter perception of public transport is often shaped by their first- and last-mile experience. Is it convenient? Is it pleasant? Is it safe? We are helping pedestrians by providing more covered walkways to transport nodes.
Shared bicycles and PMDs have also provided commuters with a new option for shorter journeys. However, disamenities, specifically indiscriminate parking and reckless behaviour, are a growing irritation.
I remember Mr Sitoh Yih Pin's reservations on e-bikes and PMDs when the Act was debated in this House last year. This year, I noticed, out of the 33 cuts for MOT, 14 were on shared bicycles and PMDs. That is a high percentage. Yesterday evening, I heard all the passionate pleas from the Members who spoke. So many spoke, including Ms Foo Mee Har, despite her loss of voice.
Let me share with Members a little secret. I heard such complaints from my wife, too. Not every night, but very often. Every time when she drives around our estate and sees such yellow, rainbow-coloured bicycles parked indiscriminately, blocking the footpaths, believe me, I would get an earful. So, clearly this is a hot topic among many people on the ground! Senior Minister of State Lam Pin Min will address this topic in full later.
I hear Mr Pritam Singh's call to significantly tweak the Certificate of Entitlement (COE) system to favour families with young children and also low-income motorcyclists. COE is a sound market-based mechanism to allocate limited vehicle supply. Favouring one specific group would inevitably disadvantage others. Far more correct is to keep the COE system pure and formulate separate specific policies to encourage couples to have babies and to help low-income Singaporeans. Meanwhile, we are committed to making public transport the preferred mode for all Singaporeans. This applies not just for new families, but also for the elderly and persons with disabilities. Senior Minister of State Lam Pin Min will also elaborate on this later on.
We also facilitate the introduction of car-sharing services, such as BlueSG, and welcome the growth of private hire car services. They have provided commuters with more on-demand and point-to-point alternatives to owning a car. We will make car-lite Singapore a reality. But the point-to-point industry is rapidly consolidating. How it consolidates can have serious implications on contestability and the welfare of commuters and drivers.
In other words, will the industry remain open and contestable? Today, we have choices between Grab and Uber, and that is why service level improved. What if the market consolidates and you end up with only one player or a very huge dominant player? I am quite sure that pricing will change drastically overnight, both for taxi drivers as well as commuters. So, as regulators, we have to anticipate such possible outcomes and try to pre-empt them. Second Minister Ng Chee Meng will discuss this very important issue later on.
Finally, we are harnessing technology to transform land transport. Last month, we launched the Land Transport Industry Transformation Map (ITM). Emerging technologies are unsettling, but the opportunities to transform land transport for the better are compelling.
The ITM will help the industry and its workers move up the value chain and serve commuters in new and better ways. Mr Melvin Yong and Mr Ang Hin Kee spoke about Autonomous Vehicles (AVs). AVs have the potential to transform transport, reinvent transport. We are working with some of the best in the world and in Singapore to tap on this exciting technology which is still developing. We are keenly watching where this technology will take us next and the benefits that it will bring to commuters. It is too early to say how widely adopted AV technology will be by 2030, but the progress of AV trials overseas and in Singapore is very encouraging.
Waymo of Google has tested their AVs on public roads in the United States (US) without a safety driver. This is what we call Level 4 or 5 of a driverless vehicle. It intends to launch a commercial AV ride-sharing service later this year. Here in Singapore, we expanded our AV testbed at one-north last year to about 70 km. As we gain experience and expertise, we will expand trials to other precincts and also pilot the use of other vehicles, like AV buses and AV shuttle services in Punggol, Tengah and Jurong.
Mr Melvin Yong asked if we have the necessary infrastructure and legislative framework. We are not yet fully ready. In fact, no cities are. But the AV trials have given us insights into the gaps which we will fill. We have amended the Road Traffic Act to facilitate our AV efforts, and we will make further amendments if necessary. We have also launched a Request for Information to seek inputs from industry and other experts.
This week's Economist magazine had a special report on AVs. Several pages of this developing technology are worth a quick flip through. It spells out possibilities, an exciting world of transport. Singapore was mentioned in the article as an example of pro-innovation regulation. It is so easy to snuff out innovation. If you regulate too tightly, too early, nothing will happen. If you maintain a light touch for too long, as has happened in the bike-sharing situation, then you have disamenities.
This reminded me of what Laozi said 2,500 years ago on the art of frying a small fish: too much fire and you burn the fish. It becomes carcinogenic, you may get cancer. Too little fire, the fish remains uncooked and you may get a stomachache.
Although it is difficult to predict the timing of widespread AV adoption, the potential for such technologies to disrupt the livelihoods of transport workers is undeniable. I, therefore, agree with Mr Melvin Yong and Mr Ang Hin Kee that we should help our transport workers adapt early.
The Government is working closely with unions and the transport operators to upskill, reskill and to transition some of them to adjacent vocations. This is being done through our Institutes of Higher Learning (IHLs), as well as the Bus Academy and Singapore Rail Academy. We will also work with Government agencies, industry champions and service providers to identify other areas of employment growth outside the land transport industry for affected workers to transition to.
LTA, SkillsFuture Singapore (SSG), our public transport operators and NTWU are jointly developing the Skills Framework for Public Transport, and we will launch this very soon in May. It will provide our transport workers with a clearer picture of what skills they should develop as well as the programmes available, if they want to upgrade. As we expect to create 8,000 new jobs in the public bus and rail sectors by 2030, we will also enhance talent management and engagement efforts for the sector to attract a pipeline of skilled workers and retain more in-service staff.
Mr Chairman, the future transport scene is truly exciting. We are lucky to be living in Singapore, and at this time. For example, AVs, combined with the sharing economy and improvements in mobile telephony, have made on-demand point-to-point transport service a reality. And when it comes about, who needs to own a car? No need to. If you want to go anywhere, use your mobile phone, call up. Likely, it would not be a car. It will be a driverless pod. Why should a car look like a car?
Once you have driverless vehicles, there is no need for steering wheel, brakes and pedals, the car does not need to look like a car. Some of these autonomous pods in the trials do not look like cars at all. And they can be reconfigured very easily to take one passenger or two passengers, if you want greater intimacy. Or if you have a family of five children, it can be reconfigured too, much like Hollywood’s transformers. Most exciting. This will have a huge impact on city planning. The roads and carparks will be freed up.
Another very important positive impact is a significant drop in casualties and road accidents because a well-programmed robot is safer than human beings. Much of the accidents are due to human errors. It will change our quality of life. Do flip through the Economist's special report this week to have a glimpse of this brave new world. Is it a dream or will it be a nightmare? Hard to say. We can never guarantee how the future will be like. But the articles in the Economist's special report offer good advice. It is in our hands to shape this future to make sure that it will not be a nightmare; it will be a good dream, provided our policies remain pro-innovation, pro-market and also, very importantly, right pricing of limited resources. The quality of life of our children will definitely be better than ours. This, I am confident.
The Chairman: Minister Ng Chee Meng.
The Second Minister for Transport (Mr Ng Chee Meng): Mr Chairman, I thank the MPs for their cuts on aviation and private hire cars (PHCs).
The air hub is a cornerstone of our economy. It contributes significantly to our gross domestic product (GDP) and provides many good jobs. The excellent connectivity that our air hub provides also helps to facilitate trade, investments and tourism. Singaporeans, our businesses and our economy continue to benefit from a strong air hub.
The year 2017 was a good one for Changi. We handled a record 62.2 million passenger movements, a 6% increase from the previous year. Airfreight throughput grew by 7.9%, and reached 2.13 million tonnes, crossing the two-million tonne mark for the first time.
Changi Airport is currently connected to over 400 cities around the world. It is well-connected to the three most populous Asian countries, with links to 34 Chinese, 16 Indian and 14 Indonesian cities.
The number of passengers in the wider Asia Pacific region is also expected to grow from 1.4 billion to 3.5 billion in the next 20 years. This is 2.5 times today's number, and more than double the expected passengers in the next biggest region, Europe.
As air traffic in our region and the world continues to grow, the Government is committed to ensuring that Changi Airport remains best positioned to capture its share of the growth. For 2018, Changi Airport is projected to grow between 3.5% and 5.5%. And in the coming years, traffic growth is expected to be at 3% to 4% annually. To ensure that Changi Airport has sufficient capacity to capture this growing demand, we need to enhance our airport infrastructure. Infrastructure development is a long-term endeavour.
We have successfully built up a strong air hub over the last 30 years, in large part due to our bold and forward-thinking approach to anticipate our future needs. Some Members in the House might recall that the Government decided to build Terminal 2 (T2) in 1975, even before we moved our airport from Paya Lebar to Changi. This was 15 years before its opening in 1990. We then made plans for a new Terminal, T3, and decided to build it in 1996.
When we opened T3 in 2008, Changi Airport was serving close to 38 million passengers and, at that time, there were some who wondered if we needed such a large increase in capacity. Today, we have almost fully utilised all the 66 million passengers per annum (mppa) capacity across Terminals 1 to 3. If we had not built T4 in good time, Changi Airport would have reached its maximum capacity in two years. T4 added a capacity of 16 mppa.
By 2019, Jewel Changi Airport will open and bring the total capacity in Changi Airport to 85 mppa. It will also further enhance the passenger experience by providing a wide range of new retail and dining offerings in what would be Singapore's largest indoor garden to come.
Our long-standing approach of building ahead of demand has served us well. It has allowed Changi Airport to consistently deliver a high standard of service to passengers, even during the peak hours. This \"Changi Experience\" is what distinguishes Changi from all other airports around the world.
We have, therefore, adopted a similar approach in planning and building T5. T5 is an integral part of our airport expansion at Changi East. It is a bold move to firmly cement Changi Airport's position as a premier air hub for the future. This is important. Air connectivity is a key link for Singapore. It is critical that our aviation sector can continue to grow and support the growing needs of our economy.
As Minister Khaw said earlier, building Changi T5 is not just building another new terminal; it is akin to constructing a second airport. The project's scale and complexity are unprecedented. Our airport expansion thus far has largely consisted of the construction of new terminals. But the Changi East project goes far beyond the terminal building itself.
Extensive land preparation and drainage works at Changi East have been ongoing since 2014. The works for a three-runway system have commenced since 2016. We are extending an existing military runway and constructing a network of taxiways to allow for Changi Airport to cater to more flights. If we actually laid out the runway and taxiways in a long line, it would stretch from Changi Airport all the way to Tuas, almost as long as the Pan Island Expressway (PIE) of 42 km!
Next comes a network of tunnels and systems, including a baggage handling system and automated people-mover system. These will allow for the efficient transfer of passengers, baggage and airside vehicles within Changi East itself, and also between Changi East and the existing Terminals 1 to 4.
Last but not least, is the T5 terminal itself. T5 is going to be a game-changer. This will be a mega terminal with satellite terminals. It will allow Changi Airport to serve up to an additional 50 mppa in its initial phase. Fifty mppa is a 60% increase from Changi's current capacity and is more than the combined capacities of Terminals 2 and 3.
T5 will allow better integration of airport operations, improving their efficiency as it allows us to pool resources. It will benefit passengers like you and me by offering quicker access to boarding gates and convenient transfers. The \"Changi Experience\" will be further enhanced and new standards for passenger experience will be set.
Mr Zaqy Mohamad raised a pertinent question about the cost and funding of T5. The entire Changi East project is expected to cost tens of billions of dollars. The Government will invest substantially in Changi East and foot the majority of the costs. To date, the Government has committed more than S$9 billion into the project. The airport operator, Changi Airport Group (CAG), has also committed S$3.6 billion to date, and will commit its reserves and future surpluses, as well as take on substantial borrowing to fund the project.
Airlines and passengers will also need to contribute towards enhancing this airport infrastructure. Currently, airlines and passengers pay various aeronautical charges to CAG. As announced last week, to help fund airport infrastructure enhancement, passengers departing from Singapore Changi Airport from 1 July 2018 will also pay a new Airport Development Levy (ADL).
Some have questioned why we are increasing the charges now when T5 will only be completed around 2030. As I have explained, Changi East is not just about Terminal 5. It is a massive project with many phases. Airport users will start to benefit from Changi East progressively. For example, Runway 3 will be ready for civil aviation by 2020, and the three-runway system will be operationalised in the early 2020s, even as T5 will only be completed around 2030. Having users start paying earlier will also avoid large spikes in the amount they have to pay later on.
I would like to thank Mr Zaqy Mohamad for his suggestion to differentiate the ADL by distance. We have, indeed, considered it, but decided on our current option, which is a flat rate, regardless of the distance travelled. Passengers use the same facilities at the airport, regardless of where they are flying to. So, it is only fair that the charges that they pay are the same. This is the same principle that has been used for other passenger charges, such as the Aviation Levy and the Passenger Service and Security Fees.
Mr Zaqy Mohamad also asked why the Government is funding the majority share of the project. Changi Airport is vital to Singapore's economy and connects us to the world. It yields significant economic benefits for Singapore beyond the airport directly and the aviation industry. By funding Changi East, the Government is making a strategic investment into Singapore's future. Without Government funding, airport charges will have to increase much more. Given the importance of the air hub to Singapore, we need to strike the right balance and keep charges for airlines and passengers at a level that will ensure that Changi remains competitive and continues to be the air hub of choice.
Mr Zaqy Mohamad also highlighted the example of Seoul’s Incheon Airport. When comparing the costs of that airport expansion, we need to take into account the difference in scale and complexity of each project. Seoul Incheon's expansion adds 18 mppa, equivalent to our T4. In comparison, Changi East and T5 is like building a brand-new airport for 50 mppa, with possibilities of growth.
The Government will ensure prudent spending on Changi East. The project will deliver good value for money. We have thoroughly analysed the traffic projections for Changi. We are also carefully scrutinising the cost of Changi East. We will strive for the most cost-effective way to develop Changi East and ensure that Changi continues to be world-class. In developing Changi East, we are building for the long term. This is a major investment, to meet our future needs and reap benefits for Singapore and Singaporeans in the long run.
CAG is in the midst of evaluating proposals from three consortiums bidding to be the Master Building Consultant for T5. The three consortiums have all submitted designs that will set T5 apart from other airports around the world. I am confident that Singaporeans will be proud of our new T5 when it is completed around 2030.
Mr Chairman, we are at an exciting time in Singapore's transport history. Besides Changi East, we are also building the new mega port at Tuas, the High Speed Rail and Rapid Transit System connecting us to Malaysia, as well as extending our MRT network. These enhancements and investments will enhance our transport infrastructure and bring with them a multitude of benefits.
First, Singaporeans will enjoy the direct benefits of greater convenience and access in their travel around the island and to other parts of the world. Second, local enterprises and their workers will have valuable opportunities to gain new expertise and enhance their capabilities.
I thank Mr Lee Yi Shyan for his suggestion to place concerted effort to develop a new industry cluster to generate more economic spin-offs. As highlighted by Mr Lee, our transport infrastructure investments create new and exciting possibilities for our businesses. Singapore businesses have the opportunity to work on complex projects which, in some cases, are of an unprecedented scale. Many of our transport projects, in fact, have stringent and unique requirements for which they need to apply innovative solutions. For example, a joint venture formed by our local companies Hock Lian Seng Infrastructure and Sembcorp Design and Construction are working on a part of the three-runway system under the Changi East development project. The works involve extensive aircraft pavement and drainage works.
On the maritime side, SurbanaJurong is the engineering design and construction supervision consultant for Tuas Terminal and has taken the opportunity to apply many innovative engineering solutions in the planning and construction process.
Our companies will gain valuable expertise and knowledge, deepen their experience and burnish their credentials from working on these and other projects. In fact, a number of projects and initiatives that the Government is supporting will result in the creation of valuable intellectual property (IP). Where there is IP created as a result of such projects, companies would typically have the rights to use the IP for their commercial purposes. And we encourage them to do so, including to develop exportable solutions, to seize opportunities abroad, especially as Asia's demand for infrastructure and transport solutions grow.
One example is Singapore Technologies Kinetics (STK), which has partnered MOT and LTA to develop autonomous buses and shuttles. I hope that, one day, we can see STK-developed AVs driving around in other cities.
The Government will continue to champion research and development (R&D) in the transport sector to ensure that local capabilities continue to grow and are showcased globally. There are already many such opportunities, such as the Singapore Airshow, the Singapore Maritime Week, and the Singapore International Transport Congress and Exhibition.
I thank Mr Lee for his suggestions, which we will explore further. As Mr Lee also highlighted, the Government can spur industry development and the growth of the transport sector by championing R&D and working with industry players to develop new technologies and adopt innovative processes. In air transport, there are two areas of focus to leverage technology developments. The first is airport operations, and the second is in the area of unmanned aircraft systems (UAS) or drones.
First, let me touch on leveraging technology for airport operations. Passengers using T4 today will be familiar with some of the new technologies, such as the use of facial recognition to get passengers from the kerbside to the plane in a speedy fashion. Advanced computed tomography (CT) X-ray machines have also been deployed at T4, which do not require passengers to remove their laptops from their bags during security checks. These are examples of the suite of Fast and Seamless Travel (FAST) self-service options which we have already tapped on to create a better, smoother and more seamless travel experience for those using Changi Airport.
We are also excited about the possibilities of using such technologies to change the way we work. By automating the routine processes, we free up workers’ time to focus on areas where the human touch cannot be replaced. For example, passenger service agents at T4 now do not stay behind the counter. They roam around helping passengers. They feel more fulfilled, contributing in more meaningful ways. This has reaffirmed their commitment to continue working as a part of the Changi Airport community.
The Government is prepared to collaborate with industry to spur further adoption of technology. For example, Singapore Airlines (SIA) launched its Digital Innovation Blueprint programme in January this year, in collaboration with the Agency for Science, Technology and Research (A*STAR), the Civil Aviation Authority of Singapore (CAAS), the Economic Development Board (EDB) and the National University of Singapore (NUS).
SIA aims to set up a Digital Innovation Lab and tap on data analytics to further enhance customer experience as well as boost the operational efficiency of its aircraft maintenance processes. This is an example of how the Government’s partnership with industry can help support companies and their staff in their digitalisation efforts, so that they can bring service standards to even higher levels.
The Government will also invest significant resources into developing innovative processes and technologies to entrench Changi as the world-class hub it is today. CAAS will launch an Aviation Transformation Programme (ATP) to promote the use of new technologies, like AVs, AI and augmented reality, to improve airport operations. ATP will focus on four crucial areas for the continued success of Singapore's air hub: (a) Strategic Air Traffic Management; (b) Seamless Ground Operations; (c) Effective and Efficient Security; and (d) Premium Travel Experience.
ATP will not only level up the system capabilities of our air hub but also ensure that our workers remain at the forefront of their fields. For example, as air traffic volume grows, our air traffic controllers (ATCOs) will have a more challenging job. We will, therefore, leverage technology to further enhance our Air Traffic Management (ATM) capabilities. This will provide our ATCOs with a wider range of tools to do their job well and ensure that Singapore remains a leading Air Navigation Services Provider in our region.
As we tap on advancements in technology to manage our skies, the ATCO's job will also evolve and require deeper skills and a wider range of expertise.
Recognising this, CAAS has taken the initiative to introduce a new scheme of service that will better enable ATCOs to hone their skills, provide them with more exposure across the range of ATM functions, and allow them to delve even deeper into specific functions, if they are so inclined. They will even participate in the development of advanced software and hardware that are more sophisticated than those available today.
Under the new scheme, ATCOs can progress along two tracks – Management or Specialist – and build their expertise along either track. The new scheme will allow ATCOs to progress to higher grades, compared to the past. By providing more avenues for progression and targeted professional development based on the aptitude and interest of each ATCO, the new ATCO scheme of service will further professionalise the job of the ATCOs. It will also deepen their expertise and allow us to develop a pool of ATCO professionals who will help to drive CAAS up the ATM value chain.
The levelling up of capabilities of workers in our air transport sector is part of the vision we set out to achieve through the Air Transport ITM. The ITM aims to create 4,700 good jobs by 2020 and grow the value-add per worker. In the third quarter of this year, we will launch a Skills Framework for Air Transport which will set out the core competencies and skills for all key air transport jobs. This will serve as a reference for those who are already in the sector or for those wanting to join the aviation industry.
It is paramount for us to support workers in the air transport sector to continually retrain and upgrade themselves, even as we leverage more advanced technologies to improve the sector's productivity. We want our air transport workers to be able to manoeuvre technological changes at the workplace to their advantage and take on new roles that will challenge and fulfil them even more. This will also allow them to add greater value to their jobs and their companies and, overall, to our economy.
The second key technological development in the air transport sector is the unmanned aircraft systems (UAS). Today, UASes are already being deployed for tasks, such as worksite inspections, surveying and mapping, improving processes and saving time and manpower. There is huge potential for UAS to spur new and innovative applications across industries. This would further increase productivity and enhance service delivery. One such area is in logistics, where UAS can quickly deliver parcels by air to the end-consumer.
In time to come, UAS can potentially even ferry people through the air, adding a new dimension to urban mobility. At the same time, we recognise that UAS operations could pose concerns about safety and security. These concerns must be addressed before the full potential of UAS can be realised. In particular, given Singapore’s busy airspace and dense urban environment, we need to be extra careful that UASes do not pose risks to manned aircraft operations or public safety.
The Government, having said all that, has been pushing the boundaries in exploring UAS in our urban environment so as to seize the potential benefits that the use of UAS could bring. For instance, LTA is trialling the use of UAS to perform rail and road tunnel inspections with greater ease and accuracy. In addition, LTA has also deployed UAS at selected Thomson East-Coast Line worksites to help our engineers monitor construction progress and identify defects.
The Government also recently designated one-north as a drone estate to serve as a living lab and testbed for drone solutions, which Mr Ang Wei Neng also highlighted. We are, indeed, excited about the drone estate’s potential to spur more R&D on UAS technologies and foster meaningful commercial partnerships. We intend to progressively expand the scope and scale of the UAS activities there, bearing in mind that we must do so responsibly and not compromise safety. I thank Mr Ang Wei Neng for his suggestions, and we will look into them. Recreation UAS flying may take a while longer.
Mr Chairman, let me now turn to how technology has transformed the point-to-point (P2P) industry. The introduction of third-party booking apps and PHC services has revolutionised the P2P industry in Singapore. The PHC industry has significantly expanded the supply of P2P services, especially during our peak. There are now more than 40,000 PHC drivers, in addition to 96,000 licensed taxi drivers. The matching of demand and supply is also enhanced through the platforms and through dynamic pricing.
Commuters have benefited the most. Commuter satisfaction has risen significantly. Based on the PTC’s latest survey, almost 99% of commuters surveyed were satisfied with taxi and PHC services in 2017. Complaints about taxi unavailability, which were prevalent before, have also come down significantly.
Taxi drivers, who were initially affected, are now starting to reap some of the benefits, too. Taxi companies are offering more flexible rental schemes, lower rental rates and more choices of service platforms to drive for. Additional booking channels have also given taxi drivers an additional revenue stream and have helped reduce empty plying of roads.
Take Mr Luen Chi Keung, for instance. Mr Luen is a GrabTaxi driver currently driving for SMRT. He likes that there are multiple rental schemes now that he can pick from. While he is currently paying a daily rental for his taxi, he is looking to switch to an hourly rental scheme which may better suit his needs.
At the same time, I also note that there is some concern on how taxi and PHC drivers could be impacted by technology changes. I thank Mr Ang Hin Kee for his suggestion and he will be pleased to know that we will continue to work closely with the National Taxi Association (NTA) and National Private Hire Vehicle Association (NPHVA) to upskill taxi and PHC drivers. We will also explore having modules in the Taxi Driver’s Vocational Licence and the PHC Driver’s Vocational Licence courses to help equip taxi and PHC drivers with digital skills, such as using navigational apps.
We had decided a few years ago, when the PHC industry was still in its early stages of development, to impose minimal conditions on PHC booking service operators. This is to avoid stifling innovation in the then nascent industry. This is why the current regulatory regime for PHCs focuses primarily on protecting commuter safety and interests via licensing of PHC drivers and PHCs. The PHC booking service operators are required to dispatch only licensed drivers and cars.
However, since then, the PHC sector has grown and changed the P2P industry significantly. From an emerging fringe transport mode, PHCs have become an important part of our land transport system. Based on PTC’s latest survey, it is estimated that there may be more than twice as many rides taken on PHCs as compared to taxis. The PHC industry has evolved and consolidated rapidly. There are currently two large players – Grab and Uber. Both companies allow taxis to use their booking services, which blurs the lines between the PHC and taxi industries.
Mr Ang Hin Kee asked whether the Government will be reviewing our regulatory approach for the P2P sector. The answer is yes, given how fast the industry is changing.
First, the sheer size of the PHC industry means that the actions of PHC booking service operators affect a significant number of commuters and drivers today.
Second, today, there are limitations to our current regulatory regime. We only have basic requirements on booking service operators to protect commuter safety. In exceptional situations, LTA can issue a suspension order to forbid drivers from driving for these PHC booking service operators. But this is a very blunt tool, which impacts commuters and drivers as well. Given the growing PHC industry, it is imperative that the Government has sufficient regulatory oversight over the PHC booking service operators to protect the interests of commuters and drivers.
Third, PHC booking service operators should bear greater responsibility in ensuring the safety of commuters, beyond the requirements today.
Finally, as the PHC and taxi industries consolidate, as the regulator, the Government has to act in good time to ensure that it remains open and contestable. We must make sure that commuters and drivers continue to have options, and that no single market player will dominate the industry to the detriment of commuters and drivers.
Hence, we are reviewing the broader regulatory framework for the P2P sector, including studying how to structure the industry and license PHC booking service operators. Licensing will give the Government a broader range of regulatory levers to ensure that the rapidly evolving PHC industry grows in a manner which meets the needs of commuters, drivers and our broader transport policy. More details will be made known in due course.
Mr Chairman, MOT is committed to making travel even more convenient and seamless, across our island and beyond, for Singaporeans. Our efforts to develop Changi East will help to achieve this, as will our investments in more advanced technologies. At the same time, we will help our workers to keep up with the changes and have good careers in the transport sector. We are confident that besides Singaporeans, Singapore companies will benefit from these efforts, as they harness new productivity gains throughout the entire transport ecosystem. We can look forward to a more liveable and well-connected Singapore, supported by robust and effective transport systems.
The Chairman: Senior Minister of State Lam Pin Min.
The Senior Minister of State for Transport (Dr Lam Pin Min): With your permission, Mr Chairman, may I display some slides on the LED screens during my speech?
The Chairman: Yes, please. [Some slides were shown to hon Members.]
Dr Lam Pin Min: Mr Chairman, Maritime Singapore is a thriving ecosystem, anchored on our global hub port and vibrant international maritime centre (IMC). Overall, the maritime sector remains a strong pillar of Singapore’s economic growth, contributing about 7% of our GDP and more than 170,000 jobs in over 5,000 maritime establishments.
Let me now provide an update on the performance of Singapore’s maritime hub and our efforts to ensure its continued competitiveness.
Singapore's port registered a strong performance in 2017. Our container throughput rose significantly by 8.9% to 33.7 million twenty-foot equivalent units (TEUs). We also handled a record total of 626.2 million tonnes of cargoes, an increase of 5.5% over the previous year.
Our IMC also performed well and was ranked the world’s top international shipping centre by Baltic-Xinhua for the fourth consecutive time. We welcomed new players, such as Ocean Network Express, which will set up its global headquarters in Singapore this April. Existing players like Maersk, CMA CGM and Thome also expanded their presence in Singapore with the establishment of their new vessel monitoring hubs.
We have done well. However, we are mindful that the sector’s landscape is evolving rapidly and remains challenging. Digitalisation is already transforming global transportation and supply chains, blurring the boundaries between the shipping and logistics sectors. Emerging technologies, like blockchain, are paving the way for new business models, forcing companies to rethink the way they do business or risk being disintermediated altogether.
The external environment is also changing. Faced with structural problems like slowing trade growth and shipping overcapacity, the outlook for the global maritime sector remains uncertain. And as Mr Ang Wei Neng noted, several developments have sparked talk about the emergence of alternative trade routes in the region. China is investing in ports and transport infrastructure across Southeast Asia under its Belt and Road Initiative (BRI). These include several ports and the East Coast Rail Line in Malaysia. Interest in the Kra Canal has also recently surfaced, but it remains uncertain whether it will be built. We will continue to monitor these developments.
As the region develops, it is inevitable that our port will face greater competition from alternative ports and trade routes. Thus, while we are well-placed, we cannot be complacent. The only way for us to stay ahead is to continue to innovate and look for new growth opportunities. For instance, with our strong connectivity, we are in a good position to contribute to and pursue opportunities under BRI. In the longer term, the growth in trade and networks in the region will also benefit Singapore.
To build on our strengths to meet new challenges, we have set out new growth strategies for Singapore’s maritime sector, which are in line with the IMC 2030 Advisory Committee's recommendations to grow Singapore as a \"Global Maritime Hub for Connectivity, Innovation and Talent\". These strategies will prepare our companies and workers for the future. Let me speak about each of them in turn.
First, we will continue to enhance Singapore’s connectivity. This will enable us to remain plugged into the regional and global economy and continue to be relevant as a hub for maritime activity and businesses.
To boost our physical connectivity, we are investing in long-term port capacity and infrastructure to meet the industry’s needs. Pasir Panjang Terminal Phases 3 and 4 will be fully operational by the end of this month. Significant investments, such as in the Next Generation Tuas Port, will ensure that Singapore retains its leading position as a global hub port. Reclamation works for the first phase of Tuas Terminal are progressing well. As of last month, more than 70% of the 200-plus caissons have been installed, and the remainder will be completed by early next year.
We will also strengthen our connections to the region to enhance Singapore's position as a key node in the region's maritime network. I spoke about how we can pursue opportunities under China’s BRI. Under the Chongqing Connectivity Initiative, which is the third government-to-government (G2G) project between Singapore and China, we have developed the Southern Transport Corridor (STC), the maritime route linking China’s overland Silk Road Economic Belt and the Maritime Silk Road. This will strengthen our position as China's gateway to Southeast Asia and create new opportunities for our local companies to venture overseas. We are working on enhancing and growing the STC.
In fact, many of our companies are already participating in BRI. To tap on growing trade from Western China, PSA operates many ports along the BRI, including Qinzhou in the Guangxi-Beibu Gulf, which provides direct access by rail to Chongqing, a gateway to China's vast inland area. Local shipping line, Pacific International Lines, has similarly invested in logistics facilities in the region and runs shipping routes between the Guangxi-Beibu Gulf and Singapore. Back home, PSA has also entered into a joint venture with China Ocean Shipping Company (COSCO) Shipping to operate three berths at Pasir Panjang Terminal, which will help bring trade volumes through Singapore.
Building up our physical connectivity alone is not enough. We must also build a more interconnected and vibrant network, to be a node for maritime business activities and information flows. Today, Singapore's IMC is home to over 5,000 establishments and offers a comprehensive range of maritime services. Looking ahead, we will continue to grow the diversity of our services. Besides encouraging established companies to venture into new business activities, we will catalyse the growth of non-traditional players. These include maritime technology enterprises, such as Alpha Ori and Metcore, and digital platforms like VesselsValue. To facilitate expertise and resource sharing among companies in the sector, the Maritime Port Authority (MPA) will also co-fund the costs of shared workspaces and services.
In the longer term, we will explore setting up a port and logistics cluster at Tuas to encourage collaboration and co-innovation with related sectors. This will open up new growth areas for our companies and enable us to leverage Singapore’s hub connectivity to enhance our value-capture. For example, co-locating logistics firms near the port could spur more efficient supply chain management and allow them to experiment with fresh concepts, such as inter-modal logistics.
Second, we will create a vibrant and innovative maritime sector to help drive industry transformation. Singapore’s maritime sector is already on the steady pathway of innovation and experimentation. But more needs to be done.
Mr Lee Yi Shyan asked about our plans to champion R&D in transport technology. We will continue to provide an enabling environment for innovation to facilitate the development of smarter solutions. MPA’s Living Lab, which was set up last year, aggregates lead user demand and allows for the test-bedding of technologies in real operational conditions. Several projects have been initiated. These include the development of a remote-assisted pilotage system for harbour pilots to steer vessels from shore, and the testing of vessel traffic management solutions.
To spur the development of more of such solutions, MPA will set up the new Singapore Maritime Data Hub (SG-MDH). For a start, the SG-MDH will make available to the industry and the public real-time access to MPA’s port and ship-related data. Over time, other kinds of industry data will also be shared. With this rich information resource, anyone will be able to analyse or even overlay the data with their own datasets, opening up possibilities for the development of new applications, services and products.
At the same time, the new Maritime Transformation Programme (MTP), which was announced by the Minister for Finance during his Budget Statement this year, will further strengthen research and innovation efforts in the sector. Supported by the National Research Foundation (NRF) and MPA, the MTP will co-fund, with matching investments from industry players, the development of technologies with high potential for industry application. With its focus on automating and digitalising port and shipping operations, and enhancing maritime safety and security, MTP will be pivotal in driving industry transformation, making our port smarter and safer, and our IMC more competitive.
To ensure that our companies and workers benefit from the sector’s transformation, we will grow and build the capabilities of local enterprises. Take, for example, Xjera Labs, a local startup that has ridden on the digitalisation wave to design AI-based solutions for the sector. With funding support from MPA, they worked with Jurong Port to develop a proof-of-concept that uses video analytics to automatically track container vehicles at the port. With this system, Jurong Port will be able to streamline security checks and improve operational efficiency, resulting in manpower savings of about 15%.
To give more startups like Xjera Labs a helping hand, MPA will launch the Maritime Technology Acceleration Programme (MTAP) to help startups translate their ideas into marketable solutions. Under MTAP, promising startups and entrepreneurs will receive tailored mentorship from industry partners, and networking opportunities with potential investors.
The Government will do its part as a convenor, demand aggregator and facilitator to help catalyse innovation. But ultimately, companies must take ownership in rethinking their operations to pursue higher productivity and new opportunities. We, therefore, encourage more companies to come on board MPA's schemes and projects under the Sea Transport ITM.
Last but not least, a skilled maritime workforce is critical to meet the needs of the industry and set us apart from our competitors. Through our Sea Transport ITM efforts, more than 5,000 new jobs will be created in the sector by 2025, the majority of which will be professionals, managers, executives and technicians (PMET) jobs. To equip Singaporeans with the necessary skills and experience to take up these good jobs, we will introduce new and enhanced training programmes.
For those who aspire to join the sector, MPA's Global Internship Award (GIA) offers students the opportunity to intern with international maritime companies in Singapore and overseas. For example, GIA was vital in helping Ms Melisa Yeo decide on embarking on a career in the maritime sector. In 2015, she completed a 10-week internship at shipping company Oldendorff, including a two-week stint in Lubeck, Germany. Melisa enjoyed the experience so much that she joined Oldendorff full-time upon graduation. She is now an operations trainee based in Singapore. Going forward, MPA will be enhancing the GIA to strengthen the relevance of the internship experience, and more details will be released ahead of the next run of the programme.
For those in the sector, we will help them progress in their careers. MPA will roll out a new Global Talent Programme (GTP) to groom Singaporeans for leadership roles in the maritime sector, by offering them opportunities to hone their skills through structured rotations and overseas exposure. For seafarers who wish to upgrade themselves beyond their captain or chief engineer positions, MPA will also provide more progression pathways for their sea-to-shore transition. More details will be announced later this year.
To implement these new manpower programmes and other initiatives in the Sea Transport ITM, MPA will top up its Maritime Cluster Fund by $100 million. The funds will also be used to grow non-traditional players in the maritime space, and support pilot projects to test new business concepts.
But as we push on with these ambitious plans to grow Singapore as a maritime hub, we cannot neglect the basics. Mr Dennis Tan expressed his concerns about vessel traffic safety in the Singapore Strait. Let me assure Mr Dennis Tan that maritime safety remains an important priority for MPA. This is especially since the Singapore Strait is a very busy waterway used for international navigation, with 83,000 vessels transiting through it last year. Despite the heavy traffic, the number of major accidents in Singapore waters has dropped over the years, from 13 in 2011 to just two in 2017.
To maintain navigational safety, MPA operates the Vessel Traffic Information System (VTIS) to monitor shipping traffic in the waters around Singapore. With the capability to concurrently track more than 10,000 vessels, VTIS enables MPA to provide timely information and advice to help vessels transit safely through the Strait. MPA carries out regular enhancements to its VTIS, which was installed in 2011 and upgraded early last year. In addition, MPA has built on the International Maritime Organisation's (IMO's) International Convention for the Safety of Life at Sea, and required all vessels, except for government and naval vessels, to turn on their Automatic Identification System (AIS) when calling at our port.
Regulations also play an important role in ensuring safety. I thank Mr Dennis Tan for his several suggestions. Mr Dennis Tan proposed to ban crossings over the Traffic Separation Scheme (TSS) for ships leaving or entering our port and, instead, require them to make U-turns at the eastern and western ends of Singapore. We have looked into this and assessed that it is not that practical.
Let me explain. Vessels that are east-bound via the Straits of Malacca will have to travel all the way to the east of Singapore, make a U-turn before calling at our port. This will require additional travel time. Moreover, if vessels are only allowed to make U-turns at these two designated areas, it may also result in bunching and congestion, potentially increasing the risk of incidents.
So, this will affect the efficiency of our port and prevent vessels from proceeding to their next destination expeditiously. Instead, areas are demarcated within the TSS where vessels, taking necessary precaution, may make their crossing. Vessels have to play their part in ensuring safety. They must also comply with the rules of crossing.
Mr Dennis Tan also suggested that MPA review the location of our pilot boarding grounds to minimise the risk of ships drifting when waiting for pilots. Indeed, we regularly review this. Most recently, in 2014, MPA worked with the industry to revise the locations of our pilot boarding grounds to reduce the risk of incidents. MPA also introduced a scheduling system for vessel arrivals. This reduced waiting time for ships and enhanced safety of navigation.
Beyond rules and regulations, we seek to improve the practice of good seamanship and advocate a safety-first culture at sea. MPA established the National Maritime Safety at Sea Council in 2015 to drive such efforts. MPA also holds safety conferences, workshops and briefings under its Safety@Sea campaign. The Third International Safety@Sea Conference will be held in June this year.
Mr Chairman, this is an exciting time for Maritime Singapore. Our maritime sector is not only growing but transforming fast. In the next few years, we expect many rewarding jobs to be created and new growth opportunities to emerge. The Government will continue to work closely with our partners so that we stand ready to seize these opportunities and ensure Singapore's continued success as a leading global maritime hub.
So, even as we create more good jobs and opportunities for our workers and companies, we are also working to enhance the quality of life for all Singaporeans.
Minister Khaw Boon Wan spoke about a more reliable and smarter land transport system. I will now share MOT's plans towards a more inclusive and safer land transport system.
Our land transport system should serve all Singaporeans, from the young and mobile, to the elderly, families with young children and persons with disabilities. We have made significant strides in our journey towards a more inclusive transport system but there are still areas where we can do better and in making the journeys more comfortable and convenient for Singaporeans from all walks of life.
We will, therefore, need to continue to make our roads and paths safer for all, not just for the young and active, but also for those who are less mobile. We will also need to ensure that our transport system is accessible to all commuters, including those with diverse needs.
Let me first elaborate on our initiatives to make our roads and paths safer for all, which both Mr Ang Hin Kee and Mr Png Eng Huat have spoken about. On Mr Png Eng Huat's concern about signalised junctions with shared green time, LTA has adjusted traffic light timings to give pedestrians a headstart in crossing the road, and installed lighted road studs, additional road markings and signs at higher risk junctions to remind motorists to give way. We will continue to study the situation and do more where we can.
Mr Ang Hin Kee asked about the progress of Silver Zones. These are special areas with modified road designs and lower speed limits to make our streets safer. We have implemented 15 Silver Zones and the results have been very encouraging. We have observed a 70% decrease in the number of accidents involving the elderly in the completed Silver Zones. We will complete another six Silver Zones this year and expand the programme to 50 by 2023. As and when the need arises, we will look into providing more Silver Zones.
We will also strive to make everyone’s journey to public transport more comfortable. This starts from your doorstep. In 2012, we embarked on the Walk2Ride programme to build a comprehensive network of covered linkways, connecting public transport to nearby developments. As mentioned by Mr Ang Wei Neng, and I agree totally, LTA usually consults the grassroots advisers and grassroots leaders before determining the alignment of the covered linkways to best serve the needs of pedestrians. I am pleased to announce that we are on track to meeting our target to have more than 200 km of covered linkways by the end of this year.
We have also received feedback from the elderly and persons with disabilities that they have encountered difficulty climbing the stairs of pedestrian overhead bridges in order to cross the road. By the end of this year, we will complete lift installations for 47 pedestrian overhead bridges near public transport nodes. We will extend this programme to about 50 more overhead bridges, starting with those within walking distance from hospitals and polyclinics.
We will do our best to meet the needs of the less mobile. However, we need to prioritise our efforts, given the high costs of about $4 million per pair of lifts. In this regard, I would like to reassure Mr Ang Wei Neng that we will be prudent in our efforts, focusing on locations which most benefit those commuters who are less ambulant.
We also believe that everyone should be able to travel independently on public transport. We do acknowledge that the elderly, families with young children, and commuters with disabilities may face some challenges. We have, therefore, worked towards building a more inclusive public transport system that caters to all commuters, including those with diverse needs.
Today, all MRT stations and bus interchanges are already barrier-free. Ninety-six percent of our public buses are wheelchair-accessible, and we are well on track to achieving our target of 100% by 2020. To facilitate priority boarding for people with special needs, the elderly and families, we have implemented priority queues at 17 MRT stations, seven bus interchanges and two Integrated Transport Hubs. We target to extend this initiative to all MRT stations by 2019 and to all bus interchanges and Integrated Transport Hubs by 2021.
I would also like to take this opportunity to commend our commuters for showing care towards one another. At Outram Park MRT Station, the PTC launched the \"Heart Zone\" and \"Heartwheels @ Linkway\" initiatives in August 2017. I was there. Commuters who need help getting to Singapore General Hospital can wait at two designated areas for assistance. Wheelchairs are also provided at both ends of the transfer linkway. Many commuters have extended a helping hand to those in need, guiding them to their destinations, or pushing the wheelchairs along the linkway. I am very heartened by the success of these initiatives.
We will continue to explore innovative solutions to help commuters with disabilities. Last year, we shared LTA’s plan to collaborate with SG Enable to \"adopt\" Redhill Station, to improve the first and last mile between the station and the Enabling Village. LTA and SG Enable have, in the past few months, spoken to and followed commuters with special needs on their journeys to understand the pain-points and challenges in their daily commute.
LTA has since installed rest stops with seats that allow pedestrians to rest, and edge markings along the footpaths to help pedestrians, those with low vision especially. Students from the Pathlight School also contributed their artistic talent, putting up unique and colourful signages to help direct the way to the Enabling Village.
LTA will also collaborate with industry partners to develop and pilot assistive technologies for commuters with special needs. One of the ideas surfaced is an Assistive Passenger Information System for buses.
It includes a mobile application that allows special-needs users to notify bus captains of their intention to board. For visually impaired passengers, there will be internal and external speakers to announce the service number, destination and the next bus stop. It also directly transmits audio announcements via hearing aids to hearing-impaired passengers. The trial will start later this year on bus service 139, which serves the Enabling Village.
Earlier, Minister Khaw spoke about the various transport options for families. We are also making public transport friendlier for families with young children. For example, all new bus interchanges, Integrated Transport Hubs and all interchange stations on the Thomson-East Coast Line will be equipped with nursing rooms. In addition, all 35 stations along the Thomson-East Coast Line and Circle Line 6 will have family-friendly washrooms, with diaper changing stations, child-size toilets and barrier-free facilities.
At the Committee of Supply (COS) last year, we announced that we would start allowing families to board public buses with open strollers from 2 April 2017. We have received positive feedback from families that these initiatives have made their journeys more convenient. Some commuters have also given feedback that there may not always be sufficient room for more than one open stroller or wheelchair. Going forward, new buses will be equipped with two wheelchair spaces, to accommodate more commuters in need.
All these efforts will make getting around more convenient for families, without the need to own a car. We will continue to listen to commuters' suggestions to make further improvements. My Parliamentary colleague Mr Sitoh Yih Pin, Chairman of the Government Parliamentary Committee for Transport, and Mr Richard Magnus, Chairman of PTC, are leading a Panel to gather feedback and will be making recommendations on how we can make our public transport system more family friendly. The Panel comprises diverse members, from academics to parents with young children. We look forward to hearing their recommendations in the middle of this year.
We will continue to push our boundaries and explore creative solutions to make our environment safer and more accessible to all. The growing use of bicycles and PMDs has made first- and last-mile journeys more convenient for many commuters. Dockless bicycle sharing services have also made active mobility more accessible and affordable.
I agree with Mr Zaqy Mohamad and Er Dr Lee Bee Wah that our infrastructure needs to keep up with the increasing prevalence of active mobility. Our priority is to build a comprehensive network of off-road cycling paths that separate cyclists from fast-moving vehicles on the roads, as these paths provide a safer environment for all cyclists of different skill levels and ages. We have built cycling path networks in nine Housing and Development Board (HDB) towns and will do so for an additional six towns in the next five years. Moving forward, new footpaths will be at least 1.8 metres wide, which will allow two wheelchairs to pass each other safely. When planning our new towns, we will also prioritise the allocation of space to pedestrians, cyclists and PMD users.
However, the rising popularity of active mobility brings new challenges. Let me start by addressing Members' concerns over the safety of active mobility, which can arise from dangerous devices and reckless user behaviour.
We have observed a number of fire incidents involving motorised PMDs. LTA is working with relevant stakeholders to study imposing more safety requirements on motorised PMDs, in addition to our existing requirements on their weight, size and maximum speed. In the meantime, users should exercise caution and purchase compliant PMDs from reputable sources and refrain from modifying their PMDs.
To deter reckless behaviour, we have enlisted the help of other agencies and community partners in our enforcement and education efforts. Since May 2016, LTA has issued over 3,000 advisories for unsafe riding on paths. The National Parks Board (NParks) rangers and the Traffic Police officers have also stepped up their patrols in parks, on park connectors and on roads. About 900 volunteers from the grassroots are patrolling their neighbourhoods to educate cyclists and PMD users on safe and gracious behaviour. We thank these enforcement officers and volunteers for their tireless efforts to keep our paths safe.
In February 2018, LTA also rolled out the Safe Riding Programme. To address Assoc Prof Randolph Tan's concerns, the programme will educate cyclists and PMD users about the appropriate use of our active mobility infrastructure, and safe and considerate behaviour when sharing paths with others. I agree with Mr Dennis Tan that we need to build a right culture for safe riding. And as Mr Dennis Tan suggested, we are already working with schools to educate students about the key active mobility rules and safe riding practices. We will also require cyclists and PMD users caught riding recklessly to attend this programme.
Despite our efforts to educate and encourage safe riding practices, Mr Sitoh Yih Pin, Mr Ang Wei Neng, Mr Yee Chia Hsing, Miss Cheng Li Hui, Ms Foo Mee Har and Ms Joan Pereira have shared their concern about the number of accidents involving bicycles and PMDs. Assoc Prof Randolph Tan had also pointed out the danger of PMDs being used on roads. I agree totally with Members that inconsiderate cyclists and PMD users not only endanger themselves, but also pedestrians and road users, and this is very worrying. We have zero tolerance for reckless behaviour and will further tighten up our enforcement efforts.
We recently enhanced the penalties for PMD users caught riding on roads. They may face a composition sum of up to $500 for the first offence. Those who ride on expressways will not be offered composition and will be charged in Court. If convicted, they will be liable to a fine of up to $2,000 and/or imprisonment of up to three months for the first offence.
Last month, the Active Mobility Advisory Panel recommended the introduction of a registration regime for e-scooters. After carefully studying the Panel's suggestion, I am pleased to announce that the Government has decided to accept the recommendation and will be reviewing the Active Mobility Act to allow such a regime. Registering e-scooters will help deter reckless behaviour, accord more responsibility to the users, and facilitate enforcement officers in tracking down errant users. We will implement the registration regime by the end of the year and will try to keep the process as simple and low-cost as possible.
The Active Mobility Advisory Panel will also take a deeper look at our active mobility rules. Ms Joan Pereira, Mr Zaqy Mohamad, Mr Yee Chia Hsing and Er Dr Lee Bee Wah have given us valuable suggestions for the Panel to look into, such as reviewing the speed limit on footpaths, and the insurance and compensation framework. The Panel will look into these issues, weighing the need for these initiatives against the impact on the large majority of responsible users and taking into account the practices of other jurisdictions. The Panel will publish its recommendations by the end of this year.
Our tough stance targets the minority of reckless users to deter bad behaviour. It should not discourage the majority of responsible and considerate users from enjoying the benefits of active mobility. With a safer environment, the benefits of active mobility far outweigh the obstacles we are facing.
Next, let me move on to addressing Members' concerns over the indiscriminate parking of dockless shared bicycles. Many Members, including Er Dr Lee Bee Wah, Miss Cheng Li Hui, Mr Png Eng Huat, Mr Yee Chia Hsing, Ms Foo Mee Har, Mr Zaqy Mohamad and Mr Lim Biow Chuan have spoken on this issue very passionately.
These bicycles obstruct other commuters and cause clutter in community spaces. It is the responsibility of every shared bicycle user to park their bicycles appropriately in bicycle racks or designated bicycle parking zones, which are widely available at all MRT stations and housing estates.
Over the past year, LTA has stepped up efforts to address the problem. Since March last year, we have significantly increased the number of bicycle parking spaces by implementing yellow boxes at housing estates, MRT stations, bus stops and parks. We now have about 174,000 public bicycle parking lots islandwide and will provide another 50,000 more by 2020.
In October last year, LTA, Town Councils and NParks signed a Memorandum of Understanding (MOU) with the bicycle sharing operators. It sets out guidelines for responsible operation in public spaces. We have also enforced strictly against indiscriminately parked bicycles. Since the middle of 2017, LTA has issued more than 2,100 removal notices and collected about $180,000 in fines and administrative fees from the operators.
Unfortunately, the problem of indiscriminate bicycle parking persists. Earlier this week, I tabled a Bill in Parliament to propose amendments to the Parking Places Act. This Bill will enable LTA to regulate the bicycle sharing operators through a licensing framework. Let me elaborate on some of the key aspects of the proposed regulatory regime.
First, LTA will be able to manage the size of each operator's fleet by setting a maximum cap for each operator. This is similar to what Miss Cheng Li Hui suggested. We will start off conservatively in the first instance. If an operator can demonstrate that it is able to manage indiscriminate parking and ensure good utilisation of its fleet, it will be allowed to grow over time. This ensures that we start off right and put in place the appropriate incentive structure for operators to proactively manage indiscriminate bicycle parking.
Second, LTA will have stronger levers to ensure operators do their part to manage indiscriminate parking. Under the proposed licensing regime, we can impose standards and conditions, for example, to require operators to remove indiscriminately parked bicycles within a stipulated period. Operators who do not comply with our standards and conditions will face regulatory sanctions, such as financial penalties of up to $100,000, reductions in fleet size, suspension or even cancellation of their licence. These penalties are higher than the $500 per bicycle fine we currently impose on operators.
We also intend to implement Er Dr Lee Bee Wah's suggestion of requiring licensed operators to provide a security deposit. This deposit can be used to defray the costs of removing abandoned bicycles of any operator that has gone bankrupt.
Er Dr Lee Bee Wah and Mr Lim Biow Chuan have also suggested requiring operators to provide bicycle parking spaces or docking stations. Operators have already helped to provide some of the yellow parking boxes at bus stops, and LTA will be able to impose requirements on them to do more under the licensing regime, if necessary. Mr Png Eng Huat suggested the implementation of docking stations. The experience of other countries is that docked systems tend to be unsustainable without private sponsorship or government subsidies. These tend to be more costly to set up, so, taxpayers or users would have to pay more for the use of the bicycles.
As Miss Cheng Li Hui, Mr Yee Chia Hsing and Mr Lim Biow Chuan have rightly pointed out, we should not just focus on the operators alone. It is also important to ensure that users act responsibly and considerately. We feel that the most effective way of doing so is through the operators. For example, LTA will require all licensed bicycle sharing operators to collectively ban users who repeatedly park the bicycles indiscriminately from using any bicycle sharing service for a period of time.
The Bill will be tabled for Second Reading later this month. We will implement the licensing framework in the second half of this year.
Mr Png Eng Huat asked about the effectiveness of geofencing. First, geofencing will be done in addition to the other measures that I have outlined earlier. Second, under the proposed licensing regime, LTA will require all licensed operators to complement global positioning system (GPS) geofencing with quick response (QR) code-enabled geofencing. And each designated parking area will have a unique QR code. Operators will be able to match the QR code used with the appropriate or approximate location of the parked bicycle obtained via GPS geofencing. So, if the location of the parked bicycle is far away from the QR code for that particular parking space, the user will not be deemed to have parked in a parking space appropriately and will continue to be charged. It is not a perfect measure but can be implemented quickly to address the urgent issue of indiscriminate bicycle parking.
In the meantime, LTA has started trials for other types of high-accuracy geofencing technology that will further improve the tracking of errantly-parked bicycles. We plan to conclude the first phase of the trials by 2019.
Mr Chairman, to conclude, we have come far in making our transport system more inclusive and safer for all commuters. However, we cannot do this alone. I would like to thank the strong support from the industry stakeholders and the constructive feedback from commuters, as well as many Members of this House, to help us develop innovative and effective solutions to improve our transport system.
We also need the community’s support in instilling a culture of safety and civic-mindedness so that everyone can enjoy the benefits of active mobility. Used safely and responsibly, bicycles and PMDs offer great convenience, promote a healthy lifestyle and is environmentally-friendly and will also help fulfil our vision of a car-lite society. Like what Er Dr Lee Bee Wah shared yesterday \"make this a beautiful dream for all, not a nightmare.\"
With our continued infrastructural enhancements, the use of technology and enhanced enforcement measures against reckless and irresponsible behaviour, I am confident that our future transport system, centred on public transport, will be safe and inclusive, leaving no one behind.
The Chairman: Clarification time. Mr Ang Hin Kee.
Mr Ang Hin Kee: Mr Chairman, I have three clarifications for Second Minister Ng Chee Meng.
First, now that we are better matching taxi and private hire services to commuters, the Second Minister mentioned a 99% satisfaction level. So, I wonder whether we still need the taxi availability indicator since we have hit such a high level of satisfaction.
Second, the Minister mentioned that he will incorporate digital training into private hire car and taxi drivers' course curriculum. My concern is more with new entrants coming into this industry. If they were to be displaced later by AV, perhaps we should better advise them as to how to make a career choice when they come to thinking about driving as a vocational skill.
Third, I welcome the move to regulate Uber and Grab-type of third-party apps operator. I was wondering whether LTA will adopt part of the tripartite workgroup's recommendation for self-employed persons, as announced by Minister Josephine Teo earlier this week concerning protection and coverage that we should be giving to self-employed persons, particularly when it comes to regulating these two operators.
Mr Ng Chee Meng: Mr Chairman, I thank the Member for his questions.
For his first question on availability on the taxi framework, well, I did say 99% satisfaction for both PHC and taxis. It is a combination. But the situation is evolving. As I have said in this Chamber for the last two years, we are monitoring but are always open to a review. Let it settle for a while and see whether we can review this again.
The second question is basically on career counselling. That, I think, is not difficult to do. We can easily put up a couple of preambles for the public coming in to apply for the licence.
On the last part, we will study the proposal.
The Chairman: Mr Dennis Tan.
Mr Dennis Tan Lip Fong: Mr Chairman, my questions are for the Senior Minister of State Lam Pin Min. I thank the Senior Minister of State for his answers. I have a few clarifications.
First, regarding his answers to me in respect of my suggestion for the TSS, the arguments the Senior Minister of State has raised regarding my suggestion for non-crossing, he mentioned about vessel bunching and the suggested U-turn spot. I have considered these arguments. May I also suggest equally, at this moment, that where vessels are coming out from the various anchorages or the terminals towards the Straits of Singapore, there is already a certain amount of vessel-bunching in any event?
I would describe it this way. The suggestion I have is more akin to a safer flow, because vessels will be moving, imagine by analogy to land transport. What I am suggesting is something like imagine cars merging and going into a one-lane highway and entering an expressway, all in the same direction. But at this moment, the ships are coming out from the various anchorages and terminals, the eastern and western anchorages, the terminals at Tuas and Keppel, and they are crossing over. So, this is akin to something like on the road, they are coming across to an uncontrolled multi-junction where there is no traffic light, and we are relying on the rules of the road. And seafarers will know that rules of the road alone are not sufficient to prevent a collision.
So, I would like to ask the Senior Minister of State to reconsider this. I know that, ultimately, it is a cost-benefit analysis. I know that time is important for our port, for PSA. But where I am coming from is a safety imperative. We cannot afford any accident, especially the kind of accident that will create oil pollution, for example, which will be a big disaster for Singapore and, hopefully, it will never happen.
I would also like to suggest regarding my AIS suggestion for Government-enabled vessels, perhaps this is a little bit awkward as a matter of diplomacy—
The Chairman: Can the Member keep it as a clarification, rather than a speech, please?
Mr Dennis Tan Lip Fong: —but I would really like the Government to consider raising a dialogue on this at the IMO-level.
On the issue of enforcement between bikes and PMDs, I have said this in my cut, and I would like to ask the Senior Minister of State to consider a more consistent enforcement against bike offences. For example, I do not see there is any difference between a PMD travelling on the road, and a bike travelling against the direction of beating the red light. I think that the enforcement measure should be equal.
Dr Lam Pin Min: I would like to thank Mr Dennis Tan for the several clarifications.
Indeed, safety is paramount along the Straits of Singapore. Like I have explained in my reply, for the traffic separation scheme, we need to have a balance between safety as well as efficiency and expediency of the vessel traffic. Currently, there are already existing safety measures put in place ‒ code of conduct for the vessels when they do the crossings. But we will continue to monitor this very carefully, bearing in mind, like what Mr Dennis Tan has said, safety is paramount. We do not wish to compromise that.
With regard to the turning on of the AIS for government as well as naval vessels, we are abiding by the IMO Convention, and I think this is widely accepted by many jurisdictions.
With regard to the enforcement on bikes and PMDs, we take this very seriously. Like I have explained in my last Parliamentary Sitting, there are measures put in place to step up enforcement action. At the same time, together with the implementation of the Parking Places (Amendment) Bill, we will be able to have more teeth in controlling the way the bike sharing operators operate and to put in measures to ensure that users of bicycles and PMDs behave in the appropriate manner, including indiscriminate parking.
The Chairman: Dr Teo Ho Pin.
Dr Teo Ho Pin (Bukit Panjang): Chairman, on behalf of Bukit Panjang residents, I would like to thank the Minister for Transport for announcing the upgrading of Bukit Panjang LRT.
Just one clarification – will the upgrading work include building a noise barrier because some parts of the LRT are very close to the HDB flats?
Mr Khaw Boon Wan: We can take a look.
The Chairman: Mr Sitoh Yih Pin.
Mr Sitoh Yih Pin: I would like to ask this question to Minister Khaw if I can. The MOT Budget has increased by more than half ‒ from $9 billion in 2017 last year, to $13.7 billion this year, a 52% increase. In fact, this year's Budget is very close to the budget for MINDEF which, traditionally, has been the highest.
I would like to ask Minister Khaw, while this is money well-spent, how long do we expect this high expenditure to persist?
Mr Khaw Boon Wan: Some are medium-term and long-term projections ‒ I cannot remember ‒ but the huge increase, much of it is capital expenditure (capex). Capex is one-off, not recurring. Unfortunately, the one-off can last several years, because the projects are so huge, especially T5. It will really be our largest integrated project for the Government in the history of modern Singapore.
It may take more than a decade. Likewise, my other MRT projects are also multi-year projects. So, it imposes a heavy responsibility on us to make sure that we spend every single dollar very carefully and, at the same time, be on a constant lookout for ways and means to save money. For example, the Changi East Coast integrated depot that we highlighted a few days ago was one of those efforts. It saves a few billion dollars. Remember when implementing a $50-billion project, even a 1% saving means saving half a billion dollars.
The Chairman: Mr Png Eng Huat.
Mr Png Eng Huat: Chairman, I have a question for the Senior Minister of State. Would the Senior Minister of State share why LTA is not in favour of reducing the number of signalised junctions with shared green time from 90%, in view of the fact that such junctions do present a safety concern for all road users, apart from the given answer of ensuring a smoother flow of traffic, which, for some urban junctions, it is never an issue?
Dr Lam Pin Min: I would like to thank Mr Png for the clarification on some of the concerns at signalised junctions. As it is, like what the Member has mentioned, about 90% of signalised crossings in Singapore have shared green time. Many of them already come with a set of standard safety features. I have already explained in my reply this included integrated pedestrian countdown timers and the turning pockets for cars to stop and wait for the pedestrians to complete their crossing.
In addition, we also have added safety enhancements which include things like \"Give Way to Pedestrian\" signs at the junction, of which some may be static while some may be Light Emitting Diode (LED)-lighted to enhance their visibility. We have also implemented lighted road studs along the crossings, to also increase visibility for drivers and alert them to the possible presence of pedestrians.
Like I have also mentioned in my reply, there are special traffic light settings to allow the pedestrians to have a headstart in crossing the road, so that by the time the driver can make the turning, the position of the pedestrian will be more obvious to the driver.
We are watching this very closely. We understand the concerns on the ground and we are doing what we can to ensure safety at signalised junctions. That also includes public education on good road safety practices, as well as to remind drivers that it is their responsibility to look out for pedestrians.
The Chairman: The very enthusiastic, as always, Er Dr Lee Bee Wah.
Er Dr Lee Bee Wah: Thank you, Sir. I have three clarifications for the Senior Minister of State.
First, I am glad to hear that the Ministry is supporting the registration of e-scooters. My question is: will the registration be extended to other motorised PMDs?
My second question is: in my speech, I asked about the on-road cycling lanes at Tanah Merah Coast Road. What is the result of the piloting, and will more such on-road cycling lanes be built? I think this is not answered.
Lastly, among the infrastructure improvements for the safety of cyclists and pedestrians, I would like to ask for a safer cross-junction between cycling lane and the pedestrian crossing, as what I have suggested in my speech, the one that I have seen in Copenhagen. And if the Senior Minister of State needs a place to pilot, I will offer him the one at Naval Base Primary School main gate.
Dr Lam Pin Min: I would like to thank Er Dr Lee Bee Wah for the passionate plea. To answer the Member's first question on registration of all motorised PMDs, at this point in time, we are going to only require e-scooters to be registered. This is based on the recommendation of the Active Mobility Advisory Panel. They have also studied the possibility of registering other PMDs, especially those that are motorised. But we are taking a risk-based approach because we feel that the speed that can be generated by the e-scooter is actually much faster than the other smaller-scale PMDs like unicycles.
We are not saying we will never implement registration for them, but at this moment, we accept the recommendation of the Advisory Panel to start registering e-scooters first. We will monitor the situation.
On the Member's second question on the Tanah Merah Coast Road designated cycling lane, it is quite well-utilised and welcomed by cyclists, especially the recreational cyclists, who cycle at a higher speed. But we also do understand that because of the limitations of the size of many roads in Singapore, it is very difficult to implement this islandwide. Although the one at Tanah Merah Coast Road stretches for a whole of 10 km, which is ideal for that sort of cycling purpose, it may not be practical on normal day-to-day roads. You may have certain roads that are wide enough for such a cycling lane, but it may come to a point where certain roads become narrow and not implementable. So, it is not that practical.
On the Member's third point on infrastructure developments, yes, we are looking at how to improve the infrastructure to make active mobility more conducive. With regard to the Member's particular suggestion about certain crossing zones, drawing from her example of some concerns outside the school, I think we do have pedestrian-priority zones that can be implemented at areas that the Member has mentioned. Meaning to say that, if you do designate this particular area as a pedestrian-priority zone, then cyclists will have to give way to pedestrians or to slow down whenever cyclists approach such a junction.
The Chairman: Mr Ang Wei Neng.
Mr Ang Wei Neng: I would like to thank Minister Khaw Boon Wan for painting a bright future on land transport in Singapore and the resolution to make it happen and make it as good as Changi Airport. Before I continue, I would like to declare my interest as a part of the management team in ComfortDelGro.
Minister Khaw Boon Wan said that the Government will spend about $20 billion over the next five years to improve the public transport infrastructure. Are we using the opportunity to also nurture local enterprises so that they can take part meaningfully in building the MRT tunnels, refurbish trains, as well as maintaining the signalling system? Because I noted that Second Minister Ng Chee Meng said that they are nurturing local enterprises in building airport runways, building seaport, but he did not touch on land transport.
Mr Khaw Boon Wan: The intent is yes. In my recent visit to our newest depot in Tuas, we deliberately invited quite a number of our local companies, particularly from the Singapore Technologies (ST) Group because they have real experience doing modern maintenance, preventive maintenance, predictive maintenance in the aviation sector. Transporting the expertise over to land transport should not be too difficult. They, in fact, used the exhibition to demonstrate to some of us how it could be done. I certainly hope that they will be able to strengthen the skillsets and then export the ideas overseas. I have mentioned this point before in this House that among the three transport sectors, the most advanced in terms of technology and applying engineering technology to maintenance, is aviation, followed by maritime, and the rail is really slow. My job is to try to see how we can help accelerate their adoption, catch up with aviation, close the gap and, along the way, build up local capabilities that we can sell overseas.
The Chairman: Would the mover wish to withdraw the amendment?
Mr Sitoh Yih Pin: Mr Chairman, I thank Members for their participation and I also thank Minister Khaw Boon Wan, Second Minister Ng Chee Meng and Senior Minister of State Lam Pin Min, as well as the entire MOT team for the responses. Sir, with that I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $1,809,017,700 for Head W ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $13,087,199,900 for Head W ordered to stand part of the Development Estimates. (proc text)]
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All of us know of many in our society who desire to do good for others and who care for the less fortunate. Question is how will the Ministry partner the private and people sectors to create more opportunities for Singaporeans to step forward and, in the process, enable Singaporeans to contribute meaningfully?
Singapore Cares has what I think is a simple but very difficult goal – to make doing good a sticky form of behaviour, to make volunteering and to make thinking about the good of others a habit of mind and a way of life.
About one in five people volunteered in 2014. This is up from one in 10 in the year 2000. This is good news. But often, we have one-off projects that may have been started by an enthusiastic group whose initial fire has dimmed; such projects are laudable but, if ad hoc, not as powerful as they should be.
We need such efforts to be embedded within the structures of our social life. What I have in mind is something like Singapore (SG) Cares, which treats people who need help as part of the Singapore family, and sees our commitment in time and effort, supported by different social groups, from families, schools, companies and grassroots organisations.
Can I ask the Minister for an update on SG Cares, what has been done in the past year since its launch, and what his plans are for the future? In particular, I would like to ask the Minister what data he plans to collect, to measure not just the number of volunteers, but the stickiness of programmes and whether volunteers prefer to stick to one particular type of activity or prefer to try out different things.
For example, although volunteerism is on the rise, only 29% of respondents aged 25 to 34 volunteered for a social cause in 2016. This compares with 48% of those aged 35 to 44. Why such a contrast? Do younger people have less time for volunteering as they begin their careers and families? If so, what sort of volunteering opportunities are there for them?
I have an idea, especially for people who have never volunteered or who see lack of time as an impediment to doing so: micro-volunteering, where tasks are completed by a volunteer in small increments of time, at his own pace. They are in short bursts and bite-sized activities, anything from baking a cake for fundraising, graphic design for a charity logo, to knitting beanies for premature babies, or counting plant and animal species for non-profit or research and data gathering, depending on the needs.
While micro-volunteering may appear to go against the long-term commitment I spoke about earlier, it is, in fact, a useful complement. Such activities are a good way to start the journey and may lead to a longer-term commitment in the future. Such volunteers also bolster the core group during peak times.
Sir, I do not advocate any particular model. But I do think all volunteering helps the community and social ties. This is always useful because thinking about the good of others, and not just ourselves, is a vital part of what it means to build a country.
[(proc text) Question proposed. (proc text)]
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling (MacPherson): Sir, the Government has done a lot to strengthen community support for Singaporeans in need, especially for our elderly and vulnerable. However, there are still needs in the community which cannot be fully addressed by machines or paid staff. We need more Singaporeans to step in and step up to help as volunteers who care.
I am, therefore, happy that the Government has started the SG Cares movement in Singapore. To fully exploit the potential of this meaningful movement, there must be a solid structure, network of services and programmes and a strong human touch. We need to organise ourselves effectively so that the total impact is greater than the sum of impact had we acted alone.
Today, we have a myriad of formal and informal groups of volunteer organisations doing community service, serving from their hearts. Still, we also see Singaporeans who would like to serve but are unsure of what they can do, what needs are still unfulfilled and whether the time commitment will be too great for them. Hence, we need to find ways to make serving a priority and organise ourselves better so that busy Singaporeans can just \"plug and play\" when serving the community.
Therefore, I would like to ask the Minister for an update on the overall SG Cares movement and how he assesses its impact so far. What is SG Cares doing to inspire Singaporeans to see community service as a priority in their lives? Does SG Cares sees itself as, potentially, the national coordinating body for community causes and needs in Singapore, one that consolidates and monitors the list of needs in the communities and resources that are already available, one that identifies the roles and corresponding manpower needed, and one that coordinates and helps everyone clearly see how we can all fit in to help?
Ms Jessica Tan Soon Neo (East Coast): Mr Chairman, SG Cares strives to build a caring society where every one of us with little acts of kindness contribute to making Singapore more caring and inclusive. In our early days, our forefathers came together, set up community groups, for example, clan associations, to support one another through difficult times. I remember when I was young, in our neighbourhood, regardless of the kind of housing we had, the whole neighbourhood would look out for one another, everyone chipping in to help one another in times of difficulty or celebrating together.
Mr Chairman, last year, in your closing speech for the Ministry of Social and Family Development (MSF) COS, you had said that \"SG Cares is not a Government scheme. It is more of giving and volunteering by individuals and groups, and a lot of this is already taking place in our community. SG Cares provides an overall umbrella to encourage and support these efforts, to facilitate and drive more outreach\".
Minister Heng Swee Keat, in his Budget Statement this year, had also stressed that it is shared responsibility which is what has made our society what it is today and will keep our community thriving in the years ahead.
In today's busy lifestyle, can the Minister share how SG Cares has helped reignite the support and the spirit of caring in our community to build and strengthen a strong social fabric that will be essential for Singapore and Singaporeans to thrive?
I know that there is a lot of focus on volunteerism in SG Cares and, while I am an advocate for volunteerism, we need to go beyond that. It has got to go beyond that to the spirit of giving. It has got to become part of life and not something that we make time for. I think that is where MSF plays a very critical role in creating that platform for making this happen.
Dr Lim Wee Kiak (Sembawang): Mr Chairman, the SG Cares movement was launched in Singapore in November two years back to bring together individuals, organisations and beneficiaries. Since then, it has enabled resources to be pooled together and appropriately channelled to those in need. The acts of kindness publicised on the platform also serve as a source of inspiration to many others. The movement has immense potential to create a strong and sustainable volunteering ecosystem so that Singapore may be a caring and inclusive home for all.
In this year's Budget, the Finance Minister mentioned that there will be further plans for SG Cares. It is uplifting to note that the Government plans to play a bigger role, through enhanced partnerships with the community to support seniors and those in need. But the Government has already been working with the grassroots and the voluntary welfare organisations (VWOs). I would like to find out what are the changes and enhancements that we can expect from this area.
The corporations in our country are key players to the field of volunteerism, for they possess ample resources and have the ability to be a significant influencer. In recent years, more social enterprises are stepping up and they have created many meaningful social projects. Corporations are different from social enterprises, but they can contribute to the community in a different way.
I think it is important to have a varied approach when it comes to fund-raising and volunteerism. Can the Minister share what is the progress in engaging corporations for philanthropic causes? Sustainability is made a mandatory requirement for all public-listed companies. Maybe the Government can explore if it can encourage these companies to make volunteerism a good activity for reporting in their annual report to all the stakeholders. This may help to boost more corporations to engage volunteerism for a good cause.
Technology has the potential to reap huge economic benefits. Adopting the use of technology to support people in developing a caring and civic culture would be in line with our drive to be a Smart Nation. Thus far, we have platforms like Giving.sg to enable charitable causes to tap on convenience of online tools to gain exposure and collect funds. There is also SG Cares, which has a website and a mobile app, allowing users to make sense of available projects and causes and so on. Can we take this further? In fact, the SG Cares website as well as mobile app are wonderful tools, and I think the level of awareness, public awareness, is lacking. So, I hope the Government as well as the Ministry can help to push for awareness of SG Cares.
An article in The Guardian shared statistics that implied a growing use of mobile apps to make donations in the United Kingdom (UK). I am sure a similar trend is happening in Singapore as well. The United Nation's (UN’s) World Food Programme released a mobile app called Share the Meal, and donors can easily make small payments by tapping on their phones. In an era where contactless payments and one-touch convenience have become a way of life, it is important for charities to keep up with the trends. Yet, while these apps would help to increase productivity and reduce reliance on manpower, charities, however, chronically fail to embrace them due to the lack of resources to tap on technology in the first place. It costs money to make an app. It also costs money to hire a professional data analyst or purchase tools to make sense of social media campaigns.
The Government should look into reaching out to these charities and helping them with the technology expertise. Perhaps SG Cares could think of how to link up mobile apps and software developers with the charities in need. With the rising popularity of software developer jobs and careers, SG Cares may even wish to link up with Workforce Skills Qualifications (WSQ) to match inspiring software developers to charities and build up their portfolio and skills.
At the local level, there are many stakeholders. The grassroots organisations, the schools, social service organisations and community organisations are all working on a variety of excellent causes on the ground, from participating in environmental issues, helping animals, to befriending and caring for the less fortunate. In fact, I was looking through the SG Cares website and I was impressed to learn about many previously unheard and unique causes. I am sure there are more out there. I often hear stories or witness acts of kindness by residents or grassroots leaders that are really taken for granted. And it saddens me to hear of others criticising or being very cynical of these efforts. For example, there is a misconception that students are being forced to participate in activities like Flag Day and that they do so only for the Community Involvement Programme (CIP) points. It is demoralising, as I know many students and teachers who find meaning in such activities, and it would be terribly unfair for their good work to be misunderstood and tarnished.
While there should be no expectation of rewards while doing kind deeds, I hope SG Cares will do more to embrace charitable causes from the ground and encouraging more Singaporeans to do so.
Mr Kok Heng Leun (Nominated Member): I would argue that in every caregiving instance, it is about making a place for the person to age, heal, grow and even to die with dignity. Designing caregiving approaches need us to think out of the box, to think in a multidisciplinary way.
St Joseph's Home houses seniors who need various kinds of nursing care and hospice, but it also has a childcare centre there. In future, the Home will also host programmes for young people. In fact, youths from the Boys' Home, which is just beside the St Joseph's Home, will come over to the Home on Friday evenings to man the cafeteria and to perform for the residents of the Home. This design allows for intergeneration care to be practised. Here, care is relational, not functional; long-term and less temporal. Such a venture, intergenerational, cross-sectorial and cross-discipline involves multiple stakeholders and multiple Ministries. In designing it and getting support for such a project, all the stakeholders and Government agencies think out of their comfort zone to facilitate such creative interventions.
In the United States (US), Creative CityMaking Minneapolis is an art-based innovation initiative that pairs city officials with experienced community artists to eliminate disparities. Creative projects designed by artists, mapping community assets, mapping the needs of the community in housing, transport and healthcare, help the city government to make informed policies. The artists also design creative projects for city officials to effect cultural change in their work approaches so that they can effectively work with under-represented community.
We can do so in Singapore. We can start with the Social Service Office (SSO) by having inhouse artists work with SSO officials and the community to design community projects, mapping out the needs of the community and co-designing good solutions for caregiving issues and other social disparity issues like digital inequality. In this way, the caring society we aim for is one that comes from collaboration among the people, agencies and policymakers. It is not just the physical and material, but the mental, emotional and spiritual well-being of the people. That is what real care means.
Ms Tin Pei Ling: Sir, the Singapore Government has, over the years, built up a wide range of social assistance schemes and programmes to support the vulnerable and less privileged amongst us. Driven by passion and in response to the call for \"Many Helping Hands\", various VWOs, grassroots, religious entities, charitable organisations or foundations and even informal volunteer groups have also introduced their own help schemes and programmes.
This is encouraging, but the wide range of schemes and programmes can be too complex for the low-income and vulnerable to grasp and navigate, and they are the very intended beneficiaries of these well-meaning initiatives. The low-income, for instance, often have to work long hours and may not have a strong education background or access to resources. Therefore, availability is less of an issue, but rather, access.
How will MSF thus ensure that low-income and vulnerable Singaporeans will be able to fully benefit from these schemes and programmes? How will MSF help to reduce the administrative paperwork and stress that often result from applicants having to approach different organisations for different purposes and having to make sense of the different qualifying criteria?
Mr Amrin Amin (Sembawang): The Government has introduced many assistance schemes and programmes and they are calibrated to meet the varying needs of different segments of society, from the elderly to couples with children and those with disabilities. However, the various schemes and programmes across all Government agencies can be difficult to navigate. Many could find it difficult to understand which scheme or programme best meets their needs or which schemes they qualify for. How can MSF further improve the delivery of social assistance so that the less fortunate can receive the holistic help they need?
Dr Lily Neo (Jalan Besar): Mr Chairman, Sir, SSO has been doing a good job assisting residents in need. It gives better accessibility and faster delivery of assistance to many residents. May I ask MSF whether SSO will be finetuned further to serve residents even better? What kind of achievements has been attained by SSO since its inception in helping families in need? How many households has SSO helped thus far? Is there a key performance indicator (KPI) to measure its outreach and effectiveness? How has SSO been collaborating with other Ministries, agencies and the community partners for a concerted effort in tapping resources to assist such families? Could MSF expand assistance to give permanent solutions to families in need by providing last-mile outreach and care?
I beseech MSF to spare no effort in assisting our less advantaged families, especially those with children. These families need the concerted efforts of MSF to get out of their predicaments and have a more level playing field for their children. I have raised this issue and the provision of holistic care for these less advantaged families in this House repeatedly in the past and I seek your indulgence for repeating it again today. Could MSF take a holistic approach in helping these families?
Most of the time, these families have a slew of needs, as in housing, income, care for children or care for sick family members and so on. They are usually families with low skills, low paying jobs and some are single-income families. There is thus an urgency to assist this group of needy Singaporeans with more lasting solutions. While they need immediate cash assistance to tide them over, it is more important that they acquire long-term capabilities so that they are able to sustain themselves.
Just giving them ComCare financial assistance will not be able to achieve this aim. Their needs have to be looked into holistically in order to lift up the family as a whole. Therefore, equipping parents with skills and finding them employment or assisting their spouses to move away from prejudices and mental barriers to employment can be useful. Their housing needs may need urgent fixing. Their children should be assisted in terms of well-being, health and education.
Most social workers and MSF staff are required to undertake such a hands-on personalised approach to solve the various needs of each family by going the last mile in outreach and care. MSF will need to liaise with various Ministries and other relevant agencies and VWOs to give permanent solutions. Most times, many of their issues cannot be solved overnight. So, these families have to be assisted with continuing follow-up. Only with such last-mile approach can the needy families achieve sustained and long-term benefits. We need to adopt this policy urgently to lift this group so that the following generations will not be in the same predicaments as their parents. In other words, let us give them a better chance of climbing the social ladder.
Extra effort and last-mile approach must be put in to solve their difficulties. By looking for the root causes of their predicament and working out the long-term solutions with the families, may I request MSF to prioritise assisting the most urgent cases quickly by having a register with data about them? With better use of information technology (IT), MSF can have faster and better targeted assistance and better follow-up for long-term solutions.
Dr Tan Wu Meng (Jurong): Sir, health goes beyond any hospital or clinic, especially for seniors and folks with chronic diseases. It is about living healthy and being supported in staying healthy, with homes, families, neighbours, communities all coming together.
The social environment makes a big difference to whether a senior citizen falls ill – whether a sick patient can receive treatment at home, near to home or recover at home without being admitted to hospital.
So, community and social support are very important, and this is something that we see even in the developed nations. Even in Switzerland, with their Swiss standard of living, they have learned this as well. For example, in recent years, in the past few years and going back further decades, hospitals in Switzerland had discovered that, increasingly, patients are being admitted for social reasons because the patients cannot cope at home. It has been published in the literature even as far back as the late 1980s by researchers in Switzerland and these are lessons we can draw from all around the world.
It is also worrying when social deterioration becomes medical deterioration and hospitalisation because a long stay in a hospital bed leads to deconditioning and loss of physical strength. It makes it harder for an elderly patient to get back on their feet with the same energy as before. Ultimately, there is no place like home for health or for healing and we should try to find ways to keep health and maintaining health to be focused on the home and the community, with hospital care needed only when deeply necessary.
The Singapore Medical Journal recently published a study by Singapore General Hospital (SGH) doctors who looked back at 16,000 patient histories. They found that, in Singapore, patients staying in public rental housing had a 30% higher risk of being frequently admitted to hospital, even after adjusting for demographics and clinical conditions.
So, there is room for us, as a society, as a community, to learn and improve. We need to look at social care and health care as different aspects of the same goal when looking after seniors, and all the more so, with an ageing population and smaller families.
The family is still core but we should find ways to involve the community more – young Singaporeans with a spirit for volunteering, or seniors who are energetic and want to reach out to their peers and in friendship and fellowship. Can the Minister tell us how we can strengthen community support for seniors, in a sustainable way?
Furthermore, social care is also about urban design. As I spoke about in the Budget Debate last year, urban design can contribute to community engagement or to social isolation. In Clementi, some older blocks have flats which cannot accommodate the wheelchair ramp designs with the traditional Housing and Development Board's (HDB's) Enhancement for Active Seniors (EASE) programme. This means seniors with mobility needs find it harder to go out, see their doctor or participate in the community.
So, at the whole-of-Government level, we can look at ways to keep seniors in the community more, and to keep them healthy.
Mr Chairman, in my maiden speech, I spoke about how we must be: all of us, one Singapore family. May our people always grow closer and stronger, at home and in the community, in sickness and health – all of us, one Singapore family.
Dr Lily Neo: Sir, can I take my two cuts together, please?
The Chairman: Yes, please.
Dr Lily Neo: Sir, in order to support our seniors in the community, will the Ministry of Health (MOH) place the Community Network for Seniors (CNS) programme under the purview of senior cluster networks where there are such centres like the Senior Activity Centres (SACs)? This will provide a one-stop centre for a targeted approach in care and also to prevent duplication of effort to achieve the best outcome.
Getting the involvement of grassroots volunteers, VWOs and befrienders will add value to SACs. The volunteers from CNS can be channelled as befrienders to assist in the social aspects of the seniors in need and especially those staying alone at home. Volunteers can also supervise medicine taking, deliver food, escort seniors to hospitals or clean their homes and so on.
Pioneer Generation Office (PGO) will be renamed Silver Generation Office (SGO) and reach out to new cohorts of seniors aged 65 and above. SGO will be housed in the Agency for Integrated Care (AIC). This would be useful for better coverage of our seniors to ensure that no one who needs care is left out. I hope AIC can help to have a register of seniors in need and the types of assistance they require so that appropriate assistance can be provided for a better matching of volunteers to provide relevant assistance. The SGO can also act as the liaison agency to refer all mobile seniors to join the nearest SAC for physical, mental and social well-being. SGO can also pick up cases that need medical care or follow-up to AIC.
Sir, in conjunction with the launch of SG Cares, I would like to suggest that MSF move a national campaign calling it \"WE CARE\" campaign, like the courtesy campaign some years back. The objective is to encourage Singaporeans to be caring towards others, especially towards the less well-off in our society. It is also to encourage Singaporeans to have a volunteering culture where people readily give assistance to the vulnerable, needy, seniors and the less advantaged families. It will be good if we can also promote graciousness in the society where Singaporeans are considerate and caring to families, friends and neighbours in our everyday life.
On SG Cares, will MSF facilitate having a register of the disadvantaged families, vulnerable children and needy adults? This register will help them better by providing a convenient one-stop matching service of available volunteers to the recipients by enabling appropriate needs to be dispensed and without duplication of services. I believe MSF is the right Ministry to collate all those in need as MSF receives many requests for assistance from residents.
MSF may need to do a last-mile approach here with staff putting in more efforts to rigorously find out the relevant needs of those in difficulty. Such a detailed register will enable urgent cases to be detected and attended to more promptly. Good capture of information and data can help those in need efficiently and in a targeted way to achieve better outcomes. It will be good to have follow-up on cases which are assisted to ensure continuity. It will also be good for MSF to allow sharing of this data with other Ministries for cross-referrals and coordination in providing assistance.
The Chairman: Minister Desmond Lee.
The Minister for Social and Family Development (Mr Desmond Lee): Mr Chairman, with your permission, may I display some slides on the screens?
The Chairman: Yes, please. [Some slides were shown to hon Members.]
Mr Desmond Lee: Sir, this joint address today together with the Minister for Health and the Minister for Culture, Community and Youth is driven by Singapore's commitment to being a caring and inclusive society where no one is left behind. This lies at the heart of the SG Cares movement.
Singaporeans have always believed in helping one another. We believe in caring for the vulnerable and less fortunate. We believe in supporting our seniors in their golden years. And we believe in standing together as a nation through good times and bad.
This spirit of caring has carried us through many moments of crisis, whether it was the Hotel New World collapse in 1986, the severe acute respiratory syndrome (SARS) outbreak in 2003 or the severe haze in 2013. And not just moments of crisis. As we go about our daily lives, we benefit from extraordinary acts of kindness, some spontaneous and some organised by those who care.
One such incredible effort which we recently saw was the project called Wheels@Ubin, an initiative by Dennis Quek and Wilson Ang, two Singaporeans who care. They believe that no part of Singapore should be inaccessible to any Singaporean. They wanted to let wheelchair users and persons with disabilities experience the rustic charm and beauty of our offshore islands, notably Pulau Ubin.
The first Wheels@Ubin event was held in conjunction with SG50, bringing 100 wheelchair users to the island. The second edition of the event was successfully concluded on 2 March this year, with 120 participants. What was impressive and heart-warming was how businesses, public agencies and departments, volunteers, VWOs, community organisations and educational institutes came together to make this possible.
First, Singapore Mass Rapid Transit (SMRT) taxi drivers with mobile ramps fetched participants on wheelchairs as well as caregivers from their homes, wherever it was in Singapore, to Changi. Second, at the Changi Sailing Club, as the fleets of taxis came one after another, volunteers welcomed the participants and fitted them with life jackets. They were then brought on board a Republic of Singapore Navy fast craft by the Republic of Singapore Navy (RSN) officers, men and women. Third, upon arriving at Ubin, the visitors were welcomed by colleagues from the National Parks Board (NParks) and entertained throughout their visit by volunteers from the Republic Polytechnic and Ngee Ann Polytechnic. Fourth, volunteer doctors and nurses took personal leave to set up a medical facility to provide backup medical support. They came from various healthcare institutions and formed one medical team.
Wheels@Ubin shows us that our commitment to inclusivity and universal access can go beyond words to become deeds that make our visions reality. Wheels@Ubin is a good example, but just one of many, many examples of how we can create opportunities to enable and empower people to contribute and give, so that giving becomes a social norm and, as Ms Jessica Tan says, a way of life, an important cornerstone of our social compact, celebrated every day in ways both big and small.
Giving is empowering. It can change mindsets, cultivate empathy, dismantle prejudices and bring people from all walks of life together for a common cause. This will put us in a better position to confront our challenges together, such as rapid cycles of economic disruption, growing social needs.
At the same time, it will let us tap into the opportunities that come with having more Singaporeans live longer, healthier and active lives, growing social entrepreneurship and innovative technologies.
Through Singapore Cares, we can become an even more caring and inclusive society, not because we say or wish it to be so, but because each and every one of us is a living testament to this: a nation of givers – not by word, but by action and by deed.
Singapore Cares is a movement to identify and share about needs on the ground, shape volunteering opportunities and match givers to causes. Since the launch of SG Cares in 2016, we have curated volunteering opportunities and worked with VWOs to improve their capabilities to empower volunteers. We have also coordinated local networks of assistance, encouraged corporate and individual giving, and inspired ground-up efforts. We are greatly encouraged by many who have stepped forward and answered the call to make Singapore a more caring and inclusive home.
One organisation which has responded to this call is Pantropic, a data protection company, which actively promotes volunteerism amongst its employees. Since July last year, staff from Pantropic have been volunteering with Lion Befrienders, a VWO which provides friendship and care for seniors. The company has allowed employees to schedule their time flexibly so that they can take time off during office hours and during the work week to accompany seniors for their medical appointments. And they do so about twice a month on average.
This relieves the staff from Lion Befrienders, allowing them more time to attend to others in need. The seniors benefit from an expanded circle of friendship with these volunteers. And it is commendable that Pantropic has come forward to contribute actively in this way, despite being a small company with only about 12 employees.
As SG Cares takes root, I am confident that we will see more such successful partnerships. Even as we celebrated diverse expressions of caring at the inaugural SG Cares carnival in January this year, we looked towards doing more.
In the next phase of SG Cares, we want to make greater collective impact. First, we can better mobilise those who want to help. Many individuals and organisations wish to volunteer but may not know about the causes and areas of need. We can think of more ways to reach out to prospective volunteers.
Second, we can better coordinate the help rendered. An individual may be receiving help from multiple agencies. Organisations on the ground may focus on specific services and may not be conscious in seeking and working with partners to provide more holistic and thorough support.
Third, the way we help can be more sustainable and scalable. This will require us to increase the capacity and capability of VWOs and givers.
The Government, corporate partners and the community can also better direct our energies in an informed, coordinated and sustainable way, supported by good platforms and working arrangements.
Our three Ministries have come together today to underscore and support the efforts of SG Cares, which is a people movement, and set out our contribution to this movement. Our work is complementary.
MSF, through more integrated delivery of social services and building up the social service sector, will improve the way we provide assistance to vulnerable individuals and families. MOH will take on the mandate of building a stronger system of support for our seniors. The Ministry of Culture, Community and Youth (MCCY) is growing our volunteering ecosystem, encouraging and enabling all of us to join in the national movement. Ministers Gan Kim Yong and Grace Fu will speak more about their Ministries' efforts immediately after I speak.
Mr Chairman, for my part, let me share how MSF sees SG Cares as integral to our work. The social service sector has its roots in the spirit of caring and the efforts of those who cared since our early days. Many VWOs in Singapore have long and distinguished histories, bearing testament to the deep roots of philanthropy and volunteerism in our nation.
As mentioned by Ms Jessica Tan, our forefathers banded together to help one another and formed community and self-help groups, such as clan associations. Those who did well in Singapore, such as Tan Tock Seng, Hajjah Fatimah and P Govindasamy Pillai, paid it forward and set up institutions to meet the needs of their fellow men and women. Our VWOs will continue to play a critical role in serving beneficiaries, and in rallying and inspiring the community to care for those who need help.
To meet the demands of the future, we must support them in their drive to be even more effective and innovative. We will continue to build up our social service sector, by strengthening capabilities and ensuring that we continue to attract capable professionals.
At the same time, we will draw on the spirit passed down from the Pioneers and encourage the community to partner the efforts of the Government and the sector. I will speak in more detail about MSF's efforts for the social service sector later.
Sir, Dr Lily Neo asked about providing holistic help to disadvantaged families, a cause she is very passionate about. Our clients today can face and do face very complex issues and challenges. Individuals and families may have multifaceted needs that require support from multiple agencies, VWOs and community groups, over a sustained period of time, before they can stand on their own feet again.
It is, therefore, important, as Mr Amrin Amin has mentioned, to have a concerted and coordinated effort to tackle our social challenges. By better mapping our needs and tightening coordination and integration of services, we can maximise the impact of social services and public resources entrusted to us. At the same time, we can better harness and channel community resources to complement efforts by the Government. Our SSOs will be key to transforming social service delivery. We will better coordinate service delivery and improve client support through the SSOs.
First, we will equip frontline officers in Government agencies and community organisations with the knowledge to provide clients with basic information and referrals to schemes and services to address their needs, beyond those offered by the agency they first approached.
We will start with the SSOs, HDB and People's Association (PA) offices at our local community clubs, which are common touchpoints for residents in need. Eventually, we will extend this to other touchpoints, including medical social workers and school counsellors.
MSF will lead by example. From the third quarter of this year, clients will be able to access schemes and services for persons with disabilities through our SSOs, such as those offered by the Special Needs Trust Company (SNTC) and SG Enable. We have also established referral protocols to link up partners to support our clients. For instance, we have been rolling out an SSO-Family Service Centres (FSCs)-Schools referral protocol so that schools know when and how to refer students and their families to the SSOs and FSCs. We will complete the rollout to all General Education schools by the end of this year.
Second, we will make it more convenient for clients to apply for assistance schemes and services from different agencies by sharing information and assessments across agencies. As far as possible, they should not need to submit the same documents, repeat their circumstances, or fill in multiple application forms asking for similar information. This will help reduce the burden often faced by low-income individuals and households seeking help, who may already be in distress or urgent need.
For example, if a client living in public rental housing is receiving ComCare assistance from SSO and we observe that he is unable to keep up with rent, the SSO will share its assessment with HDB to consider a reduction in rent.
From the second half of this year, the Institute of Technical Education (ITE) students from households receiving ComCare assistance will also be assessed for their eligibility to receive a Community Development Council (CDC)/Citizens Consultative Committee (CCC) Bursary or a Ministry of Education (MOE) Bursary, without having to apply separately for them. We will progressively extend this to the mainstream schools, polytechnics and Autonomous Universities (AUs).
Similarly, later this year, we will make it easier for mothers or single parents who are working or seeking work and receiving ComCare assistance to access financial support for childcare. This will allow them to focus on obtaining or sustaining their employment. These clients will also be assessed for additional financial support, without having to make separate applications.
We will continue to explore more ways to reduce the burden on individuals and households in need. At the same time, we are mindful not to do this indiscriminately, so that we do not inadvertently erode people’s will to be self-reliant, or create, for that matter, a large cliff effect where multiple lines of assistance come up for review at the same time.
Third, we will strengthen cross-agency coordination so that clients receive more holistic and coordinated assistance from the agencies and VWOs that are supporting them.
In complex cases where multiple agencies and VWOs are involved, the case lead may not be obvious. SSOs will assign a case lead, depending on the client’s underlying issues. The case lead should step up to coordinate among agencies and VWOs, to work on a common plan of action for the client. Where necessary, cases will also be escalated to the parent Ministry or agency for flexibility to be exercised.
To bring about greater convenience to ComCare clients who need access to different services and facilitate collaboration across agencies, we will explore co-locating complementary services, such as family services, employment assistance and SGO, with our SSOs, to look at it from a client-centric point of view, instead of asking the client to travel from one point of the island to the other.
Already, five SSOs are co-located with or near Workforce Singapore (WSG) or Employment and Employability Institute (e2i) career centres, or provide job matching and skills upgrading services for low-income residents. Two months ago, SGO officers serving Taman Jurong and Jurong Spring started operating at the SSO at Taman Jurong.
Similarly, the SGO serving the Marine Parade area will be co-located with the SSO at Geylang Serai from the second half of this year. This will support closer collaboration between the SSO officer and SGO officers in supporting clients, especially elderly clients, and planning for programmes and services. We will explore more such collaborations.
Where co-location is not practical, we are looking into video-conferencing for clients to communicate with officers from other agencies. The SSO at Geylang Serai, for example, will pilot video-conferencing links with SG Enable, SNTC and HDB from the end of this year. Clients at the SSO who need to have discussions with case officers from SG Enable, SNTC or HDB when applying for services will be able to do so from the SSO, rather than having to separately visit SG Enable at Lengkok Bahru, SNTC in Tiong Bahru or the HDB branch office, wherever that may be.
The initiatives I have spoken about will make the SSO of the future more of a single touchpoint for residents with financial and other social needs. Let me illustrate this with a hypothetical example.
A family of four living in a public rental flat applies for ComCare assistance at the SSO. They have one child with special needs and another studying in ITE. In addition to the assistance provided by the SSO, the family will be able to access schemes and services from SG Enable for their child with special needs, without having to travel to their offices. If their ComCare assistance is approved, the child studying in ITE will be considered by ITE to receive a bursary, without having to separately apply for one.
And if the family needs to have discussions with the HDB branch office about their rental situation or whether they are eligible for the Fresh Start Housing Grant, they can do so via video-conferencing. And we will tap on the network of the grassroots and the local community to better assist these families as well.
As social needs evolve, we will continue to work to make sure that our SSOs are equipped to handle the evolving, complex and varied needs of those we assist, to help them get back on their feet again. The SSOs are also in a good position to foster collaboration and partnerships within the local community. Currently, SSOs have good working relationships with different Government agencies and community partners.
Going forward, the SSOs will step up efforts to bring together community partners to forge a picture, a better picture of local needs, gaps and resources. With this common understanding, community organisations will be better able to develop local schemes and programmes, and mobilise and organise volunteers under SG Cares. In doing so, community and Government efforts will complement each other to contribute towards better social service outcomes and a caring nation.
Mr Chairman, I have spoken about the spirit of caring that animates SG Cares and how this same spirit drives the social service sector. I have also explained how MSF will continue to build up the SSOs and the social service networks on the ground to collectively direct our motivations and resources to make an even greater impact. This will, of course, take time and the support of VWOs, agencies, volunteers, corporations and all members of society.
Ultimately, I hope all Singaporeans will recognise that the success of SG Cares rests upon an important truth, that is, we are all responsible for one another. When we say that we are Singaporeans, we recognise the bond that ties us together as a community and society. We recognise our responsibilities and duties to one another, especially in times of need.
None of us got to where we are purely on our own. Along the way, we have been helped by others, like our parents, friends, teachers and even complete strangers. We must recognise this and always pay it forward.
The Chairman: Minister Gan Kim Yong.
The Minister for Health (Mr Gan Kim Yong): Mr Chairman, may I also have your permission to display some slides?
The Chairman: Yes, please. [Some slides were shown to hon Members.]
Mr Gan Kim Yong: Sir, Minister Desmond Lee has mentioned the SG Cares movement and how it will galvanise the whole nation to care for fellow Singaporeans, especially the more vulnerable, including the seniors. Let me elaborate on our efforts in supporting seniors, our initiatives to build \"communities of care\", and how we can each play our part in nurturing a caring society.
We will continue to plan ahead for our seniors. Since 2011, we have expanded our healthcare capacity to help seniors age in place. We are continuing to develop new models of care and improve the affordability of eldercare services. In 2012, intermediate and long-term care (ILTC) subsidies were enhanced to cover up to two-thirds of Singaporean households.
As many Members know, we are reviewing ElderShield to provide stronger support for disability in old age, and recommendations of the review committee will be released by mid-year. This year’s Budget has put aside $2 billion for ElderShield subsidies to ensure premiums will be affordable. We are also enhancing our Seniors’ Mobility and Enabling Fund (SMF) and expanding the Community Silver Trust (CST) fund to cover active ageing initiatives.
Preparing for our ageing population is a whole-of-nation, whole-of-Government endeavour, which is why we launched the Action Plan for Successful Ageing in 2015 to drive collective action in areas, such as employability, senior volunteerism, health and wellness, housing and transport. Dr Amy Khor gave an update of the action plan in Parliament last month.
I agree with Dr Tan Wu Meng that we must address the needs of seniors holistically. Seniors often have multiple needs, and we can better coordinate services among partners and stakeholders. This is why we piloted the Community Networks for Seniors (CNS) in 2016 to mobilise and coordinate efforts of community volunteers, service providers and other stakeholders in each community to care for seniors.
In Tampines, for example, the Evergreen SAC and the Residents' Committees (RCs) work together to organise regular active ageing activities to keep seniors well and active. We recently started a Community Nurse Post at Evergreen SAC, where a nurse from Changi General Hospital (CGH) is available once a week to help conduct health checks and follow-ups for residents. For lonely seniors, volunteers and block representatives visit and befriend them. Care Line, a 24/7 telecare and befriending service, is also available. Should seniors require a home visit to check in on them, the Singapore Red Cross volunteers can be activated.
Sir, our vision is to build more of such \"communities of care” throughout Singapore. We are making two structural moves to achieve this. First, the repositioning of PGO as SGO, housed within the AIC, will help extend our outreach efforts to seniors beyond the Pioneers and tap on the capabilities and services of AIC.
Some 3,000 volunteers have been trained as Pioneer Generation (PG) Ambassadors since 2014. They have done good work and many of them have established personal relationships with the seniors they care for. In fact, one in four PG Ambassadors are themselves seniors aged 60 and above. Our PG Ambassadors remain the cornerstone of our efforts to create local communities of care. They have connected with more than 400,000 seniors in almost 800,000 engagements since 2014.
The conversion of PGO to SGO reflects the Government’s commitment to proactively reach out to our seniors, to engage them, understand their needs and care for them. I agree with Dr Lily Neo, who suggested that the new SGO act as a liaison agency for seniors to proactively connect them to services in the community.
As mentioned earlier by Minister Desmond Lee, my Ministry will also be working with the SSO to do this. Moving forward, SGO will do more targeted outreach to bring preventive health and wellness programmes to seniors. For those with multiple needs, they can be quickly connected with relevant health and social support services under AIC.
One example of a senior who has benefited from CNS is Mdm Lim. She is now in her 70s and used to be a lively Chinese opera singer but spent more time alone at home after retirement. Thanks to a PG Ambassador, Madam Lim is connected to TOUCH Community Services, which subsequently helped her install grab bars in her home, arranged for medical escort and transport services for her medical appointments and also linked her up with Meals on Wheels so that she gets proper meals. Today, she attends the National Trades Union Congress' (NTUC’s) SilverACE Senior Activity Centre at Taman Jurong regularly and even takes up taichi at the nearby Community Centre (CC). Madam Lim also spends time with a befriender every week. I am cheered to know many helping hands are working together to care for her through CNS.
Sir, our second shift is to consolidate all health and social aged services under MOH to better support seniors to age well within the community. The transfer of MSF’s social care functions to MOH allows us to deliver support to seniors more seamlessly, with AIC as our central implementation agency to coordinate all social and health-related services for seniors and their caregivers. This move also allows us to plan ahead for eldercare services at the national level and in a more integrated manner.
As Dr Lily Neo suggested, the transfer of services under the Senior Cluster Network (SCN) from MSF will enable MOH to better integrate SCN services into the wider CNS. For example, MOH can now engage service providers to discuss new opportunities for SACs to help seniors age in place, such as through active ageing programmes.
Sir, ultimately, however, what defines us as a nation is how well we, as a society, collectively show respect, care and concern for our seniors. The progress we make in strengthening intergenerational bonds will shape our social fabric in the future.
We see this happening in many purposeful ways. For example, St Joseph’s Home, which Mr Kok Heng Leun mentioned earlier, has a childcare centre and intergenerational playground co-located with the nursing home, creating many opportunities for shared experiences like meals and activities. At Bedok Orchid RC, students from Temasek Junior College read newspapers and share current affairs with seniors every week, including the Budget. Not only do both parties gain new insights, they also form new friendships.
Volunteerism is another way through which we unlock our community resources. The 15,000 volunteer Health Ambassadors and Health Advocates from our Health Promotion Board (HPB) come from all walks of life and play an important role in health promotion and raising public awareness.
We can also harness the immense wealth of knowledge and experience of older volunteers who continue to contribute to the society, as Dr Tan Wu Meng and Dr Lily Neo suggested. A good example is Mr Eric Teo, whom I met last month. Eric is 78 years old and has been volunteering actively at Siglap for the past five years. In particular, he helps out with the Health Peers Programme run by CGH and the South East Community Development Council (SECDC). Eric keeps himself busy by encouraging fellow seniors in Siglap to go for health screenings and he visits the residents to raise awareness of diabetes prevention and management. In the process, his volunteer work helps keep him fit!
Mr Eric Teo exemplifies the spirit of SG Cares and shows us how seniors, too, can care for fellow seniors. I hope his experience inspires more Singaporeans, regardless of age, to come forward to volunteer in the community, so that we make SG Cares an enduring movement. Minister Grace Fu will speak more on volunteerism in her speech.
Last but not least, several Members touched on the role of caregivers in the Budget Debate. We recognise the dedication of caregivers and the important role they play in caring for our seniors. My Ministry will provide greater support for caregivers. Providing respite options will give relief to caregivers who need help for a few hours over the weekend. They can leave their loved ones at one of the 10 senior care centres across Singapore, where they will be looked after. For those who need a longer respite, they can have their elderly cared for at one of the over 40 nursing homes for several days, up to a month. In addition, our Eldersit programme provides an eldersitter, just like babysitter, to look after seniors with dementia at their homes. We have also rolled out financial schemes to help defray the costs of care and caregiver training.
Going forward, there is room to do more. Emotional and timely support is important for caregivers. We are working on new approaches, to embed dedicated support for caregivers within eldercare centres. For example, support could take the form of phone conversations with caregivers, face-to-face meetings or even home visits. We have a national toll-free hotline for seniors and their caregivers, the Singapore Silver Line (1800-650-6060), for assistance regarding our community care services and schemes. MOH and AIC will continue to take on board feedback from caregivers and work closely with our partners to support them. Mr Chairman, let me say a few words in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Mencius once said, \"Love the elderly as you would love your own aged parents\". We must respect and care for our seniors who are an integral part of our society. The Government will do our best to help our seniors in their golden years. However, this cannot be done without the help of families and the community at large.
We must work together to build a caring society for all ages. This way, seniors can age gracefully and confidently among their family, friends and community.
(In English): Mr Chairman, I look forward to working with fellow Singaporeans to foster a caring society in the spirit of SG Cares.
The Chairman: Minister Grace Fu.
The Minister for Culture, Community and Youth (Ms Grace Fu Hai Yien): Mr Chairman, with your permission, I will display some slides.
The Chairman: Yes, please. [Some slides were shown to hon Members.]
Ms Grace Fu Hai Yien: Many Singaporeans agree that Singapore is a caring and cohesive society but there is still much more that we can do to be a caring people. MCCY will work with community and corporate partners, along with MSF and MOH, to support SG Cares. In line with Dr Lily Neo's suggestion, we want to foster a culture of consideration and contribution, where every citizen is ready to step forward, engage in service to others, and contribute to build a better home for all Singaporeans.
Our PG embodies this spirit of giving. When Singapore was finding its feet as a young nation, they made sacrifices to build a better future for all. They exemplified the kampung spirit so vital to nation-building. Today, many are still doing their part to help fellow Singaporeans.
Take 73-year-old Mdm Jumiah Yunos, for example. Recognising that seniors tend to stay at home most of the time, Mdm Jumiah started giving qigong lessons in 2013 to promote healthy living in her neighbourhood. She takes what she has learnt from her qigong master and teaches a group of up to 50 residents in easy-to-follow qigong exercises. With her nursing experience, she also shares tips for healthy living with them. Mdm Jumiah’s qigong lessons have encouraged neighbours to bond and stay active together. This is so useful for the elderly as it is right in their neighbourhood, and it is an ideal way for seniors to keep active in their retirement age.
We want this giving spirit to be passed on to each succeeding generation. To support MSF's efforts to enhance social service delivery on the ground through its SSOs and MOH's expansion of CNS and repositioned SGO, we now need more volunteers than ever to address our growing social and healthcare needs.
As Ms Tin Pei Ling shared, there are many passionate Singaporeans volunteering, whether through formal or informal ways. Yet, there are also many others who are willing but do not know where, who or how to help. Some may not know what the available volunteering opportunities are or where the needs are in their local community. Some may only have little time to give because of work and family commitments. Others could be too shy to approach neighbours who seem to need help. These are some of the barriers that stop us from reaching out to help and do our part.
Through SG Cares, we hope to break down these barriers. We want to create a society where everyone both gives and receives the care and support they need. We want Singaporeans to enjoy a culture of neighbourliness and rekindle the 'kampung spirit' within our communities. My colleagues and I believe this is possible if we all do our part to help our neighbours, nurture our youths and serve our seniors, so that no one is left behind.
As part of the SG Cares movement, my Ministry will work through corporates and the community while leveraging technology to make it easier and more meaningful for a person to volunteer. We will focus our efforts on encouraging corporate Singapore to step forward and do its part. As Dr Lim Wee Kiak pointed out, corporates must be key players in the field of volunteerism. Many of us spend significant hours at work and want to work with a company that does good for society.
Corporates have the ability to organise and mobilise their employees for social good through Corporate Social Responsibility (CSR) initiatives. Once we leave school and enter the workforce, we volunteer a lot less often because there are other competing priorities. But through organised CSR activities that are scheduled around our work commitments, we can continue to do our part.
One example is the partnership between the Post Office Savings Bank (POSB) and NTUC Health. NTUC Health is a social enterprise that provides health and eldercare services. POSB, as we know, is a bank with a network of branches. By adopting flexible volunteer hours and matching employees to an NTUC Health nursing home close to the POSB branches they work at, this partnership saw POSB employees conducting bi-weekly activities, such as morning exercise therapy and breakfast with residents, at NTUC Health nursing homes. This has brought joy to the residents and helped POSB employees grow a sense of pride in their company and a sense of compassion for our frail elderly.
We will continue to help companies in their CSR journey, through the Company of Good, a programme by the National Volunteer and Philanthropy Centre (NVPC) to help companies give more strategically, sustainably and meaningfully. Since its inception, close to 1,000 companies have come on board. As part of this programme, we will grow corporate leaders for giving under the Company of Good Fellowship. In this five-month programme, corporate giving advocates across companies come together to share good practices and develop proposals for more impactful corporate giving.
One participating corporate is Fullerton Hotel. Putting its proposal into action, it launched the Fullerton Academy last month. The Academy mobilises hotel staff and partners as volunteers to provide training for youths from REACH Community Services in areas, such as culinary, etiquette and creative arts, that will help prepare them for future employment.
We will also work through the Community Development Councils (CDCs). With a good understanding of the needs on the ground as well as their network of community partners, the CDCs can help to connect corporates to local CSR opportunities.
Ms Tin Pei Ling also reminded us of the need to organise volunteer opportunities better so that busy Singaporeans can just \"plug and play\", making it convenient to do good. Community needs can be made bite-sized and flexible, so that more Singaporeans can get involved whatever their skills, interests and commitments in their current life stage.
We are seeing an increasing trend of micro-volunteerism in Singapore – volunteerism broken into discrete tasks with flexible commitments, allowing on-the-go Singaporeans to slot doing good into their busy schedules. We are studying the landscape and will work with partners to explore new ways to organise tasks that will enable neighbours to help one another and take care of their neighbourhood. This will enable more Singaporeans to be involved and feel a greater sense of ownership for the community they live in.
Additionally, the National Council of Social Service (NCSS) has been working with SSOs to restructure roles, ensuring that they are both suitable for volunteers and meet the needs of the community. NCSS is also helping SSOs build up capabilities to manage their volunteers well and deploy them meaningfully so that they feel that they are not \"just another volunteer\" but someone who is making a difference to the community.
Dr Lim Wee Kiak asked about the use of technology to support people in nurturing a caring civic culture. Today, about 50% of Singaporeans are already familiar with online giving, and 25% actively support charitable social media campaigns. Technology has made it easy and convenient for us to provide quick help, collaborate and form community.
We will study how to harness the power of technology for social good and provide a one-stop avenue that Dr Lily Neo spoke about, where Singaporeans, especially those with the desire to help but do not know where or how to start, can easily find volunteering opportunities.
The recently launched SG Cares app is a good start. It is a free mobile app that enables everyone to be plugged into the community of volunteers and opportunities. We will continue to enhance the application to provide a good user experience and build a social network where volunteers can share experiences, learn from one another and serve the community together. With technology, we can reach out to show we care, at the touch of our fingertips.
Dr Lim Wee Kiak spoke about the good work that many are doing on the ground. We are fortunate to have many helping hands in the community. But, as Minister Heng Swee Keat aptly puts it, \"our many helping hands need to work hand-in-hand.\"
Under SG Cares, one role for the Government is to facilitate better coordination among the various helping hands NVPC, NCSS, social and healthcare organisations, corporates and the community so that we can mobilise volunteers to meet needs on the ground. To do this, we have set up pilots in Bedok and Jurong East to bring partners together to co-develop coordination models that can be replicated in other towns.
In Jurong East, various stakeholders work together to serve the seniors in different ways. They are supported by a network of SSOs with a central coordinator, in this case, Loving Heart Multi Service Centre. It receives referrals from grassroots networks and the SSO on seniors who require support, links up with partner organisations, refers residents to service providers, and mobilises community organisations and support. Partners, such as St Luke's ElderCare, provides rehabilitation programmes; Touch Community Services ensures regular home visits and provides services, such as counselling and transitional care from the hospital; and Thye Hua Kwan offers recreational activities and courses to keep the senior engaged and connected with the community. Loving Heart also engages volunteers from partner schools nearby to help in the Centre's activities.
The SG Cares movement has helped to bring these stakeholders together to map out the needs, roles, resources and areas where we need more volunteers. By combining our efforts and resources, we have a better picture of the needs in each community and how the various partners can work together to provide more seamless and citizen-centric support.
Say, for example, a senior who has difficulty walking and living on his own is discharged from the hospital. Understanding that the senior will require home medical and nursing care, a Medical Social Worker at the hospital refers him to the AIC, which gets him connected with the CNS. A CNS coordinator will link up with the SSO and various SSOs in his neighbourhood to provide coordinated assistance and support services to the senior. However, the CNS, SSO and other SSOs cannot address all his needs on their own.
This is where we, as neighbours and volunteers, can step up and play our part. Everyone can contribute. You do not need money, special skills or a lot of time. You just need a good heart. If you are an outgoing individual with time to spare, you can volunteer as a befriender to visit him monthly and check out how he is doing.
If you cannot volunteer regularly, you can still help with ad hoc tasks, such as buying groceries or changing a light bulb. You can be alerted to these tasks through a tasking app if you live or work nearby. If you are volunteering as part of your company's CSR, you can be on the \"Meals-on-Wheels\" roster and help deliver meals to him. Or if you happen to be his neighbour, you can just drop by his home once in a while, to say \"Hi\" and to see if he needs any help.
Sir, my colleagues in MOH, MSF and MCCY are working together so that our social and healthcare agencies provide better coordinated services in partnership with the SSOs on the ground. Just as importantly, we seek to enable fellow Singaporeans to step forward as caring citizens and good neighbours to bridge that last mile of care that only family, friends and community can provide.
At the end of the day, SG Cares is about the kind of society we wish to live in. We believe that a strong society is one that leaves no one behind and one that focuses on helping the vulnerable amongst us. A strong society is one where the civic spirit is strong and where citizens contribute to causes they believe in. MCCY has been working to mobilise volunteers through the arts, heritage, youth and sport through initiatives, such as Team Nila, SportCares, HeritageCares and the Youth Corps. Through SG Cares, we seek to build a civic culture of care, consideration and contribution where all Singaporeans can work together for a better Singapore.
The Chairman: I am not sure whether this is a first time, but certainly it is significant for us to note that we have three Ministers from different Ministries coming together to speak on one topic under one Head. I would like to thank them for their collaboration and their commitment to the cause. Mr Seah Kian Peng.
Mr Seah Kian Peng: Sir, the need for empathy is well-established. The processes to ensure and encourage empathy, however, are very complex and perhaps not always possible to put in place.
Our approach to designing social policies and programmes reflect the values of our society. The \"Many Helping Hands\" approach is the foundation of our social policy. Ultimately, it is the shared values of Singaporeans that are at the heart of our social compact. It helps us weather difficult times together, to move us together and forward to success. In recent years, we have been focused on making sure low-income households have a roof over their heads, that every child has access to food, shelter and education. But in today's Singapore, all this may not be enough to get them up the social mobility ladder.
As we continue to face widening income inequality, the Government's approach to these challenges will continue to be based on the principles of \"family\" as the first line of support. Even if this is so, if \"family\", defined in the widest possible way, is the first line of support, sometimes, family members just have no means or resources.
I have heard of an organisation that gives out book prizes to primary school students who show an aptitude in Maths and Science, to further expose them to opportunities outside of school to fan their passion for sciences. They are supposed to embark on a science project of their interest over the school holidays with an assigned mentor/volunteer and put up a show-and-tell. However, before the journey commences, some of them drop out; they have no one to transport them to and from the discussion venue as their parents are working on weekends. The intention to help exists but implementation can be better.
Sir, we know of sportsmen and sportswomen whose parents fetch and send them to practise early in the mornings and late in the evenings. That they win medals is due to their hard work, talent and their families, but also, dare I say it, luck that some of them are rich. No one who braves a daily 90-minute commute on the public transport will not be hard-pressed to perform at the same level. We need to guard against inequality in Singapore; some are more tolerable than others. It is up to us to stand against those forms and those extents of inequality that will impact Singaporeans’ ability to live dignified and meaningful lives.
The Prime Minister has explained that there is a concerted and coordinated effort among Government Ministries to tackle these challenges together in various fora. Specific to the social service sector, what is MSF's contribution towards tackling these critical issues? And how does it intend to work with other Ministries to ensure that all facets to tackling inequality are addressed?
Finally, as mentioned earlier, we know it is the shared values of Singaporeans that lie at the heart of our social compact, building our resilience to weather difficult times together. How do MSF's programmes encourage and reflect the values of self-reliance, empathy and compassion?
Ms Jessica Tan Soon Neo: Mr Chairman, in a recent survey done on Social Capital in Singapore by the Institute of Policy Studies (IPS), it found that social division in Singapore may now be based on class rather than race or religion.
While it may not be realistic to expect that all our children and individuals will have access to similar learning opportunities to develop their talent and that everyone would have the same access to job and career opportunities, as a society, we must still aspire to do so, and our systems and structures must continue to strive to provide opportunities for all Singaporeans. To do this, it will require deliberate and a whole-of-Government effort to mitigate inequality of opportunity, ensure social mobility and foster social integration.
With regard to the social service sector, MSF has taken a holistic approach in its efforts to improve social mobility by providing upstream support and strengthening the sector. And this we can see in the help that is given to beneficiaries through SSO, and also through what the Minister is sharing in terms of the plans to enhance and strengthen SSO.
To enable every child to have the right start, access and the quality of preschool education are important. Preschool and early childhood development platforms are not just about providing childcare but also the environment for our children to develop and build confidence for social integration and life. In fact, this is the case for all throughout our learning journey and, especially now, with continuous learning.
With the technological shifts and disruptions that are confronting us, digital capabilities and skills will be crucial for individuals to thrive. Because with these skills, it will help translate ideas and talent for impact. With these trends, the early childhood sector will need to look at how to better support young families and children for the digital world, specifically those in the lower-income families.
The Chairman: Ms Chia Yong Yong. She is not here. Mr Amrin Amin.
Mr Amrin Amin: Parliament recently discussed mitigating income inequality, ensuring social mobility and enhancing social integration. Concerns were raised following a nationwide survey conducted by IPS released last December which found that class boundaries tend to be more salient than gender, racial and religious boundaries.
The Prime Minister had explained that there is a concerted and coordinated effort among Government Ministries and agencies to tackle these challenges together in various fora. Specific to the social service sector, how is MSF tackling these critical issues?
Dr Lily Neo: Sir, may I ask MSF how many people sleep on the streets in the past year? Is the number for homelessness getting bigger over the years? Does MSF monitor the reasons for those who sleep on the streets? Is there any ongoing outreach to them island-wide in order to understand their problems? How can MSF help this group better? Could MSF follow up individually and provide long-term solutions?
Many of them may have a variety of problems, such as family feuds, HDB housing issues, mental issues, employment and financial issues. These issues will need close follow-up with various Ministries and assistance rendered to achieve permanent solutions. Unless we provide such assistance, it is going to be an unending problem. It is futile trying to discourage them sleeping on the streets by chasing them away as they will just go sleep at another location.
I have had residents sleeping in Chinatown staircases or plastic chairs due to frequent quarrelling with co-tenants in HDB rental flats due to incompatibility of personality and character. Our housing policy requires two individuals to share HDB rental homes. This can create a lot of problems, especially for those having to stay with strangers because they do not have family members to rent with. This is especially so for many seniors who have difficulty adjusting due to their seniority. There are some individuals who just cannot live with strangers despite many transfers of HDB rental homes.
Apart from sleeping on the streets, MSF may also encounter them coming for ComCare as they cannot continue working, because they cannot sleep at night or they face daily living issues due to unreasonable co-lessees, according to them. Could MSF intervene in such cases and recommend for these individuals to rent HDB flats on their own, following psychological assessments?
Many homeless people do not like the shelter homes, such as Pelangi Shelter, as they prefer to have freedom to move about. Can MSF provide a better concept for shelter homes catering to the homeless group, giving them the flexibility of going out and about, staying in touch with their friends in the community and continuing to work whilst residing in a shelter home?
Ms Sylvia Lim (Aljunied): Chairman, Sir, Singapore has acceded to the Convention of the Rights of the Child, which defines children as persons below the age of 18. Being a signatory, Singapore is obliged to take all measures for the implementation of the rights recognised in the Convention.
Our Children and Young Persons Act (CYPA) currently only protects youths up to the age of 16. This means that youths between 16 and 18 do not enjoy the Act’s protections, such as not having their particulars published in the media and having more sentencing options.
In February 2017, an interagency committee chaired by the Attorney-General's Chambers submitted a number of recommendations to the Government, including the recommendation to raise the CYPA cut-off age from 16 to 18. One year on, has the Government come to any conclusions on doing so, and when will this be effected? If not, what are some issues the Government is grappling with?
Mr Murali Pillai (Bukit Batok): Sir, it is the parents' responsibility to bring up their children well so that they have the best chance possible to succeed in life. By and large, it would be a natural instinct on the part of the parents to discharge this duty. Unfortunately, from time to time, there have been cases of parents abdicating their responsibility towards their children.
Just on 2 March 2018, during the COS debate on the Ministry of Home Affairs (MHA), we heard the hon Minister for Home Affairs providing some examples of serious child abuse and neglect. These are heart-wrenching cases.
The principal legal tool used to intervene when a child or young person is neglected by his or her parent is the Children and Young Persons Act. Under the Act, a child or young person is deemed to be in need of care or protection if his or her situation falls within the nine enumerated categories stated therein. In such an event, the Director of Social Welfare, a protector or a Police Officer is empowered to remove the child from the custody of the parent and place him or her in a place of care and protection.
I recently had occasion to deal with a case which threw into focus the current requirements under the Act. Sometime in the second half of last year, I met the parents of a 7-year-old boy. The boy’s father sought my help to deal with a problem he had with a Police Officer. The mother was a young lady who was rather quiet. Whilst I was talking to the father, I noted that the boy sported long hair; it was even below his shoulders! Curious as to how he could keep such long hair in school, I asked the boy which school he was studying in. To my surprise, I learnt that he was not registered in primary school. This is a violation of the Compulsory Education Act. As a matter of fact, the boy did not go to kindergarten as well.
Both parents were content for their son to be at home and schooled by his mother. However, prior approval from the Director-General of Education, as required under the Compulsory Education Act, was not sought.
I must add that, from a physical perspective, the boy appears to be reasonably taken care of. Mentally, he is normal, too. My community leaders engaged the father and attempted to persuade him to register his son for school as soon as possible. Based on the last update I received, despite six months of trying, the boy has yet to be registered. He is eight years old now this year. Officers from MOE and MSF have been engaging the father and trying to persuade him to send his son to school.
Under the Act, as the boy is physically well taken care of, it would not be possible to intervene under the Act on the ground that the parent neglected to ensure that he is enrolled in a primary school.
In response to a Parliamentary Question (PQ) I filed in November 2017 suggesting that the criteria under the Act be expanded to include situations whereby a parent neglects sending a child to primary school, the Hon Minister replied that the reasons for a child not attending school are often complex. The hon Minister opined that it was not necessary to extend the criteria under the Act on the basis that the framework provided under the Compulsory Education Act already covers this aspect. Finally, he explained that the Act is meant to be invoked where children are seriously harmed or at risk of serious harm. I respectfully seek a reconsideration of the Government's position for the following reasons.
First, I think we can all agree that it is critical for a child to attend primary school for the sake of his own development and to create the common experience necessary for the child to identify himself as part of our community and nation. This is the raison d'etre behind the enactment of the Compulsory Education Act in the first place.
Second, the framework under the Compulsory Education Act does not extend to intervening in the event the parent neglects sending his or her child to primary school. What it does is to provide penal consequences. However, it does not directly address the plight of the child if the parent does not do the right thing. Also, as mentioned by the hon Minister for Education (Schools) Mr Ng Chee Meng in this House before, the approach of MOE is not to charge the parents in Court but to counsel them to comply with the requirements.
Third, the future prospects of the child would be indelibly affected by reason of the parents' neglect in registering him for school and ensuring that he attends school regularly. Whilst this is not physical harm, it is harm that is still debilitating in terms of the impact on his future.
In my respectful view, the Compulsory Education Act and the Children and Young Persons Act should complement each other so that the whole suite of options would be available to help the child if a parent neglects to send his or her child to school. After all, the parent would have committed a criminal offence by virtue of his conduct.
I am aware that we are not dealing with big numbers. In 2003, this House was informed that there were about 10 cases of violations under the Compulsory Education Act per year. In my respectful view, though, even one case of a child being deprived of education is a case too many.
I am not advocating that the powers be exercised in every instance that a parent does not send his or her child to school. I acknowledge that the reasons are complex. All I am asking is that the state be provided with the requisite powers so that it can intervene in an appropriate case.
The Chairman: Assoc Prof Fatimah Lateef. She is not here today. Mr Seah Kian Peng. You can take your two cuts together.
Mr Seah Kian Peng: First, on seniors. Do a quick search on adult diapers in online marketplaces, and you will be inundated by the array of long-term care products and services listings. If we fast forward to 10 years, we will see more white-hair people around us. By then, one in four Singaporeans, or 900,000 of us, will be aged 65 and above. I will just be promoted to be a member in this group!
Second, on the middle-aged. There is an increasing need for the younger population to plan ahead as they get older. But getting people to plan ahead earlier is an uphill one. Often enough, they feel they are \"too young\" to have a situation where they have a chronic illness or to do retirement planning, and that the policy message is for someone else.
Also, there is a lack of recognition that many of the policies earmarked for the younger population are likely to have long-term consequences as they age, fertility rate, for instance. This is especially when the Government has limits to policy implementation. A classic example, I was just talking to a friend of mine. She is in her 40s and works in the healthcare sector. Yet, she is totally impervious to the policy messages because she has other priorities to think about.
We know what we should do, but actually doing it is another matter. As we all know, we are all good doctors but bad patients. Good at dispensing advice but bad at heeding them.
I just spoke of two different demographics – the elderly and the middle-aged. How is the Ministry working to reach out to these different groups? We will inevitably see, in time to come, that sales of incontinence products will outpace that of milk powder and baby diapers. How will the Ministry ensure that the elderly population is being cared for without curbing the well-being of its young?
How do we balance the need to care for the older generation without neglecting the needs of the young? Stating it starkly, will we one day see MOH's budget outstrip that of MOE or even the Ministry of Defence (MINDEF) and thereby placing even greater demands on MSF as well?
Indeed, the demographic challenges we face are daunting, with falling birth rates and a rapidly ageing population. In light of these challenges, how is MSF working to meet the changing needs of Singaporeans and our families?
The recent IPS survey asked if one is willing to pay higher taxes to fund higher social spending on the elderly or go tap the national Reserves.
Looking at the mixed bag of responses, there are almost equal differing responses. About 40% felt that the Government should chime in on the support. Thirty-four percent said otherwise. Interestingly, 41% believed each generation should take care of itself, without support from other generations. An almost equal proportion, about 38%, disagreed.
I came across this feature from Assoc Prof Tan En Ser, Department of Sociology at the National University of Singapore (NUS). He postulates that in most Confucian societies, the basis of intergenerational support is filial piety, a value which prescribes that the adults have an obligation to support their parents if they are in need. Nonetheless, filial piety is an often-socialised term in this country. So, many Singaporeans exhibit filial piety and believe this to be an important and enduring trait.
However, this attribute is easier to fulfil if there is financial independence either on the part of the parents, or the children are there and able to support their parents comfortably. We all want to be filial. But our commitment to observe filial piety can be severely tested. We can be forced to a corner when we face difficulties upholding our end of the commitment.
With the IPS study in mind, and without eroding the role of values or family as the first line of support, how does the Ministry see the role of the Government, social service sector and the community actively coming forward to help? How can the Ministry strengthen families, as well as the community, so that they are confident in providing care for the vulnerable among us?
Ms Sylvia Lim: Chairman, Sir, according to section 31 of the Mental Capacity Act, the Public Guardian has a total of 11 functions that are geared towards enabling and protecting persons who lack mental capacity. These functions include setting up and maintaining a register of Lasting Powers of Attorney (LPAs), setting up and maintaining a register of Court orders that appoint deputies, receiving reports from donees and deputies, and investigating any alleged violation of any provision in the Mental Capacity Act, including complaints about the way in which donees and deputies are exercising their powers.
Given the many onerous functions of the Public Guardian, I would like to find out how many staff work in the Office of Public Guardian (OPG) and whether there is enough manpower to handle the work. To illustrate, OPG has, in recent months, written to applicants to register LPAs that it would take longer than the preferred 15 to 20 working days to review their applications due to a greater than expected volume of LPA applications.
I know of one case where an LPA sent to OPG for registration is still pending after three months. Such delays might also have serious consequences, if the donor's mental state is fast deteriorating and he becomes mentally incapable while his LPA application is pending for registration by OPG.
I am concerned that if the function of registration is already backlogged, how does the OPG carry out the other more difficult functions, such as investigating alleged violations of the Act?
Sir, I also note from the OPG's website that there is a list of Revoked LPAs that is updated periodically. As at 28 February 2018, the number of Revoked LPAs was recorded as 1,841. Does the Ministry know what the common reasons were for the donors to revoke their LPAs? Do these reasons indicate that there is some lack of understanding of how the LPA works?
Mr Chen Show Mao (Aljunied): Sir, on the subject of Eldercare Leave for employees caring for their parents, the Minister announced last month that the Ministry is prepared to study the idea in consultation with the tripartite partners though we should also give businesses some time to adjust and adapt to recent enhancements in Family Leave.
As the Ministry looks into the matter of Eldercare Leave for caregivers who are also employed in full-time or part-time jobs, I would like to urge that they will also consider ways of providing assistance to those caregivers who are not.
Sir, in many ways, informal or unpaid caregivers enable other Singaporeans to carry out the economic activities that are counted in our gross domestic product (GDP), while their own caregiving is not. As of now, the burden of informal caregiving falls disproportionately on women. And our dependence on this group of Singaporeans is real. It is substantial and very often unacknowledged.
Eldercare Leave could well help relieve some of the pressure on informal caregivers who also work at other jobs, but almost half of our informal caregivers to seniors do not work at other jobs, often because of the unpaid caregiving responsibilities that they have taken on to their financial detriment and to their reduced retirement adequacy.
Would the Government consider measures, such as Central Provident Fund (CPF) top-ups for full-time informal caregivers in low-income households to reduce the pressure of being underemployed and under-prepared for retirement, as a result of taking on the responsibilities of caring for their loved seniors?
The Chairman: Ms Kuik Shiao-Yin. She is not here. Ms Tin Pei Ling.
Ms Tin Pei Ling: Sir, strong families have been a cornerstone of our society. As an Asian society, we believe in families as our first line of support. Over the years, various studies done reaffirm this. For instance, in a study done by Kau Ah Keng et al, published in 2001 – a little bit dated – Singaporeans \"strongly subscribed to the traditional value of supporting one's parents in their old age\".
However, as our population changes with rapid ageing, smaller family sizes and more singles, the strength of family support is increasingly being tested. This will have profound implications on our social structure and how welfare is delivered.
In a recent IPS study published in \"Singapore Perspectives 2018 'Together'\", one finding indicated that Singaporeans believe the Government ought to bear greater responsibility in taking care of older people in the absence of familial support, a shift from the \"many helping hands\" concept. But I wonder if it is also the beginning of a shift from our traditional value of family support.
Given these, I would like to ask MSF if indeed there has been a shift in family and social values and, if so, how will this impact Singapore in the long run.
Ms Rahayu Mahzam (Jurong): Sir, many of the elderly residents who come to see me at my Meet-the-People Sessions (MPS) request for financial assistance. Often, many of these senior citizens are uncomfortable seeking help from their children. They feel that their children have enough financial problems of their own without having to worry about their elderly parents. I would refer these seniors to SSO and, usually, some form of assistance is given.
There appears to be an increasing expectation that the Government ought to bear a large part of the responsibility of taking care of the elderly. Is this reflected in the results of the recent IPS survey which Ms Tin Pei Ling also referred to?
To some extent, I understand the sentiment. If families are facing some difficulties, as far as possible, there should be a support structure in place to assist. However, it is important that the family continues to be the first line of support for those who need help. This is a value that our society should embrace and adhere to. I would like to understand the Ministry's view on this issue, in particular, how does the Ministry see the role of the Government in providing the social support structure for the people? Is there some way we could provide families with some support but ultimately empower them to care for their vulnerable family members themselves?
Mr Desmond Choo (Tampines): Chairman, MSF has committed to improving early childhood education outcomes through raising the quality of our educators and the centres' operations. In a tight labour market, how can the Ministry continue to grow the sector?
Raising the quality of early childhood education requires better staff and curriculum. This, in turn, necessarily incur higher manpower and operating costs. Consequently, there would be higher fees.
However, our younger Singaporeans are already facing twin challenges because they are already having children later in life, they end up having to take care of the young children while caring for the elderly parents at the same time. Such sandwich situation is expected to be more commonplace over time.
Currently, Singapore Citizen children are eligible for a basic subsidy of up to $300 for childcare per month. This was implemented in 2008. Since 2011, the childcare operators have raised the median fees by 22%. This has somewhat eroded the support from the subsidies.
Can the Government review the subsidies, taking into consideration the twin challenges that our middle-income young parents face? How can we continue to ensure that early childhood education continues to be affordable or the quality improved? In conjunction with the review of the subsidies, we should also expand the market-moderating effect of anchor operators.
Beyond childcare, student care support is something that our parents will need readily as more families have both parents working. It has become as indispensable as childcare support.
Subsidy for student care was enhanced since 1 January 2016. This subsidy is made available to families with a monthly household income of 20th percentile and below. It is comforting to note that our lower-income families at the lowest income tier can pay as little as $5 per month. I hope that the Ministry can also similarly look into enhancing our student care support to include parents up to the 50th percentile income tier, so that our young parents can have similar support from preschool to primary school.
Next, I would like to discuss the issues surrounding caregivers taking care of our special needs, disabled and elderly residents. Caregiving can be both physically and emotionally draining. Often times, caregivers need some short time away to either recharge or run errands.
However, respite care can be expensive, especially for lower-wage caregivers. Can the Ministry look into strengthening the provision of respite care with a view towards increasing the availability and reducing the costs of respite care?
Besides respite care, more caregivers would also need support in accessing the wide range of Government services and also mutual support from other caregivers. A \"one-stop centre\" announced earlier last year was an important milestone. Would the Minister provide an update on the new caregiver support centre and if more centres are planned for island-wide implementation?
Lastly, we have done much over the years to support our parents in helping to care for the special needs children under the Enabling Masterplan. One of the key concerns that many parents have is what happens to the children when they are old enough – 18 years old?
Most of them will have to leave the Special Education (SPED) schools and either go into open employment, sheltered employment or training development centres. Would there be sufficient affordable places in these different pathways and day-care centres for them, such that they can continue with development? With sufficient capacity, we can give our parents, who have worked many years to provide care and support to their special needs children, the comfort knowing that they will continue to be taken of and to lead meaningful and abled lives.
Mr Png Eng Huat (Hougang): Sir, like many residents, I welcome new estates for their inclusiveness in providing much needed facilities at SACs and childcare centres at the void deck.
Residents at the two new estates in Hougang spoke about the convenience of having such facilities within a stone's throw from where they live. Some young parents told me part of the reason they bought a flat in this estate was predicated on the availability of childcare facilities in the neighbourhood.
However, the number of places available at these childcare centres is limited due, in part, to high demand and also to the size of the centre. Thus, some residents were disappointed to find out that despite having a childcare centre next door, enrolment is not a given. Some residents shared that they even attempted to apply for a place for their children before these centres were completed or way before the centre opened their doors for registration, but were always met with a waiting list.
In March 2015, the Early Childhood Development Agency (ECDA) was reported to have said that the agency does monitor local demand and works closely with HDB on the issue of childcare places. It said, \"the new estates with more young families, childcare centres are pre-built into new Build-To-Order (BTO) developments to cater to demand ahead of time\". Thus, I would like to find out from the Ministry whether such demand is adequately met in new estates.
Furthermore, in the planning of such highly sought after facilities, could the Ministry ensure that residents living nearest to these childcare centres get some priority for admission? This arrangement should apply to anchor operators, especially since they are given subsidies and grants to operate childcare centres for the sole purpose of serving the new estate and the surrounding community.
At this point, I would like to declare my interest as my wife has an interest in special needs childcare.
Mr Pritam Singh (Aljunied): Chairman, Sir, parents who send their children to anchor operator My First Skool were hit by news of another school fee hike this year of between $6 and $33 for childcare; and $5 and $20 for infant care. These hikes this year come hot on the heels of similar hikes by My First Skool in 2013, 2015 and 2016 which, cumulatively, mean that it now costs $100 a month or more, and more than $1,200 a year to enroll a child into My First Skool.
Chairman, these hikes hit the middle-income the hardest. It may also be a disincentive to some couples who may want to have more children. Even though the absolute increase is below the fee cap established by the Ministry, four fee hikes since 2013 appear to suggest that the fee cap can operate as a shield to raise prices, particularly when parents do not have a clear idea for the reasons behind the price hikes.
In 2015, I asked the Ministry if it would provide a breakdown of the cost components to justify fee hikes at childcare operators, but this was rejected. Ironically, NTUC, which owns My First Skool, recently called for higher childcare subsidies to help middle-income parents.
Can the Ministry share details on the cost pressures impacting anchor operators in the child and infant care space? How does the Ministry check on the basis and justification of fee hikes, particularly from anchor operators who would benefit the most from economies of scale?
Ms Rahayu Mahzam: At a time when Singaporeans are getting worried about the social divide between those who are better-off and those who are less advantaged, it is important for us to focus on core efforts that can help close this divide. I trust we can all agree that quality education can be a social leveller. Every child, regardless of his or her background, should have access to good education from a young age.
We know that ages between 0 to four years old are the most important years for development. Therefore, I am happy to hear the Prime Minister's announcement at the National Day Rally last year about the Government's investments into early childhood education.
In recent years, we have made significant investments in this sector which has expanded so rapidly to cater to the needs of our young. To have quality preschool education, you need good infrastructure, good resources and, more importantly, good and sufficient teachers and other staff members. I would like to find out from the Ministry how will the Ministry support the growth of the early childhood education sector amidst a tight manpower situation.
Mr Amrin Amin: To make a difference to children not just academically but also emotionally and socially, our children deserve to have access to good education and resources that will provide the foundation on which they can pursue their dreams and passion in life.
To enable every child to have a good start in life, the standards of preschool and preschool education have to be raised. The passion and the skills of our preschool teachers will make a critical difference. What are the Ministry's plans to develop the early childhood profession?
Mr Christopher de Souza (Holland-Bukit Timah): Sir, a key concern of young families is the availability of childcare centres near their homes. This is because these centres meet many needs. First, the need of the mother who wishes to return to work to advance her career or supplement the household income together with her husband. Second, the need of the child who will benefit from early childhood education. And third, the need of the grandparents who will find time to rest when the child is at the childcare centre.
Therefore, in order to incentivise young couples to have more children, I have two suggestions.
First, how can a larger amount of void deck space be allocated for childcare centres at the planning stage of new HDB BTO precincts? Secondly, how can the Ministry incentivise childcare providers to provide affordable services within private property estates to also meet the needs of the families who live in the private property estates?
Mr Ang Hin Kee (Ang Mo Kio): Mr Chairman, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] Although I graduated from an English medium school, the lessons that I learnt from young, songs by Feng Fei Fei and other songs that I listened to from the radio, Chinese novels that I read from libraries and the Chinese newspaper Sin Chew Jit Poh helped me fall in love with the Chinese language.
Today, young children receive good quality preschool education in their mother tongue language (MTL) starting from preschool. In my work with the Education Services Union and the Committee to Promote Chinese Language Learning, I had the honour of witnessing the dedication and hard work of preschool Chinese teachers in cultivating love for the Chinese language amongst our children.
Besides enabling individuals to converse comfortably in their mother tongue for business and social interactions, it can also enhance understanding of our own culture. I have met many parents who are also very supportive and believe that children should start learning how to use their mother tongue at childcare centres and homes to communicate.
With the foundation that has been established, how can we do better going forward? Does MSF have an estimate of the number of MTL teachers we need in our preschools to meet future demands? What is the Ministry's strategy to attract and retain local MTL teachers?
I would like to suggest that more effort be directed towards cultivating greater interest in MTL among preschool children and improving the teaching methods for MTLs.
Will the Ministry consider giving greater support by providing teaching aids and tools for MTL preschool teachers, or inviting more education experts to share their expert knowledge and experience, so that MTL preschool teachers can have more resources to develop teaching materials containing localised content?
Besides attracting more Singaporeans to join this profession through internship programmes, will the Minister consider launching more scholarship or bursary programmes targeted at preschool MTL teachers so as to identify, grow and nurture a pool of Singaporeans who are passionate about teaching MTL?
I would like to urge the Government to offer more support to preschool MTL teachers, provide them with relevant educational tools and resources at different stages, and develop pathways for them to upgrade their skills, so that teachers can help young children not only to learn and speak their mother tongue, but also to love the language as well.
Ms Rahayu Mahzam (In Malay): [Please refer to Vernacular Speech.] I am the Chairperson of the Malay Language Month this year which is an annual event to celebrate and encourage the use of Malay Language amongst the public.
One issue that deserves attention in our effort to preserve the Malay Language is the importance of cultivating interest among the young. We are aware that the early years are important in our children's development. Early education and exposure are important in order to develop their linguistic capabilities.
In my discussions with preschool educators in my role as the Malay Language Month Chairperson, some of them said they have difficulties in getting suitable teaching materials for their students. I understand that improvements have been made in this matter whereby materials like Big Books were made available for teachers. I am sure that this situation can be further improved to help mother tongue teachers in preschools.
As Singapore prioritises bilingual education, what can the Ministry do to ensure that preschool students receive quality mother tongue education?
Ms Denise Phua Lay Peng (Jalan Besar): Sir, I will use the terms \"disability\" and \"special needs\" interchangeably in this speech although not everyone with special needs is disabled.
Sir, Singapore's population growth is said to be at its lowest. Our local workforce is shrinking. Everyone born in this country is precious, and for more than economic reasons.
In an effort to encourage Singaporeans to give birth to more, we must offer the assurance that their offspring would be valued, regardless of the condition they are born with. No one can guarantee that a child born to them is perfect. Like you and I, people with special needs are sons and daughters of Singapore. They must be granted equal access to opportunities to partake in all aspects of society.
In fact, neither can anyone guarantee that a typically developed person would not acquire any disability that comes with getting old or through an accident or mishap. Including people with disabilities and other special needs among us, hence, is not doing charity.
Research in the past already showed a close link between disability and poverty for various reasons. Unless there is effective and timely intervention, persons with special needs are likely to be unemployed, socially excluded and can encounter health issues earlier than others. For those who are more economically oriented, please know that the cost of supporting people with disabilities escalates when the latter are not educated, trained and supported effectively.
In a rapidly disruptive age, such as now, people with special needs are clearly at risk of being left behind. I have three questions I wish to seek clarification and make suggestions on.
First, on Enabling Masterplans. Since 2007, Singapore has seen three Enabling Masterplans. These are the roadmaps for Singapore to build a more inclusive society where persons with disabilities are empowered and enabled to realise their true potential. Singapore has also ratified the United Nations (UN) Convention on the Rights of Persons with Disabilities in 2013, signalling the Government's serious commitment to the disability community.
The latest Enabling Masterplan which will see us through 2021 is at its implementation stage. It has been almost two years now. There are not many targets set, whether basic or stretched goals, and updates from the Ministry have been ad hoc.
Sir, it is not enough to just engage citizens and stakeholders during the masterplan development. There is also a need to watch tightly the implementation of a plan that involves the whole of society, report to society, and systematically and visibly invite and engage society to form part of the often complex solutions. I therefore seek an update from the Minister on the progress of the latest Enabling Masterplan.
I also ask for a tighter rein on its implementation by convening, for instance, an Execution Implementation Body comprising key strategic and hands-on leaders from the public, private and people sectors. This body should preferably be led by the highest authority in a coordinating Ministry like MSF, to ensure it has the muscle to influence and ensure the accountability by the various Government agencies and other stakeholders. New MSF Minister, or not so new, Desmond Lee, is known to be strong in such a coordinating role. I have seen him in committees like this.
Two, on supporting and resourcing disability-specific enabling plans. Sir, improving the landscape for disability, we know for sure cannot be the job of the Government alone. I had begun to encourage each major disability group to take ownership, to do a proper study and develop mini plans, so that the needs and gaps in their specific groups can be accurately defined, identified and addressed with outcomes and impact.
However, the role of the Government is not diminished. The Government has to take the lead to work much closer with the ground, meet them regularly and seriously nurture the ground. It can resource the ground in solutions that could already be working, or at risk of being terminated, and address genuine gaps in the landscape.
For instance, NCSS had helped in the pilot of weekly respite programmes for families with more severely disabled adults with autism. The staff from the Autism Association Singapore (AAS) where I volunteer, started a very successful pilot, providing much-needed respite to caregivers. The programme, however, will not be financially supported after the pilot ends. This is a potential area to resource.
Another gap. Some members from the deaf community have identified a high priority need for inclusive preschools, much like the Mayflower Primary School model that MOE has launched. The preschool will provide the pipeline of students that will be more school-ready in the mainstream classrooms in Mayflower.
Yet, another gap in the adult space. The take-up rate for employment is not as high as desired for this community. VWOs providing job training and employment services, together with SG Enable, will need a stronger listening ear from the Government and resourcing to expand their services so that more can work. There is a need to quickly create and nurture sheltered enterprises to support those who are more severe but can do lighter duty work. I urge the Ministry to work closer with the ground to identify, support and resource disability-specific programmes surfaced by the ground.
Three, on mainstreaming disability into national policies. I would like to repeat my call to ask all Government agencies to ensure that their plans, especially for anything to do with our future – future economy, education, Smart Nation, healthcare, transport, housing and all essential services – to include the special-needs community in their primary policy planning. We do not want to go back to the dark ages more than a decade ago when students from special schools were forgotten when the anti-Severe Acute Respiratory Syndrome (SARS) measures by MOE excluded them during that time.
From the COS' announcements that I have listened to carefully this week, I believe that the public sector has not yet cultivated that habit of including this special group in their policy framing. There are great opportunities to ensure workforce inclusion and training, housing and digital equity through a digital literacy curriculum for special schools and so forth.
The Chairman: Kindly wrap up your speech, please.
Ms Denise Phua Lay Peng: I have worked with many public servants to know that many of them are supportive of the cause. But it is not yet a systemic habit.
I, therefore, ask for an automatic checklist during policy formulation by every Government agency to ensure persons with special needs are always considered and included. Let them be elevated from being footnotes or after-thoughts. Finally, a big \"thank you\" to many of you who believe in this special community.
The Chairman: Finally, a big \"thank you\". Mr Ang Wei Neng.
Mr Ang Wei Neng (Jurong): Sir, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] The Enabling Masterplan 3 has been accepted by MSF for over a year. I would like to ask the Minister which recommendations have been implemented and what is the timeline to carry out those that are yet to be implemented.
I would also like to ask the Minister if more Government agencies or private companies are willing to hire people with disabilities. Are there any data to show the progress in this area? Does the Government intend to take the lead in redesigning jobs so that people with disabilities can also make contributions at the public sector? I would also like to thank the Enabling Village for its efforts in this regard. Not all the graduates from special needs schools are able to find a job or work. However, even if they cannot work, it does not mean that they have to be cooped up at home all day. Therefore, I would like to ask the Minister whether there are any plans to strengthen the operations of adult centres for persons with disabilities.
The Senior Parliamentary Secretary to the Minister for Social and Family Development (Assoc Prof Dr Muhammad Faishal Ibrahim): Chairman, I thank the Members for their continued support of my Ministry's work. I would like to start with a few words in Malay.
(In Malay): [Please refer to Vernacular Speech.] Over the past two weeks, Members have highlighted the importance of strengthening the foundations of our social harmony, even as we overcome the challenges ahead. I am glad that the Budget this year seeks to support individuals and families to better prepare them for the future and care for one another.
MSF strongly believes that families are critical institutions to enable a harmonious society. We have always encouraged Singaporeans to make family life a priority. Nonetheless, we recognise that the pressures of life can make it difficult for us to do so. We have many policies aimed at easing these pressures, like parental leave provisions and parent support networks. This is to ensure that we do not inadvertently sacrifice family for other demands.
To better support young families in raising children, preschools play a key role. Research has shown that the early experiences of children provide the foundation for their future learning, behaviour and health. Thus, we will double our investment in the early childhood sector over the next five years. We will introduce 40,000 more preschool places, mainly in estates with young families. We wish to ensure that every parent who wants a preschool place for their child will be able to have one. This will give every child a good start in life.
To establish a strong bilingual foundation for our children early, and to give them exposure to their own customs and culture, we will also expand the provision of quality mother tongue teaching in preschools over the next five years. There will be more MOE Kindergartens, which provide all three MTLs. The number of preschools run by five Anchor Operators (AOPs) providing Malay or Tamil, will double to 350 by 2022.
To support the sector’s growth, we may need over 1,000 more MTL teachers by 2020. The Government has been supporting more locals to become MTL preschool teachers. Since 2016, polytechnic students can pursue specialised MTL tracks. Going forward, ECDA will work closely with the new National Institute of Early Childhood Development and other partners to enhance the training of MTL teachers and encourage more locals to take up MTL teaching in preschools. ECDA and MOE will also continue to work with sector partners to explore what other forms of professional support can be developed for our MTL teachers.
Let us continue to work together and strengthen families. Let us work together to create a conducive environment for Singaporeans to start families and raise children, enjoy family life and build meaningful family ties. Let this be our investment for a better society and a brighter future for all Singaporeans.
(In English):\tWith your permission, Sir, I would like to display two slides.
The Chairman: Yes, please. [Slides were shown to hon Members.]
Assoc Prof Dr Muhammad Faishal Ibrahim: Over the past week, Members have highlighted the importance of strengthening the foundations of our social harmony despite the challenges ahead. I am glad that the Budget seeks to support individuals and families to better prepare them for the future and care for one another.
MSF strongly believes that families are critical institutions to enable a harmonious society. Today, I shall talk about our roles in strengthening families, as well as in building a caring and inclusive society.
Mr Seah Kian Peng and Ms Tin Pei Ling expressed concerns about changing values and demographics, and if the family can continue to be the first line of support. I would like to assure Members that family ties in Singapore remain strong. In a survey conducted by MSF in 2016, 93% of respondents agreed they had a close-knit family, and 98% agreed it was their responsibility to take care of their parents, regardless of their qualities or faults.
In the IPS Survey cited by Mr Seah Kian Peng, Ms Tin Pei Ling and Ms Rahayu Mahzam, respondents were asked to rank who should shoulder the main responsibility of taking care of our elderly, and 73% of the respondents ranked family first. After family, the Government was ranked second, and the community third. Hence, Singaporeans do see family as the first line of support, but with the Government and community playing a major supporting role.
We will continue to encourage Singaporeans to make family life a priority, such as through the Families for Life Council, which champions family time. We also have many policies, like parental leave provisions and parent support networks, to ensure that we do not sacrifice family for other demands.
We agree with Mr Christopher de Souza that preschools are key in meeting the needs of young families. As noted by Ms Jessica Tan, the early experiences of children are also the foundation for their future learning, behaviour and health. Thus, we will introduce 40,000 more preschool places over the next five years, mainly in estates with young families. We wish to ensure that every parent who wants a preschool place for their child will be able to have one. This will give every child a good start in life.
Mr Png Eng Huat asked if we are providing enough preschool places for residents of new estates. ECDA has been working closely with HDB to build preschools as part of HDB BTO developments so that they can open earlier. To meet the preschool needs of residents, these new centres will have 200 places, twice the size of an average centre today. We will continue to look at projects and watch supply and demand, and work closely with operators to establish childcare centres in areas of high demand. Where there are areas with high demand, we will continue to build.
ECDA has also been working with the Urban Redevelopment Authority (URA) to ensure that developers set aside space for preschools in private residential sites released through the Government Land Sales programme.
Mr Desmond Choo asked how we will ensure that preschool and student care remain affordable. Mr Pritam Singh also asked how we review fees for preschool operators. I would like to assure Members that we closely monitor changes in preschool fees, and that preschools are kept affordable through a series of measures, including Government schemes and direct subsidies. Similarly, we will continue to monitor the affordability of student care for the lower-income families.
Preschool operators are private entities. They raise fees periodically to keep up with increases in operating costs, and to recruit and retain teachers. While ECDA does not regulate fees charged by these operators, it requires centres to report fee increases and give parents at least four months’ notice. Centres need to explain the basis for the increase and directly engage parents who face difficulties in meeting the new amount.
In addition, Anchor Operators and Partner Operators are subjected to fee caps. For other preschool operators, fees are adjusted to keep pace with manpower and operating costs, as well as quality enhancements.
Together with MOE Kindergartens, these Government-supported preschools provide affordable, quality services for almost half of all preschoolers, and have stabilised industry median fees. By 2023, two in three preschoolers will have a place in such preschools, where the fees are capped.
The early childhood sector is expanding rapidly. By 2020, we will require 20,000 early childhood professionals, 3,000 more than today. Ms Rahayu Mahzam and Mr Desmond Choo asked how this growth can be supported amidst a tight manpower situation.
To ensure sustainable growth, ECDA has worked with operators, unions and industry associations to develop innovative and forward-looking manpower strategies in the Early Childhood Industry Transformation Map (ITM) which we are releasing today. There are three key strategies under the ITM.
First, we will develop more efficient, innovative services for parents and children. For example, infants and toddlers currently have separate spaces within the same centre. These spaces could be shared, so that children can transit more smoothly from the infant to toddler age group. Operators can also enroll more children, while maintaining standards of quality and safety.
Second, we will introduce solutions to free up teachers’ time for higher-value work, such as lesson planning. Administrative responsibilities will be simplified through centralised services and use of technology.
Third, we will expand the opportunities for more people to join the early childhood sector. Beyond academic qualifications, there are many persons with aptitude and competence to join the sector. One job role we have piloted is Allied Infant Educarers, who receive on-the-job coaching and supervision to care for babies.
To complement the ITM, we will do more to support our early childhood professionals. Our efforts have seen some results. Enrolment in early childhood diploma courses has doubled since 2015. Early childhood professionals have also enjoyed higher salaries and more professional development.
Mr Amrin Amin asked about plans to further develop the profession. The AOPs will take the lead to develop career progression opportunities for their teachers. This is possible because our AOPs have grown in scale and diversity of operations. Over the next five years, they will create some 1,000 senior professional positions, doubling the current number. These leadership roles include managing a larger centre or a cluster of centres or mentoring junior teachers. To support this, the AOPs will provide more structured leadership development. These efforts will raise the quality of our preschools.
Let me share the story of Ms Amanda Lim, who started out as a preschool teacher 13 years ago. Under the guidance of her principal then, she developed her skills and attended professional development courses. She then became a senior teacher and honed her leadership skills by mentoring trainee teachers. Due to her strong performance, Amanda has been promoted to Acting Principal of My First Skool @ Senja. It is now her turn to provide her teachers with opportunities to grow and develop.
I would like to encourage all operators to support the development of our early childhood professionals. There are many resources to tap on, such as the Professional Development Programmes under ECDA. I would also like to encourage operators to recognise the growing contributions of their staff and remunerate them based on their job responsibilities, competencies and performance. This way, they will be able to retain good teachers with passion, and raise career prospects across the whole sector.
Ms Rahayu Mahzam asked how we can better support quality bilingual education in preschools. Mr Ang Hin Kee also asked how we can attract and retain sufficient MTL teachers. I agree that MTL is important and, when it comes to language, starting early helps. Over the next five years, parents can look forward to more MTL exposure in preschools. There will be more MOE Kindergartens which provide all three MTLs. Today, all AOP preschools already provide Chinese lessons. By 2022, we plan for the number of AOP preschools providing Malay or Tamil to double to 350.
To support the sector's growth, we may need over 1,000 more MTL teachers by 2020. The Government has been supporting more locals to become MTL preschool teachers. Since 2016, polytechnic students can pursue specialised MTL tracks.
These efforts have increased the pool of local MTL preschool teachers to 3,300 in 2017, 35% more than in 2015. Going forward, ECDA will work closely with the new National Institute of Early Childhood Development and other partners to enhance the training of MTL teachers and encourage more locals to teach MTL in preschools.
Teaching resources, such as the Nurturing Early Learners, or NEL Framework for MTL, Educators' Guide and NEL Big Books for MTL have also been shared with the sector. One beneficiary of these resources is Ms Nabilah Binte Abdul Fitrey from PAP Community Foundation (PCF) Sparkletots Preschool @ Bukit Batok. Ms Nabilah used to teach English but switched to teaching Malay in 2017 when the centre decided to provide Malay lessons. She has found the NEL resources for MTL useful. Through teaching Malay, she hopes for her children to learn about the customs of their culture and establish a strong bilingual foundation.
ECDA and MOE will continue to work together with sector partners to explore what other forms of professional support can be developed for our MTL teachers. To Mr Ang Hin Kee, wo men hui jing li er wei (我们会尽力而为). To Ms Rahayu Mahzam, kami akan melakukan yang terbaik. And in Tamil, நம்மால் முடிந்ததைச் செய்வோம். All these mean we will do our best.
Besides investing in our future generation, we should also care for the generation before us, our seniors. They have a wealth of skills and experiences and continue to contribute to our communities and families. But we acknowledge that it may not be easy to manage the deepening demands of caregiving.
Mr Kok Heng Leun suggested at the Ministry of Manpower's (MOM's) COS to provide allowances to caregivers. Currently, caregivers may tap on the Caregiver Training Grant which provides $200 for the caregiving training courses each year. They also benefit from tax reliefs and a lower foreign domestic worker (FDW) levy. Hence, our approach is to help to defray costs to families caring for their seniors and loved ones. We will continue to review how we can provide more support for caregivers, including respite care options at Senior Care Centres and Adult Disability Homes.
We also thank Mr Chen Show Mao for his suggestions. We will study all ideas raised by him and other Members as well.
In addition, MSF works to ensure that we are adequately prepared if our loved ones lose mental capacity. Beyond our seniors, we encourage Singaporeans, especially our middle-aged population, to plan ahead by making an LPA. We have made it much more convenient and affordable to do so, by simplifying the application process and waiving the application fee. Since then, the number of LPA applications has tripled from 4,600 in 2014 to 13,900 in 2017.
Ms Sylvia Lim asked if the OPG is able to cope with the workload. Although the surge in applications has led to a longer processing time, we have already streamlined processes and hired more staff. I wish to assure the public that the longer processing time does not affect them adversely, as the LPA application will still remain valid. We will also introduce a new online LPA system by 2021, which should cut down processing time. The increased workload in LPA registration does not affect the supervision and investigation functions of the OPG, as it is done by a separate team of officers.
Ms Sylvia Lim also asked about the reasons for the revocation of LPAs. This could occur due to events, such as the donor’s or donee’s death, or the donee’s loss of mental capacity. To date, about 80% of revocations were due to death of the donor or donee, and a further 15% were revoked upon the donor’s decision.
I will now speak on persons with disabilities and their families. Ms Denise Phua and Mr Ang Wei Neng asked about the progress of the 3rd Enabling Masterplan (EMP3).
Over the past year, we have enhanced training and employment opportunities for persons with disabilities. Under the Hospital-to-Work programme, SG Enable and the Society for the Physically Disabled (SPD) have extended assistance to persons with acquired disabilities by supporting their return to work through reskilling, goalsetting and rehabilitation through therapy. We have also extended the School-to-Work programme to more schools. It provides counselling, soft skills training and work trial opportunities for students in special education (SPED) schools before they are matched with suitable jobs.
Mr Ang Wei Neng asked if employers are becoming more receptive to employing persons with disabilities. SG Enable works closely with employers to help them build an inclusive company culture and redesign jobs. These efforts have borne fruit. The public sector has been leading the way and hired over 70 new employees with disabilities in the past two years. More employees with disabilities have also been hired in the private sector. Over the past two years, 2,700 new employees and over 1,300 new employers have benefited from the Special Employment Credit which supports employers in hiring employees with disabilities.
To defray transport costs, we also enhanced the Taxi Subsidy Scheme to benefit more persons with disabilities, including those attending employment-related training supported by SG Enable. The scheme now supports up to 80% of the cost of travel, up from 50% previously, and has been extended to private hire cars.
Ms Denise Phua asked if MSF could set up a committee to involve the community more in the implementation of EMP3. MSF chairs an interagency committee which collaborates with the people and private sectors to implement the EMP3 recommendations. Community groups are closely involved in various work areas, and we will continue to approach the community for feedback, ideas and partnership in EMP3 initiatives. To facilitate community-driven ground-up initiatives, we have also created several channels to provide for funding support.
As we strengthen support for persons with disabilities, let us not forget their caregivers. The role of a caregiver is critical but challenging, and more support will be provided to caregivers of persons with disabilities. SG Enable today supports caregivers in their care role. This includes the information and referral to disability services provided through the SG Enable Infoline and the concierge at the Enabling Village.
Moving ahead, SG Enable will further work with public sector agencies and community partners to equip caregivers with information and advice to build up their self-care and caregiving skills. It will also partner VWOs to improve caregiver support, especially at critical transition points of the care recipient’s life.
There is much to be gained from the support and solidarity of fellow caregivers. To facilitate this, SG Enable will be setting up a Caregivers' Space at the Enabling Village by the end of the year. It will serve as a place for activities organised by peer support groups, as well as caregiver training and engagement by VWOs and community partners. We want caregivers to come, learn from the experiences of fellow caregivers, and get advice and moral support as they walk their caregiving journey. This will strengthen the network of support for caregivers, which Mr Desmond Choo spoke about.
Mr Desmond Choo also highlighted the importance of respite care in improving caregivers’ well-being. Ample respite care services are provided at seven Adult Disability Homes and three Children Disability Homes supported by means-tested subsidies of up to 75%.
With more caregivers remaining in the workforce, the demand for day care may grow, as Mr Ang Wei Neng noted. We will add another 200 Day Activity Centre places this year for adults with disabilities. We are also building up the centres' capabilities to support persons with moderate-to-severe needs with quality programming and intervention services.
Another issue that preoccupies caregivers is the care of their loved ones with disabilities upon their death. Caregivers will be better supported with care and financial planning for their dependants. The Special Needs Trust Company (SNTC) is a non-profit trust company which provides subsidised trust services. It has served more than 500 families since its inception 10 years ago. One family that benefited from its service is the Yaps.
Mr Yap and his son Hon Wee, who has cerebral palsy, live in a rental flat. Mr Yap was diagnosed with cancer last year and worries about Hon Wee’s long-term care needs. As he has no other familial support, Mr Yap approached SNTC to set up a trust for his son. Now, Mr Yap is assured that if his son outlives him, his savings, including CPF monies, will be safeguarded, invested and paid out according to a care plan customised to meet Hon Wee’s needs.
Many more caregivers of loved ones with disabilities can benefit from such peace of mind. SNTC will be stepping up its outreach to caregivers to raise awareness on the care planning and financial education available to them. Over the next five years, SNTC will work with community partners, including the SSOs, to reach out to more than 1,700 caregivers of persons with disabilities.
We will also enhance the application processes to schemes and services that support caregivers. As Mr Murali previously highlighted, persons with cognitive disabilities sometimes face difficulties in being assessed for schemes. Their caregivers will soon be able to apply for the FDW levy concession and grant with greater ease.
MSF has worked with MOH to include MSF’s Client Assessment Form (CAF) as an alternative tool to evaluate the level of support a person requires to pursue activities of daily living, to support applications for the FDW levy concession and grant. From 1 April 2018, persons with disabilities and their caregivers can approach the special education schools or disability care services, such as Day Activity Centres, to have the assessment done onsite or be linked up to the Therapy Hubs for the CAF assessment. We estimate that about 1,000 persons with disabilities and their caregivers could benefit from this.
We will also strengthen the last mile of support, ensuring that caregivers know about our services and can access them conveniently. As my Minister has announced, we are working towards making information and referral to services by SG Enable and SNTC available at our SSOs through video conferencing. We will work with other agencies to explore equipping more frontline officers, including those from SGO, with knowledge about disability-related schemes and services.
Chairman, my Ministry is committed to strengthening families and building a more inclusive society. However, we are only one piece of the puzzle. This endeavour requires the combined efforts from all of us – Government agencies, businesses, community organisations and, indeed, every Singaporean, including all of us here.
Let us continue to work together to make Singapore a great place for families and an inclusive home for all Singaporeans. This will be our investment for a better society and a better future for all of us.
The Chairman: Minister Desmond Lee.
Mr Desmond Lee: Mr Chairman, I thank Members for their valuable thoughts and comments.
Our work at MSF covers a broad range of complex issues, like strengthening families, providing social safety nets, giving children from all backgrounds a good start, enabling people with disabilities and special needs, as well as protecting the vulnerable amongst us.
One area of our work is to tackle the challenge of income inequality. This is part of concerted and coordinated efforts among Government Ministries to ensure social harmony for Singaporeans, as highlighted by the Prime Minister recently.
Over the years, we have put in place support schemes and networks on the ground. This has ensured broad-based social uplifting through employment, sustained income growth, and universal access to education, housing and healthcare. These mutually reinforcing economic and social policies have been at the core of our success in strengthening our social compact and moving the whole of society forward.
Most Members of this House would have had this experience of visiting the modest homes of our seniors. Because of a lack of opportunity in the early years, they had lower educational qualifications, but worked hard for many decades, often in lower paying jobs, such as factory workers, cleaners or hawkers.
On the walls of their flat, however, would usually be a family portrait taking pride of place. Their children would often be seen wearing mortar boards and graduation gowns. They would have done better in life, because of the broader opportunities they had, which their parents had not.
I met one such couple, an elderly Indian couple, who worked in low wage jobs before retiring. One of their sons was sent by his company to head their operations overseas, while the other two are professionals. Social uplifting for this family and others took a single generation.
Recently, I met some families that used to get financial help and bursaries for their children. For various reasons, these middle-aged parents did not do so well when they were growing up, and needed help with arrears, health problems and unemployment. Their parents were low-income, and they, too, remained low-income. But they have since stopped approaching social service agencies for help, because their children have recently graduated from university, polytechnic or ITE, and found good jobs. For these families, it took yet another generation.
So, our broad-based policies continue to keep the engine of social mobility strong. Having said that, as society develops, it tends to settle and stratify and those who remain at the lower end of the income spectrum face the risk of remaining there, for a variety of intractable reasons – health, disability, family problems, incarceration, addiction, unemployment and many other reasons. And because of economic and technological disruption picking up pace, families that have been doing well all along may suddenly find themselves in dire straits, for example, because the main breadwinner has been made redundant or been retrenched. What this means is that we must focus even harder on targeted interventions, over and beyond our broad-based social policies.
Members asked about MSF’s specific role in tackling this issue. We have made deliberate moves to strengthen social mobility by providing early, upstream support and more targeted assistance to lower-income Singaporeans.
Education has been key in the Government’s efforts to improve social mobility. MSF's touchpoint starts much earlier, before the formal schooling years. As shared by my colleague Senior Parliamentary Secretary Faishal Ibrahim, we will continue to expand the provision of affordable, accessible and quality preschool places, so that every child can have a good start in life.
For children from low-income families, we embarked on the KidSTART pilot in 2016 to proactively identify them early and support them intensively, through early access to health, learning and developmental support. Early feedback on KidSTART's impact on child outcomes has been promising.
We have also steadily strengthened our social support system. Since 2013, we have progressively set up SSOs to bring more accessible and coordinated social assistance to Singaporeans. In the past few years, we have enhanced the coverage of ComCare assistance by expanding the income criteria and increased the cash amount of Long-Term Assistance. And as I shared in my opening speech, we are continuously seeking to improve our schemes and social service delivery, so that we can maximise the impact of social services and community resources.
Our other recent initiatives are in the same spirit, involving stronger collaboration with other agencies and VWOs and listening even more actively and intently to the community. For example, we will set up an interagency committee, comprising Government agencies and VWOs, to see how we can all work much closer together to tackle offending, re-offending, and to support offenders to rehabilitate and reintegrate into the community.
We have also set up a Youth Advisory Group, comprising 12 young people, some of whom have been through very, very difficult times, to help us review and test our policy ideas and better implement policies and programmes, so as to reach out to vulnerable youths at-risk.
To support vulnerable seniors with multiple or complex needs and facilitate planning, SSOs will continue to work closely with AIC and other community agencies to strengthen CNS.
Some VWOs I spoke to highlighted the importance of upstream preventive work that could enable us to identify and intervene at the start, where families or individuals show signs of need. We will work closely with them to do so.
Mr Seah Kian Peng rightly pointed out that our shared values lie at the heart of our social compact. Our policies to improve social mobility are motivated by our conviction to build a Singapore where all of us can lead lives with dignity and meaning and participate and contribute in our own ways. This is not only about enabling personal responsibility, but about society collectively stepping in to play a part.
At the National Day Rally in 2013, the Prime Minister articulated the new way forward, where the community and Government do more to support individuals, especially vulnerable groups, like the low-income, elderly and persons with disabilities.
We will continue to support individuals to be self-reliant. This is where we do not just provide a safety net, but a trampoline to help people to bounce back up, where possible. This requires a whole network of support to break the cycles that have led to the situation. It is not just about referring and providing someone in need with the right assistance but, more importantly, about showing empathy to fellow Singaporeans and banding around to lend support.
Collective responsibility and personal responsibility are not trade-offs. The community and the Government doing more does not mean that individuals are disempowered to play their part. If we each put in our bit and work together, we reinforce one another and multiply our ability to tackle challenges manifold. So, we must continue to make space for the community to contribute, alongside the Government, to help those who need help to regain their footing. And as we do so, we must be careful not to erode the dignity and resolve of individuals in wanting to improve their own and their family's lives. Chairman, I would now like to say a few words in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Parliamentary colleagues, one of the top priorities of our Ministry is to look into building a caring and inclusive society.
Over the last few years, we have invested a lot of resources and explored new ways to ensure that our social support system is better able to satisfy the needs of our people. Since 2013, we have set up a total of 24 SSOs island-wide so that Singaporeans in need can have easier access to assistance.
Looking forward, our Ministry will focus on studying ways to uphold our people-centric principle to further enhance the coordination and collaboration of organisations providing assistance in order to offer more comprehensive assistance to those in need. We strive to provide simple and convenient one-stop assistance to all those who seek help so that they can receive timely assistance to regain their footing.
For applicants who apply for assistance at social service agencies, they will have easier access to basic information on various assistance schemes and will be referred for the necessary services. Social service agencies will also further simplify the application procedures for various assistance schemes. This includes sharing the information of those who seek help so that they do not have to repeat their stories over and over again to the various agencies or to fill in the same information repeatedly. I believe that with better coordination and collaboration among agencies, Singaporeans facing difficulties will then be able to better get the help they need.
One example is 50-year-old Madam Cheok. She is a single mother who lives with her two sons and aged divorced parents. She is unable to work as she needs to go for regular treatment due to illness and, unfortunately, both her children also have medical conditions. Furthermore, her aged mother likes to hoard things in the house. So, besides financial assistance, she also needs help to clean the house and improve her living condition. The SSO @ Woodlands thus worked together with HDB, Fei Yue Family Service Centre, medical social workers, the school and the PA's grassroots organisations to come up with solutions for her entire family. They helped Mdm Cheok to apply for financial assistance, and are providing long-term counselling for the family. They also helped to clean up her house. Her 16-year-old younger son has started classes at ITE, and her 26-year-old elder son has started an ad hoc job.
This proves that as long as there is good coordination and good collaboration, we would be able to help Singaporeans in need more comprehensively, so that every one of us can be self-reliant and enjoy a better life.
(In English): Mr Chairman, this whole-of-society approach runs through MSF's continued efforts to improve outcomes for vulnerable and at-risk groups. This includes our work on children and young persons, and even individuals who sleep rough in the open.
Ms Sylvia Lim asked for an update on whether we will be raising the age in CYPA to 18 years old. Our review of the youth justice system is ongoing, with CYPA being one component. Our approach towards youth offenders is premised on gradated intervention. Where possible, we do not want youths to enter the criminal justice system.
Since 2016, we have stationed social workers at Police divisions to assess the risks and needs of youth offenders up to 19 years of age. Where suitable, youths are referred to attend diversionary programmes to address the risk of re-offending.
Nonetheless, some youths may require firmer intervention when the offence is more serious, or when family support is unavailable. These youths would tend to be heard by the Community Court, which adopts a more restorative and rehabilitative approach, compared to the adult Courts. Our aim remains the same – to ensure youth offenders in Singapore receive appropriate help to reintegrate into society.
Mr Murali Pillai suggested for the CYPA to protect children beyond serious physical harm, including children with persistent school absenteeism issues. Irregular or non-school attendance can be a manifestation of complex underlying family issues, such as marital, financial or health challenges. Statutory intervention and legal enforcement cannot be the only or \"go-to\" approach. The use of legislative levers is insufficient on its own. So, our approach must continue to be to work with community partners to provide a range of help options to holistically and sustainably address the family’s needs.
As to Mr Murali Pillai's specific case that he is dealing with, we will support the work of partners on the ground to solve the case. We will try to help this family.
Another issue that will benefit from Government-community partnership is rough sleeping or homelessness. Dr Lily Neo asked if we could reduce the number of Singaporeans sleeping rough in the open, and about the available shelter options for them.
MSF assists around 300 reported cases of homelessness each year, and this figure has remained thereabouts for the past five years. This is a segment of the cases we encounter, where persons sleep in public places, instead of returning to their homes due to – as the Member says – family conflicts, disputes with co-tenants, cluttered homes, and many other reasons. Sleeping in the rough puts their welfare, health and safety at risk, and also impacts the immediate neighbourhood. MSF officers regularly engage persons sleeping rough in Chinatown and other locations to provide assistance that may be needed to address the challenges they face.
We need a more coordinated, whole-of-society approach to address the underlying issues and needs of these individuals. MSF works closely with other frontline agencies and the community to reach out and coordinate the help that they need. This may include admission to a shelter, financial assistance or counselling for social or family issues, or for us to work to with MOM to give their employers a call, if they are foreigners, for instance, are sleeping rough to be close to their workplaces.
MSF has also established referral protocols and platforms among SSOs, FSCs and HDB to assist persons facing complex social and housing issues. We can do more and will continue to strengthen interagency coordination and information sharing to enable clients to secure stable housing.
Individuals who are unable to work and have no financial means and family support may be admitted to Welfare Homes. For those who are work-capable, the Welfare Homes will work towards reintegrating them into the community. Individuals who have exhausted all housing options may be supported by Transitional Shelters which provide temporary accommodation. During their stay, the individuals can continue to work or receive assistance to seek employment and access social services and other assistance to address their needs.
We are blessed that there are community groups which are reaching out actively to befriend these individuals and encourage them to seek assistance. We have been engaging these groups to see how we can work even more closely together and welcome more to partner us on this journey forward. Members of the community can also play their part by looking out for those in need and rendering assistance or referring them to us in MSF.
Mr Chairman, I now move on to speak about the social service sector.
The sector and those who work in it are vital and indispensable partners in our mission to tackle income inequality, uplift families and individuals, protect the vulnerable, and ensure that no one is left behind. As I hear more about the work that social service professionals do each and every day, I am humbled and inspired by the deep care and concern they show towards fellow Singaporeans.
But the social service sector is not immune to the challenges that affect other sectors – an ageing workforce, slowing workforce growth and the need to upgrade skills and innovate work processes. In addition, our future social needs are growing in complexity and intensity and will inevitably demand more from the sector and our professionals. It is, therefore, timely to reflect on how the sector can be better prepared for future demands and challenges to sustain and also to multiply their impact.
In 2016, NCSS and our social service partners laid out a vision and roadmap for the sector through the Social Service Sector Strategic Thrusts (4ST). This is a strategy developed for the social service sector by members of the Social Service Sector. They have highlighted three key areas.
The first is empowered individuals, families and communities. The social service sector believes in treating everyone, especially the vulnerable, with dignity and care. The way help is given to individuals and families should empower them, enable them to take personal responsibility for their lives and build resilience.
The second is effective VWOs that deliver quality, innovative and sustainable solutions. VWOs deliver more effective and impactful services when they are well-run, healthy and innovative. Good organisations can create more impact with the same amount of resources.
The third is a caring, collaborative and impactful social service ecosystem. The social sector does not exist in isolation, but seeks to work with the wider community, bringing everyone together to contribute our skills, time and resources to care for the vulnerable. The impact is not only on those being helped, but also in transforming the nature and character of society.
So, I am very glad that VWO sector partners and NCSS have come up with this shared vision. Many VWOs have already rallied behind that vision and exemplify it in their work. I hope this remains a good guidepost to shape the work of the sector towards stronger collective impact.
Sir, for our VWOs to be effective, we need to continue to get good people to join and stay in the sector. Our social workers, therapists, psychologists and teachers all work to improve and shape the lives of their beneficiaries, with many of them going the extra mile.
One such dedicated professional is Ms Teo Yafen, a speech and language therapist at the Cerebral Palsy Alliance of Singapore. She helps adults with disabilities overcome speech impediments, so that they can better integrate and contribute to society. She has been actively advocating the importance of speech therapy for her clients, as she believes it improves their health, safety and ability to communicate.
For example, speech therapy services ensure that any early signs of swallowing difficulties in persons with cerebral palsy are recognised and managed, preventing complications, such as chest infections. Ultimately, Yafen believes in a Singapore where persons with disabilities are fully integrated and can contribute to the community.
Many of those who work in the social service sector do not do it for the remuneration. They see it as a calling. Nonetheless, they deserve to receive a fair and competitive wage and have their contributions duly recognised.
Every three years, MSF reviews the salary norms for Government-funded programmes. After this year's review, the salary norms will increase by up to 12% across the various funded social service professions and job levels. For example, a senior teacher trained in early special needs education may expect an increase of about 8% after the revision.
Accordingly, MSF’s recurrent funding to our VWO-run programmes will increase by about $11 million, or 5%, in financial year (FY) 2018. The updated norms form the basis for NCCS’ Salary Guidelines for the social service sector. And I urge VWOs to use these guidelines to guide their wage adjustments. In line with the SkillsFuture movement, we will create more developmental pathways and build up the skills of those who work in the social service sector.
Earlier, Minister Ong Ye Kung had shared that SkillsFuture Singapore (SSG), the Singapore University of Social Sciences (SUSS) and Nanyang Polytechnic will be introducing a new Work-Learn Programme (WLP) in the second half of this year. Under this programme, diploma graduates with less than two years of work experience will undertake studies in Social Work while working as social work associates. Students will take courses from Nanyang Polytechnic’s post-Diploma programme during the first year, followed by a two-year part-time Bachelor's in Social Work programme at SUSS to become qualified social workers.
SSG will also provide course fee subsidies and incentives to participants and grants to help participating employers defray the costs of running the programme in their organisations. WLP is part of a wider effort to open up pathways for individuals to fulfil their professional aspirations and also to support employers in training their employees.
Social service professionals need to be equipped with the requisite skillsets to be effective and to be prepared for future demands. We will be launching the Skills Framework for Social Service later this year. This framework is developed jointly with SSG, our VWOs and social service professionals to help professionals better plan their careers and proactively develop their skills to meet the demands of the sector. It will have information on career prospects, skills required for key professions, as well as the learning platforms to develop these skills. These and other initiatives support VWOs in attracting and grooming good people. I hope that employees and employers will make full use of them, so that we can become stronger as a sector and fulfil our mission in social service.
Even as we work to build up the social service sector and skillsets of our social service professionals, I am very much aware that the work you do demands a lot of you and from you. I would like to thank everyone in the sector for your commitment, your hard work and your sacrifice.
Sir, the social service sector would not be where it is today without the strong support of the community over the years. I draw back again to the fundamentals driving the SG Cares movement. SG Cares is about helping the vulnerable and less fortunate in our society. It is equally about a transformation in our national spirit. When we work to change the lives of others, we also change our own lives for the better. We become not just individuals concerned with our own interests but part of a larger community of giving, and these activities become a vital and intrinsic part of our identity and social fabric. We become better people and, collectively, a better society. The Government, therefore, should play a role to coordinate, facilitate and make the best use of the community’s efforts and energies.
Earlier, Ms Tin Pei Ling asked about volunteerism. We are working to redesign volunteer roles to best match the needs of the organisation and the busy schedules of volunteers. For example, NCSS partners VWOs to identify their needs before matching them with corporates located ideally in close proximity and encourage them to volunteer regularly to meet these needs. We are building up the capacity and capability of our VWOs to ensure that volunteers are meaningfully deployed and engaged while volunteering. We are helping our VWOs to develop volunteer management frameworks to enable them to recruit, engage and retain volunteers more effectively to foster sustained volunteering. We are also training and developing the competencies of volunteer managers.
Sir, we will continue to support sustainable giving by corporates and individuals. In last year’s debate, we spoke about SHARE As One, which is a grant scheme introduced in 2016 to encourage individual and workplace giving and create more volunteering opportunities.
Under SHARE As One, the Government provides dollar-for-dollar matching for new and incremental donations to the SHARE programme above 2015’s level. Under SHARE, employees donate regularly to the Community Chest through payroll deductions, General Inter-bank Recurring Order (GIRO) or by credit card.
Businesses can use a portion of the Government's matching grant to organise CSR and volunteerism activities, and the rest will be channelled to a fund managed by ComChest to build the volunteer management capabilities of VWOs.
ComChest plays an important role in supporting about 80 VWOs in fundraising so that they can better focus on caring for the disadvantaged. Programmes supported by SHARE include FSCs and day activity centres for adults with disabilities.
SHARE as One has successfully brought in about a million dollars more in new and incremental donations in 2016. As announced by the Minister for Finance, the matching grant for SHARE as One will be extended from 2018 till 2021.
ComChest is working to implement an opt-out contribution system for SHARE in the public sector. Public sector agencies have responded well. We are also looking to extend this to the private sector, and I hope businesses will enroll for this initiative.
SHARE as One, as well as ComChest's other efforts, will make giving more sustainable and stable. The sum total of regular and long-term giving by many individuals goes a long way towards helping VWOs and the beneficiaries that they serve.
Mr Chairman, I have chosen to round off my replies by talking about our social service sector because the dedication of those who work in this sector and the sacrifices that they make deserve our respect and support.
I am heartened by the generous contributions of donors and the tremendous efforts of volunteers. Because this giving is precious, and because so much heart goes into it, we must make sure that it does not go to waste. We can and will make our efforts count and maximise our impact on the lives of Singaporeans.
Many of the initiatives I have spoken about today contribute to this drive to build up and better channel resources and services from the Government, community and corporations to those who need it most. In providing these services and resources, we want to uplift these vulnerable individuals and families and give them the opportunity to take charge, improve their lives and fulfil their aspirations.
We wish to build, in the words of our founding Prime Minister, the late Mr Lee Kuan Yew, I quote: a \"fair, not welfare, society\", where everyone has an equal shot at success.
This is the kind of inclusive and caring Singaporean society we aspire to be.
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling: Mr Chairman, I would like to thank the Ministers for their answers, and I also like to thank the Senior Parliamentary Secretary for addressing the topic of family support.
Clearly, I strongly support the idea of having family as the first line of defence. Still, I would like to ask how MSF balances the need to emphasise family as the first line of defence and the need to help our elderly or the vulnerable in a timely manner. Some elderly residents have shared that their children simply refused to help and yet they have immediate needs to be addressed. How will MSF achieve the balance and help assure those in need that they will not be left in the cold?
Second question, in addition to the Families for Life Council, what other organisations seek to promote family life and development? Are there organisations that cater to the needs of families from various ethnic groups?
Lastly, besides the skills framework and salary guidelines for the social service sector, what other measures are in place to attract and retain good people?
The Chairman: Minister Desmond Lee.
Mr Desmond Lee: I thank Ms Tin for the range of questions.
On the elderly, Members would have heard the Minister of Health describe how, under the SG Cares movement, CNS, allows us to tap on the strength of a network of volunteers who live in the community to look out for our seniors and to be able to alert us on occasions of need. Then, behind the scenes, MOH, MSF and the other agencies will coordinate and try to resolve issues that the seniors face.
The key is to take a practical and not a dogmatic approach to help him. When an elderly person who might technically have family support runs into difficulties, we need to first address immediately needs like health, financial difficulty that needs to be addressed immediately and their welfare. Beyond that, our FSCs, counsellors, social workers from the FSCs, including those from specialist agencies, if need be, will come in and work alongside us to see how we can bring reconciliation within the family and encourage the family to step up and to play their part.
We recognise that in this day and age, younger people come under a lot of stress with their own work, jobs and families and, therefore, it is a case of them playing their part, but both Government and the community doing more as well.
On the Member's question about the skills framework and how to attract more people into the social service sector, I have said earlier that remuneration is not something that social service professionals come into the sector to look for. But we certainly need to make sure that it does not fall too far behind median wages in comparable professions elsewhere. So, we treat our social work professionals and colleagues with dignity and respect.
NCSS works very hard on branding, awareness and outreach to help young people who are thinking of a career to decide whether the social service sector is one area they would like to move into, with not just broad information about the sector but also making available to them information about, say, the disability sector and its challenges and opportunities, young children, the elderly, and so and so forth.
So, NCSS, our VWOs and MSF continue to make efforts to reach out through career fairs, branding campaigns, outreach and open houses to continue to bring people into the sector. Ultimately, it is about people with a heart who want to give back that we want to attract.
The Chairman: Senior Parliamentary Secretary Faishal Ibrahim.
Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, this has to do with the Families for Life Council. Beyond the Families for Life Council, we also have many community agencies that actually play an important role in promoting families. They include the Centre for Fathering, Fei Yue Community Services, Morning Star Community Services. For example, some of them have their own programmes that we and the laymen would know. For example, the Centre for Fathering is very well-known for Dads for Life, which, I think, Mr Speaker, is also very actively involved.
Beyond that, we also look at some organisations that look at the ethnic groups and specific groups, for example, the Chinese Development Assistance Council (CDAC), the Council for the Development of the Singapore Malay/Muslim Community (MENDAKI) and the Singapore Indian Development Association (SINDA). We are also very happy that, lately, we are seeing more organisations working together. This is something that they believe in, that family development is very important. It is not only about helping vulnerable families but also how, as a whole, we can develop and give opportunities for Singaporeans to have good families.
I want to share a personal experience, if you allow me, Mr Chairman. We are all busy and very fortunate to be in MSF where we try to promote family life. I make it a point to spend time with my wife and children since I got married and we are very close together. We help one another, we face challenges together, and it is seldom that I have been home alone. A week ago, I was home alone for about a week plus. I share quite a number of the activities at home, like washing and cooking. I am quite familiar. I do that and I share part of the responsibilities of my wife. But one thing I realised when I was home alone was that I missed my family. I began to feel the \"miss\" and love for my wife and my children, and I realised that what I did to make my family time was worth it because it came out.
So, when my wife and son came back on Monday, then I started to feel a sense of happiness, a sense of fulfilment that what I have done actually brought that happiness and sweetness in my heart and mind. Then I am more determined to spend time, to make time and to say \"I still do\" to my wife.
So, I want to urge Singaporeans to actually make time, spend time with your spouse and be part of the life of your children because it is all worth it and it is something that we all should strive for. As far as when you are married, you look for happiness together and you want to see how you can journey through your family journey together with your children and your spouse, as part of a bigger family together. So, make time and spend time. [Applause.]
The Chairman: Mr Ang Hin Kee.
Mr Ang Hin Kee: A question for the Senior Parliamentary Secretary. Earlier, the Senior Parliamentary Secretary mentioned that the Early Childhood ITM will be released today. For MTL preschool teachers, I would like to enquire whether in this ITM there will be clear career and skills upgrading pathways for MTL teachers. They, too, look forward to career progression and good pay rises.
Assoc Prof Dr Muhammad Faishal Ibrahim: I thank Mr Ang for the question. Yes, indeed, we have plans and also training programmes for the MTL teachers. There are scholarships as well as training awards to be given. WSG will also look at it to see how we can facilitate the process. Some of the programmes that are being rolled out, such as Work Trial and the Enhanced Work Trial, will also be relevant to our MTL teachers.
The Chairman: Mr Seah Kian Peng.
Mr Seah Kian Peng: I thank and welcome the Minister's announcement on the various measures to enhance social service delivery on the ground. As we all know, the key is about effective case management and coordination. In the roadmap, the SSO is in the centre of it all. I would like to ask the Minister what the role of SSOs vis-à-vis all the other players will be in that space.
The second point I would like to raise is that I also welcome that the Minister announced that for the lower-income families, in particular, this early upstream approach is key. It enables them and gives them a way out. I would like to ask the Minister whether there is a way where we could adopt a more proactive approach, almost to the extent of handholding this group of children from the preschool days all the way as they journey on throughout their education journey. Is there a way we could almost handhold them to make sure that nothing gets dropped? How can that be enhanced?
Mr Desmond Lee: I thank the Member for sharing in our vision of greater social service coordination delivery. The policies and the programmes are there. Of course, more policies and programmes can and will be rolled out over the course of many years. But implementation is key and coordination on the ground is critical. All social service delivery is local. It is localised. It is targeted at families and individuals and communities. So, the role of the SSOs in this enhanced social service delivery framework is as follows.
One, to bring networks of communities together at the local level. I said earlier in my speech that our SSOs will facilitate networking amongst VWOs, FSCs, schools, organisations and grassroots. Any organisation on the ground that participates either generally or sectorally in supporting the vulnerable and the low income, we want to network with them so that we can work better together.
Second, through our SSOs, we will continue to oversee the identification of proper case leads for complex cases. Individuals may face issues with housing that may pertain to both HDB and CPF. They may need financial assistance but they would also like to be employed, have the skills needed to get a job so that they can stand on their own two feet. They may have family members who suffer from health or disability and, as a result, they need caregiving support, disability support or even respite care.
Identifying the whole range of needs around the individuals and not looking at it purely from an agency's point of view will allow us to look at the individual and the family holistically, and see what steps need to be taken together or chronologically in sequence to try to enable them, where possible. So, that will be what we need for SSOs and our partner agencies to do.
Through networking, we may also be able to unlock community resources that hitherto have not been part of the formal scheme of things. I think that would just allow more people to come in to provide support and to do so holistically in relation to an individual or a family in a way that enables them and not erodes whatever will they have to want to also play their part. And in a way that does not erode the principle of family as the first line of defence. So, support the individual, support the family but, if all else fails, make sure your social safety net is as effective as it can be.
As I said earlier, programmes and policies are there. Make good use of them. Apply them sensibly. Coordinate cross-agencies on the ground. Scaffold around individual and family. That is first.
On the Member's second point about whether we can identify people from a young age and make sure that they are supported as far as possible, through as much of life as possible, that really is what Mr Speaker initiated when he started KidSTART because he dreamt about the possibility of making sure that these children can aspire and dream and be able to meet those dreams. That is why KidSTART has put in a tremendous amount of resources.
MSF and ECDA, partnering some hospitals, in this case KK Women’s and Children’s Hospital (KKH), and a pilot to identify, but not stigmatise, to be able to approach and not force, to be able to encourage and not cajole these families to come on board to show that the children will have a better start in life if they, number one, enroll their children in early childhood, ensure that the childcare centres or kindergartens are adequately resourced to support them, to work with the families, including the parents, to give them the skills they need to contribute more effectively as parents, especially when one or both of them are working, or is a single parent family and be able to rope in and pull in the schemes from across the landscape of the Government and the community try to help these families and enable them.
How far this goes through the child's journey and through teenage and adulthood, we will see as this pilot develops. But early indications show that it is welcomed by the families, both the information and the support and awareness, and welcomed by the childcare centres who get the support they need to enable these children to bloom.
The Chairman: Ms Denise Phua.
Ms Denise Phua Lay Peng: I have two clarifications. One, still continuing on the SSO issue, I have worked with very good SSOs before, but now that the landscape is going to be more SSO-centric, how do we ensure that they have the muscle and the influence and even properly resourced to be able to coordinate all the various many helping hands together? Because some of the players might be more compliant VWOs but some are really people who just want to do their own stuff. How do you ensure that? Things actually can change. Because in some of our constituencies, some of us MPs are trying to play that role. And sometimes we were successful and sometimes we were not. So, that is my question. How do we ensure they have the muscle and the support and the resource to do so?
My second clarification is to do with the Enabling Masterplan. Based on the Senior Parliamentary Secretary's update, things are really all in order but the latest Enabling Masterplan has four key thrusts, nine strategic directions and 20 recommendations. A lot of us contributed to it, including members of the public, more than 400, 500 in numbers. So, I am wondering if there is a more structured and systematic way by which this plan can be updated. There are targets set. Some may be basic targets, some can be stretched targets. And, of course, we know plans are plans, these are five-year plans, things might change. How can there be a better, more systematic and structured way to update the ground?
The next clarification is, I brought up three key gaps and I chose the gaps and the examples because I think they are quite genuine and real. One is the respite programme that is about to be terminated because it is a pilot. The second one is what the deaf community has asked for − a preschool model that is something like the one at Mayflower that MOE has started. And the third one is on sheltered enterprises, not just social enterprises, which are really quite important for those who are more severely disabled but can do some light duty work instead of sending them to day activity centres. So, I would like to ask for the Minister and Senior Parliamentary Secretary's update on this.
Mr Desmond Lee: I thank the Member for her questions. I think the road ahead is not going to be easy − putting in policies, getting agencies to make sure that they provide good service, that they assist people within the schema of that portfolio. I think that is already one task that in Singapore our agencies do well, reasonably well. There is always room to improve but reasonably well, comparatively. Wanting to coordinate across agencies, making each frontline counter provide information beyond what they already do will be something that we need to push on for many years to come and continuously refresh as officers come and go and join or retire. So, this will be a continuous work-in-progress and will take time.
But I firmly believe that many people in the social service sector and also many people in this House whom I have spoken to, believe that if you really want to make that difference, especially for those who are stuck in very difficult situations because of a complex series of problems that beget them, we really need to centre around the individual, not erode their aspiration to also want to play a part in solving their problems long term, but make sure that we scaffold them in the system. It will not be easy. There will be hits and misses. We will succeed but we will also fail, case-by-case. We will need to always recognise that when we make mistakes, we do not coordinate so well, do an after-action review and see how we can make it better and make the next case better managed.
The Member talked about the landscape in future being more SSO-centric. I am wary to want to continue that mindset that the future is an SSO-centric one. Because we started off with many helping hands and we want to have many helping hands working hand-in-hand and we have SSOs that work on the ground together with community partners and sense-making the issues on the ground. Now, we are trying to have the SSOs play a little bit more of a coordinating role, providing information about needs on the ground and supporting individuals by marshalling themselves or through a lead agency identified for a particular case to assist.
In the social service sector and in the realm of volunteerism, none of us, no volunteer, no VWO would feel very encouraged if they were to be told to operate like automatons. Everyone gives because they have the desire to want to contribute. They give of their own free will. That is why they are called volunteers.
And so even as we try to provide more holistic support to individuals through case coordination, the key is to retain and to, in fact, strengthen the autonomy and desire of those, including VWOs, who wish to do good. But enable them with information, with data. Enable them by partnering one another and with us, the SSOs, to better provide support. We want to strike a balance and make sure that we strengthen the social service sector and volunteering sector but, at the same time, secure better outcomes for those in need.
In terms of ensuring that our SSOs get the muscle, the resource and the influence to be able to achieve greater outcomes, this is something that we need to work with internally but also work through the network that I talked about on the ground. So, this is a work-in-progress. But it involves building a network comprising many existing networks. It is not a high-tech solution necessarily. If I know you and I am from one FSC and you are from another FSC, and we can find a way to work together to better help this family, it is that personal touch and the willingness to communicate that can sometimes make that difference to the family.
On the Member's point about the Enabling Masterplan, I share the Member's anxiety that having participated very actively in producing a very important roadmap to strengthen and enable Singaporeans with disability that the Member and others who are heavily involved in the process would like to know where we are. There is no time or space during clarification to provide a full update, but I assure the Member and others that we would provide a proper update and we would involve the sector in the implementation and will continue to hear from you, listen to you and work alongside you.
On the three points the Member raised on the respite programme pilot terminating, whether, apart from the Mayflower programme, we will be able to work with people with hearing impairment to do pilots in preschool as well as sheltered enterprises in the community, these are all details that we will work very closely with the Member on and with the disability sector on.
The Chairman: Ms Jessica Tan.
Ms Jessica Tan Soon Neo: This clarification is for the Senior Parliamentary Secretary. Given the digital trends, I had asked what the plans are in terms of the early childhood sector in helping young families and children prepare for the digital world. Can the Senior Parliamentary Secretary share that?
Assoc Prof Dr Muhammad Faishal Ibrahim: I thank the Member for the question. We agree with the Member that young children need to be prepared for the digital world. In fact, we realise and we also share that technology can play a very important role in the learning experience. As such, IMDA has rolled out a PlayMaker programme. It is part of the process to introduce technology-enabled toys as a learning process for the kids. A few of the schools, for example, Skool4Kidz have also looked at it and have implemented it. They found it a worthwhile opportunity for the kids to interact and be open and forthcoming in the process of learning, using a digital perspective.
What we will do is that we will continue this process because we also believe and share the Member's view that it is something that we should prepare our kids for and immerse them, and make it natural because that is the space where they are going to grow up in and that is where they can play a bigger part in the future.
The Chairman: Ms Rahayu Mahzam.
Ms Rahayu Mahzam:\tEarlier, the Senior Parliamentary Secretary addressed the query I had regarding the solutions for the tight manpower situation for the preschool sector. The Senior Parliamentary Secretary had indicated that there were innovative strategies to deal with this. Can I check how many preschools are using the technological solutions in the schools and how have these been improving their productivity?
Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, I am happy that there is quite a good interest in how we can use technology and smart solutions in the operation of our preschools. Today, about 800 preschools have already indicated their interest to adopt smart solutions. We realise that, by doing this, it will bring lots of benefits. In fact, about half of these centres have implemented some of these solutions and they can expect a savings of 40-100 man-hours a month. In some centres, if you look at it, they have enjoyed a savings of as much as 270 man-hours a month. That is quite a good number.
When we also look at the centralised meal catering services, more than 50 schools have taken up this arrangement. And we found that it has reduced costs by as much as 10%. So, it shows that the preschools and operators can benefit a lot by using smart solutions and we want to encourage more take-up rates.
The Chairman: Dr Lily Neo.
Dr Lily Neo: I would like to seek a clarification from the Minister. Now that MSF is playing a much larger role in funding services and programmes, how does MSF also ensure that it does not erode the role of the community in giving them the space to continue to provide resources for the less fortunate?
Mr Desmond Lee: I think the Member hit the nail on the head. Even as the Government does more, the community also should step up more. That is what we see, both existing organisations and new ones coming forward to meet the needs of vulnerable Singaporeans.
We also see a lot of informal giving and informal volunteering within the community. None of what we intend to do should nudge that out because that really strengthens us collectively as a society.
The Member is right that MSF funds a lot of services in the social service sector, especially key ones that we think are important to have alongside what we do in the Government, such as FSCs. Even then, there is always that element for the VWO which takes up that MSF-funded service to contribute to their own fundraising or develop their own complementary programmes that can operate out of those centres.
There is also a wide range of services and programmes run by VWOs in the rest of the social service centres. For example, in NCSS, there are more than 460 social service VWOs and they serve a whole range of needs in society. We want to continue to encourage that. ComChest, for instance, supports more than 80 smaller VWOs and fundraise for them. There are matching schemes that help supplement what the VWOs raise to run their own schemes.
The VWO sector came in in the early years when they saw needs and gaps. And increasingly, as the Government does more in some of these areas, we build that partnership with them and work with them to tackle some of the challenges that they have been working on for many years.
The Chairman: Would the mover wish to withdraw the amendment?
Mr Seah Kian Peng: Sir, on behalf of all Members who spoke, I wish to thank Minister Desmond Lee, Minister Gan Kim Yong, Minister Grace Fu and also Senior Parliamentary Secretary Muhammad Faishal Ibrahim for their responses to the various issues we have raised. Our appreciation also goes to all the other important stakeholders in this sector, from the hardworking and caring staff at the Ministry, to the social workers at VWOs, SSOs, FSCs and many others. Your work and your empathy assure the heartbeat of our country remains warm, caring and inclusive for everyone. With that, Sir, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $2,972,104,000 for Head I ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $116,334,300 for Head I ordered to stand part of the Development Estimates. (proc text)]
The Chairman: Order. I propose to take the break now.
[(proc text) Thereupon Mr Speaker left the Chair of Committee and took the Chair of the House. (proc text)]
Mr Speaker: Order. I suspend the Sitting and will take the Chair at 4.00 pm. Order. Order.
Sitting accordingly suspended
at 3.40 pm until 4.00 pm.
Sitting resumed at 4.00 pm
[Deputy Speaker (Mr Lim Biow Chuan) in the Chair]
[(proc text) Debate in Committee of Supply resumed. (proc text)]
[Deputy Speaker (Mr Lim Biow Chuan) in the Chair]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head O (Ministry of Health)","subTitle":null,"sectionType":"OS","content":"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\".
We are now just two years away from the year 2020, and I would like to begin by asking the Ministry of Health (MOH) to give an update on the progress of the Healthcare 2020 Masterplan.
The Budget Statement which was delivered last week, gave us a stark reminder that although Singapore may be one of the healthiest nations in the world with a healthcare system that is admired by many, and Singaporeans may be amongst the longest living, but with our ageing population and a growing chronic disease burden, healthcare expenditure is rising, and it is rising very quickly. The MOH's operating Budget has risen from $5.87 billion in financial year (FY) 2014 to almost $9 billion for FY2018.
In an effort to maintain the relevance and sustainability of our healthcare system, MOH earlier outlined its chief strategies to transform our healthcare system to meet the challenges of the future with three key shifts. The first was moving beyond healthcare to health; the second, moving beyond the hospital to the community; and third, moving beyond quality to value. I would like to comment on these proposed shifts.
First, moving beyond healthcare to health. Over the past few years, the focus on health promotion and maintenance has been unrelenting and I applaud all Singaporeans for rising to this challenge. The call to arms to fight diabetes has reverberated through our society. We are all exercising more, eating more brown rice, for instance, saying \"no\" to sugar and \"no\" to over-eating.
I appreciate the many initiatives and the nudges that we are making to make Singaporeans choose a healthier lifestyle. For instance, where I work, all of the kopitiams and coffee-shops no longer put sugar in their beverages of coffee and tea. If you want to, you actually have to add it yourself. It is initiatives and small little measures like these that will help our fight forward.
I look forward to more initiatives from MOH and the Health Promotion Board (HPB) to promote healthy living in Singaporeans. As in every battle, it would be a mistake to step back when the tide is in our favour. I would like to request an update from MOH regarding its strategies for promoting healthy lifestyle choices amongst Singaporeans.
Second, moving from hospital to community. I have voiced my strong support for the right citing of medical care to the community wherever possible and, for this to be possible, we have to continue strengthening both our primary care and intermediate and long-term care (ILTC) sectors.
I will speak on primary care transformation later. But at this juncture, I would just like to ask: are our efforts to increase ILTC manpower and infrastructure on track, as detailed in the 2020 Masterplan?
This call to shift from hospital to community also heralds another key theme that was announced in this year's Budget Statement. Many Members have already spoken on this, but I was heartened, like the rest, by the announcements that health and social services will be more closely integrated. This is because there is clear evidence from around the world that the health of an individual is closely related to one's socioeconomic status. The wealthier also tend to be healthier.
A recent study from the United States (US), using data from the Centres for Disease Control, confirmed that people with higher incomes lived longer and had better health scores in virtually every parameter. One commentator went so far as to suggest that \"being rich is the best healthcare plan that America has to offer\".
Closer to home, as Member Dr Tan Wu Meng had alluded to in an earlier speech, a study in Singapore also noted that if you use public rental housing as a measure of socioeconomic status, then this, in itself, is independently associated with increased hospital re-admission risk, and being a frequent hospital admitter and also an Emergency Department user.
There could be many reasons why people with lower incomes have poorer health scores. The most obvious would be access to healthcare, but this is probably less true in Singapore than in other countries because our comprehensive healthcare system with universal coverage and very targeted subsidies has tended to flatten inequities in medical coverage. What then about other factors?
Poorer health has also been associated with educational level which, itself, correlates with lower income. People with lower educational status, however, are not necessarily less knowledgeable about health, compared to those with higher education. Allow me to elaborate with two examples.
We all appreciate that one of the most important paths to good health is to exercise good food choices. One study looked at why children coming from wealthier, better-educated parents grew up preferring healthier foods and were ultimately healthier. It is important before we go in to understand that where children are concerned, research has shown that kids might actually need to try a new type of food, about eight or up to 15 times, before they can accept it and perhaps grow to like it.
So, what the researchers found was that while parents from all backgrounds understood which foods were healthy and which were not, eat more vegetables, less fried foods and so on and sweets, parents who were less educated and with lower incomes often did not persist in offering healthier foods to their kids. This could be because of the steep upfront cost in introducing these foods to children.
Let us take vegetables, for instance. If a parent who is already working within a tight budget and time is short and a child refuses broccoli, for instance, then they will be less likely to persist with it because the child will probably refuse and it will end up on the floor. They would soon give up and say, \"Okay, maybe we will just give them the chicken nuggets that they are clamouring for\". A family which is wealthier may perhaps have the luxury to be able to continue offering this food, even though the broccoli ends up on the floor 10 or 15 times, until the child learns to appreciate it.
In line with this, let me call on the Ministry to continue working with MOE and our schools to ensure that only healthy foods be served to our children. I understand the constraints that some families will face in regard to food choices at home, but I hope that our schools can play a bigger role towards inculcating healthy eating habits in our young. I feel that this should actually start at the preschool level, rather than just at the primary school level.
Another example closer to home. Some years ago, a team from the Saw Swee Hock School of Public Health worked with myself and my grassroots volunteers to conduct a health survey in one area of Queenstown. This survey reached out to almost 3,000 residents and was conducted over a period of about a year. It was a very good study but, I think, one repeated observation that I got was that residents who had higher educational levels were less likely to smoke and they were more likely to go for health screening, such as colonoscopy for colon cancer, mammography for breast cancer and pap smears for cervical cancer.
The researchers actually found that this difference was not due to any knowledge gaps. If you ask people from all educational levels whether they knew what mammography was and why it was important, I think the knowledge was the same. Whether you came from a low or high educational background, you understood the importance of it. It was just that those from higher educational levels actually made that extra effort to go ahead with the screening.
Thus, it is clear that an important determinant of health inequity is also social inequality, and as we strive to be a healthier country, we should never lose focus on enhancing social mobility and reducing social inequities. In the meantime, I hope that this new compact between our social and health services will allow us to dive deep into the social circumstances of our lower-income fellow Singaporeans to give them the support that they need to achieve a long and healthy life.
I hope that the Ministry would be able to share more about the proposed integration of health and social services, as I feel that this would go a long way towards flattening the social gradients in the health of our population.
Finally, from quality to value. It is a tricky subject, because what is value in healthcare? Just as the quality of health services is sometimes difficult to quantify, what represents good value in medical care?
Of course, value is important because, if we are counting our pennies, we have to ensure that healthcare remains affordable by ensuring that we get the best outcomes for the lowest financial outlay.
Budget 2018 is frank and upfront about the financial pressures that our nation is likely to face over the next decade, and healthcare spending is one of the areas that will see the greatest increase in public spending. Value-driven healthcare policies could be a significant avenue of ensuring the sustainability of our system.
Our healthcare institutions were recently reorganised from six clusters to three. This was announced last year. Can I ask if this has led to any desired gains in efficiency and value of care delivery?
I have also previously asked for a body to be set up to evaluate not only the efficacy, but also the value of various medical and health-related interventions, whether diagnostic or therapeutic. I am glad that we now have the Agency for Care Effectiveness (ACE), and I call for ACE to play a bigger role in our quest for value and clarity in our healthcare spending.
Some interventions may seem very promising but with uncertain benefits, and they are controversial. For example, for things like hypertension, hyperlipidaemia, at which point do we actually choose to treat otherwise healthy individuals with medications, new technologies, remote consultations? Some studies have shown that although it is easier, but it tended to increase the utilisation of services with no discernable improvements in health outcomes.
In conclusion, the health check for our healthcare system is good for now, but just as our economy needs to transform itself to position itself for the future, so, too, does our healthcare system, which needs to see through its transformation to continue serving our country well beyond 2020, and, in fact, beyond 2030. Thank you and I beg to move.
[(proc text) Question proposed. (proc text)]
The Chairman: Mr Gan Thiam Poh.
Mr Gan Thiam Poh (Ang Mo Kio): Chairman, in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] A good healthcare delivery system has to be supported by robust infrastructure. I would like to ask the Minister about the progress of the development plans for our primary and secondary care infrastructure.
Will the Minister share updates on the investments for ILTC? How do we make sure that we have enough beds in our hospitals, nursing homes and care centres to meet the increasing demand of our ageing population? Will the upgrading and expansion of our current infrastructure be enough to meet the targets set in the Healthcare 2020 Master Plan?
In addition, how will the Ministry be integrating \"smart\" technology into our healthcare infrastructure to boost care delivery standards and efficiency, and to reduce costs?
Ms Sylvia Lim (Aljunied): Sir, over the years, I occasionally encountered residents dissatisfied with the quality of care received at our public hospitals. Their grievances range from an unexpected death in hospital, to a physical accident while conveying a patient, causing patient injury.
In cases of unexpected death, the Coroner and the Police are likely to be activated, ensuring a strong measure of independence into the inquiry. However, in non-fatal cases, the hospital is usually the one which conducts an investigation or review into the incident.
As the hospitals are investigating their own handling of patients, a question that arises would be: what safeguards are there to ensure there is independence injected into the review process? How far is input from patients or next-of-kin sought in such investigations? Will the patient or his representative have the opportunity to contradict evidence presented by the staff? What role does the Ministry itself play in ensuring that hospital investigations are fair and transparent to patients?
In a 2004 article entitled \"Quest for Quality Care and Patient Safety\", MK Lim of the National University of Singapore (NUS) Faculty of Medicine noted that Singapore had more than 10 years ago, moved to a broader concept of quality assurance in healthcare that included the monitoring of clinical indicators and medical errors. According to him, what was lacking then included public involvement and patient empowerment. Have we made any improvements in these areas?
I am aware that MOH has since moved on and now has a healthcare performance group that oversees clinical quality and care effectiveness. Could the Ministry tell us more about the priorities of this group?
Finally, the United Kingdom (UK) in 2017 set up its Healthcare Safety Investigation branch, an independent body to conduct no-fault reviews of incidents to enhance patient safety and knowledge sharing across healthcare institutions. How are we doing this here?
Mr Low Thia Khiang (Aljunied): Chairman, Sir, personalised medicine which involves the customisation of medical treatments to specific patient groups based on genetic profiles, seems to be a fast-emerging field of clinical research and application in Singapore. But I believe the general public knows very little about this.
There is, for example, the National Precision Medicine Initiative, which appears to need supercomputing resources to gather the genomic information of the whole Singapore and Southeast Asian populations to determine genetic risk and other personalised treatment.
Can the Minister share more about the National Precision Medicine Initiative and whether MOH has oversight of the Initiative and its programmes? What is the long-term plan for the development of precision medicine in Singapore? Will a national registry of genetic disorders be developed? If so, how will it be used and how will the data be shared, nationally and internationally? Does precision medicine research here involve deoxyribonucleic acid (DNA) editing? If so, what are the bio-ethical rules governing the research?
In March last year, MOH announced that the standards for the provision of clinical genetic testing were being drafted and would be ready as a code of practice by late 2017 before becoming enforceable in late 2018. Is the Ministry still on track with this timeline?
It was reported in The Straits Times in August last year that hundreds of patients have already benefited from personalised medicine treatments in Tan Tock Seng Hospital, KK Women’s and Children’s Hospital (KKH) and Singapore General Hospital (SGH). I would like to know how will ordinary Singaporeans benefit from precision medicine and how will the Government manage the cost of its widespread usage.
The Chairman: Assoc Prof Fatimah Lateef. Not here. Dr Chia Shi-Lu, please take both cuts together.
Dr Chia Shi-Lu: Sir, the objective of the Health Insurance Task Force (HITF) is to study ways of improving private health insurance in Singapore in order to achieve more efficient and sustainable outcomes for our healthcare system. This is important as close to two-thirds of Singaporeans currently have an integrated health insurance plan.
In its report that was released in 2016, HITF had recommended a few things, the first being the publication of medical fee benchmarks to help raise price transparency so that patients can make more informed choices. The fee guidelines are expected to be published sometime this year. The intention is to rein in escalating healthcare costs and ensure that medical services and goods remain affordable and accessible to all Singaporeans.
The second recommendation was that HITF noted in its report that there were private insurance features and riders that \"provide policyholders with 100% coverage without any co-payment\", and they expressed their concern that the absence of co-payment may encourage both over consumption and over servicing in regard to medical care. And I note from the report in today's papers that the six Integrated Shield Plans (IP) insurance have appealed to MOH to make co-payments compulsory.
Finally, HITF also made other recommendations to manage IP claims costs, such as the use of a panel of preferred providers and pre-approval of claims. What is the status of MOH's review on the HITF's report and recommendations?
Over the years, MOH has liberalised the use of MediSave for outpatient medical costs, and I would like to ask if MOH would consider further enhancements to the Chronic Disease Management Programme (CDMP) and also the Flexi-MediSave Scheme, which allows the elderly to utilise more of their MediSave for outpatient medical expenses. Will the Ministry consider raising the Flexi-MediSave sum? Would MOH consider liberalising the use of MediSave for the cost of other allied services, such as physiotherapy, or perhaps the use of consumables for chronic conditions like heart disease and diabetes?
As I often call for during the COS debate, I would like to ask the Ministry to include more chronic conditions under CDMP. I have always felt that this is an excellent programme and feel that it should be expanded wherever possible. Including more conditions beyond the 19 already included will reduce the cash outlay required and encourage patients to be more compliant with treatment.
I would also like to renew my call for the CDMP withdrawal limit to be calibrated to the number of chronic conditions that a patient has. Thus, a patient suffering from three chronic illnesses should perhaps be allowed to withdraw a little bit more than a patient who only has one chronic illness.
Mr Zainal Sapari (Pasir Ris-Punggol): Sir, in Malay.
(In Malay): [Please refer to Vernacular Speech.] Raising special needs children comes with a lot of challenges. Undoubtedly, it can be financially straining to families and parents who are taking care of these children. Even though Singapore has a support system that helps to lighten their load, there will still be occasions where it can be financially draining, especially when paying for the costs of medical treatment for these special needs children.
Recently, one of my residents with moderate income had to postpone the basic dental treatment for his special needs children due to the high cost since the children had to be administered with general anaesthesia. These problems do surface when caring for special needs children.
Would MOH look into the possibility of allowing such parents to tap on their MediSave account to pay for the outpatient treatment for those who have special needs children, if the bill exceeds a certain amount?
Mr Louis Ng Kok Kwang (Nee Soon): CDMP is meant to allow patients with chronic conditions to use MediSave and reduce out of pocket expenses. However, it currently covers only two auto-immune conditions, that is, rheumatoid arthritis and psoriasis.
Members from the Auto-immune Illness Support Group Singapore have bravely shared with me about their conditions, which are lifelong, chronic and not curable. They can only manage their symptoms by regular doctor visits and long-term medications, without which it can result in serious complications and prolonged hospitalisation. Because of individual reactions to medications, some have no choice but to take high-cost, non-subsidised medications.
Based on an internal survey by the group, there is a huge range and no single most common auto-immune condition. Will the Ministry consider including more auto-immune conditions into CDMP, allowing patients to use their MediSave and relieve their financial burden?
Mr Leon Perera (Non-Constituency Member): Mr Chairman, Sir, some vaccines, like pneumococcal and human papillomavirus (HPV), are not subsidised but can be paid for using MediSave. Minister Gan said, in reply to Mr Low Thia Khiang at last year's COS, that Government MediSave top-ups can be used to pay for vaccines.
However, many Singaporeans may not want to use MediSave for vaccines, preferring to keep the MediSave for bigger bills incurred later in life. The HPV vaccine, for instance, can prevent most cervical cancers, saving lives and cost, but only about one quarter of Singapore women are vaccinated.
I have two suggestions. Firstly, can ECI consider studying and quantifying the marginal benefit in disease incidence and marginal long-term cost saving for the Government in healthcare subsidies, MediFund and so on from the increased vaccine take-up that a bigger subsidy for the vaccine price would bring?
Secondly, can MOH study, by way of perhaps a trial, to what extent lowering vaccine prices through targeted Government subsidies for key vaccines would result in higher take-up of the vaccine?
Based on these two actions and their results, my suggestion is that MOH can introduce targeted subsidies to greatly reduce the price of vaccines if there is evidence that this would stimulate higher take-up and not only reduce disease incidence later in life but reap long-term cost savings for the Government.
Mr Murali Pillai (Bukit Batok): Sir, I wanted to start off my speech by stating that this is the third time I will be speaking on this topic in Parliament and I hope that I would be third time lucky. But as it turns out, I do not have to implore for a third time.
Senior Parliamentary Secretary Assoc Prof Muhd Faishal Ibrahim announced in this House just about two hours ago that from 1 April 2018 onwards, the Ministry of Social and Family Development (MSF) and MOH have agreed to use an additional yardstick, in the form of MSF's Client Assessment Form, to evaluate the level of support a mentally disabled person requires to perform Activities of Daily Living (ADL).
This, in turn, will determine the eligibility of caregivers of mentally disabled persons to qualify for a foreign domestic worker (FDW) levy concession of $60 per month or a grant of $120 per month. MSF estimated that about 1,000 caregivers will benefit from the enhancing of the system. I welcome the announcement.
With the implementation of the new system, we would be removing an anomaly that has previously existed. Depending on circumstances, many mentally disabled persons are effectively in the same position as young children as they can only perform ADL under supervision. Yet, their caregivers did not get the levy concessions and grants that caregivers of young children did. I am sure these affected caregivers will warmly welcome this announcement.
Assoc Prof Faishal announced that the evaluation of support level for mentally challenged care recipients will be done at Day Activity Centres and Therapy Hubs. It seems to me that appropriate resources and tools would have to be provided to the Day Activity Centres and Therapy Hubs so that they can better assess the mentally challenged care recipient's needs level. The officers would have to contend with a wide spectrum of mental conditions, too. I would welcome MOH's elaboration on the system that will be implemented in three weeks' time. Without a doubt, though, we are moving in the right direction.
The Chairman: Assoc Prof Daniel Goh, can you take both cuts together?
Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Chairman, Sir, we have many agencies and programmes promoting mental well-being and assisting Singaporeans with mental health issues. The National Council of Social Service (NCSS) publishes the Mental Health Resource Directory on its website. The Directory is 60 pages long and there are 11 helplines listed in it. By 2021, the Agency for Integrated Care (AIC) will manage 50 community outreach teams to raise awareness of mental health, identify those at risk and conduct preventive care programmes. Also, by 2021, the Mental Health General Practitioner (GP) Partnership Programme run by MOH will partner 180 GP clinics to manage patients with mental health issues.
With these programmes and resources, we have the elements of a mental health support system in place in Housing and Development Board (HDB) estates. By themselves, the programmes and resources can be too complex for a person with mental health issues to navigate. The next step, thus, is to bring the elements together and integrate them to build a system that is easily accessible to people with mental health issues or their family, with a No Wrong Door policy to direct persons to the most appropriate help.
I have two questions in this regard. Just as AIC has been designated as the central agency to coordinate diverse senior care services to better deliver care to our seniors, should there be a central agency to coordinate mental health care services? Secondly, we already have an accessible network deeply embedded in HDB towns that coordinate the delivery of services to residents. This is the network of Social Service Offices (SSOs) under MSF. Would it make sense for MOH to partner MSF to leverage the SSOs to coordinate mental health care services in the heartlands?
Dementia is the most prevalent neuro-degenerative disease that affects an estimated one in 10 people aged over 60. There were over 40,000 seniors suffering from dementia in 2016. This is expected to rise to 92,000 by 2030. Dementia poses significant health and socio-economic burdens to patients and caregivers and to society as a whole.
I would like to propose for the Ministry to seriously consider a National Dementia Plan that systematically addresses the needs of dementia patients, promoting public awareness and improving the quality of healthcare, social care and long-term care support and services for all affected. Countries like Korea, Japan and Australia are implementing similar high-level plans, making dementia a public health priority. These plans include accessible early detection services, access to information, pre- and post-diagnosis care and support, as well as supporting people with dementia in aged communities to remain socially engaged and active.
In 2016, AIC was discussing plans with stakeholders to develop a national registry of dementia patients so that they can be more easily located if they go missing and their caregivers contacted. However, these plans were put on hold last year. Would the Minister give an account of why the plans were put on hold? Were there issues with getting the consent of families? Were there issues with implementation linked to the registry held by the Neighbourhood Police Centre in Yishun, as part of the dementia-friendly community initiative launched there in 2016? Would the plans for a national registry be revived?
Miss Cheng Li Hui (Tampines): Sir, with an ageing population, we will see an increase in the number of Singaporeans with dementia.
There are a few types of dementia and it is possible to lower the risk of dementia through lifestyle choices and habits, such as staying mentally active, socially engaged and physically active. Knowing the warning signs and symptoms of dementia can help patients and their families discover their condition earlier and help them better manage.
MOH has previously launched a few dementia friendly communities (DFCs) where the community at large knows what dementia is and better support the persons and their caregivers. Can MOH give us an update on DFC's efforts and what plans does the Ministry have in the pipeline to further enhance our current efforts to better cope with the higher number of Singaporeans with dementia?
Ms Joan Pereira (Tanjong Pagar): Chairman, with an increase in our ageing population, more seniors will be facing mental health issues. They may suffer from depression, memory loss and dementia. This poses a challenge not only to the seniors but also to their caregivers and family members. Their mental illness can result in their being isolated from the society.
We are already seeing cases of our elderly living alone, perhaps because the spouses have passed on, and gradually they go into depression and some would be gripped by dementia. Some have no relatives or friends to care for them. They become dependent on social workers and the community volunteers to give them the support in their twilight years. We need to prepare ourselves for more of such cases, as improved medical care is seeing people living longer lives.
How is the Ministry making mental health services more accessible to support these seniors with such conditions? Also, how can their caregivers and their family members be better supported?
The Chairman: Assoc Prof Fatimah Lateef. Not present. Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Sir, due to our ageing population, the demands upon our healthcare providers are expected to escalate. As this is a labour-intensive sector, our manpower shortage has to be overcome through enhancing productivity and innovation. How is MOH encouraging innovation and spurring productivity in the healthcare sector? Would the Minister elaborate on process improvements which have contributed to better patient care and experience and boost productivity gains in different segments of our medical sector?
Tremendous gains are being made every day in the fields of robotics, artificial intelligence (AI), big data analytics and the Internet of Things (IoT). These have the potential to vastly improve healthcare delivery and outcomes. How are we leveraging such positive disruptions in healthcare services for Singaporeans? Would the Minister share an update on the investments the Government is making to boost automation and tap upon new and innovative technologies to provide quality, affordable healthcare?
Increasingly, the healthcare sector will have to work closely with diverse fields, such as information technology (IT), engineering and biotech, to come up with innovative healthcare solutions but, at the same time, without losing the human touch. What are some of our local success stories in innovative research and cross-sector collaboration?
Mr Leon Perera: I declare that I am the Chief Executive Officer (CEO) of an international research consultancy whose Korean arm has researched this subject.
Mr Chairman, the Korean Silver Town model is worth a closer look since it is a roughly S$10 billion industry and it has had a long runway in Korea, evolving over the decades. In Korea, private sector Silver Towns emerged in the 1990s. Initially, they were driven by big conglomerates or chaebols, which developed a site for senior residences but also built in proximate facilities like retail, personal services, sports and recreation facilities and even, in some cases, childcare and play facilities for the grandchildren when children visit their parents.
The Korean Silver Town model emphasises high-rise, high-density living, integrating smart technology, which is a little different from the assisted living and retirement community models seen elsewhere. Silver Towns in Korea have since evolved. There are different Silver Towns in Korea with different mixes of facilities catering to different price points.
Silver Towns embody a balanced point between, on the one hand, personal independence and freedom to seniors and, on the other hand, the presence of medical staff, facilities and the most structured daily routine administered by professionals for those seniors who need it, such as those having dementia.
I do not suggest Silver Towns as a substitute to seniors staying with their children. However, for some seniors, this is not possible while, for others, this is not desirable. So, Silver Towns could be part of the ecosystem, catering to the needs of our seniors, offering one option for living arrangements. Lest I be misunderstood, I do not advocate that Silver Towns be run by the Government, as some are in Korea, or come with 100% subsidies.
The roadmap to this could be, after the concept has been studied, to issue a tender to invite master developers to build and operate a Silver Town. A pilot project could be used to test demand. Means-tested subsidies could perhaps be applied in some cases.
The Government could also nudge Silver Towns to become testbeds for the trial of new, disruptive concepts catering to the senior community and make it convenient for non-government organisations (NGOs) to target and trial programmes aimed at seniors.
Sir, Korean Silver Towns are not without their negative points, but I hope that the Government will study this idea further.
Miss Cheng Li Hui: Sir, in the past, nursing homes were mainly operated by voluntary welfare organisations (VWOs). Recently, private companies have been taking over the operations of nursing homes. How does the Ministry ensure that nursing home prices are kept at an affordable price?
My main concern is whether the objectives and goals of the private companies are able to be aligned with the business model of the nursing home. If the profit maximisation approach is adopted by these companies, then we could see the undesirable rise in charges that will inevitably drive up the cost of nursing care.
When needed, how does MOH get the private nursing homes to meet changing trends to include new services that the nursing homes might not previously have, services, such as home personal care, home nursing or nursing posts to help residents change bandages and so on?
Miss Cheryl Chan Wei Ling (Fengshan): Sir, accessibility and affordability are key in giving Singaporeans greater peace of mind about healthcare. But much of these actions are augmenting the support rather than preventive. As we extensively focus on how to enable the Baby Boomers to age in place, we must begin thinking of strategies to ensure that the Generation X/Y is managing their health on a different trajectory, a trajectory where the starting point of their mental and health state are healthier, with lower dependence on medication and the need for longer-term care needs in future.
It is common knowledge that we must eat well and exercise frequently to stay fit. But apart from health campaigns or one-off activities like the National Step Challenge, Let Us Beat Diabetes, how has MOH engaged the Generation X/Y on a continuous basis to ensure that we have a future ageing population that is healthy?
I say we need longer-term plans. First, on exercising. Given the busy schedule of our young working adults, accessibility to exercises is critical. The community exercise initiatives by HPB and Active SG are encouraging. It not only provides exercise options close to their homes but also encourages community bonding. Is there any plan for MOH to keep this interest towards a healthy lifestyle more sustainable?
Second, healthy eating habits. Variety and ready availability of food choices today have spoilt our consumers at a young age. With their busy lifestyles, more families are dining out and consuming more, as shown in the National Nutrition Survey. While food preference may be individual, some policy adjustments can help with mindset change in dietary habits. Some areas for consideration I would like to put up are: (a) types of ready-processed food allowed to be sold in vending machines near the residential neighbourhood, medical facilities and Institutions of Higher Learning (IHLs); (b) proportion of meal sizes sold in hawker centres and food courts at commensurate prices; and (c) inculcating the concept of discipline in healthy food intake rather than mere caloric value of every bite.
As we understand there is a growing need for caregiving support to our elderly, we are constantly looking at ways to supplement this network of caregivers. This effort can enhance the supply and we must continue doing so. But as we extend this support through FDWs to future robots, we should not forget the human touch. The emotions and human interactions remain the backbone of caregiving.
I would like to highlight a specific group which MOH can consider tapping upon. There is a pool of low-income women and single mothers, estimated to be 25,000, representing a third of Singapore's unemployed population. Some of them had roles of caregiving to their families, and certainly many still bear the brunt of caring for their own children. Their unfortunate family circumstances aside, these women require the necessary skills to gain confidence and rebuild their lives. But beyond themselves, what we can potentially change here is the provision of employment and lifting their families out of poverty in a dignified way.
There are VWOs like Daughters of Tomorrow (DOT) which began in 2017 to provide professional training skills for these women in eldercare services. They have successfully placed them in the eldercare sector or as freelance caregivers. With the strong push for Community Network for Seniors (CNS), MOH can assist by working with these VWOs to identify a pool of known resources and accelerate the training of the individuals through funding or fill the gaps in resource deployment. As a start, these beneficiaries can be assigned to work within the community where they live in. The benefits are two-fold, as they can manage caring for their family and also be gainfully employed. Over time, I hope these women will also have more options in employment and can better care for their own elderly at home and be financially independent.
Lastly, Seniors' Mobility and Enabling Fund (SMF). Today, SMF provides the seniors with subsidies for assistive devices and homecare items or transport. But there are those seniors whose annual value of property do not fall under the current criteria and may also face challenges. With the advent of technology, we should look beyond direct subsidies into social outcome to benefit the larger group of seniors. For example, social partnerships with the private sector in creating environment and alert tools from remote operating centres that can deploy assistance to those seniors in need. Or to provide home-based care products and services, where it also monitors health and movement conditions of seniors.
Another way is to create new funds for app developers who can create socially engaging apps aimed at active agers or to draw experience from those who understand the mindset of how an elderly reacts, for example, like Mdm Masako Wakamiya, 82 years old, who is one of the world's oldest app developers. We should creatively generate options and create accommodative relief for individuals and families, rather than one where individuals are more likely to become supplicant recipients of charity.
The Chairman: Ms Tin Pei Ling, can you take both cuts together?
Ms Tin Pei Ling (MacPherson): Sir, with Singapore undergoing rapid ageing, it is not only important that we set the right policies, put in the right resources and organise ourselves the right way now, but we should also start exploring solutions that can help more seniors age gracefully and live independently in the comfort of their own homes and communities.
With an ageing population, there may soon be a point in time when there are more who need care than those who can care. Other concerns also include seeing more with age-related disabilities and loneliness, as more elderly outlive their family members or as more choose to remain single.
While the human touch in eldercare can never be fully substituted, we can leverage technology to mitigate some of these concerns. By leveraging technology and AI more effectively, we can drastically change how care is provided and help even more Singaporeans age in place.
At present, many of the technology-related pilots conducted are focused on making the living environment more enabling, which is the right thing to do. I am also aware that there are some solutions, such as telemedicine and marketplace applications, to help seniors live more conveniently. But I hope we will also start exploring solutions that can provide effective and transformative interventions to help individual seniors live independently.
Take Japan as an example. Japan is even further ahead of us in terms of ageing. They have an increasing number of elderly with a decreasing number of working adults. They suffer severe labour shortage, especially in eldercare nursing. Yet, they reinvented how the elderly can be cared for by leveraging technology and AI. From Toyota's Robina and Humanoid, Honda's ASIMO, Tokai's RIBA to AIST's PARO, which is a very cute seal, Japan has a full range of robots that can help the elderly with household chores, to get out of bed, conduct conversations complete with emotions and even help paraplegics walk again. Imagine if these solutions are available to us in Singapore, many elderly whom we used to think can only be cared for in nursing homes, can now lead a fairly independent life in their own flats.
Alas, while these are possible and already in existence, it is still not known if these solutions can be exported and at what price. It would, therefore, be most ideal if Singapore can leverage our existing competencies in research and development (R&D) to develop digital eldercare solutions for ourselves.
I understand that MOH had introduced a funding scheme to encourage innovations to solve elderly-related challenges. Therefore, I would like to ask for an update on the utilisation of funds to support R&D efforts and startups looking into digital eldercare solutions. Could the Government share some of the success cases so far? Could we accelerate developments locally and implement sooner than later?
With the drive towards a Smart Nation, how is the Ministry part of this effort and what other programmes or public-private partnerships might be available that can be utilised to further our agenda for seniors?
Sir, I have just spoken on the use of technology and AI to transform eldercare and enable more seniors to live independently in the comfort of their own homes and communities. I am also aware that the Government has been looking into ways to make our living environment more elderly-friendly with initiatives, such as City for All Ages, Enhancement for Active Seniors (EASE) and other general upgrading programmes. These are great efforts in retrofitting hard environments to become more enabling.
However, it is the details that often make the difference. Therefore, designing with the elderly in mind, ensuring that products, services and the real or virtual environment that we are immersed in are inclusive and empowering is important. We should design to include and empower our seniors. We must not design only with the \"majority\" in mind, who used to be younger, and expect the rest to comply or find their own solution. Even this \"majority\" is getting more mature. Moreover, what is designed for the elderly, surely must be suitable for the young, too.
Hence, we should conscientiously and actively apply elderly-friendly designs into all our hardware and heartware solutions. Currently, there are only two silver industry guidelines in Singapore. One is the \"Guidelines for age-friendly homes\" and the other is the \"Guidance for digital devices and online services to be senior friendly\". These are a good start, but we need to mainstream elderly-friendly designs much more and make them pervasive. We need to apply elderly-friendly designs to the development of common spaces, facilities, machine and application interfaces, workflows, public processes and more. The key is to make them pervasive such that seniors can move from setting to setting smoothly and live a completely normal life.
No institution or country so far has been an authority in terms of setting elderly-friendly design standards. Singapore can take the lead in setting elderly-friendly standards and be the authority in this area. We are already doing so much to get ourselves ready for an ageing population, I believe we should look into this area.
Therefore, I would like to ask if the Ministry will consider setting up an office that does research, set standards and audit public and private projects to ensure elderly-friendliness. Is there effort to train more students in elderly-friendly designs? And perhaps, would the Government consider creating specialisations for students to undertake in tertiary institutions?
The Chairman: Dr Lily Neo.
Dr Lily Neo: Sir, I am happy that MOH will take on policy ownership for the spate of aged care services across both the health and social domains from April this year. This will enable the long-term needs of our seniors to be catered more comprehensively. As I have said in my Budget speech, I hope MOH will spell its objectives clearly for a good outcome.
The operation details will need a lot of consideration and supervision. It will need the considered effort of Senior Activity Centres (SACs), stakeholders and staff to come on board with a shared mission. Some centres may have become entrenched in their own ways of operation and MOH may face and need to address some resistance to change.
Will MOH adopt the concept of physical, mental and social well-being for the seniors in the Senior Cluster Network (SCN) so that these seniors can stay active and healthy through having daily balanced nutrition, physical activity and cognitive stimulation?
Thus, daily meals and activity programmes must be provided with an aim in mind, that is, to assist these seniors remain in the community and ward off frailty, diseases and immobility.
May I ask MOH what kind of emphasis will be placed on these aged-care services? How many administrative staff and medical staff will be deployed to manage the present SCN? Are there enough personnel to take over the transfer from this April? Is MOH poised to train present and future personnel to provide for these aged care services? Will MOH be planning to provide SCN centres in more constituencies? Will MOH consider setting up SACs for every cluster precinct of 1- to 2-room flats as surveys have found that seniors who live in this type of housing tend to be more frail?
Community Aged Care Services will require many social and medical personnel, especially for seniors who are house-bound with partial or full disability. I hope MOH will spare no effort to provide these personnel as it will determine the outcome of these services. Could MOH train healthcare workers and consider using not only full-time paid personnel but also family members, community volunteers and so on? Healthcare aides can be trained for specific skills, like simple dressing of wounds, simple grooming, toe-nail cutting for non-diabetics using sterile techniques, assisting with feeding, catheter care, prosthesis use and so on. This will free up medical staff like the nurses.
I am also happy that AIC will act as the single agency on delivery of holistic aged care services to seniors across both the health and social domains. Many seniors living alone with medical conditions and mobility problems can be managed at home with these holistic services.
Like the one at Chin Swee, AIC assists with the nurses and healthcare aide team that look into the needs of the seniors daily in supervising their medical conditions and daily living essentials. A team of one nurse and five foreign healthcare aides, together with SAC staff and grassroots volunteers, can look after a few hundred residents. This has enabled residents to have lesser frequency of hospital visits and enabled them to stay in their own homes despite their illnesses and immobility.
With AIC under MOH being the agency in charge of SACs, I feel that we can achieve better preventive healthcare, meaning early detection and treatment with better follow-up of patients to achieve good outcomes in preventing irreversible medical conditions that result in permanent impairment in health and mobility. I hope that such models of care can be expanded quickly as we are fighting a tide of the increasing numbers of seniors who can benefit from such holistic care services.
There are health and social benefits in volunteering. It offers seniors significant physical, emotional and cognitive health benefits. Could MOH promote volunteerism in seniors? Could MOH provide a broader spectrum on the types of volunteering to attract more seniors? Can these seniors be reimbursed for volunteerism similar to the Pioneer Generation (PG) ambassadors?
I hope MOH will spare no effort in ensuring this new initiative takes off well, to enable seniors to stay healthier and happier and age more gracefully in place, living with their loved ones in their own homes, and in their familiar environment in the community.
The Chairman: Ms K Thanaletchimi, you have two cuts. Please take the first cut only.
Ms K Thanaletchimi (Nominated Member): Thank you. Sir, I welcome the integration of social support and health under AIC that comes under MOH. However, I hope the services provided are more holistic and sustainable.
I would like to call for the Senior Network Centre to be a one-stop service centre providing holistic services for seniors beyond social and health. Skills training with services for employment and employability and active ageing programmes can form part of this enhancement. The one-stop service centres should be easily accessible near to the homes of the seniors, and the programmes should be cost-effective and affordable.
It is important to care for the mental health of seniors. At age 65, some seniors may have retired or are about to retire. Besides the loss of income, these seniors may also feel less purposeful and bored without daily work to occupy their time. Willing seniors with capability to contribute can be assisted to transit into less demanding jobs with shorter working hours. With their new-found time on hand, some seniors may also be interested to pick up new skills or knowledge. This interest in lifelong learning should be encouraged and supplemented with learning institutions’ recommendation of courses based on individual interests.
This centre can also be a conduit to all relevant services that may be required by the seniors. Some examples include providing awareness of advance care planning, lasting power of attorney (LPA) and understanding of the various Government schemes, such as ElderShield, MediShield and the Community Health Assist Scheme (CHAS). The current PG Ambassadors can help to support this one-stop service centre for seniors.
The seniors who benefited from the service centre are also the best ambassadors to encourage and guide other seniors to access the services provided. A volunteer network can also be developed among these seniors for them to give back in other areas of the community, such as healthcare.
It is essential for a well-established facility to be complemented by professionals. As such, it is equally important to ensure that the support staff running these service centres are adequately equipped to support seniors, attend compulsory training in basic geriatric services, have relevant language proficiency and are able to identify mental health issues among seniors.
The initiative to integrate the SCN and AIC will surely help to streamline and consolidate the services provided by the respective agencies to better support seniors in Singapore. However, will there be current jobs at risk or new jobs created with this integration effort? What new skillsets are required to better prepare integrated AIC staff to better manage both social and health issues so that there can be cross-training and learning opportunities? Employees of SCN moving over to AIC must be engaged early and transited with no less favourable terms and conditions as a package. There must be efforts to integrate the employees of AIC and those from SCN for better team coordination and morale to serve the seniors better.
The Chairman: Minister for Health Gan Kim Yong.
The Minister for Health (Mr Gan Kim Yong): Mr Chairman, first, let me thank all the Members for their comments and the suggestions. With your permission, may I display a few slides?
The Chairman: Yes. [Some slides were shown to hon Members.]
Mr Gan Kim Yong: Today, Singaporeans are living longer and our Health Adjusted Life Expectancy, which estimates the number of years a person is expected to live in good health, remains one of the best in the world, at 72 years for males and 75 for females. Women always beat men in this.
But we cannot afford to be complacent. Our population is ageing rapidly, with a growing chronic disease burden. About three in four Singapore residents aged 65 and above are affected by diabetes, high cholesterol or hypertension or a combination of these three. If nothing is done, diabetes, for example, is projected to affect more than one million Singaporeans by 2050.
We want to not just live long but also live well. To do that, each of us must also do our best to adopt a healthy lifestyle. We also need a good healthcare system that is both accessible and affordable.
Dr Chia Shi-Lu asked about our progress on Healthcare 2020 which outlined our strategy to improve accessibility, quality and affordability of healthcare. We have made good progress but much needs to be done from now until 2020 and beyond.
Over the next few years, we will continue to add healthcare facilities across Singapore. To the north, we are developing Woodlands Health Campus, which will be ready progressively from 2022. Down south, we are developing Outram Community Hospital and the new National Cancer Centre as part of the redevelopment of the Outram Campus. In the north-east, we are on track to open Sengkang Hospitals later this year. The new Changi General Hospital Medical Centre in the east will also be ready this year. In the west, we look forward to the new Centre for Oral Health at the National University Hospital (NUH). Not forgetting the central region, where the Integrated Care Hub and National Centre for Infectious Diseases are being built at Novena.
Since 2011, we have added 1,700 acute hospital beds, 1,200 community hospital beds, and 5,300 nursing home beds. To support ageing in the community, we have also added 4,200 home-based and 2,900 centre-based care places. We have also grown our healthcare workforce by about 25,000, or about 36%, since 2011.
To ensure healthcare remains affordable to Singaporeans, we increased subsidies at outpatient clinics and enhanced CHAS for primary care, commonly known as the Blue Card and the Orange Card. In 2015, we introduced MediShield Life for inpatient care.
We are also investing in a future-ready workforce that will anchor the transformation of our healthcare system. Senior Minister of State Amy Khor will elaborate on our plans to grow and upskill our healthcare manpower later. We need to innovate and find new ways to deliver quality care to patients in a more effective and efficient way and for better outcomes. For example, at Pioneer Polyclinic, which opened in July 2017, patients are cared for by a team comprising doctors, nurses and allied health professionals. Having a regular primary care team will ensure better continuity of care for patients. This is one of the many initiatives that has improved the quality of care.
Sir, our continued investment in healthcare means higher National Health Expenditure (NHE). NHE has increased by more than 60% in five years, from $10.9 billion in 2010 to $18.9 billion in 2015. At 4.6% of gross domestic product (GDP), this is lower than most developed countries, but we expect this to rise over time as our population ages.
On the other hand, Government expenditure on health grew twice as fast, by about 120% over the same period, to fund infrastructure investments and to keep healthcare affordable for Singaporeans, by reducing their share of out-of-pocket expenses from about 40% to 30%. With the introduction of the PG Package and MediShield Life and the extended use of MediSave, the out-of-pocket for eight in 10 subsidised hospitalisation bills was below $100. But we cannot simply keep increasing subsidy or insurance payouts. Higher insurance payouts will result in higher premiums or higher subsidies will need to be funded. All these will be borne by Singaporeans eventually through higher premiums and higher taxes.
Therefore, we need to take a long-term view on this. Even as we implement Healthcare 2020, we need to look beyond 2020 and make three key shifts to ensure our healthcare system is future-ready. The Three Beyonds, which Dr Chia Shi-Lu reminded us about, provided the roadmap to a sustainable system beyond Healthcare 2020.
First, we are going Beyond Hospital to the Community. Over the last decade, we have increased our total spending in the primary care and ILTC sectors by close to four times, from $1.3 billion in FY2007-2011 to $5.1 billion in FY2012-2016. These investments reflect our priority to anchor care firmly in the community. As we continue to invest in community care, we also need to bring social and healthcare services closer to better serve our people. This has led to the formation of the Silver Generation Office (SGO) as well as expansion of Community Networks for Seniors (CNS), which I elaborated earlier in my speech on SG Cares.
Senior Minister of State Lam Pin Min will share later how we are strengthening primary care for the future. Six new polyclinics are being built under Healthcare 2020; two are already open, and four more to come by 2020.
We will add another six to eight new polyclinics by 2030. This is part of our commitment to ensure Singaporeans can access primary care closer to their homes. We are not just building polyclinics; we are also partnering private GPs through the Primary Care Networks (PCN) to offer subsidised team-based care in the community under CHAS.
Our second shift, Beyond Quality to Value, plays a pivotal role in ensuring sustainability. We adopted a multi-pronged approach to manage healthcare costs.
We set up the Fee Benchmarks Committee earlier this year to provide a reference to guide doctors in setting reasonable fees and to help patients to make informed choices on their care options. We established ACE to provide guidance on cost-effective drugs and treatment, and I thank Dr Chia Shi-Lu for supporting the work of ACE. We also introduced the Healthcare Productivity Fund to spur productivity improvement efforts in our healthcare institutions. But we need to do more.
Mr Chairman, co-payment has been an integral feature throughout all our healthcare schemes, including MediShield Life as well as IPs. It plays an important role in ensuring our healthcare system is sustainable by emphasising personal responsibility in healthcare, by encouraging service providers to focus on appropriate and cost-effective interventions, and by nudging patients to make prudent decisions in healthcare services. This is important as it ensures that all stakeholders, including patients, have a stake in their decision.
As Dr Chia Shi-Lu pointed out, some private insurance policies offer zero co-payment coverage. They are called \"full riders\". Such riders encourage a \"buffet syndrome\" as patients do not need to pay anything when they receive medical treatment. It undermines the co-payment principle and dilutes the personal responsibility to choose appropriate and necessary care. This will encourage unnecessary treatment, leading to rising healthcare costs not only for those with such riders but for all of us.
Therefore, MOH has been working with the insurance industry and we have issued a set of new requirements to IP insurers which will be applied to all new rider policies. We will require them to have co-payment features going forward. Senior Minister of State Chee Hong Tat will elaborate more. This will encourage responsible behaviour by both patients and healthcare providers.
We will continue to review our healthcare financing policies to ensure that co-payment remains affordable, through targeted subsidies, MediSave use and for those who still have difficulties, MediFund will be a safety net. No one will be denied appropriate healthcare because they cannot afford to pay.
But ultimately, the best way to beat rising healthcare costs is to stay healthy. This is a focus of our final shift Beyond Healthcare to Health. Parliamentary Secretary Amrin Amin will give an update on WoD and detail how we are encouraging and supporting healthier lifestyles. We will create a supportive environment for Singaporeans to lead healthy lives, but each of us must do our part.
These three shifts will be a multi-year effort. To support these initiatives, we have taken the first steps to reorganise ourselves. Last year, I announced plans to reorganise the public healthcare system into three integrated clusters. I am pleased to report that the reclustering exercise has been successfully completed. I would like to take this opportunity to thank the unions and management for their support in this exercise, and all our staff who have worked very hard to ensure a smooth transition. That is the good news.
The bad news is that this is not the end. In fact, this is just the beginning of a long journey to create synergy and deliver better care for Singaporeans. Let me share an example. A patient, Mr H, 73 years old, was admitted to SGH after a fall last year. Besides rehabilitation treatment for his fall, he also needed to manage his diabetes and hypertension. Miss Siti Hajar, a Patient Navigator and experienced nurse from SGH, coordinated both his health and social care even after he has been discharged. Miss Siti visited him fortnightly and ensured that his chronic conditions are well-managed from home. As Mr H lives alone in his flat in Kaki Bukit, the CGH Community Care team – now part of the SingHealth team – was activated to accompany him for follow-ups at Bedok Polyclinic and arranged for home help services for him.
I am pleased to know that Mr H's condition has now stabilised, and the SingHealth team continues to provide him with strong support. This is what reclustering is all about – bringing healthcare institutions and the community closer together to provide good, seamless care for patients, such as Mr H, and many others.
Another example of this synergy is the new national integrated supply chain we are setting up. This goes beyond the Group Procurement Office currently run by SingHealth. It pools the whole supply chain's functions, including procurement and resources of the three clusters, together to achieve economies of scale, create greater synergy, develop new capabilities and evolve innovative supply chain solutions. This will yield system-level gains for patients, providers and staff. This will also help to mitigate cost increases and bring greater convenience to patients.
The transformation process must continue. Advances in medical science, increasing digitalisation and connectivity hold tremendous promises for rethinking healthcare.
In addition to progressive improvements, we also need to explore game-changing ideas. That is why we have set up the MOH Office of Healthcare Transformation (MOHT), to identify and experiment with bold innovations. MOHT will focus on longer-term ideas that can be scaled up for system-level transformation.
Some of these ideas will be tested at the health empowering Alexandra Hospital campus which the National University Health System (NUHS) will take over from the second half of 2018. Similarly, we will be initiating the master planning of NUH's Kent Ridge Campus in the West, to see how Kent Ridge can be best positioned to meet future healthcare needs. We have already started some development at the Kent Ridge campus. In 2013, we opened the NUH Medical Centre, and we will be opening the National University Centre for Oral Health next year. The master planning study presents us with the opportunity to plan ahead and reimagine how the future Kent Ridge campus, including the main NUH hospital building, which is more than 30 years old, can be rejuvenated to support current and future models of care.
At the end of the day, we must remember that the state of our health primarily depends on our choices. As far as we can, we must choose to live healthily. This is the key not just to a sustainable healthcare system, but a vibrant society and good quality of life.
Mr Mohamed Irfan is a good example. He is pursuing a sports diploma at Republic Polytechnic. Keeping fit is as much part of his work as it is his passion. Not only is he enjoying the benefits of better health, but he is also going the extra mile to influence others. He persuaded his family to start eating brown rice, more fruits and more vegetables and less fried food. Last year, he co-started a health programme, where he was the health coach. Every week, the group gathers to exercise. Mr Mohamed Irfan believes an active community can motivate individuals to sustain a healthy lifestyle. He exemplifies how taking ownership of one's health can have a ripple effect, to better the lives of many more.
Mr Chairman, I believe that by working together, each of us playing our part, we can bring about Better Health, Better Care and a Better Life for all Singaporeans.
The Chairman: Senior Minister of State Chee Hong Tat.
The Senior Minister of State for Health (Mr Chee Hong Tat): Mr Chairman, a key priority for MOH is to keep our healthcare system sustainable and affordable for this generation and future generations. I will elaborate on our efforts to achieve this outcome under the three Ps: Productivity, Partnerships and Prevention.
Let me start with Productivity. Dr Chia Shi-Lu and Mr Gan Thiam Poh asked how MOH encourages healthcare innovation and productivity.
We set up the Healthcare Tripartite Committee for Workforce Innovation and Productivity in 2016. The Committee has reviewed rules and policies based on ground feedback to streamline work processes, encourage adoption of smart technology and empower different groups of healthcare workers to maximise their contributions.
MOH introduced the Healthcare Productivity Fund (HPF) in 2012. More than 250 projects have been implemented so far, benefiting over 70 public healthcare and community care organisations.
Our productivity movement is achieving good progress. To encourage more to participate and seize opportunities to improve productivity, we will add another $80 million in productivity funding to HPF over the next three years to support our institutions and healthcare workers.
Use of smart technologies will be integrated in existing and upcoming public healthcare facilities to increase system-level productivity, improve patient care and prepare our healthcare facilities for the future.
The productivity efforts extend beyond hospitals to the community. AIC will collaborate with providers to redesign traditionally manpower-intensive processes, such as rehabilitation and showering. AIC will also help providers to adopt assistive equipment, such as ceiling hoists, to ease the physical strain on our healthcare workers.
I will now speak on the next P: Partnerships.
Besides working closely with public healthcare institutions, we collaborate with private sector providers to tap on their expertise and resources. For example, a local startup, Kronikare, developed a smartphone application using AI to analyse wounds. It can do so within seconds to detect early stages of infection, a task that previously required two or more nurses up to 30 minutes to perform.
In the ILTC sector, MOH invites VWOs and private operators to tender for operating rights at our Build-Own-Lease (BOL) facilities, and we partner private operators to provide subsidised nursing home care through the Portable Subsidy Scheme (PSS).
BOL and PSS operators are appointed via competitive requests-for-proposal, where operators propose and commit to their fees and charges for subsidised residents. As Miss Cheng Li Hui said, this can help to ensure prices for quality care remain reasonable. MOH supports providers, including private nursing homes, with manpower development and productivity initiatives.
Mr Chairman, partnerships also mean all stakeholders – patients and caregivers, healthcare providers and professionals, insurers and employers, and the Government – working together on a common goal to keep healthcare costs sustainable and affordable for everyone over the longer term. At the most fundamental level, it is in the philosophy and design of our healthcare financing system.
During the Budget Debate, Ms Sylvia Lim asked if the higher MediShield Life deductible for older policyholders was a form of \"reverse discrimination\". This is not the case. We should look at the complete picture rather than focus on a single observation in isolation. Allow me to clarify.
The MediShield Life Review Committee wanted MediShield Life to be a basic health insurance plan for all Singaporeans. The objective was to provide coverage for large hospital bills based on inpatient treatment at subsidised wards, as well as costly outpatient treatments like dialysis and chemotherapy. For the scheme to remain sustainable, premiums are computed to be actuarially sound. The Government then provides means-tested subsidies and additional premium support to ensure that premiums remain affordable for lower- and middle-income Singaporeans. This is a progressive and inclusive scheme.
On MediShield Life deductibles, the amount is set for each policy year and not for each treatment. The deductible amount can be paid using MediSave and Singaporeans who require further financial support can approach our medical social workers for assistance. As older policyholders incur higher medical bills in each policy year compared to younger cohorts, their premiums are higher to reflect the larger and more frequent claims. There is a trade-off between the deductible amount and premiums, with lower deductible amounts resulting in higher premiums. On balance, the Committee recommended a higher deductible for those aged 81 and above to reduce their premiums.
The Government accepted the Committee's recommendations. Recognising that policyholders will pay higher premiums as they age, the Government has provided higher MediShield Life premium subsidies for older Singaporeans. This is in line with the progressive design of our healthcare financing system, with more Government subsidies going to older Singaporeans and those from lower- and middle-income families.
On average, an elderly Singaporean aged 65 and above obtains more than six times the amount of Government subsidies per year, compared to younger Singaporeans below 65. Besides higher MediShield Life premium subsidies, they also receive 50% more subsidies in polyclinics. For PG, they enjoy further benefits, such as special CHAS subsidies at GP clinics, additional MediShield Life premium subsidies and MediSave top-ups every year.
So, rather than having \"reverse discrimination\" against older Singaporeans, our healthcare system is, in fact, providing them with more financial subsidies. We do the same for the lower- and middle-income Singaporeans. Singaporeans support this financing approach because it is consistent with our values to build a fair and just society.
Mr Chairman, beyond healthcare financing, partnership amongst all stakeholders is also needed to ensure that quality care is delivered at sustainable and affordable cost for Singaporeans.
Since May 2017, MOH has issued Appropriate Care Guidelines on medical treatment and drugs to guide healthcare providers making decisions that are based on clinical and cost effectiveness. Last year, the Singapore Medical Council revised their ethical guidelines for doctors indicating that fees paid to Third-Party Administrators must not be based on a proportion of the doctor's fees, or what is commonly known as \"fee splitting\". This is to prevent unnecessary inflation of healthcare costs.
In January this year, MOH set up a Fees Benchmarks Advisory Committee to recommend and develop fee benchmarks for medical procedures and services. The purpose is to encourage appropriate charging by healthcare providers and enable patients and payers to make better informed decisions.
As I have said in this House at a previous Sitting, most of our doctors do charge appropriately, as they have their patients' well-being at heart. But for the ones who charge excessive fees, please know that MOH is monitoring and will take action against doctors who overcharge.
During the Budget Debate, Ms Sylvia Lim suggested reviewing medical insurance schemes to include deductibles and co-payments, to discourage over-consumption and inefficient use of resources. This was similar to the earlier recommendations from HITF which Dr Chia Shi-Lu has asked for an update. Let me explain why these are important issues and what MOH intends to do.
Every Singaporean Citizen and Permanent Resident (PR) is covered by MediShield Life. Today, about two in three Singapore residents have also bought IPs, and these are private insurance products that offer added coverage.
Both MediShield Life and IPs have co-payment features in the form of deductibles and co-insurance, and their premiums can be paid using MediSave. Among those who have bought IPs, some have paid additional cash, for what is known as \"full riders\". These cover the entire co-payment under the IP plan so that the policyholder ends up paying nothing, regardless of the bill size.
Currently, about 29% of Singapore Residents have these full riders. As highlighted in the HITF's report, the zero co-payment feature of these full riders has resulted in the buffet syndrome, leading to over-consumption, over-servicing and over-charging of healthcare services.
In 2016, the average medical bill size for full rider policyholders was about 60% higher than the average bill size for those without riders, even though rider policyholders are younger and generally in better health. Some of the examples of over-consumption and over-servicing are, to put it plainly, disturbing.
In one case, a full rider policyholder made claims for 12 nose scopes in a year without clear medical need. We also have patients who are admitted for gastritis or piles and then referred to many other specialties ranging from dermatology, ophthalmology, ear, nose and throat, and orthopaedics, for additional scans and tests. The final bill? Up to $25,000 for a hospital stay that was less than 24 hours.
There was also a full rider policyholder who underwent an expensive surgery for a small breast lump removal that cost $70,000 in doctor's fees alone, when there was an equally effective alternative procedure which costs only $5,000.
To be fair, not all doctors prescribed such expensive treatments, and not all full rider policyholders submit such large claims. But it is clear that full riders have a detrimental impact on overall healthcare cost in Singapore. This is a key reason why rider premiums have increased by up to 225% over the past two years.
The negative impact of the zero co-payment feature extends beyond full rider policyholders. Over the last two years, IP premiums have also risen by up to 80%, with older policyholders and those on private hospital plans experiencing higher increases. If this trend continues, I am worried that IP and rider policyholders will find their insurance premiums increasingly unaffordable as they age.
The zero co-payment feature of riders also pushes up healthcare costs in Singapore. Over-consumption, over-servicing, over-charging of healthcare services will lead to faster and larger increases in overall healthcare expenditure. These increases will ultimately be borne by all Singaporeans through higher medical fees, insurance premiums and taxes, which all of us will pay directly or indirectly.
So, I am glad there is support from both sides of the House on the need for co-payment to keep healthcare expenditures sustainable and affordable for all Singaporeans over the longer term. Ms Salma Khalik has also written an insightful piece in today's Straits Times. We have to make a change now to prevent the problem from becoming worse in future.
In line with the HITF’s recommendation, MOH will issue the following requirements for all new rider plans with immediate effect. New IP riders must incorporate co-payment of 5% or more. To address concerns from some policyholders that they may face high co-payment amounts due to the unlikely event of very large bills, the new riders will have a cap on the co-payment amount each year. Most insurers are planning to launch their new riders with an annual cap of $3,000, though they are allowed to set higher thresholds. This places an upper limit on the risk exposure of policyholders, to protect them against very large bills.
New riders will be available within a year. In the meantime, insurers can continue selling their existing rider plans but must inform new policyholders that they will transit to the new riders with co-payment from 1 April 2021. Once the new riders are ready, these policyholders can choose to switch to the new riders earlier if they wish to do so, and any pre-existing conditions that are covered prior the switch will not be excluded. We expect the new riders to have lower premiums than full riders, so the switch will result in premium savings for policyholders.
Let me be clear that MOH is not issuing these requirements to bail out the insurers. Our objective is to address the concerns with overconsumption, over-servicing and overcharging as these will lead to patients and policyholders paying rapidly escalating fees and premiums over time. It will be an unsustainable and undesirable outcome for Singapore, especially when we are ageing as a society.
Policyholders can continue to tap on MediSave to pay for their co-payment amounts under the new riders. At 5% co-payment, half of the inpatient bills in 2016 would have a co-payment amount of $100 or less. Three quarters of inpatient bills would have co-payment of $250 or less. Nine in 10 inpatient bills would have a co-payment of $550 or less. The 5% co-payment can be covered within the current MediSave withdrawal limits for 99% of all inpatient bills.
For private hospital inpatient bills, in 2016, one in two would have a co-payment of $380 or less. Three in four would have a co-payment of $670 or less, and nine in 10 would have a co-payment of $1,270 or less.
The above requirements will apply to new rider policies. We recognise that existing rider policies are commercial contracts between insurers and their policyholders. If insurers intend to make changes to their existing policies, they should consider the interest and well-being of all policyholders as they seek to keep premiums affordable for everyone in the longer term.
The requirements for new riders will not affect MediShield Life and IPs which already have co-payment features. For patients who face financial difficulties with their bills, MediFund remains available as a safety net to ensure they continue to have access to quality subsidised healthcare in our public hospitals.
Let me now move to the third P – Prevention.
An important aspect of Prevention focuses on early screening and intervention. Last year, I announced the enhancements to the Screen for Life programme where eligible Singaporeans can have access to subsidised health screenings at a cost of $5, which includes the first post-screening consultation with a doctor. CHAS cardholders ‒ both orange and blue ‒ will pay $2, while the package is free for Pioneers.
Dr Chia Shi-Lu asked whether the Ministry is considering further enhancements to CDMP as well as the Flexi-MediSave Scheme. I recalled Ms Thanaletchimi had raised a similar query during a previous COS debate.
From June this year, MOH will make the following enhancements to CDMP. These will also broaden the coverage of our CHAS chronic subsidies.
First, we will extend the scope of diabetes to cover pre-diabetes. Based on current trends, one in three people with pre-diabetes could develop Type-2 diabetes within eight years. Through early detection and intervention, we hope more patients with pre-diabetes can improve their condition and avoid developing diabetes.
Second, we will expand the list of CDMP conditions to cover ischaemic heart disease (IHD), bringing the total number of covered conditions to 20. This will benefit all our patients with IHD, even if their condition is not linked to diabetes or hypertension.
Third, we will enhance the support for diabetics who require insulin injections, as they require lancets and test strips to regularly monitor their blood glucose levels. To support these patients, MOH will extend CDMP to lancets and test strips.
In addition, we will raise the withdrawal limit for MediSave400 scheme by 25%, from $400 per year to $500 per year. This will take effect from June this year.
We will also lower the eligible age for Flexi-MediSave, which is currently set at 65. From June this year, Singaporeans aged 60 and above can use up to $200 of their MediSave per year, for outpatient medical treatments at public sector Specialist Outpatient Clinics (SOCs), polyclinics and CHAS GPs. This expansion of Flexi-MediSave will benefit an additional 260,000 Singaporeans between the ages of 60 and 64.
To conclude, Mr Chairman, we need to transform our healthcare system so that it remains sustainable and affordable for all Singaporeans. Productivity, Partnerships and Prevention are key enablers. Everyone needs to play our part to stay healthy and prevent healthcare costs from rising too rapidly. Together, we can achieve better health and a better life for our people.
The Chairman: Ms K Thanaletchimi, can you take your second cut now.
Ms K Thanaletchimi: Sir, one of MOH's key thrusts, that is, \"Beyond hospital to community\" will give rise to more job opportunities in the community sector. As such, will there be current jobs at risks and new jobs created across the healthcare sector? With the expansion of the ILTC sector, how can we better attract locals for the jobs when, at present, 80% to 90% of these jobs are filled by foreigners?
Singaporean healthcare professionals are less inclined to join the ILTC sector due to the perceived prestige, progression as well as the varying remuneration offered, which is less favourable than that provided by public healthcare institutions.
I applaud MOH for the efforts and training programmes it has introduced to attract Singaporeans into this sector in recent years, though more can be done.
To further drive the success brought about by the existing MOH and AIC initiatives to bring locals into ILTC, I would like to suggest a holistic review of jobs, skills training, career progression and remuneration across this sector. Jobs can be redesigned to create higher value jobs that provide areas of growth for the individuals.
Sir, let me declare my interest as the President of the Healthcare Services Employees' Union (HSEU).
For example, in the public healthcare sector, HSEU had worked closely with the healthcare institutions to redesign the career pathway for Patient Service Associates (PSAs). The process included multiple consultation sessions with our members to tailor the job role as they were the key stakeholders. It is essential for them to take ownership of their own future. The union helped to convince our members with the advantages of taking on larger specialised job roles to meet the changing needs of this sector so as to energise them with possible career progression and enhanced remuneration.
With strong union-management collaboration, the redesigned career pathway for PSAs greatly enhanced the attractiveness of the job. Concurrently, it has mitigated the possible redundancy for this group of employees whose jobs are increasingly at risk with the advent of technology.
We should also look at other initiatives to attract back-to-work women, to encourage non-practising nurses to return to nursing and workers from other sectors to join through the Professional Conversion Programme (PCP). Retiring healthcare workers in the mainstream of public healthcare institutions should also be given the option. On this, I urge those who are in their early 50s and 40s to be engaged in the conversation as early as possible for second career options in ILTC.
The union can act as a conduit to refer more local workers into this sector for upskilling and reskilling. I urge MOH to implement a national skills framework for ILTC sector jobs and remunerate based on the skills and job worth.
Lastly, I would again urge MOH to act as a catalyst to help navigate the formation of an association for the ILTC sector so that the national skills framework and all relevant best practices can be uniformly adopted by the players in this sector which will be a win-win-win for all, that is, the organisations, staff and patients at the heart.
Ms Tin Pei Ling: Sir, nurses play a crucial role in healthcare. They are on the frontline every day, tending to the sick, counselling patients on their health, improving processes throughout the healthcare system, and the list goes on.
With the push towards delivering greater quality and value in healthcare, the role of nurses is undoubtedly even more important. We must, therefore, equip our nurses with adequate skills and knowledge to meet the increasing demands on them and also empower them to tackle the many difficult situations that they are faced with on a day-to-day basis.
Therefore, I would like to ask the Ministry for an update on the development and career pathways for our nurses. As our public healthcare transforms, how will the role of nurses change and how will their training and career development transform along with it as well?
Ms Joan Pereira: Chairman, one of the challenges facing the Ministry is that of getting sufficient healthcare workers, both frontline and backroom. This is especially so with the adding on of more healthcare facilities and the rising demands on our medical services. With tight manpower against high demand, it will mean longer queues and much inconvenience for the patients.
The Ministry has succeeded in getting some retired nurses to come back. This is very good. Can I ask if the Minister would draw on the pool of retirees in Singapore and offer them a career path in the healthcare sector so that it is a mutually beneficial exercise?
(In Mandarin): [Please refer to Vernacular Speech.] Apart from welcoming retired nurses to come back to work, we can also encourage retirees or mid-career switchers to join the nursing industry. Some women quit their job in order to look after the children or the elderly in the family. After their children have grown up, they may want to come back to the workforce. We should encourage these women to join the nursing industry. If these mid-career switchers and retirees can undergo relevant nursing training, they will be able to help to alleviate the manpower shortage issue in the healthcare sector.
Mr Christopher de Souza (Holland-Bukit Timah): Sir, allied healthcare workers provide a strong human resource infrastructure in our healthcare system. Facilitating career advancement and training of allied healthcare workers will benefit many Singaporeans.
First of all, the patients who will receive quicker and more targeted care; second, the doctors' workload will be alleviated; the third to benefit are the allied healthcare workers themselves as they can look forward to career opportunities; and fourth to benefit would be the next generation of Singaporeans who will have the option of entering meaningful healthcare-related vocations.
Therefore, would the Minister for Health consider a central body which studies and charts career opportunities of the allied healthcare workers in each of the integrated healthcare clusters?
Mr Kwek Hian Chuan Henry (Nee Soon): Sir, in my recent Private Member's Motion on senior policy, I noted that MOH has embarked on arguably one of the fastest expansions in healthcare spending among developed countries. In a few short years, we have ramped up considerable infrastructure.
However, effective healthcare, especially to meet our ageing population, requires a well-trained healthcare workforce. This proper training is especially important, given that we are also transforming the way we deliver healthcare services, from a hospital-centric to a people-centric model, and through an aggressive adoption of technology.
As such, can MOH provide an update on our preparations to ensure that our healthcare workforce have both the necessary hard skills and soft skills to care for the aged?
Lastly, I would like to note my appreciation for our healthcare workers – nurses, doctors and medical social workers – for their hard work and dedication.
Mr Christopher de Souza: Sir, it is good that concerted effort in policymaking has been undertaken to meet the healthcare needs of Singaporeans.
However, is MOH also tracking the supply and number of doctors needed to meet the vast cross-section of healthcare demands in Singapore? For example, are the sizes of the cohorts in the medical faculties in our universities calibrated such that the rate of supply of doctors in the profession would meet the needs of our population over the next 10, 20, 30 years?
Additionally, can MOH, in collaboration with the integrated healthcare clusters, provide guidance and regulations to prevent a disproportionately high number of qualified doctors from specialising in niche specialties? This is because disproportionate over-specialisation may leave other specialties less well-staffed which will, in turn, lead to multiple healthcare needs not being met.
The Chairman: Assoc Prof Fatimah Lateef. Not here. Dr Lily Neo.
Dr Lily Neo: Sir, breast cancer was the top killer of women cancer sufferers in Singapore from 2011 to 2015. The Breast Cancer Foundation conducted a nationwide survey last year and found that more than half of the 1,005 women aged 15 and above who were surveyed had limited knowledge of breast cancer. Only 45% of the women did self-examination as well as went for medical check-ups.
Early detection of breast cancer in the early stages of the disease offers a higher chance of survival. This is because breast cancer is one of the easiest cancers to beat, if found early.
May I ask MOH if there is an improvement in the early detection of breast cancer since the start of national screening in 2002, and have we achieved better outcomes on the prognosis of breast cancer in the past 10 years with better treatment? In order to further improve the early diagnosis of breast cancer, could MOH please enhance our national screening programme? And how can MOH raise public awareness of breast cancer further?
Mr Alex Yam (Marsiling-Yew Tee): Chairman, I am heartened to note that the number of unwanted pregnancies is decreasing in Singapore.
According to figures by MOH, the number of abortions between 2007 and 2017 has dropped nearly 40% to 7,217 last year. Medical advances, the easing of stigma over unwed mothers, the availability of contraception, and the support available for unwed parents could be contributing factors for the decline in the numbers.
But let us put things in context. In the same time period in 2017, there was 39,605 life-births in Singapore. Therefore, it is a proportion that means at least 15% of pregnancies were terminated.
Under the 1974 Termination of Pregnancy (Amendment) Bill, abortions are currently allowed up to 24 weeks of pregnancy without restriction. This was based on the scientific norms of the time where 24 weeks were considered the justification age by which babies have a chance of survival. The same Act of 1974 removed the previous stipulations of parental consent rallied round abortion and approval by the Termination of Pregnancy (ToP) Authorisation Board.
As we look at the basis of the 1974 Termination of Pregnancy Act, we have progressed on many fronts since then. We no longer have a population explosion. We have access to proper and high-quality healthcare. Gone, too, are backstreet quack doctors.
Science and medical care have advanced greatly, too, and evidence shows that survival rates for extremely early pre-term babies have improved dramatically in the last 15 years. In 1995, practically no children survived when born at 22 weeks of gestation age, while in 2008, 21% survived. A 2015 report in a New England Journal of Medicine also found that infants born at 22 weeks could have a good chance of survival without severe health problems if hospitals treated them.
Termination of pregnancy is not an easy decision. I remember still the words of a 68-year-old lady who told me, \"The procedure itself did not hurt much but my heart has been aching for the last 47 years.\"
Ms Tin Pei Ling: Sir, gestational diabetes can lead to birth complications and a higher risk of diabetes in the children born to mothers who suffer this condition. In Singapore, one in five pregnancies are affected by gestational diabetes and two in three mothers who have gestational diabetes go on to develop diabetes later in life.
So, may I ask what is the Ministry doing to control gestational diabetes among women in Singapore?
The Chairman: Senior Minister of State Amy Khor.
The Senior Minister of State for Health (Dr Amy Khor Lean Suan): Chairman, with your permission, may I display some slides?
The Chairman: Yes, please. [Some slides were shown to hon Members.]
Dr Amy Khor Lean Suan: Thank you. Singapore needs to prepare for a rapidly ageing population in the next one to two decades. By 2030, the number of seniors aged 65 and above will almost double to over 900,000. The largest increase will occur between 2020 and 2025, with about 179,000 Baby Boomers entering 65 years and above.
Our vision is a Nation for All Ages, where all our citizens can age healthily, purposefully and gracefully in place. Hence, we are investing efforts at three levels.
First, at the individual level, we will create new options for ageing in place and empowering self-care. Second, at the community level, we will build a strong community care system for seniors. And third, at the national level, we will develop enablers to better deliver care services for seniors.
Our models of care will need to evolve, as there is no one-size-fits-all option for seniors. Mr Leon Perera spoke about Silver Towns. MOH is working closely with MND, HDB and the Urban Redevelopment Authority (URA) to pilot new forms of housing developments that are twinned with care services and integrated within public housing estates. This will be our Singapore model for assisted living.
Both Ministries are already studying potential sites for such \"assisted living\" developments within public housing as well as in the private residential market. Basic domestic services, such as housekeeping and 24/7 monitoring and response, could be offered to support independent living. Home care could be layered on, as needed, for frail seniors. We are collaborating with the Singapore University of Technology and Design (SUTD) and various agencies to explore how design interventions can help make our neighbourhoods age-friendly, as suggested by Ms Tin Pei Ling. The Standards, Productivity and Innovation Board (SPRING) Singapore also works with public agencies and private organisations to develop national standards to support active ageing and senior-friendly infrastructure design.
Beyond new \"housing plus\" models that combine housing with care, we also need to enhance current services to support the majority of seniors who are already staying in existing residential estates to age in place.
For seniors in ageing rental precincts who are unable to afford domestic help, for example, we had piloted the Care Close to Home (C2H) programme in 2014 where care services are provided out of SACs. To date, over 2,500 seniors have benefited from the C2H programme. This year, we will expand the programme from the current 11 to another four sites in the Beach Road, Chai Chee, Chin Swee and Lengkok Bahru areas, so that more seniors can benefit.
Today, our Active Ageing Hubs (AAHs) provide a suite of care services for seniors as their needs evolve over time. We have started two AAHs at McNair and Kampung Admiralty, and will be opening three more in the Toa Payoh, Queenstown and Bukit Merah planning areas.
Overall, I am encouraged to know that home and community care services have gained traction among seniors in Singapore. Around 14,000 clients have benefited from subsidised home and community care services as of late 2017, more than the 10,000 clients who had taken up subsidised nursing home places. In fact, this has been the trend for the last three years.
MOH will do more to support ageing in place in the coming months. Today, seniors with complex medical conditions may be taking multiple medications prescribed by various doctors. There is also the risk of non-compliance or medication errors.
We will launch a new community-based Pharmaceutical Care Services pilot so that, in the future, seniors can get help with their medications at community touchpoints, such as senior care centres, where community pharmacists will be stationed, saving them multiple trips to the doctor or hospital. We will start with a pool of some 20 pharmacists from our polyclinics and retail pharmacies, such as Guardian, Unity Pharmacy and Watsons.
This year, we will enhance the Seniors’ Mobility and Enabling Fund (SMF) to enable seniors with frailty to age confidently. To date, we have disbursed close to $100 million since the launch of the scheme in 2011, with over 49,000 beneficiaries. As earlier announced at Budget, we will top up another $100 million over the next five years to further extend SMF subsidies to benefit more seniors.
To lend more support to end-of-life care, we are extending SMF subsidies to clients on home palliative care services in the coming months. MOH will also review the SMF means-testing tiers for devices so that our subsidies remain effective and targeted at those who need help.
Ms Tin Pei Ling asked for an update on Our National Innovation Challenge on Active and Confident Ageing. I am pleased to report that we have launched six grant calls to date, with around $33 million awarded across 23 projects. These include projects in areas, such as home monitoring solutions and assistive devices.
To improve care navigation, we are leveraging technology, which Miss Cheryl Chan spoke about, to develop a Health Marketplace.
Many consumers are already using e-platforms, such as \"Amazon\" and \"Redmart\". We hope to create an equivalent platform to make it easy for seniors and their caregivers to find, customise and order community-based eldercare services, such as home care, medical escorts and transport and meals on wheels. They can do so via a mobile app and will also have the opportunity to give ratings on services and providers. We plan to collaborate with the industry to start a Health Marketplace over the next year or so.
We believe that it is also important to integrate seniors within supportive communities so that they do not feel isolated, as mentioned by Dr Lily Neo. Our goal is to build an inclusive “Kampong for All Ages” through the Community Networks for Seniors (CNS) programme.
As announced at Budget 2018, we will be expanding CNS island-wide by 2020. The Silver Generation Office (SGO) placed within AIC, also puts us in good stead through our SG Ambassadors to proactively reach out to new cohorts of Singaporeans aged 65 and above, bringing health and healthcare to them. And where help is needed, various Government agencies and partners will come together to deliver coordinated care to the senior, closing the “social last mile” for our seniors.
Ms K Thanaletchimi and Dr Lily Neo asked about the benefits of our integration efforts. The transfer of functions from MSF to MOH, including services under the SCNs, will be accompanied by a transfer of staff and resources. No jobs will be lost. This will allow MOH to plan and develop health and social support services for seniors more holistically. The staging of SCN services already takes into account the demographics of each planning zone and will continue to do so.
The consolidation allows us to make the delivery of services more citizen-centric, increases productivity by minimising duplication and ensures that no needy senior falls between the cracks. MOH will take the opportunity to review and inject more programming to enhance the SACs, such as conducting preventive health and wellness programmes, to keep seniors active and well in the community.
Ms Thanaletchimi also asked about a one-stop centre for all relevant senior services. AIC currently provides a one-stop service to help seniors and their caregivers navigate services and schemes in the community, with several touchpoints to facilitate this. Many of our VWOs are also go-to points for seniors and caregivers.
In parallel with our nationwide rollout of CNS, MOH will also invest in community nursing. Our healthcare clusters are doing more to support this shift to community care. In the past year, they have piloted eight geographically-based community nursing teams, to anchor population health and care for residents and, in fact, these teams have actually reached out to more than 10,000 patients. Our nurses are familiar with the services in hospitals and the community and can bridge patient care needs across both settings.
We currently have a pool of about 130 community nurses from our three clusters providing care for residents with different needs across care settings, and we hope to increase this to 200 by end 2019. In the area of preventive health, for instance, community nurses can reach out to residents in the community and coach them to manage their health better. For residents who have been discharged from hospital and may have complex medical issues, the community nurse can provide direct care in their homes, for example, in wound care management. And for those in need of end-of-life care, they can be supported by community nurses trained in palliative care.
Senior Staff Nurse Noormala Hamid from the National Healthcare Group is one example. Noormala is experienced in managing palliative care patients, and works closely with other healthcare professionals to coordinate care plans, administer medication and monitor patients at home. She serves as a bridge between her patients and their doctors, and also provides support to families and caregivers who experience the psychological and emotional challenges that come with end-of-life care.
A strong community care system also includes community mental health. Ms Joan Pereira asked how we are making mental health services more accessible, while Assoc Prof Daniel Goh suggested a national dementia plan. Dementia support has been a central component of our community mental health plan which I announced last year. We have strengthened measures to provide care for persons with mental health conditions and dementia, including making services more accessible for them. We have made good progress to date. Over 6,000 frontline staff from various Government agencies and community partners have been trained to identify and respond to persons with mental health conditions. AIC is the key agency that coordinates care and support of persons with mental health needs in the community across health and social care sectors, including SSOs. More than 1,900 individuals have benefited to date.
In addition, AIC has worked with social service partners to establish a network of 33 community outreach teams to reach out to persons at risk of depression or dementia. They also educate the public on mental health and dementia conditions as part of our outreach efforts.
In the area of Primary Care, we have rolled out a combination of mental health and dementia services in eight polyclinics. We are on track to meeting our target for one in two polyclinics to implement mental health clinics by 2021. More than 140 GP partners have been trained to diagnose and support persons with mental health conditions in the community, supported by allied health-led community intervention teams. To date, 16 of such teams have been established to support the GPs, community and grassroots organisations in caring for persons with mental health conditions.
To date, some 8,800 patients have also benefited from the Institute of Mental Health’s (IMH’s) post-discharge \"after-care\" support, transiting smoothly from hospital to home. MOH will continue to work closely with IMH to enhance its capability to monitor these patients post-discharge.
As mentioned by Miss Cheng Li Hui, we have established six dementia friendly communities (DFCs) to create a culture of awareness of dementia and inclusivity so that persons with dementia and their families feel at home and supported in the community. We plan to expand to 15 DFCs in the next three years or so. To date, we have reached out to over 23,000 people to support persons with dementia and their caregivers and will continue to do more.
Similar to the Singapore Civil Defence Force Community First Responder app, AIC is developing a Dementia Friends mobile app to support seniors with dementia and their caregivers. We had initially considered building a national database of persons with dementia which Assoc Prof Daniel Goh spoke about. However, families we consulted preferred a voluntary approach where caregivers can register their loved ones. Going forward, caregivers can do so by using the AIC's mobile app and also access useful resources. Members of the public can also register as Dementia Friends to learn about the signs and symptoms of dementia and to help keep a look-out for persons with dementia who are lost or wandering. We plan to launch this app later this year.
Mr Murali Pillai asked about how we will work with MSF to implement a change for Persons with Disabilities (PWDs) who need to apply for the FDW schemes. MOH will accept the Client Assessment Form which is already administered by disability care services, such as day activity centres, so that the PWDs need not have to go through an additional assessment.
Next, let me touch on our healthcare workforce, a critical enabler in achieving our vision for community care. Given the twin challenges of rising demand for healthcare and slowing local labour force growth, we need to ensure the sustainability of the healthcare workforce over the long term. Our approach, as reflected in our Healthcare Manpower Plan 2020, must be to equip our healthcare workforce with future skills to provide better care, achieve higher productivity in healthcare and grow a strong local core.
The growing healthcare industry offers good jobs, and we are stepping up efforts to attract more locals into the sector, from school leavers to mid-career professionals as well as older workers.
Our local medical intake has grown from 350 to 480 students over the past five years, and we are on track to reach our target of 500 in 2018. The total nursing intake has also increased by 30% from 1,500 in 2012 to around 2,000 students in 2017. To attract more mid-career Singaporeans into the nursing profession, I announced last month that NUS Nursing will launch a two-year Bachelor of Science (Nursing) Programme later this year under the PCP for Registered Nurses (PCP-RN) and will complement the existing PCP-RN at Nanyang Polytechnic.
I agree with Ms Joan Pereira and Ms Thanaletchimi that the silver workforce is an important resource and can be an engine for national development. Today, more than nine in 10 public sector healthcare professionals who reach the age of 62 are re-employed, and we will do more to attract seniors without prior healthcare experience into the sector.
In going beyond hospital to community, we have also accelerated recruitment efforts over the past year to place more than 1,000 Singaporeans with some 29 aged care service providers in the community. This includes over 40 professionals who made a career switch to the community care sector in 2017 under the Senior Management Associate Scheme.
Mr Henry Kwek and Ms Thanaletchimi asked about our plans to develop the healthcare workforce as we grow the sector. Ms Tin Pei Ling also asked for an update on the training and career pathways for nurses.
MOH has been working closely with SkillsFuture Singapore (SSG) to develop a Skills Framework for nurses, allied health professionals as well as support care staff to facilitate a national recognition of skills in the healthcare industry and development of career progression pathways as well as remuneration frameworks. This is targeted to be developed by the end of this year, and we will be engaging employers and the healthcare union on its adoption. I note that Ms Thanaletchimi has also called for the formation of an Association for the ILTC sector. As Senior Minister of State Lam Pin Min mentioned in Parliament on 1 March, we already have existing structures in place to promote collaboration among sectoral bodies, AIC and MOH, and will continue to strengthen existing partnerships as well as build new ones.
MOH will be investing in developing a more robust Continuing Education and Training (CET) system, which is skills-based and industry-focused, for our nursing profession to complement pre-employment training in a few ways.
First, we want to develop a more comprehensive and coordinated system of upgrading to higher qualifications. We will collaborate with our Institutes of Higher Learning (IHLs) and healthcare institutions to design skills-based, modularised and stackable courses for our nurses that can add up, over time, to higher qualifications. Both the Nanyang Polytechnic and Ngee Ann Polytechnic have introduced part-time skills deepening programmes, such as the Specialist Diplomas in nursing gerontology, community gerontology and clinical education. As of end 2017, about 90 nurses have enrolled in the three specialist diploma courses.
Later this year, NUS Nursing will introduce a new part-time and modular graduate diploma in Community Health Nursing to equip nurses with the clinical skills to manage population health needs in the community, including clinical decision-making and chronic disease management. The new programme will allow nurses greater flexibility in pursuing part-time study while continuing to work. They can obtain a graduate certificate upon completion of each module that will \"stack up\" towards a graduate diploma.
Second, we want to build a more robust system of in-employment training across the acute as well as ILTC sectors. Given the dynamic healthcare landscape, our nurses will have to continue to learn and deepen their skills on the job. MOH, together with the Singapore Nursing Board, will engage the nursing leadership to look into a stronger system of skills recognition so that nurses who are trained by any accredited healthcare institution, can have their skills recognised for portability across the healthcare sector. This may mean that a stronger national skills credentialing capability will have to be built.
Third, we want to nurture and build up stronger institutions for nursing education. As a start, we will be working with NUS Nursing to strengthen the nexus of its curriculum with practice, by forming a new advisory council comprising key nursing leaders from both the acute and community care sectors. In the future, we envisage new national centres of excellence in specific areas of specialised nursing education that will train practising nurses across the various healthcare clusters in specific skills, such as geriatric care.
Taken together, we hope to build a first-class nursing education system that can empower our nurses with deep skills and give them the confidence to be at the forefront of driving care transformation.
During last week's Budget Debate, Assoc Prof Daniel Goh Pei Siong called for an increase in the salaries of our local nurses, citing a lag when benchmarked against the pay ratios in other countries. Let me highlight that the basis of the health local income statistics he quoted are not comparable. The median monthly income for full-time employed residents had included employer's Central Provident Fund (CPF) contributions, but the amount cited for registered nurses had not. If we exclude employer's CPF contributions for both, the local ratio is, in fact, not 1.06 but 1.2, which is actually comparable to the pay ratio in Australia, as quoted by Assoc Prof Daniel Goh Pei Siong. However, as workforce demographics and income profiles vary across countries, benchmarking purely based on pay ratios is not meaningful.
Over the years, we have reviewed the salaries of nurses, which have increased in tandem with their expanding roles and responsibilities.
Beyond pay, we have also enhanced professional development and career advancement opportunities for our nurses. Through these efforts, we are encouraged that our nursing intakes have increased by 30% over the past five years and the proportion of males in nursing has also risen from 8% to 10% during the same period.
I am personally inspired by the experience of Dr Pauline Tan. Currently CEO of Yishun Community Hospital, Pauline started out as an enrolled nurse at the age of 18, and actively pursued training opportunities to upgrade her skills and knowledge. Over the years, she has made invaluable contributions in various roles within the healthcare sector. Pauline is testament to the capabilities and potential of our nurses and the many career progression pathways available.
As we deepen the skills and capabilities of our nurses and other healthcare professionals, we can also enhance their scope of practice to support the implementation of more person-centred care models. Today, all prescriptions drafted by nurses and pharmacists require a doctor's counter-signature. Moving forward, we will revise our rules and put in safeguards to allow experienced and qualified nurses and pharmacists in the public healthcare sector to legally prescribe medicines through collaborative prescribing, under the supervision of doctors, so as to increase patients' access to quality care.
Let me illustrate with an example of 77-year-old Mr Tan. Diagnosed with prostate cancer in July last year, he was referred to a home palliative care team upon discharge. With the introduction of collaborative prescribing rights, Mr Tan’s palliative care nurse can assess his condition and issue the prescription for antibiotics, for example, saving his caregiver an additional trip just to collect the prescription.
We recognise the need to also upskill our allied health workforce, as highlighted by Mr Christopher de Souza. MOH and our public healthcare institutions have established various initiatives and grants to support the training and development of our allied health professionals (AHPs). These include skills attachments, postgraduate qualifications, and fellowships in clinical, education and management-related areas. We have been supporting the development of close to 250 AHPs annually.
Our therapy support staff are an equally important group who work alongside therapists to provide rehabilitation care to patients. As a further boost to their training and development, the Institute of Technical Education (ITE) will be rolling out a new Work-Learn Technical Diploma in Rehabilitation Care in April 2018. The new apprenticeship-based diploma, where a majority of the training is conducted in partnership with the employers, allows newly hired and in-service therapy assistants to take on larger roles to provide rehabilitation care to seniors, and progression in their careers as senior therapy assistants.
Mr Alex Yam asked whether MOH will be reviewing the abortion time limit. This upper gestational limit of 24 weeks for abortions is based on scientific evidence of foetal viability outside the womb. Medical experts from our healthcare institutions note that foetal viability below 24 weeks remains low, while neurodevelopmental disabilities are very high among premature babies who survive.
This is also supported by international studies and professional bodies. Only 1% of all abortions in 2017 were performed between 22 and 24 gestational weeks, of which, more than half of these were due to foetal anomalies and other medical reasons. MOH will continue to monitor and review this issue as new evidence emerges.
Chairman, to conclude, let me affirm MOH's commitment to build communities of care for seniors across Singapore so that they benefit from preventive health and affordable, quality healthcare that is person-centric. Together with a capable workforce, we can meet the needs of our ageing population in a sustainable way, enabling our seniors to age gracefully in place and with peace of mind.
The Chairman: Mr Baey Yam Keng.
Mr Baey Yam Keng (Tampines): Mr Chairman, when the Prime Minister spoke about the War on Diabetes during his National Day Rally last year, there were some questions why this topic warranted such a high level of attention.
As the saying goes, \"health is wealth\". It does not matter how much money one makes or receives in the SG Bonus. Without good health, it is useless having lots of money. Wealth cannot always buy good health. That is why, during Chinese New Year, I always wish my residents and friends good health, \"身体健康\" and people always respond that that is the best and most important blessing they desire.
However, I am glad to note that people do not just wish for good health blessings. Many have taken heed of the call to fight and prevent diabetes. People are mindful of what they eat. There are now healthier food options available at buffet spreads and I have seen many taking the effort to exercise more regularly, with quite a few looking reasonably slimmer, fitter and better.
Diabetes is a chronic disease. It is a lifelong condition and takes a dedicated effort to keep it under control. The beautiful part of it is that regular exercise and controlled diet can also help fight other chronic conditions like high blood pressure and high cholesterol levels.
I would like to ask MOH for an update on the War on Diabetes. What are the challenges faced and what is the plan to sustain awareness and translation into action over the long term?
Mr Chen Show Mao (Aljunied): Sir, in 2015, the International Diabetes Foundation reported that Singapore has the second highest proportion of diabetics among developed nations. In 2016, the Minister for Health declared War on Diabetes. In 2017, the Prime Minister spoke of diabetes as one of the three key long-term issues for Singapore.
Sir, the importance to Singapore in the War on Diabetes cannot be overstated. Our children and young people are increasingly overweight. One in three Singaporeans has a lifetime risk of developing diabetes with serious and costly consequences. Could the Minister give us a report of progress from the front? What are our new and continuing efforts, plans, strategies and tactics?
In this connection, could the Ministry explore avenues for working with the food manufacturing industry and the Ministry of Trade and Industry (MTI) to apply existing incentives and support local food manufacturers to release low-sugar snacks and drinks? The Industry Transformation Map (ITM) for food manufacturing is more advanced than most other ITMs and seems well-placed to develop and promote low-sugar products on an industry basis.
Dr Chia Shi-Lu: Sir, MOH has previously stated its support for the principle of \"One patient, One doctor\", and I am heartened by its commitment towards strengthening our primary care services through many programmes, such as the Primary Care Network, for example.
Our family doctors, I am sure everyone will agree, are at the frontlines of healthcare in our community. Often, they are the first point of contact for medical intervention by patients and their families, and patients and their families have also built a relationship with them. Family doctors are thus usually in the best position to provide patient-centric care as they have a comprehensive overview of their patients' physical and mental health conditions and, to varying degrees, the context as well. They play an important role in complex care needs, such as case management and preventive care. These will help lower our escalating healthcare expenditure due to our ageing population.
Can MOH provide an update on the progress of and future plans for primary care transformation in Singapore?
Dr Lily Neo (Jalan Besar): Sir, I wish to declare that I am a general practitioner. MOH has previously indicated its intention to repeal the Private Hospitals Medical Clinics Act (PHMCA) enacted in 1980. In view of the fast-changing medical and IT development, the intention on repealing it is timely, to align MOH's priority and better safeguard patients' interests.
Embracing IT is necessary for the provision of medical care at a higher level of proficiency and efficiency. Having this new Bill will also improve governance of healthcare providers and ensure continuity of care and accountability.
I hope MOH will be thorough and will not leave out any inadequacy of governance to tackle unfavourable healthcare practices that have no recourse with the present Act. This will ensure that the new Bill will be relevant and encompassing.
MOH has sought public feedback on the draft Healthcare Services Bill earlier this year. I would like to seek an update from the Ministry on the feedback given, and the progress of the Bill, including the provisions to contribute to the National Electronic Health Records (NEHR).
I favour the NEHR system because health records follow the patients. This means convenience for patients and accuracy of medical information, without them having to repeat their medical histories and medications at every visit to a clinic. This is especially important in emergency settings when patients cannot relate.
I want to share the challenges I face when I adopted a clinic IT system that contributes to NEHR in my clinic last year. My very first concern was what happens if the IT system should suddenly fail, a possibility from any computer or IT glitches? I stand to lose all the medical records of my patients. The system did fail; true enough. It was just as well that I continued manually writing and recording on the usual hard copies whilst I entered electronically entailing double work. There is also another concern of late, that of cyber security. NEHR also needs getting accustomed to, even if the staff and nurses are IT-savvy, thus they have to be retrained, entailing expenses on the adoption of NEHR.
When MOH rolls out NEHR more widely, I hope the above challenges can be addressed to ease its adoption. There will be patients who prefer to opt-out from NEHR record sharing for various personal reasons. I hope MOH will give flexibility of choice that includes opt-out options to those who request.
Dr Chia Shi-Lu: Sir, sadly, the proportion of smokers in Singapore has stayed around 13% for the last few years. The recently announced 10% increase in excise duty on all tobacco products may help to reduce the demand for cigarettes but we must also continue with other measures, such as public education, to highlight the negative effects of smoking and perhaps also increasing the number of smoke-free zones.
The Government will also need to step up its surveillance in this regard. Smugglers are increasingly creative due to the attractive profits. Beyond raising the minimum legal age for smoking and purchase of tobacco to 21 years by the year 2021, what other measures is MOH taking or considering to reduce tobacco use in our population? In addition, what measures does the Ministry have to reduce the impact of second- and third-hand smoke?
The Chairman: Senior Minister of State Lam Pin Min.
The Senior Minister of State for Health (Dr Lam Pin Min): Mr Chairman, may I have your permission to display some slides during my speech?
The Chairman: Yes, please. [Some slides were shown to hon Members.]
Dr Lam Pin Min: Minister Gan has highlighted efforts to ensure healthcare remains accessible, affordable and is of good quality. I will now elaborate on how we are developing capabilities and capacity for the future, ensuring that Singaporeans have access to good care close to their homes.
The cornerstone of a sustainable healthcare system is strong primary care, where patients with chronic conditions are managed well in the community, with better health outcomes. In addition to our newly opened polyclinics in Punggol and Pioneer, there are ongoing polyclinic developments in Eunos, Kallang, Sembawang and Bukit Panjang scheduled to open by 2020.
The Minister has announced plans to develop a further six to eight new polyclinics which will enlarge our network to 30-32 polyclinics by 2030. I am pleased to inform Members that two of the new polyclinics are expected to be operational by 2023 and will be developed in the northern region in Nee Soon Central, and the eastern region in Tampines North. Residents in the West and Central regions can also look forward to new polyclinics.
We are also renewing our existing facilities. Redeveloped Bedok and Ang Mo Kio polyclinics opened in July 2017 and January 2018 respectively. The redeveloped Yishun Polyclinic will open in mid-2018.
Dr Chia Shi-Lu has asked for updates on our primary care transformation efforts. We are investing more resources to support our GP partners, through the PCN scheme. PCNs are networks of GPs delivering care via multidisciplinary teams comprising doctors, nurses and primary care coordinators, who provide holistic care. The PCN scheme commenced in January this year with 10 PCNs on board, involving more than 300 GP clinics. We hope to eventually see 50% of CHAS GP clinics on board the scheme.
I have shared MOH’s vision for primary care, which is \"One Singaporean, One Family Doctor\" in previous COS debates. The PCN scheme complements our efforts to encourage trusting, long-term relationships between doctors and their patients. Let me elaborate.
Mdm Siti Saujana, a diabetic patient, has seen Dr Kwong Kum Hoong for the past six years. This continuous follow-up has allowed Dr Kwong to gain a deeper understanding of her needs. For example, Mdm Siti’s high blood pressure was detected early as Dr Kwong had advised her to screen for other chronic conditions, as part of the plan in managing her diabetes.
Mdm Siti has also benefited from the team-based care offered by the NUHS PCN, which Dr Kwong's clinic is a part of. She received advice on her diet and lifestyle activities from the PCN nurse, as well as utilised diabetic eye and foot screening services provided by the PCN team. The PCN care coordinator also ensured her appointments were well-coordinated.
I am heartened by the strong rapport and trust forged among Mdm Siti, Dr Kwong and the PCN care team, and encourage all Singaporeans to have a regular family doctor today.
To augment our Primary Care sector, we are also increasing capacity across various settings to ensure appropriate and seamless care. Since 2010, we have opened or expanded five hospital facilities, namely, Ng Teng Fong General Hospital, CGH-St Andrew's Community Hospital Integrated Building, Jurong Community Hospital, Yishun Community Hospital and Khoo Teck Puat General Hospital.
The development of three more hospitals are underway. Sengkang General and Community Hospitals will open by the second half of 2018, while Outram Community Hospital will open progressively by 2020. Hospital bed capacity will increase further when the Integrated Care Hub at Novena and the Woodlands General and Community Hospitals open by 2022. In addition, the National Centre for Infectious Diseases will progressively open from end-2018.
Aged care capacity will be increased to meet the demands of an ageing population. By 2020, home care capacity will increase from the current 8,000 places to 10,000 places, while day care capacity will increase from the current 5,000 to 6,200 places. There are also plans to increase the number of nursing home beds from the current 14,900 to 17,000.
In tandem with the increase in infrastructure capacity is the need to ensure sufficient manpower. Mr Christopher de Souza asked if we are calibrating the training pipeline for specialists to meet medium- to long-term needs. We have increased the proportion of residency positions offered to specialties that are in greater need to address the demands of an ageing population. The number of residency positions taken up in Advanced Internal Medicine, Rehabilitation Medicine and Geriatric Medicine have doubled from 4% of the total residency intake in 2013 to 8% in 2017.
MOH does regular reviews to calibrate the number of residency positions for each specialty, based on our projected needs. MOH also periodically reviews the training requirements to ensure relevance to our local context. This includes instituting a mandatory Geriatric Medicine Modular Training Programme to equip residents with the skills to manage elderly patients. However, we cannot indefinitely increase capacity and manpower. We have thus embarked on efforts to improve our care delivery.
Mr Chen Show Mao and Mr Baey Yam Keng have asked for updates on the War on Diabetes (WoD). This is a whole-of-nation effort where everyone has a role to play. MOH is developing a Patient Empowerment for Self-care Framework to empower people with diabetes to initiate and sustain lifestyle changes with the support of healthcare professionals, community-based providers and other forms of social support.
Under this framework, there will be a National Curriculum developed with educational materials for patients, caregivers and the public, and resources which healthcare professionals and community-based providers can use for patient empowerment. The first tranche of the materials will be available by mid-2018.
MOH is currently enhancing our diabetes management programmes. As part of the Disease Management Workgroup, set up under the National Diabetes Prevention and Care Taskforce, we have rolled out initiatives targeted at eye and kidney complications. We will now address diabetic foot complications, as diabetes is the most common cause of non-traumatic lower extremity amputations (LEAs). In 2015, about 180 diabetes-related major LEAs were performed for every 100,000 adult Singaporeans with diabetes, compared to the Organisation for Economic Cooperation and Development (OECD) average of 60.
MOH will be setting up a workgroup to review the national organisation of diabetic foot services, make recommendations on national care guidelines, and review the roles and training needs of healthcare professionals involved in diabetic foot care to decrease the lifetime risk of amputation for diabetic patients. Mr Speaker, let me now speak in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] If diabetes is not treated early or managed well, there may be long-term complications, such as blindness, kidney failure and LEA.
In 2015, for every 100,000 adult Singaporeans with diabetes, about 180 had an LEA, which is much higher than the OECD average. We must pay attention to this problem.
MOH will be setting up a workgroup to develop a strategy to reduce diabetes-related amputations. The workgroup will review the national landscape of the diabetic foot services provided to patients with diabetes, make recommendations for the national care guidelines, and review the roles and training needs of healthcare professionals involved in diabetic foot care. Through improving the quality of care services, we can promptly detect foot problems among patients with diabetes and start treatment immediately to avoid amputations.
(In English): Chairman, WoD is a shared responsibility. We have thus provided funding to support cluster-led, community-based diabetes prevention and management programmes.
For example, in the Central region, the National Healthcare Group (NHG) has launched a Diabetes Community Intervention Programme (CIP) pilot with Toa Payoh Polyclinic to engage patients with, or at risk of, diabetes to take ownership of their well-being. In the East, CGH has worked with the East Coast Group Representation Constituency (GRC) to train volunteers as Health Peers to motivate residents with, or at risk of, diabetes towards behavioural change.
Later this year, NUHS will launch the Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) programme in the West where patients will be assigned to dedicated multidisciplinary care teams who will support them to take on proactive roles in disease management and lifestyle changes. Even as we develop new initiatives, we need to ensure the delivery of safe and quality care.
Ms Sylvia Lim has asked about how hospital complaints on patient care are handled. Hospitals have their own Hospital Quality Service/Patient Relations Office to deal with such complaints, and patients’ inputs are sought as part of the review process. Mediation is another avenue for patients and their families to resolve their disputes with hospitals.
Complaints escalated by patients to MOH are taken seriously and assessed in an independent manner for potential breach of the Private Hospitals and Medical Clinics Act. A formal investigation will be initiated by the Regulatory, Compliance and Enforcement Division against the hospital once a potential breach is identified. The independent investigation by MOH will include opinion from the relevant appointed experts, and interviewing all parties related to the case, including the patients and their next-of-kin.
Under the Private Hospitals and Medical Clinics Act (PHMCA), institutions are required to report occurrences of Serious Reportable Events (SREs) to MOH and establish quality assurance committees (QACs) to review these SREs. Investigation reports are submitted to the Clinical Quality, Performance and Technology Division under the Healthcare Performance Group of MOH. The priorities of this Division include Quality Assurance, Patient Safety systems and Quality improvement. One of the Division’s foci is to leverage the reported serious events for improvement and cross-institution learning opportunities, similar to the approach of the UK’s Healthcare Safety Investigation Branch. Anonymised information is shared amongst the healthcare institutions, and forums are organised for healthcare institutions to discuss gap closure measures.
To future-proof our healthcare system, it is important that our laws stay current and flexible. As announced earlier, MOH is enacting a new Healthcare Services Bill to replace the current PHMCA this year. The Bill will adopt a modular services-based licensing system to allow providers more flexibility in holding licences for any combination of healthcare services provided. It will also appropriately regulate non-premise-based services, particularly as we want to encourage the outreach of community healthcare services, such as home medical services.
Regulatory clarity will be enhanced to make it easier for providers to understand and, therefore, comply with the legislative requirements. New requirements and competency mandates will also be introduced, including an additional governance layer called the Clinical Governance Officer, to provide technical oversight over more complex services, such as clinical laboratories and radiological services.
Fundamentally, the new Bill will allow MOH to strengthen its legislative powers to achieve our primary regulatory objective of safeguarding patient safety and welfare, as well as continuity of care. Such powers include prescribing a list of prohibited unsafe practices that providers cannot offer, as well as mandatory participation of all healthcare service providers in the National Electronic Healthcare Records (NEHR). I will elaborate more shortly.
We have actively consulted stakeholders on the proposed policies in the new Bill and I am heartened by the generally positive feedback received. Licensees appreciated the flexibility of the licensing approach to accommodate various care models. The public was also supportive of the enhanced powers in the Bill to have \"step-in\" rights, tighter publicity controls and prohibition of unsafe practices.
Specifically, on the mandatory contribution of summary clinical data to NEHR, licensees and members of the public were generally supportive, and provided feedback on aspects, such as the cost of digitisation, opt-out procedures and patient confidentiality issues.
Dr Lily Neo has asked about patients who may prefer to opt out of NEHR. I would like to reassure her that patients can choose to have their records logged, which would prevent it from being viewed and accessed. We are also studying a proposal when patient's future records will not be stored in NEHR at all. However, patients should note that this will cause a permanent gap in their medical record history.
To support licensees in this journey, MOH and the Integrated Health Information System (IHiS) have introduced financial, technical and clinical support to help licensees. For example, $20 million under the Early Contribution Incentive scheme is available to help licensees defray the cost of upgrading their IT systems to contribute data to NEHR by June 2019.
Even with the introduction of the new Bill, current regulations may not be flexible enough for the emergence of innovative care models. To address this, MOH will be rolling out the Licence Experimentation and Adaptation Programme (LEAP), which is a regulatory sandbox that will allow new services to be piloted in a controlled environment.
During the pilot, MOH will ensure that these businesses maintain essential safeguards for patient safety, while relaxing certain regulatory requirements or introducing new ones. Thereafter, successful pilots will be mainstreamed under the Healthcare Services Bill with appropriate regulatory requirements.
For a start, the sandbox will focus on piloting models in three areas, namely, telemedicine, precision medicine and models of care that support ageing. More details will be announced in the coming months.
Mr Low Thia Khiang has asked about how precision medicine can be harnessed for patients' benefit. Worldwide, we have seen how precision medicine treatments can be costly without strong evidence for improved health outcomes. Our end objective must be to support the development of precision medicine for positive health and economic outcomes.
To this end, MOH is coordinating a multi-agency effort to develop an integrated national strategy for precision medicine research and its subsequent implementation. This includes looking at enabling infrastructure, regulatory and ethical frameworks, as well as public education. We will provide a thorough update at an appropriate time.
MOH also ensures that human biomedical research is carried out ethically. Gene editing is presently used in basic research in Singapore and is governed by the Human Biomedical Research Act, and guidelines issued by the Bioethics Advisory Committee and National Medical Ethics Committee.
Mr Low Thia Khiang has also asked about the standards for the provision of clinical genetic testing. MOH conducted stakeholder consultations last September. The feedback provided will be taken into consideration when refining the standards, which are targeted to be rolled out in the second quarter of 2018. The sector will be given a sufficient ramp-up period before the standards become legally enforceable.
Part of developing a future-ready outlook is the task of preparing for anticipated healthcare challenges.
Overuse of antimicrobials, such as antibiotics, in the human, animal and agricultural sectors has exacerbated the problem of infection-causing microorganisms developing drug resistance. Antimicrobial resistance (AMR) is an international issue as drug-resistant microorganisms in other countries can easily spread across borders into Singapore.
MOH, the Agri-Food and Veterinary Authority (AVA), the National Environment Agency (NEA) and the Public Utilities Board (PUB) had jointly developed Singapore’s National Strategic Action Plan on AMR, which was launched in November last year to chart out how agencies will work together to detect and arrest AMR through increased surveillance, education, management, research and international cooperation.
As a member of the Association of Southeast Asian Nations (ASEAN), Singapore will continue to promote cooperation and innovative collaboration to strengthen ASEAN's resilience against AMR.
Besides AMR control, vaccination is important to prevent infection and reduce the risk of infectious disease outbreaks. Mr Leon Perera has asked about MOH’s approach towards subsidising vaccinations.
To ensure collective population-level protection or herd immunity and encourage vaccine uptake, childhood vaccinations against highly infectious diseases with community outbreak potential, such as measles, are fully subsidised at the polyclinics.
For diseases with low community outbreak potential, for example, Human Papillomavirus (HPV)-related diseases, vaccination is recommended for personal protection. The National Adult Immunisation Schedule was introduced on 1 November 2017 to provide guidance on the recommended vaccinations that persons 18 years and older should receive, and MediSave use is allowed for these recommended vaccinations.
Mr Chairman, my Ministry will continue to build capabilities and increase capacity in the future to ensure that we have a future-ready healthcare system.
This task cannot be achieved alone. I urge all Singaporeans and healthcare providers to partner us in these initiatives to make our healthcare system better and keep Singaporeans healthier. Thank you.
The Chairman: Next cut, Assoc Prof Fatimah Lateef. Not here. Ms Joan Pereira.
Ms Joan Pereira: Chairman, the Government hospitals and clinics are one of the best sources for reliable and impartial information on healthcare. Will the Ministry review its handouts and information sheets for the elderly and their caregivers, using big fonts and graphics, where possible, on how to better manage their varied health conditions?
Can the information be printed in different languages to explain, for example, what type of exercises and diets are best suited for a diabetic patient, or what food or vegetables are good for lowering cholesterol levels?
This can empower our elderly and their caregivers with very helpful information and help them better manage their health and their lifestyle, so that they can live a good quality life for as long as possible.
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling: Sir, we know the ills of sugar and our Government has taken major steps to cut down on sugar intake, including setting a cap on the amount of sugar packet drinks can contain. It is also very encouraging to see how drinks manufacturers have responded in support of such a move.
Still, changing habits and combatting diabetes is a long journey. Hence, I would like to ask the Ministry how it is furthering efforts to promote healthy living through lowered consumption of sugar or sugar-sweetened beverages.
Also, habits are cultivated from young and it is important that our children start their lives with the right habits. I would like to ask the Ministry how it will ensure that preschools and childcare centres also actively cut down on the sugar intake for young children.
The Chairman: Parliamentary Secretary Amrin Amin.
The Parliamentary Secretary to the Minister for Health (Mr Amrin Amin): We are encouraging greater personal responsibility for healthy living, and community partnerships to make healthy living more accessible and sustainable for Singaporeans.
I will touch on three key areas – the War on Diabetes (WoD), health promotion efforts for all, particularly seniors and ethnic minorities, and tobacco control.
Mr Chen Show Mao and Mr Baey Yam Keng asked for updates on WoD. Miss Cheryl Chan spoke about helping Singaporeans lead a healthy lifestyle. We will continue to support all Singaporeans, regardless of economic and socioeconomic backgrounds, to eat healthily, be screened and exercise as part of our WoD.
HPB’s Healthier Dining Programme offers more affordable, delicious and nutritious food options. In addition to food courts and restaurants, we have extended the Healthier Dining Programme to coffee shops and hawker centres in December 2016. More than 3,000 stalls in coffee shops and hawker centres, as well as over 2,000 food and beverage (F&B) places are under this programme. We now have healthier mee soto, chapatti and carrot cake, just to name a few. So, yes, you can have your cake – just make sure that it is a healthier cake – and eat it, too. Eating healthy and well is possible.
Mr Chen Show Mao asked for an update on plans to develop low-sugar food and drinks locally. In July 2017, HPB launched the Healthier Ingredients Development Scheme (HIDS) to build our food sector’s capabilities to innovate and produce new healthier food products, like healthier oils, rice and noodles. As of December 2017, we now have 14 partners offering 37 healthier products, supplied to over 2,000 F&B stalls.
Let me share one success story. With support from HIDS, Mr Desmond Goh from People Bee Hoon invested in R&D, marketing and trade promotion of new wholegrain healthier bee hoon. Sales of Chili Brand wholegrain bee hoon doubled over the past months. This means that more families are buying, cooking and eating healthier bee hoon.
We will be further extending the HIDS grant to include sugar-sweetened beverages, desserts and sauces. Such food products contribute to about 90% of total sugar intake in our diet. I am happy to announce that HPB will be providing an additional $15 million on top of the current $20 million grant to support innovation in healthier food categories. This is a potential game changer, benefiting Singaporean families and could contribute to reducing sugar in Singaporeans’ diet by 25% by 2020.
We are working with MTI, through the Economic Development Board (EDB) and SPRING Singapore, to align our industry efforts, including through the ITM for food processing. Together, we will spur businesses to innovate and market new healthier food products.
Ms Tin Pei Ling asked about the efforts to promote lower consumption of sugar-sweetened beverages (SSBs) and to help young children develop healthier dietary habits.
Current efforts, such as the Healthier Choice Symbol (HCS) and the Healthy Meals in Preschools Programme, have shown encouraging results. The market share of lower sugar beverages marked with the HCS symbol has grown from 30% in 2012 to 43% in 2017.
Under the NurtureSG initiative, we have partnered the Early Childhood Development Agency (ECDA) to ensure all preschools only serve drinks with the HCS symbols from 1 January 2018.
We are studying sugar-reduction measures from other countries, such as the UK and France. The UK and France have implemented colour-coded front-of-pack labels for food and drinks. The UK uses traffic light colours to tell consumers whether a food item has high, medium or low amounts of nutrients, such as sugar and saturated fats. France has Nutri-score which scores the nutrient content of food and drinks.
Some countries have implemented a tax on SSBs to encourage manufacturers to reformulate their drinks and reduce the sugar content. In March 2016, the UK announced a 2-tiered levy on pre-packaged beverages. The purpose is not to raise revenue but to encourage product reformulation. Although the levy only takes effect in April 2018, the UK authorities have shared with us that more than 40% of affected products have been reformulated. MOH will carefully review this and other measures to encourage product reformulation and conduct a public consultation before deciding our next steps.
Moving on to screening, if discovered early, interventions, such as diet and exercise, can prevent pre-diabetes from worsening. Younger Singaporeans are advised to go for diabetes screening if they are at higher risk of having diabetes. Risk factors include a family history of Type 2 diabetes, overweight or high blood pressure.
We are helping Singaporeans between 18 and 39 to assess their risk for diabetes through the Diabetes Risk Assessment (DRA) on HPB's HealthHub app. To date, the DRA tool has been used about 116,000 times by younger Singaporeans. Those identified as high-risk for diabetes should go for medical screening. For those above 40, they should go for regular diabetes screening once every three years and they can benefit from subsidies under the Screen for Life initiative.
Moving on to stepping up to the challenge of an active lifestyle. On active lifestyle, we have made strides in the first two seasons of the National Steps Challenge. HPB has rolled out the third season in October last year. More than 650,000 people have signed up and clocked more than 260 billion steps. This is equivalent to 200 million kilometres (km) or more than 5,000 times around the Equator!
We are working with SportSG to organise more fun social physical activities for all ages so that Singaporeans can have access to them at various community and workplace settings.
On the second area of health promotion efforts for seniors and minorities, on seniors, I agree with Miss Cheryl Chan that we need sustainable preventive health efforts to address the needs of an ageing population and we have stepped up efforts to improve healthy living in this aspect. Through the Community Network for Seniors (CNS), HPB, with support from Silver Generation Ambassadors, has implemented several active ageing programmes. Let me share some highlights.
Over 24,000 seniors have attended the Seniors' Health Curriculum, a series of workshops to improve seniors’ physical, mental and functional health. Community Health Posts, located in the neighbourhoods, offer health screenings, regular health coaching and lifestyle follow-up for seniors to help manage chronic conditions better. As of December 2017, over 3,400 senior Singaporeans have benefited from these health coaching sessions.
Thirdly, we have started senior-centric exercise programmes, such as Zumba Gold and FIT+, and mass workout sessions under the Community Physical Activity Programmes (CPAP). Over 159,000 older residents have participated.
Ms Joan Pereira suggested that the Ministry review information on diabetes management and diet for elderly patients and their caregivers. The Patient Empowerment for Self-Care Framework aims to help Singaporeans with diabetes initiate and sustain lifestyle changes. Under the Framework, we will develop a national curriculum to equip persons with diabetes with knowledge and life skills to manage their condition. We will take on the good suggestions by Ms Joan Pereira and will review the information on diabetes management and diet of our elderly patients and their caregivers.
On health promotion among ethnic minorities, we are seeing greater awareness among Malay and Indian communities on health matters but there is more to do.
Sir, allow me to share in Malay some of initiatives for the Malay community.\tThe key thing is that \"healthier choice\" is decided based on whether that category of food is lower in terms of sugar or other not too healthy things. Is it healthier for that food band or for that food category?
(In Malay): [Please refer to Vernacular Speech.] Last August, I visited popular comedian Alias Kadir. Alias had to undergo a surgery to amputate his lower leg due to diabetes. He already had diabetes when he was in his 40s, but he did not seek treatment. As a result, he experienced complications. Unfortunately, it was already too late. His leg could no longer be saved.
After the surgery, however, Alias was determined to change. He also wanted all of us to learn from his experience – that we must always take care before something goes wrong with us. And if something does go wrong, we must not underestimate the importance of taking medications and watching what we eat, as well as remembering to go for follow-ups with doctors to manage diabetes.
Staying healthy is a lifelong commitment. We are working with many community partners to help the Malay community stay healthy at each stage of life. Let me share three areas of cooperation.
Step One – Towards a Healthy Diet. We have taken steps to collaborate with caterers to slowly change the way we eat at the community level. For instance, we are working with the Singapore Halal Culinary Federation (SHCF) and caterers, such as Eternally Yours and Jamil Catering, so that they can provide healthier halal food choices. Through this effort, it is hoped that the community can gradually grow to like healthy food that can still taste delicious.
Step Two – Towards Mosques as Health Movers. Taking care of our health is part of our religious obligations. We worked with the Islamic Religious Council of Singapore (MUIS) and, as a result, the Jaga Kesihatan, Jaga Ummah (Taking Care of Health, Taking Care of the Community) programme was born, whereby HPB collaborates with mosques to organise healthy lifestyle activities. And another outcome is that 15 mosques have now joined this health initiative. We hope that this initiative will grow and reach 20 mosques by the end of this year.
Hence, what will be done at these mosques? The mosques will provide services to help diabetes sufferers manage their condition, undergo health screening, and conduct physical activities. We are heartened to see more mosques joining this initiative.
For instance, Al-Mawaddah Mosque sent their canteen staff to attend culinary training organised by HPB so that healthier dishes can be served at the mosque. Our hope is that healthy yet delicious food is served at all mosques, be it for gatherings, breaking of fast, Hari Raya celebrations and so on. The mosques should be the health movers of the Muslim community.
Step Three – Towards a Community That Loves Exercising. We will add more spaces and opportunities for our Malay community to exercise or engage in physical activities. For example, I launched the \"Get Fit for Umrah\" initiative, which encourages pilgrims to build up their fitness before performing their umrah (minor pilgrimage). This is done with the support of TM Fouzy Travel and Tours last year.
We will scale up this programme so that more umrah and haj pilgrims can benefit from it. HPB will be working with the Association of Muslim Travel Agents Singapore (AMTAS) to include more Muslim travel agencies that can also offer this initiative. In addition to having a good reputation as disciplined pilgrims in Mecca and Medina, our Singapore pilgrims will also be known as healthy and fit pilgrims!
I am happy with the strong support from the community. They participated in the four health conversation sessions \"Awak Ok?\" (\"Are You OK?\") at Geylang, Jurong, Tampines and Woodlands; they worked out together, for example, at the Zumba sessions at Tampines Hub; and they also rolled up their sleeves – like the doctors, nurses and partners from Muslim Healthcare Professional Association (MHPA). So, let us work together to build a community that is active, fit and healthy!
(In English): Community organisations like the Hindu Endowments Board and the Singapore Indian Development Association (SINDA) are actively promoting healthy living to the Indian community. We want to complement and build on these efforts in three ways.
One, we will intensify health outreach to the Indian community through places of worship, Indian F&B outlets and Indian media to promote healthy eating, regular physical activity and regular screening and follow-up.
Two, we are partnering Sikh and Indian temples to bring health programmes, such as screening, exercise and healthy cooking programmes.
Third, we will leverage social networks to train Health Ambassadors and equip them with skills to actively reach out to and promote healthier living to their families and friends.
The final key focus area of my speech is tobacco control. Dr Chia Shi Lu asked what other measures we are considering to reduce tobacco use in our population. This year, we will be launching a new public education campaign to encourage Singaporeans to live a tobacco-free lifestyle. We will re-emphasise the harms of environmental tobacco smoke and the harms of tobacco. We will have a ground-up campaign involving youths in schools and IHLs. HPB will also work with partners, such as the Singapore Cancer Society and the Football Association of Singapore and other partners, to reach out to all and, in particular, youths on social media, in schools and other places.
We will continue to enhance our smoking cessation services to support smokers on their tobacco-free journey. HPB will engage more workplaces, such as taxi and bus transportation sectors, to help their employees to quit smoking. We hope to see more companies create a health promoting working environment for their staff.
There continues to be a debate on e-cigarettes. We debated this last November. Our position is clear. Any product that contains nicotine can cause addiction and pose risks to health, including e-cigarettes. We want a nicotine-free and tobacco-free future. We will allow e-cigarettes only if they are scientifically proven to be effective nicotine replacement therapy products, for smoking cessation.
MOH is also considering introducing standardised packaging. Singapore recently announced a public consultation to gather detailed views on a proposal for the introduction of standardised packaging, together with enlarged graphic public health warnings.
The public consultation will end on 16 March 2018, and we invite interested parties to submit their views. A final decision on whether to introduce the standardised packaging proposal will be made only after the public consultation. We will ensure that any measures, if introduced, are consistent with Singapore’s domestic laws and international obligations.
MOH will continue to invest and promote good health. We will work closely with individuals, families, industry and community partners. But personal responsibility for healthy living remains key. Each of us has to do our part. Our goal is to realise a sustainable healthcare future where all Singaporeans enjoy Better Health, Better Care, Better Life. We ask for your support.
The Chairman: We have some time for clarifications. Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Chairman, just two clarifications on manpower.
Firstly, I am glad to hear that locally trained doctors would reach the target of 500 per year from local institutions. As I understand it, Singaporeans who are training abroad to be doctors, the numbers of them could reach the same number every year. I am just wondering how the Ministry is looking into these numbers and factoring them into our manpower planning plans. Also, are we still quite dependent on foreign medical manpower to meet our medical needs for the near future?
The second question is about nursing manpower. I am glad to hear about the remuneration framework. But as we have just heard from MSF, social service professionals are looking at up to a 12% rise in their remuneration package. So, I am just asking whether our nurses can also look forward to such salary increases, to attract more local nurses into the workforce.
The Chairman: Senior Minister of State Amy Khor.
Dr Amy Khor Lean Suan: Well, for nurses, under the National Nursing Taskforce, we have reviewed the salaries of nurses in 2014 and 2015, twice, between 3% and 10% increase each year and we introduced a special nurse payment bonus at the end of the year. We will continue to monitor and review their pay to make sure that they remain competitive. But in addition to that, of course, we also continue to look at their professional development and career progression to make sure that it would be an attractive profession to recruit and to retain nurses. In fact, one of the things we have also done is to have an assistant nurse clinician role added in so that there will be more of them who can get promoted at an earlier stage.
With regard to doctors, yes, indeed, we regularly monitor the demand and supply of doctors, taking into account demographics as well as disease trends. As I have noted, we will have a local training pipeline of 500 by this year. We do offer pre-employment training grants to Singaporeans who are graduates from recognised overseas universities and we will have to take the total number into account, even as we monitor demand and supply.
The Chairman: Ms Joan Pereira.
Ms Joan Pereira: Clarifications for Senior Minister of State Khor. The number of persons with dementia is increasing and the Senior Minister of State shared a lot of details on the services and support available for them. But I would like to know what about their caregivers? What are the support and services available for them?
My second clarification: may I also know what MOH is doing in enhancing palliative care services?
Dr Amy Khor Lean Suan: In terms of support for caregivers, over the years, we have implemented quite a lot of support for caregivers.
For dementia, as I have said earlier in my speech, we are introducing a Dementia Friends mobile app. This is to complement the range of services that we provide to help the caregivers. The mobile app is really to help caregivers in terms of providing resources, as well as push notifications. For instance, if their loved ones get lost, Dementia Friends is just like the Singapore Civil Defence Force's (SCDF's) First Responder mobile app. You can receive push notifications and try to help to find the loved ones.
But there are other services that we provide, the Eldersit Programme, for instance. The Eldersitter can actually look after the loved one at home, whilst the caregiver takes her rest or needs to do other work. We have got Weekend Centre-based Respite Care, long-term Nursing Home Respite Care for seven to 30 days and so on; as well as Caregivers Training Grant to help caregivers get training through AIC programmes, for instance, to be better able to care for their loved ones. So, there is a range of services that we provide, including the Singapore Silver Line, Singapore Silver Pages webpage where caregivers can also access resources, services, referrals and information.
The other question is on palliative care. For palliative care, we have been expanding the number of in-patient palliative care beds, for instance, as well as home palliative care services, increasing the capacity. I have just said that there is the Seniors’ Mobility and Enabling Fund (SMF), where we are now also providing a subsidy through SMF for home palliative care, in terms of consumables.
The Chairman: Dr Lily Neo.
Dr Lily Neo: Mr Chairman, Sir, my cut on breast cancer has not been answered.
Dr Amy Khor Lean Suan: I want to thank Dr Lily Neo for her question and let me apologise that I was not able to reply to the cut due to lack of time for my other colleagues. So, let me just give a reply.
First of all, indeed, as Dr Lily Neo had said, early detection facilitates prompt treatment and, in fact, it is key to improving the health outcomes of women diagnosed with breast cancer.
I am pleased to say that the percentage of early stage breast cancer diagnosed has actually increased from 70.9% in the period 2003 to 2007, to 72.4% in the period from 2012 to 2016.
In addition, there was a significant increase in a five-year observed survival of breast cancer patients from 66% in the period 2003 to 2007, to 71% in 2012 to 2016. I think this is likely due to improvements in treatment, as Dr Lily Neo had alluded to.
As regards access to breast cancer screening, HPB's Screen for Life currently offers subsidised screening programme at participating polyclinics to women aged 50 and above, and close to 43,300 women have benefited from this programme last year.
In addition, HPB collaborates with partners like Singapore Cancer Society, as well as Breast Cancer Foundation. These partners provide full sponsorship of screening programmes for lower-income women, such as CHAS cardholders, so that they do not even have to pay $50 to get screening.
This year, to increase the number of women screened, HPB will work with the National Healthcare Group Diagnostics, as well as the community partners and healthcare institutions to bring the Mammobus, the mobile mammogram service, closer to the target population, to 12 additional sites. All of us, indeed, have a part to play in ensuring that people around us, our loved ones, do go for their mammogram screening.
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling: I would also like to ask that given the prevalence and complications of gestational diabetes, what is the Ministry doing to increase awareness and control the incidence of gestational diabetes amongst women in Singapore.
Dr Amy Khor Lean Suan: For gestational diabetes (GDM), MOH announced last year that we will undertake routine screening and make it available for all pregnant women under the care of the public hospitals with maternity services.
Since the introduction of this policy in March last year, over 12,000 pregnant women have been screened at our three public healthcare institutions – KK Women’s and Children’s Hospital (KKH), SGH and NUH. About one in five pregnant women screened over the past year was found to have GDM.
So, MOH has been reviewing relevant considerations pertaining to the management of GDM and longer-term post-delivery management. We will be issuing an appropriate care guide later this year to better support primary care doctors who are involved in the care of women with GDM post-delivery.
The Chairman:\tMs Thanaletchimi.
Ms K Thanaletchimi: Sir, I have two clarifications for Senior Minister of State Amy Khor. One is with regard to non-practising nurses. Have we utilised all means to bring them back into the workforce, especially in the ILTC sector?
The second clarification is on emplacing graduands, that means, new entrants to nursing. Is there a difference between a diploma graduand and a degree graduand? Can we break the glass ceiling and emplace them correctly since they will be doing the same job?
Dr Amy Khor Lean Suan: For the non-practising nurses, in fact, we have enhanced our Return-to-Nursing programme. What we have done is to change this into a Place-and-Train programme, so that the nurses who are coming back will be placed first before they go for training, refresher course. So, they will be paid a salary instead of an allowance.
Over the last two years, we have been able to get about 25 non-practising nurses back into practice in the community care sector. We are doing as much as we can to encourage the non-practising nurses to come back into the sector, particularly in the community care sector.
For new entrants, staff nurses, diploma and graduate nurses, basically, our public healthcare institutions are paying our nurses or healthcare professionals on a performance basis, not just based on qualifications. But for new entrants, that is, people who have very little or no working experience, academic qualifications will be used as a basis.
For degree graduates, they have gone through at least six years of post-secondary education. When they join the profession, they are paid at the Staff Nurse Grade I level, simply because they have gone through a longer period of training and they would have attained deeper skills to kick off, as well as the fact that when they are employed, they would likely be assuming a wider breadth or scope of duties.
For diploma graduates, their post-secondary education is around three years. They will be able to start work after that and they would then have the same opportunities as the graduate nurses to progress in their career. In fact, after they join, both diploma and degree graduates will be assessed based on their performance, as well as any additional specialised skills that they would have gotten in the in-service training.
The Chairman: Mr Patrick Tay.
Mr Patrick Tay Teck Guan (West Coast): I have a clarification for Senior Minister of State Amy Khor.
Following from hon Member Dr Chia Shi-Lu's point on review of social workers' salaries, because we have a big group of medical social workers in our public healthcare institutions, I hope MOH can consider reviewing this as well. I am speaking on behalf of all my sisters and brothers from HSEU.
Dr Amy Khor Lean Suan: Sir, the answer is that we will continue to review and make sure that the pay remains competitive.
The Chairman: Mr Yee Chia Hsing. Is it for Senior Minister of State Amy Khor as well?
Mr Yee Chia Hsing (Chua Chu Kang): No. My question is not for Dr Amy Khor. I am very glad to hear from Parliamentary Secretary Amrin Amin that we are now only allowed to serve healthier choice drinks in our schools, but I believe these are limited to canned and packet drinks.
One of my friends told me his son became chubbier after going to school because he discovered this thing called \"Ice Milo Dinosaur\". To those of us who are not familiar, \"Ice Milo Dinosaur\" is ice milo with a heap of raw milo powder.
The Chairman: Mr Yee, no speech, please. Just a clarification.
Mr Yee Chia Hsing: So, I hope MOH can work with the schools to eliminate this \"abnormality\".
The Chairman: Mr Amrin, you know what is \"Ice Milo Dinosaur\"?
Mr Amrin Amin: Yes. I thank the Member for the question. The current focus is on pre-packaged drinks, but we will certainly look into freshly brewed drinks later on, especially given the Member's concern on ice Milo.
The Chairman: Mr Louis Ng.
Mr Louis Ng Kok Kwang: I think Senior Minister of State Amy would be relieved that my question is not for her.
I thank Senior Minister of State Chee Hong Tat for sharing the various improvements to CDMP, but I would like to ask for one more improvement, which is, addition of more auto-immune conditions, please.
Mr Chee Hong Tat: Mr Chairman, I thank Mr Louis Ng for his question. I apologise for not having enough time to address it earlier during my speech.
The CDMP, in deciding what conditions are covered, we have a CDMP Clinical Advisory Committee which comprises healthcare professionals from the public, as well as the private sector. They will review the various conditions based on considerations, such as the disease's prevalence and the effectiveness of earlier interventions to reduce complications.
So, certainly, we will refer the suggestion from Mr Louis Ng to the Advisory Committee for their discussion and review.
The Chairman: Mr Vikram Nair.
Mr Vikram Nair (Sembawang): This is also picking on the healthier choice point. Any progress we make towards encouraging people to take healthier choice is good. But I would like to make two suggestions.
The first suggestion is that we move from just healthier choice to actually healthy choice, because some things that are labelled \"healthier choice\" may not, in fact, be healthy. In fact, I understand Milo is considered \"healthier choice\", but people may be misled into thinking that means it is healthy.
Likewise, many breakfast cereals which have lots of sugar are also labelled as \"healthier choice\" even though that just means they are healthier than something else, but they are not healthier than, say, bread, even white bread. So, I think it may be good to have absolute standards.
And the second suggestion is: whether we want to take this even further and encourage or require companies to label sugar content in full, given if that is what the main focus is.
Mr Amrin Amin: I thank the Member for the observations. The Member is right that \"healthier choice\" symbol does not mean that you can \"whack\" and \"take\" as much as you can! So, that is the warning.
The key thing is that \"healthier choice\" is decided based on, for that category of food, it is lower in terms of sugar or other not too healthy things. It is healthier for that food band or for that food category.
As I mentioned in my speech just now, we are considering other measures. We are studying what the UK is doing with regard to its \"traffic light system\" for food and drinks, as well as France's Nutri-score. That is something we are working towards and we will update this House, as well as seek public consultations before making a decision on this.
The Chairman: I am not sure how \"whack\" and \"take\" would appear in the Hansard. Dr Chia, you want to raise a clarification?
Dr Chia Shi-Lu: Thank you, Chairman. Just one quick clarification for the Parliamentary Secretary.
I talked about the 10% increase in excise duty for tobacco. It seems that it has been an ongoing thing. We raise these taxes every few years. Could we have an idea of how useful these taxes are, in terms of reducing smoking prevalence?
Secondly, would the Parliamentary Secretary know whether there are any plans to further increase these taxes? Some people say that 10% is too little. So, perhaps I could have the Parliamentary Secretary's comment on that.
Mr Amrin Amin: I thank the Member for supporting the increase in tax for tobacco. Tobacco taxes complement other measures to reduce smoking. So, price and tax on tobacco have shown to be one of the most effective methods in reducing demand as well as subsequent demand for tobacco products. There have been numerous studies that have documented that price as well as tax increases have an effect in reducing demand or affecting demand.
Taxes work in conjunction with our other control measures and if Members look at how we have reduced the smoking prevalence rate from the high of 23% in 1977 to around roughly 13% in recent years, it shows the extent of our success. It is, of course, very difficult to pinpoint specific measures, like how much have tax increases contributed to reducing this prevalence rate. Holistically, we have to see that, in toto, our measures have been effective and the Government will continue to review and to see what we can do to enhance this to achieve our vision of a tobacco-free and nicotine-free future.
The Chairman: I think we have come to the end of clarification time. Would the Member wish to withdraw the amendment?
Dr Chia Shi-Lu: Thank you, Chairman. First of all, I would like to thank all Members for their healthy participation in this debate and, of course, as usual, to thank Minister Gan Kim Yong, Senior Minister of State Chee Hong Tat, Senior Minister of State Amy Khor, Senior Minister of State Lam Pin Min and Parliamentary Secretary Amrin Amin and, of course, all the staff of MOH for their detailed clarifications. I wish them every success in their efforts to transform healthcare for Singaporeans, for now and for the future. Thus, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $8,951,942,100 for Head O ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $1,279,876,000 for Head O 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 Reporting Progress","subTitle":null,"sectionType":"OS","content":"The Minister for Health (Mr Gan Kim Yong): Chairman, may I seek your consent to move that healthy progress be reported now and leave be asked to sit again tomorrow?
The Chairman: I give my healthy consent.
[(proc text) Resolved, \"That progress be reported now and leave be asked to sit again tomorrow.\" ‒ [Mr Gan Kim Yong.] (proc text)]
[(proc text) Thereupon Mr Deputy Speaker left the Chair of Committee and took the Chair of the House. (proc text)]
Mr Gan Kim Yong: Mr Deputy Speaker, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2018/2019 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":"[(proc text) Resolved, \"That Parliament do now adjourn.\" – [Mr Chan Chun Sing.] (proc text)]
Adjourned accordingly at 7.20 pm.
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