1 Mr Yip Hon Weng asked the Minister for Social and Family Development (a) in the past two years, what percentage of special needs adults are gainfully employed and how does this compare to the pre-COVID-19 pandemic levels; (b) what sectors are most of these adults employed in; (c) among those who are capable of working but remain unemployed, what are the common reasons; and (d) what forms of targeted help are available to them if they are unable to find employment after tapping on the various career placement and development programmes.
The Parliamentary Secretary to the Minister for Social and Family Development (Mr Eric Chua) (for the Minister for Culture, Community and Youth): Mr Speaker, Sir, based on latest available data from the Comprehensive Labour Force Survey (CLFS), the average resident employment rate for persons with disabilities aged 15 to 64 was 30.1% in the period of 2020 to 2021, an increase from the pre-pandemic level of 28.2% in the period of 2018 to 2019. We are talking about two-year moving averages.
Most persons with disabilities work in the community, social and personal services, food and beverages services, and professional services sectors. Some common challenges that persons with disabilities face in securing employment include the need for additional support to adapt to the workplace and difficulties in communicating with co-workers and supervisors. Some employers are also concerned about the additional costs required to hire and support persons with disabilities, such as physical workplace modifications and the purchase of equipment.
We will continue to avail various measures to support the employment of persons with disabilities. Persons with disabilities seeking employment can approach SG Enable. The Open Door Programme, or ODP for short, administered by SG Enable, aims to support employers in hiring, training and integrating persons with disabilities into the workforce. Under ODP, persons with disabilities receive up to one year of job matching and customised employment support from trained job coaches. Grants under ODP provide help to support the cost of job redesign, workplace modifications and subsidies for workshops that prepare employers and their employees without disabilities to interact, hire, integrate and retain employees with disabilities in their organisation. Between 2014 and 2021, SG Enable and its job placement partners helped to place over 3,500 clients in employment. In addition, about 600 organisations have participated in training to learn skills on how to recruit and integrate persons with disabilities at their workplace.
The Government also supports employers of persons with disabilities with the Enabling Employment Credit (EEC), which provides them with wage offsets of up to 30% for each Singaporean employee with disability earning below $4,000 per month. In the first half of 2021, more than 5,200 employers hired more than 8,600 persons with disabilities with support from EEC.
Employers who expand local hiring may also be eligible for wage support under the Jobs Growth Incentive (JGI). Based on latest available data, more than 2,900 persons with disabilities were hired between September 2020 and August 2021 with support from JGI. JGI will be extended till September 2022 and we encourage employers to tap on Government support to continue hiring more local persons with disabilities.
Besides enabling employers to hire persons with disabilities, persons with disabilities can also tap on the ODP Training Grant to attend training courses to develop new, or improve existing skillsets to boost their employability. Between 2014 and 2021, SG Enable and its partners trained more than 2,800 persons with disabilities.
To provide targeted employment support for persons with disabilities amid the pandemic, SG Enable introduced three new programmes under the National Jobs Council – Place-and-Train, Attach-and-Train and Skills Development Programme – to provide customised employment, traineeships and skills upgrading opportunities last year. Close to 300 job and training opportunities have been created for persons with disabilities under these programmes.
\tMr Speaker: Mr Yip Hon Weng.
\tMr Yip Hon Weng (Yio Chu Kang): Thank you, Mr Speaker. I thank the Parliamentary Secretary for his reply. Besides SG Enable, will the Ministry consider working with Workforce Singapore and e2i for job-matching of special needs adults with suitable employers, with the appropriate funding schemes.
\tMr Eric Chua: Mr Speaker, I thank the Member for his supplementary question. Yes, operationally, SG Enable is already working very closely with Workforce Singapore (WSG) and e2i. Whenever WSG and e2i receive the call for help from persons with disabilities, they do refer cases to SG Enable. At the strategy level, we also have a WSG representative on the board of SG Enable; and ODP is actually funded by WSG. So, there is definitely a close working relationship between WSG, e2i and SG Enable. We will seek to build on this foundation that we have.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Update on Application Made against Attorney-General by 17 Prisoners Awaiting Capital Punishment","subTitle":null,"sectionType":"OA","content":"2 Mr Murali Pillai asked the Minister for Home Affairs (a) whether more details can be shared regarding an application made against the Attorney-General by 17 prisoners awaiting capital punishment; and (b) what can be done to counter foreign interference on sensitive issues such as the death penalty.
\tThe Minister of State for Home Affairs (Assoc Prof Dr Muhammad Faishal Ibrahim) (for the Minister for Home Affairs): Mr Speaker, Sir, on 13 August 2021, an application was filed in Court by 17 prisoners awaiting capital punishment against the Attorney-General. The application sought declarations that in prosecuting them for capital drug offences, the Attorney-General had acted arbitrarily and discriminated against them as persons of Malay ethnicity and had exceeded his powers and acted unlawfully.
On 2 December 2021, the High Court dismissed their application, finding the plaintiffs' allegations to be baseless. The High Court went further to find that the application was an abuse of court process. No appeal was filed against the dismissal of the application.
On 13 August 2021, the day the application was filed, the plaintiffs’ counsel posted on social media and credited an “English Barrister” for assisting him with the application. This English Barrister appears to be associated with a London-based NGO.
Subsequently, before the case was heard by the Court, details of the plaintiffs’ affidavit were published online on a Malaysian news portal, even before it was adduced as evidence in Court. This was a breach of the Supreme Court Practice Directions. It was also revealed that the plaintiffs’ counsel had furnished the cause papers, including the affidavit, to a group of foreign lawyers from a Malaysian human rights NGO, Lawyers for Liberty (LFL).
Minister Shanmugam had referred to this during the Second Reading of the Foreign Interference (Countermeasures) Bill in October last year, as an example of the chance of leakage in the court process, since the affidavit was published even though it should not have been.
The affidavit made completely false but sensational allegations – designed to grab attention. In the normal course, if the matter had gone on, the allegations would have been shown to be false. But they were published before that.
The whole unseemly series of events: putting up false allegations on affidavit and then leaking it overseas, seems to have been an attempt to weaken public trust in the criminal justice system, stir feelings in our multi-racial society, by using foreigners. The High Court said that the allegations were \"speculative assertions\" and \"conjecture cloaked in general interest\".
This is not the only time that LFL has tried to intervene in our criminal justice process. In February 2022, two other persons awaiting capital punishment applied to the Court of Appeal for leave to review their concluded appeals to set aside their death sentences. LFL attempted to participate as one of the applicants, despite not being a party to the earlier appeals. The Court dismissed this attempt as LFL had no locus standi.
The Member's question on what can be done to counter foreign interference is important. As Minister mentioned in his Committee of Supply (COS) speech, the death penalty remains relevant and important in our criminal justice system, as a deterrent against serious crimes and to keep Singaporeans and Singapore safe and secure. The majority of Singaporeans support the use of the death penalty for serious crimes.
While other countries and NGOs may not share the same view as us, this is an issue for Singaporeans to decide. In the incident I referred to, we see them trying to mobilise public opinions, using baseless accusations to play up the issue of race – to weaken Singaporeans’ trust and confidence in our criminal justice system. We must be on our guard against such foreign interference.
We need to build a broader awareness amongst Singaporeans to such foreign interference.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Placing Primary School Students Taking Subjects at Foundation Level in Same Class as Other Students to Ensure Social Mixing","subTitle":null,"sectionType":"OA","content":"3 Mr Louis Ng Kok Kwang asked the Minister for Education whether Primary school students taking subjects at a foundation level can be placed in the same class as students who are not taking foundation level subjects to ensure social mixing, similar to that in Secondary schools.
The Second Minister for Education (Dr Mohamad Maliki Bin Osman) (for the Minister for Education): Mr Speaker, Primary schools strive for diverse form classes with a good mix of gender, race and learning ability. Thus, form classes at Primary 5 and 6 can have students of several subject combinations, including a mix of students taking subjects at Foundation and Standard levels.
Beyond classes, students also have opportunities to interact with their peers through school-wide platforms such as Co-Curricular Activities (CCAs).
\tMr Speaker: Mr Louis Ng.
\tMr Louis Ng Kok Kwang (Nee Soon): Thank you, Sir. I thank the Second Minister for the reply. Two clarifications. One, could I ask then how exactly is streaming done at Primary 5 and how do we segregate them into different classes based on their learning abilities or, as the Second Minister said, is it based on their race or their interest?
Two, Minister Chan shared during the MOE Committee of Supply (COS) debate that we would have mixed form classes in Secondary schools, where students can interact with peers of different strengths and interests. Can I check whether that will be extended to Primary schools as well?
\tDr Mohamad Maliki Bin Osman: Sir, I thank the Member for the supplementary questions. Yes, as I mentioned, we do group students in form classes at Primary 5, because at Primary 4, they take tests to ascertain their competency level and they are allowed to then decide based on consultation with their parents, too, on the subject level that they are prepared to take – whether it is at Foundation or at the Standard level. Some students do take one or two subjects at the Foundation level, depending on their level of abilities.
Let me give a broad overview as to how we allocate students in their class formation. When allocating students to classes, schools aim to create an inclusive and caring learning environment, so as to nurture and develop students holistically. We provide the foundation for students to shape their attitudes towards learning, build future knowledge and skills and develop soft skills that are needed for them to navigate in the future world, which is really, very challenging for them. This is better achieved with diverse classrooms within the classroom setting and as diverse as we can, to provide better social mixing. But there are certain considerations, given the class size that we have.
\tThese considerations include having enough common subjects for the form class to bond but it also depends on the capability of teachers with a wide range of abilities and resource limitations. Schools are given flexibility to manage and operationalise the groupings.
As I mentioned in my earlier reply, we want to manage better social mixing between gender, ethnicity, abilities. More importantly, Sir, we understand the Member's concern about social mixing. Social mixing is but one of the many considerations in how students are grouped in classes. But we must be careful that social mixing, if brought to the extreme, may impose more challenges for our teachers and how they can teach. So, we want to strike a balance, in managing what we can do. But beyond the classrooms, we also facilitate social mixing through other platforms, as I mentioned earlier, in CCA activities.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Construction Projects with Permission to Work on Weekends","subTitle":null,"sectionType":"OA","content":"4 Mr Yip Hon Weng asked the Minister for Sustainability and the Environment among current ongoing constructions projects (a) how many have been granted permission to work on weekends; and (b) whether there has been an increase of constructions projects granted permission to work on weekends as compared to the last tightening of COVID-19 pandemic restrictions.
The Minister of State for Sustainability and the Environment (Mr Desmond Tan) (for the Minister for Sustainability and the Environment): Mr Speaker, construction works are not allowed on Sundays and public holidays at sites located within 150 metres from any hospital, home for the aged sick, or residential building. Nonetheless, contractors can apply for a permit from NEA to carry out specific types of quieter construction works on Sundays and public holidays. These quieter works are also subject to a set of conditions, including more stringent noise limits and restricted working hours.
In the current Transition Phase to COVID-19 Resilience, which began on 22 November 2021, 79 ongoing construction projects have been granted permits to carry out quieter construction works on Sundays and public holidays. In comparison, 70 such permits were granted during the preceding Stabilisation Phase from 27 September 2021 to 21 November 2021.
\tMr Speaker: Mr Yip Hon Weng.
\tMr Yip Hon Weng (Yio Chu Kang): Mr Speaker, I thank the Minister of State for his reply. Will the Ministry consider: one, tighter enforcement on noise management for construction activities on Sundays and public holidays; and two, reducing the hours on Sundays and public holidays for construction if the construction sites are sited near residential areas.
\tMr Desmond Tan: I thank the Member for the feedback. On the first one, NEA has been stepping up on enforcement. Last year, in Parliament, we passed amendments to the Environmental Protection and Management Act that require errant contractors to install real-time video surveillance so that we can enforce the \"no-work rule\" more effectively over the public holidays as well as Sundays. This is something that will come into effect in October this year and will help NEA to better enforce some of the errant practices of working on a \"no-work day\".
The second point about reducing hours, it is something that we constantly try to strike a balance for, between creating a more conducive environment and ensuring that the projects, construction works, progress within certain timeframes and with certain costs. This will have an impact not just on the duration of the work, which will ultimately cause more disamenities and prolonged noise for our residents. So, on this part we will try to strike a balance.
Today, on Sundays and public holidays, the work hours are already restricted between 10.00 am and 5.00 pm and the kind of works that are allowed are quieter works that will not cause additional noise to the residents.
The current regulation and guidelines in place would be effective to try and reduce and balance the need for construction to progress within certain time and costs, and the noise disamenities that is caused for our residents. NEA will continue to do the enforcement and monitor to make sure that we keep the environment conducive.
\t
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Town Councils' Enforcement Actions against Unlawful Parking in Common Areas by Foreign-registered Vehicles","subTitle":null,"sectionType":"OA","content":"5 Mr Yip Hon Weng asked the Minister for National Development (a) whether Town Councils are authorised and has the powers to conduct enforcement actions against unlawful parking in common areas by foreign-registered vehicles similar to local registered vehicles; (b) if so, how are such enforcement actions conducted against foreign-registered vehicles; and (c) whether there is a difference in enforcement actions conducted against foreign-registered and local registered vehicles.
\tThe Senior Minister of State for National Development (Ms Sim Ann) (for the Minister for National Development): Sir, Town Councils may prohibit or regulate the parking of vehicles on common property within HDB estates under their own by-laws. A breach of any of a Town Council’s by-laws is an offence. The Town Councils Act does not differentiate between foreign- and local-registered vehicles.
Town Councils have the autonomy to decide how they wish to enforce their by-laws, including those pertaining to unlawful parking in common areas. Enforcement actions against vehicles found parked illegally on common property can include issuing notices of offence, removing, or detaining the vehicles, if the Town Council is empowered to do so under its by-laws. Town Councils can approach HDB and LTA for assistance if they require information about foreign-registered vehicles for their enforcement efforts.
\tMr Speaker: Mr Yip Hon Weng.
\tMr Yip Hon Weng (Yio Chu Kang): Mr Speaker, I thank the Senior Minister of State for her reply. Before the Town Council can issue a summon for the foreign-registered vehicle, the Town Council needs the owner's details. My understanding is that as foreign vehicles are not registered LTA, it would not be able to provide the Town Council with the foreign owners' details and so the Town Council cannot proceed with summons. Will the Ministry consider working with ICA and LTA on this matter so that the Town Council can issue summons as part of its enforcement actions?
\tMs Sim Ann: Sir, currently what is being done is that HDB and LTA will look at the information that they have available if the Town Council approaches them and they will try to assist to the best of their ability. My understanding is that some Town Councils, if their by-laws allow, also detain the vehicle by clamping and require the vehicle owner to pay the fine at the Town Council's office before the vehicle is released back to them. That is also another way in which enforcement can be done.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Ratio of Singaporeans to Foreigners in Autonomous Universities for Faculty Members","subTitle":null,"sectionType":"OA","content":"6 Mr Leon Perera asked the Minister for Education for each year in the past 10 years, what is the respective ratio of Singaporeans to foreigners in Autonomous Universities for faculty members (i) on an overall basis (ii) for Humanities and Social Science-related departments (iii) on the tenure track and (iv) on the non-tenure track.
\tThe Second Minister for Education (Dr Mohamad Maliki Bin Osman) (for the Minister for Education): Mr Speaker, the number of Singaporean faculty as a proportion of the overall faculty in the Autonomous Universities (AUs) has remained stable at around 50% over the past 10 years. Based on available data over the past five years, the proportion of Singaporean faculty in the Humanities and Social Sciences-related departments in our AUs is around 50%.
For National University of Singapore (NUS), Nanyang Technological University (NTU), Singapore Management University (SMU) and Singapore University of Technology and Design (SUTD), which have a tenure system, the proportion of Singaporeans in tenured and tenure-track faculty has remained stable at around 40% over the past 10 years. For faculty on the non-tenure track, the proportion of Singaporeans is higher, averaging at around 60% over the past 10 years.
We will continue to work with the AUs to build a strong Singaporean Core in our faculty. The AUs actively reach out to Singaporean academics based overseas to attract them to come back to Singapore. We also support young Singaporeans keen on pursuing an academic career at the AUs through the Singapore Teaching and Academic Research Talent Scheme (START) which was introduced in 2015. There are 162 START award recipients to date.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Applications to Import Embryos Back to Singapore for Assisted Reproductive Technology Procedures","subTitle":null,"sectionType":"OA","content":"7 Mr Louis Ng Kok Kwang asked the Minister for Health in the past two years (a) how many applications has the Ministry received to import embryos back to Singapore for Assisted Reproductive Technology procedures; (b) how many of such applications have been successful; and (c) what are the main reasons provided for rejections.
\tThe Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam) (for the Minister for Health): Since the process was established in June 2021 to review applications to import embryos back to Singapore for Assisted Reproduction treatment for couples affected by the COVID-19 travel restrictions, MOH has received 62 such applications.
Of these, 59 applications were successful; three were unsuccessful. Three were unsuccessful as they did not meet the regulatory requirements stipulated in the Licensing Terms and Conditions for Assisted Reproduction Services, such as exceeding the allowed egg donor age limit.
\tMr Speaker: Mr Louis Ng.
\tMr Louis Ng Kok Kwang (Nee Soon): Thank you, Sir. I thank the Parliamentary Secretary for the reply. Two clarifications. Can the Parliamentary Secretary share what are the other reasons why there was such a high rate of rejection?
Two, I asked earlier whether MOH can establish a standardised application form so that people can just fill in to apply to import the embryos back to Singapore. I think that will help reduce the stigma of couples undergoing IVF and also reduce the stress. So, a standard application, rather than an appeal which makes them feel like they are begging to import their own embryos back to Singapore.
\tMs Rahayu Mahzam: I think the Member for the question. Firstly, I just want to express how I understand the anxieties of the couples going through this process, especially during such times. I know their concerns and the urgency of such situations.
I would just like to highlight though that I mentioned earlier that there were 62 applications in total, 59 were successful. So, it is not really a high rate of rejection and really, the rejection was as a result of not meeting the regulatory requirements stipulated in our licensing terms and conditions for Assisted Reproduction (AR) services. So, that is something that they would need to align with.
In respect of the other point about the standard forms for application, I recall that we had this exchange, about a year back, in relation to this matter and Mr Louis Ng had raised this point about making it convenient and using a standard form. We had taken on board Mr Ng's previous suggestion.
To facilitate the MOH review of the increasing number of appeals at that juncture, MOH developed an online application form, specifically for the purposes of such appeals. A circular was issued on 3 June 2021 to all licensees providing AR services under the Private Hospitals and Medical Clinics Act that set up the conditions for appealing to import gametes or embryos during the COVID-19 travel restrictions and the information that MOH would require the information required to carry out its review. I hope that addresses the Member's query.
\tMr Speaker: Order. End of Question Time.
[Pursuant to Standing Order No 22(3), written answers to questions not reached by the end of Question Time are reproduced in the Appendix, unless Members had asked for questions standing in their names to be postponed to a later Sitting day or withdrawn.]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Estimates of Expenditure for the Financial Year 1 April 2022 to 31 March 2023","subTitle":"Committee of Supply – Paper Cmd 12 of 2022","sectionType":"OS","content":"[(proc text) Order read for consideration in Committee of Supply [6th Allotted Day]. (proc text)]
[Mr Speaker in the Chair]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head W (Ministry of Transport)","subTitle":"Creating an inclusive and sustainable home","sectionType":"OS","content":"[(proc text) Head S (cont) – (proc text)]
[(proc text) Resumption of Debate on Question [8 March 2022], (proc text)]
[(proc text) \"That the total sum to be allocated for Head W of the Estimates be reduced by $100.\" – [Mr Saktiandi Supaat]. (proc text)]
[(proc text) Question again proposed. (proc text)]
Mr Murali Pillai (Bukit Batok): Sir, hon Members on both sides of the aisle have expressed concern about the high motorcycle COE prices. These prices impact persons from low-income background, especially those who use motorcycles as part of their work. For them, taking public transport is not a viable option. Even as demand for these continue to be strong, the supply has been squeezed. Last year, the Government announced a zero-growth rate for cars and motorcycles until 31 January 2025. In these current circumstances, motorcycle prices may rise even further unless something is done.
I support a cap on our vehicles, as the number on our roads draw near to one million, but I wonder if the total number can be allocated differently. For example, I note from the categorisation of vehicles for COE purposes, goods vehicles are in a separate category, Category C. I further note that this category is allowed a growth rate of 0.25% of the vehicle population divided by four until 2025. I wonder if the Government is prepared to recognise a separate category of delivery motorcycles and apply a similar growth rate for this category. This may go some way to mitigate the high COE prices for motorcycles used for work. It is a practical and fair way to harness the market to work for us.
Mr Abdul Samad (Nominated Member): Chairman, the cost of owning a motorcycle has risen miserably for motorcycle riders since the past year, more so with COEs for motorcycles crossing the $10,000 mark. This has impacted many workers riding small motorcycles, not just to and from work but also for those who use it to earn a living, to bring food on the table for themselves and their family members.
Many of my cousins, friends, union members and fellow workers shared with me their concerns and they are worried about how the cost of owning a motorcycle would affect their livelihood. Not more than three years ago, the cost of purchasing a new motorcycle with a small engine capacity is around $8,000 or below, including with COE. But today, it is a really big challenge for them. My recent engagement shows that owning a new small motorcycle with the same small engine capacity will cost between $15,000 and $18,000 dollars.
MOT certainly has the data of motorcycle ownerships based on engine capacity. Hence, on behalf of all of them, I am appealing that MOT takes a much deeper and closer look and provide the necessary support or assistance for this group of riders. Can MOT also consider tiering the COE prices based on engine capacity?
To the Minister for Transport, this is the plea I wish to convey on behalf of them: \"We like to earn a living for ourselves and family and this is only what we can afford. If you don't help us, who then should we turn to, Sir?\"
Mr Liang Eng Hwa (Bukit Panjang): Sir, the Certificate of Entitlement (COE) premiums for motorcycles hit new highs and stayed above the $10,000 level since January this year. The premiums now can cost more than two times the price of an entry level motorcycle. Does this make sense? And how does it impact those who are dependent on motorcycles for their livelihoods?
Sir, while the market-based approach to allocate COEs is efficient, it may not always lead to the desirable economic and social outcomes. Motorcycles is one the essential mode of transport that have helped many meet many critical and general business needs, such as delivery and dispatch of goods and documents. It is less impacted by traffic jams and hence, can be a more reliable transport mode to get around, including delivering essential items like medicines or attending to emergency repairs and many other economic activities.
Many full-time and freelance workers are also dependent on their motorcycles for livelihoods. Hence, the sharp rise in COE premiums do cause anxieties to these riders. Their concerns are whether would the COE premium continue to rise higher and to stay high.
Like any markets, there is always room for interventions when the price actions do not reflect fundamentals, or where there are market distortions that cause imbalances in demand and supply.
What are the reasons for the recent record high premiums of motorcycle COEs? What can the Government do to moderate or bring down the premiums to more affordable levels? Should we look at the supply of the motorcycles' COE as one way to meet the higher demand? Otherwise, would the Government consider other additional measures to help those who are impacted and dependent on their motorcycles for livelihoods?
Mr Kwek Hian Chuan Henry (Kebun Baru): Chairman, in previous Budgets, COS debates and Parliamentary Questions (PQs), I have spoken about whether the Government can do more regarding the high prices of motorcycle COEs.
High demand, like what my Parliamentary colleagues have just mentioned, is one of the reasons. Another possible reason is that over the years, there was a reduction of the percentage of total COEs used by motorcycles. And this is because a portion of motorcycle COEs were converted previously into Open Category COEs, even though motorists rarely used the Open Category COEs for motorcycles.
I previously asked for MOT to consider stopping this transfer to Open Category and for a greater proportion of COEs to be allocated to motorcycles over time, with an eye of restoring the original ratio of motorcycle versus non-motorcycle COEs. MOT has responded then by stopping the transfer to Open Category, which was helpful to moderate motorcycle COE prices then. In view of the current prices of motorcycle COEs, is there more that MOT can do and possibly increase the number of COEs for motorcycles?
Ms Poh Li San (Sembawang): Chairman, over the years, the Government has conducted several reviews of regulations to ensure safe usage of active mobility devices. Active mobility modes have also increased in popularity since the pandemic started.
Would the Ministry provide an update on the situation today? How many Singaporeans and residents are using active mobility devices on a regular basis today, compared to the last two years? What are the Government’s plans to support active mobility while ensuring safety for all users and pedestrians?
Would the Ministry provide an update on the Islandwide Cycling Network? With the rise in the number of cyclists for commuting, delivery and leisure, would the Government speed up the construction of cycling networks, especially in towns with dense cycling traffic?
Mr Dennis Tan Lip Fong (Hougang): Mr Chairman, in the past half a year or possibly longer, I have noted from media websites that the authorities have been regularly conducting operations to promote safe riding efforts by cyclists and Personal Mobility Devices (PMD) users.
And according to news, media reports or the LTA Facebook page, these efforts included enforcement against errant riders, as well as efforts by officers to stop and engage riders on-the-ground on safe riding etiquette, as well as use of the right equipment, such as having compliant e-bikes complying with road traffic or active mobility rules – such as observing appropriate speed limits, complying with traffic lights, riding against the traffic, no riding on expressways, wearing of helmets and riding in the right numbers or formation.
I had previously spoken of the need for consistent enforcement and I am heartened by the publicity on more regular enforcement. The enhanced publicity for these operations and engagements are also good, as they should help to encourage riders to be more conscious in riding safely and complying with road traffic or active mobility rules.
Will the Government give a brief report of its enforcement and engagements over the past year, including the number of cases of infringements by cyclists or PMD users, who were taken to task?
While I agree that the recent efforts are a step in the right direction, I have continued to see, on quite a regular basis, that there are still riders who, for example, beat red lights or cycle against the traffic, or do not wear helmets and riding on the road. I still see some e-scooters on the road or on footpaths, even though their use on these services have been banned for some time.
Though I agree that the use of PMDs on roads or footpaths have reduced considerably from the time before the ban took place, I am often surprised to see that people continue to take the risk of riding illegally. Sir, I hope the Minister would share MOT's plans on how the Ministry will engage or deal with this smaller group of active mobility users who may continue to use their bikes or e-scooters illegally or inappropriately, so that we can continue to improve the riding culture in Singapore.
In particular, are there any lessons learned from the enforcement or engagement efforts in recent months, which can be applied to persuade this group of active mobility users?
Dr Shahira Abdullah (Nominated Member): With Singapore moving towards being a car-lite society, as well as the COVID-19 pandemic leading to a cycling boom, there have been many altercations between motorists and cyclists in Singapore. These incidences may be uploaded on social media, which serves to stoke further tensions between them. Therefore, the recommendations from the Active Mobility Advisory Panel (AMAP) came at a timely juncture to ensure safety as motorists and cyclists increasingly share the roads.
I am glad the Panel has recommended that cyclists take up third-party liability insurance. It can help protect the cyclists when accidents occur, providing compensation for victims of accidents. As such, I would like to find out the timeframe for rolling out these measures.
Even though the Panel has decided not to license on-road cyclists, public education is still an important part of the adoption of these recommendations. There is also a concurrent need to educate the drivers as well. Motorists may not be aware of what cyclists can do on the road and not all cyclists are familiar with the highway code. What will the Ministry be doing to step up public education on road safety for cyclists and motorists hand-in-hand with its enforcement action? How will the Ministry be ensuring that errant cyclists and motorists will be caught and censured?
Assoc Prof Jamus Jerome Lim (Sengkang): Sir, I wish to make the case for designated bike lanes in towns, carved from the existing road network. These lanes would be proposed by the Town Councils in collaboration with LTA and can be piloted on roads that are less heavily utilised within their estates.
To be clear, there is already an extensive network of island-wide bicycle-friendly trails, comprising the Park Connector Network (PCN), alongside trails as well as corridors. But these trails do no address the so-called \"Last Mile Problem\", where riders are still required to ride on regular roads and occasionally on pavements, to the detriment of some of the Members of this House as well as safety, to get to their final destination, or to traverse across the estate.
Bicycle riders can, of course, make use of existing roads, riding to the far left. But when bike lanes are not designated, there is an absence of clear guidelines for vehicle drivers and this often results in compromising the riders' safety when passing vehicles leave uncomfortably little space.
Accordingly, riders ride defensively, sometimes two abreast, to occupy the entire lane, which would be more inefficient than designating a clear, even if narrow, bike lane and correspondingly narrow lines for regular vehicles.
Dedicated bike lanes will support commercial activity. Since cycling paths currently allow the use of powered vehicles, delivery riders that cannot ply foot paths, will have a safe alternative for their Personal Mobility Devices (PMDs). In Sengkang, such delivery riders and dedicated bike lanes seem like a win-win solution that will accommodate our many PMD users. Such bike lanes will also encourage activities that promote environmental sustainability. Lanes that connect within estates will serve as an important supplement to the tripling of bike trails envisioned in the Singapore Green Plan 2030.
Mr Lim Biow Chuan (Mountbatten): Sir, last year, during COS debate, I spoke about the frustration caused to many pedestrians due to a minority of reckless cyclists, who speed along shared paths and footpaths. Their inconsiderate behaviour is a cause of danger to other users of the shared paths or foot paths, who may be injured by such riders.
I have seen regular enforcement action taken by LTA and NParks' officers, but this situation does not seem to have improved. The enforcement officers cannot possibly be at the park connector or other shared paths every day. Pedestrians tell me they do not feel safe using the shared paths or footpaths, when cyclists zip by them at high speeds and in a dangerous manner. And this is especially so for pedestrians who are seniors or with young toddlers. One wrong step by the toddler or the senior person may mean serious injury if a speeding bicycle crashes on them. It does not help that many shared paths do not have clear demarcation as to which side of the path is for pedestrians and which side is for the cyclists.
Indeed, I myself have walked along such paths and I felt it was very stressful not knowing whether a reckless cyclist would crash into my back.
May I ask LTA to do more – to educate and remind all cyclists using shared or footpaths that they should not speed and be considerate to other users? Can LTA put up more prominent signs along the paths reminding cyclists on the dangers of speeding and riding recklessly?
In Tanjong Rhu, there used to be a sign – a small sign – that the cyclists are not supposed to ride beyond the bicycle lane. But nobody obeyed it. But when a prominent \"No Cycling\" sign was put on the floor of the footpath bridge, I saw marked improvements in the behaviours of cyclists and a large majority of cyclists dismounted and pushed their bicycles across the foot path. Without the prominent signage, many cyclists would just ride across the bridge.
Mr Cheng Hsing Yao (Nominated Member): Sir, recently, a foreign friend shared that one of the best things about Singapore is that people can walk freely and comfortably on the streets, even in the early morning or late at night. They do not feel that their safety is threatened. This is the combined efforts of MHA, which maintains a very low crime level in Singapore and the concerted planning and execution of various Ministries, like MND and MOT. I am a member of the Discover Tanjong Pagar Business Improvement District (BID), which is an association of private development stakeholders. We work together to find ways to enhance the Tanjong Pagar neighbourhood. Initially seeded by MND and URA, the Discover Tanjong Pagar BID has become a close-knit group of stakeholders. The BID had many positive experiences working with the agencies, such as URA, NParks, SLA, PA and LTA.
On walkability, members of the BID had site walks with LTA officers to explain some of the areas of concerns for pedestrian safety or comfort. With the other agencies, we have jointly developed green spaces, introduced play facilities and tree planting. LTA considered the inputs from the BID and implemented improvements, such as introducing new traffic lights or widening of footpaths. These efforts cannot make news headlines, but they relate to the detailed on-the-ground adjustments that greatly improve the experience of the neighbourhood. Can MOT share more about how agencies and stakeholders can work together to make our city more walkable, vibrant and liveable?
The Chairman: Mr Gan Thiam Poh, take your three cuts together.
Mr Gan Thiam Poh (Ang Mo Kio): Thank you, Chairman. More Singaporeans and residents are taking up cycling as a form of exercise and as a green mode of transport. Can the Ministry share an update on the islandwide cycling network as well as plans to make cycling safer for cyclists and pedestrians on pathways which are currently not part of the network?
Our road network spans 9,000 lane-kilometres and requires much maintenance to keep it in good and safe condition. In the face of labour shortage, how would LTA upkeep maintenance? Will LTA be leveraging on new technology or materials to maintain this network effectively?
Illegally-modified vehicles cause not only noise pollution, which disturb residents, especially late at night. They also put the drivers, passengers and other road users at risk. There have been quite a number of incidents where they either burst into flames or would not be able to function safely. What is LTA doing to address this problem of illegally-modified vehicles and motorcycles?
Ms Yeo Wan Ling (Pasir Ris-Punggol): Through the years, our taxi and private hire vehicle driving community has been keeping Singapore going. Rain or shine, early mornings and late nights, pandemic or no pandemic, providing a reliable and safe form of transportation for many Singaporean families. Our resilient hardworking drivers have weathered changes to their industry, affecting their livelihoods and lives. Some changes are sudden, like COVID-19; some changes are long-tailed, like technology changes, ranging from changing diesel standards, the invention of ride-hailing apps, the rolling out of full EV vehicles.
Our drivers have rolled with the times and, with the support and representation of the NTUC Associations, National Taxi Association and the National Private Hire Vehicles Association, their resilience and courage have carried them out of these situations stronger and better. In the midst of the fuel price surges, which have left our drivers reeling and frightened about the sustainability of their livelihoods, our association leaders have led the charge and bringing the matter of business cost up to the taxi and ride-hail platform partners as well as LTA. Our leaders have similarly worked with the tripartite partners in the introduction and extension of the COVID-19 Driver Relief Fund (CDRF), which has given our drivers some added measure of relief.
One evergreen challenge our leaders have brought up is the support needed to aid drivers looking to transit out of driving. Unlike salaried employees who may take paid training leave, for every hour a self-employed driver spends away from his trade, it is an hour less spent on earning a living. Hence, most drivers who wish to undertake training must bear triple costs – training fee, vehicle rental and loss of income. To provide some ground reality, the current training allowance provided by WSG is pegged at $4.50 per hour. An eight-hour training day equates to $36 or 50% of vehicle rental cost. Given that many drivers have depleted their savings trying to cope with COVID-19, this is a challenging dilemma. As our drivers seek for more sustainable future-proof livelihoods, will the Ministry consider training allowances to be adjusted? Can the Ministry also provide an update for the support of our drivers to prepare for a better future?
Throughout COVID-19, our drivers have been frontliners and sometimes face the wrath of angry and unreasonable commuters. This can range from ugly spats on the COVID-19 measures to our female drivers who meet the tricky passengers as they brave the long night drives. What are some of the new safety nets that the Government will be putting in place to ensure that our drivers remain safe and how has it been effective as a deterrent for taxi drivers and PH drivers since its inclusion in July 2021?
The Chairman: Minister S Iswaran.
The Minister for Transport (Mr S Iswaran): Mr Chairman, I would like to thank all Members for their questions and suggestions for my Ministry, which Senior Minister of State Amy Khor, Senior Minister of State Chee Hong Tat, Senior Parliamentary Secretary Baey Yam Keng and I will endeavour to address.
Sir, connectivity is the lifeblood of Singapore. We depend on our transportation links, domestic and international, for our lives and our livelihoods. Hence, MOT's aim is to build a Resilient, Sustainable and Inclusive Transport Hub. I will focus my response to Members' cuts on four themes: first, the recovery of our Aviation Hub; second, our sustainability initiatives; third, keeping land transport accessible and affordable; and fourth, creating good job opportunities in the transport sector.
Let me start with the reopening of borders and aviation recovery, which Mr Melvin Yong, Mr Gan Thiam Poh, Ms Poh Li San, Mr Dennis Tan and Mr Raj Joshua Thomas have asked about. This is our immediate priority.
Changi's air connectivity anchors the Singapore economy. Many companies choose to be in Singapore because they can easily reach their customers and suppliers in our region and beyond. To lose Changi's connectivity is to lose this key competitive advantage and our livelihoods that depend on it.
In the early stages of the pandemic, we were faced with a stark and difficult trade-off between protecting public health and opening our borders. Fortunately, we are in a different situation today, thanks to a better understanding of the virus, well-established safe management measures and high levels of vaccination in our population.
Hence, we have been able to take careful and calibrated steps to reopen our borders. In early 2021, the passenger volumes were at 3% of pre-COVID-19 levels. We introduced Vaccinated Travel Lanes (VTLs) from September last year, barely six months ago, although it feels like a lifetime. Today, we have VTLs with 32 countries and regions. These VTLs have enabled us to attain passenger volumes of about 15% of pre-COVID-19 levels in December 2021. Flights at Changi have reached 38% and city links are at 58%. Many have, finally, been able to reunite with family and friends abroad.
We must sustain this momentum. Other aviation hubs, like Dubai, Qatar and Istanbul, are already at up to 70% of their pre-COVID-19 international passenger traffic. In our region, Malaysia, Vietnam, Thailand and the Philippines have announced plans to reopen their borders to all vaccinated travellers. In short, the world is learning to live with COVID-19.
We now have the confidence and opportunity to move decisively. IATA forecasts that international passenger volumes in the Asia Pacific will recover to about 40% of pre-COVID-19 levels this year. We aim to restore Changi's passenger volumes to be at least 50% of pre-COVID-19 levels in 2022.
We are now in the first phase of this plan, launching VTLs with specific countries and regions. Just last week, we announced further VTLs with Vietnam, Greece, Malaysia, Indonesia, India and Europe.
The next phase will entail a more fundamental shift – from Vaccinated Travel Lanes to vaccinated, quarantine-free travel. Our aim is to allow all fully-vaccinated travellers from countries and regions under MOH's \"Low Risk\" and \"General Travel\" categories to enter Singapore without having to serve Stay-Home Notice (SHN) or quarantine. This will, effectively, reopen our borders to the rest of the world.
MOT will work closely with the Multi-Ministry Task Force (MTF) and MOH on the timing of this transition, which will depend on the public health situation in Singapore and the world, among other things.
We share Ms Poh Li San’s concerns about the potential impact of the situation in Ukraine. It has already affected fuel prices and could impede the recovery of the global economy and international aviation. We are monitoring the situation closely with our aviation partners and will mount an appropriate response should the need arise.
In the meantime, our airport community is gearing up for higher travel volumes. During the pandemic, the workforce in Changi Airport Group, SIA, SATS and other aviation companies fell sharply. Based on MOM's latest published employment data, as of September 2021, the air transport sector employed about 25,000 workers, nearly one-third less than pre-COVID-19 levels.
Our companies are now ramping up recruitment. SIA has started hiring new cabin crew and SATS is bringing back experienced workers. This is an important effort, but by no means an easy one. The Government will continue supporting our aviation sector amidst the continued uncertainty with a $500 million \"OneAviation Resilience Package\" in the coming financial year. Of this, $60 million will go towards manpower support, as companies build up capacity ahead of demand; $390 million for continued cost relief and measures to safeguard public health at the airport; and $50 million to support long-term industry digitalisation and transformation efforts via a top-up to the Aviation Development Fund.
Mr Melvin Yong and Mr Dennis Tan asked for an update on Terminal 5 (T5). In 2020, we announced a two-year pause in the development of T5.
We have used the opportunity of this pause to review the T5 design in light of the pandemic experience and the heightened sustainability ambition. But there should be no doubt that we are firm in our resolve that Changi must have the capacity and capability to seize opportunities that arise from aviation growth, especially in Asia, and we will provide an update on the review in due course.
Let me now turn to Environmental Sustainability. Yesterday, in the Joint Segment on the Singapore Green Plan, I announced our land transport emissions target and explained how vehicle electrification will contribute to that effort. Today, I will cover other sustainability initiatives in the transport sector.
Let me begin with our Aviation Hub. Ms Poh Li San asked about the Sustainable Air Hub Blueprint which is key to Changi’s future competitiveness. The Blueprint will establish emissions reduction targets for 2030 and 2050 and the specific measures we will take at the airport, with airlines and in air traffic management. All of these can contribute to a more sustainable air hub. Besides lowering emissions, it will also create new opportunities for Singaporeans in fields like data analytics and engineering. The detailed plans will be announced in early 2023.
Ms Poh also asked how we will help aviation companies cope with increased business costs arising from carbon taxes, which would include higher electricity charges. MOT and Civil Aviation Authority of Singapore (CAAS) are working with our aviation companies to adopt new technologies and other measures to enhance energy efficiency, reduce electricity usage and lower carbon emissions, such as through the deployment of solar panels at the airport. I should add that our aviation enterprises should also view this as an opportunity to differentiate themselves and enhance their competitiveness, given the global focus on sustainability.
In a similar vein, I would like to inform Mr Dennis Tan that we are making significant efforts to build a sustainable maritime hub. International shipping accounts for about 3% of global greenhouse gas emissions. Maritime centres like Singapore can play a meaningful role in achieving the emissions targets set by the International Maritime Organization.
As a follow-up to last year’s recommendations of the International Advisory Panel for Maritime Decarbonisation, the Maritime Port Authority of Singapore (MPA) has held extensive consultations with the industry. This effort has culminated in the Maritime Singapore Decarbonisation Blueprint, which I am happy to launch today. Let me highlight three aspects of the Blueprint.
First, we will reduce emissions from our port terminals and harbour craft. Our terminal operators will electrify equipment, optimise energy usage and leverage renewable energy. We aim to reduce emissions by at least 60% from 2005 levels by 2030 and achieve net-zero emissions at our port terminals by 2050.
For harbour craft that operate in our port, we will first use low-carbon fuels such as biofuels, LNG and diesel-electric hybrids. This will enable us to reduce emissions by 15% from 2021 levels by 2030. In parallel, we will develop and deploy zero-carbon vessels such as those using electricity, to further halve 2030's emission levels by 2050.
Second, we will support global efforts to decarbonise international shipping. We are working with the industry, research community and international partners on R&D, pilots and standards development for low and zero carbon fuels, especially at the new Global Centre for Maritime Decarbonisation. We expect hydrogen and its carriers, including ammonia and methanol, as well as bio-LNG, to be important components of the future fuel mix. We will, therefore, prepare our port for this multi-fuel transition.
Third, MPA will commit an additional $300 million in funding over the next 10 years to reduce emissions from our port terminals and harbour craft and support the development of green technologies and fuels for international shipping.
Finally, public transport is a core element of our sustainability efforts. As I shared yesterday, the adoption of EVs can make an important contribution, but the greenest modes of mobility are walking, cycling and the use of public transport. We will continue to enhance these options for commuters.
Let me start by first assuring Members that notwithstanding the disruptions wrought by COVID-19, the Government is committed to continue expanding our rail network. It is a critical investment in the capacity of our public transport system, the productivity of our economy and effective mobility for our people.
We are making good progress in this regard. LTA’s 2021 Household Travel Survey shows that seven in 10 households now live within a 10-minute walk of the nearest train station. This brings us closer to our target of eight in 10 households by 2030.
Trips during peak hours are also shorter. The proportion of peak hour walk, cycle or ride journeys completed within 45 minutes has increased from 66% in 2019 to 71% in 2021. We aim to raise this to 90% by 2040.
In August last year, we opened the second stage of the Thomson East Coast Line, or TEL. We expect 11 more TEL stations to commence service in the second half of 2022. This will connect residents in the north directly to many destinations in the city and significantly shorten travel times. Those who live or work near stations like Great World, Maxwell and Shenton Way will have direct connections to the entire MRT network. When TEL is fully opened over the next few years, more than 240,000 households will be within a 10-minute walk from a TEL station.
Beyond the Thomson East Coast Line, the Jurong Region Line (JRL) and Cross Island Line (CRL) will open in stages from 2027 and 2030 respectively. The JRL serves the north-western part of Singapore, connecting towns like Choa Chu Kang, Tengah and Jurong to Nanyang Technological University and the Jurong Innovation District. For CRL, we had earlier shared details about the first stage comprising 12 stations from Aviation Park to Bright Hill, as well as the extension with three stations from Elias to Punggol. The second stage of the Cross Island Line will extend further west and run through areas such as Turf City, Sunset Way, Clementi, West Coast and Jurong Lake District. We will release more details later this year.
The Cross Island Line will have interchanges with all the radial lines, giving commuters more travel route options. A wider and denser network also strengthens resilience at the system level. When these lines are completed, we would have increased our rail network by 50% to 360 kilometres.
The rail network is complemented by bus services. As we expand our public transport system and the asset and operating base grows, costs will inevitably rise. One way to sustain this growing network and manage costs is to optimise the provision of bus and rail services holistically at the system level. This may entail reallocating capacity and resources. Senior Minister of State Chee will elaborate on how we seek to achieve this, with a focus on the overall benefit to commuters.
Mr Ang Wei Neng suggested giving discounts to encourage more off-peak travel. Indeed, this is another way to better utilise our existing public transport infrastructure. Today, commuters who tap-in at any MRT or LRT station before 7.45 am on weekdays, excluding public holidays, enjoy a discount of up to 50 cents. With changing work and travel patterns, we will continue to work with employers and study various options to smoothen peak demand.
Some Members like Mr Lim Biow Chuan have pointed out that a high-quality public transport system must be resilient, yet affordable and accessible. The challenge is in striking the difficult but essential balance, between quality, affordability and financial sustainability of our public transport system over the long term.
In particular, even as we manage increasing costs, we have always sought to keep public transport affordable for all Singaporeans, especially for vulnerable commuters like our seniors and persons with disabilities (PWDs). Indeed, that is why we tilt public transport subsidies towards more vulnerable commuter segments. In addition, in the last two Fare Review Exercises, for example, we set aside approximately $20 million a year in Public Transport Vouchers to help defray the impact of the fare increase. Seniors and persons with disabilities from lower-income households can benefit from this additional support.
So, when Assoc Prof Jamus Lim suggests making public transport free for seniors and persons with disabilities, we understand where he is coming from, yet do not necessarily agree with where he suggests we go. To address the Member’s proposal, it is worthwhile to first understand what we are already doing today and what his suggestions mean for commuters and taxpayers.
Overall, the Government spends more than $2 billion annually in subsidies for public transport commuters: about $1 billion for bus operations and $1 billion for train operations. On average, we subsidise more than $1 for every journey taken on public transport.
As of January this year, there are around 975,000 seniors and persons with disabilities who hold concession cards, which is nearly 1 million. Depending on the trip, they receive a discount of up to 55% from what an adult commuter would pay. The Member has estimated that his proposal will cost $300 to $400 million annually, which he has acknowledged has to be paid for by commuters or taxpayers. Using his numbers, for taxpayers, this would mean a 15% to 20% increase to the $2 billion in subsidies already borne by them. If borne by commuters, adult fares will have to be increased by around 20% to 25% today, or 30 cents to 40 cents on average – this is up to 11 times the fare increase last year.
This financial burden is by no means insignificant and it will only grow by 2030, when the number of persons with disabilities and seniors aged 60 and above is expected to increase, by about 28%, to about 1.2 million.
In contrast, the Public Transport Council, or PTC, which is cognisant of the need to ensure that fares remain affordable for vulnerable commuter groups, adopts a different approach. When fares are increased, PTC has apportioned less of the increase to concessionary commuter groups and more to other adult commuters. But everyone pays a share and those who can pay more, do so. This is a more equitable approach, which has served us well over the years.
Looking ahead, several converging trends will affect our public transport system over the next decade – a growing rail network, shifting work and travel patterns, our ageing population and volatile energy prices. Amidst these changes, it is important to have a fare formula for long-term financial sustainability. The current fare formula is valid until 2022. We will commence the fare formula review this year and conclude the exercise by next year. The PTC will continue to strike a delicate balance across cost pressures faced by public transport operators, the burden on taxpayers of public transport subsidies and fare affordability for commuters.
Mr Chairman, let me now turn to active mobility and private transport.
Walking and cycling complement our public transport network, especially to bridge the first- and last-mile connections. Many different groups of commuters use our various paths and I note the comments by several Members about the nature of the interactions in these different pathways. These paths should not be territory that is jostled or contested over. Rather, they should be common spaces that we share and enjoy with a culture of graciousness. To balance the needs of different users and promote safety and graciousness, the Active Mobility Advisory Panel, or AMAP, was first formed in 2015. I would like to thank the Panel for their good work over the past few years under the strong leadership of Minister of State Muhammad Faishal Ibrahim. Senior Parliamentary Secretary Baey Yam Keng has taken over from Minister of State Muhammad Faishal Ibrahim as Chairman since the start of the new term of AMAP in January this year and he will elaborate more on the steps that we have taken and on AMAP’s key priorities going forward.
Next, private transport. Given our limited land, we have long pursued a car-lite strategy. The COE system is an allocation mechanism that responds to market forces. Mr Liang Eng Hwa, Mr Murali Pillai and Mr Abdul Samad raised questions about motorcycle COEs where prices have been high in recent times. Mr Henry Kwek and Mr Murali Pillai have also suggested increasing motorcycle COE supply. I understand the reasons for their suggestions and share their concerns for those who may depend on motorcycles for a living. However, it is important to note that there has been strong and persistent demand for motorcycles. This is reflected in the utilisation rate of motorcycle Temporary Certificates of Entitlement, or TCOEs, which have remained consistently high at over 99% since bidding resumed in July 2020. TCOEs mean that the bidder has six months. So, it is a temporary COE – six months within which they can then utilise that COE. And the fact that, over that six-month period, the utilisation rate has been high consistently at 99% underscores the point that demand has been high.
The distribution of these COEs is also noteworthy: 70% have been used for motorcycles with 200 cc engine capacity or less, about 20% in the 201 cc to 400 cc range and about 10% are more than 400 cc.
There have been some suggestions, like from Mr Murali Pillai, that perhaps we could consider a special sub-allocation. But the problem is that the overall number of COEs available is between 400 and 600, on average, per bidding cycle exercise. That being the case, if we further subdivide the category, the likelihood of greater volatility in the prices is significantly increased.
Having said that, we have observed early signs that the utilisation rate may be softening for TCOEs obtained in more recent months. So, I want to assure Members that I have asked LTA to study this very carefully and they will be completing their review soon.
Several Members asked about job prospects and how we will develop local talent.
Mr Chairman, the changes I have outlined will need the support of our transport workers and unions. The past two years have been difficult for the entire transport community, especially for our frontline workers in our airport, seaport and land transport system. With hard work and grit, they have kept Singapore connected. And I want to thank the entire transport community, especially our frontline transport workers, for their tenacity and forbearance in this most challenging of times.
Beyond COVID-19, as we forge ahead with electrification, digitalisation and automation, I know that many of our workers in the workforce may be worried about their jobs and their future. Our commitment to you is that we will be with you every step of the way. We are working with the unions and employers, our tripartite partners, to ensure that you navigate this transition successfully. We will help you to upskill and retrain so that you can seize these new opportunities. Senior Minister of State Amy Khor and Senior Minister of State Chee Hong Tat will elaborate on how we will do this.
Mr Chairman, a resilient, sustainable and inclusive transport network is essential for Singapore's survival and success and to safeguard the lives and livelihoods of our people. Our world-class Aviation Hub, Maritime Centre and land transport network of today are the fruits of the labour of earlier generations who adapted to the challenges and needs of their time while planning and investing for the future.
The critical decisions our transport pioneers made were not necessarily conventional wisdom of the time nor were they self-evident. Building Changi Airport, betting on containerised shipping, constructing an MRT network and introducing vehicle population control measures are just some examples. But with the passage of time and the benefit of hindsight, we can appreciate how their decisions, some even unpopular, positioned Singapore strategically for the future.
In the same way, the responsibility now falls upon us to steward our world-class transport ecosystem adapted to the evolving circumstances and emerging trends and, ultimately, pass on an even more resilient, sustainable and inclusive transport hub to and for future generations of Singaporeans. [Applause.]
The Chairman: Senior Minister of State Chee Hong Tat.
The Senior Minister of State for Transport (Mr Chee Hong Tat): Sir, let me begin with Mr Melvin Yong and Mr Gerald Giam's questions on bus services. Mr Yong proposed that bus operators tap on taxi drivers as reserve bus captains who can be deployed during a crisis. Ms Joan Pereira made a similar suggestion at a recent Sitting to bring back former and recently retired bus captains. I thank both Members for their suggestions. These are possible ways to increase the resilience of our public transport workforce.
On Mr Gerald Giam's questions, we shortened three bus services on 12 December 2021. Service 22 and service 66 ran from Ang Mo Kio to Tampines and from Jurong East to Bedok respectively. Service 506 was an express service from Jurong East to Upper East Coast. As Service 22 was shortened, consequential changes were made to service 65 to serve Tampines Avenue 4.
Sir, I understand Mr Gerald Giam's concerns. When there are changes to bus services, commuters need time to adjust to the new arrangements. My PAP colleagues, who look after areas affected by these changes, have also shared feedback from their residents.
I thank Mr Giam for giving MOT this opportunity to explain our approach to keep Singapore's public transport system financially sustainable while trying our best to balance the different trade-offs and always focusing on the best overall interests of commuters.
Earlier, Minister Iswaran spoke about the importance of financial prudence and sustainability, for our public transport system to remain resilient, affordable and accessible over the longer term. To achieve this, we need to regularly trim and reallocate excess capacity, including bus services, when we expand our MRT network to keep overall costs manageable for commuters and taxpayers. So, how does LTA decide on changes to bus services? We start with ridership data, which is an objective indication of commuter demand.
To be clear, we do operate bus services with low ridership. There are many such services which run at a loss and require funding from the $1 billion pool of bus subsidies every year because they provide necessary connectivity for commuters in some areas who otherwise would not have alternative public transport options. We also keep some trunk services for network resilience.
However, there are bus services with low ridership that run parallel to MRT lines and have alternative bus services plying similar routes, including the three services 22, 66 and 506 that we are discussing. Their ridership numbers along some parts of the trunk route had been low and fell further after Downtown Line 3 became operational in 2017. If we look at the data before COVID-19, the sustained drop in ridership for these three services ranged from 32% to 55% for parts of the routes.
This is because many commuters preferred to take MRT for longer journeys, using buses as feeder services for travelling to and from key transport nodes within the town.
By switching to a combination of bus and MRT for long journeys, commuters enjoy lower fares and shorten their total travelling times, compared to taking the bus from start to end. For example, a trip from Bedok North to MacPherson, after including waiting and transfers, would take around 25 minutes via feeder bus and DTL versus 42 minutes via bus service 66. The bus-MRT option also costs less because the distance travelled is shorter.
LTA amended the route of bus service 65 in Tampines, so that commuters would still have connectivity between Tampines Avenue 4 and Bedok Reservoir Road when service 22 was shortened. The original route for service 65 through Tampines Avenues 1 and 5 has three other bus services.
LTA will continue to explore cost reduction methods before making changes to a bus service. This includes switching from double deck to single deck buses and reducing service frequency where possible. These steps were taken for the three bus services before the decision was made in 2021 to shorten their routes.
However, the cost reductions from the above changes are not very significant as running a bus service still requires bus captains to work in shifts and a technical crew to maintain the buses. By trimming some of the existing bus services with low ridership, we free up resources that can be reallocated to provide new feeder services for new residential estates.
Through these efforts, we are better able to meet new demand for bus services without a rapid increase in operating costs and subsidies.
The shortening of the three bus services, for example, saved $9.5 million of subsidies per year, which can be reallocated to new bus services. Put another way, if we continue to run the three bus services without any changes, it means that either commuters or taxpayers would have to pay an additional $9.5 million per year.
Hence, I hope Mr Giam understands why we are unable to agree with him to retain as many trunk services as possible. We will retain some as I explained, but we cannot go to the extent he has proposed. That will not be financially prudent and sustainable. And we will not be doing what is in the best collective interests of commuters and taxpayers.
Sir, I will now speak about the plans to grow our maritime sector. Maritime Singapore did well in 2021. We strengthened our reputation as a trusted hub port and international maritime centre (IMC). Container throughput reached a new high of 37.5 million twenty-foot equivalent units (TEUs), while our IMC attracted 23 companies to expand or set up operations in Singapore.
Singapore ranked top in the 2022 Leading Maritime Cities of the World report, including for \"Attractiveness and Competitiveness\" and \"Maritime Technology\". I would like to thank our tripartite partners and maritime workers. This achievement would not have been possible without your dedication, your contributions and your sacrifices.
Mr Saktiandi Supaat asked how we are enhancing Singapore as a reliable and resilient transport node. Maritime Singapore will develop strong capabilities, superior connectivity and rewarding careers to address emerging challenges and seize new opportunities.
First, building strong capabilities. PSA has commenced operations of its first two berths at Tuas Port as scheduled. We are making steady progress with the rest of the construction. When completed, Tuas Port can handle up to 65 million TEUs a year, 50% more than our current capacity. Tuas Port will secure Singapore’s cargo connectivity to the world and keep up our competitiveness as a global hub port.
Our port will leverage on technology to operate more efficiently, sustainably and safely. MPA will use artificial intelligence (AI) and machine learning to manage the increasing scale and complexity of ship movements in our waters. Our next-generation Vessel Traffic Management System (VTMS) will be equipped with advanced smart collision detection capabilities. It will be based at the future Port Operations Control Centre in Tuas, to be completed in 2025.
Another key technology is 5G telecommunications, which will support new concepts of operation. It will enable shore-to-ship deliveries using drones, which is cheaper, better and faster than the traditional method of sending a boat and crew; or piloting a containership safely from a control room on shore. 5G will support our vision to be the Silicon Valley of Marine Tech and be a game-changer to differentiate our port and IMC from the competition. Maritime 5G for Maritime SG.
We will also help maritime SMEs build capabilities to ride the digitalisation wave. We currently provide funding support under the Sea Transport Industry Digital Plan (IDP) and this is given to SMEs in the ship agency, harbour craft and bunkering sub-sectors to help them implement digital solutions to improve their operations. We will expand IDP to cover all SMEs in the Sea Transport sector, including those providing ship supply services. MPA will also extend the grant beyond end 2022, to benefit eligible maritime companies on an ongoing basis.
Next, we will expand our physical and digital connectivity. Tuas Port will be the nucleus of a larger ecosystem of business and industrial districts. We can enhance the connectivity of high-value sectors like advanced manufacturing and cold chain logistics by locating such companies close to the port. The Government has set aside land around Tuas Port for companies to integrate their developments with the port. We will also review our regulatory processes to maximise the benefits from integration and process efficiency.
MOT will leverage on our strengths as an air and sea hub to expand the suite of connectivity options for cargo owners, including multimodal options. Such air-sea cargo solutions provide additional efficiency and resilience and support just-in-time manufacturing and distribution for regional supply chains.
In the information age, digital connectivity is as important as physical connectivity. Electronic bills of lading (eBLs) are documents proving ownership of cargo in transit. The benefits of eBLs over physical documents are clear: receive cargo faster, free up working capital and have more secure transactions. However, adoption of eBLs has been slow due to legal and technical hurdles. MPA will co-fund three consortiums to develop and trial eBL solutions across the container, wet bulk and dry bulk segments. Through these trials, we aim to grow the ecosystem and encourage adoption of eBLs in Singapore and beyond.
With the expansion in capabilities and connectivity, Maritime Singapore will grow and create rewarding career opportunities for our people.
In response to Mr Saktiandi and Mr Melvin Yong, the Sea Transport sector aims to create 1,000 good jobs for locals between 2020 and 2025, including traditional maritime jobs like seafarers and port operation managers, and many emerging roles such as software engineers and supply chain managers. Looking at our progress so far, there is scope to grow even more good jobs by 2025, if conditions remain favourable.
As Mr Yong noted, it is important to attract more local workers to take up both seafaring and shore-based jobs. MPA is supporting the industry and unions to attract talent, nurture our workforce and transform workplaces in Maritime Singapore.
Seafaring experience is important in the maritime sector and can open doors to good shore-based careers. Captain Ranesh Sandhu started out as a seafarer in Neptune Orient Lines and became a ship master after a decade of sailing. His seafaring credentials have laid the foundations for a meaningful shore-based career, including in leadership positions such as Senior Director of Shipping for Marathon Petroleum Corporation and Managing Director at BTS Tankers.
MPA has partnered the Singapore Maritime Officers’ Union (SMOU), the Singapore Organisation of Seamen (SOS) and maritime companies to attract and develop locals for seafaring careers through scholarships and awards. Local seafarers like my Toa Payoh resident, Mr Takamasa Ng, have benefited from the Tripartite Maritime Scholarship (TMSS). Takamasa obtained his Class 3 Certificate of Competency (CoC) in 2018. He currently works on board a ship for NYK Line and he wants to continue sailing and attain his Class 1 CoC, which is the highest level of certification.
Qualifying as an experienced seafarer is a long and challenging journey. Attaining the Class 1 CoC can take eight years or more and the job requires frequent stints away from home. We will support our local seafarers on this journey.
Beyond the existing scholarships, MPA and our tripartite partners will provide an additional $12.5 million to fund a new Sail Milestone Achievement Programme (SailMAP) to enhance the retention of local seafarers.
Over the next five years, up to 250 local seafarers can receive up to $50,000 each, when they attain key career milestones. This helps to support their income when they are not sailing, so they can continue to upgrade their seafaring skills and knowledge. Most of the funding will come from the Government and the remainder will be funded by the Singapore Shipping Association, SMOU and SOS as part of this tripartite partnership.
In addition, we will launch an accelerated training pathway for individuals with mechanical engineering backgrounds to become shipboard marine engineers, shortening the duration from the current 120 weeks to 22 weeks. I hope this will encourage more local mechanical engineers to become marine engineers.
We have also collaborated with Yellow Ribbon Singapore to place suitable inmates as trainees with harbour craft operators to become steersmen or engine drivers. Eight ex-offenders have benefited so far and we hope to increase the number over time.
Since 2018, we have helped around 200 mid-career workers undergo skills conversion to take up new roles through Career Conversion Programmes (CCP) in the Sea Transport sector. This includes 30 PMETs who have been successfully placed in new roles in 14 companies under the enhanced CCP for Sea Transport Professionals and Associates launched in November last year.
Sir, as we attract and nurture local talents, our maritime hub must remain open and welcome people from abroad. This is especially important for an international industry like maritime, which requires openness and connectivity to thrive.
Singapore cannot be a hub for maritime, aviation, finance or technology, if we adopt populist manpower policies, build walls around us and disconnect ourselves from the world. We cannot aim to be a hub and yet become inward-looking. There is no such thing as an inward-looking hub.
Foreign talents bring new capabilities and perspectives that keep our hub dynamic and they complement our Singaporean Core. The tripartite partners fully support this approach, as we understand that a good local-foreign complement is necessary to grow our economy and create good jobs for our people.
Sir, as Maritime Singapore grows our capabilities, connectivity and careers, an ocean of exciting possibilities awaits. I would like to encourage our students, our workers and our businesses to make Maritime Singapore your port of call and join us in turning these opportunities into reality. [Applause.]
The Chairman: Senior Minister of State Dr Amy Khor.
The Senior Minister of State for Transport (Dr Amy Khor Lean Suan): Chairman, I will speak about MOT’s efforts to improve Singapore’s land transport system, in four aspects. First, I will touch on how we have transformed the taxi and private hire car sector and made it more resilient.
Second, I will share on how we leverage technology to improve the resilience and reliability of our road network, and how we prepare for new shifts from these technologies, like vehicle electrification. Third, I will explain how we are reshaping our transport infrastructure by focusing on people and sustainability. Finally, I will conclude by sharing about our continual pursuit to enhance safety on our roads.
Our land transport sector has remained resilient through the pandemic. This stems largely from the courage and dedication of our frontline workers.
Taxi and private hire car drivers took extra precautions such as regularly disinfecting their vehicles even as ridership plunged. To tide them through, the Government, associations and operators provided targeted financial support. Close to 50,000 drivers benefited from over $390 million of support through the Special Relief Fund and COVID-19 Driver Relief Fund.
Today, the situation has improved. The number of trips is about 75% of pre-COVID-19 levels, up from about 25% during the circuit breaker period. We expect this to rise further but will continue to monitor the situation closely. If necessary, we will step in again to support our drivers.
Ms Yeo Wan Ling will be glad to know that we go beyond financial support. We will improve our service delivery to drivers, with the launch of the digital vocational licences in the second quarter of this year. Prospective drivers will receive their digital licences in about half the time, from around 20 days today. Drivers no longer need to worry about losing their vocational licences, as they can easily access it through Singpass.
We also agree that drivers should feel safe. Indeed, taxi and private hire car drivers are covered as public service workers under the Protection from Harassment Act. We stand ready to support drivers who encounter abusive passengers.
Chairman, our land transport system is in the midst of a major transition – towards vehicle electrification. A wide range of industries will be affected and workers, such as workshop technicians, must upskill to remain competitive. The Government is, therefore, actively consulting OEMs, fleet owners and other industry partners to better understand the training needs of these workers. The aim is to equip them with the necessary skills to seize these new opportunities.
Our taxi fleet will also be increasingly electrified. At least half of our taxi fleet will be electric by 2030, up from about 2% today. To prepare drivers, LTA will launch an updated training curriculum for taxi and private hire vocational licences this month. The refreshed curriculum will cover electric vehicles and the latest on-the-road competencies, such as the use of mapping and navigational tools.
Our public transport workers will also receive support to be future-ready. As Mr Saktiandi Supaat and Mr Melvin Yong would know, we want to ensure that public transport workers, young or old, are ready to seize new opportunities arising from the greening of our fleet. The Singapore Bus Academy has conducted 17 runs of cleaner energy bus training programmes since December 2019, involving over 550 workers.
While preparing for the future, there are core functions that LTA must continue to perform, such as the maintenance of the expanding rail, road and footpath infrastructure. As Mr Gan Thiam Poh shared, technology can help us be more efficient.
One example is the use of video analytics and artificial intelligence in the maintenance of our 9,500-odd lane kilometres of roads. LTA has trialled the use of highspeed cameras mounted onto a van to automatically detect and report defects on the road since 2020. Defects are automatically logged backend, to enable targeted, predictive maintenance. When fully implemented, the technology-enhanced process can reduce manhours by up to 30%.
Beyond leveraging technology, we will build more sustainable transport infrastructure, in collaboration with our communities.
The greenest way to travel is by walking, cycling and using public transport. That is why we have several Transit Priority Corridors, or TPCs. These corridors incorporate bus, cycling lanes and footpaths for all.
We will add another 60 kilometres of these corridors by 2030, including the longest TPC along the North South Corridor. This may not sound like a lot, but each TPC will become the key thoroughfare for the neighbourhood. An example of an upcoming TPC is along Sin Ming Avenue, between Upper Thomson Road and Marymount Road. Wider footpaths, new cycling paths and bus lanes will be incorporated. Residents in the area can more seamlessly ride a bus, walk or cycle to the amenities near them, such as schools and the Bright Hill MRT station.
Mr Cheng Hsing Yao will be glad to know that we have made good progress in reimagining our road spaces. We widened the footpaths along a busy stretch of Havelock Road, where there are several popular eateries. Residents and visitors now find it a safer and more comfortable walking experience.
We have also transformed the Civic District as we closed Connaught Drive, Fullerton Road and Anderson Bridge to vehicular traffic. Pedestrians can now walk freely and enjoy the picturesque landscape, as they visit key landmarks, such as the Padang and the Esplanade Park or various art and cultural institutes, all without having to worry about traffic and fumes. This has also opened up opportunities for us to work with stakeholders in the Civic District to bring new arts and cultural activities outdoors to further enliven the area. It does not stop there.
Residents in Tiong Bahru, a popular neighbourhood, can look forward to wider footpaths and more community spaces. Works will begin later this month.
With your permission, Chairman, may I display some slides on the LCD screens.
The Chairman: Please do. [Slides were shown to hon Members.]
Dr Amy Khor Lean Suan: We will convert the roadside car parks along Seng Poh Road to wider footpaths. This will create a safer environment for pedestrians, especially for seniors and children. We will also begin pedestrianisation trials for Eng Hoon Street to create space for community use.
These ideas were shaped in consultation with the local community including residents, shop owners and the Tiong Bahru Market and Hawkers’ Association. LTA will work with URA to co-create placemaking ideas with the local community that will be implemented through the Lively Places Programme.
Another identified area is Tanjong Pagar. URA had earlier announced the pilot Business Improvement District programme to drive placemaking efforts. To complement this, LTA will lead an inter-agency workgroup to study plans to enhance the pedestrian and cycling experience. Key areas of focus include connectivity to transport nodes, conversion of road spaces for wider footpaths and cycling paths and community activities.
These repurposing projects are connected by a common thread – the active input from local communities. Going forward and in the spirit of inclusivity and citizen participation, this approach will be our modus operandi.
Finally, enhancing safety remains a priority.
Illegally modified vehicles are dangerous to motorists and pedestrians and many of them cause noise disturbances as Mr Gan pointed out. To ensure roadworthiness of vehicles and compliance to in-use noise emission standards, LTA mandates periodic vehicle inspections.
LTA also conducts joint enforcement operations with other agencies to flush out these vehicles. During a joint enforcement conducted in December 2021, LTA officers issued summons for 34 vehicles for offences including illegal modifications. Two workshops were charged last year for providing illegal modification services.
Our approach to safety must take cognisance of society's changing needs. Given our ageing population, LTA has implemented Silver Zones at towns with a higher senior population since 2014. Key measures implemented include reduced speed limits and narrower roads to slow traffic. They have proven effective, reducing the accident rate of senior pedestrians by about 80%.
To date, LTA has completed 22 Silver Zones. LTA will implement another 28 Silver Zones by 2025 in towns, such as Tampines, Ang Mo Kio and West Coast.
Agencies have also been working to improve the safety of workers transported on lorries. Mr Yong asked for an update on this.
We understand the union's and NGOs' concerns and likewise want to improve safety for workers. To protect lives and livelihoods, we need to take a balanced approach and make changes that are sustainable. This is why we consulted extensively on this issue, including with trade associations in the construction sector, such as Singapore Contractors Association Limited, the marine and process sectors and private bus operators.
Indeed, their needs are different. Many small and medium enterprises, especially in the specialist trade, shared with us the constraints they face. They may need to transport a small crew with bulky equipment to several different locations in a single day. It will be operationally challenging and inefficient for them to use buses for workers and separately transport their equipment in lorries.
In addition, in our engagements with private bus operators, they have told us that there are simply insufficient private buses and drivers to transport the large number of workers in the manufacturing and construction, marine and process sectors, especially when other activities like tourism resume post-COVID-19.
A full transition to buses could require a doubling or even tripling of the number of large private buses in the industry today! Even if multiple and staggered trips are made, the demand for buses will still be significant. Furthermore, bus operators shared that the shortage of bus drivers would be an even more binding constraint.
These challenges are not all insurmountable, but we will need time to work through them with the industry and relevant agencies.
The good news is that some firms have already shifted away from using lorries for some projects. For example, Tong Tar Transport was asked by a multinational construction company to ferry about 3,000 workers of their main and sub-contractors between dormitories to the construction site via buses.
This was a large-scale endeavour that involved coordination among various bus operators but shows that it is possible under the right circumstances. We encourage more in the industry to follow. We will facilitate the sharing of best practices and will study the \"conditions for success\" to enable more companies to make the shift.
In the meantime, we have identified two areas to further improve the safety of workers on lorries.
First, the Government will require all lorries to be subjected to some form of speed management device. Today, speed limiters are already mandated for all goods vehicles with maximum laden weight (MLW) of 12 tonnes and above. The Traffic Police (TP) will be expanding the speed limiter regime to encompass all lorries of MLW above 3.5 tonnes. TP will be engaging the industry closely on this and will release more details when ready.
Second, besides ensuring the relevant hardware is in place, it is crucial to ensure that lorry drivers operate safely behind the wheel at all times. MOM will introduce new measures to require employers to provide sufficient rest for their drivers, in particular, those who play dual roles of a driver and ground worker.
MOM will also mandate that every lorry ferrying workers have a designated vehicle person-in-charge who will sit next to the driver. This person-in-charge will be empowered to stop the driver from driving if he deems the driver to be unfit for driving.
Some have also suggested requiring lorries to be fitted with seat belts. We recently consulted the motor vehicle dealers and workshops again. Their feedback remains that retrofitting seat belts would not be feasible and could in fact pose safety risks.
How so, you may ask? Commercial lorries today are not designed for seat belts to be installed in the rear deck, as the floorboards in the rear deck might not be sufficiently strong to keep the seat belts anchored in the event of an accident. There are also liability issues for such modifications without the support of the lorry manufacturers. Without the industry being able to bring in lorries with seat belts and vouch for their safety, it is not prudent to mandate this.
Lastly, we have heard calls to mandate rain covers to lorry rear decks to shield workers from the elements. Most employers today already do so. But we will take this one step further. LTA, with the support of MOM, have decided to mandate the installation of such covers on all lorries used to ferry workers. We will share implementation details at a later date.
We will continue to study further measures even as industries adapt and more companies move towards alternative modes of transport. Once again, I urge employers to do their part in ensuring the welfare and safety of their staff.
Chairman, in conclusion, we will improve our land transport system by adopting new technologies, upskilling our workers and refreshing our approach to infrastructure design, all while maintaining safety at the forefront. Together we can look forward to a more sustainable, vibrant and safe land transport system!
The Chairman: Mr Baey Yam Keng.
The Senior Parliamentary Secretary to the Minister for Transport (Mr Baey Yam Keng): Mr Chairman, Minister Iswaran spoke about our plans to transform Singapore into a resilient, sustainable and inclusive transport hub. To support a shift towards greener choices, I am going to cover the two transport modes that have the lowest carbon emission: active mobility and public transport. In particular, I will share how we will continue to invest in both the \"hardware\" and \"heartware\".
First, Mr Ang Wei Neng, Mr Gan Thiam Poh, Assoc Prof Jamus Lim and Ms Poh Li San will be pleased to hear about our efforts to enhance our cycling path network.
Despite the pandemic, we have accelerated the plans for the Islandwide Cycling Network. These are not easy infrastructure projects, especially in mature towns where there is little space on the sidewalk and various utilities underground. The cycling network is around 500 kilometres long today. We will grow it to 800 kilometres in the next two to three years and eventually reach our target of around 1,300 kilometres in year 2030.
This will greatly improve convenience and connectivity both within and between towns. A good example of connectivity within a town is Bukit Panjang, where LTA is on track to complete seven kilometres of cycling paths this year. By then, residents can cycle to Bukit Panjang Hawker Centre for lunch, continue to Zhenghua Community Club for activities and then to Bukit Panjang Integrated Transport Hub to take a bus or train.
Active mobility users and pedestrians will also enjoy the perks of improved connectivity between towns. Once the North-South Corridor is completed, it will connect to the park connector network and local cycling paths within HDB towns along the entire corridor. Someone living in Woodlands can cycle along dedicated paths all the way to work or play in the Rochor area. This will allow more convenient inter-town travels.
We will also increase the number of end-of-trip facilities. Today, we have about 27,000 bicycle parking lots at public transport nodes. We will provide 3,000 more at MRT stations by 2025. We are encouraging workplaces to provide such facilities through the Active Commute Grant and have awarded the grant to 14 workplaces so far. We hope that more workplaces will make good use of this grant when the next round of applications open this year.
Next, like Mr Dennis Tan suggested, education and enforcement of our rules must go hand in hand.
To reduce the risk of severe accidents, we have put in place regulations that are reviewed regularly with the support of the Active Mobility Advisory Panel (AMAP) in consultation with the public. Over the years, we have imposed speed limits on paths and set restrictions on the weight and size of devices.
At the start of this year, to enhance safety of on-road cycling, we introduced a guideline on safe passing distance between motorists and cyclists, and a new rule to limit cycling group size on roads. However, we heard the desire of cyclists to cycle in larger groups. I am happy to share that we intend to conduct a trial to provide dedicated cycling space along West Camp Road in Seletar on Sunday mornings. More details will be shared at a later date.
We have stepped up enforcement efforts to deter errant riders since the ban of e-scooters on footpaths in 2019. We have also leveraged technology to identify hotspots for enforcement, many thanks to public feedback from the MyTransport app. Notably, the number of off-road accidents involving active mobility devices has decreased by 40% since 2019.
To ensure riders of personal mobility devices (PMDs) and power-assisted bicycles are familiar with active mobility rules, we have introduced mandatory theory tests.
To date, close to 31,000 riders have passed the tests. A significant number considering that we have a population of about 40,000 registered devices. At the same time, like Mr Lim Biow Chuan and Dr Shahira Abdullah pointed out, public education is key. LTA and the Traffic Police are working together to raise awareness among cyclists and motorists through campaigns, and we are also looking to incorporate these materials into the driving theory test curriculum.
Third, an inclusive active mobility system requires a gracious and responsible community, underpinned by clear and forward-looking regulations.
Since 2016, the AMAP led by Minister of State Muhammad Faishal has played an important role in building a safe and gracious active mobility landscape. The AMAP strikes a balance among the many competing needs of different users in consultation with the public. I thank Minister of State Faishal for his leadership over the past six years.
As the new AMAP chairman, I would like to share two key priorities for this new term. First, we will stay ahead of emerging trends that could shape the active mobility landscape. For instance, we will review the use of devices, such as cargo bikes and trikes which have gained popularity overseas and are starting to enter the local market. We will also review the safe use of recumbent bikes and personal mobility aids.
Second, we will continue to strengthen our engagement and education efforts to collectively build a safe and gracious culture on our paths and roads. Many stakeholders have responded positively in partnering us. For instance, public bus operators have emphasised to their bus captains the importance of defensive driving and keeping a lookout for road cyclists. Earlier this year, a few cyclists from the Singapore Cycling Federation tried out bus simulators to better appreciate the perspective and challenges of bus captains. Last year, LTA also launched the new Confidence on Wheels Programme to equip active mobility riders with practical riding skills and to promote safe riding habits. We will build on the momentum set forth by the AMAP to expand and deepen our partnerships with the community.
Next, I will share about our progress towards an inclusive public transport system. Let me start with our efforts on thoughtfully designed hardware for three groups of commuters.
First, to better support communication between commuters and public transport staff, we are working with the Singapore Association for the Deaf to introduce a visual communication tool in all MRT stations and bus interchanges by end 2022. This tool contains pictures and keywords that commuters can point to so that public transport staff understand their needs more easily. Besides the deaf or hard-of-hearing community, this should also be useful to commuters who have other communication difficulties.
Second, we have installed the Hearing Enhancement System at Passenger Service Centres, starting with those at the Thomson-East Coast Line. The system reduces background noise so that commuters with hearing aids can communicate better with station staff.
Next, the elderly group. With an ageing population, conditions such as dementia will likely be more prevalent. Hence, we are working with public transport operators to list all public transport nodes as Dementia Go-To-Points by end 2022. More than five million trips are made on public transport every day. We hope that the millions of eyes and ears can help to look out for people who show signs of dementia and are lost. Members of public can bring them to these Go-To-Points and enlist the help of our staff who are trained in dementia awareness. Everyone can do a part to help commuters with dementia who lose their way to be reunited with their loved ones quickly.
The third group is families with young children. We currently have baby care rooms at all interchange stations on the Thomson-East Coast Line and 60% of our bus interchanges. I am happy to announce that all new bus interchanges and all stations on Jurong Region Line and Cross Island Line will each have a baby care room. In addition, families travelling with young children in strollers will find it more convenient now that stroller restraints are installed on all public buses.
To achieve a truly inclusive public transport system, we must also cultivate our \"heartware\". Tasked with this mission, the Caring SG Commuters Committee has collaborated with partners on various initiatives, such as by engaging different profiles of commuters on the ground, including those with invisible disabilities. I will urge all of us to adopt four caring behaviours in our daily journeys: give time, give care, give a hand and give thanks.
How else can we play a part in this journey? We can become Caring Commuter Champions to better assist commuters in need. Since its launch in December 2020, more than 500 people have signed up as volunteers. One of them is Ms Ashley See. For her university's final year project, Ashley had researched about wayfinding for persons with visual impairment. She has benefited from the Champions training on how to assist other profiles of commuters. As a Champion, she hopes to encourage more people to lend a helping hand to others.
While the Committee has laid a good foundation, all of us must play our part. Moving forward, the Committee will deepen stakeholders' involvement at the individual, enterprise and community levels to facilitate more ground-up initiatives. Mr Chairman, I would like to say a few words in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] We have spared no efforts to build an inclusive public transport system that is a choice mode for all. Over the years, we have enhanced our infrastructure so that all commuters, including persons with disabilities, the elderly and families travelling with young children, can navigate the public transport system more easily. However, a truly inclusive public transport system is not built on infrastructure enhancements alone, but also requires a gracious and caring commuting culture. By giving time, giving care, giving a hand and giving thanks to others during our daily commute, we can all make a positive difference to our fellow commuters' journeys.
(In English): Mr Chairman, people are at the heart of what we do, in connecting people, places and possibilities through our different transport modes. We will continue to invest in both our hardware and heartware. I urge everyone to play our part towards a gracious culture to spin wheels of virtuous cycles that will make every journey on our paths and public transport a safe and inclusive one for all.
The Chairman: Mr Gan Thiam Poh.
Mr Gan Thiam Poh: Thank you, Chairman. I thank the Senior Minister of State Amy Khor for the update on the actions against modified vehicles. May I know from Senior Minister of State, is there a plan to go for enhanced penalty against those who modify their vehicles, the owner and also the one who provided the service?
Dr Amy Khor Lean Suan: I thank the Member for his supplementary question. Since last year, in July, we have enhanced the penalty framework and doubled the fines for illegal modifications. On 1 March this year, a motorcyclist was fined $1,200 for illegal modification of his exhaust system.
We have also decided to enhance the penalty framework by, for instance, applying to the Courts for second and subsequent offenders to have their motorcycles detained for up to three months for illegal modification. Currently, the agencies are looking into imposing demerit points in addition to fines for offenders who knowingly drive an illegally modified vehicle. And we continue to undertake investigations on workshops who provide such services.
The Chairman: Mr Gerald Giam.
Mr Gerald Giam Yean Song (Aljunied): Sir, for trunk services, if ridership has been low, can we use smaller buses or increase the intervals between buses instead of cutting services? This is for trunk services.
And for feeder services, after bus 66 was re-routed, my residents were left with only bus 228 as a feeder service to Bedok Interchange. Many have told me that the intervals of 15 minutes or more are really too long and LTA would be aware of this because I have written many letters on behalf of my residents on this matter. So, can LTA increase the frequency of feeder bus services to make up for the reduction in other services?
Lastly, while I agree there is a need for financial prudence, we must not be penny wise and pound foolish. If more commuters take public transport instead of private transport, it will lower our carbon footprint and reduce traffic congestion. So, does MOT take this into account when it reduces the bus services?
Mr S Iswaran: Mr Chairman, I thank the Member for his questions. I have a clarification for him, because he has heard the explanations that I and also Senior Minister of State Chee Hong Tat have given in terms of the process and how we go about this. So, may I understand, does he accept the principle that as we expand our rail network and as we invest more, and as the capital base and the asset base grow, we have an obligation to optimise across the system?
Is he disagreeing with us on the principle or is it about the process? Or is it specifically about the outcome in his constituency? I would like clarity on that.
Mr Gerald Giam Yean Song: I thank the Minister. I do not disagree with the principle that we must optimise, but I disagree with how it is sometimes optimised. Because I feel that sometimes, for example, for trunk services, yes, there is a need to ensure that the services are not running empty. But there is a small group of people – the elderly, disabled – who need to travel for long distances and they find it very inconvenient to transfer a lot. So, that is why I am asking, as a compromise, can mini or smaller buses be used?
Mr S Iswaran: Mr Chairman, I thank the Member for that clarification. It is helpful because it means that we agree in principle that we have a fiscal responsibility to see what we can do to optimise the resources.
Senior Minister of State Chee Hong Tat would be able to give more information on his specific points about trunk routes and alternatives.
But the Member also raised the point about financial prudence and about being penny wise and pound foolish. When a proposal is made that will incur $300 million to $400 million more a year, when we raise questions about that, I do not think that is being penny wise and pound foolish. I think it is all about big pounds that are at stake.
When I listen to some of the comments from Mr Giam and also his colleague Assoc Prof Jamus Lim, I am reminded that, Mr Chairman, with your indulgence, there is an Ernest Hemingway book “The Sun Also Rises”. In it, there is a character Mike Campbell and he is asked, “How did you go bankrupt?” And he replies, “Two ways – gradually, then suddenly.”
I think we need to remember this: if we resist every effort to optimise and if we champion every effort to increase services or collect less, but resist every effort to perhaps increase fares and other measures to have the financial resources to do what we need to do, then, what we will end up with is this – the creep will be gradual and the end will be sudden. That is the risk that we run.
So, what we are trying to do here – and I think I am not the first Transport Minister to make this point; it has been made by generations of Transport Ministers and I am sure many more to come – is really to strike that all-essential balance. I do not think there is a monopoly of virtue here, in terms of wanting to help Singaporeans, especially those who are in vulnerable segments, but what we are trying to do is make sure that we are being fair to our commuters, to our taxpayers, to the vulnerable segments and also, to public transport operators and their financial viability.
The Chairman: Senior Minister of State Chee Hong Tat.
Mr Chee Hong Tat: Mr Chairman, I will address some of the more specific points that Mr Giam mentioned. Specifically, on service 228, I touched on feeder services in my speech earlier. For service 228, Mr Giam did give us some feedback because initially, when the bus services were shortened, what LTA then tried to do was precisely like what he mentioned – make sure that we have bus service 228 to provide the connectivity to the necessary key transport nodes.
When Mr Giam shared the feedback with us, we then followed up with the bus operators to make improvements and adjustments to bus service 228. Just to share some data, in terms of the loading level and the waiting time. Before Mr Giam shared the feedback with us, the maximum load during peak periods was about 70% to 75%. This was not excessive, but it would feel more crowded than usual. So, we understand the concerns. When Mr Giam shared the feedback with LTA, LTA then worked with the operator to make some adjustments and the peak loads have now dropped to below 45%. In fact, on most days, and I am referring to peak periods, it is around 25%.
So, the situation has improved and I want to thank Mr Giam for sharing his feedback with us to enable us to be able to address some of these local concerns.
About waiting times, Sir, service 228, I do not think what Mr Giam said earlier is factually correct. During the morning peak, between 6 am and 6.45 am, LTA has asked the bus operator to increase the frequency, precisely because we understand that this is the peak period. So, the frequency is actually every five minutes.
There is another way to help residents to shorten the waiting time, so they do not have to go to the bus stop too early. That is to help them to use the MyTransport app. I understand, maybe some of the seniors may not be so familiar with technology, but that is also an area where, collectively, as a community, we can reach out to them through raising awareness and public education, help them to be able to use these tools, so that they can plan their journeys, they can shorten the waiting time. And, I think, importantly, the shift that I was explaining in my main speech will allow us to provide new feeder services to new areas, meeting the needs of other commuters.
So, yes, we want to take care of as many commuters as possible, but our responsibility is not just to one group of commuters, but to all commuters, collectively. We do need to weigh difficult trade-offs and make the adjustments accordingly.
One last point, Sir. I think I do need to point out that because we shift from bigger buses to smaller buses, it does not mean the cost will shrink correspondingly. I explained in my speech we still need to have bus captains to drive the buses in shifts. We still need to have a maintenance crew to be able to maintain the bus fleet. In fact, if we buy new mini buses, we would have to incur additional upfront costs to buy the buses and train a new group of bus captains and a new group of technical crew to maintain these mini buses. So, from a logistics and maintenance cost point of view, I am not sure that will actually end up with lower costs.
The Chairman: Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim: Thank you, Chair. I thank Minister Iswaran for his explanation. I feel I should clarify that the proposal that I had explicitly states that the subsidy should be borne by MOT expenditures, not by other riders. He spent quite a bit of time, I felt, attacking a little bit of a straw man.
It is fair to say that $300 million, $400 million is not a chump change, but as I also mentioned in my speech, we should be clear that this is about 3% to 4% an increase in the Ministry’s budget, when you set it within context.
I did also seek a compromise and this was not touched on in Minister Iswaran’s clarification. Which is that even if MOT believes that an unconstrained subsidy is unaffordable, what of the possibility of free ridership during off-peak hours? The marginal costs in this case are likely to be minimal, mainly in the form of foregone revenues, since buses and trains are already operating with spare capacity in this case. And in fact, during the description of what happened during COVID-19, ex-Transport Minister Ong Ye Kung mentioned that buses were ferrying air.
So, I wonder if instead of ferrying air, could we instead ferry the elderly and the disabled in our society?
Mr S Iswaran: Mr Speaker, I thank the Member for his question. Let me start by saying it is not exactly a straw man argument at all. Because, fundamentally, there is a need to explain where the money is going to come from. By the Member’s estimate – I am not saying that I agree with his estimate – but his estimate is $300 million to $400 million. And then, he says it is 3% to 4% of the Ministry’s budget.
I would urge the Member to look at the budget carefully. The Ministry’s budget of $11 billion includes two-thirds which is development expenditure. What the Member is proposing, is a recurrent operational subsidy of $300 million to $400 million. So, in other words, it is on the lower base which we are looking at.
Specifically, the Ministry’s operating budget in the last couple of years has been increased because of COVID-19-specific measures. So, if you discount that further, what the Member is actually proposing is an increase in the subsidies – if I use my $2 billion reference point – of about 20% to 25%. That is a significant increase!
Should we incur such an increase? I think it is something we should debate. But I think then, we should also, to be intellectually rigorous, examine where the Member and his party stand when it comes to sources of revenue. Because you have to square the circle.
Last year, we increased fare revenue and I know that the Leader of the Opposition made a point about how fares have increased and that is contributing to cost of living. In other words, the Workers’ Party looks askance at increases of fares. And yet, we are also arguing about spending more. And where do we get that from? From the Government revenue? And the Member and his party also take a dim view of several of the revenue sources that have been proposed by the Finance Minister.
So, we have to square the circle. And it is by no means a straw man.
The Chairman: Ms Poh Li San.
Ms Poh Li San: Thank you, Mr Chairman. I have two questions. One is for Minister Iswaran. I thank him for the One Aviation Fund to assist the airport community. Minister Iswaran mentioned that about one-third of our airport workers have already left the airport sector, given the pandemic situation and we know that in the Airport, many frontline jobs are actually filled by foreign workers. So, my question is that given the border closures or the border restrictions, how can Government further help airport companies get ready and ensure that we have sufficient workers prepared for the recovery of the aviation sector?
The second question is for Senior Parliamentary Secretary Baey Yam Keng. I thank him for sharing about the island-wide cycling network and the plans. I would like to know if there are any plans to prioritise the building of the stretches of cycling network for cyclists who are involved in day-to-day commuting, especially in the last mile stretches, for example, to the MRT stations? During these peak periods where the cyclists are rushing, there could be a surge in the traffic and that may lead to safety concerns, especially against pedestrians who are using the same stretch. So, I hope that there will be some prioritisation of the building of such last mile stretches in the cycling network.
Mr S Iswaran: Mr Chairman, if I may, I omitted to respond to a specific point that Assoc Prof Jamus Lim made which was on whether we could consider off-peak measures which, I think, was one of his ideas. I would never rule any option out. But again, I just want to make the point that when you run a concession fare system, then, basically, what it means is, you pay one concession fee and then you can vary the terms, but then the revenue level is there. But once we say we are switching from off-peak to peak and so on, then essentially, it changes the construct and we have to look at this quite carefully.
So, I just wanted to make the point. I would not rule out any options going forward because, as I have said, there are various factors that we have to take into account in thinking through our fare formula and our approach. But I just wanted to make that point specifically.
I want to thank the Member Ms Poh Li San for her question. Indeed, she has raised a very important point because it is one thing to say we want to increase our arrivals to 50% or more of pre-COVID-19 levels, but how to make it happen? Because there has been a significant attrition in manpower and we have to re-employ.
MOT and CAAS are working with the unions and with the companies, first, of course, to see how many Singaporeans we can bring back into the fold. This is an important priority.
But at the same time, a significant portion of the attrition has been manpower from overseas. So, we are also working with MOM to see what kind of solutions we can put in place because once we decide to go towards vaccinated quarantine-free travel, the volumes will pick up significantly and we need to make sure that, from a capacity perspective, we are geared up. The ability to bring in the requisite level of manpower is key and we are working with the companies and MOM on that.
The Chairman: Leader of the Opposition. Oh, a reply from Mr Baey Yam Keng.
Mr Baey Yam Keng: Sir, I would like to assure Member Poh Li San that when we planned the islandwide cycling network, it is, first, at the town level and within the town, at different phases. As we plan the roll-out, we will look at the last-mile connectivity, especially to places where many residents go to. So, in the Bukit Panjang example I quoted, the CC, the transport hub or hawker centres.
We must also plan it such a way that there is connectivity amongst the different stretches of cycling paths so that it makes sense for cyclists to be able to enjoy a more seamless cycling path network.
The Chairman: Mr Pritam Singh, if you can keep it to a minute, so that we can have a minute’s response.
Mr Pritam Singh (Aljunied): I will, Chairman. Thank you.
I did not intend to rise, but I had to, after the Minister for Transport stood up and spoke of \"intellectually rigorous\". I think he was going to say \"intellectually honest\" but he stopped himself and said \"intellectually rigorous alternative proposals\".
Indeed, as part of this Budget debate, the Workers' Party has put up four alternate levers. It is not as if the money is going to come from an unknown source. So, I just wanted to clarify that point, that the party put up four different levers to consider where additional revenues can come from to address some of the issues we have raised, not just here by Member Jamus Lim, but also in our manifesto. I think it is important for me to put that out.
Mr S Iswaran: Mr Chairman, I thank the Leader of the Opposition for the clarification. Intellectual rigour, intellectual honesty – I am not sure, I mean the Leader of the Opposition appears to be imputing words. Whatever it is, I think you cannot have rigour without honesty. So, let us leave it as that.
In terms of proposals, I do not intend to canvass again the arguments about the different sources of revenue. I think they have been well discussed in the main Budget Debate on the Budget policies and so on.
However, I want to bring it back to this Ministry’s budget because it is an important point. Every year, we have to address this issue of the balance between quality service, affordability and financial sustainability. This is not going to go away.
So, when we make proposals, it cannot be that we make proposals that incur additional expenses under one Head, but then, say it will all be taken care of at some macro level. Because we do need the discipline of also addressing how, within that particular Ministry’s budget, we are making every effort to find the appropriate balance.
The Chairman: Mr Saktiandi Supaat, if you can withdraw your amendment, please.
Mr Saktiandi Supaat (Bishan-Toa Payoh): Mr Chairman, the state of our air, sea and land transport is a reflection of our economic and the social state of our country. And we have discussed today quite a significant range on air, land and sea. I am really looking forward to all our efforts to make our air and sea hubs status thrive again: the job opportunities that Senior Minister of State Chee mentioned just now in maritime Singapore and in various other sectors, the dedicated cycling paths that are going to come on stream and also the TEL, JRL and CRL. So, in other words, a wide range of exciting opportunities in the transport sector.
Before I withdraw my amendment, I would like to thank Members for their 30-plus cuts and many thanks to Minister Iswaran, Senior Minister of State Amy Khor, Senior Minister of State Chee Hong Tat and Senior Parliamentary Secretary Baey Yam Keng for their responses. And also the Permanent Secretary of MOT and his team and our MOT family of agencies – CAAS, MPA, LTA.
And most importantly, to all our frontline workers in the transport sector. I think they have put in a huge effort, not just over the last year but over the past two years. I have been saying this for the previous Budget cuts and discussions. So, all their hard work, conviction and passion to keep our air, sea and land hubs working well and going forward, being future-ready. With that, Chairman, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $3,704,101,400 for Head W ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $7,216,684,300 for Head W ordered to stand part of the Development Estimates. (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head O (Ministry of Health)","subTitle":"Fostering a resilient and caring society","sectionType":"OS","content":"Dr Tan Wu Meng (Jurong): Mr Chairman, I beg to move, \"That the total sum to be allocated for Head O of the Estimates be reduced by $100.\" I declare that I am a medical doctor in a public hospital.
In the Budget debate, I spoke on \"stress tests\" for Singapore. COVID-19 is testing us today. But we also need to prepare our healthcare system for tomorrow, test our plans for the future before the future tests us.
I will speak on three areas today: better care for an ageing population, amidst better care coordination, better access to treatments and better support for our healthcare workers and frontliners.
Sir, today Singapore is ageing – more chronic diseases; patients with multiple medical conditions.
I asked a Written Question in Parliament early this year: how many Specialist Outpatient Clinic (SOC) visits a patient might have in a single year in our public hospitals? Here are MOH's figures from 2019, before COVID-19.
Over 7,000 patients each had 24 or more clinic visits a year. That is 7,000 patients averaging two or more clinic visits a month. Over 2,000 patients each with 36 or more clinic visits a year. That is 2,000 patients, each averaging three or more clinic visits a month.
Each visit means travelling to and fro. If you are less mobile, it might mean having to take a taxi. If you are still working, it might mean time away from work. For caregivers, time commitment, too, and not every employer is supportive. And for some low-income, daily-rated workers, each clinic visit means loss of income.
I have met Clementi residents, worried about this. But they also see how busy our healthcare workers are across Singapore. And yet, without enough time, space, opportunity to fully coordinate the care, it is hard to reduce and simplify the number of visits and appointments and journeys across multiple medical teams when a patient has multiple medical conditions.
Let me speak on the value of care coordination. I raised this back in 2009 in the Singapore Medical Association Newsletter – the SMA News.
Sir, in Cabinet, there are Coordinating Ministers. It recognises that coordination is important, adds value in and of itself beyond a single specialisation, beyond a single Ministry. Likewise, there is a role for the coordinating physician, someone who has walked with you for years, knows the ins and outs of your medical journey throughout your journey as well. And when the situation is complex, someone that can be a bridge between different specialists, different medical teams, not taking the place of individual experts, but bringing that holistic view, working with you, for you, for your health and your care.
Sir, in some cases the coordinating physician might be a doctor who has known the patient for years – a specialist, a family physician or general practitioner (GP).
But ultimately, it is a role that requires deep knowledge of the patient, deep understanding of the patient, a certain breadth of medical experience and, most importantly, depth of wisdom. It is high-value work, it takes time, it takes effort and it should be appropriately recognised and supported throughout the healthcare system.
Sir, COVID-19 has been very, very hard on our hospitals. And it would have been even harder without the help and support of our family physicians and our GPs in the community, on the community frontlines, supporting patients, helping patients recover in the community, to help reduce the brunt of the COVID-19 wave at our acute hospitals. I know some family physicians, including in Clementi, some are themselves not young and faced significant personal risk in looking patients in the early days the pandemic especially, before there were vaccinations against COVID-19.
Some have also asked about support, closer collaboration with our hospitals, in peacetime and in crisis. Can it be easier for family doctors to link up with the hospital team, to keep updated on the mutual patient's condition, or even to mobilise the resources of a hospital cluster, working with family doctors to help support patients in the community?
We need to keep our healthcare system fit for purpose, amidst Singapore's ageing population. And this means we need to find ways to support and empower our family physicians and GPs better, help healthcare clusters and family doctors connect to work together more closely, make it easier for information to flow and be shared to build that understanding of how best to care for a patient – so that care can be better coordinated even amidst an ageing population and patients with more complex medical conditions.
Sir, let me speak on the healing power of therapeutic time because empowering healthcare workers also means understanding the work, how much time it takes to deliver quality care.
Sir, imagine sitting down with a friend, encouraging them to stop smoking; listening to their story – how they started, the challenges they face; persuading that person to change their lifestyle. It takes time.
Quitting smoking, lifestyle changes, challenging conversations in a health crisis. These are not just KPIs or targets or policy. It takes time.
Each healthcare worker has but 24 hours a day. Yet, our time is one of the most precious gifts we can give to a patient. And decision makers and planners need to get even better at understanding how much time it takes to deliver quality care – whether face-to-face in clinic; on the telephone or through video-conference, including after hours; connecting with different patient care stakeholders, different medical teams; coordinating, improving a patient's journey.
Because it is only when decision-makers deeply understand what is needed, that planning and policy can be implemented in a way that does the most good. It is like flying an airplane. Even the best pilot needs to know what is the air speed, what is the altitude, how much fuel in the tank.
Sir, let me speak about technology and IT. In 2019, the last year before COVID-19, from public available figures, there were 14 million consultations across the public healthcare sector.
Today, there are computers everywhere in healthcare but we know that the computer systems can be improved, made easier to use.
Imagine: if healthcare workers spent just one minute less waiting in front of a computer, waiting for a computer app to load, working with a mouse, data entry, or grappling with technology. That alone, Mr Speaker, would mean 14 million minutes saved in the healthcare system; a quarter-million hours, 10,000 work days, or 27 years of someone working 24 hours a day – that is how much time could be saved.
Those 14 million minutes could have helped our healthcare workers connect better with patients. Building a care relationship to help someone stop smoking, or forging that trust through a healthcare journey, that trust which is needed in a mental health situation or when there is a life-changing diagnosis, a health crisis.
It matters in a pandemic too. Every minute matters when there are many, many people sick, needing urgent care. So, work spaces, IT user interface – not a small matter. We must give it the same attention and focus on policy and implementation that the big firms, like Apple and Google do.
We have seen that GovTech can develop best-in-class user interface: simple, elegant, gets the job done. Parking.sg – a small app but it shows we do have these capabilities. Should we also have a higher ambition, designing and building our own homegrown national IT healthcare platform, best-in-class, competitive or better than what is available internationally? As easy to use as an Apple or Google app, built by Singaporeans, for Singaporeans? And if we build something that good, we know that we can sell it to the world as well.
Sir, on access to treatments, we know that by improving access to subsidies and MediSave, we help patients and doctors manage chronic illnesses upstream before they grow into a bigger healthcare crisis. Can CHAS and Outpatient MediSave be streamlined further, access improved?
On Integrated Shield Plans (IP Plans). In September 2020, I had spoken about this, how individual patients, individual consumers do not have the bargaining power to take on an insurer, even when there are asymmetric terms and conditions. How the invisible hand of the market can become unbalanced and sometimes, you need the visible hand of the regulator to put things right on an even playing field.
Some Clementi residents have asked: \"Why are IP insurers’ panels of doctors so different from one company to another?\" In May last year, the Singapore Medical Association (SMA) News reported that one IP insurer for their panel of breast surgeons only had male surgeons, which meant a female patient, if needing a female breast surgeon in the private sector would have to co-pay more. But surely if a doctor is fit and proper for Company A, presumably they are fit and proper as well for Company B? Unless the different insurers have made these decisions due to business considerations, rather than clinical performance – in which case, the insurers should be upfront and transparent with patients.
I call upon MOH to continue looking at this to see how we can make the journey better for patients who have invested many years of their CPF, MediSave savings or personal funds in IP Plans.
On better medication prices, I also asked how we can ensure affordable access to new treatments, like cell-based therapies? Whether we can have cheaper, equally effective medications competing in the Singapore market amidst our Free Trade Agreements and intellectual property regulations. Can MOH provide an update?
Sir, I want to speak on supporting our healthcare workers who have held the healthcare system together amidst the pandemic. More than two years, working guts out – day in, day out.
On our nurses and our allied health sisters and brothers, I previously called upon MOH to look at paying our nurses more. Last year, then Finance Minister Heng Swee Keat announced improvements, but there is still room to look further at raising the remuneration of our nurses and our allied health workers because what our nurses and allied health sisters and brothers do is essential work, deep skills, physical, mental, emotional labour, reducing the burden of suffering for patients and patients' families.
It is important work. And so, I call upon this Government to do a deep review – see what more can be done, because how we budget, how we formulate manpower policy, it is not just a question of market forces. It speaks to the values we have, what we hold dear and to the direction and message we want to send for our society.
Sir, I want to speak for our outsourced healthcare workers. In Parliamentary Questions and in last year's Budget debate, I asked about outsourced healthcare workers serving on COVID-19 frontlines, in our COVID-19 wards, same patient care area, same risk, facing the same virus.
Can MOH provide an update on what is being done to better support our outsourced sisters and brothers in healthcare? Because every worker matters, including outsourced workers, because in a pandemic, the virus does not ask to read your contract terms and conditions before deciding whether to infect you. We need to continue looking at this and continue improving.
I also want to speak up for our young doctors who do long hours, long shifts on call. This can mean working a full day, sometimes starting at 6.00 am, sometimes earlier, working the whole night and working for a significant part of the next day.
Today's patients are more sick, more complex than when I was a houseman many years ago. There is also a much heavier load of electronic records, electronic messages, administrative loads as well for our young junior doctors.
So, we need again, Mr Speaker, to seek truth from facts. We know in America, their house officers, their interns are more likely to have a motor vehicle accident at the end of a long shift.
In 2007, 15 years ago, in SMA News, I asked whether we should do more research into how the performance of healthcare workers is shaped by long shifts and sleep deprivation. Are hospital near-misses more likely to happen towards the end of the shift? Does a night shift system change the pattern of near-misses? The aviation industry, militaries around the world have studied the impact of sleep deprivation for many years. We can learn from this and see how we can improve safety and patient care in Singapore.
I also want to speak up for healthcare workers who are caregivers at home, nurses who, after a long shift looking after very ill patients, return home and have to care for a parent who is ill with dementia, a parent who is herself or himself needing care. Young doctors who worry if becoming a mother will have implications for their traineeship journey.
We must keep on looking at how to make our healthcare workplaces more family-friendly, because that is how we build more inclusive workplace for healthcare workers across a diversity of backgrounds, a diversity of personal journeys.
Sir, as I said during the debate on the President's Address, healthcare is about our people's lives – your life and mine. The lives of our loved ones, the life of every Singaporean. We owe it to our fellow Singaporeans to keep our healthcare system fit for purpose, not just for today, but for tomorrow.
[(proc text) Question proposed. (proc text)]
Ms Ng Ling Ling (Ang Mo Kio): Mr Chairman, first I would like to declare my role as a consultant in healthcare transformation. Sir, when a person falls ill and needs to see a doctor, primary care is often the first line of care in the community that they think of. It is an important line of defence and primary care family physicians play a very critical role in caring for patients for non-emergency needs, preventing acute hospital episodes where possible, especially seen during this COVID-19 pandemic period.
Many developed countries around the world attempt to provide proactive primary health services instead of reactive care where a person will only visit a doctor when they are sick. This can improve population health in general. In the United Kingdom, more than 99% of residents are enrolled with their General Practitioners (GPs) who will provide health screening and follow-up care within six months of their enrolment. This practice shifts the focus from treatment of acute and chronic diseases to disease prevention and early management.
With our chronic disease prevalence continuing to rise with our rapidly ageing population, this form of comprehensive primary care delivery may be beneficial for our population for several reasons. Firstly, when a person is enrolled to a GP, it allows both the doctor and patient to establish a long-term care relationship together. Furthermore, early screening and diagnosis can also help in better management of chronic diseases, rendering it more cost-effective in the long term by avoiding complications and reducing needs for hospitalised care.
A point to note is that to anchor health delivery in the primary care and activating more GPs to engage in preventive and chronic disease management, GPs will have to assume more responsibility for the long-term health and well-being of their patients that they are serving. This is likely to have additional workload for GPs as they would now have to monitor and provide follow-up care for more.
This is especially important to note, as we know that many GPs have already stretched themselves to support the fight against the COVID-19 pandemic. As such, I would like to ask if MOH will consider providing more resources and incentives to encourage GPs to step up in preventive and chronic disease management to enhance healthcare for our ageing population?
Mr Yip Hon Weng (Yio Chu Kang): Mr Chairman, primary care is the first line of defence in the healthcare system. General Practitioners (GPs) are critical to the care landscape. Not only can they help to alleviate pressure on the public healthcare system, as they have demonstrated during the pandemic, they are also important for chronic disease management, especially for our seniors.
One of the main roles of GPs is to identify the need for specialist care and to refer patients accordingly. But holistic healthcare for seniors goes beyond physical health. I wish to ask on the progress of the enrolment of GPs in the primary care network.
For holistic care, GPs should also connect patients to social service agencies for social interventions. For instance, if they need to exercise or to take part in interest groups. How does the Ministry intend to activate the GPs in these areas? How can we better connect the GPs to the various social services in the community?
In countries like Sweden and Norway, each family is assigned to a GP of their choice. This is ideal for health management, because a good doctor-patient relationship plays a significant role in fostering trust in patients to accept healthcare advice and to adopt good healthcare practices. In Singapore, some patients have the tendency to doctor-hop. A possible reason could be that different GPs have different rest days and opening hours. Do we intend to introduce a similar model of gatekeeping to specialist care as in the Nordic countries, or do we intend for this relationship to be primarily for chronic disease management?
Lastly, I would like to take this opportunity to express my appreciation to our GPs for stepping up during the pandemic.
Mr Ang Wei Neng (West Coast): Chairman, it was Benjamin Franklin who said: \"An ounce of prevention is worth a pound of cure\". He said it nearly 300 years ago, but it still holds true today. Mr Ong Ye Kung during his recent event has already predicted that healthcare expenditure in Singapore will triple in the coming decade to almost $60 billion by 2030.
Chairman, I fully agree with the Minister that preventive healthcare is critical. In the last two years, about 5% of the MOH non-COVID-19-related budget was spent on preventive healthcare efforts, including the $330 million to fund the work of the Health Promotion Board (HPB). Spending 5% of the healthcare budget on preventive healthcare is quite respectable, as compared to 2.9% in US and 5.9% in Canada.
Currently, one of the main incentive of encouraging Singaporeans to maintain a healthy lifestyle is to give vouchers. For example, the scheme to give up to $380 worth of e-vouchers when one uses the LumiHealth app for the Apple Watch to achieve healthy lifestyle goals. In the private sector, at least one insurance company allows healthy members to enjoy insurance benefits, like additional coverage or premium discounts.
We should up our game. If you want to prevent the steep escalation of healthcare costs by three times over the next 10 years, we need to go upstream to persuade Singaporeans to live a healthy lifestyle so as to maximise their chances of having more years of healthy living and quality living in their twilight years.
Beyond e-vouchers, I suggest we could incentivise Singaporeans to exercise regularly, eat healthily and take the appropriate vaccines by giving discounts on the CareShield Life Insurance premium, that means, giving a discount to the premium that we all have to pay. And give a discount to the medical cost during visits to polyclinics and public hospitals for treatment as well as for medical check-ups. The discount given can be tiered according to the level of achievement based on clear KPIs. This may mean that we have to increase the budget for preventive healthcare because of all these discounts and incentives given. But such investments are worthy, especially if we can significantly reduce the pace of increase of medical cost over the next decade.
Next, we need to limit the intake of sugar and salt. In 2016, MOH declared a war against sugar and set up a new task force, chaired by then Minister Gan Kim Yong. Could MOH provide an update on the result of the war against sugar? Does MOH have a similar plan to wage a war against salt as well?
In summary, I concur with the need to encourage healthy living. In particular, we need to allocate more resources to preventive healthcare and the efforts to keep our Singaporeans healthy very significantly, at least in the next few years. Thereafter, we can adjust the investment into preventive healthcare. This will slow the overall healthcare cost.
Dr Lim Wee Kiak (Sembawang): Sir, I will take both cuts together?
The Chairman: Yes, please.
Dr Lim Wee Kiak: Chairman, I declare my interest as a practising eye doctor in the private sector.
The adage \"Prevention is better than cure\" still holds true and is even more relevant today as we face rapidly increasing healthcare costs. Many of us take health for granted and only start to regret when we lose it. Those who own a car will know the importance of preventive maintenance for their beloved cars but how many of these drivers actually do preventive health for themselves?
Preventive healthcare is certainly a hard sell. It is especially challenging when someone feels, “Why do I need to spend the money or the time, or worry about my health when I am feeling alright?” Little do they appreciate and, often, until it is too late, that preventive healthcare means catching potential problems before they become real big problems. Many do not realise that it is more cost effective to do regular preventive health checks than to seek help when a problem arises.
What is the response to MOH’s various health screening programmes and campaigns in the past five years? In what areas of preventive health is MOH going to focus on? What is the longer-term plan for preventive health for a healthier Singaporean population? What can be done to encourage and promote preventive health in our community? Has any study been done to understand the reasons why people generally avoid preventive healthcare? Can Government put more subsidies into preventive health to make it more accessible and affordable to all Singaporeans?
Currently, there are insurance companies who incentivised their insured to practise good and safe driving habits using various apps and offering discounts to the premiums for renewal and also offer e-vouchers for the insured to adopt healthy lifestyle. Can MOH consider more similar incentives to Singaporeans to encourage them to embrace preventive health? Perhaps Government can offer a discount to our MediShield and CareShield premiums as incentives for those who adopt regular health screening and healthy lifestyle.
We all have heard the saying on the ground that \"one can die but cannot afford to be sick\". Healthcare costs and affordability is a real concern for many as our population ages rapidly. The Government has swiftly addressed some of these concerns over the years by introducing various medical subsidy schemes, including Pioneer Generation, Merdeka Generation health benefits, CHAS cards for middle and lower-income groups to cushion the impact of rising healthcare costs. But are these enough?
Healthcare expenditure has tripled to $11.3 billion in 2019, from $3.7 billion in 2010, over a 10-year period. And with the current spending in this sector, excluding COVID-19 related expenditure, it is expected to rise and hit $27 billion by 2030, which means that in another decade, it will triple again. These are very sobering figures. What is the Government doing to slow down the rise of healthcare expenses?
What are the main drivers of rapidly rising healthcare costs in Singapore? In this Budget, one of the reasons given by the Government for the GST hike is to fund the expected increase in healthcare due to the ageing population. How will the Government use the increase in revenue collected through the GST hike to improve healthcare delivery to our ageing population? What can Singaporeans expect to see in our healthcare infrastructures and services in a decade from now?
When we discuss healthcare financing, our famous 3Ms healthcare financing framework comes to mind – our current MediSave, MediSheid and MediFund. Are they working well? When was the last time we refined, or changed or augmented our current framework? Will we see an increase in our MediSave contribution rates, an increase in MediSave limit and an increase in our MediShield premiums as healthcare costs increase?
To help Singaporeans cope with healthcare costs, especially those with chronic illnesses, can the Government raise the MediSave limit we can use for both inpatient as well as outpatient for these diseases? Can the MediSave limit be relaxed for those who are older, especially for those who have significant savings in their CPF MediSave account? They always lament that \"I have money in my MediSave account, why do I need to use my hard-earned cash to pay for my medical bills, as I stretch my dollar? So, with that, I hope the Government can continue to work towards a healthier Singapore.
Ms Mariam Jaafar (Sembawang): Chairman, our healthcare workforce needs to transform to accelerate the implementation of the \"3 Beyonds\" strategy.
First, putting in place the organisation enablers to support the shifts in the \"3 Beyonds\" – how to manage the workforce across the public and private healthcare system in the new healthcare delivery model and increase their productivity.
Doctors, GPs, nurses, pharmacists and more in the community will play new roles and need to be empowered with new skills, capabilities, evidence‐based practices and tools, as we move beyond hospital to the community.
As we move beyond quality to value, behavioural shifts are needed across the system, from the hospital CEO to frontliners.
As we shift beyond healthcare to health, new skills will be needed, such as in data analytics and behavioural economics.
Across the board, new ways of working – much more multi-disciplinary, much more agile, will be needed. This means putting in place the right organisational structures, achieving clarity of roles and responsibilities, aligning funding models, KPIs and incentives, and bringing in and building the right talent. Can the Minister share what the Government is doing to facilitate this transformation?
Second, the work of healthcare worker needs to be re-imagined digitally as we move to increasingly digital integrated care. New digital roles will be needed in data analytics and AI, in robotics and they will need to be brought in from outside. But importantly, all healthcare workers, will need to embrace digital skills and adopt a digital mindset, seeing digital as an enabler rather than a threat. What forms of digital reskilling and upskilling programmes are being developed to help our healthcare professionals pivot to the digital future of healthcare?
Third, addressing the shortage of nurses. Nurses are the bedrock of our healthcare workforce. At around 7.5 nurses to 1,000 population, our nurse to population ratio is lower than the OECD average of nine. The burden of the pandemic has without a doubt, been felt most keenly by our tired nurses. With an ageing population, increasing life expectancy and increasing incidence of chronic diseases, the demand for nurses can only continue in intensity and nursing care required will also increase. As we shift beyond hospital care to community care, nurses will be needed not only in hospitals but also in the community.
I echo the hon Member Dr Tan Wu Meng's point that more needs to be done to raise the standing of the nursing profession and further review of remuneration. Those are calls for rationality and pragmatism in addressing the foreign nurses who complement our pool. The shortage of nurses is a global one. The UK has launched the Health and Care Worker Visa that allows settlement in the UK after five years and applicants can be joined by dependent partners and children. Are we similarly considering something like this? What more is the Government doing to attract, train and retain nurses?
Fourth, increasing diversity in the healthcare system. There is a need to broaden the definition of a healthcare worker, where someone who has good interpersonal skills and motivational skills, and with technology, can play a key role in population health. There is also scope to increase diversity in leadership, including in cluster leadership, to better reflect the population we serve and the skills and backgrounds required in the new healthcare model. Can the Minister share what is being done to recruit, nurture and deploy people from different backgrounds, especially in leadership roles?
The Chairman: Can you please wrap up?
Ms Mariam Jaafar: Chairman, it has been several years since we embarked on the \"3 Beyonds\" strategy. But I have a lot of hope that we are now ready to make some bold calls to really unlock it and move forward. There is an urgent need to transform to keep our healthcare costs in check. Our healthcare workforce must be ready.
The Chairman: Ms Sylvia Lim. Not here. Mr Leong Mun Wai.
Mr Leong Mun Wai (Non-Constituency Member): Chairman, since the end of last year, many countries around the world have removed most, if not, all of the COVID-19-differentiation measures. With the infection cases and deaths from COVID-19 still at a high level, we are not against postponing the easing of the slew of COVID-19 measures announced by Minister Ong Ye Kung on 16 February. However, we hope the Minister will not forget what he said at that virtual media conference, that these rules, meaning the COVID-19 rules, accumulated over the past two years have become quite unwieldy.
Indeed, we need to review and streamline many of these rules and the most unwieldy of these must surely be the vaccination-differentiated safe management measures (VDS) introduced incrementally from July 2021, when we switched to the living with COVD-19 strategy. This has brought significant misery to a number of Singaporeans who have valid personal reasons not to vaccinate.
Unfortunately, up till today, many of these VDS are still enforced, never mind that other rules have been relaxed with the arrival of the dominant but less virulent Omicron strain.
The vaccines reduce the severity of COVID-19 infection, but they have generally fallen short in their touted efficacy. Vaccination was not the universal panacea we imagined and had little impact in reducing both infection rate and a spread of the virus, especially with the current Omicron variant.
As we move forward towards normalcy in 2022, we urge the Government to relax all its discrimination policies based on vaccination status. The relevance and justification for VDS have dwindled and I believe the general public does not view this as being favourable or fair.
Singaporeans who are unvaccinated are genuinely concerned about their health and each has valid concerns about the vaccine. Their movements continue to be restrained and some had to give up their right to employment due to such restrictions. Now, parents too, have to contend with stress over vaccinations for their children. And there is a growing number of vaccinated Singaporeans agonising over the issue of booster shots.
The latest vaccine safety update by HSA on 23 February reported 10 cases of children, aged five to 11, with serious side effects following vaccination and 280 cases of non-serious side effects. This is of particular concern and warrants closer scrutiny. One case of severe reaction compromising a child's health, going forward, is one case too many, given the fact that children are largely spared from any adverse health challenges from COVID-19 infection.
It is time for the Government to show its magnanimity to this small group of unvaccinated people by relaxing the VDS and not continue to punish them for making rational personal choices. They are not troublemakers as the Government seems to make them out to be.
With the continuous surge in Omicron infections despite having all the VDS in place indicates that the VDS are not critical in the fight against the virus anymore. Hence, VDS should be relaxed immediately. Instead, the Government should focus its resources on approving more therapeutics for GPs to treat patients, to deal with the surge and infections.
We are especially concerned about the senior citizens. In the last two years, we have established that age is the most important determinant in risk factors leading to death. Hence, management of the senior COVID-19 patient can be more targeted. Should approved therapeutics like Molnupiravir or Paxlovid not be made available to senior patients through the GPs, even before they turn seriously ill and need hospitalisation?
We see hope in Omicron being a game changer. Let us review and refine our measures in our fight against COVID-19 and emerge as a people that is more compassionate and united than ever.
Dr Tan Yia Swam (Nominated Member): Mr Chairman, I declare pecuniary interest as a breast surgeon in private practice and as the elected president of Singapore Medical Association (SMA).
Last year, I spoke on the difficulties faced by patients in the fair utilisation of their Integrated Shield Plans. I am glad that the Multilateral Healthcare Insurance Committee (MHIC), of which I am a member, has made some progress in this area over the past year. Today, I would like to share my views on the limitations of Employee Benefit (EB) plans, also commonly known as corporate insurance, or company insurance; the influence of Third Party Administrators (TPAs) and concierge services. These last two arose out of an apparent need to provide a gap in services and, like any other businesses, they charge. But how do they charge, who do they charge and who regulates them?
To give the background, healthcare economics is incredibly complex, with seven Shield Plan providers, multiple types of insurance products, numerous insurance companies offering EB plans, private hospitals, day surgery centres, close to 2,000 private specialists, 3,000 GPs, multiple radiology centres and labs and all with different business models.
TPAs and concierges are, perhaps, the natural result of market needs and forces. For any company offering health benefits, the administration needed to manage employees’ healthcare claims may be deemed too tedious or not cost-effective to be done in-house by their Human Resources team. Therefore, TPAs are engaged.
In the most idealistic form, concierge groups help patients to find doctors suitable for their conditions. Some patients would go by friends' or families’ recommendations, some ask their GPs, some would check their Shield Plan panel list, some would google and do their own research – but some, some would use concierge services. This is where things get tricky. I do not have any access to contracts and only a few colleagues have told me in confidence about how these work. Such services may be marketed as free for patients, but doctors have to pay a referral fee, which may be a percentage of their usual professional fees. In addition, it is said that doctors on such contracts are asked to restrict referrals to other doctors on such concierge contracts, thereby restricting patient choice, which is against the concept of patient autonomy.
I know that the SMC Ethical Code and Ethical Guidelines (ECEG) has clearly stated that fee-splitting is wrong, but the ECEG applies only to doctors. The onus is on us to be aware of the fees and not to fall foul of our ethical code. But are the contracts transparent? Do we understand market forces? Some say that one simple solution is for doctors to refuse to sign any TPA or concierge agreements. But it may not be possible for a doctor to refuse to sign on any of these, depending on the location and model of their practice.
A robust private sector complements the restructured services. The unity of the various healthcare sectors in rising up to the unprecedented challenge of COVID-19 is a matter of public record. The private primary care sector has answered the call of MOH, in the Public Health Preparedness Clinics and Swab and Send Home clinics.
As awkward as it is to talk about money, fair reimbursement is necessary for a sustainable business model. As president of SMA, I have received feedback on what sounds like grossly unfair reimbursements by TPAs. Several have claimed consultation fees may be as low as $6, but they are bound by NDAs, so I do not have more information. Most TPAs often have limits or caps on medications and some GPs have taken the loss on themselves if they want to provide an adequate course of medications for the patient, for example, the duration of antibiotics. This may result in a compromise of good patient care when doctors are not adequately reimbursed.
Payments may be delayed for as long as six months, causing cash flow problems for a small practice. The ongoing Fullerton case reported in The Business Times in January this year left some doctors wondering if they will ever receive their fair pay. GP clinics meet 80% of the primary care demand. They are our first line of care for the community. GP clinics are not just sources of income for doctors, they are also places where nurses and administrative staff are gainfully employed.
TPAs may be the main source of income for many private clinics and I fear that the livelihoods of many will end up being held hostage to the unilateral pressures of the larger and financially stronger TPAs. We should not allow the livelihoods of private healthcare workers to be lost in the name of turning a profit.
In reply to a supplementary question I asked in August last year, Minister for Manpower Dr Tan See Leng replied favourably that there can be increased education to workers on the use of EB versus IP plans, a relook at how TPAs and EB plans are administered, with a need for multiple stakeholders to be involved. I ask for MOH and MOM to consider this in the year ahead.
Finally, even though my leadership in SMA has a limited tenure, I believe SMA, together with our sister professional bodies, will continue to help in the integration and support of healthcare workers through stronger representation for doctors. My vision is that SMA continues to be the bridge between doctors and patients, doctors and insurers, doctors and the Government, to achieve an equitable healthcare ecosystem for doctors and for patients.
Mr Pritam Singh (Aljunied): In late June 2021, the Multi-Ministry Task Force (MTF) announced plans to transition to COVID-19 endemicity. While the Minister for Health announced that we would be ready with 1,000 ICU beds, a figure that was subsequently clarified, it remained unclear what the plan was to ramp up ICU bed capacity without the degradation in the standard of care, in preparation for an endemic COVID-19.
I asked a Parliamentary Question on ICU bed capacity last year and the response received was that we should avoid getting near or needing 1,000 beds and to focus on stabilising COVID-19 case counts. I note the points made subsequently about the trade-offs in the standard of care if a large number of ICU beds have to be stood up. But this still does not get to the meat of the matter. To this end, what specific preparations were made for the recruitment of healthcare manpower in step with preparations for endemicity, as announced by the MTF in late June 2021?
In November 2021, Senior Minister of State Janil reported to the House that about 1,500 healthcare workers had resigned in the first half of 2021, compared to about 2,000 annually pre-pandemic. Foreign healthcare workers also resigned in bigger numbers especially as they were unable to travel to see their family back home. Close to 500 doctors and nurses, healthcare workers, resigned in the first half of 2021 as compared to around 500 in the whole of 2020 and around 600 in 2019, about double the usual rate.
I asked the Senior Minister of State at the same Sitting in a supplementary question what were the recruitment rates of healthcare manpower over the same period; what efforts, if any, were taken in the middle of last year in step with the transition to COVID-19 endemicity, to recruit foreign manpower on an exceptional or an urgent basis. Even if, for example, the training of new foreign manpower to complement local healthcare workers would take some time, it would, nonetheless, have played an important part in reducing the load on our healthcare workers in time.
More generally, a labour shortfall in the public healthcare sector also appears to persist in recent weeks. The stresses on our healthcare workers have been well-publicised online with anecdotes of longer working hours and lesser staff looking after patients' needs. As a percentage today, what is the manning situation in our public hospitals? Are we at 80% or 90%? And at what percentage must manning levels not fall below to ensure an optimal level of healthcare is rendered to patients?
It would be important for the Government to lay out its short- or medium-term solution to this. I asked the Ministry to share its manpower recruitment plans and the additional doctors, nurses and allied health workers required, in view of our COVID-19 endemic strategy. The number must also accommodate the prospect of other future contingencies including any Disease X which is likely to overwhelm our medical services.
In view of Omicron, future potential variants and surges, what is the recruitment plan for medical manpower that can sustain us through COVID-19 and, more generally, for the longer term? Has MOH develop a roadmap or a plan with public healthcare institutions to make up for the attrition in healthcare workers?
Mr Leon Perera (Aljunied): Mr Chairman, I recently filed Parliamentary Questions on junior doctors' working conditions. I would like to call for a review of the current 80 working hours per week guidelines, with a view to reducing it marginally, say, to 70 hours.
Some overseas studies do show that work hour reforms are not necessarily tied to adverse patient outcomes and that 80 hours is more than what is necessary. We can study this locally before making changes.
While it is understandable that hours are frontloaded in a junior doctor's career, so they are exposed to a variety of cases and have experience of disease progression and so on, recent reports of burnout are very concerning. Burnout harming doctors' well-being can impact patient care. Sleep deprivation research shows it can impair psycho-motor abilities to a degree comparable to intoxication. Lack of work-life balance may also push well-trained healthcare workers to work in other countries or industries.
Secondly, let us move towards 100% compliance with the current 10-hour intervals between duty periods and after in-house calls, up from 90% now. We must also ensure that there is no under-reporting. I understand from my past Parliamentary Question that MOH has indicators showing that there is no systemic under-reporting, but anecdotal feedback suggests that this still happens to some extent. In cases where under-reporting or lack of compliance is found, let us move fast to study lapses and ensure manpower is sufficient.
Lastly, I would like to suggest that MOH mandates concrete steps to shorten the time spent handing over and peripheral duties. A 24-plus-hour duty is taxing and reducing administrative time will allow junior doctors to obtain sufficient rest before their next shift.
Dr Wan Rizal (Jalan Besar): Chairman, it is clear that COVID-19 has complicated matters, especially for our healthcare workers. Due to exigencies of service, many are required to cover one another – sometimes at the last minute – work a bit longer, do a bit more and these may add up to less rest time or family time.
The number of abuse or harassment cases rose from 1,200 in 2019 to 1,400 as at the end of November last year.
In the first half of 2021, 1,500 workers resigned, compared with 2,000 annually before the pandemic. The increase in the number of patients, coupled with rising expectations from patients and their family members for high quality care and service, may be the push factors. Hospital visitation, limited by COVID-19, may also have resulted in heightened frustration from some of the patients’ families.
Sir, our healthcare workers have always been exemplary in their service. We expect them to care and smile, but do we care and smile back? The COVID-19 situation merely spotlighted the hard work that they have always, always put in. Thus, we must ensure that they come to work energised, feel protected and respected by both colleagues and stakeholders.
Sir, I would like to ask the Ministry what plans are there to continue to safeguard the well-being of their workforce and improve retention.
Dr Shahira Abdullah (Nominated Member): Chairman, I declare that I work in a hospital.
Chairman, we have a healthcare manpower shortage. Recently, MOH called for help to support the COVID-19 operations as healthcare facilities find themselves overwhelmed by the Omicron wave. A Ministerial Statement in November 2021 showed worrying resignation rates with foreign healthcare workers resigning in bigger numbers.
As such, can we do more to encourage young Singaporeans to take up a career in healthcare so we can become more self-sufficient in the long term? How can we better support workers who would want to have a mid-career conversion to healthcare?
We also need to retain the senior talents that we have as they are key to training the next generation of workers. To do so, employee well-being and working environment are important. A local study by NUS Medicine, National Heart Centre Singapore and Duke-NUS Medical School in 2017 found that eight out of 10 medical residents were burnt out. During the pandemic, healthcare workers are also feeling the strain of more work and longer hours.
Taking into consideration the ageing population and the threat of Pandemic X, what will change moving forward, with the master planning of manpower capacity for the healthcare sector so we can take into account the working environment and wellness of the healthcare workers? This may mean, among other things, beyond remuneration, better work-life balance, enough manpower for better working hours, the ability to take sufficient leave instead of encashing them and the improvement of the healthcare worker to patient ratio. Would these be more effective in encouraging Singaporeans to consider a career in healthcare?
Lastly, how can we leverage workplace improvement, automation and digitalisaton to improve the delivery of healthcare? How can we improve processes to ensure that more time is spent on tasks directly related to patient care instead of administrative processes while not sacrificing patient safety?
Dr Tan Yia Swam: Mr Chairman, I declare my interest as a breast surgeon in private practice and my role as the elected President of Singapore Medical Association.
In recent months, there have been articles in the news and letters to the Forum page highlighting the abuse of healthcare workers in Singapore. Twenty-five months of COVID-19 have placed immense social pressures on every single one of us. But being stressed should not be an excuse for patients to take on abusive behaviour towards healthcare workers or anyone for that matter. The number of harassment cases reported has been increasing yearly, from 1,080 to 1,300 cases.
I am glad that there is increasing awareness of this longstanding problem. Healthcare professionals place patients at the heart of all we do and service before self. But when it comes to abuse, it becomes a really difficult thing to express how one feels abused without feeling guilty of being derelict in our duty. If healthcare workers are given the training to recognise it and the organisational support to be able to call out abusive and manipulative behaviours from patients or their families, it will give us all more protection, peace of mind and the strength to keep on doing what we love best.
Before you worry that healthcare workers over-react and claim that every patient complaint is an abuse, let me share two real-life examples.
One, after a routine, uneventful surgery, on the day of discharge, a patient’s children demanded that the ward staff arrange for daily food delivery to the patient at home because they are all too busy to do so and said, I quote, \"if anything should happen, it'll be your fault\".
Two, as a junior doctor, I once had to call a patient’s son to explain why a surgery had to be postponed for a second time – once, due to salt imbalance and once again due to unexpected fever. The son said, \"You are lucky I am not there; otherwise, I will hang you, every single one of you\".
I am certain that many healthcare workers have their own stories of abuse to share. Our professionalism mostly keeps us in check and stops us from posting on social media. And this is why there is such a skewed representation of cases of lapses in healthcare because healthcare workers would do open disclosures when a medical error has happened. Yet, when the abuser is the patient, who can we talk to? Who will believe us?
Part of the problem is under-reporting. Healthcare professionals in public healthcare institutions are categorised as Public Service Workers under the Protection from Harassment Act. Yet, many healthcare workers may refrain from making an official Police report. They feel it is just a one-off event, they feel sorry that the patient is sick and not feeling well, or that the families are worried, thereby excusing such behaviour.
Another insight is that the type of emotional or verbal abuse that healthcare workers get can be just as elusive as that in an abusive relationship. We may not always recognise it, we just feel drained and guilty after meeting such patients or their families. We are afraid of speaking up, because patients hold the power here – a complaint to the senior management or their Member of Parliament may bring in undue social pressure to give in to unreasonable demands.
For a doctor, an SMC complaint may take months or years to resolve, the media may splash a doctor's name across the main page and his or her reputation is ruined, even if found to be innocent later.
So, what can be done?
The Protection from Harassment Act (POHA) covers only public healthcare workers. It does not allow for immediate remedies to be taken. There must be zero-tolerance of abuse on many different fronts.
At the healthcare workers' level, one should have the professional option to terminate the patient-carer relationship after an encounter of abuse, with transfer of care to another provider.
At the institution level, there needs to be clear protocols for reporting and management of abuse cases: such as making a Police report, making CCTV evidence available and with calling of witnesses.
As a country, we can all play a part to be courteous and kind to one another, to give basic respect and human decency. My vision for Singapore – and even the world – is for us to be kinder, sensible towards and tolerant of differences. Even as the world becomes divided over race, nationalities, vaccine status and so on, as individuals, let us be kind, embrace the Singapore Kindness Movement and practise it in our daily lives. Everyone is going through their own personal hardships, which we may never fully understand.
As Minister Lawrence Wong said, let us build a more caring and inclusive society. I applaud MOH’s written response on 10 January that states a zero-tolerance stance towards the abuse and harassment of healthcare workers. I hope that, on the ground, we will see a greater push and enforcement of measures to ensure a safe environment.
Mr Adrian Tan, current President of the Singapore Law Society, shared in a LinkedIn post in December regarding healthcare worker abuse. That post had a wide discussion and engagement from professionals across different sectors. Some, in service industries, brought up denial of service to abusive customers. This is such a foreign concept to most local healthcare workers. But a few friends who have worked overseas have shared that, yes, their hospitals have provisions in place to turn away such visitors. These rare situations are typically for drunks or known drug addicts who come into the Emergency Department, not for a medical condition, but to demand drugs and were clearly abusive, such as screaming, shouting or even spitting at staff.
Maybe COVID-19 has, indeed, made it timely for there to be stronger legislation to protect all healthcare workers against bullying and harassment. Please, help us, to help you.
Mr Abdul Samad (Nominated Member): Chairman, this COVID-19 crisis has certainly tested the patience and resilience of our healthcare system and, most importantly, our healthcare workers. We are also heartened to see many individuals and organisations that have stepped forward to lend support with food, care packs and others to show our appreciation to them.
It was very heartening that on 5 November 2021, MOH boosted the public healthcare workers with an announcement of a monetary award of up to $4,000 in recognition of their efforts in the fight against COVID-19. In fact, this applies to those at community care organisations that deliver frontline services, such as nursing homes and dialysis centres.
Notwithstanding the above incentives, there were also not so nice news, whether in social media or even mainstream, on the mental challenges faced by this group of workers within the sector. We are also not sure how many of such workers that are facing similar workplace stress and challenges.
In addition, quite a high number of reported resignations was recorded from healthcare staff due to the stress at the workplace.
Notwithstanding these reported incidents, how does MOH engage the hospitals' management to identify the workers that are having mental health issues or stress during these challenging times? What kinds of support are there? What kinds of support are provided to any worker who comes forward? For those who had resigned, were they our locals or foreigners who had decided to return home to be with their beloved families?
News of these resignations from this group of healthcare workers should not be seen as an obstacle for fellow Singaporeans or even students who may want to pursue a career in healthcare – friends and cousins that I know of are still contemplating their decision in this meaningful sector.
I am appealing to the Government, specifically to the Minister for Health, to again give out one-off bonus for this group of workers, not just confining to the earlier groups that had benefited.
In fact, there are also outsourced workers, such as cleaners, housekeepers, porters, technicians and even security officers, whose lives are equally exposed in hospitals, community care organisations and also neighbourhood clinics.
Besides that, I am not sure if MOH and MHA can also announce such incentives to all paramedics who have to receive and send COVID-19 patients either from their homes or even neighbourhood clinics to hospitals. This is because every worker matters.
Chairman, our doctors and nurses serving fellow Singaporeans to provide treatment and care in this never-ending battle against COVID-19 crisis deserve the fullest moral support in the course of their work. I call on fellow Singaporeans to continue showing support for this group of workers in the battle during this pandemic. Each simple smile and word of thanks to them will certainly help to boost their morale.
Dr Wan Rizal: Chairman, mental health issues and well-being are a whole-of-society approach that spans across different age groups and segments of the community, from students to workers, youth to the elderly – and rightly so. In last year’s COS, MOH announced two task forces to strengthen support for mental health and well-being as a whole.
First, Senior Minister of State Dr Janil Puthucheary shared that the Taskforce for Mental Health and Well-being will work on three areas: the development of a national strategy; creation of a resources webpage; and a competency training framework.
The second task force, announced by Minister Masagos, revolved around Child and Maternal Health and Well-being, to provide comprehensive support to women and their children. Like some say, \"A healthy and happy mother has a healthy and happy child\". And, of course, an even happier father.
Sir, the family nucleus remains an important bedrock of our society. Investing more in our children is, inevitably, investing more in our mothers, too. Therefore, we must continue to provide the infrastructure and support: through greater access points within the community like the GP clinics and polyclinics. Support programmes and resources for mothers and families as a whole must continue to be made available and accessible.
Sir, I also believe that screening, both physical and mental, is important, especially at the antenatal and postnatal stages so that proper and early intervention is provided.
Therefore, I would like to ask the Ministry what are the updates from the Mental Health and Well-being Taskforce as well as the Child and Maternal Health and Well-being Taskforce respectively.
Mr Xie Yao Quan (Jurong): Chairman, it is heartening to see more open conversations acknowledging the stigma around mental health and the need to break this stigma.
Our key task ahead is how to break the stigma, keep chipping away at it, keep shifting the needle, as a whole of society.
As a first step, I believe we need to raise our collective awareness, knowledge and empathy on mental health. So, for instance, understanding that signs of distress do not mean a disorder per se. A person who shows signs of anxiety, for example, may not have an anxiety disorder. A person with low mood, low energy, feeling \"depressed\", may, nonetheless, not be facing a depressive disorder. Symptoms and seeking help, counselling, therapy for these, do not mean there is a clinically-diagnosed condition. There is a difference.
And conversely, understanding that a person living with a clinical disorder may not actually show signs. People around him or her may not even know. It may not be obvious.
So, we need to continue working at our collective understanding and sensitivity on mental health as an essential first step in tackling stigma as a society. Because this translates into our words, the language that shapes our discourse. And words do matter.
Where our words are understanding, authentic, but sensitive and nuanced, it helps someone else to reach out to us. The right words can open up more doors for a person who may need help. The right words can also help us to reach in, to open the doors of someone else's heart. So, building a kind, compassionate environment free of stigma starts with our words and our language. And it also takes real skills, skills to truly listen and respond with empathy.
In a dialogue I moderated, a youth in his early 20s made this important point. He suggested that older students in higher education should all have a chance to learn such skills. This would better equip students to provide peer support and, indeed, a strong tapestry of peer support is also key to tackling stigma. Peer support can be that first net to catch and embrace persons dealing with mental health challenges.
And this should not just be for youths. We should strive to build up a state of peer support that permeates through a person's life course, through youth, as a working adult and, importantly, as a senior, when challenges such as isolation become particularly salient.
But peer support cannot replace professional help, when it is needed. In this respect, for professionals working with children, the obligation to inform is a particular challenge at times. It deters some children who need help from coming forward. And the interplay with the existing stigma adds to the complexity.
It is hard work for mental health professionals who are working with parents and children to see how best they can support each child and every case is different. But where there are successes, we should get these stories out, so that we can encourage more children and more parents who need help to come forward.
Stigma and other crucial issues relating to better mental health and care are a long journey that takes all of us. And the formation of the Interagency Taskforce on Mental Health and Well‐being is a strong signal of the Government's commitment to this very important journey. I look forward to an update by the task force about its work later.
Dr Shahira Abdullah: Chairman, I initially filed this cut under the Prime Minister's Office because I am raising the recommendation for a permanent Mental Health Office under PMO.
Multiple studies and public polls, such as those by the Institute of Mental Health, SG Mental Health Matters and other community groups have shown that factors impacting mental health are complex and cut across many domains of our lives. On 23 August 2021, an Interagency Taskforce on Mental Health and Well-being was set up to address the multifactorial nature of mental health and well-being. Could the Minister update on the progress of works since the announcement?
Mental well-being is something of national concern, which straddles many Ministries. Adult mental health and well-being will require a different approach as compared to that of youth and seniors. In addition to age differences, there is also a need to address the mental well-being of people of different backgrounds, such as teachers, social workers, ex-offenders and victims of scams, just to name a few. To touch all bases requires close coordination between Ministries, as well as adequate authority and resources to be able to roll out the initiatives.
Mental health issues are something that will not go away. We should not invest in mental health only as a COVID-19 response and recovery but as something permanent to create better physical health outcomes, stronger families, increased economic productivity and long-term growth and development. The mental well-being of a nation is essential for Singaporeans to reach their full potential. Therefore, would it be more effective to make it a permanent office or agency? Since it also requires close coordination among many Ministries such as SNDGO, could the Ministry share what factors it considers when determining whether to form a permanent office under PMO, to oversee an issue of national concern?
Mr Dennis Tan Lip Fong (Hougang): Mr Chairman, COVID-19 has impacted our mental health too. An IMH study last year found that 13% of the participants reported symptoms of increased anxiety and depression. But 81.8% of participants said that they will be willing to seek professional help. I am therefore concerned that the current MediSave cap is insufficient for low-income individuals that may wish to seek help but may not be able to afford it.
Currently, only mental illnesses listed under the 20 chronic diseases under the Chronic Disease Management Programme entitle a patient to pay using his MediSave account. Patients with complex chronic mental conditions will be able to use up to $700 of Medisave per patient yearly, while other patients will be able to use up to $500 of their MediSave per patient yearly for treatments. I would like to ask MOH to review the current MediSave cap of $700 allowed for chronic mental illnesses.
To allow greater accessibility to psychiatric care in the community, the cap can be reviewed considering that on average, consultation fees in the private sector is over $100 per session, excluding the course of medication. Increasing the amount allowable under MediSave may also allow patients more flexibility to consider seeking consultation with doctors in private hospitals as the wait time may be too long in structured hospitals.
Further, as part of the new focus on mental wellness, I would like to ask that we allow MediSave payments for consultation with psychologist, which I understand it is currently not possible. We can perhaps, set a cap of a maximum number of sessions per year, for example, up to five.
Mr Leon Perera: Mr Chairman, from FY2016 to FY2018, our public and total healthcare expenditure remained constant at 2.1% and 4.1% of our GDP respectively, approximately, but has since increased.
For comparison, Japan spends 9.3%, Germany spends 10.7% and the OECD average is about 8.8%. However, these two years have shown that we need a much more anti-fragile system. Healthcare workers, including nurses, ambulance staff, junior doctors, are overworked the moment colleagues begin falling ill or are told to stay at home. This is not sustainable. I believe the Government understands that it needs to spend more. We see this in plans for upcoming infrastructure, like new polyclinics.
I would suggest that public mental health and dental care also needs to expand a lot faster than the headline rate. For mental health, I was told in a Parliamentary Question reply, that the number of psychologists here is only increasing by 4% annually. It is also not easy to qualify as a psychologist.
From conversations with my constituents in the Serangoon ward of Aljunied GRC, the waiting time to see a public sector mental health professional or dentist can be long. For such conditions, intervening early is important to limit further health or social consequences. I would like to urge greater urgency in the expansion of our public dental healthcare capacity as well as our public mental healthcare capacity, especially at the tertiary level.
Mr Edward Chia Bing Hui (Holland-Bukit Timah): Mr Chairman, Sir, according to NKF, dialysis centres are experiencing a growing number of applications, more than 100 a month, up from 60 a few years ago. The age profile of applicants are largely seniors. As a member of the PAP Seniors Group, I am concerned about these rising numbers and will speak on co-locating hemodialysis centres for added convenience and the promotion of alternative treatments plans to cope with the anticipated increase in caseloads.
I am heartened to know that NKF has been working with MOH to build more centres for hemodialysis at HDB void decks. In addition to building dialysis centres closer to the community, a co-location with other medical facilities such as polyclinics can enhance patients' care. For example, dialysis patients often need wound care and can seek such treatments at the polyclinic. Secondly, co-locating a dialysis centre with a nursing home can provide added convenience for nursing home clients. Lastly, co-locating a dialysis centre within transportation hubs can significantly reduce patients' travelling time. These forms of co-location provide better overall care outcomes as patients can now seek complementary treatments and greater convenience.
At large, there is an increasing demand for Renal Replacement Therapy (RRT) on a national and global level. Hence, current hemodialysis treatments are unlikely to meet demand due to inherent constraints and there is a need to look for alternatives beyond community satellite hemodialysis. Alternatives include promoting peritoneal dialysis, which is a home-based treatment where patients can carry out treatment themselves in the comfort of their own homes. Peritoneal dialysis also allows for more flexibility, enabling patients to better fit dialysis into their lifestyles. Peritoneal dialysis can also help tackle a manpower crunch faced as the number of nurses required are halved, compared to the nurses needed for hemodialysis with the same number of patients.
Despite peritoneal dialysis being a viable alternative to hemodialysis, most patients are still choosing HD as a dialysis treatment. Therefore, it is of paramount importance that we strengthen our public education on peritoneal dialysis treatments and empower healthcare providers to promote these alternative treatments.
As close to 70% of kidney failure is a result of diabetes, we need to strengthen the link between diabetes and kidney failure in public education messages. Lifestyle modifications are the best way to prevent deterioration of one’s kidney function. Upstream intervention and prevention are key to dealing with the anticipated increase of numbers of patients requiring dialysis.
The Chairman: Mr Yip Hon Weng. You can take your two cuts together.
Mr Yip Hon Weng: Mr Chairman, in Singapore, many healthcare providers leveraged on telehealth to remotely monitor at-risk patients’ conditions during COVID-19, when they were discouraged from visiting the hospitals.
With the current healthcare crunch, telemedicine is a solution to do more with less. This is especially so considering that many healthcare professionals find their time taken up by administrative work, which could be better used on clinical work and delivering better bedside care. How does the Ministry plan to use smart technology to relieve the healthcare crunch? Within the community, how can we accelerate the adoption of telehealth? The polyclinics continue to be crowded with patients, especially seniors, many of whom who are not familiar with telehealth, despite being the group that would benefit most from it.
Yet, with the convenience brought about by digitalisation, security always seems to be the trade-off. But this must not be the case, given the highly sensitive nature of healthcare data. The World Economic Forum warned that more needs to be done to strengthen healthcare cybersecurity. Serious ransomware attacks could jeopardise the timely delivery of quality healthcare. What is the Ministry doing to ensure security of our data and IT systems in the healthcare sector? How are we applying the lessons learnt from the 2018 SingHealth hack and subsequent cybersecurity breaches in other healthcare systems?
The increase in our Budget expenditure was largely attributed to the costs associated with caring for an ageing population.
The instructor-led fitness and exercise group workouts around the island by the Health Promotion Board is part of the Action Plan for Successful Ageing. It gave an outlet for seniors to stay physically and socially active. During the pandemic, these exercises took a step back. For two years, we encouraged our seniors to stay home for their health and safety. Not everyone was able to switch to electronic means of socialising and exercising.
As we emerge from the pandemic, we urgently need an update on the Ageing Plan Refresh. What are the new priorities? What are the tangible methods to measure the success of the programme? What are the significant timelines and milestones?
Even though the Ministry has committed more resources to improve the healthcare infrastructure, there are other areas of opportunity that require resources to grow. We need to improve our home-based care, caregiving and ageing in the community to free up resources from the public hospitals and clinics. By leveraging on digitalisation, we can use telecare to reduce crowds in our healthcare institutions and provide more accessible healthcare in the community and convenience to patients. A better relationship between seniors and GPs, and allowing seniors to choose their GPs, can help seniors manage their chronic health conditions better.
And, as I have spoken in my Budget speech, the palliative care sector is in need of more resources for development. As Singaporeans live longer, there is a higher likelihood of suffering from more chronic health complications and severe illness. These can bring about rather immense suffering, physically and emotionally. Palliative care plays a significant role in helping a patient maintain their dignity and peace at the end-of-life. I urge the Government to commit more resources to this.
Employment has generally been recognised as being good for health, as it provides for a sense of purpose, a social life and financial independence, which are crucial in old age. A senior-friendly workplace will contribute many more productive years to a senior's health. I hope the Ministry can have more cross-collaboration with MOM to introduce more targets and programmes to get companies in Singapore to hire senior workers and make their workplace more senior-friendly.
Successful ageing in Singapore should be a multi-pronged approach that involves self-reliance of seniors, partnerships with stakeholders, such as employers, and empowerment of family to care for their seniors.
Mr Pritam Singh: In 2016, MOH rolled out the senior support call centre service, Careline. It was targeted at seniors living alone who could enrol in the service and receive support, medication reminders and tele-befriending, if needed.
The Minister for Health last year noted that Careline has supported around 10,000 seniors. I would like to ask how many Singaporeans have signed up and of which, what has been the proportion of seniors who have had their needs met through Careline. Has the number of sign-ups remained promising after four years?
We also know that language barriers tend to be a challenge in bringing care to our seniors. Has there been feedback on whether this was also an obstacle in Careline and what steps have been taken to bridge that?
I gather that how Careline works is not necessarily by sending someone down to the senior who calls but also by linking them up with relevant agencies and community partners to provide more well-rounded support.
It is hard to quantify the success of holistic support though. Perhaps, one way to measure efficacy would be to think of how Careline has helped expedite seniors' access to emergency responses. How many Careline calls in 2019, 2020 and 2021 have been referred to emergency services?
Which brings me to Careline's specific role. It is but one among a buffet of tele-medical services that seniors and other vulnerable citizens can choose from when they are in distress. Other 24-hour hotlines like the IMH's Mental Health Helpline. Eldercare centres also conduct check-in calls to seniors in need of support, as does the Silver Generation Office, albeit with a more targeted approach. There are also support hotlines operated by independent counselling centres and the National Care Hotline offering pandemic-related psychological support.
With so many different options, are seniors made sufficiently aware of the range of support that they can access, or is there some scope for a rationalisation exercise without drop in the quality of care? Does the Government envisage expanding Careline and rolling it out to more seniors?
Mr Kwek Hian Chuan Henry (Kebun Baru): Chairman, I noted that MOH has stared on the Ageing Plan Refresh, which gives the Government an opportunity to review the whole-of-Government efforts to empower and support our seniors, which is much needed given how much change has happened with COVID-19.
We at the PAP Senior Group are watching this review closely and with much anticipation. While MOH continues with the review, I hope MOH can consider the following.
One, once Omicron subsides, decisively change the SMMs to encourage the revival of wellness activities conducted by the grassroots and by senior activity centres. This is a point that my colleague, Mr Yip Hon Weng, mentioned before.
Two, put a renewed focus on preventive health campaigns against diabetes, cancer, stroke and mental health.
Three, accelerate the efforts of Queenstown Health District and quickly scale up beyond Queenstown and hopefully, the whole of Singapore.
Four, introduce fresh ideas to encourage more seniors to come forth for health screenings.
And five, enhance the scope of healthcare screening to detect and resolve more types of preventable and degenerative diseases and conditions.
Given that we have transited to living with COVID-19 and most of our seniors are vaccinated and more anti-COVID-19 treatments are available, can MOH also share and elaborate on the current thinking on how to best care for our seniors' health and well-being moving forward?
Ms Tin Pei Ling (MacPherson): Sir, pandemic has reset all active ageing efforts. While some seniors are raring to resume activities, some have retreated and gotten used to staying home. This leads to significant deterioration in mental acuity, emotional and physical well-being.
For instance, I always remember Uncle Lee to be a jovial and active senior who loved to organise day trips for residents and tell me stories. And I would see him with a big smile on his face at our community events. Since the pandemic, I saw little of him as he stayed home. Each time I saw him, he was less engaging and slower to react. In January this year, I visited him again and he just sat in his chair, unable to recognise me. It is heart-breaking.
I have also met other seniors who have aged so much faster in these two years. Some of them were pleased when I visited them and as we chatted, they broke down in tears as they articulated how lonely they felt. We must not let our seniors retreat into isolation and wither alone.
What is the Government doing to resume seniors' engagements in the community in a safe manner? How can this be expedited? What more can be done to compensate for this \"vacuum\"?
The Chairman: Ms Ng Ling Ling, you can take your two cuts together.
Ms Ng Ling Ling: Mr Chairman, the Population in Brief 2021 continues to report an increasing trend of our citizen population aged 65 and above, with the proportion growing at a faster pace compared to the last decade. From Census 2020 data, we note that 22.8% of this group of seniors are living alone or with their spouse only. As our population ages and family sizes decline, more seniors are likely to have only themselves or their spouses to support them in their old age and many may require community care at some point in time.
I would like to continue to call attention to integrate housing and care needs for our seniors. During the Budget debate last year, I strongly supported the Community Care Apartment model piloted at the Harmony Village at Bukit Batok. I am glad to hear from the MND's COS session yesterday that more of such Community Care Apartments (CCAs) will be launched and I hope MND will spread them island-wide to benefit more seniors.
A related issue that I hope to raise is incorporating senior care services in new BTO projects with flexi 2-room flats. During my walkabouts to newly completed BTO projects in the Buangkok Crescent estate of Jalan Kayu, which consist of mixed room types of between 2- to 5-room flats, I noticed that the flexi 2-room flats are mostly occupied by seniors living alone or with their spouse only, many of whom have chosen to downgrade to a smaller flat in their advanced years, mostly in their 70s and 80s.
BTO projects in newer estates consist predominantly of younger families and the social and community services around then tend to cater to their needs. I would like to thus suggest for coordination amongst the Ministries, between MOH, MND and MSF, to profile the BTO blocks with a larger number of seniors in 2-room Flexi Flats, to provide integrated senior care support in addition to services for young families. In fact, if more inter-generational community services that cater to both social and health well-being of our younger and older residents together, it will be beneficial to the community as a hope.
Mr Chairman, in my COS cut last year, I raised the concern of maternal health of mothers and its impact on their children. With our birth rate continuing to slide, every child born is precious to us. Ensuring the health of mothers and their children is hence a priority that needs our continued efforts.
I am glad to hear that MOH has developed a Child and Maternal Health and Well-being Strategy to provide comprehensive support to women and their children, spanning from pre-conception to youths aged 18. These are formative years with many critical milestones. I hope to have more updates on what the new initiatives are and how the strategy will address health needs and mitigate risk factors of mothers and children in Singapore.
One emerging risk that I would like to highlight is on children's screen time usage and addictions.
According to data from IMDA, Internet usage among children aged 15 and below increased from 69% in 2016 to 92% in 2020. COVID-19 has intensified the usage of technological devices for communication and entertainment. A study done in 12 countries on those aged eight- to 36-month-old showed that children's screen time increased during COVID-19 lockdown relative to before. The study found that many caregivers would have to juggle both caring for children working from home had limited access to other activities to occupy their children's time and this resulted in screen time being the only way to occupy their children. An informal study done by The Straits Times in February this year with several counselling agencies showed that the number of cases they received for intervention regarding screen time addiction rose by up to 60% during the circuit breaker period.
I also note another Straits Times' article published just last Sunday, introducing a set of guidelines by a workgroup led by KK Women's and Children's Hospital (KKH), aimed at supporting parents to instil better daily habits from birth, helping young children get enough sleep and reducing screen time exposure to improve their health and well-being in the long term.
I would like to raise two suggestions for MOH's considerations.
Firstly, can we support the good work of the workgroup led by KKH, which I mentioned earlier, by supplementing their guidelines with tool kits, play resources and other practical help to support young parents and educators in the early childhood sector to be trained and equipped with strategies to manage screen time for children from early childhood?
Secondly, can we research and implement evidence-based programmes to support educators, community health practitioners, parents and caregivers of children and youth who are at risk of developing Internet addiction or who already have total mean screen time above a certain threshold?
As we move to an endemic Singapore, I hope that more outdoor activity options will become the preferred choices of our children and youth to participate in so that screen time will not dominate their days.
Miss Cheng Li Hui (Tampines): Chairman, last year. I spoke extensively on the need to lift the restrictions on egg freezing for singles.
More Singaporeans are getting married later and having children later, which may have some impact on fertility. For the singles who had wanted to go overseas for egg freezing in the past two years, they could not and their eggs' quality and quantity would have declined.
Singapore has been experiencing low Total Fertility Rate (TFR). While immigration helps to moderate the impact of ageing and the low birth rates in our citizen population, it is by no means a silver bullet to tackle our longer-term demographic challenges.
Couples who have wanted to seek cheaper IVF procedure or Pre-implantation Genetic Screening (PGS) procedure overseas would also have difficulties doing so with the COVID-19 situation. How is MOH helping Singaporeans with the total fertility health as part of their parenthood journey?
Ms Ng Ling Ling: Mr Chairman, during the Budget debate, I spoke about the increased prevalence of patients with chronic diseases and sought clarifications from MOH on the ways that can better address this trend. Given that our resident population will continue to age, it is inevitable for our healthcare needs and costs to rise.
To mitigate the costs of healthcare on individuals, especially long-term burden of chronic diseases, I believe that we need to empower individuals to understand our own health, both in the prevention and prompt management at the onset of common chronic diseases like high blood pressure, diabetes and high cholesterol as well as long-term management and disease control.
A study on a cluster of polyclinics in Singapore has shown that the median annual healthcare costs per capita increase with the number of chronic diseases. To reduce such cost burden especially on our seniors, it is important to increase education to at-risk groups with customised and relatable content, enable screening for early diagnosis and support long-term management to prevent complications from chronic diseases.
I acknowledge that the efforts to reach out and enable more individuals to manage their own health, if solely placed on our healthcare professionals, will increase their already stretched workloads without more supportive tools provided.
In this regard, I hope that MOH will consider more use of technology, including telehealth and artificial intelligence amidst our nation's digitalisation efforts to help individuals monitor and manage our health in partnership with our healthcare providers.
I hope to ask MOH how it will leverage on technology amongst our healthcare professionals and patients, especially in the space of prevention and management of chronic diseases and how it will help to make care treatment augmented by technologies, such as telehealth affordable through, for example, the use of MediSave or CHAS.
Dr Wan Rizal: (In Malay): [Please refer to Vernacular Speech.] Last year, MOH set up the Minority Community Outreach (MCO) working group to improve health for minority communities. These health issues need to be addressed with care and strategically, taking into account factors, such as cultural differences.
Since then, we have seen several innovative campaigns and programmes, such as Yok Jalan Amal organised by M3@Jurong in Jurong, which received encouraging response. Besides physical health and diet, other issues such as mental health have also captured the interest of the community, especially among the youth and elderly.
I would like to ask the Ministry if it can provide an update on MCO's efforts.
Dr Lim Wee Kiak: Chairman, I spoke on adult immunisation last year and, this year, I will again broach this topic.
Getting vaccinated has been a buzzword since the outbreak of the COVID-19 pandemic and we have seen so much effort put in by governments and health authorities globally. In Singapore, we have been very lucky and very successful in our vaccination exercise during this pandemic and we are pushing harder for the younger Singaporeans now to get themselves vaccinated.
Vaccination is important, not just for this pandemic, but for many other diseases. Most adult Singaporeans would have been more familiar with Influenza vaccine and perhaps also hepatitis B, measles, mumps and rubella. The National Adult Immunisation Schedule (NAIS) was set up in 2017 to provide guidance on vaccinations that anyone aged 18 and above should adopt to protect themselves against vaccine-preventable diseases. Eleven diseases were identified, namely, Influenza, pneumococcal diseases, human papillomavirus, tetanus, diphtheria, pertussis, mumps, measles, hepatitis B and varicella, which is the chickenpox virus.
The question is how many adult Singaporeans have kept up with their vaccinations according to this schedule? What is MOH's plan to encourage more adults to keep their vaccinations up-to-date to protect themselves? Even in this House, I am sure many Members have not heard about this particular programme, let alone be up-to-date for the vaccinations.
The COVID-19 pandemic has highlighted the importance of preventive health through vaccination. In Singapore, we have a well-developed childhood immunisation programme. Adult Singaporeans should be encouraged to get their immunisations updated periodically to protect themselves against diseases. Why is the adult vaccination schedule not given more limelight? Can the Government make it more comprehensive as well as easily accessible and affordable and promote it more?
Perhaps MOH can consider sending reminders to Singaporeans who have missed their scheduled vaccinations and also provide some incentives, such as MediSave top-ups for those who have their vaccinations updated? Then this would definitely encourage more to consider vaccination.
The Chairman: Order. I propose to take a break now.
[(proc text) Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mr Speaker: Order. I suspend the Sitting and will take the Chair at 3.05 pm.
Sitting accordingly suspended
at 2.48 pm until 3.05 pm.
Sitting resumed at 3.05 pm.
[Deputy Speaker (Mr Christopher de Souza) in the Chair]
[(proc text) Debate in Committee of Supply resumed. (proc text)]
[Deputy Speaker (Mr Christopher de Souza) in the Chair]
[(proc text) Head O (cont) − (proc text)]
The Chairman: Dr Janil Puthucheary.
The Senior Minister of State for Health (Dr Janil Puthucheary): Mr Chairman, our hospitals, healthcare workers and GP clinics continue to work under pressure as a result of the Omicron wave. Individuals who are not fully vaccinated are more likely to be hospitalised, to require oxygen supplementation, be admitted into ICU care and die.
Three percent of our adult population who are not fully vaccinated accounted for 25% of our ICU cases and deaths. As the unvaccinated are at a higher risk of infection and becoming seriously ill, Vaccination-differentiated Safe Management Measures (VDS) have been put in place to protect this group of individuals while allowing the fully vaccinated to resume more social and economic activities.
Mr Leong Mun Wai, I feel, has cherry-picked the data. He is advocating on behalf of individuals who have not been vaccinated; that is quite reasonable. I think he should have a proper understanding of the effectiveness of vaccinations as the most effective intervention that we have in our COVID-19 fight. Let me share a few points of data for him to consider and see if he may change his mind about how he would like to represent the effectiveness of vaccines in our fight.
For individuals below the age of 12, there are about 40 per million severe adverse reactions reported after vaccination and most of these will recover quite quickly with no effects, no long-term effects. When an individual under 12 is infected by COVID-19, the risk is that about 320 individuals per million will develop Multisystem Inflammatory Syndrome in Children (MIS-C) and about 450 per million will develop myocarditis. And each of these may require admission to ICU, certainly, admission to hospital and have the potential to be fatal. So, you can see that the infection-related complications are at least 10 times more frequent than any side effects from the vaccine; and most of the side effects of the vaccine are short-term, temporary and do not have any long-term consequences.
These infection-related complications are much more frequent, potentially more severe as compared to vaccine-related adverse events. And the odds are clear, every case of MIS-C and myocarditis is one too many. I think Mr Leong needs to weigh up both sides of the risk.
At the other end, if you are admitted to hospital, vaccinated individuals who have received their booster doses are 33 times less likely to die from COVID-19, as compared to individuals who are not fully vaccinated. So, to Mr Leong – it is not appropriate to lift the measures at this stage. Once the Omicron wave has subsided, we will be in a better position to ease our safe management measures further.
I understand that Ms Sylvia Lim is interested about the access to and approval for ART test kits. The key considerations when approving ART kits for public health use in Singapore are to ensure that the kits, when used as a self-test, are sufficiently sensitive in detecting COVID-19 infection, easy to use and affordable. The process for approving locally-produced ART kits to meet quality standards is quite clear. It is not more stringent than for foreign-produced kits and is made known to all interested manufacturers and importers who have enquired about ART kits.
The Health Sciences Authority (HSA) has made available the Pandemic Special Access Route (PSAR) for expedited registration of ART kits to be used for public health use as directed by MOH. Only ART kits that meet the quality standards of MOH are invited by HSA to apply for PSAR. And this PSAR route requires significantly fewer clinical samples than the full registration route as MOH will continue to monitor the performance of these kits as they are deployed. There have been instances where local manufacturers could not meet the quality standards, but this should not be misrepresented as an unclear process. They have been told what else they need to do to meet the quality standards.
Lower-income households can already apply through Social Service Offices and Family Service Centres for free kits supplied by MOH. MOH also provides free kits for individuals on mandatory Rostered Routine Testing (RRT) at the workplace. Those on Protocols 1, 2, 3 also have access to free ART kits via the ART vending machines located island-wide.
Sir, the pandemic has posed a challenge to both the physical and mental health of our people. We will be doing more to support the mental well-being of our citizens. Our local study \"Growing up in Singapore Towards Healthy Outcomes\" (GUSTO) found that the mental well-being of the mother during pregnancy can affect the brain development of the foetus, resulting in vulnerability to mood or anxiety disorders later in life. So, KKH and NUH will increase their antenatal and postnatal mental health screening for more mothers. This will allow pregnant women with depressive symptoms to be identified earlier and allows treatment during both pregnancy and motherhood to occur earlier.
Studies have shown that screen time during early childhood could have a negative association with later cognition. We agree with Ms Ng Ling Ling that more can be done to support parents in calibrating the exposure of their children to screen time. Practical guides and resources will be developed for parents to help them develop healthy screen time habits in their children. We need to encourage healthy lifestyle habits from as early as possible.
The Interagency Taskforce on Mental Health and Well-being comprises members from over 30 organisations and we met regularly to review the population’s mental health needs, discuss identified gaps and develop some preliminary recommendations. The focus of these efforts are challenges that cut across the responsibilities of several agencies.
Dr Wan Rizal and Mr Xie Yao Quan asked about our progress. The Taskforce has identified four focus areas: first, to strengthen services and family support for parents and youths; second, to provide and improve access to quality and affordable mental health care by integrating health and social services; third, to provide employment support for persons with mental health conditions; and fourth, to improve mental health literacy among the citizens and create an inclusive society for persons with mental health conditions.
One of the issues identified is the need for better coordination between the health and social service sectors for individuals with mental health needs. Another clear need is to increase community touchpoints for access to mental health services. We will better leverage existing health and social care settings for service delivery and also equip our frontline workers with skills to identify persons with mental health needs.
We are now refining the recommendations for each of these areas and we will be seeking the public’s views in the coming months. After that, a national strategy and an action plan on mental health will be developed. We will also study Dr Shahira’s suggestion to set up a mental well-being office.
Part of our efforts have been the Youth Mental Well-being (YMWB) Network, launched in February 2020. This aims to implement initiatives to enhance the mental well-being of youths, mobilise the enthusiasm of youth volunteers to work to improve our mental health. The Network has brought together more than 1,500 individuals and saw the formation of over 20 ground-up initiatives.
Moving forward, the Youth Mental Well-being Network will be transiting to a wider remit to expand the focus of engagement beyond youths. The new Network will be supported by MCCY and advised by the Interagency Taskforce. My colleague, Minister of State Alvin Tan will share more about this initiative.
During the pandemic, we saw an increase in the demand for mental health services. Planning has started to future-proof more hospital capacity for psychiatric services beyond the Institute of Mental Health (IMH), our main psychiatric hospital.
The National University Health System will set up psychiatric services at the redeveloped Alexandra Hospital, in addition to the general hospital services that would be located there. This includes inpatient beds for acute and sub-acute psychiatric care and rehabilitation, as well as services such as Medical Psychiatry, Child and Adolescent Psychiatry, and Psychogeriatrics. In addition, the National Addictions Management Service currently at IMH will be extended to other hospitals, including Changi General Hospital and National University Hospital, to make the service more accessible.
Mental health care services need to be more accessible and delivered in many settings, other than only in IMH, as well as integrated into the community and general medical services. The new unit at Alexandra Hospital and the provision of new services in other centres will increase the outreach of mental health care and improve the care of patients and the support to their families.
We will extend this approach to social service organisations and other partners working in the community. We have piloted youth community outreach teams and youth integrated teams to provide a range of support to persons aged 12 to 25 who are at risk, or who are suspected to have mental health conditions. We have rolled out four outreach teams and two youth integrated teams in 2021.
To better support persons experiencing a mental health crisis such as self-harm, IMH has piloted a Crisis Response Team to respond to calls from the Singapore Police Force on cases of attempted suicide. This multi-disciplinary team will conduct an on-site assessment of the suicidal individual and provide appropriate intervention and follow-up management after the immediate crisis is resolved.
Some youths who are hospitalised for risk of suicide or severe self-harm may require post-discharge residential care to allow for space and time to integrate back into the community in a more gradual way. MOH will be developing a new intermediate residential facility to address this. This will add another therapeutic environment – not acute hospital care, not quite a community – for young patients and a new range of possible support services. Further details will be provided soon.
Mr Dennis Tan asked about the cost of mental healthcare services. Patients can tap on the MediSave500/700 scheme to pay for treatments for four mental health conditions under the Chronic Disease Management Programme (CDMP). This includes consultations with psychologists providing services to CDMP providers accredited in giving mental healthcare.
Sir, we have had several iterations of development plans for mental health. The work of the Interagency Taskforce on Mental Health and Well-being is the latest. I hope Members can see that our approach will be comprehensive and holistic. We will be considering a range of challenges from prevention upstream to how to deal with acute, severe illnesses, where time is of the essence. We will also take a good look at facilities, skills and processes, all the way from the community, a new residential centre and the acute services within the hospitals.
We will do this work together with the many professionals and voluntary community organisations that have stepped up an extraordinary mental healthcare response to the challenges of the pandemic, for which I thank them. We will ensure that the lessons learnt become institutionalised and sustainable to benefit our collective mental health for the future.
If I may then, Sir, turn to a different issue – technology.
In response to Ms Mariam Jaafar, as we move to more telehealth solutions and a paper light environment with electronic medical records, clinical staff will receive training and orientation for new workflows.
We agree with Mr Yip Hon Weng that we should continue to better leverage technology in healthcare delivery and our efforts have accelerated during the pandemic. For example, telehealth, virtual ward programmes, the use of chatbots, messaging, video or phone calls to interact with patients, so that they can recover at home instead of in the hospital.
The initial success of these programmes and services has prompted us to study how we can extend it to other groups of hospitalised patients and more clinical services under a Mobile Inpatient Care at Home (MIC@Home) sandbox. We will provide updates on this in the future.
In response to Ms Ng Ling Ling and Mr Yip Hon Weng, similar technology is also being used to help patients manage chronic conditions. For example, the Primary Tech Enhanced Care (PTEC) Home Blood Pressure Monitoring programme at selected polyclinics. These patients monitor their blood pressure regularly at home and submit their readings to a care team in the polyclinic, through a Bluetooth-enabled blood pressure machine and a mobile phone application, saving them a visit to the polyclinic while still receiving timely support. We will be scaling this to all polyclinics and progressively introduce the approach to other conditions such as diabetes.
Project Pensieve is another technology driven initiative. It could enable the earlier detection of dementia among seniors who are at high risk of the disease. Many of our seniors with dementia and their caregivers are not aware of the condition until a more advanced stage of the disease, missing the opportunity for early intervention. This is in part because early symptoms can be subtle and require specialised assessments by a trained healthcare professional in a clinic or hospital, taking up to two hours sometimes.
By using local clinical and technology expertise, an interagency team has developed a digital drawing test, draw with a pen or stylus on a tablet. It takes as little as 10 minutes to estimate the risk of dementia. It uses shapes and symbols and is not affected by which language the patient prefers. Artificial Intelligence is used to analyse how these shapes and symbols are being drawn. The process is simple and can be administered by non-clinical staff and volunteers. The test, then, is accessible. More seniors who are at risk could benefit from earlier diagnosis. This project is still in the research phase, but it represents some of the ways in which we are using technology and local clinical expertise to address the health problems we will face in the future.
We share Dr Tan Wu Meng’s view that technology must enable our healthcare workforce to deliver better care to patients. Good IT user interfaces can indeed improve ease of use and productivity, if they are well-integrated with data systems and clinical workflows. The user experience as well as the manpower and time savings are important considerations when we enhance or roll out new healthcare IT systems. We currently either procure or build our platforms, depending on the availability of ready solutions in the market that meet our needs, at an appropriate price point.
Even as we digitalise, we agree with Mr Yip Hon Weng on the importance of protecting and securing systems and data. MOH has addressed all the Committee of Inquiry (COI) recommendations arising from the SingHealth incident and learnt from them to improve our cybersecurity defences.
We would like to assure Mr Leon Perera that we are actively managing healthcare capacity for future challenges. Last year, we opened three new polyclinics and five new nursing homes including the new NTUC Health (Tampines) Nursing Home which has operated as a Community Treatment Facility (CTF) since September 2021 to support our fight against COVID-19.
This year, the new National Cancer Centre Singapore (NCCS) and Sembawang Polyclinic are on track to open. Preparation works for the redevelopment of Alexandra Hospital and the new Eastern Integrated Health Campus at Bedok North have also started. In addition, the Woodlands Health Campus (WHC) and the TTSH-Integrated Care Hub (ICH) are scheduled to open progressively from 2023. As part of our plan to expand to 32 polyclinics by 2030, residents of Taman Jurong can look forward to a new polyclinic by 2028. The existing Queenstown Polyclinic will also be redeveloped by the end of the decade.
For dental health, we are expanding and upgrading our specialty centres. The new National Dental Centre will be expanded as part of the overall Outram Campus plan. The National University Hospital Dental Centre has started accepting specialty referrals and the new National University Centre for Oral Health has started operations from 7 January 2019. The number of dental specialists in our public health care clusters has risen by 9% per annum from 2017 to 2021.
Mr Edward Chia asked about a sustainable renal treatment strategy. The emphasis should be on the upstream prevention of chronic diseases, through screening for diabetes and hypertension, and promoting healthier lifestyle interventions. MOH has also taken steps to provide better access and integration of care for dialysis patients through the co-location of renal dialysis centres with polyclinics and community hospitals and will continue to do so. In addition, we are encouraging the use of peritoneal dialysis which can be administered at home by the patients themselves.
Sir, in my speech, I focused on mental health, technology, services and infrastructure, but the most important part of our healthcare system is our people, our healthcare workers. Details about our plans from MOH will be provided in the further speeches by my MOH colleagues, but I would like to record my thanks to all healthcare workers for their service to Singapore. Protecting us, keeping us healthy. On a personal note, I would also like to record my heartfelt appreciation to those healthcare workers across our institutions that I have had the privilege to work with personally. My colleagues, my students, most of all, my teachers.
In my speech, I have highlighted examples through which we will make sure that our healthcare workers will have the best possible tools, technology, services and infrastructure, so that they can focus on delivering the best possible care. Curing the sick, relieving suffering, easing our pain and fears and helping all of us to prevent disease and stay healthy. With that, Sir, I wish you and all Singaporeans good health. [Applause.]
The Chairman: Senior Minister of State Dr Koh Poh Koon.
The Senior Minister of State for Health (Dr Koh Poh Koon): Mr Chairman, today, I will address the challenges faced by our healthcare workers, especially during the pandemic and outline MOH’s longer term efforts to take care of our healthcare workers’ well-being and professional development.
Even before the pandemic, an ageing population and increased burden of chronic diseases have placed an increased demand for more healthcare manpower. We factored these needs into our manpower plans and recruitment initiatives.
But COVID-19 has stretched us further. We had to adjust our manpower deployment during the pandemic to meet evolving needs such as the migrant worker dormitory outbreak, as well as swab and vaccination operations.
To Mr Pritam Singh’s query about preparations for ICU surges, I want to reassure him that we have sufficient equipment and consumables to step up ICU beds significantly. And as of January 2022, more than 800 non-ICU nurses have been trained as a reserve to augment ICU nursing manpower by up to 57%. This would enable us to stretch our ICUs temporarily if needed. Thankfully, our ICU capacity is able to cope with the current surge and patients requiring ICU care are a fraction of what we had during the Delta wave. Nonetheless we will continue make the necessary contingency plans given how unpredictable the pandemic has been.
But the pandemic had caused a sudden surge in workload and severely stretched our healthcare workforce. We reprioritised workload and reduced non-essential elective treatments. Absenteeism rates have stayed low, below 10% so far.
Not only have we stretched the public healthcare sector, but those in the private sector stepped forward to help in so many ways, including support from nursing and other healthcare students, as well as SAF. Many have gone beyond their call of duty and we owe them a debt of gratitude.
In spite of COVID-19, we have persisted with actively recruiting for our healthcare workforce from both local and international sources. As of end 2021, the public healthcare workforce stood at about 62,500 staff, an increase of about 1,800 compared to end 2020.
To address Mr Pritam Singh and Dr Shahira Abdullah’s concerns about attrition, MOH had previously shared that the average attrition rate of doctors and nurses from public acute hospitals in 2020 and 2021 combined together was comparable with that in 2019. Specifically, the attrition in our public healthcare workforce was 9.6% in 2019 and it dipped to 6.8% in 2020 at the height of the pandemic. This then accumulated, resulting in a rise in 2021 with a 9.8% overall attrition. But this is rather similar to our 9.6% in 2019.
Specifically, for the acute public hospitals, the average attrition in the period 2020 to 2021 was about 7% to 9% for nurses and about 3% to 5% for doctors. So, the two-year average was quite similar to 2019 levels. However, the 2021 attrition among foreign nurses was 14.8%, much higher than the 7.4% among local nurses. Understandably, some left due to family and personal reasons as the COVID-19 travel restrictions had stopped them from being able to visit and be with their loved ones. But our healthcare workers have stood their post. They have not abandoned their fight against COVID-19 and we thank them for the commitment and the steadfast efforts.
Having said that, this does not mean that we dismiss the concerns of attrition. We will still need to do more to tackle our growing manpower needs. Given our low birth rate and shrinking local workforce, there are just not enough Singaporeans to meet all our healthcare manpower needs.
As many Members, including Ms Mariam Jaafar, have pointed out, we will need a combination of approaches to ensure an adequate and strong healthcare workforce.
First, we must ensure adequate local training pipelines and continue to attract and enable more mid-career locals to enter the healthcare sector. Our intakes for healthcare programmes at the Institutes of Higher Learning have increased over the past five years. Between 2016 and 2021, intakes for medicine and nursing each increased by about 15%, while the combined intake for allied health programmes increased by about 65%.
The healthcare Career Conversion Programmes (CCPs) enables mid-career locals to acquire relevant training to join the healthcare sector as nurses and Allied Health Professionals (AHPs). An average of around 180 mid-career locals per year entered training between 2019 and 2021 amid COVID-19, higher than the average of 110 per year between 2016 and 2018.
We will regularly review remuneration, to ensure that we continue to attract and retain staff and maintain market competitiveness. We last enhanced the salaries of selected groups of doctors and dentists in 2019. Dr Tan Wu Meng asked that we do a deep review of salaries for nurses and allied health professionals. In fact, we enhanced the salaries of nurses, allied health professionals, pharmacists and allied admin staff in 2021. And there is a second tranche of increases for nurses this year, 2022. We will continue to monitor and review salary benchmarks in a timely manner.
But with a tightening workforce situation here in Singapore, we will have to accept that there will continue to be a need to hire foreign healthcare manpower to complement our local workforce and meet the needs of our ageing population. So, I thank the Leader of the Opposition Mr Pritam Singh for supporting the need for us to hire more foreign manpower to support our healthcare needs.
We are also looking on retaining foreign nurses, including keeping their remuneration competitive. We have also worked with other agencies on factors that are important for their retention.
We also need to look beyond manpower to ensure our resources are optimised. This includes further leveraging technology to extend the capabilities of our healthcare workers and innovating the way we deliver care and services and redesign healthcare jobs along with training and development opportunities so that each category of staff can perform at the top of their licence. This includes training for digitalisation for healthcare professionals to be prepared for the future. For example, NUS has a Nursing Informatics course to equip nurses with the knowledge on the development, analysis and evaluation of information systems augmented by technologies that support, enhance and manage patient care.
We will also continue with our job redesign efforts in introducing new role and new breeds of staff such as Care Support Associates (CSAs) that blend clinical support, administrative and operations responsibilities. We will also change our care models to ensure efficient and effective delivery of appropriate care at all care settings. This includes making sure we right-site patients to ensure that our resources are optimised.
But there will never be enough manpower if we do not empower ourselves to improve our own health. Hence, through preventive health, population health, Healthier SG, as Minister Ong will address later, we will also reduce the load on our overall healthcare system.
To Ms Mariam Jaafar's point about organisational enablers, we agree that this is important and thus, as part of population health, we will be aligning incentives and KPIs with public healthcare clusters in how we design our programme.
All these measures are in progress and will take some time to bear fruit. But there are also immediate pressures that we need to resolve and support our healthcare workers straining under the burden.
The COVID-19 restrictions on healthcare workers intermingling to bond and destress has led to a sense of isolation among healthcare workers. So, I want to assure Dr Shahira, Mr Leon Perera, Mr Abdul Samad and Dr Wan Rizal that staff well-being and morale is an important priority for us.
MOH had set up a cross-cluster Staff Well-being Committee in 2019 to improve the well-being of staff and to minimise burnout. All three public healthcare clusters also provide their staff with counselling services, helplines and peer support networks.
MOH is working with the clusters to review and improve staff feedback channels, staff well-being and mental health tracking and monitoring processes. There are also plans to appoint a Wellness Officer or its equivalent in every cluster to oversee and develop the system changes that are needed.
We are also reviewing our staffing norms in the public healthcare system to strengthen our resilience to future shocks and better cope with fluctuations in workload.
We also agree with Ms Mariam Jaafar's feedback that clusters ought to continue to induct a diverse range of talents and skillsets in their talent development and leadership pipeline.
As highlighted by Dr Tan Wu Meng, one specific group of concern are the junior doctors who had to do long shifts on night calls.
Singapore Medical Council guidelines stipulate that junior doctors may work up to 80 hours a week, including overnight duties of not more than 24 hours, with up to six hours after that for handover or training. This is benchmarked against the USA’s Accreditation Council for Graduate Medical Education’s (ACGME) guidelines.
Surveys showed that 20% of all junior doctors exceeded the stipulated 80-hour work week. This could be due to the nature of clinical work in certain departments or exigencies of service.
Some have proposed night float systems. This entails doctors taking turns to work night shifts for a few days at stretch without covering the daytime work, whilst others work the day shifts. Doctors may feel more refreshed when they start their night shifts with a full day’s rest, although there are possible trade-offs in requiring more manpower to do a shift system, more hand-off between team members, which carries some risk of omission in tasks, and possibly reduced learning experience as they may not follow-through in the entire care process to see how their patients progress over time.
It would be useful in disciplines where doctors on night duties have fewer opportunities to rest, such as Internal Medicine or General Surgery.
The system has been tried in two large departments. Plans to trial this in smaller departments, unfortunately, were curtailed due to COVID-19. When the situation allows, we intend to restart the trials.
As we look at the issue of work hours, let us not lose sight of these important considerations which are inherent in the nature of our work as doctors. With shorter working hours in a week, a junior doctor may have to undergo a longer apprenticeship to acquire the necessary competencies.
But we also recognise that the workload and the nature of clinical work today is different from yester-years, a point which Dr Tan Wu Meng has made, with an ageing population and higher chronic disease incidence, and expectations of more collaborative and consultative care from patients and their families, the nature of clinic work has changed for our junior doctors.
The stresses faced by junior doctors today are symptomatic of a wider need for transformation in the current care delivery arrangements. Whether it is 24-hour or 30-hour shifts, what is clear is that we should not stretch our junior doctors beyond what is physiologically possible and what would risk compromising patient safety, a point also highlighted by Dr Tan Wu Meng.
But I want to caution that a simplistic framing of the issue as just work hours is not diagnosing the root cause of the problem.
Recently, I met with junior doctors from the Singapore Medical Association’s (SMA) Doctors-in-Training Committee and other groups of junior doctors from all three healthcare clusters. They were proactive in sharing best practices on the ground. We had a candid discussion on the challenges they faced, particularly in this COVID-19 period, as well as the trade-offs of possible junior doctor workflow changes.
I am heartened that many of them recognised the complexity and inter-linked nature of the issues pertaining to junior doctors’ working hours.
Therefore, as a first step, MOH has formed the National Wellness Committee for Junior Doctors. Co-led by senior doctors from all three healthcare clusters and MOH, we aim to review and recommend changes to existing healthcare practices and guidelines to improve and ensure the well-being of junior doctors, in three main areas.
First, a review of junior doctor workflow models and work hour norms. Other than the considerations I shared earlier, the review will also have to be done carefully as it will have an impact on the workflow of other healthcare workers who work alongside our junior doctors.
Another area will be to look at the fundamental balance between training and service workload, and transforming our manpower model. It would not be sustainable for us to just simply increase the \"flow\" of trainees going through the system to meet service demands, as this will eventually lead to a large \"stock\" of doctors and cause an oversupply later on. Instead, we need to raise the importance and attractiveness of work roles that are core to the service workload.
The second area of focus is career development and training of our junior doctors. Traditional specialist-focused residency programmes are not the only desirable career pathways and there is a need for stronger broad-based generalist paths such as family medicine and hospital clinicians, which if successfully implemented may also address the issue of care-fragmentation across multi-specialty teams.
One such pathway is the Hospital Clinician track we launched in 2020, which we hope to expand significantly in the years to come.
A third area of focus for this Committee will be on working with key stakeholders to promote a more inclusive culture where junior doctors can feel safe in speaking out on matters related to their safety and wellness, and importantly, to co-create policies and solutions at both the institutional and national level.
The issues are complex and seeks to change years of established practice. We aim to put forth preliminary recommendations by the middle of this year so that some immediate measures can be implemented, with a view to completing their final recommendations by early 2023.
We recognise that our healthcare workers have always gone above and beyond, especially during these trying times.
Mr Abdul Samad and Dr Tan Wu Meng would also be pleased to know that MOH has extended the COVID-19 Healthcare Award not just to healthcare staff in public institutions, but also to outsourced staff. This includes cleaners and security officers, who were directly contracted by the public health institutions and publicly funded Community Care Organisations (CCOs). Paramedics under SCDF would be recognised in their own way.
But the biggest encouragement for our healthcare workers must come from the support and appreciation from Singaporeans-at-large whom they serve. We read about spontaneous ground-up actions from Singaporeans to encourage and thank our healthcare workers; examples which were cited by Mr Abdul Samad.
Unfortunately, COVID-19 has also brought out some bad behaviour. We have read about the cases of abuse and harassment towards our healthcare workers. The perpetuators have been taken to task and convicted by the Courts.
Sadly, the number of cases has been on the rise. At end 2021, there were about 1,500 such cases, up from 1,080 cases in 2018.
The actual number may be higher, as many healthcare workers exercise empathy and, therefore, do not always take a legalistic approach, and report and escalate every altercation. However, their compassion should not be misconstrued as an acceptance to abuse or harassment. We need to make sure that our healthcare workers feel safe in their work environment. I agree with Dr Tan Yia Swam that we need to recognise such abuse and institute safe reporting systems and clear penalties on offending parties.
Let me unequivocally state that verbal or physical abuse of any healthcare workers will not be tolerated and offenders will be taken to task. MOH and our public healthcare institutions adopt a zero-tolerance approach towards abuse and harassment of our healthcare workers. Under the Protection from Harassment Act (POHA), public healthcare workers are accorded enhanced protections under section 6 if abused or harassed while carrying out duties.
Aside from legislation, we should look at other ways to deter abuse and harassment and move more upstream. Healthcare workers should have the assurance that their employer and the healthcare system have their back, while providing them with the training to handle situations where compassion and empathy are tested to the limits.
MOH will, therefore, be establishing the Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers. With representatives from MOH, the Healthcare Services Employees’ Union, public healthcare clusters, community care partners and private healthcare providers, the workgroup aims to spearhead a coordinated national effort to prevent abuse and harassment of healthcare workers in the public, private and community care sectors.
Our healthcare workers should feel safe to be able and to call out abuse to allow them to focus their energies with the right frame of mind on doing their best for their patients.
Sir, let me address some other issues raised by Members.
On healthcare affordability, Dr Tan Wu Meng will be happy to know that from 1 July this year, we will expand the number of chronic conditions in the Chronic Disease Management Programme from 20 to 23. The three new conditions included allergic rhinitis, gout and chronic hepatitis B. More than 134,000 individuals will benefit as they can now use their MediSave and CHAS subsidies for these conditions.
We will strengthen our private sector partnerships to meet our growing healthcare needs. Dr Tan Yia Swam raised the need to have stronger oversight over business practices and medical middlemen. Today, Third Party Administrators (TPAs) and concierge services are not regulated under the Private Hospitals and Medical Clinics Act (PHMCA) or the Healthcare Services Act (HCSA), which focuses on regulating direct service provision.
Nevertheless, the Singapore Medical Council's Ethical Code and Ethical Guidelines (SMC ECEG) guide that medical practitioners contracting with TPAs should ensure they remain objective in their clinical judgement, provide the required standard of care and reflect their fees fairly and transparently to the patients.
MOH will continue to monitor patient safety risks and study the evolving landscape of these TPA companies. We will examine how the TPA market will need to be reshaped as we make bigger shifts in preventive healthcare beyond healthcare to health.
On Dr Tan Wu Meng's concerns on Integrated Panels, we had earlier announced that Integrated Shield Plan (IP) insurers had accepted the Multilateral Healthcare Insurance Committee's (MHIC) recommendation to expand their panels.
Today, most IP insurers have at least 500 private specialists, with each insurer's panel covering 80% to 90% of their private medical institution claims. To enable even greater patient choice and better continuity of care, the MHIC is considering if doctors who are already with an IP panel can be recognised by other IP insurers to some extent, as Dr Tan Wu Meng has suggested. We will announce more details in the coming months.
Regarding access to treatments, our Free Trade Agreements and Intellectual Property obligations provide due recognition to investments that patent proprietors make in developing pharmaceutical products. This is not only fair, but also ensures that Singapore remains an attractive location for drug manufacturing, research and innovation. Having said that, we are working with relevant Government agencies to ensure that generic drugs are not unduly delayed or obstructed from entering the Singapore market.
MOH will also continue to strengthen our position as a biomedical hub and anchor our domestic capabilities in new technologies, such as cell-based therapy, and strengthen the resilience of our healthcare system.
Mr Chairman, in today's speech, I spoke extensively about our healthcare workers. To our healthcare fraternity, I know many of you may have felt exhausted and demoralised, especially in the last two years. Take heart – Singaporeans are appreciative of your steadfast commitment and dedication.
MOH is undertaking reviews to introduce structural changes in our healthcare system and manpower. We seek your patience as we work with the healthcare clusters to engage you on improving the situation on the ground.
Let us uphold the values of the healthcare profession to provide the best care we can for our patients. Indeed, patients must be at the heart of all we do. But every healthcare worker also matters. Let us all, Singaporeans, help them to take better care of us. [Applause.]
The Chairman: Minister Masagos Zulkifli.
The Second Minister for Health (Mr Masagos Zulkifli B M M): Chairman, families form the bedrock of our society. Since our Independence till today, they have been our first line of support, crisis after crisis. During the pandemic, families have been a key pillar of strength, supporting each other through the ups and downs, in many ways that we, the Government, can never replace. Over the decades, we have strengthened our policies to support the building of strong and resilient families.
At MOH, we are fully committed to this mission. One way that we are doing so is by making Singapore a great place to raise families. And we will do so by building a more integrated social-health ecosystem for our next generation – our young. This support will be anchored in the community, close to our homes and, most importantly, anchored around the family.
Our starting point is to give every child a good start in life. This also means enabling parents to raise healthy, happy and able children, who can reach their fullest potential in life.
MOH has been building an integrated ecosystem to support children and their families, across the health, social and education domains. Last year, we set up the interagency task force to develop a five-year Child and Maternal Health and Well-being Strategy.
Ms Ng Ling Ling and Dr Wan Rizal asked for an update and how we were addressing the health needs and risk factors of mother and child. Let me share briefly.
Over the past year, the task force has focused our efforts along three main thrusts.
First, we have reviewed evidence-based research findings and are translating them into policies and programmes. This will enable us to effectively address the health needs, risk factors and the wider health determinants across the developmental stages of a child, starting as early as pre-conception to adolescence.
Second, we have reviewed the current model of service delivery for children and their families, with the aim to improve accessibility to services. We engaged a wide range of stakeholders on how we could strengthen support for them. This included parents, grandparents, caregivers and professionals from the healthcare, education and social service sectors.
Third, we reviewed how we communicated and engaged these stakeholders because we wanted to know what mattered most to them and to ensure that our messages and support to them remained relevant. I am glad to share that we have completed the first phase of review and planning. We will continue further cross-domain and cross-agency discussions over the next year.
Allow me to elaborate on two cross-agency initiatives that we will be rolling out from this year.
Let me first say also that parents play a pivotal role in their child's development. To build strong and resilient families, we need to ensure that parents can get timely access to health services so that they are healthy and able to take care of their children.
We recognise the challenges that many parents face. They are often stretched for time, having to balance multiple roles, both in the family and at the workplace. This is an area where we could better integrate services so both parents and child can receive support concurrently without making multiple trips.
To this end, we started two mother-child dyad service pilots at our polyclinics – the Integrated Maternal and Child Wellness Hub programme at Punggol Polyclinic since 2019 and the EMBRACE programme at Yishun polyclinic in 2020.
Families can access integrated services, such as vaccination, childhood developmental and postnatal depression screenings and breastfeeding support services concurrently, for both mother and child. Since their launch, I am glad that more than 10,000 children and mothers have benefited from these services.
An example is Ms Joan Zhu. She had brought her nine-month-old son to Punggol polyclinic for his vaccinations. At the same time, the care team at the Integrated Maternal and Child Wellness Hub provided her with detailed guidance on what to expect at each stage of her son's development, for example, the types of food and developmental activities that may be appropriate at different stages. Through their support, she and her husband have developed better knowledge and are more confident in caring for their newborn. We are happy with the success of the pilots and the positive feedback given by the parents.
Therefore, I am pleased to announce that MOH will scale up the mother-child dyad services to 12 more polyclinics over the next three years. We want more children and their families to benefit from this service.
To strengthen support for children with higher or more complex needs, the National Healthcare Group Polyclinics has also rolled out the EMBRACEPLUS programme, a component of EMBRACE pilot. It actively identifies and supports young children under three years old from low-income families living in rental flats, to address potential health risks.
Under this initiative, the children will be systematically screened for both health and social needs, when they visit the polyclinic for their regular check-ups, such as vaccination or childhood developmental screening, for example, whether the child's family may be facing any financial difficulties that could impact their health and well-being.
The EMBRACEPLUS team will also work closely with social and community agencies, including practitioners from KidSTART. This ensures that their needs are holistically supported.
Next, we want to take integration a step further and will do so across the health and social domains so that we can provide for our mother-child dyad, beyond just physical well-being and those with complex care needs like the EMBRACEPLUS.
To this end, I am glad to share that we will pilot an integrated family support programme later this year. It will be called \"Family Nexus\". Families can access varied services at a one-stop community node near their homes, such as polyclinic, a GP clinic or a social service agency.
For example, families can attend both parent support groups organised by Families for Life @ Community and receive vaccinations or developmental screening for their children at the same location. We will also have a \"concierge service\" representative onsite. They can assist families with accessing other relevant programmes by our community partners. We will also explore the use of virtual access to services to enhance convenience.
The pilot will reduce the need for families to visit multiple sites for different services and most importantly, to integrate and provide wraparound support across the social-health domains for families as their children grow. Our support for families and their children must also be holistic and comprehensive. Senior Minister of State Janil has shared on initiatives to promote mental well-being and improve lifestyle habits and Parliamentary Secretary Rahayu will elaborate on our public education efforts.
In closing, together with the support of Singaporeans, community partners and Government agencies, we will continue to strengthen support for families. We will anchor care and support for our young and their families in the community and, most importantly, around the family, because we want Singapore to be a great place for families to thrive and flourish. [Applause.]
The Chairman: Parliamentary Secretary, Ms Rahayu Mahzam.
The Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam): Mr Chairman, preventive health is an important part of ensuring overall health and well-being. Good preventive health will lead to lower health risks, earlier detection and management of diseases, as well as longer-term sustainability of our healthcare system.
To support good preventive health, we constantly evolve and adjust our approach to build a healthy ecosystem for Singaporeans. In response to Ms Ng Ling Ling's question on how we encourage individuals to take ownership of their health, we do so by making it easier to adopt and prioritise healthy living and bring more lifestyle programmes closer to our residents.
Our efforts can only succeed with strong participation of Singaporeans. Today, I seek the continued support of Singaporeans as I share our upcoming efforts to collectively nudge the community towards healthier ways of life and strengthening support for women, seniors and their families.
Key components of a healthy lifestyle include good nutrition and diet as well as sufficient physical activity.
First, good nutrition and diet. We actively encourage Singaporeans to adopt a healthier diet, particularly for sugar and sodium consumption.
Mr Ang Wei Neng asked about the War on Diabetes, which we declared in 2016. Since then, based on the recent National Population Health Survey, age-standardised prevalence of diabetes has remained stable at 7.9% from 2017 to 2020.
In 2019, MOH announced plans to introduce regulatory measures for beverages high in sugar content. From 30 December 2022, Nutri-Grade beverages sold in Singapore in prepacked form and from automatic beverage dispensers will be subject to new labelling requirements and advertising prohibitions.
The Health Promotion Board (HPB) also extended the Healthier Ingredient Development Scheme (HIDS) in 2018 to support the development and commercialisation of lower-sugar products. As of December 2021, seven beverage suppliers were on board the scheme.
Through these efforts and support from the industry, we have observed early success with the industry accelerating the reformulation of sweetened beverages.
Singaporeans can now choose from a larger variety of healthier drinks. From when engagement started with the industry in 2017 to 2019, the proportion of healthier choice beverages in the market increased from 58.6% to 71.7%. The median sugar level of sweetened beverages has also decreased from 8.5% to 6.3% over the same period.
To further reduce the intake of sugar, MOH also announced in 2020 that the labelling and advertising measures for sugar will be extended to freshly prepared beverages. HPB has conducted an implementation consultation with the industry on the proposed specification. More details of the measures will be released when ready.
Together with public education, we will continue to explore using regulation and industry support to make healthier ingredients and foods easily accessible to Singaporeans.
Mr Ang Wei Neng will also be pleased to know that we will be doing more to reduce Singaporeans’ sodium consumption. Singapore residents are on average consuming 3.6 grammes of sodium a day. This is almost double that of World Health Organization’s recommended limit, translating to more than 1.5 teaspoons of salt daily.
High sodium intake is associated with increased risk of hypertension, which is in turn associated with higher risks of stroke and heart attack. The National Population Health Survey revealed that slightly more than one in three Singapore residents aged 18 to 74 had hypertension during the period 2019 to 2020. This is a significant increase from 2017 and reminds Singaporeans of the need to adopt better dietary practices.
We will introduce a three-pronged strategy to reduce sodium consumption.
First, sodium substitution. We will increase support through HIDS to shift the food service sector towards using lower-sodium alternatives such as lower-sodium salt, which contains about 30% less sodium compared to regular salt at the same quantity.
Second, increasing the range and variety of lower-sodium salt, sauces and seasonings. HPB will work with major salt suppliers and retailers to expand the range of lower-sodium salt. We will also ramp up existing efforts using HIDS to spur reformulation of lower-sodium sauces and seasonings.
Thirdly, public education. HPB will launch a multi-year nationwide campaign to raise awareness of the effects of overconsuming salt in our diet and educate the public on available alternatives and ways to replace salt without compromising on taste.
Sufficient physical activity is also important for a healthy lifestyle. There are various efforts to support Singaporeans to exercise. For example, the National Steps ChallengeTM continued amid COVID-19 and is now in its sixth season.
Additionally, HPB’s leisure-time physical activity programmes such as mall workouts at health promoting malls, Sundays at the Park, Community Physical Activity Programme are still available where possible, in line with prevailing safe management measures. Where feasible, some on-ground programmes are taken virtually, for participants who work from home or prefer to work out remotely or individually to keep active.
Another area of concern impacting healthy living is smoking. Tobacco use is the single greatest cause of preventable death globally. About 10.1% of Singaporeans smoke daily based on results from the National Population Health Survey 2020.
In Singapore, we are committed to our long-term goal of bringing the overall smoking rate to a level that is as low as possible. We need to consider Singapore’s context and local trends of tobacco use in developing our tobacco control strategy.
Globally, there is an increasing trend of smokers using vapourisers. Together with HPB and the Health Sciences Authority, we are employing heightened multi-pronged measures against vaping. This includes increasing education on the harms of vaping, enhancing the penalty framework for vaping and better whole-of-Government coordination in preventing smuggling and illicit sale and use of vapourisers. To strengthen public education efforts and reduce demand for vaping, HPB is planning to roll out a vape-free campaign later in 2022 targeted at youths and younger adults through popular digital platforms.
To support smokers who wish to kick their smoking habits, we previously announced plans to provide subsidies under new tobacco cessation pilots at public healthcare institutions. I am pleased to share that we have received proposals from our healthcare institutions and are evaluating them closely.
Concurrently, we will continue to strengthen our existing multi-front approach to curb tobacco consumption and vaping.
With a healthy diet, active and smoke-free lifestyle, we can all live better. To help us make timely adjustments to our lifestyle behaviours and seek treatment early if needed, I encourage Singaporeans to seek appropriate, evidence-based health screening.
Chronic disease screening participation rates had hovered around 63% to 66% from 2017 to 2020. We note Dr Lim Wee Kiak’s interest in health screening. We will be doing more to increase take-up, such as working with partners to further encourage the use of Screen for Life, a national health screening programme that provides heavily subsidised chronic disease and cancer screenings.
As Dr Lim Wee Kiak pointed out, immunisations are important to protect ourselves against vaccine-preventable diseases. The National Adult Immunisation Schedule (NAIS) was introduced in November 2017 to provide national-level guidance on important vaccinations for persons aged 18 and older. Based on the National Population Health Survey 2020, the uptake for influenza vaccination in persons aged 65 to 74 has increased from 14% in 2017 to 23% in 2020.
[Deputy Speaker (Ms Jessica Tan Soon Neo) in the Chair]
To make vaccinations recommended under the NAIS more affordable and accessible, subsidies have been extended to these vaccinations since November 2020, at both CHAS GP clinics and polyclinics. MOH actively works with our primary care partners and other stakeholders such as HPB to increase uptake of these nationally recommended vaccinations, especially among seniors for influenza and pneumococcal vaccinations. We urge Singaporeans to proactively find out more and take up these vaccinations.
To support everyone to be as healthy as possible, we also cannot adopt a one-size-fits-all approach, as everyone faces different risks and challenges. Our health promotion efforts are inclusive to all and targeted efforts taking into consideration different backgrounds and cultural preferences are layered on for select groups to increase their access to healthy living resources.
HPB’s Healthy Living Passport programme was piloted with about 50 families last year to serve the needs of our lower-income families. Activities that parents and children engage in include planning for healthier and economical meals as well as games emphasising the importance of parent-child communication and a balance of physical activities with age-appropriate use of smart devices. Volunteers who befriend the families also participate in the programmes and continue to provide health tips based on the families’ needs after the programme.
Preliminary results from the pilot indicate that more than 90% were satisfied with the programme and about one-third of them have started to adopt healthier habits in the areas of nutrition, mental well-being and physical activity. HPB will be reaching out to more families this year. Mdm Chairman, please allow me to say a few words in Malay.
(In Malay): [Please refer to Vernacular Speech.] Dr Wan Rizal asked about outreach efforts to our minority communities. Last year, I shared plans to form a new workgroup aimed at strengthening health efforts for the Malay community. After identifying the key issues that should be given attention, HPB has brought together community leaders with the experience and expertise to form a Malay Community Outreach workgroup, or MCO. Under MCO, there are five new sub-committees focusing on mental well-being, reducing smoking, improving dietary habits, increasing physical activity and health screening within the Malay community.
MCO will work with various parties to expand the reach of successful HPB programmes. For example, HPB collaborated with M3, the Malay Activity Executive Committees (MAECs) and mosques to organise online wellness workshops for more than 200 Malay residents. This year, HPB will expand its reach by working with all MAECs.
To encourage healthier eating habits within the Malay community in the month of Ramadan, HPB partnered with MAECs, Mendaki, mosques and Malay-Muslim organisations, such as the Tabung Amal Aidilfitri Trust Fund and Perdaus to distribute healthier groceries to more than 24,500 Malay families. We will work with more MAECs, mosques and Malay-Muslim bodies to promote healthier eating habits during the month of Ramadan this year.
I would like to share and celebrate the success of Mr Azrin, a strong advocate for healthy living in the community. Mr Azrin has served the Marsiling MAEC for more than 10 years. As chairman of Marsiling MAEC, he works actively with HPB and other partners to organise various activities that cater to residents’ needs, such as health talks and screenings. During Ramadan last year, he helped HPB to distribute healthy grocery packs to low-income families and encouraged them to choose healthier food during the festive period. As the Vice-Chairman of An-Nur Mosque, he also onboarded the mosque on the Jaga Kesihatan, Jaga Ummah (Taking Care of Health, Taking Care of Community - JKJU) initiative. Mr Azrin also practises what he preaches daily. He and his family stay active by walking and cycling, and chooses healthier products that carry the Healthier Choice Symbol when buying groceries. May Mr Azrin's efforts inspire the community to lead a healthier lifestyle.
[Deputy Speaker (Mr Christopher de Souza) in the Chair]
(In English): Similarly, HPB also considers cultural sensitivities and partners stakeholders to implement health promotion activities for the Indian Community.
For example, HPB has been working with key stakeholders like the Singapore Indian Development Association (SINDA) to tap on their programmes and culturally significant events such as Deepavali to reinforce healthy cooking and eating as a family. HPB also actively engages Indian food and beverage outlets to participate in the Healthier Dining Programme, which provides and rewards customers for selecting healthier options.
Individuals, such as Mdm Lalitha have also stood up to promote health within the community. Believing that mental well-being is just as important as physical health, she co-founded Club2Care in 2017, a non-profit organisation to create awareness of the importance of mental well-being and seeking help when needed within the Indian community. Club2Care is a supporter of HPB’s \"It's OKAY to reach out\" campaign for good mental well-being. Thank you, Mdm Lalitha, for your support and extension of our work.
HPB is partnering MCCY to establish a $1.5 million Our Healthy Singapore Fund. The fund will support more community volunteers and partners like Mr Azrin and Mdm Lalitha to develop programmes that are closely in tune with their communities’ needs, and therefore, be more targeted and effective in developing a healthier nation.
Other than keeping the general population healthy, MOH is adopting a whole-of-Government approach to provide holistic support to women as well as their partners and families for better population health outcomes.
Minister Masagos and Senior Minister of State Janil shared on the Child and Maternal Health and Well-being Strategy to give our young a head start. Please allow me to elaborate on some of our communications and engagement efforts under the Strategy.
Over the course of last year, HPB has conducted focus group discussions and in-depth interviews with parents-to-be, fathers, mothers, medical and social service professionals to gain insights to their needs and preferred type of support.
HPB also launched Parent Hub recently. It is a one-stop evidence-based resource portal providing local health information. Resources are broken down into actionable steps that parents can adopt for children and youths' health and well-being. This addresses feedback from couples and parents about being “lost” in the varied opinions that are available online and consolidates reliable information in one place.
Parents like Ms Richelle and Mr Tan have given their stamps of approval for Parent Hub. As parents of two children of different ages, Ms Richelle and Mr Tan shared that most online resources and e-books they referred to previously were age-specific and time consuming to go through, but they now can find all the information they need for their children under one portal. As relatively new parents, my husband and I are also benefiting from the nuggets of information and quizzes on Parent Hub.
In addition, we are working across various public agencies to coordinate programmes so that parents-to-be and parents are kept up to date, equipped with relevant information and skills, and can easily navigate programmes from different agencies. For example, updates on school-based health programmes are also shared via MOE’s Parent Kit, a resource kit that parents can conveniently access digitally via the MOE’s Parent Gateway mobile application.
We understand Miss Cheng Li Hui had concerns about how we are supporting couples on fertility health. Firstly, as fertility declines with age and the likelihood of pregnancy complications increases with maternal age, we should continue to encourage couples to marry and start their families early. We are looking into supporting couples with ready access to evidence-based fertility health information to empower them to make fertility decisions and enable them to seek help when needed.
Secondly, Minister Indranee had earlier shared that we will be introducing new funding support for certain types of Pre-implantation Genetic Testing, which will benefit Singaporean couples who would like to conceive but are at risk of transmitting serious inheritable diseases to their offspring. We also recognise the psychosocial impact that fertility treatments may have on couples and are exploring how we may better support them.
Our partners in the community have done good work to increase awareness on women’s health issues and promote healthier lifestyle practices amongst women. Some of these partners like Breast Cancer Foundation, Singapore Cancer Society and Persatuan Pemudi Islam Singapura (PPIS) have been encouraging women to come forth for their recommended breast and cervical cancer screening tests. Other partners, such as Osteoporosis Society Singapore, have been reaching out to the wider population, from Primary school students to adults and seniors, to increase awareness about bone health, osteoporosis and fall prevention.
To amplify awareness and create sustainability to some of these initiatives, the Women’s Health Committee that I chair will run a women’s health event in the later part of the year. This would strengthen our outreach efforts by bringing together all the members’ efforts, events and activities with the aim of getting women to take charge of their own health under a common umbrella.
Finally, I would like to bring your attention to another core segment of our society: our seniors. We are committed to celebrating our seniors and enabling them to live to their fullest potential in the community.
Mr Yip Hon Weng asked about the Ageing Plan refresh. We have engaged over 5,000 Singaporeans from all walks of life to discuss the refresh of our Action Plan for Successful Ageing.
Over the past year, we also started working on our plans to support seniors in the three Cs: Care, Contribution and Connectedness.
The first C – Care. Many seniors take pride in staying active and taking charge of their own well-being. To support this, MOH actively onboard aged care facilities onto the new Eldercare Centre Service Model, where seniors can receive Active Ageing, Befriending and referral to Care services.
Ms Tin Pei Ling spoke about engagement with seniors. This model enabled seniors to remain connected to both care staff and other seniors even during the pandemic.
For example, Mdm Jarnail, who stays alone, has received continuous support and social engagement from the Blossom Seeds’ Eldercare Centre care staff. With their support, she continues to engage in both physical and virtual activities, such as the National Day Intergenerational Programme with schools. She also participates in exercise sessions, where she made friends with other seniors and became healthier and more alert. Mdm Chua from the same Eldercare Centre, also benefits from the Healthy Ageing Promotion Programme For You, HAPPY in short, which consists of dual-task exercises incorporating cognitive and social engagement elements to delay physical frailty and prevent dementia. This enables her to stay socially connected and healthy, while her son works in the day.
We are encouraged by these and many other positive stories and feedback received and are expediting the onboarding of more Eldercare Centres. By June 2022, we will set up over 115 Eldercare Centres. These will be accessible and located near both existing and new BTOs.
Ms Ng Ling Ling can be assured that we will provide care and support services for seniors, including those living in new 2-room Flexi flats. Befriending is also a key part of the Eldercare Centres, especially for seniors staying alone. This will be complemented with outreach by the Silver Generation Ambassadors.
In addition, we provide tele-befriending and emergency response services to seniors through the \"CareLine\" social support hotline. CareLine runs 24/7 and is supported by call agents trained in vernacular languages. I would like to share with Mr Pritam Singh that CareLine is supporting around 17,000 vulnerable seniors, as of December 2021. Each month, we also receive around 30 calls that require emergency services. To reduce the burden on emergency services, call agents are trained to triage seniors’ conditions after a distress episode and provide remote assistance or activate non-urgent in-person assistance through nearby community providers.
Over the past few years, we have taken many steps to strengthen care initiatives for seniors in a comprehensive, accessible and cost-effective manner. We will share more details during the launch of the Refreshed Action Plan later this year.
The second C – Contribution. Many of our seniors want to contribute meaningfully. This may be through learning, volunteerism and employment.
One interesting project which emerged during our engagement sessions with Singaporeans was \"Stories for Our Seniors\". Through this initiative, seniors can volunteer to tell stories using their Mother Tongue Language. This encourages the building of inter-generational bonds with younger Singaporeans and the imparting of life learnings and values through recounting their own experiences, history and heritage. These active interactions can help to address concerns raised by Ms Tin Pei Ling about the deterioration in mental acuity, emotional and physical well-being that seniors may face during the pandemic.
I would like to assure Ms Tin Pei Ling and Mr Henry Kwek that we have also been actively resuming active-ageing programmes and revising the guidelines to facilitate seniors’ participation in a safe manner.
Next, HPB and the People’s Association will also jointly roll out a new Health and Wellness Programme called \"Live Well, Age Well\" in our community nodes. Through a holistic programme, it aims to empower seniors to improve and maintain their physical, mental and social well-being. It will be gradually rolled out nationwide from May 2022.
The last C – Connectedness. We will continue to support seniors to age-in-place by increasing access to diverse home and community-based care options within an inclusive built environment. For example, as Mr Yip Hon Weng pointed out, palliative care is an important focus. We have grown our home palliative places steadily from 2,900 places in 2019 to 3,400 places in 2021 to fulfil seniors’ wishes to pass on at home. This enables seniors to access affordable care options, even at the end-of-life and as they stay close to their families and friends.
Last year, we also launched the Community Care Apartments at Bukit Batok, which was oversubscribed. We, therefore, see potential in expanding the housing-cum-care model to the private sector.
As announced by MND, we will launch a private Government Land Sale in 2022 to catalyse care innovation for seniors, where tenderers will be invited to propose innovative assisted living models. This will complement the public Community Care Apartment model. Seniors can look forward to a continuum of care that supports their physical and mental well-being.
To conclude, MOH will continue to enhance upstream efforts to sharpen our preventive health strategy. We are also committed to strengthening our support for couples before and throughout their parenthood journey and seniors to age well in their golden years.
As the Government puts in place various measures and resources, we would also like to urge Singaporeans to take greater ownership of your health today and make positive strides, so that together, we can all live better, for longer. [Applause.]
The Chairman: Minister Ong Ye Kung.
The Minister for Health (Mr Ong Ye Kung): Mr Chairman, I want to thank Members for all your questions and your cuts, and my MOH colleagues for addressing most of them and stitching up most of the cuts. There is a remaining batch mostly on preventive care, which I will address.
Mr Chairman, please allow me to start with a tribute to our healthcare workers. For over two years, they have toiled and fought against the COVID-19 virus, putting themselves in harm’s way, undergoing tremendous stress and, even as we speak, they are keeping our population safe and life in Singapore as normal as possible.
At MOH, we have been doing whatever we can to support them, ensuring sufficient PPE, prioritising them for vaccinations, decanting as many patients as possible to COVID-19 Treatment Facilities and out of the hospitals, persuading the public to undertake self-recovery if they are infected and experience mild or no symptoms, and imposing the very difficult \"no visitor\" rule in hospitals.
More than these clinical protections, we must stand up for them, against the abuse they suffer under the hands of a small minority of our population. I thank Members who have spoken up for healthcare workers on this. MOH’s instructions to the leaders of our public health institutions are clear – we must always protect them against abuse and insults. This is something that we must also do as a society.
There are now good indications that the Omicron transmission wave has peaked and starting to subside. With that, I hope, not too long from now, healthcare workers will finally have a well-deserved and lasting respite.
The men and women of the healthcare sector, are brave, dedicated, committed, big-hearted, professional and they deserve all the support, respect and understanding that we can give. [Applause.]
Mr Chairman, today, I would like to update Members on a major healthcare initiative to focus on preventive care. It is called Healthier SG. It will address the questions on preventive care from several Members – Dr Tan Wu Meng, Ms Ng Ling Ling, Mr Ang Wei Neng, Dr Lim Wee Kiak, Mr Henry Kwek and maybe others.
This is a journey started more than 10 years ago by previous Health Ministers, to focus on health, rather than cure. During this journey, we have built a very robust foundation for the Singapore healthcare sector. The changes I am about to announce are only possible because of all these past achievements. For example, from 2010 to 2020, the capacity and capability of the healthcare system have been strengthened significantly.
Let us take acute hospital beds which increased by 40%, as we opened three new acute public hospitals – Ng Teng Fong General Hospital, Sengkang General Hospital, Khoo Teck Puat Hospital. Nursing home beds increased by 70%. Senior Care Centre capacity expanded almost four times.
The number of doctors and specialists increased by 65% to almost 15,000 now; nurses increased by 45% to 42,000 now. As a result, the number of doctors per thousand population improved from 1.8 to 2.6 and that for nurses gone up from 5.8 to 7.4. These ratios are similar or higher than most Asian regions and territories, normalised to the proportion of older people in the population. But they are lower than ratios in OECD countries, as observed by Ms Mariam Jaffar. This is due to a variety of reasons, including the population age profile, the model of care in different countries, between western countries and in Asia, and also the way western countries fund, subsidise and insure healthcare.
In terms of policies, we implemented MediShield Life and CareShield Life; we rolled out the Pioneer and Merdeka Generation Packages; we introduced the Community Health Assist Scheme or CHAS.
In terms of structures, we established three healthcare clusters, centering around Singapore General Hospital (SGH), Tan Tock Seng Hospital (TTSH) and National University Hospital (NUH), each with significant economies of scale and capabilities.
Outcomes have improved. Between 2015 and 2020, there are fewer readmissions into hospitals within 30 days after discharge, fewer U-turns, from 11.5% in 2015; 2020 – it came down, 10.7%. Response time to cardiac and stroke care at our hospitals have also improved.
So, now, if you look across 204 countries in the world, Singapore had the highest life expectancy at birth – for men, at 83 years; and women, at 87 years.
After 10 years of foundation laying, plus a pandemic crisis, it is time for us to take the next big step. There is urgency to this, because in the next 10 years, long after the COVID-19 dust has settled, we will have to tackle our biggest healthcare challenge since our nation began – the deteriorating health of our population.
Dr Lim Wee Kiak asked what is driving cost increases. Deteriorating health is driving cost increases. What then in turn drives deteriorating health? Two major driving forces.
First is ageing. Currently, about one in seven residents in Singapore are seniors aged 65 and above. By 2030, that number goes to one in five. An older person is more likely to fall sick or suffer from severe illnesses compared to a young person – it is a fact of life. We see this in our parents and grandparents and in time, we will feel it ourselves.
Second driving force, which is quite aside from age, Singaporeans young and old, are, generally, getting less healthy, even after adjusting for age. For example, in 2017, about two in 10 has high blood pressure. In 2020, this has become about three in 10. There are more of us with high cholesterol, from about three in 10 to four in 10, and I am one of them.
Fortunately, for diabetes, the prevalence rate has been constant, likely due to our efforts in the War on Diabetes.
More of us are getting obese. From 2017 to 2020, the obesity rate has gone up from under 9% to over 10%, undoing many years of progress.
The first factor of ageing, that is due to the march of time. There is very little we can do about.
The second driving force due to deteriorating health, this is due to the will of people, of which there is plenty we can do about it. Because deteriorating health is mostly a function of lifestyle – too sedentary, too much device time, too little exercise, too much sugar, salt and fat in our diet; and putting off looking after our health until it is too late.
And indeed, living unhealthily is often more carefree and often more enjoyable. But we do not realise that we are paying for these instant gratifications by instalments, with our long-term health – bit by bit – until we realise the snowballing cost later in life.
So, a young person who is obese, or has high blood pressure or high blood sugar, he may feel all right now, but actually, he may be a walking \"time bomb\". When he is older, there is a high chance of him being struck with a heart attack, stroke or require dialysis.
When these illnesses strike, they are painful. They snatch away from us quality of life and happiness. They will burden family members and loved ones, emotionally and financially.
For this generation of seniors, many have several children, who can all chip in to help take care of them. And even so, it can be quite taxing.
But people around my age, slightly older, slightly younger, we have fewer children and we are likely to live longer. That means when we are in our 80s, 90s and if you are lucky, 100s. If you fall very sick, unable to walk, change, eat, shower, our children will be in their 50s or 60s and hopefully, they will be able to take care of us.
Beyond the immediate family, sickness across the population imposes a huge burden on the healthcare system and on our taxpayers.
We heard this sobering piece of data during the Budget debate and Minister Lawrence Wong mentioned – Government healthcare expenditure tripled over the last 10 years. Based on current trajectory, it will again, more or less triple in the next 10 years, to $27 billion in 2030. By then, healthcare budget may well be larger than that for defence and education.
To make healthcare affordable, the Government will have to continue to subsidise healthcare. And that is the key reason why additional revenue from GST increases is needed.
Even so, the two percentage-point increase in GST may not be sufficient given the rate at which healthcare costs are increasing. That is why we also need to control costs. We have been doing so through bulk buying of drugs, using cost-effective treatments, better clinical procedures, right siting patients and moderating the buffet syndrome caused by healthcare insurance.
But the more fundamental way to tackle cost is at its roots. That is, to make us healthier. It would not reverse the impact of an ageing population, but it can reduce the rate of increase and \"bend the cost curve\" downwards in the long run. It will still slope upwards but we can bend it downwards.
How are we doing this? Let me explain.
Many doctors that I have spoken to have always wondered: how did a patient become so stricken with chronic illness? Why did not he make lifestyle adjustments when he was younger? Why did he leave it too late? Why only now that he comes to me when he is so sick?
I can relate to that inaction. When I was younger, in my 30s and 40s, you feel almost invincible – you will never fall sick. And I did not feel the need to take care of my health too. Then, a doctor friend of mine kept nagging me to go for health screening. \"Go for health screening.\" He sees me, he says, \"Go for health screening.\" Since he is my friend, I listened to him.
Then, after the test, he found that I have quite high levels of cholesterol. Based on my risk level, he performed further tests and found a very small calcium deposit in one of my heart arteries. So, at his advice, I started taking some medication, adjusted my diet – nothing very austere. I have to cut down chilli crabs, prawns and sotong – not a huge sacrifice, as Mr Pritam Singh is acknowledging. That is austere? No, I can still eat them once a month. I just do not eat them every other day! So, eat in moderation but certainly not deprivation. If anyone wants to treat me to seafood, I will say yes!
I just went two weeks ago and my reading are now fine. More importantly, because of early intervention, I probably averted a major heart bypass surgery when I become old, or worse, a heart attack that may kill me and distress my family and my loved ones.
We usually associate better healthcare with fascinating medical technology or heroics in the operating theatre like when we watch Grey's Anatomy. Those are important but good health is more likely to come from an accumulation of the humdrum and the mundane, because as the saying goes, \"prevention is better than cure.\"
We need to, as Mr Ang Wei Neng and Mr Henry Kwek said, maintain health, rather than treat sickness. That is why we are not called the Ministry of Sickness, but we are called the Ministry of Health!
The measures must be taken early, when the person is still healthy. It must identify the risk factors in our lives that will erode our health slowly and quietly, and then address these factors. It must be done in homes and in the community, not in hospitals or clinics.
It is best centred on the family doctors – in polyclinics and GP clinics – and less on surgeons and specialists in hospitals. Family doctors must then become the most important anchor of our healthcare system.
This new strategy centred around primary care is called Healthier SG. We have worked out the broad plan but still finalising the details. Over the next few months, we will be consulting different stakeholders, Singaporeans from all walks of life, GPs, healthcare workers and community partners to gather their inputs and views.
MOH will then flesh out the details in a White Paper and table it in this House for debate. Today, I will outline five key components of the Healthier SG strategy.
First, mobilise our network of family physicians and family doctors. Studies have shown that people who go to only one family doctor consistently, are generally healthier. They have fewer visits to the emergency department and fewer episodes of hospital care.
This is because the doctor and his care team know you well and can detect early signs of any problems in a timely and accurate way. The family doctor can do for you what my friend has done for my chronic condition. They can be what Dr Tan Wu Meng described as the \"coordinating physician\".
However, only three in five Singaporeans have a regular family doctor. The other two tend to doctor-hop. Go to doctor A for hypertension medicine, go to doctor B for cough and cold and get MC. So, there is no one family doctor who knows our overall health condition and family health history well enough to be able to see the link between different care episodes, even across different family members.
And we now have a golden opportunity to bring as many of our family doctors as possible into this long-term national public health programme – and that opportunity is made possible by COVID-19.
When we needed more people to get vaccinated against COVID-19, I personally wrote to the GPs and also to TCM practitioners and asked them for help. So, they heeded the call, explained the need for vaccinations and persuaded many of their patients to take the jab.
GPs are nodes of trust. Throughout the pandemic, they served as the first port of call for people who fell sick and suspected that they might have been infected by COVID-19.
Then, during the Omicron wave, GPs took on an even greater role – they assessed the severity of patients coming to them, placed them on home isolation if they have mild symptoms and low risk and then supported their recovery, often by telemedicine. And therefore, they demonstrated that rest and recovery at home is appropriate for many ailments and that telemedicine does work.
Our COVID-19 response would have been inadequate, even crippled, if not for the contributions of our family doctors. They have been a key component of the national crisis response.
MOH has been working in partnership with GP clinics for some time, started by my predecessors. They are part of our CHAS programme. They also serve as Public Health Preparedness Clinics (PHPCs) during pandemics. COVID-19 has deepened that partnership and now, we can leverage on this in order to implement Healthier SG.
We can leverage GPs to attend to more patients, not for coughs and colds, but devoting time to provide preventive care. MOH will support this, by building up the clinics' capabilities, such as telemedicine and IT systems. We will work with the GPs to develop the skills of clinic healthcare team and forge partnerships with hospitals to deliver more integrated team-based care.
The second component of Healthier SG is healthcare plans. Seeing our family doctor for preventive care is different from the occasional visit to their clinics when we do not feel well.
It means regular scheduled check-ins – at least once a year – so that the family doctor can assess your overall health condition, conduct necessary health screenings, track your results, administer vaccinations if need be, advise you on adjustments in lifestyles to help you achieve your health goals.
And this is especially useful if you are at risk of developing a chronic condition, like diabetes. A care plan can help prevent it. To support residents to follow through with the care plans, we need to make them accessible, attractive, maybe even rewarding.
We will conduct public and stakeholder consultations to work out these proposals and incorporate them in a White Paper. I am very sure there will be no shortage of ideas and we have heard several today from Members. I do not think we can implement them all, but we will try to put together a package that is compelling, attractive and which we can afford.
Perhaps, some ideas: preventive care consultations with family doctors and recommended health screenings could be made free or costing only a nominal sum. Just to assure Dr Tan Yia Swam, this does not mean that GPs will not be paid, they will just be reimbursed elsewhere. Perhaps we can claim higher CHAS benefits for drugs if we go to the same doctor; perhaps we can tap on MediSave more for our care plan. Perhaps we can offer insurance premium discounts or vouchers if we diligently follow our care plans or even, better still, show good outcomes. These are all possible ideas.
By enrolling on Healthier SG, a resident will commit to see one family doctor and adopt one care plan.
Our third component is that we then need community partnerships. Preventive care plans involve lifestyle adjustments, which need to happen outside of the clinics and in our living environments. Doctors have a name for these. They call these \"social prescriptions\", as opposed to drug prescriptions.
We, therefore, need the support of agencies, many of them, Health Promotion Board, Agency for Integrated Care, People’s Association, SportSG, National Parks Board and community partners that oversee various social services. They run various activities and programmes in the community which we then get family doctors to tap on.
So, one analogy: if we have a major illness, we go to a doctor, the doctor often refers us to a few specialists or therapists. But in a preventive care plan, the family doctor may refer us to a qigong class, to a brisk walking group, or a community farming club, for example. Social prescriptions.
We already have such collaborations on the ground – some Members have mentioned it – in Queenstown and Tampines. We need to roll out such initiatives across every town to make good health not just a matter for doctors in clinics, but for all of us in everyday life and places.
That brings me to the fourth component. Once the first three components are in place, we will roll out a national Healthier SG enrolment programme. That is when I mentioned by enrolling into Healthier SG, a resident will commit to see one family doctor and adopt one care plan.
The national enrolment programme will be coordinated by our three healthcare clusters. Each will look after a region of up to about 1.5 million residents and work with the family doctors and other partners in the region to reach out to as many residents as possible.
We will probably start with people in their 40s and older, because that is when chronic illnesses may start to set in. Then, we will have to build up the participation base progressively.
When HPB rolled out the latest season of the National Steps Challenge, it recruited 900,000 participants. We hope Healthier SG can be even more successful than that.
I want to specifically highlight the importance of this collaboration between healthcare clusters and the family doctors. It is a very important nexus, because the family doctors will receive support from hospitals in looking after residents with more complex needs. Hospitals, after discharging a patient, can refer them back to the family doctor. This is exactly what we did during COVID-19. It works and there will be seamless coordination and continuity of care.
We have taken a geographical approach to enrol residents because this will cater to the needs of the great majority because, today, about nine in 10 residents will visit a family doctor or hospital near their homes. Nevertheless, individuals will have choice. You can choose whether to enrol or not. You can choose who to enrol with, even doctors who are far away from your home. There are a variety of reasons why some Singaporeans may decide to do that, because the clinic may be nearer to your workplace, near your parents’ place, or is a friend that you have known for many years.
Finally, the last component. We need the necessary support structures to make Healthier SG work and this is actually no small matter.
Manpower is a big part of this.
Ms Mariam Jaafar asked for our workforce transformation plans. So, let me share briefly.
We need to build up and optimise our primary and community care workforce further. Today, a fifth of doctors and nurses are in primary and community care. By 2030, we will need to increase this to at least a quarter. But besides growing the number, we will further build up the competencies and skills of our healthcare workforce. For doctors, family medicine should feature even more strongly in the curriculum of our medical schools. We now encourage new graduates not to become a specialist and do your residency straightaway but get exposed more broadly in medicine and build up confidence in dealing with chronic illnesses. Postgraduate training in family medicine will be strengthened, too.
For nurses and other healthcare professionals, the potential for skills upgrading is even greater. We need to broaden interdisciplinary training and empower them to practise at the highest level of their licences. For example, once we roll out Healthier SG, I expect preventive care efforts to be implemented in communities and these efforts can be led by nurse clinicians and pharmacists, not necessarily by doctors. So, I foresee Healthier SG opening up many new job roles for our healthcare workers.
Finance is another major support system. We have been funding our healthcare clusters, largely by their workload, such as the number of treatments, number of surgeries and operations. We will change this to a capitation model, where healthcare clusters get a pre-determined fee for every resident living in the region that they are looking after. Under the new system, the absolute budgets of each healthcare cluster will not be affected. In fact, the budgets will go up a little bit. What will change is the basis of calculating the budgets. Appropriate surgeries, procedures and treatments will always be provided when required. But with this shift in the basis of funding, there will be a natural incentive for hospitals to try to keep residents healthy through preventive care.
Complementing this new basis of funding is a set of KPIs, a set of health outcomes. Some salient indicators are quality of care, uptake of healthy lifestyles and habits, prevalence of chronic illnesses, cost effectiveness of treatments and so on.
The last critical support structure is IT. Family doctors in the frontline of Healthier SG will need good system and data support. They must have access to patients’ medical records. They must have the IT tools to track their patients' conditions and progress over time.
They must also be able to share their records with other healthcare providers. We want to work towards a scenario that no matter where you are receiving care, for example, at the GP or dental clinics, polyclinics, hospitals, SOCs, nursing homes, eldercare centres, the same data can be retrieved to support your care. That is why MOH has been enhancing and rolling out the National Electronic Health Record (NEHR) system. We then need to ensure that such data sharing is secured and users take greater responsibility for data access. We would need new legislation to govern this and we intend to put in place a Health Information Bill in the next couple of years. Mr Chairman, let me now say a few words in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Chairman, in the next few years, we will be putting in place a major healthcare reform.
We will focus on preventive health care for two reasons. First, ageing population. As we get older, we will inevitably have more illnesses. Second, Singaporeans are actually becoming more and more unhealthy.
What we should do more, we do not do enough and vice versa, what we should do less, it is not sufficiently less. Not enough physical activity, not enough exercises on a daily basis, over-use of electronic gadgets, consuming too much sugar, salt and oil. Hence, there are more people with chronic diseases. If we do not change our lifestyle and habits, we will suffer more illnesses in the next 10 years.
If you are sick, your quality of life will be compromised. After retirement, you may have plans to try something new, or spend time with your family, but should you become sick, you will be unable to achieve your aspirations. Once we fall ill, we have to rely more on our families, children and grandchildren for simple daily living or medical expenses, and this will add to their burden.
Apart from this, the healthcare system will also be under more pressure, so will Government healthcare spending.
Fortunately, many chronic diseases can be prevented. We know the saying \"prevention is better than cure\". TCM practitioners also often say that \"illness is best treated at an early stage\".
But this requires lifestyle and diet changes, even before you fall sick. The Chinese idiom of “preparing for rainy days before the torrential rain” is most appropriate to use on healthcare. Therefore, our top priority is to help you stay healthy, instead of going to the doctor only after you fall sick.
In any healthcare system, prevention and treatment are equally important. But with an ageing population, we need to recalibrate and tilt the balance towards preventive healthcare.
Hence, we are going to launch the Healthier SG strategy. This is a national strategy that focus on preventive health – a strategy that will provide health check-ins for Singaporeans and improve their lifestyle and habits.
We will encourage middle-aged Singaporeans to sign up with their family doctor. After that, the family doctor will work with public hospitals to assist you in disease prevention and stay healthy. The doctor will also help you do health screening on a regular and scheduled basis and get you vaccinated. They will work with community partners, including the People's Association and SportSG, to help you improve your eating habits and diet, quit smoking and do more exercises.
But preventive care means that you see a doctor, go for regular check-ins and even health coaching when you are feeling fine. This is not the habit of Singaporeans. We tend to think \"why do we see a doctor for no reason?\".
To encourage people to do so, we need some incentives. Over the next few months, MOH will conduct public consultation to gather views and inputs and come up with an attractive and affordable package.
Within the package, perhaps, preventive health screening can be free, or at a nominal cost. Perhaps, more Medisave can be used to pay for medication. Perhaps, if you stay healthy according to your family doctor’s care plan, there could be MediShield Life premium discount. This is like car insurance. If your car is accident-free and no repair is needed, then your insurance premium will be reduced. After designing the package, we will draft a Healthier SG White Paper and table it in Parliament for debate.
With the strategy direction in place and with the support and cooperation of hospitals, family doctors and the public, we can all lead healthier and more fulfilling lives, and the elderly can enjoy their twilight years happily.
(In English): Mr Chairman, a central issue of the Budget this year has been the increase of GST, because we need to meet the rising healthcare expenditure of an ageing population. Healthcare expenditure will increase because we are committed to make healthcare affordable to those who are sick by heavily subsidising healthcare bills.
After subsidy, there is still a remaining sum that needs to be paid. We can cover most of them through MediShield Life. And then there is still a smaller remaining sum, which the patient can pay through his MediSave. And if there is still a small sum that the patient cannot afford, he can apply for MediFund. So, subsidy, then MediShield, MediSave and MediFund – that is, essentially, the S+3M framework – a multi-layered safety net for healthcare and it will continue.
However, it is important to understand that spending on health is quite different from spending on, say, education, which is always forward-looking, moulding the future of Singapore. Healthcare spending is critical, it is essential but mostly about treatment – trying to restore a sick person back to where he was in the past and, often, imperfectly. Sometimes, we hear comments, including in this House, that healthcare spending is an investment in our people. If we are honest with ourselves, we know it is not the same as education. It is driven by deteriorating health that can be prevented. It is often about paying for unwise lifestyle choices of our past.
But there is a component in our healthcare spending that is forward-looking and about investing in our future and, that is, preventive care. Healthier SG will grow that component. What we are saying here is that as healthcare spending inevitably grows in the coming years, let us have the discipline to always set aside enough to invest in keeping our people healthy for the future.
Our multi-layered safety net in healthcare, embodied in the S+3M policy, will always be universal. That is, we will not have a situation which happens in other countries, where a patient comes to a hospital and gets turned away because he is unable to pay, because he is not covered by insurance. We will not let that happen. That universality will now expand in coverage, beyond medical treatment, to preventive care and population health.
The more well-off and better-informed are already taking better care of themselves, with coaches, therapists, personal doctors and diet plans. We want to extend these interventions to the broad population, which will benefit most those with lower incomes who do not have the time, resources or wherewithal to do this.
I have been lucky to have a highly-trained and well-meaning doctor friend who nagged me and helped me. We hope everyone in Singapore will have such a friend, too – a family doctor to advise and nag us to do what is right for our long-term health and for our family. We want to make it easier and affordable for everyone to stay healthy.
We will have a fuller debate on Healthier SG in the House later this year when we present the White Paper. I seek the support of Members to translate Healthier SG into a healthier Singapore population. [Applause.]
The Chairman: The Guillotine Time is 5.35 pm. Any clarifications? Dr Lim Wee Kiak.
Dr Lim Wee Kiak: Chairman, I thank the Minister for showing the healthier way forward. I have three clarifications.
First is on infrastructure. Over the next 10 years, will new hospitals be built, just like the last 10 years that the Minister has just painted? So, if there are going to be new hospitals, how about the private sector-wise? Will there be new private hospitals as well? So, that is something I would like to know.
Second, since we need more medical manpower, from that itself, will current medical school enrolment numbers increase? There are many Singaporeans who aspire to study medicine but just because they cannot get into our local medical schools, many of the parents have to spend lots of money to send them overseas. So, will that be expanded?
Third, regarding the S+3M framework, I agree with the Minister that that is the bedrock for healthcare financing now. But as healthcare cost goes up, how will this structure change? When was the last time we reviewed this framework? Will we review it again?
The Chairman: Minister Ong Ye Kung.
Mr Ong Ye Kung: Let me talk about S+3M and I will invite Senior Minister of State Janil Puthucheary to talk about new hospitals and manpower.
The Member is right to describe that it is a bedrock and it is also very robust, designed and evolved over the years. I took Members through the process of subsidy; insurance; remaining, use your own savings in MediSave which is also contributed by your employers; and then, for those with low income, MediFund.
There is longevity in this framework. But having said that, even today, as Members read out your cuts, there are several suggestions: how to activate them better to help make things easier for the population to take care of their health. We will take them in, we will continue to review and, as you can see, over the years, the rules are always being refreshed, improved and strengthened to better support Singaporeans.
The Chairman: Senior Minister of State Janil Puthucheary.
Dr Janil Puthucheary: Sir, I thank Dr Lim Wee Kiak for his questions. He asked about whether there would be further hospitals, further healthcare capacity. We watch the issue of healthcare capacity quite closely and, as Minister Ong Ye Kung has laid out, the key thing that we want to achieve going forward is better utilisation of the healthcare capacity that we have, integration into the community facilities that we have and where care can be sited outside of the hospital, if possible. Studies have demonstrated quite clearly that this is going to be better if we can go upstream and better integrate recovering patients into the community. So, we will watch the need for healthcare capacity quite closely, but we are hoping that the solution to the healthcare capacity issue is not just more and more acute care hospitals. We are hoping to be able to reduce the need for them.
For the point on medical schools, indeed, medical manpower is important and a lot of people who are interested in pursuing a career in healthcare, we need healthcare workers from many, many degrees and many, many domains and many, many disciplines, and we would encourage people who are interested in a career in healthcare to explore a wider variety of possibilities.
The Chairman: Senior Minister of State Koh Poh Koon.
Dr Koh Poh Koon: Thank you, Mr Chairman. I will just add a couple of points about the possibility of increasing medical school intake. In fact, over the last five years, the number of doctors has increased by about 30%. We are talking about registered doctors with the Singapore Medical Council – from about 13,400 to 15,400. We will continue to monitor the manpower pipeline needed to support our healthcare needs. And, as I have said earlier in my speech, we are looking at care model changes and how care delivery in hospitals ought to be changed. So, it is not just going to be a single-track increase in numbers to meet needs but, actually, evolving a model so that we can do more with less. And also the manpower projections will change based on the kind of care model that we are going to put in place in the hospitals.
The Chairman: Mr Yip Hon Weng.
Mr Yip Hon Weng: Chairman, I welcome the Healthier SG plan and working closer with GPs. I have two clarifications.
First, how will MOH measure the outcomes of success under this plan, especially since some of the interventions for seniors involve not so much medical care but rather social prescribing like exercise activities and so on and also working with social care agencies?
Second, under this plan, will we encourage GPs to work together to share resources and for better demand aggregation to serve residents better?
The Chairman: Minister Ong Ye Kung.
Mr Ong Ye Kung: Yes, we will have to measure the outcomes of success. I mentioned earlier that we are moving to capitation and, along with the funding model, there will have to be a set of KPIs and these will have to be outcome-based. I have mentioned some of them, such as prevalence of chronic illnesses, as well as the driving factors that lead to these outcomes, such as re-admission and various clinical effectiveness, cost effectiveness of treatments. I can tell you, as of now in MOH, we have developed such a long list of KPIs. We need to whittle it down to a more manageable set and, in time, I think we can share them.
As to the Member's second question whether GPs are encouraged to work together, the answer is yes, because a third of our GPs are now already in PCNs or primary care networks and that is a very important resource and very important starting point to bring them into Healthier SG.
The Chairman: Dr Shahira Abdullah.
Dr Shahira Abdullah: Thank you, Chairman. I think the Healthier SG initiative is a very exciting development. As a dentist myself, I would also like to say that oral health is very important. It is intricately linked with good health and dental treatment is also quite expensive. So, may I know if this initiative will be extended to preventive dentistry as well? And is the Ministry planning to engage with the dental fraternity for the White Paper?
The Chairman: Minister Ong.
Mr Ong Ye Kung: Thank you for reminding us. We will do so. I should inform Members that, in Singapore, for our young children below 12, we have one of the best oral health in the world and that is because of a very strong collaboration between MOH and MOE schools. When we were in Primary schools, we all dreaded the dental nurse coming into the classroom and reading out our names, because that means we would be going to the dentist. But because of that, preventive care was done and executed very well for children. As we get older, bad habits set in and then dental hygiene and dental health deteriorate. So, actually, the dental programme is a very good story about how effective preventive health or preventive care can be.
The Chairman: Mr Leon Perera.
Mr Leon Perera: Thank you, Mr Chairman. I just have two clarifications.
The first one to Minister Ong. As the Minister observed, preventive healthcare has been a long journey. HPB was founded in 2001 and we have been spending, I think, about $300 million a year for quite some time. But over the last 10 years, I think the outcomes for chronic conditions seem to have not done very well and perhaps, even gone in the opposite direction. I noted in my Adjournment Motion speech on preventive healthcare that the proportion of older adults with three or more chronic conditions almost doubled between 2009 and 2017. I think the Minister and others have also elaborated on some data points.
So, my question is, will the Ministry reflect deeply and, perhaps, audit all the efforts that have gone into preventive healthcare in the last 10, 20 years to find out why there has been this disconnect between the investment and the efforts and the kind of outcomes that we have seen in the last 10 years of chronic conditions. Will that be factored into the preventive healthcare plan going forward?
My second clarification is to Senior Minister of State Dr Koh. It is a narrower one. I just wanted to confirm what he said on the COVID-19 Healthcare Award for cleaners. I actually filed a Parliamentary Question on 14 February about whether cleaners were eligible for the COVID-19 Healthcare Award. The answer seemed to be no. It did not exactly say no, but it did not say yes and it said that there are other schemes for cleaners. So, I just wanted to confirm if I heard the Senior Minister of State correctly that now the position is that cleaners in healthcare institutions are eligible for this $4,000 COVID-19 Healthcare Award.
The Chairman: Minister Ong.
Mr Ong Ye Kung: Healthier SG has been something we had been talking about for the last few months. When I came to MOH in May last year, my first speech was about preventive care. And I spoke to the healthcare community and the leaders of both private and public healthcare institutions, from then on, we have been talking about Healthier SG and consulting many people.
What I announced today, in the healthcare sector, it is not a secret – except the name \"Healthier SG\" which we came up with a few weeks ago. But the capitation model, IT system, preventive care, enrolment process are some things we have been talking about. So, I am not surprised that Mr Leon Perera filed an Adjournment Motion talking about this topic, because it is a very live topic within the healthcare sector. And I thank him for that contribution.
But when he mentioned the outcomes going the other way, I think that argument is counter-factual. Imagine if we had not had HPB, imagine if we had not had \"Step Challenge\", imagine if we had not had the Primary Care Network (PCN), Public Health Preparedness Clinics (PHPCs) – I think that the outcome today would be far worse. Because we know what drove unhealthy populations are lifestyle, food, devices, sedentary lifestyle, all kinds of things that we are also guilty of.
Fortunately, we have all these interventions. But in the last 10 years, could we have, as he mentioned, thought deeply about it and come out with Healthier SG? I think the ideas would have been there, execution would not be ready. It took 10 years, more than 10 years of work from my predecessors: set in place the structure, three clusters; put in place the basic IT system, without the IT system you cannot implement this. Think through the funding process, communicate and talk to the clusters, build up the PCN structure, so that we have a basis to work on now.
That 10 years of hard work enabled us to implement Healthier SG today. So, I think we need to get that perspective correct.
As for the COVID-19 Healthcare Award (CHA), the intention is and has always been, to also distribute to outsourced workers who are full-time, working in the healthcare institutions. It has always been the intention, but the details took a while draw up. And so, shortly after this, it will be announced and they will get to know when and how much they are getting.
The Chairman: Ms Ng Ling Ling.
Ms Ng Ling Ling: I thank the Minister for sharing about the Healthier SG initiative. Indeed, in the healthcare sector, many have been thinking that is very important to pivot to primary care. And community care is a very important part of managing our ageing population, with a growing chronic disease burden.
I have two clarifications. I know there will be more consultations and a White Paper later on, but I hear Minister mention the National Health SG enrolment programme would likely be through the three clusters. I am wondering for residents who may have GPs that they have been seeing that is outside the cluster, would they be allowed to choose and would they still get the potential incentives? In some countries that have similar systems, they have, in fact, allowed residents to have up to a choice of two GPs because a lot are working; so, they have a GP when they are in their workplace and one nearer their homes.
The second clarification I have is that, when I speak with my senior residents about where they get chronic care, their chronic disease management and when I ask them about whether they go to the nearby GP clinics, many of them still feel that the out-of-pocket expense can be higher than if they go to a Public Health Institution. So, I just wanted to check whether that is an area of focus during the White Paper consultation?
The Chairman: Minister Ong.
Mr Ong Ye Kung: The short answer to the first question is yes. Choice will be preserved. And I mentioned in my speech: there are residents who for various reasons, see a doctor that is not near their home and in fact, out of the cluster that they come under. So, choice will be preserved as a principle.
Second question: during our consultation, we will not prejudge what we want to include, or what we want to exclude. If the Member feels that out-of-pocket expenses for consultation is an issue, by all means, let us know. I assure you it will not be the first time we hear that feedback and certainly will have to consider. We want a package that is compelling, attractive and that we can afford.
The Chairman: Dr Tan Yia Swam.
Dr Tan Yia Swam: Thank you. I want to thank Senior Minister of State Dr Koh for the reply that MOH will monitor the situation of TPAs. But I have done the research and I am sure that in 2016, Mr Desmond Choo raised a Parliamentary Question and the reply then by Mr Chee Hong Tat was that MOH will monitor the situation regarding TPAs. So, in these five to six years, what have we understood about the situation? May I ask for a more proactive review, including consultation of the professional bodies, so that we can at least better define the problem.
The Chairman: Senior Minister of State Dr Koh.
Dr Koh Poh Koon: Sir, I thank Dr Tan for her question. As I said in my reply, we will continue to watch this, but we will be happy to also engage with the Singapore Medical Association (SMA) to see if they have insights on areas that we need to focus a bit more attention on.
Let me also say that a lot of these arrangements are private contracts between the GP and a third-party provider. Which is why our emphasis always has been that the GP entering into a contract with a service provider ought to be clear that the boundaries of ethics and ethical behaviour ought to be observed. Otherwise, it is very hard for us to police every single private contract between the GP and a third-party provider. I think that the principle must be observed.
But if there are unsavoury practices that GPs have engaged in and if SMA is aware, we will probably take some investigative action and advise the relevant parties to not undertake such actions to the detriment of patients.
As we evolve the primary healthcare landscape based on Healthier SG, some of these arrangements between GPs and third-party service providers, like TPAs, may also need to be relooked at as well to see how they should reshape themselves in the larger landscape of primary care changes.
The Chairman: We still have some time before the Guillotine Time of 5.35 pm. Are there any more clarifications from Members? Yes, Mr Leong Mun Wai?
Mr Leong Mun Wai: Chairman, thank you. I would like to thank the Minister for sharing with us such an exciting plan. One of the reasons that the Progress Singapore Party (PSP) has rejected the Budget is that we want the Government to concentrate more on cutting healthcare cost. We hope that this plan would realise that in the future. I have three supplementary questions with regards to the plan.
One is, a lot of feedback from the ground about our current healthcare system is, not so much of the poor being not given medical, healthcare services or treatment, but more of the middle class who can pay. When they get into a healthcare situation, it somehow drains their finances very fast, although we talk about S+3Ms and all that.
The first question I want ask is: will the new plan that the Ministry is coming out with take care of that as well, that means give more relief to the middle class? There are many, many areas like, for example, they do not get so much subsidies compared to the lower income, certain medicines are not included and so on. So, that is one point.
The second point is that the Minister mentioned about outcome. That is a concept in healthcare for quite some time already. So, I look forward to seeing how the Minister is going to present the plan that take cares of that. One of the things that I thought of in the past when I was running a healthcare fund, that we have also talked about, is how to incentivise the —
The Chairman: Excuse me, Mr Leong, a clarification is really about you raising a question regarding what a person has already said. It is not a licence to give another speech.
Mr Leong Mun Wai: I will try.
The Chairman: I will give you some leeway, please ask your points two and three quickly, so that the Minister can reply. Thank you.
Mr Leong Mun Wai: Okay. So, the second point is: can the Minister enlighten us a bit more on what kind of outcome, what kind of incentive, just a little bit, how is it related to incentivising the individual patient to take more care about his health?
The third point is: healthcare is a very resource-intensive thing. I have read that overseas, people are activating community resources to help. So, in Singapore today, when I walk the ground, there are a lot of Singaporeans who are prematurely retired. Are there plans, in the plan that the Minister is putting up, to tap into this resource?
The Chairman: Minister Ong.
Mr Ong Ye Kung: Thank you. Mr Leong said three questions, but I counted quite a number. I will just try to address them. First, he said PSP recommend \"cutting\" healthcare costs. It is not the right description of what we are doing here. We are trying to make people healthier. By making people healthier, it is less likely they will get chronic diseases and, so, healthcare costs can be moderated. It will still increase due to ageing, but we can moderate the increase. But we are not \"cutting\" healthcare cost per se. When treatments, operations, surgeries are required, they will be given.
As for the middle class, how will Healthier SG take care of their current issues, where if they have a catastrophic illness, it will wipe out a lot of their cash? We are all responsible for our own health and in some sense, our own finances too. We are helping, not just the middle class, but everyone else, it has to be universal. We want to help every Singaporean take care of their own health, through Healthier SG.
Outcomes delivered by our healthcare system, is not a new concept. I mentioned about setting outcome KPIs, but they have always been there. I mentioned some of them, today we have the highest life expectancy at birth for men and women, across 204 countries. That is a major outcome, delivered over the decades. And we will continue to focus Healthier SG on delivering right outcomes.
But now, because of the design of that programme, we have to look at specific outcomes that we are driving at. How many percent taking up enrolment, taking up healthcare plan, how many percent have one single doctor, what is the subscription of doctors into this plan, how many doctors are in our national IT system, because those are essential. So, some of these outcomes, drivers have to be captured as well.
Mr Leong also mentioned incentive. I think I have answered that in my speech, which is we will have a consultation, we will put in the package, we will describe the package in the White Paper to be tabled in this House later. I think I have answered all his questions.
The Chairman: If there are no further clarifications, may I invite Dr Tan Wu Meng, if you like, to withdraw your amendment?
Dr Tan Wu Meng: Mr Chairman, we have seen around the world challenges from the pandemic and what has been at stake. What has happened to those healthcare systems that broke under pressure. And thankfully, we did not. And some of this is through the policies and effort of the MOH team – the civil servants, the Director of Medical Services (DMS), everyone working, policies that lay the groundwork for healthcare workers to be able to do their best as far as possible.
The Healthier SG announcement is significant and will be an important part of the next bound for Singapore healthcare. It will shape us a generation from now.
So, I would like to thank Minister Ong, Second Minister Masagos, our two Senior Ministers of State, Senior Minister of State Dr Koh Poh Koon, Senior Minister of State Dr Janil Puthucheary, Parliamentary Secretary Rahayu, our Permanent Secretaries, our DMS – the whole team at MOH. And in particular, I want to again thank every single healthcare frontliner, whose effort and sacrifice has kept Singapore afloat and in one piece through this pandemic. Mr Chairman, I beg leave to withdraw my amendment. [Applause.]
The Chairman: Is the hon Member given leave to withdraw his amendment?
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $17,840,315,300 for Head O ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $1,447,569,700 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 – Head I (Ministry of Social and Family Development)","subTitle":"Fostering a resilient and caring society","sectionType":"OS","content":"Mr Seah Kian Peng (Marine Parade): Mr Chairman, I beg to move, \"That the total sum to be allocated for Head I of the Estimates be reduced by $100\".
Chairman, I have for several years now supported the broad principle that the family unit is the foundation of Singapore society. At the same time, I made the call for a wider definition of what a family unit comprise. Such definitions are not mere semantics – they carry with them moral and policy weight – for the Government encourages strong families by way of subsidies, programmes and support.
In turn, such families are themselves sources of support for its individual members. Therefore, if I may make a pragmatic point, lightening the load on the state and the tax burden on society.
It is thus an important point to consider – what is \"family\" in Singapore today? Here, I would say, we can be even more inclusive. For many years, together with other Members of the House, we have argued for parity in treatment of single parents, especially single mothers, as a parent of equal standing.
What are the current norms on family? We are seeing some demographic trends including increasing singlehood, declining fertility rates and an ageing population. We need to consider more incentives, for example, for singles who have ageing parents, since caregiving duties fall most heavily on them.
All these trends have put stresses on the institution of family across different life stages. COVID-19 has made the situation worse.
Mental health, which we discussed just now during the COS on MOH, is such a big issue now. These stresses also add to the negative impact on Singaporeans' well-being and Singapore as a society. Can I ask the Ministry what it is doing to promote and to strengthen families so that we can be a more resilient society? Can the Minister also outline some changing trends and the implications for our various social and fiscal policies?
[(proc text) Question proposed. (proc text)]
Mr Murali Pillai (Bukit Batok): Sir, in 1993, this House adopted five shared values that were identified as what holds us together as Singaporeans. \"Family as the basic unit of society\" is one of them. The late Dr Ong Chit Chung, then Member of Parliament for Bukit Batok, argued in this House, that the family should be called the \"pillar of society\" instead. For \"if the pillar is eroded or weakened, society will not stand\". He was right. Our society's response to COVID-19 demonstrated it. As we pitched battle against COVID-19, the Singaporean family was a pillar of strength holding us together.
This was no easy task. To date, we have about 850,000 infections, more than 1,000 have died. Our families, as the first line of support, lovingly cared for the sick. When any succumbed, we cried as a family and rallied around each other. When our children were not able to attend school, our families encouraged them in their remote learning from home and took care of their mental health. When in doubt or fear, we found strength in talking to each other, to get vaccinated, boosted, wear masks and commiserate about the need for safe management measures. Families helped those who have lost jobs or suffered pay cuts.
The time-honoured qualities of our Singaporean families which includes resilience, self-reliance and filial piety must be preserved. I believe, ultimately, it is the strength of our families that will determine whether our nation will emerge from this pandemic stronger. A lot can be done at the community level to celebrate family milestones and share ideas as to how to keep families strong.
In Bukit Batok, we regularly hold birthday celebrations for our centenarians. There is no better celebration than to see up to five generations of family members coming together. One centenarian whom I met was Mdm Ng Ah Luah who lived until 105. I asked her for advice as to how to keep a family harmonious. She told me she would organise frequent family gatherings to bond over food. She also said, family members should not bicker over little things. Simple lessons but difficult to put in practice.
Families go through good times and bad. Different families have different challenges. We must provide more support for families that face challenges in keeping together. Again, easier said than done.
May I ask the hon Minister for his plans to strengthen our families? Today, more than ever, it is needed as a pillar for our society facing so many challenges, for if it is eroded or weakened, society will not stand.
Dr Tan Yia Swam (Nominated Member): Mr Chairman, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] Mr Chairman, the saying goes \"it takes a village to raise a child\". The importance of the extended family has shown itself more obviously in these past two years.
In general, many married couples live with their children and pay regular visits to both sets of grandparents. In the past two years, to prevent the virus from spreading, the Government has imposed various restrictions including the size of family gatherings. I believe the majority of families have been compliant.
Less family gatherings, less face-to-face contact; phone calls and video conferences have become the norm of communication. Most of the elderly I know are not comfortable with a video call. Uncles, aunts and cousins all form part of the extended family. With the current restrictions of groups of five, there is hardly any chance for two families to meet in public.
In my work as a doctor, I see the fallout from this loss of human connections. Many middle-aged people develop cognitive and physical dysfunction. Many reported being more forgetful, lonelier and sleeping poorly, and expressed they fear going out. They miss their children and grandchildren, but do not want to disturb their work. They lose muscle tone, get hunchbacked, unsteady on their feet and tire more easily.
Young working parents face the pressures of job, childcare and elderly care. Some have lost their jobs, some in healthcare have worked non-stop without a break for months; and every time there was a school closure, we have to figure out how to adapt. Now, so many school-going children have received the Health Risk Notice (HRN) and need to do daily ART swabs. Not every child can tolerate the procedure. If one has elderly parents who need medical attention, whether in clinic or admission, the barriers to visit are another source of distress.
Because of COVID-19, mask-wearing has become a daily necessity. The young are growing up amongst masked faces. There is some scientific evidence showing that this could lead to delayed social developments in young children. The adverse impact of COVID-19 on our nation’s mental health is well reported.
I ask for a simplistic solution: consider allowing familial gatherings. Just like how the COVID-19 protocols get streamlined into three, we can simplify rules for interactions and allow people to make their own risk assessments. Allow families to unite once the COVID-19 situation improves, please.
The Chairman: Ms Ng Ling Ling. Please take both your cuts.
Ms Ng Ling Ling (Ang Mo Kio): Mr Chairman, the Government has consistently upheld the philosophy of family as the first line of support as our social compact in Singapore. The World Values Survey conducted in 2020 has shown that family remains a key priority for most Singaporeans, forming the core of our social values today. Upholding the institution of family and keeping families strong will thus be a continuous endeavour that we must be committed to.
I am heartened to know that the number of marriages in 2021 has returned to pre-pandemic levels, despite a slight decline in our birth rate. However, there are still some risks that threaten our family institutions as a nation. Some of the emerging social trends warrant our attention to ensure that we continue to support our Singaporean families to stay strong. There are several observations that I noted from the Singapore’s Census 2020 that I would like to highlight.
Firstly, more young adults are choosing to stay single longer, with the proportion of singles aged 25 to 29 rising from 74.6% to 81.6% for males, and from 54% to 69% for females between the years 2010 and 2020. Secondly, the average number of children born over the same period has decreased. Lastly, the old-age dependency ratio has drastically increased from 13.5 to 23.4 in the same 10-year period. These trends of increasing singlehood, declining fertility rates and a rapidly ageing population can place additional strains on our families across different life stages.
Furthermore, the COVID-19 pandemic has also taken its toll on some family relationships. Various studies across the world on the impact of COVID-19 on family resilience have shown that the pandemic has caused psychological distress for children and parents. In Singapore, our families are also not spared from these effects.
Sir, under the backdrop of these social trends, I would like to ask what more will MSF be doing to promote and strengthen families in Singapore so that we can continue to be resilient as we gradually recover from the impact of the COVID-19 pandemic.
Mr Chairman, in my previous cut on Keeping Singapore Families Strong, I mentioned the impact of the COVID-19 pandemic on the resilience of family relationships. In times of strained relationships or when the families are under stress, it is challenging for the family to act as the first line of support.
During my Meet-the-People Sessions, I often encounter residents who would share with me their family problems. The lower-income group remains the most vulnerable to fallouts from strained family relationships because of the limited resources among family members to support one another.
A resident couple’s story left an impression on me as it presented the need for greater upstream support when families are faced with early signs of stress. The couple initially approached me when they were struggling with their finances after their employment was affected by the pandemic. They had pressing needs because they had just welcomed their newborn child, but their income dropped drastically at the same time.
In order to take care of the child, the wife decided not to look for employment and the husband became the sole breadwinner, continuing the financial strains of the family. The couple later developed relationship strains and the husband moved out and contemplated divorce. This further left the wife in limbo, as she had to fend for financial support and caregiving while going through a difficult time with her husband.
All this while, I appreciate the partnership and support rendered by the Social Service Office who worked with me and the family to stabilise their circumstances, to help the wife find suitable employment and caregiving arrangements and for the couple to work on their strained relationship.
As families face financial issues or other unexpected circumstances like health problems, family relationships are bound to be affected. They will present early signs of stress, which may lead to greater challenges down the road. I would like to ask MSF, what more can we do as a community to increase upstream efforts to help families from at-risk groups, such as those from low-income groups, or those who are suffering from illnesses.
Mr Gan Thiam Poh (Ang Mo Kio): Chairman, the Ministry launched the Alliance for Action to Strengthen Marriages and Family Relationships in August last year. What has been the progress so far? What would be the new initiatives in the six areas of focus – newlywed couples, parents, single parents, families with early risks, marriages and families among different religious faiths, and families in general?
The Chairman: Mr Louis Ng. Please take both your cuts together.
Mr Louis Ng Kok Kwang (Nee Soon): At a recent dialogue session, single unwed parents spoke courageously about the stigma they faced. Many were in tears as they spoke. As Minister of State Sun Xueling shared after the dialogue: \"They shared the pain and hurt felt when faced with the stigma that comes along with being a single unwed parent\".
We should help end the discrimination and stigma they face. Our policies should reflect what we already say: “Single unwed parents are valued citizens and, like all parents, are respected for the love and care they provide for their children. They are no less a mother or a father, just because their child was born outside of marriage”.
They are no less a mother or father. Why then do we give them less? Why deny them the cash component of the Baby Bonus?
It may be because the cash component is part of the marriage and parenthood package, the key word being \"marriage\". But single unwed parents already receive the CDA component of the marriage and parenthood package. Why give one and discriminate when it comes to the other?
With a median salary of only $600 a month, the cash component would really help single unwed parents under 35 years old. For many, it is not a luxury but a lifeline. Everyone will also face higher living costs, with core inflation projected to be 2% to 3% this year. Increased costs will hit single unweds even earning $600 a month even harder.
I have raised this many times in this House. I hope we can finally help end the stigma single unweds face and help provide them with this cash component of the Baby Bonus. They desperately need this.
Being a single parent is twice the work, the stress and the tears, but also double the hugs, the love and the pride. It is twice the work as single parents have to juggle work while caring for their child. They do not have an additional pair of hands.
In my Adjournment Motion, I shared the story of Ema, a single unwed parent who raised her daughter in a shelter. Thanks to HDB and a change in our policies, Ema can now provide a stable living environment for her daughter in a rental flat. She now also has a good job but has difficulties keeping her job as she has to work at odd hours on short notice. She has difficulties finding help on such short notice on an ad hoc basis. She does not have family members she can count on.
Many single unwed parents face similar challenges. Can the Government provide this additional pair of helping hands so single unweds can remain in the workforce, contribute to Singapore and work towards becoming more independent? Will MSF establish a pilot programme of providing low-cost, ad hoc nanny services for our single unwed parents?
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Sir, in replying to my Parliamentary Question on whether MSF could consider debarring individuals who are under both Self-Exclusion and Family Exclusion Orders under the Casino Control Act from placing bets at Singapore Pools outlets, the Minister had noted that there were several safeguards around betting with Singapore Pools and that such an exclusion may drive more gambling underground and cause more harm.
Sir, I raise this issue because I have a resident who has continuously lamented to me on his wife's problematic gambling habits. Although the lady is under both Self-Exclusion and Family Exclusion Orders, she has continued to spend thousands of dollars gambling at Singapore Pools using her salary and borrowing from licensed and unlicensed moneylenders.
Sir, no measures can stop problem gamblers from feeding their addictions. However, I believe that we need to consider how to disincentivise gambling and reduce opportunities for gamblers to indulge in their habit.
We can use technological solutions for this. I propose creating an additional requirement for Singapore Pools' counter staff to scan the identity card of individuals placing Toto and 4D bets above a certain threshold. The purpose of the scan would be to verify that the said individual is not, in fact, under an Exclusion Order and should thus be prohibited from placing bets with Singapore Pools. While this will create some delays in the process, I believe it is worthwhile if it deters those on Exclusion Orders from gambling excessively via legal platforms.
Mr Melvin Yong Yik Chye (Radin Mas): Mr Chairman, the COVID-19 pandemic has put a strain on the relationship of many families over the past two years.
Prolonged telecommuting work arrangements, home-based learning and, more recently, a spike in Omicron cases among young children are just some examples of how families can be stretched emotionally, physically and mentally. Unfortunately, this is felt most keenly by vulnerable and stressed families.
What is the Ministry doing to support families upstream to address stresses early? Can we do more to support couples from the point of marriage?
Has MSF seen an increase in the number of family violence cases received by the Family Violence Specialist Centres since the start of the pandemic? Can the Ministry provide an update on the progress in implementing the recommendations by the Taskforce on Family Violence, which were released just last year?
Sir, the pandemic has put a strain on the institution of marriage. We should do all we can to support families and strengthen family bonds.
The Chairman: Ms Carrie Tan. Not here. Mr Seah Kian Peng, please take both your cuts together.
Mr Seah Kian Peng: Yes, Chairman. Mr Chairman, the Conversations on Singapore Women's Development were concluded in September last year, with the Government promising concrete proposals in three areas.
First, more equal workplace opportunities; second, more caregiver support; and third, increased protection for women.
What stood out for me was the engagement of many Singaporeans through these conversations, all 160 of them, involving more than 5,700 participants. I know we are all now looking forward to the White Paper which I am sure will draw from these conversations.
Can Minister share about some of the initiatives which might be in the White Paper? Can the Minister also share some data and statistics on the size and the type of problems that Singapore women face?
Even as the Government puts in place new policies and laws, I would also like to ask if there are specific areas of improvement we must bear in mind relating to our mindsets and attitudes. For example, in the light of the recent attention on sexual misconduct towards women, I note that most Institutes of Higher Learning now have compulsory respect and consent courses. But shifting mindsets must not just be within a section of society but it must involve everyone.
Second, this bias is not just a matter of serious misconduct, but of everyday behaviour. Interruptions, patronising explanations and unwarranted assumptions of emotional fragility – I think all these are poor companions to our social life. But these are experienced by many women on a daily basis. What can we all do to promote this mindset shift?
All children deserve to grow up in loving families. Last year, the Ministry announced that the Adoption of Children Act is being reviewed to better safeguard the welfare of adopted children and sought the public's feedback on the proposed amendments to the Act.
Adoption is certainly a complex process as, even with the best of intentions, there are many minefields to navigate. And the people who are affected, they include the children being adopted, the adoptive parents, adoption agencies, agencies supporting foster parents, the pregnant mother, lawyers and so on.
Some poor behaviour must clearly be constrained, for example, any suspicion of \"marketing\" children as if they are goods for sale, rather than human beings to be nurtured and loved. Some parents, for example, are tricked into giving up their flesh and blood to strangers.
On the other hand, there are those people who are unfit to be parents but, yet, refuse to give consent for their children to be adopted. Whether they have abandoned the child or cannot be found, or have neglected or ill-treated the child, one has to ask if the consent of these adults, who, in my view, are not fit to be parents, is required. There is a case to be made that such parents have no standing as parents.
In any case, can the Ministry provide updates on the progress of the review? Can the Minister also provide some background on the state of adoption in Singapore? How many children are waiting to be adopted, what is the profile of adoptive parents and the help rendered to these families by the Government?
Second, the review of the Act was motivated, in part, by the need for Singapore to keep pace with international practice. Can the Minister let us know where Singapore lags behind the rest of the world and what can be done in these aspects and how we can do better?
The Chairman: Ms Joan Pereira, please take both your cuts together.
Ms Joan Pereira (Tanjong Pagar): Chairman, to build a Singapore that is \"made for families\", we have to make it more conducive for our busy parents, many of whom are working full-time and long hours. Parents have shared with me that getting a place in a preschool within walking distance of their homes has been particularly challenging. How will the Ministry help such families?
Parents normally place their child's name or children's names on waiting lists and the wait can be several months or even longer, causing great anxiety for parents. Can the Ministry set a certain timeline where after a certain number of months of waiting and still no vacancy, ECDA should engage the parents, understand their needs and propose a few suitable nearby centres with vacancies for their selection and registration?
The early years are especially important for children's development. We must seize this golden window of opportunity to nurture and help them build a strong foundation for learning. However, some families from disadvantaged backgrounds face various challenges in sending their children to preschool.
KidSTART was launched in my division in 2016 and I saw first-hand the difference that it has made and is still making. Hence, I welcome Prime Minister's announcement last year that KidSTART will be expanded nationwide. In my division, KidSTART is effective because ECDA and community partners work very closely together to tackle issues in a more comprehensive manner to better support families in need. I speak to all the agencies and they concur.
However, I hope the Ministry can share with us regularly how our families are progressing with all these interventions in place. Are the families progressing well? Do they need more help or are there gaps that need to be plugged? Sometimes, such help can be more effectively and quickly provided by the community itself.
I also hope that there could be long-term studies to review and track the progress of our children and their families in KidSTART.
I would also like to ask MSF if it can share how families will benefit from the expansion of KidSTART and provide an update on the Growing Together with KidSTART initiative. How many more children are expected to be included? Will community partnerships be considered so as to widen the scope of programmes that can benefit the children and their families?
Mr Leon Perera (Aljunied): Mr Chairman, Sir, students from low-income families tend to be more vulnerable to long-term absenteeism in schools. For families where persistent absenteeism is an issue, I would like to propose a conditional cash transfer programme – not a transfer to the Child Development Account – for these students in Primary and Secondary schools conditional on their commitment to student early intervention programmes and regular school attendance. Such programmes, like the widely praised Bolsa Famílias, have have been found to improve school attendance and even cognitive development internationally.
This is not a novel concept in Singapore. Since 2001, The Straits Times School Pocket Money Fund has been providing a monthly allowance for students from low-income backgrounds conditional on school attendance. An independent study of its impact found positive feedback from parents and students. Its recipients maintain regular attendance, perform better in school, were more engaged and more confident in achieving educational goals.
Whilst specific aid programmes, such as the MOE Financial Assistance Scheme (FAS), are useful in fulfilling specific educational needs, they typically have strict conditions on the usage of the aid. Conditional cash transfers are nudges that, nevertheless, enable families to retain the freedom to choose how best to fulfil their needs, be it for better nutrition or savings for University education.
The Straits Times School Pocket Money Fund study found that some recipients were keen to save the money. I was most heartened to read that as it could help them build healthy financial habits to cope with future difficulties. Some may object that such a policy creates moral hazard and some families may get their children to be absent to get the grant. There are levers to guard against this by keeping the grant small and directing it only at lower-income or multi-problem families.
Mr Melvin Yong Yik Chye: Mr Chairman, quality preschool education is vital in allowing our children to achieve their fullest potential in life.
How often does the Early Childhood Development Agency (ECDA) review the pedagogies of our early childhood curriculum? What are the areas that ECDA will focus on in the coming years to further improve the quality of our early childhood education?
Beyond curriculum, can MSF share what are its efforts to build the key competencies of our preschool teachers? Has there been an increase in attrition among local preschool teachers?
Sir, the recent surge in Omicron infections has also left many preschools struggling to cope and our teachers grappling with an unprecedented workload. One teacher told me she is tired, but yet, she cannot afford to be sick because there would be no one left to help cover her class. Can ECDA ensure that there are sufficient teachers in our preschools to cope with the increased workload?
The quality of our preschools depends heavily on the quality and quantity of our childhood educators. For our future generations, we must do more to make early childhood education a choice profession.
Mr Seah Kian Peng: Mr Chairman, given the marked rise in cost of living in recent times, is MSF bringing forward the review of the quantum to be given to eligible recipients of the ComCare and Public Assistance schemes?
Also – and perhaps this is a radical idea – does the Minister think that the current criteria are sufficient, or is there a case for us to explain the giving of public assistance to more people?
Public assistance is given to the poorest amongst us and it is a long-term assistance scheme, in contrast to short- and medium-term care. Public assistance is bare bones – it is for those who cannot work as a result of old age or illness and have little or no family support.
A single person, he or she, gets $600 a month and other help, such as free healthcare. Parents with children receive help in educational expenses. In 2020, there were 4,263 people on the scheme, 3% fewer than the year before. Many of these are elderly men who are not married.
Mr Chairman, I have two questions.
First, is the number of 4,000-plus on public assistance too few or too many? How do we decide on this? Is there a case, for example, to be made that our qualifying criteria are too stringent?
Second, is $600 too much or too little? Can the Minister give an idea of how this $600 was derived and whether it ought to be reviewed in light of recent inflationary pressures?
Finally, can I ask the Minister for a deeper review of the idea of “needs-based” funding of public assistance? I know our philosophy is to give adequate, but not generous, welfare. I agree with that. Certainly, for the most part, I agree with this because a bloated welfare state with a high tax burden is something that Singaporeans collectively do not want. Still, as a society and a government, let us think more deeply about what is required for this group in our midst – how they could live a dignified life and with peace of mind.
Of course, in addition to $600, there are many other forms of help and many other partners in the community who do give help. But $600 a month, I think in the present circumstances, is a precarious way of living. Can we do more to help this group of the poorest amongst us?
The Chairman: Ms He Ting Ru. Not here. Mr Leon Perera.
Mr Leon Perera: Mr Chairman, Sir, in my Budget speech, I argued for a war on poverty and a different approach based on defining a poverty line, channelling all schemes through FSC social workers, reducing the stress involved in applying for financial assistance, providing longer lead times and larger amounts of financial assistance based on new research and with part of it tied to conditions. I also called for more aggressive early intervention for children born into poor families. The overarching goal should be to achieve a massive measurable dent in poverty and the poverty cycle.
Sir, ComLink, which is to be scaled up across Singapore, reflects some of these elements but not all. I am specifically calling for FSCs to be able to approve and administer all the various state financial assistance schemes directly for those defined as poor and at risk. I argue for FSCs to be like venture capitalists, making financial investments, coaching and hand-holding to get a return on that investment. Social workers today do not actually administer the aid in all cases. My arguments on the financial aid application process and amounts are also separate issues from what ComLink per se is focused on. To do all this, social workers need visibility on the holistic situation of the family. Vulnerable families often face complex issues, such as chronic illnesses, mental health issues, school absenteeism and other social issues. Hence, more needs to be done to ensure that social workers get that visibility via tools like One Client View and other forms of cross-agency data sharing, with permissions.
Sir, let me speak now on the social work profession. Social workers should see an increase in their remuneration, given the increased scope of work. In 2019, the overall annual resignation rate of social workers was 17%, which is double that of the estimated 8% attrition rate of healthcare workers in 2021. In a recent SUSS study, 57% of social workers were found to be suffering from anxiety during the pandemic in 2020. Social workers are professionals battling a national crisis on the frontlines and should be adequately compensated. A revolving door of social workers is detrimental to the support offered to vulnerable families.
I would like to ask the Government to review social workers' compensation and progression pathways in a very outcomes-oriented way, with a view to raise retention. Above all, efforts should be made to expand recruitment so as to lower caseloads, as I spoke about in my Budget speech.
And lastly, Sir, one possible objection to all I have thus far said is this: one could say that providing more welfare support to the poor more smoothly will breed welfare dependency. By doing this, we will trap the poor in a cycle of welfare dependency and will doom them and their children to poverty. We used to hear this argument a lot. We still do and it is heard around the world. Such arguments are not without a grain of truth. Hence, I want to be absolutely clear.
I am not calling for unlimited welfare aid that is so much that it discourages work. What I am calling for is enough aid for the basic dignity of the poor relative to minimum wage benchmarks and inflation and based on the latest research; enough aid to break the poverty cycle for the children; and with aid delivered in such a way that it drives better outcomes. Above all – I am just wrapping up – we must set ambitious goals to massively reduce poverty and the poverty cycle. A nation which does not set ambitious goals in any policy arena —
The Chairman: Mr Perera, I am afraid you have to end. You are almost a minute over your time.
Mr Leon Perera: Okay, I will end it there.
The Chairman: Ms Carrie Tan. Not here. Mr Muhamad Faisal Abdul Manap.
Mr Muhamad Faisal Bin Abdul Manap: Sir, MSF had launched the ComLink initiative in 2019, which aims to provide comprehensive, convenient and coordinated support to empower families with children living in rental housing through a proactive outreach and closer case support. I understand that under ComLink, the Social Service Office (SSO) for each town leads a team consisting of Government agencies, corporates and community partners.
I note, Sir, that a good interpersonal relationship between the beneficiary and the case worker is a pertinent factor behind the success of such programmes. In this regard, I would like to better understand ComLink and request that MSF provide details on how beneficiaries are engaged and managed. For example, is each family assigned with one case worker? Is there any minimum number of engagement session requirement for each family in a month? And can MSF also share the ratio of beneficiary to a case worker?
On a related note, Sir, I believe it is also important that the beneficiary is fully involved and committed. However, many low-income workers are engaged in jobs that involve irregular hours, such as daily- or hourly-rated work or food delivery. Also, time spent on programmes, interviews and counselling is time not spent working. This means lost income. I propose providing such individuals with a make-up allowance so as not to deter them from participating in such programmes towards their long-term benefit.
Finally, Sir, can I confirm that the ComLink for Bedok covers the rental blocks in the Kaki Bukit ward of Aljunied GRC?
Dr Shahira Abdullah (Nominated Member): MSF has announced that, over the course of the next two years, ComLink will reach rental households with children and young people all across Singapore. With this programme, low-income families will be matched to dedicated befrienders and get customised help to address their problems as well as help families connect to community groups and Government agencies so they get more targeted help.
I am excited about these developments as I feel that it will help to render more timely and holistic care for the families with young children. It does, however, seem very resource-intensive and I have some queries regarding the execution of the programme.
How do we ensure the competencies of the befrienders? How do we match them to lower-income families? Do we have an ecosystem to support them as they approach the different Government agencies? What might be some indicators of success, both short and longer term, that MSF and ComLink partners are potentially looking at achieving? What might be some obstacles to achieving these goals? What is MSF’s strategy in attaining its objectives?
Mr Mohd Fahmi Aliman (Marine Parade): Chairman, last year, MSF announced that it would scale up the ComLink initiative nationwide to 21 towns over the next two years. Notably, the upscaling efforts are expected to benefit 14,000 families with children living in rental housing across Singapore. I applaud MSF for the efforts to upscale the ComLink initiative. Upscaling this initiative would make ComLink towns more accessible to lower-income families. Moreover, the expansion of ComLink will also go a long way in supporting low-income families adversely impacted by the pandemic. More families can take active steps towards stability, self-reliance and social mobility with adequate social support.
Having said that, could MSF provide an update on the progress of ComLink's expansion? Could MSF elaborate on the number of families it has assisted through ComLink so far and outline how frequently are check-ins conducted with the families?
Mr Don Wee (Chua Chu Kang): Chairman, MSF piloted ComLink three years ago in 2019 and I am very glad to hear that the Ministry will scale up the scheme over the next two years island-wide. I want to thank the Ministry for implementing ComLink in towns like Choa Chu Kang. This will really help the vulnerable families with young children staying in rental flats.
At the heart of ComLink are volunteer Befrienders, who play a critical role of befriending and suggesting plausible options for the families under ComLink and journey along with them. What is MSF doing to ensure that the volunteer Befrienders are adequately trained and of sound moral character, given he or she will be working closely with different members in the ComLink family?
As part of ComLink, would MSF consider implementing a seamless application process for these families? For example, for disadvantaged children who require financial assistance to attend schools, Social Service Offices’ records about their families can be shared with MOE and the schools, so that the children do not need to apply for the Financial Assistance Scheme, the Straits Times School Pocket Money Fund and other related help schemes separately.
Likewise, for other assistance that the families will need, I hope that MSF can tap upon information technology to make all the application processes easier. A seamless and integrated assistance application process will need more proactive and closer collaboration amongst all the involved Ministries, including MSF, MND, MOH and so on. Would the Ministry share an update on how the integration of assistance services for these families is progressing?
Mr Leon Perera: Mr Chairman, Sir, a recent study estimated that 10% of resident households were food insecure in 2019. The COVID-19 pandemic has exacerbated this, with many low-income families struggling from the financial fallout. Food distribution drives do important work but may be fragmented and lead to food wastage if rations are unsuitable due to health preference or dietary reasons.
I propose that the Government coordinate food aid by expanding the Community Shop concept of public rental flats and pockets of low-income family areas island-wide. The Community Shop was launched by Food from the Heart and lets beneficiaries choose some groceries every month for free from special minimarts in their area. This caters to different needs of beneficiary households, such as those who cook and do not cook, those with children or elderly who may require certain foods. Participants appreciate the flexibility and freedom of choice. Ninety-eight percent of respondents selected it as their preferred type of food programme after the first year.
I also propose an electronic point-of-sale system with digital currency loaded in a card. A large proportion of the credits could be earmarked for healthier food products to encourage healthy eating. The card could also be used at participating hawker stalls for those who do not cook. This repeats two calls in my recent Adjournment Motions on preventive health and hawkers. NGO Food Bank Singapore has piloted a similar Tap-A-Meal initiative, where beneficiaries are given cards loaded with credit to order what they wish from Encik Tan's menu.
Ms Joan Pereira: Chairman, families in need usually struggle with multi-faceted, interlocking problems. It takes the teamwork of different Ministries, agencies and volunteers to help them. I want to take this opportunity to recognise the efforts of my grassroots volunteers, community partners and Government agencies helping the vulnerable families in my division. A coordinator will keep track of the help rendered by the different agencies, share regularly how the family is doing after the various interventions and highlight areas where more or new help is required. Such regular sharing has been very effective in providing timely help to these families.
Therefore, I welcome the announcement by Minister Lawrence Wong to scale up Community Link or ComLink. I would like to ask the Ministry if all cases under ComLink will have dedicated case officers going forward as that would be extremely helpful. I would like to ask how many families and children have benefited from ComLink so far and if there are any important learning points that it can share.
The families in need also spend a considerable amount of time filling up and submitting multiple forms to apply for assistance schemes under the different Government agencies. Will the Ministry consider streamlining all these processes so that they need not spend so much effort on administration matters and instead focus on improving their situation? Will the Ministry monitor these families in the longer term to ensure that they can continue to cope and do well?
The Chairman: Ms Denise Phua. Please take your three cuts together.
Ms Denise Phua Lay Peng (Jalan Besar): Sir, pandemic or not, many individuals and businesses in Singapore are passionate and concerned about issues such as inequality and caregiving support. Unfortunately, there are still many residents in need who are either over-served or completely missed out. And the impact of giving and volunteerism is not as strong as it should be.
Take food or grocery distribution for instance. Although MSF attempts to coordinate ground efforts, there is often repeat giving, wastage, food items that are not healthy or do not meet the needs of the beneficiaries. We usually have little choice.
In local caregiver support on the ground, there is either lack of a local network, a local plan or a one-stop hub where a caregiver can approach.
How can the Ministry play a more active role to involve the ground better and also direct help to where it is needed? I suggest the following.
Set up a Local Co-ordinator Network, much like the ComLink network, for young families in need. And like ComLink, this network can comprise the local Social Service Office, Family Service Centres, other social service agencies and even the CDCs. It can identify, curate, cluster and collate unmet needs; start with the rental estates.
Publish and publicise the needs in a user-friendly and accessible way. Set up a calendar of giving and volunteering in each neighbourhood. Educate potential donors on meaningful giving; focusing on needs, allow choice and not trying to create demands. And also equip recipient organisations with better volunteer management skills and tools, that are appropriate to their size and bandwidth.
As a Member of Parliament, it is not uncommon for me to see distraught residents whose loved ones have lost their mental capacity. These residents are legally unable to make decisions for the personal welfare or assets of their loved one because a Lasting Power of Attorney (LPA) had not been made before. Many of them are shocked that they have to apply to be legally appointed as deputies to then make decisions for loved ones who had lost capacity.
If LPAs are not as widespread as desired, deputyships are even lesser known.
Another group for whom deputyship is relevant are persons who are born disabled and do not have capacity to make decisions on their own. They require a deputy when their parents or guardians can no longer make decisions on their behalf, after the age of 21.
Based on data from the Office of the Public Guardian (OPG), only 873 Court orders appointing deputies were received in 2021. The reasons for this low take-up rate are several: a genuine lack of awareness, difficulty with applications, costs and so forth.
There is also a need for knowledgeable medical practitioners who have the experience or ability to write a good enough medical report for deputyship applications.
Charities which try to help their clients with disabilities are also crying for help. They are not set up or resourced to facilitate deputyship applications for their clients. One charity head told me about the shortage of in-house psychologists and the challenges of coordinating with legal professionals.
Will MSF work with MinLaw to start a workgroup to seriously look into: (a) starting a mobile team which can focus on these services for residents and charities; (b) curating a list of experienced medical doctors and lawyers to help them; let fair fees be charged and subsidise applications for the lower-income; (c) developing an effective communication kit readily accessible to residents of different language abilities, education and backgrounds; and (d) training and sustaining a pool of volunteers able to share and guide the applicants.
Singapore’s next Enabling Masterplan for the Disabled (EMP4) is in the making. Unlike earlier plans which lasted for five years, this one will expire in 2030, eight years later. To ensure that this plan truly delivers better outcomes for persons with disabilities and the sector, we need to better organise, instil more rigour and constantly review for better results.
I suggest the following steps to be taken at the systemic level.
One, size the problem and do a better job at communicating all these main clusters of needs to all stakeholders.
Two, assess and cluster the needs according to importance, urgency, size of impact, or difficulty of implementation and pay special heed to areas which are highly important, highly urgent, with higher impact on the population; especially obvious pain points highlighted so many times over the years – the dearth of services for adults; the helplessness of caregivers who continue to fret about what happens to their children after they are gone. Some who cannot cope basically take their own lives or their children's lives or worry to their graves.
Three, strategically assign task forces to areas of priority. Not just any helping hands. Give the job to people and organisations with track records, who are not only commentators but willing and able to dirty their hands, tap on their networks and influence or empty their pockets to deliver the results expected of the tasks. This EMP4 is not a feel-good exercise to increase the number of volunteers, which is important, but is not first objective, which is to solve the root issues.
Four, resource appropriately this EMP4. At the national level, there must at least be a computation of what disability services would cost to meet basic and then aspirational goals. Leverage on mainstream facilities and programmes. MOH and MND have several that we can tap on. MSF ought to be better funded in the national budget for these critical essentials. Partners such as the Tote Board, Temasek and other foundations should be persuaded to address important pain points. Other stakeholders such as families, family caregivers and advocates can organise ourselves better to fundraise, to find regular income streams, to call upon our networks to resource the disability services better! Be part of the solution.
Five, set up a EMP4 Executive Council to report and review the EMP4 yearly after the Masterplan is published and to report and review at specific milestones or during major changes. It is naive to think that an eight-year Masterplan would still be relevant in 2030 if we start with just a plan now.
Sir, the state of the union in the disability sector is both encouraging and discouraging. A lot has been invested. Government has paid a lot of attention but needs are getting complex and multiplying. Expectations are rising. Demands keep surfacing. Tough as it may be though, we must never give up this space. Including the disabled is an important chapter of a Singapore Story that will make us truly human, caring and inclusive.
Sir, I urge Government to better organise, instil more rigour and constantly review for better results for the disabled.
Mr Pritam Singh (Aljunied): In January, the MSF announced an expansion of the Seniors' Mobility and Enabling Fund (SMF) as well as the Assistive Technology Fund (ATF). Amongst others, the existing schemes will be extended to support seniors and the disabled over a longer period of time and to cover a wider range of assistive devices. What new assistive devices has the Ministry noted a high demand for and that were not covered under the previous regime? Separately, which top five items does it project to have high subsidy utilisation up to 2030 under both SMF and ATF?
In 2019, the Minister for Social and Family Development shared that 2,037 persons with disabilities had benefited from ATF, a steady increase from 2016 and 2017. Since then, over the last three years, how many individuals have sought assistance at each subsidy tier?
The new items covered under the enhanced scheme have not been fully stated in the January announcement. There are common examples, but I ask that MSF consider the release of the full range of items that are eligible for subsidised purchase under the new scheme for better public utilisation of both funds.
Annex B of the MSF January press release contains a noteworthy footnote. It says that the enhancements to ATF will only apply the Singapore Citizens while there will be no changes to benefits for PRs. There does not seem to be any publicly available information on the dollar amount of subsidies provided to Singaporeans and PRs respectively under ATF before the latest update to the scheme. Would the Ministry be able to provide a breakdown between Singaporeans and PRs from SMF and ATF utilisation, in dollar terms, since each fund was launched?
Mr Gerald Giam Yean Song (Aljunied): Many residents with moderate to severe disabilities require care provided by adult disability care facilities, like day activity centres, adult disability homes, adult disability hostels and sheltered workshops.
May I ask the Minister what is the current utilisation rate among each of these facilities and what are their staff-client ratios? How many individuals are on the waiting list for these centres currently? Based on publicly available information, I understand the waiting times, depending on centres, can vary from three months to two years? If there is insufficient capacity and inadequate staffing at these facilities, this can create a cliff effect for those with special needs. They would have been receiving care from special education schools, but have difficulty finding the same level of support after leaving school. As a result, their ageing parents often have to bear the full weight of caregiving and many worry about how their children will be cared for after they pass on.
I would like to call for MSF to enhance its funding and support for the adult disability care facilities to be at least on par with what SPED schools receive. Such funding can help expand the capacity of care facilities and reduce their long waiting list. It can also go towards hiring and retaining more good staff, including Singaporeans with better pay and working conditions.
All this will help enable the centres to conduct more meaningful and effective engagement and training activities for their clients and lighten the worries of their caregivers. Besides improving the welfare of their clients, it will also give their caregivers much needed respite and allow them to be economically active if they choose to. This will produce both tangible and intangible benefits and returns for families, our society and our economy.
Ms Yeo Wan Ling (Pasir Ris-Punggol): Since 2007, MSF has charted three Enabling Masterplans. These Masterplans have not only achieved material changes in infrastructure, policies and support for persons with disabilities but have seeped these changes into the attitudes of fellow Singaporeans, including educators, employers and the public at large. Therefore, it is with great anticipation that we look forward to this new edition of the Enabling Masterplan which I understand takes a longer view than previous iterations charting a roadmap through 2030.
In particular, the topic of future care planning with caregivers weighs very heavily on my heart. I take particular note of households with special needs adults in my block and home visits with my residents and I am always left in admiration of our family caregivers' unwavering dedication to their charges. Some caregivers dedicate their entire lives, foregoing careers and other relationships in order to fulfil their caregiving responsibilities. And I think more needs to be done to support them.
I met Mdm Tan, not her real name, on a block and I immediately was taken by how well-designed her home was. Mdm Tan, who is in her late 50s, shared with me that she and her brother, who she suspects to be on the autism spectrum, live together and she is the sole caregiver for her brother. Her home was specifically designed to allow her brother to live comfortably and happily. She used to work in an office but as her brother started to age, she gave up her work and became a freelance interior designer so that she can work from home to care for her brother full-time. She is older than her brother by a few years and is worried about his well-being should she not be around to care for him any longer. To Mdm Tan, this fear of leaving behind her brother is very real and – given that she is in her late 50s – very near.
This visit left me with many questions as to how we as a nation and community can help and support the people in the same situation as Mdm Tan and her brother. Will Mdm Tan's brother be able to age-in-place in a home that he loves should she no longer be able to care for him? Is living in a purpose-built facility the only other alternative? What are the interventions out there available for undiagnosed adults with special needs?
Besides setting up trusts, what other supporting structures do we need to put in place as a nation to support our differently abled countrymen? While these remain as questions to many, to Mdm Tan and many caregivers in her shoes, these are very real, everyday realities with a looming timeline that is ticking away.
Although previous iterations on the Enabling Masterplans have indeed sought to alleviate the worries of caregivers in future care planning, I invite the MSF to consider how we can better reach out to caregivers like Mdm Tan with many going under the radar due to their charges undiagnosed or unreported disabilities.
Also, I invite the MSF to assess informational gaps faced by caregivers of adults with disabilities perhaps due to digital divide or language barriers so that we can better build bridges to alleviate the concerns of these caregivers.
Mr Mark Chay (Nominated Member): Martina Navratilova once said disability is a matter of perception. If you can do just one thing well, you are needed by somebody.
Persons with disabilities (PWDs) are part of our society and should be given a fair shot and employment without discrimination.
As Members of this House know, I am privileged to be coaching a champion paralympic swimmer Swimming and representing her country have been Pin Xiu's dream. However, not all persons with disabilities are as fortunate as Pin Xiu.
Through my journey in parasports, I have met many other differently abled individuals. Some are already in the workforce; some are in school. But what is most evident is their desire to be independent and productive members of society. This is why I will be speaking on stronger employment support for PWDs.
Sir, everyone needs to earn a living and support themselves and their dependents. This is especially so in Singapore, differently abled or not, but if opportunities are thwarted and with no support by society, there will be no means for survival.
PWDs can work and earn a decent living. Most PWDs are highly skilled and should be given a chance at employment and not be rejected.
I recognise that over the years, MSF has steadily increased employment support for PWDs. While PWDs who are able to work have access to job opportunities, there is still more that we can do on this front. There is also feedback that more services could be provided for PWDs above 18 years of age who are unable to work.
Chairman, I would like to ask if MSF has plans to support PWDs above the age of 18 with work opportunities and services so that they may stay meaningfully engaged.
Ms Rahayu Mahzam (Jurong): \"Walk with me for a while, my friend; you in my shoes, I in yours. And then, let us talk,\" Richelle Goodrich. I thought that is an apt quote to start with, to invite you to imagine walking in the shoes of caregivers of persons with special needs. I have shared my personal story in this House but it is the stories of others that inspire me to urge for more understanding and more support for these families.
Firstly, I would like to reiterate that there is a spectrum of disabilities and diverse needs. There are physical disabilities, intellectual disabilities, developmental delays and even within each category, there are different needs. Some may be high functioning; some require a lot more support. I would therefore caution against brushing \"support\" in this sector, with a broad stroke, lest we miss out specific needs and think that we have done enough.
I accept though that it would be unrealistic to expect the Government to provide solutions to all issues and address every problem. But there is a need for the Government to synchronise efforts especially on larger issues like early intervention, costs of medical care, infrastructure and also create platforms for people to come together to augment Government support.
Secondly, I would like to highlight that caregivers of persons with special needs face significant challenges on a day-to-day basis, including financial, physical and emotional challenges. Parents among us would understand that raising children can be an adventure. We love our children very much but there are days which test our resilience. Imagine a day in a life of a parent of a child with physical disabilities. Just washing up your child is a whole logistical affair. Sometimes, your child runs around in a public place and you need to discipline her. Imagine a parent of a child with autism, having a meltdown in the MRT. Calming the child down takes skill and a thick skin, as others watch you, sometimes with judgement or pity.
Thirdly, for these caregivers, the intense anxiety never ends as various challenges emerge and evolve at different milestones of the lives of the persons they care for. When they are young, caregivers worry about early intervention, finding the right school, how waiting times to enrol will impact their child and cost of therapies which they hope can help the child's development. When the child transits to a different education level, caregivers worry about how he or she would adjust. When they grow older and sometimes even stronger than the caregivers, parents worry about their waning strength in handling the child or how anyone else would do it. They worry about employment or how their children would survive when they pass on.
It is against this backdrop that I am asking for some attention to be given to the plans in supporting the caregivers. I am grateful for the Government's various efforts including engaging different stakeholders through focus group discussions and working with partners and charities to enhance services and funding. I am appreciative of the ongoing efforts and I am heartened to hear that we will be launching the Enabling Masterplan 2030 to further strengthen support in areas like employment, lifelong learning and respite care.
This is, indeed, a meaningful platform focusing on key concerns of the special needs community. Could I get further details on the Enabling Masterplan and the strategic effort to bring in different stakeholders and the community to provide different dimensions of support to the caregivers?
I hope we remain cognisant of the varying needs and deepen our understanding of effective support that can be provided. This is work-in-progress and I trust the Government will remain committed to develop the support structures. I hope the larger community too, will continue to deepen their understanding about different abilities and do their part to embrace and support the caregivers.
Mr Shawn Huang Wei Zhong (Jurong): Youths today face a multitude of challenges; in particular, youths who leave school prematurely, after which, it leaves them in a vulnerable state, where they no longer have access to guidance and an environment that can provide them with the right conditions to realise their fullest potential.
I believe that every youth should be given more opportunities throughout life. Many are incredibly successful after several attempts. Many success stories would have credited their success to a teacher, a mentor, someone who along their journey was able to guide them to better understand themselves and amplify their strengths. We want all to have such opportunities in life.
Can MSF provide a progress update on the mentoring programme? How many mentors and mentees have been recruited thus far and what might success look like, at the end of the programme?
Mr Seah Kian Peng: Mr Chairman, we know that our adolescent years are a big influence in our lives. They certainly shape who we are and can have a profound impact on our outlook in life and our life trajectory.
Those young people who do go into further education after they turn 18 will find many mentors within their education journey. Those who enter into the workforce, however, may find it harder to do so. Still, others may not realise the powerful role that mentors play in living a successful life.
Mentors help us develop in ways that go beyond the obvious, beyond grades and promotions, beyond financial and social success. Mentors are guides in the journey of life and they are especially useful to young people. Having been a mentor myself, I know that I may not be able to help people avoid mistakes in life and, in fact, some lessons cannot be learnt except through paying for \"tuition\" in mistakes. But I can help them. I can forewarn them, I can forearm them and I can also help in the recovery.
At last year's COS, the Ministry announced the mentoring programme pilot for youths. Can the Minister provide an update of the progress of this pilot and how it will benefit the youths who have participated?
Can the Minister also provide some numbers as to the size and impact of the programme? How many young people have benefited from it and what are some of the variables being measured?
How do the mentors get into the programme and are there any sorting mechanisms for such mentors who, after all, may be paired with young people who themselves are vulnerable?
Are there any lessons or concerns from such programmes? Do we have plans to expand the programme, especially to those young people who have not had access to formal mentors in school? Can I ask that the Minister update especially on the opportunity for lower-income youths or youths at risks, to acquire mentors and the impact that these have on them?
The Chairman: Mr Xie Yao Quan. Not here. Mr Louis Ng.
Mr Louis Ng Kok Kwang: I shared in my Budget speech that Family Service Centres (FSCs) social workers are asking for a cap on the number of active cases they handle, funding for headcounts and resources for research work, more funding for headcounts and resources for community work.
I met many passionate social workers, but they struggle with heavy caseloads and were burnt out. One social worker told me to tell everyone here, \"just tell everyone we are just very tired and frustrated\".
MSF has programmes for FSCs and monitors and helps them when needed. These are good but not enough.
Despite all these programmes, nearly 60% of frontline social workers were affected by anxiety at the height of the pandemic, with 45% facing depression.
FSCs are also handling more cases which are getting more complex.
Let us focus on what more we can do for social workers, by improving our existing programmes and launching new initiatives like the Community Capacity Trust, by moving beyond guidelines and helping FSCs implement these programmes and use the grants provided. Let us help social workers help the most vulnerable in our society.
Mr Seah Kian Peng: Mr Chairman, the community, including social service agencies (SSAs), community groups and corporates, all play a critical role alongside the Government in supporting the social needs of Singaporeans.
Indeed, it is the community that has allowed Singapore to pursue a unique welfare model where the state is small, but the work it does is amplified through the effort of community partners.
During this COVID-19 period, many SSAs, they had pivoted to digital modes and transformed their service delivery.
For many, this has been an opportunity to reap efficiency gains and to magnify their impact. Technology has enabled us to do more than we have done before, to reach more people in the comfort of their own homes and at times, most convenient to them. It has allowed more frequent check-ins and more innovative use of scarce manpower in the social service industry.
And yet, SSAs are one of the most high-touch sectors. That is to say, the human connection must be established through real meetings, where we can see and we can hear, not just what is conveyed through the camera and microphone, but in a million ways through body language, the blink of an eye, the crossing of a defensive knee, the discomfort unspoken but to an experienced social worker, as clear as a shout.
In short, with digital modes, the gains are clear, but what we lose are less. How will the Ministry help SSAs to be prepared for the future? Can the Minister let us know how SSAs have harnessed technology and how it measures service delivery? Have there been any adjustments that social service professionals have had to make and what has been the feedback from clients?
And finally, have we seen an increase in participation and support of corporates in this space? Is there more that the Government can do to encourage community partners to step up?
The Chairman: Minister Masagos Zulkifli, would you like to report progress?
","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 Social and Family Development (Mr Masagos Zulkifli B M M): Mr Chairman, may I seek your consent to move that progress be reported now and leave be asked to sit again tomorrow?
The Chairman: I give my consent.
[(proc text) Resolved, \"That progress be reported now and leave be asked to sit again tomorrow.\" – [Mr Masagos Zulkifli B M M.] (proc text)]
[(proc text) Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mr Masagos Zulkifli B M M: Mr Deputy Speaker, Sir, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2022/2023, 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 to 10.30 am tomorrow.\" – [Ms Indranee Rajah]. (proc text)]
Adjourned accordingly at 6.44 pm.
1 Mr Louis Ng Kok Kwang asked the Minister for Home Affairs (a) whether he can provide an update on the rollout of video-recording of statements from suspects; and (b) when will the video-recording of suspects' statements be fully implemented.
Mr K Shanmugam: Video Recording of Interviews (VRI) was introduced in 2018 for the recording of statements for rape cases. It has since been expanded to include more categories of offences such as aggravated outrage of modesty cases, sexual assault by penetration, child abuse cases, maid abuse cases and non-capital drug-related offences.
VRI is more resource-intensive as compared to the traditional method of statement-taking. Transcripts have to be prepared. Accuracy of the transcripts needs to be checked – that is time and resource intensive. Technology such as speech-to-text (Artificial Intelligence) transcription will help reduce the costs and augment manual transcription. But it is not yet at a level where we can use it confidently. MHA is also working to streamline the transcription process. Over time, we hope to expand the use of VRI to more cases.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Plans for Continued Education and Training for Special Needs Children after 18 Years of Age","subTitle":null,"sectionType":"WA","content":"2 Mr Christopher de Souza asked the Minister for Education whether there are plans for continued education and training for special needs children after 18 years of age given their need for a longer period of education to gain the relevant life and vocational skills.
Mr Chan Chun Sing: MOE seeks to enable students with Special Educational Needs (SEN) to maximise their potential and lead independent and meaningful lives.
The majority of students with SEN, who have the cognitive abilities and adaptive skills to access the national curriculum and mainstream learning environment, are enrolled in mainstream schools and progress to Institutes of Higher Learning (IHLs).
Students with moderate to severe SEN require more intensive and specialised assistance and are enrolled in Special Education (SPED) schools that offer a customised curriculum to support their diverse needs.
MOE has placed a Transition Planning Coordinator in each SPED school, who works with the graduating class form teachers and parents to develop an Individual Transition Plan together with each student. Families are helped to prepare and plan for meaningful post-school pathways, taking into consideration students' strengths and interests.
Students who are work-capable can participate in vocational programmes offered by SPED schools which lead to the Institute of Technical Education (ITE) Skills Certificate (ISC) and the Singapore Workforce Skills Qualifications (WSQ), to prepare them to join the workforce upon graduation. Students with the ISC or WSQ can also pursue further education and training at ITE and external vocational training centres. SPED schools have numerous tie-ups with businesses to offer internship opportunities to their students.
Work-capable students who require more time to be work-ready can be further supported through the MOE-MSF-SG Enable School-to-Work (S2W) Transition Programme where customised job training by SG Enable's job coaches provides up to two years of preparation and internships before eventual employment.
After graduation, Persons with Disabilities (PWDs), including SPED graduates, can continue to pursue lifelong learning opportunities to acquire vocational skills and to work and live meaningfully. PWDs can draw upon the broad-based SkillsFuture support provided for all Singaporeans. This includes course fee subsidies and SkillsFuture Credit for those aged 25 and above.
In addition, PWDs can also tap on the Open Door Programme – Training Grant, which offers 95% course fee subsidy and a training allowance for PWDs attending SG Enable-approved programmes. SSG is also encouraging more training providers to customise courses to meet the skills and training needs of PWDs, including through the provision of grants.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Creating More Inclusive Environments in Public Schools Beyond Special Education Schools","subTitle":null,"sectionType":"WA","content":"3 Mr Christopher de Souza asked the Minister for Education whether more inclusive environments can be created in public schools beyond special education schools to allow special needs children to play and learn alongside other children, but also cater to their specialised needs.
Mr Chan Chun Sing: Both mainstream and SPED school students are provided with opportunities to enjoy purposeful and meaningful interaction through Satellite Partnerships. Under the Satellite Partnerships initiative, SPED and mainstream school students interact through joint activities in Values-in-Action, CCA and camps. For example, students in Canossian School join their mainstream peers in Canossa Catholic Primary School for academic learning. Prior to the COVID-19 pandemic, Fernvale Primary School extended the use of their school canteen and library to students from MINDS - Fernvale Gardens School. These meaningful experiences provided opportunities for students from partner schools to interact and relate with each other. Even with the pandemic, schools kept partnerships going through online interactions.
Pre-pandemic, partner organisations also leveraged arts and sports to build inclusivity. These included National School Games, Singapore Youth Festival Arts Presentation, National Day Parade, MOE-OBS Inclusive Sailing programme and the Play Inclusive campaign, organised by SportCares and Special Olympics Singapore in partnership with MOE. Despite the disruptions brought about by the pandemic, some of these activities, like the Singapore Youth Festival and Play Inclusive, have continued online.
These purposeful and meaningful interactions have offered students in mainstream schools the context to appreciate how their SPED peers are differently abled and develop values such as patience and kindness. SPED schools also gain greater access to and opportunities to take part in activities alongside, and to interact with, mainstream peers. These activities support SPED schools in developing students who are active in community and valued in society. Both groups of students come to appreciate diversity and develop empathy.
MOE will continually work with mainstream and SPED schools to nurture these partnerships so that students in Singapore can continue to learn and grow together.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Profile of Students Admitted to Gifted Education Programme in Past Five Years","subTitle":null,"sectionType":"WA","content":"4 Mr Leon Perera asked the Minister for Education for each year in the past five years, what is the percentage breakdown of students admitted into the Gifted Education Programme by (i) housing type (ii) parents' education levels (iii) race and (iv) financial assistance status.
Mr Chan Chun Sing: Our schools offer a range of programmes catering to the diverse aptitudes and learning needs of their students, so that they realise their full potential. This includes the various learning support programmes for low progress students, as well as the Gifted Education Programme (GEP) and school-based provisions for high ability learners in our primary schools.
Over the past five years, students who join the GEP came from around 60% of Primary schools each year and about 45% of them lived in HDB flats.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Mean and Median Numbers of Dwelling Units Served by Each Family Service Centre","subTitle":null,"sectionType":"WA","content":"5 Mr Louis Ng Kok Kwang asked the Minister for Social and Family Development based on the current geographical boundaries, what are the respective mean and median numbers of equivalent dwelling units that each Family Service Centre serves within each geographical area.
Mr Masagos Zulkifli B M M: FSCs serve individuals and families with social and emotional needs and provide case management to coordinate support from other agencies.
The mean and median number of dwelling units within each FSC's service area are about 32,000 and 30,000 respectively.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Support Schemes and Respite Care Options for Families with Special Needs Children","subTitle":null,"sectionType":"WA","content":"6 Mr Christopher de Souza asked the Minister for Social and Family Development (a) what are the current schemes in place and what support do families with special needs children receive; and (b) whether more financial support can be given to all families of special needs children given the expenditures needed for education and therapy from infant years into adulthood.
7 Mr Christopher de Souza asked the Minister for Social and Family Development whether more respite care options can be made available to alleviate the load on caregivers of special needs individuals.
Mr Masagos Zulkifli B M M: MSF, MOE, the Early Childhood Development Agency (ECDA) and SG Enable offer a range of services and programmes to support persons with disabilities and their families, from the early years to adulthood.
SG Enable was set up in 2013 to support persons with disabilities and is now the single touchpoint for disability and caregiver support services. Caregivers of persons with disabilities who need information to better care for their loved ones and themselves may access the Enabling Guide at www.enablingguide.sg. They can also access information on disabilities in general, as well as available disability services, schemes, caregiver training opportunities and informal caregiver support groups. Caregivers who need referrals to disability services for their loved ones may also approach SG Enable.
Today, there are preschools and early intervention (EI) centres which enrol and provide support for children under the age of seven with developmental needs. Children under the age of seven with developmental needs can receive intervention through Government-funded EI programmes. Children who require low levels of EI support are supported by the Development Support - Learning Support (DS-LS) and Development Support Plus (DS-Plus) programmes, in a preschool setting. For children who require medium to high levels of EI support, they are supported through the Early Intervention Programme for Infants and Children (EIPIC), provided at EI centres. Additionally, ECDA is piloting an Inclusive Support Programme (InSP) which integrates both early childhood and EI services at preschools for children aged three to six, who require medium levels of EI support. These EI programmes also provide training for caregivers to equip them with the skills and knowledge to support their child at home.
As they reach schooling age, students with special educational needs receive support in mainstream schools or in SPED schools depending on their level of need. In mainstream schools, Allied Educators (Learning and Behaviour Support) and Teachers Trained in Special Educational Needs partner closely with parents. In SPED schools, in addition to trained SPED teachers, students are supported by Allied Professionals including psychologists and occupational therapists and families can receive support from each school's Social Worker.
Beyond their schooling years, persons with disabilities can tap on various MSF-funded services to meet their needs. The Open Door Programme helps those who are work-capable and independent with job placement and job support. The School-to-Work (S2W) Transition Programme provides work-capable SPED graduates with supported work placements and job coaches to prepare them for open employment. Sheltered Workshops (SWs) offer skills training and work therapy for those who are not yet ready for, or unable to take up open employment. Day Activity Centres (DACs) provide day care programmes for persons with disabilities who are not work-capable and live with their families. Adult Disability Homes (ADHs) provide residential care and the Home-based Behavioural Intervention Services (HBIS) pilot programme supports those with behavioural needs who are unsuitable for centre-based services.
We also offer services to support caregivers who need respite. Special Student Care Centres (SSCCs) provide before-and-after school care service for students aged seven to 18. DACs offer part-time day programmes, while Children Disability Homes and ADHs provide short-term residential care. We have also piloted the \"Take-A-Break\" programme, which provides home-based care on a short-term basis to give caregivers some respite.
We have been taking steps to improve the affordability and quality of our disability services. Fees for Government-funded EI programmes are subsidised to ensure affordability, with means-tested subsidies ensuring that lower-income families pay less. For instance, a family with a per capita household income (PCHI) of $1,000 per month pays $10 monthly for EIPIC while a family with a PCHI of $1,400 per month would pay $50. Eligible Singapore Citizen (SC) students in SPED schools from lower-income families are supported by the SPED Financial Assistance Scheme (funded by MOE and Community Chest), which covers full waiver of school fees, free textbooks and school attire, school meals and public transport subsidies. They may also be eligible for other support schemes.
In July 2020, MSF enhanced subsidies and broadened the income criteria so that more households would qualify for the Student Care Financial Assistance Scheme (SCFA), thus improving the affordability of SSCC services for students with special needs. In October 2021, fee caps were put in place for DAC clients from households with gross per capita household income of $2,800 per month or less, to help lower their out-of-pocket expenses. MSF has also enhanced funding support for ADHs (from 1 July 2021) and DACs (from 1 October 2021) to raise their quality of care and service standards.
MSF subsidises the cost of purchasing assistive technology devices through the Assistive Technology Fund (ATF). ATF was enhanced in February 2022 to cover a wider range of devices to enable independent living and to provide higher subsidies for Singaporeans of PCHI between $801 and $2,000.
To further defray the costs of caregiving in the community, MOH provides the Home Caregiving Grant to eligible individuals with at least permanent moderate disability. Eligible caregivers of persons with disabilities can also apply for the Migrant Domestic Worker Levy Concession if they need more help to look after their loved ones.
Support for persons with disabilities and their families can be more effective when there is a whole-of-society effort involving the Government and the larger community. One community-led example is Project 3i under the SG Together Alliance for Action for Caregivers of Persons with Disabilities, formed by the National Council of Social Service (NCSS) and SG Enable. Project 3i was started by CaringSG, an organisation set up and led by caregivers, for caregivers. Project 3i aims to strengthen community support for caregivers by connecting them with others in the community, providing befriending and peer mentorship, and offering professional advisory support to help caregivers better navigate and access mainstream health and social services.
We recognise that more can be done to support persons with disabilities and their families and have plans under the next Enabling Masterplan 2030 to improve and expand our services. We will share more about these when ready.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Expansion of Enhanced Pilot for Private Intervention Providers Programme","subTitle":null,"sectionType":"WA","content":"8 Mr Christopher de Souza asked the Minister for Social and Family Development whether the Enhanced Pilot for Private Intervention Providers can be expanded to more early intervention programmes for infants and children so as to allow more families to qualify for financial support.
Mr Masagos Zulkifli B M M: Under the Enhanced Pilot for Private Intervention Providers (PPIP) programme, the Early Childhood Development Agency (ECDA) appoints private sector operators to provide early intervention (EI) services for preschool-aged children requiring medium to high levels of EI support. Families are supported by relevant means-tested subsidies. The PPIP programme serves as a complement to the Government-funded Early Intervention Programme for Infants and Children (EIPIC) run by social service agencies. Parents whose children are referred to EIPIC can choose to enrol their child in an approved PPIP programme.
ECDA is committed to ensuring the adequate provision of EI services for children with developmental needs. From April 2022, the number of centres providing the PPIP programme will be increased from 10 to 16, increasing the total number of PPIP programme places by 40%. Appointed centres have to participate in an open selection process and be evaluated in areas such as programme design, staff quality and centre management.
To meet increased demand for subsidised EI services, we will also expand the number of EIPIC places through the construction of two new EI centres. These are expected to be ready by end of 2022 and mid-2024 respectively.
Aside from increasing EIPIC and PPIP programme capacity, we have also expanded the range of EI services within preschools to support more children with developmental needs. For example, we introduced the Development Support Plus (DS-Plus) programme in 2019, to cater to children who have made sufficient progress under EIPIC and are able to transit to receiving intervention in a preschool setting. We are also piloting an Inclusive Support Programme (InSP) to support children aged three to six, who require medium levels of EI support, to access both early childhood education and EI services within their preschool. These initiatives will help more children requiring varying levels of support access subsidised EI services.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Penalties on Employers for Failure to Comply with Advisory on Work and Leave Arrangements for COVID-19-positive Employees","subTitle":null,"sectionType":"WA","content":"9 Mr Louis Ng Kok Kwang asked the Minister for Manpower (a) whether and, if so, what penalties will be imposed on employers who fail to comply with the Ministry's \"Advisory on work and leave arrangements for employees who test positive for COVID-19 but are mildly symptomatic or physically well\" updated on 5 January 2022, such as requiring employees under this category to submit a medical certificate or going on unpaid leave; and (b) what remedies are available to such employees.
Dr Tan See Leng: Tripartite advisories are issued by the tripartite partners to guide employers on implementing employment practices in a fair and responsible manner. They are issued after careful consideration of the interests of both employers and employees.
Employers are expected to follow the positions set out in the advisories. If any employer deviates from the advisory without good reason, employees may approach MOM for assistance. MOM will verify the facts with the employers and advise them to follow the advisory. Thus far, MOM has not encountered any employer who wilfully refuses to conform after being told of the advisory. Should this happen, MOM will suspend the work pass privileges of the employer.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null}],"writtenAnswersVOList":[],"writtenAnsNAVOList":[],"annexureList":[],"vernacularList":[{"vernacularID":4811,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Baey Yam Keng","filePath":"d:/apps/reports/solr_files/20220309/vernacular-Baey Yam Keng MOT 9 Mar 2022 -Chinese(mot).pdf","fileName":"Baey Yam Keng MOT 9 Mar 2022 -Chinese(mot).pdf"},{"vernacularID":4819,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Dr Wan Rizal","filePath":"d:/apps/reports/solr_files/20220309/vernacular-9 Mar 2022 - Dr Wan Rizal - MOH Cut.pdf","fileName":"9 Mar 2022 - Dr Wan Rizal - MOH Cut.pdf"},{"vernacularID":4820,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Ms Rahayu Mahzam","filePath":"d:/apps/reports/solr_files/20220309/vernacular-9 Mar 2022 - Parl Sec Rahayu - Reply to MOH Cuts_for Parl Sec.pdf","fileName":"9 Mar 2022 - Parl Sec Rahayu - Reply to MOH Cuts_for Parl Sec.pdf"},{"vernacularID":4821,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Ong Ye Kung","filePath":"d:/apps/reports/solr_files/20220309/vernacular-Ong Ye Kung MOH 9Mar2022-Chinese （moh).pdf","fileName":"Ong Ye Kung MOH 9Mar2022-Chinese （moh).pdf"},{"vernacularID":4822,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Dr Tan Yia Swam","filePath":"d:/apps/reports/solr_files/20220309/vernacular-Tan Yia Swam MSF 9Mar2022-Chinese.pdf","fileName":"Tan Yia Swam MSF 9Mar2022-Chinese.pdf"}],"onlinePDFFileName":""}