[(proc text) Order read for consideration in Committee of Supply [6th Allotted Day]. (proc text)]
[Mdm Speaker in the Chair]
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[(proc text) \"That the total sum to be allocated for Head X of the Estimates be reduced by $100.\" – [Mr Baey Yam Keng]. (proc text)]
[(proc text) Question again proposed. (proc text)]
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Madam, since 2011, the Government has set out to foster social cohesion and to build an inclusive society through the Budget. While an inclusive society means different things to different people, it is important to know that the fundamental tenet of an inclusive society is a tolerant and respectful embrace of the cultural values that each community in Singapore holds dear. In the context of the new normal in Singapore's society, Singaporeans are increasingly more vocal and want their views to be heard. I believe that in fostering multiculturalism, public dialogue and constant consultations are the way forward.
In the case of the recent hijab issue, to the best of my understanding, the dialogue that was conducted with the representatives of the Malay community was more of a platform for the Government to convey its stance rather than a dialogue. This is because the Government has already come to the decision of not allowing hijab to be worn prior to the dialogue session instead of making a
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decision at or after the session.
I am of the view that the Government should enhance not only the manner in which it communicates but also its attitude when forming the communications. At the same time, consultation with one community alone is inadequate, as it may lead to hasty conclusions and unnecessary assumptions. The more constructive approach would be public consultations conducted with different stakeholders and the different ethnic communities.
Singaporeans from the different ethnic communities understand that the final policy outcomes may not go according to their preferences. Nonetheless, it is hoped that the Government should also understand that the process is equally important to them. It is the responsibility of any government not to overtly impose its assumptions on any issue, particularly on sensitive and emotional issues. Rather, it should base its understanding on scientific findings and in the event that such information is not available, commission a study on the matter.
The Government should also make available information that it has. Public engagement and consultations that adopt a more transparent, forthright and comprehensive approach will allow us to better understand the issues at large, the context and the nuances behind each issue.
I hope the Minister would agree with me that such an approach would bring us closer to a consensus that is workable, productive and acceptable by the various stakeholders involved. That should be the way forward towards an inclusive society and a multicultural Singapore.
The Senior Parliamentary Secretary to the Minister for Education and Acting Minister for Manpower (Mr Hawazi Daipi): Mdm Chair, I agree with the Ministry's proposed plan to set up a new tribunal to deal with feuding neighbours who are not able or not willing to settle their disputes. In cases where the voluntary dispute resolution system does not work, we need a legal recourse.
I believe the Tribunal will help reduce the frustration of the aggrieved party and prevent the differences between neighbours from escalating. The community dispute resolution framework could potentially provide a mechanism to contain and end neighbourly disputes in an impartial, systematic
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and orderly manner, with the force and authority of the law, where necessary.
But, Madam, there are two things to note. First, the crucial role of our grassroots leaders, especially our residents' committee members, who work behind the scenes to prevent many disagreements from snowballing into full blown conflicts and for organising programmes to promote good neighbourly ties and inculcate civic-mindedness. Legislation and enforcement should only be taken as a last resort. The tribunal will be important, but the personal outreach of our grassroots leaders (GRLs) may still be able to foster goodwill between disputing neighbours and encourage residents to take ownership of their private disputes. For that to be effective, our GRLs should be trained to deal with the different types of disputes.
Second, the value of mediation. Despite the problems that we face, mediation is still very important. The community dispute resolution framework should also be accessible, cheap and fast and its proceedings should be simple and users should not require formal legal representation. May I get the Minister's comments, please?
Mr Vikram Nair (Sembawang): Mdm Chair, a few days ago, an announcement was made that the Government is planning to set up a tribunal to adjudicate what was described as \"intractable community disputes\". It was also mentioned that this was part of a broader framework for the management of disputes in the community. Could the Minister share more details about this broader framework for dealing with community disputes?
I understand that the aim of the framework is to promote good neighbourliness and to encourage neighbours to resolve disputes amicably where possible. Could the Minister share what additional measures might be taken to encourage more neighbours to use mediation before going to the tribunal?
Apart from dispute resolution mechanisms, is the Government also considering a change in the legal framework to deal with neighbourhood nuisance? This would include, for example, developing rules to deal with issues such as noise from neighbours and in public areas such as void decks, and also other elements of nuisance such as smoke from burning of papers and incense.
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At the moment, the authorities are unable to do much because there are no clear rules on what are the acceptable levels of these sorts of disamenities. While reasonable people may come to some agreement on what is acceptable, if parties become unreasonable and press for their rights, it is not exactly clear where these would fall.
Exact rules may be developed as part of the community engagement that the Ministry plans to embark on in relation to the tribunal. I do believe that having such rules would be helpful, at least as a starting point for parties in their negotiations.
Ms Tin Pei Ling (Marine Parade): Madam, many Members in this House are no strangers to community disputes within our constituencies. This is perhaps expected, given the high residential density in local housing estates and personal spaces are inevitably infringed on now and then. The Community Mediation Centre (CMC) is, therefore, useful. However, those that could not make it to the CMC or could not be resolved at the CMC are the ones that can be most challenging and energy-consuming for everyone, including grassroots leaders, Government agencies and neutral innocent neighbours.
In an article in Saturday's The Straits Times, which also quoted Minister Lawrence Wong, it was stated that about 60% of meditation applications could not proceed because one party did a \"no show\". According to CMC's 2011/2012 Annual Report, of the cases that did go through mediation, about 30% could not be settled. A back-of-the-envelope estimation reveals that about 72% of applications have gone unresolved per year. This figure does not include disputes where both parties refuse to even try to settle it at CMC. In essence, the current CMC is not sufficiently empowered to have the teeth to bite.
Hence, I am glad that the Ministry is considering a tribunal framework and I hope that this cut will help tip the balance in favour of it. At the same time, would the Ministry consider putting in place mandatory mediation, once an application is made but prior to the tribunal hearing? In serious cases where both parties refuse to go to CMC for mediation, could neutral parties, such as neighbours, apply for mediation on their behalf, so that at least there is a way of getting them to come to the table and resolve it? This is to offer a last chance for both parties to resolve their disputes, fully knowing that the next step requires them to face a judge in Court and comply with the Court's decision, even if it is against their will. Also, this is a last shot at preserving goodwill between the parties and, therefore, preserving harmony within the community.
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Madam, we live in a diverse society with our own individual uniqueness or quirks. Understanding the concept of co-existence and accepting our diversity is key in maintaining harmony in environments where we work, play or live in. We must not only tap on soft approaches to inculcate the right culture, but we must also be prepared to have concrete measures in safeguarding our much valued peace and harmony.
Ms Irene Ng Phek Hoong (Tampines): At my block visits and Meet-the-People Sessions, it is not uncommon to hear residents complain about their neighbours. For many, their relationships with their neighbours have become so toxic, having festered for so long, that they just want their neighbours to suffer, sending the Police to warn them, sending the Town Council staff to warn them, sending the HDB staff to harass them, and now, hoping to also send their Member of Parliament.
Often, the issues which triggered the disputes appear quite minor: flower pots cluttering the area, dog urine, dripping wet clothes, noisy children. By the time their disputes come to us, they would have escalated to the point where it would often be too late. Some, stewing in anger, would refuse mediation. If such a situation is left to fester, however, it not only makes life quite unpleasant for themselves, but also affects other residents and damages the community spirit in the neighbourhood.
In this regard, I welcome the move to set up a tribunal with the power to order both parties to go for mediation and to impose judgements and sanctions. But sending disputes to the tribunal should only be a last resort. While it would restore a semblance of peace in the neighbourhood, it would probably destroy the possibility of them having any kind of relationship after that. We need to focus on educating people to take early steps to try to resolve their disputes and to do it in a positive and constructive way. We should also train more people in the neighbourhoods to help those involved in conflict, and to facilitate processes that enable each person to understand another's perspective.
But how do we encourage residents to take greater ownership for private disputes? I would urge the Minister to beef up the community resources available to residents and to mount a campaign on this.
Disputes can get more complicated, however, when it involves people with mental illness. Some cause their neighbours grief by constant abuse and other
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behaviour which can make life quite miserable for them. I would urge the Minister to strengthen the mechanism for managing disputes which involve residents with mental illness, ensuring that residents are protected and also that proper diagnosis and treatment be made mandatory for those who need it.
Mr Alex Yam (Chua Chu Kang): Madam, curries, flower pots, music, children running, incense and even alarm clocks – all seemingly innocuous, but it is often the simple things that serve as the spark for neighbour disputes. I often cite the case of two gentlemen that I have met previously, who have been neighbours for 15 years and had feuded for 13 of those years. When I met the first neighbour on my house visit, he complained about this neighbour. I also spotted a pencil line on the wall. I asked the second neighbour and realised it was the border, the de facto no man's land that no orchid or hydrangea should ever cross. They have known each other for many years, by names too flowery for parliamentary decorum, but with the help of our volunteers, we formally introduced them to each other. To our surprise, the curse was broken. Learning each other's names perhaps made the issue now too human. So, now there is peace, there is embarrassment, too, but largely peace.
This is perhaps one miraculous resolution that we have had. I joined fellow parliamentary colleagues in calling for a review of the legislation over the last year. Madam, I am heartened to hear that the tribunal has been announced and it will have additional powers proposed that will help to resolve long-standing cases.
However, I wish to ask the Minister how soon we can expect the tribunal to be in place, what are the exact powers vested with the tribunal. More importantly, I hope it does not become the first port of call. What other means have the Ministry considered to build stronger community ties, further encourage mediation and reduce the surge in neighbour disputes?
The Chairman: Mr Patrick Tay. Not here. Mr Hawazi Daipi.
Mr Hawazi Daipi: Mdm Chair, at last year's National Day Rally, Prime Minister Lee announced the setting up of the Volunteer Youth Corps to enable young Singaporeans and Permanent Residents between 15 and 35 years old, including students in ITEs, Polytechnics and Universities and young adults, to do community projects overseas and in Singapore.
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MCCY and the National Youth Council (NYC) plan to pilot it in early 2014, and I have a few questions for the Minister.
One, what is the size of the first intake and how are we going to sustain the interest and the programme?
Two, I understand that the selection and assessment process involves essays, situational tests and interviews. Would this process deter youths who do not write and speak well or those who have to work part-time and, therefore, may not be able to spend the time to finetune an essay or prepare for interviews, from applying?
Three, the diversity of participants is important as it enhances the learning experience, and their abilities should be relevant to the project they want to work on. How will the Ministry ensure there is diversity among applicants and the selected candidates? Will funds be made available for them to ensure that they can cover transport, meals and other needs during the programme?
The programme is a meaningful endeavour and it is full of promise. Among others, it can help reduce the drop in volunteerism among youths as they progress from school to the workforce. What are MCCY's plans to keep the participants engaged upon completion of community service programmes bearing in mind the many competing demands amidst a competitive environment?
Miss Penny Low (Pasir Ris-Punggol): Madam, volunteerism can shape and empower youths to become active citizens. Last year, the Volunteer Youth Corps (VYC) was launched. Can the Minister give an update on VYC?
Some people have noted that VYC community partners are required to assign a dedicated staff to conduct impact evaluation, facilitate learning and reflection of VYC members even if it is for a small project. If so, criteria may favour only fairly sizeable NPOs and disadvantage smaller resource-strapped NPOs and unwittingly stumping their growth.
To encourage more bottom-up initiatives and inclusivity, can the Minister (a) level the playing field by tweaking the details of the VYC implementation; (b)
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elaborate on other youth engagement and development efforts and how NYC will strengthen itself to cope with it; and (c) enlighten us on the plans to rally youths around our nation, in view of Singapore's 50th birthday in 2015?
Madam, in Singapore, many youths are active volunteers while they are in school, possibly because of school-based programmes and a facilitated environment. When youths graduate into the corporate world, career takes precedence, particularly for those between ages 23 and 30. Time, opportunities, support become obstacles and many drop out as a result.
However, given the rise in corporate citizenry and many companies now trying to get into CSR and understanding how to do so, youth engagement and CSR can go hand in hand but I think it needs to be structured and facilitated.
I hope that MCCY would do more to spur active corporate citizenry, invest in intermediary organisations to set up programmes and match-make employers and youths in giving through the various stages of their life. Can MCCY look into a life-stage approach to volunteerism? Can the Government agencies take the lead?
Mr Seah Kian Peng (Marine Parade): Madam, I would like to address the \"bathtub effect\" or the dip in volunteering when youths leave school and enter the workforce.
NVPC's Individual Giving Survey 2012 showed that volunteering rates peak when youths are in school. From a high of 55% for youths aged 15 to 19, the volunteerism rate drops significantly when they leave school and enter the workforce. I am not surprised. Young working adults have other competing priorities but we know many would still like to contribute to the community.
One way to address this issue is to integrate the spirit of giving and community involvement into the workplace and to give working adults opportunities to participate in corporate volunteering or philanthropy programmes. Corporate giving does not always have to be in monetary terms. Employees volunteering for worthy social causes represent a meaningful way of corporate giving. Will the Ministry encourage and promote such forms of corporate giving? Can the Ministry share its plans to do so?
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The Acting Minister for Culture, Community and Youth (Mr Lawrence Wong): Mdm Chair, with your permission, I would like to display some slides on the screens.
The Chairman: Yes, please. [Slides were shown to hon Members.]
Mr Lawrence Wong: Yesterday, I spoke about looking to the past and also to the future as we imagine what Singapore can be. We must also not forget to think about the values we should uphold because these will underpin the choices we make. As we approach our 50th birthday, it is timely to reflect seriously on these values and how we want to anchor our society as we enter a new phase of development.
When Mr S Rajaratnam was asked many years ago whether we can create a national identity, he said and I quote, \"We must first accept the premise that it is an act of faith that a national consciousness is desirable, possible and inevitable.\" So, it is an act of faith and it was on this conviction and faith that our pioneers went about building Singapore and strengthening our Singapore identity.
At the same time, we hold a high ideal in Singapore, which is that the Singapore identity is open and inclusive. It is an identity that espouses unity in diversity. We do not insist on any Singaporean having to choose between his ancestry and being Singaporean. You can be Chinese, Malay, Indian, Eurasian, Jew, Parsi, Arab, whatever your origins – you can be that and Singaporean at the same time.
This is our approach to multiculturalism and this is how we have developed over the last 50 years – learning to trust and respect our different races and religions, and to live peacefully with one another.
Mr Muhamad Faisal Abdul Manap asked about more public consultations and dialogues in order to strengthen this approach to multiculturalism. And indeed, we do have many platforms for consultations and dialogues. Some of them are open, some of them are closed door, depending on the nature of the topic. Some of the sessions are with specific communities, some cover many communities, but we have many platforms as well; our schools and our public housing estates are natural platforms for interaction and mixing.
Our Inter-Racial and Religious Confidence Circles (IRCCs) promote dialogue and foster friendships across faiths and ethnicities. We have a National
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Community Engagement Programme which brings the different communities together to discuss many issues on interaction and multiculturalism.
On occasion, some of the issues we discussed have to be done behind closed doors. That is because we know that there are sensitive issues that need to be addressed and not all issues lend themselves well to an open discussion, which may end up causing different groups to raise their demands that they want, reduce the common space that we share and raise temperatures. We do not think that is a useful approach.
We have a mix of different platforms, both closed-door and open consultations, which we will continue. And indeed, that is the approach that we have. We want to give maximum space for each community to nurture its own roots. The proviso is that these efforts must not pull us apart, but should bring us together. To cite the analogy that Mr George Yeo once gave, we want to let Singaporeans nurture our own ancestral roots, but these roots must all support the same Singapore tree. That is how we can continue to strengthen our multiculturalism in Singapore.
There are also important institutions that help to promote social mixing and multiculturalism, and strengthen our common space. Dr Teo Ho Pin spoke earlier about this in the Budget debate on the role of the CDCs. I had asked Dr Amy Khor to speak on that earlier in her capacity in the People's Association (PA) and as a mayor. But since Mr Patrick Tay was not here to file the cut, she does not have the opportunity to respond. I would just say that I agree with Dr Teo that the CDCs play an important role in strengthening social harmony, and MCCY and PA will study how best to support the CDCs to do more in this area.
One challenge we face in Singapore is that living in a crowded city heightens our sensitivity towards disagreements. Little things such as noise, smells and the use of common areas can cause unhappiness. We can find it especially difficult to get along with those who live closest to us.
Good neighbourliness is an important place to start in building harmony. I give an example of residents in Opera Estate holding an annual street party where they play games and enjoy potluck. It is a small way to bring neighbours together but has been going strong for the past 14 years, and still going strong. One of the organisers, Mr James Suresh, says, \"We aren't just a loose collection of people who happen to live on the same street. We are neighbours, and when we begin to think of each other as friends, it becomes natural to care for and
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help each other.\"
By showing care and concern for our neighbours, we can make Singapore a better home for all, and I emphasise community ownership, as many Members here did just now as well, because the effort has to come from ourselves. We can live peacefully together if we show consideration and learn how to give and take. To this end, I agree with many Members like Ms Irene Ng and Mr Hawazi Daipi that citizens should try to resolve their personal conflicts amicably, amongst themselves.
We have spoken to some stakeholders on managing community disputes. Many say that building strong neighbourly ties can help to reduce conflict. If neighbours know one another, they will be more likely to broach issues sensitively and come to a consensus. Most of the people we consulted called for more public education efforts to encourage consideration and graciousness in our community and we agree with them as well as with suggestions from Members to put more effort in this area because day-to-day acts of kindness will help to make our communities a more pleasant place to live.
Every day, there are many Singaporeans practising good neighbourliness and kindness in their communities. Like Mrs Chandra Sivarama Krishnan – she has been there to help her elderly Chinese neighbour Mdm Ah Ho for 20 years. Her neighbour can only converse in Chinese, but the language barrier has not stopped Mrs Chandra from reaching out. Though they can only communicate through hand signals, Mrs Chandra helps her neighbour with reading letters received in English and she explains the contents as best as she can. She also checks on her neighbour regularly to make sure that she is doing well. Once, when the electricity supply was cut off, she helped to ensure that the problem was fixed. Her story shows that kindness can go beyond the boundaries of race and language, and these are the acts of kindness we want to promote.
MCCY will continue to work closely with partner agencies like HDB and the Singapore Kindness Movement (SKM) to encourage neighbours to get to know one another to strengthen the \"kampong spirit\" in our urban city.
At the same time, we recognise that there are some who need help resolving tensions with their neighbours. It is sometimes useful to have a neutral party to help disputing parties communicate better. Grassroots leaders already undertake this role and they do their best to informally mediate disputes between neighbours.
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Residents can also seek formal mediation at the Community Mediation Centre (CMC). It has a fairly good success rate. Out of the 521 cases heard last year, about 70% were successfully resolved. We believe that mediation continues to be a very important process as both parties agree on a solution, so there is ownership and responsibility to follow through. It also helps to preserve and mend relationships, so that neighbours can continue living harmoniously alongside one another. So, we also intend, as part of our enhanced framework, to increase the CMC's capacity and provide more mediation training to grassroots leaders.
However, as several Members have noted, we cannot compel people to go for mediation. Currently, 60% of the cases registered with CMC do not turn up. There are also several difficult and long-standing cases that are initially resolved through mediation but later flare up again.
Several Members spoke about some of these very difficult cases and \"deadlocked disputes\". I share their concerns and that is why we had earlier set up an inter-agency team involving my Ministry, together with MinLaw, MHA, MND, and the team has proposed several measures to strengthen our community dispute resolution framework.
A key part of the framework is a Community Dispute Resolution Tribunal to adjudicate difficult cases between neighbours. The tribunal will have the powers to mandate mediation, to give parties the chance to communicate and compromise. The tribunal can also make judgements and issue orders which will have to be complied with, failing which there will be consequences including prosecution. The tribunal will provide legal recourse for difficult cases and especially for aggrieved parties. But I must qualify that the tribunal should neither be the first recourse nor the main way we resolve our disputes. This would be counter-productive. We want to promote community ownership and collective responsibility and mediation should remain the first priority. Ms Irene Ng also agrees with that and several Members as well. We do want the tribunal to be there but it should be there as a last resort, for the difficult cases.
For the tribunal to work well, we will require better frontline responses to community disputes and more effective enforcement capabilities. These are complex implementation issues, which the relevant agencies are working through, and we will build these capabilities progressively, starting with a few estates, learning from the experience and then scaling up over time.
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Mr Vikram Nair also asked about clear rules and penalties. As I have mentioned earlier, our key thrust is on public education and mediation but we recognise there are cases which do require rules and penalties. So, we are also looking at legislative amendments such as to the Miscellaneous Offences (Public Order and Nuisance) Act to allow the Police to take enforcement action if needed.
Ms Irene Ng highlighted that some of the more difficult dispute cases may involve persons with mental health issues and that we need to find different ways to tackle such cases. I agree with her and we are looking into this as part of the community dispute resolution framework but I would say that this is, in fact, a broader issue that requires further study into our mental health provisions, especially in the community. Again, here, the relevant agencies are looking into this, namely, MOH and MSF.
I have spoken about the importance of good neighbourliness and kindness to harmonious living. Another value that Singaporeans cherish is giving. Singaporeans are a generous people. They are willing to give of their time, treasure and energy to those in need.
This spirit of giving was certainly in our Pioneer Generation – they were prepared to serve, make sacrifices for one another and for the nation. And this same spirit of giving must continue in future generations. I think one good sign we see is in the trends of volunteerism. A survey by the National Volunteer and Philanthropy Centre shows that nearly one in three Singaporeans is engaged in volunteer work today, compared to just one in five two years ago. And Singaporeans are also donating more to help others.
We hope that more Singaporeans will continue to step forward. One challenge, as Mr Seah Kian Peng highlighted, is the \"bathtub effect\" in our volunteerism trend. Members can see it very clearly in the chart [Please refer to Annex 1.] Volunteer involvement is high among Singaporeans aged 15, in the younger age groups, but it declines sharply in their mid-20s as they enter the workplace. And participation comes back up again in their 30s, but it is still not as high as before.
As highlighted by Members, like Mr Seah Kian Peng and Miss Penny Low, obstacles to volunteering are chiefly when individuals enter the corporate world. So, we must do more to take a life-stage approach in volunteering, as Miss Low
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said, and encourage corporate giving.
In his Budget round-up speech, Deputy Prime Minister Tharman spoke about transforming the workplace culture and our social culture in two aspects: embracing older workers and self-service as the default. I would like to suggest a third aspect, which is to make giving part of the DNA of corporate Singapore. I believe this is something which several Members also mentioned, including Assoc Prof Eugene Tan in an earlier speech.
The workplace is where individuals spend a significant amount of their time. Our workplaces need to transform, if we want acts of giving to be a natural extension of work life.
I have spoken to several corporate leaders and many have expressed interest. However, some do not know how to get involved, lack confidence that their contributions will be put to good use, or think that giving makes little business sense. Some local companies may also find it harder to get involved than larger ones, or the MNCs, which have the experience of corporate giving in other countries. They also face resource constraints and the resultant costs may not seem sustainable.
Despite these challenges, there are SMEs in Singapore who make an effort to practise corporate giving because they want to give back to society. Take for example civil engineering company Feng Ming Construction. Feng Ming has a policy of donating one per cent of the value of each contract that it clinches. And aside from cash donations, Feng Ming also organises visits to homes or orphanages, and movie day outings twice a year, with all the staff taking part. According to the Managing Director, Mr Lim Hong Beng, he does this to instil values in his staff. And he said, \"If you take from society, you must give back to society. This is something I always tell my employees.\"
To transform our workplaces, we have to transform mindsets – that companies have the ability to give, no matter their size or their industry. When our corporate leaders set the tone, individuals in the workplace will have the opportunity to practise giving too.
Companies can also encourage other companies to be involved. One example is ABR Holdings Limited (ABR). They manage several food and beverage companies like Swensen's and Gloria Jean's, and have nurtured a spirit of giving that not only engages their own employees but also other businesses and their consumers. They use their F&B outlets for charitable
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causes, bringing cheer to children from Club Rainbow with life threatening and chronic illnesses by hosting birthday parties for them at Swensen's. And when it comes to fundraising, ABR also ropes in their suppliers. For the World Mental Health Day last year, ABR provided dollar-for-dollar matching for donations from their suppliers to the Institute of Mental Health.
These are just some examples of how companies can leverage on the networks and resources that are already at their fingertips to do good for communities in need. I hope that more companies will start to get involved. Public sector agencies can also step forward. Making giving a workplace norm sends a powerful message. It says that giving can coexist with the demands of building one's career and family, because one can never be too busy to do one's bit for society.
So, we in MCCY plan to do more to break down these barriers to corporate giving. We will work with our partners like NVPC, as well as like-minded companies to champion a strong corporate giving culture in Singapore. This is a key priority for us in the coming year and I will share more when our plans are ready.
Finally, let me touch on our plans for youths. Several Members spoke about this, and I share their hope and optimism about our young people. We want to expand opportunities for our youths to contribute in a sustained and meaningful way. And that is why we decided to set up the Youth Corps.
Both Miss Penny Low and Mr Hawazi Daipi asked for more details about the Youth Corps. Over the past few months, we have consulted youths from our Institutes of Higher Learning as well as many community partners about what they would like to see in the Youth Corps. We have also been studying youth-related and community organisations in other countries.
We are still finalising the programme details, but for now, we envisage that it will be a one-year programme with the following key components.
First, a structured residential training programme that equips youths with knowledge and skills in leadership, project management and service learning.
Second, an overseas community project in one of the regional countries.
Third, a community project in Singapore, undertaken in partnership with an existing NGO or community group, which would be sustainable and
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impactful and meet the needs of the community.
There is still much to be done and I have asked Minister of State Desmond Lee, who is also a board member of the National Youth Council, to chair an advisory committee comprising experienced youth leaders and members from the 3P sector to guide the development of this programme.
The Youth Corps will be launched in phases with a pilot intake in June this year; we think it is about the size of 200 youths. The pilot group will be drawn primarily from nominations by youth sector organisations (YSOs) and the Institutes of Higher Learning (IHLs). This first run will enable us to improve the design of the programme, and fine-tune the working protocols with different partners. So, we have brought in Outward Bound Singapore (OBS) as a key partner to implement the Youth Corps and we are also looking for other community partners to be involved.
After this first run, we will open up applications to more youths later in the year. I would encourage those who are passionate about impacting their communities to come forward and apply. We have a rigorous selection process, as Mr Hawazi Daipi mentioned, but we do not want that to be a deterrence to youths from stepping forward. We are not looking at academic qualifications. We are looking for youths with strong leadership qualities, a commitment to serve the community and a desire to learn. And we do want a diverse mix of youths in the Youth Corps. And that is why, when we do the Youth Corps programme, we look forward to a mix of students from ITE, Polytechnics and Universities coming together.
The Youth Corps will be the first national level programme of its kind. It is also a first in many steps towards more impactful youth development and engagement. To better support youth engagement in the community, NYC will strengthen its partnerships with schools and tertiary institutions, as well as other youth organisations. For example, we are working with schools to enable students to contribute their SG50 celebration ideas. I think it is something that Miss Penny Low highlighted just now. We have also developed resource kits for interactive lessons that will inspire students to organise their own activities, which can also be supported through the SG50 Celebration Fund.
In the coming months, MCCY will look at how to better engage youths through more youth-oriented spaces such as *SCAPE. All this will require more resources in NYC, so we will plan to strengthen its capacity and enlarge its reach
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to even more young Singaporeans and youth organisations.
Finally, Mdm Chair, to wrap up, let me go back to our SG50 celebration next year. I think it is an occasion to celebrate what we have achieved, but it is also an important milestone to reflect on what we want for the future.
What will Singapore be like in 50 years' time? In the Our Singapore Conversation, many Singaporeans shared their aspirations for the future – we want a strong \"kampong spirit\", we want to build a caring and compassionate society; we also want to strengthen the things that bind us together, like our national heritage, our shared memories and our communal spaces. The arts, heritage and sports, which I spoke about earlier yesterday, are part of this shared identity.
At the end of the day, it is for our youths today to shape the next 50 years into the Singapore they want. This generation of youths – those who are in their teens to their 30s, they are the post-post Pioneer Generation. In other words, we have the Pioneer Generation who are above 65; the post-Pioneer Generation – I suppose it will be many of us, 40s to early 60s – and the youths today who are the third generation.
Our pioneers laid the foundations for Singapore's rapid development. The next generation benefited from their hard work, and continued to build modern Singapore. What will the third generation do?
Now, we are all familiar with the Chinese proverb that family wealth does not last three generations. It is not just a Chinese saying; in fact, similar sayings can be found in many cultures. But there are also exceptions to this. And so it is for our country – our nation's destiny is not preordained, it is what we choose to make of it.
As we celebrate SG50, I hope that our youths will take the time to reflect on what they would like to do and what kind of Singapore they would like to have in 50 years' time. Their attitudes and mindsets are important – if they take Singapore today to be the pinnacle of achievements, then the rest of the journey will be an inevitable downhill slide. But if they see today's Singapore as a springboard for new and better possibilities, if they uphold the same pioneering spirit of our founding generation, then 50 years later, we will see an even bigger and better celebration for our centenary.
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Mdm Chair, we are investing in our youths, and I have faith in them. They are our future and we will work with them to make Singapore a good home for all generations.
The Chairman: We have a bit of time for clarifications. Mr Baey Yam Keng.
Mr Baey Yam Keng (Tampines): Thank you, Mdm Chair. I have two clarifications. First is regarding the $20 million fund that the Acting Minister talked about yesterday to raise the extension profile of Singaporean artists and cultural institutions for the next five years. The Straits Times reported today that the fund will not be opened for application by the artists but instead it will be recipients selected by the Ministry. I would like the Acting Minister to clarify if that is so. And if not, what would be the criteria for the artists to be selected?
My second clarification is related to the traditional arts, for which I will speak in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] The Senior Parliamentary Secretary mentioned yesterday that NAC will have a fund to support traditional arts groups. I would like to find out – in this five-year programme – how many groups have we supported? And when the five-year programme ends next year, will the Government consider extending it so as to give more support to these traditional arts groups?
Mr Lawrence Wong: I thank the Member for the very useful opportunity to clarify what was also raised in The Straits Times' Commentary today. We already have many existing grants to support overseas performances, which operate on an open-call basis.
The new $20 million fund is meant to complement and enhance our existing efforts, and it will operate in a different way to build on what we already have. It will be quite complex if you think about it, when we want to showcase our artists overseas, we have to think about what markets to go to, which audiences we want to target, if at all, what events and platforms. And these are international events which will have their own curators and organisers. We will also have to take their views into consideration. It may be an international showing; an international platform which may be curated separately, and we have to work with international stakeholders.
So, in working and operationalising this $20 million fund, we envision that it will operate differently from existing mechanisms using an open call. I think
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this will be more complex and it will require more consultations with the different stakeholders, including international organisers as well as our overseas missions. So, as we implement and operationalise the fund, we have to take into account these considerations. But I would like to assure the Member that one important group we would certainly want to consult is our local artists and our art community. As we work out the selection process and the criteria for the use of the fund, we will be having extensive consultations with the artists and arts groups in Singapore before we make any decisions and finalise the mechanics of the fund.
The Chairman: Senior Parliamentary Secretary Sam Tan.
The Senior Parliamentary Secretary to the Acting Minister for Culture, Community and Youth (Mr Sam Tan Chin Siong): Mdm Chair, I will respond to Mr Baey Yam Keng's other question.
(In Mandarin): [Please refer to Vernacular Speech.] I thank Mr Baey for his question. Like Mr Baey, we are also very concerned about the development and future of traditional arts in Singapore. Traditional arts are an important part of our heritage. Therefore, the National Arts Council (NAC) will continue to support their development. Please allow me to take this opportunity to explain what traditional arts constitute and their current situation.
As most traditional arts are currently practised by interested amateurs, NAC's support and training will strengthen the management of the traditional arts groups and help them to become more professional. We hope this will strengthen the organisational structure of the arts groups so that they can put up better performances and attract more audiences. This is a long and arduous process which cannot be achieved overnight.
In terms of financial support, in the past five years, the Government has increased its funding under the National Traditional Arts Plan from $1.1 million in FY 2010 to over $5 million today. The increase was about five times and it was in line with the funding needs of the traditional arts. We estimate that from 2010 to end of 2014, the Government's total funding support for traditional arts would reach close to $17 million. In the past two years, under the main and seed funding programmes, our support for traditional arts has increased by more than 80%, from $1.07 million in 2011 to $1.97 million in 2013.
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Mr Baey also asked if the National Traditional Arts Plan would be extended. Indeed, we will extend the programme after its expiration. In order to improve the efficiency of this programme, we will consult traditional arts practitioners. By then, I hope that Mr Baey and all those who are passionate about traditional arts will also give their feedback and suggestions.
Last of all, I would like to emphasise that the Government is always committed to supporting our traditional arts. We hope that through our long-term support and cultivation, traditional arts will be able to bloom and flourish.
The Chairman: I see hands being put up, but we have very little time left, so if you could keep your clarifications and replies short, more people can raise clarifications. Ms Tin Pei Ling.
Ms Tin Pei Ling: Thank you, Madam. I have one supplementary question on community meditation. It is a point that I raised in my speech and I would like to have it addressed. The point is about whether neutral parties can help to make application for meditation, should both parties refuse to go to the meditation on their own. One of the issues now is that they have an ongoing dispute, but neither side is willing go to the meditation and it just continues. It affects the environment and the neighbours around them. I hope that the Minister can help to address this.
Mr Lawrence Wong: We will look into the suggestion. In fact, we are having a public consultation now for the Community Dispute Resolution Framework, including the way the tribunal operates, but we will be happy to take the suggestion and study this. We have not finalised but I must add the qualification that whatever measures we take, we must not undermine the personal ownership and responsibility for resolving the dispute. So, even if the application is by a third party, there needs to be responsibility placed on the parties in dispute to want to come together to resolve the dispute by themselves.
Ms Janice Koh (Nominated Member): Thank you, Madam. I wish to thank the Minister for being so responsive to my continued call for greater protection of our public artworks. I have three clarifications.
The first is regarding the 25 community nodes around the island to encourage arts participation. Are we building the capacity of our own cultural officers and actively training them to work with artists and to develop new audiences? The feedback on the ground from arts practitioners is that there is limited knowledge and experience amongst, say, the PA and CDC staff on the
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ground. How can we ensure that these key arts personnel at these 25 nodes have the relevant training and experience?
Second, regarding the $20 million Cultural Diplomacy Fund. Bringing our arts overseas requires people with the domain knowledge, experience, and the personal connections with major venues and festivals overseas, and such relationships are not built overnight. It sounds like MCCY is acting like a bridge builder. How will the Ministry build the capacity within the Government to establish these relationships and will the Ministry consider extending this funding, not just to arts groups but also to intermediaries like producers and agents who already have the domain experience in marketing Singapore artists overseas?
My final clarification and I have spoken much at this debate on the potential of tapping into our Singapore films, contemporary music and designers, which are all part of our creative industries. How will we tap on these sectors as part of our cultural diplomacy efforts? I know these sectors are not under MCCY's charge, but will funding be open to these sectors as well, as part of our cultural diplomacy efforts? And will funding be open to Singapore artists who are already based and working overseas?
Mr Lawrence Wong: Madam, I agree with the Member that capability building is an important part of this. We need to do more for capability building in terms of the cultural officers within Government itself, not necessarily just within the PA and CDC, because some of them also reside also in the libraries and some of them reside in the Esplanade which also does a lot of community outreach. So, we are looking at how we can strengthen that. That is certainly something we are focused on.
Likewise for what the Member talked about, there is a lot more bridge building that we need, as she has put it. Similarly, we will have to strengthen that part of what NAC is doing today – establishing these linkages with many of these overseas platforms. We will study whether we can extend funding and support to intermediaries, meaning to say, we do not necessarily have to do everything within Government. We can find partners that we can do the work with.
On the last point, we would certainly be open to using the fund to support the wide range of Singapore's arts and culture, not necessarily limited to what MCCY is looking at, including film, music and design.
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Mr Nicholas Fang (Nominated Member): Thank you, Madam. Apologies to the Minister to strain his voice for replies to two supplementary questions.
In my cut yesterday on sporting culture, I mentioned that there seems to be a need for a greater appreciation of sports as an entertainment option comparable to movies, theatres and things like that. Would the Ministry consider doing anything to help local providers of such events or organisers for such events with some support? That is, some guidance as to how to create iconic events that Singaporeans will appreciate as sports and entertainment options, rather than just participative.
My second question is related to the heartening news of the greater encouragement for the greater spirit of giving among corporates in Singapore. I would like to ask the Minister how this balances them with efforts to encourage individual philanthropy and how to strike a balance between the two elements.
Mr Lawrence Wong: On the first point, sports entertainment is something I think we want to build up. We do not have a lot of expertise in this, but that is a direction to go for some of these sports events, which can be built up to more than just sports alone but can incorporate entertainment and lifestyle. We have already done it quite well for the F1. The next major project which we are doing is the WTA Championship, and STB and various Government agencies which have been involved in the F1 are also assisting and discussing with WTA Championship organisers on how they can make that event into more than just a tennis event, but also a broader entertainment and lifestyle event. Progressively, as we build up these capabilities, we will be able to do more in other sports as well.
On corporate giving, I do not see that as detracting from our efforts to promote individual giving. They are mutually reinforcing. Many individuals who give are themselves corporate leaders, and so as leaders in the corporate, if they are good individual givers, then, hopefully, they would also take that approach in the way they manage their companies and that culture can then be translated into the workplace. The other way round as well, because if somebody who is running a company, an SME, does something within the organisation, they can take a personal satisfaction in giving, that will hopefully filter down into their own personal lives.
Er Dr Lee Bee Wah (Nee Soon): Thank you, Mdm Chairman. I have two clarifications. I would like to thank the Minister for not forgetting about Yishun in the community-based sporting-based facilities planning. Many residents say
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that the swimming pool is very run-down. I would like to ask the Minister when will this be done because I did not see Yishun in the beautiful pictures yesterday.
Next question. I am very excited about the new Sports Hub. I am glad to see that there will be world-class tennis and netball events, but we seem to have forgotten about the game that has brought us three Olympic medals. When will we have a world-class table tennis competition in Singapore?
Mr Lawrence Wong: Madam, I do not have any specific details which I can provide satisfactorily to the Member. I mean these are things that we will continue to do, because Nee Soon is in the pipeline. I do not have the details with me, but we can discuss offline when it is coming. Our plan is a long-term plan and progressively it will cover the whole of Singapore.
On table tennis in the Sports Hub, we rely on organisers and promoters to bring in international events. I think if there are interested parties who would like to discuss with SSC or the Sports Hub Private Limited – the consortium running the Sports Hub – on anchoring an international table tennis championship in Singapore, we will be happy to discuss this with them.
Mr David Ong (Jurong): Thank you, Madam. The Senior Parliamentary Secretary spoke about the importance of keeping our heritage alive. I know that there is a heritage grant scheme to achieve this objective. I would want to check with the Senior Parliamentary Secretary on the progress of this scheme, how many have taken up this scheme? Can he share with us the types of projects that have been supported?
The second clarification is for the Minister to see how we better profile and develop our sports ambassadors. How do we leverage on their popularity and achievements? For me, I have the privilege of listening to Mr C Kunalan sharing his achievements in school. Students may not know him, but after a session, I tell you they were totally in awe. He is a giant not only in sports, but also as a person —
The Chairman: You have only one minute, Mr Ong.
Mr David Ong: I hope the Minister can develop ambassadors for sports and have them share in the community.
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Mr Sam Tan Chin Siong: Mr Ong asked about how much has been spent on the Heritage Grant scheme. In less than a year since the inception of this scheme in August 2013, $1.4 million has been spent to support 46 community-initiated and ground-up heritage projects. As to what types of projects, I will brief Mr Ong offline, because I need to give some time for my Minister to respond to the next question.
Mr Lawrence Wong: Madam, I agree with Mr David Ong's suggestion on building up more sports ambassadors. We are already doing so. There are two groups that we are doing this with. One is our current athletes. I think we can do more to profile them, and to bring them out into the community to engage young children to motivate them. There is a plan to do that. We can also do another second group, and it would be for the former athletes, including many pioneer athletes like Mr C Kunalan. Again, we will see how we can engage them better, and tap on their experience, stories to motivate and go out to engage the community, including many of our young children in schools. That is something which we are planning to do.
The Chairman: Mr Baey Yam Keng, do you wish to withdraw your amendment?
Mr Baey Yam Keng: Thank you, Madam. I would like to thank Acting Minister Lawrence Wong, Senior Parliamentary Secretary Sam Tan, Assoc Prof Dr Yaacob and although she did not get a chance to speak – Mayor Amy Khor – for their patience in listening to the GPC and to other Members, and also addressing our concerns and views on the wide portfolio that MCCY is handling. I would like also to thank the Permanent Secretary, the staff at the Ministry and the various Statutory Boards for your hard work. Just like the windows in your Ministry's building, your work adds colour to Singapore and the life of Singaporeans. With that, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $1,284,076,300 for Head X ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $678,450,600 for Head X ordered to stand part of the Development Estimates. (proc text)]
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","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head O (Ministry of Health)","subTitle":null,"sectionType":"OS","content":"Dr Lam Pin Min (Sengkang West): Mdm Chair, I beg to move, \"That the total sum to be allocated for Head O of the Estimates be reduced by $100\".
Singapore's healthcare system has developed and evolved through the years to what it is today, through a mix of pragmatism, eclecticism, learning and adapting from best practices to arrive at a formula that works for us. It is a system built on firm foundations, resting on the tenets of individual responsibility, ensuring healthcare quality, accessibility and affordability through Governmental support.
Our healthcare system has been the subject of numerous comparisons and, more often than not, has been praised for its efficiency and quality. In a 2012 Forbes article, Singapore's healthcare experience was touted as a \"Singaporean Miracle\". I quote the article here: \"Singapore has, arguably, the most market-oriented system in the world. Singapore's GDP per capita is about 20% higher than America's, with comparable (if not higher) health outcomes, and spends an absurdly low amount on healthcare relative to the West.\"
Similarly, in 2013, Slate magazine also published an article that highlighted aspects of Singapore healthcare; Government subsidies, MediSave, MediShield and MediFund which America could learn from. The effectiveness of Singapore healthcare is further affirmed by a Bloomberg Healthcare survey, which ranked us second, in terms of efficiency, no doubt helped by our low GDP per capita spending and healthcare cost per capita.
The accolades accorded to us are many, but we all know that we are not perfect and we continue to face many challenges and issues in our healthcare system. The rapidly ageing demographics will also impose additional strain on our healthcare system. With a good healthcare system, life expectancies of Singaporeans have also improved. Income inequalities in Singapore have also risen, and together with rising medical costs, reflect the key challenges that we in Singapore need to deal with.
Nonetheless, let us not rest on our laurels even as we are acknowledged worldwide for our efficient healthcare system, but ensure that we remain at the forefront to meet the healthcare needs of Singaporeans. My colleagues and I have raised some of these challenges and made recommendations in the GPC
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(Health) Report submitted to MOH last August.
In recent months, we have also seen signs that the bed crunch situation is not abating. While we seek to add more beds to the system in the form of acute and community hospitals, let us not lose sight of the bigger picture. To me, the bed crunch is just a manifestation of the underlying fact that we have not effectively deployed our resources and ensure right siting of care. They are many measures we can take to ensure the right siting of resources, for instance, ensuring that A&E services are not over taxed by minor non-urgent cases, or encouraging the primary care and private sectors to take up more of the burden of our acute public hospitals. In these terms, what steps then is the Ministry taking to restructure our system to ensure the right siting of care and the full use of our limited resources, both in the public and private sectors? What is MOH's plan with regard to health and social care integration?
While we strive to restructure and ensure our healthcare system remains accessible to all Singaporeans, let us also remember that affordability is one key concern of many Singaporeans, especially the elderly and the low- and middle-income families. I have in the past pointed out that medical inflation is rapidly outstripping wage increases. Income inequalities would also lead to difficulties from the low- and middle income groups to afford medical services. While we have means tested subsidies, we need to ensure that our services remain affordable to all.
In this view, I would like to know the measures that the Ministry will be taking to ensure that healthcare remains affordable for all Singaporeans in the next decade. Will the Ministry consider measures like introducing a fixed treatment rate for low-income Singaporeans at CHAS GPs and polyclinics for certain common ailments and chronic diseases, or expanding the standard drug list by including more essential drugs used in the treatment of common conditions and surveying and making public information on fees across the healthcare industry?
I do not want to sound like a broken record, but the liberalisation of MediSave use is one area my fellow GPC Members and I have been calling for over the years. Many Singaporeans have given me feedback that they have sufficient MediSave in their CPF but the current rules do not allow them to use beyond the current ceiling. For example, $400 per year is allowed for use in the Chronic Disease Management Programme (CDMP). Can we allow more MediSave to be used for outpatient treatment of chronic diseases, or even purchase drugs, or essential medical paraphernalia? This will definitely help ease the out of pocket expenditure on healthcare services for many
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Singaporeans.
Let us also remember that while the tool may be sharp, the worker also needs to be skilled. Indeed, while we have a good tool in the form of our healthcare system, we also need good people to run it. Without them, the doctors, the nurses, the pharmacists, the administrators or even the cleaners in our healthcare system, we will not be able to meet the needs and expectations of Singaporeans. Between 2007 and 2012, Singapore's doctor-to-population ratio improved from 1:620 to 1:520. Similarly, our nurse-to-population ratio also improved from 1:205 to 1:154. However, how are we compared to other developed nations in the West?
In recent years, with the tight labour market and high demand for healthcare workers, we have had our fair share of healthcare professionals from overseas. With the anticipated opening of more hospitals and step-down care facilities, we will need more good people in our healthcare system. In this context, I would like to know the short- and long-term plans to develop the manpower necessary to meet our future needs, and also measures to ensure that foreign healthcare workers are well integrated and capable of delivering the high standard of care expected.
At the same time, with the ageing population, we will expect our healthcare utilisation to increase. Many people have often taken a rather pessimistic perspective of ageing as a \"silver tsunami\", adding burden to the society. As you may know, tsunami is a series of gigantic tidal wave with enormous destructive power, often causing mayhem along its path. It has a rather negative connotation. But I would beg to differ and see ageing as something beautiful. An aged person is like a treasure to the people around. As the Chinese saying goes: 家有一老, 如有一宝.
Let me quote a poem entitled \"Treasure\" by Cara Marie Filipeli:
\"Oh the value of the elderly! How could anyone not know.
They hold so many keys, so many things they can show.
We all will reach the other side this I firmly believe,
And the elderly are closest oh what clues we could retrieve.
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For their characters are closest to how we'll be on high.
They are the ones most developed, you can see it if you try.
They've let go of the frivolous, and kept things that are dear.
The memories of so sweet, of loved ones that were near.
As a nation we are missing our greatest true resource,
To get to know our elders and let them guide our course.\"
This poem captures the essence of what I view and want growing old to be. As a society, we need a mindset change. Growing old should not be seen as a burden. In every elderly, there is a person who has lived a meaningful and fulfilling life, just like any of us. Our elders have devoted their lives to the building of our nation. Even when they are old, they still have a role to play. They have seeds of wisdom which they can share with us. Many of them want to continue to contribute to the society.
Madam, the Pioneer Generation Package, MediShield Life and the SG50 Seniors' Programme announced by Deputy Prime Minister Tharman in his Budget Speech are good initiatives to address the needs of the elderly. MOH can perhaps consider engaging professionals and subject matter experts to look closely into the issue of ageing holistically – by consulting the public widely on an array of ageing related issues, so as to address all aspects of ageing, not just one-off, but for the long haul. Maybe we can even consider having a national conversation on ageing, and collectively decide on how we want to engage one another and make ageing as something beautiful. One thing for sure, if we are lucky and live a healthy lifestyle, we will reach the other side.
Dr Lily Neo (Tanjong Pagar): A well-planned policy calls for enhanced awareness and early intervention to try to cushion the exponentially-increasing demands on our healthcare needs in the years ahead. The old adage \"Prevention is better than cure\" is even more apt today than ever. MOH should step up on the following areas.
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One, promotion of healthy lifestyles to prevent chronic diseases and better control of chronic diseases. Apart of strengthening the existing programmes, I feel that MOH should be more actively promoting this at workplaces targeting the young. There should be even more campaigns to promote healthy living and prevent chronic diseases.
Two, at any one time, there would be some 8% of the elderly requiring step-down care of varying levels of intensity. There must be adequate step-down care facilities available to ease this transition. Such step-down care facilities should also include not only those for physical illnesses but also for mental illnesses and dementia. May I ask the Minister if such facilities are adequately available for now and for future planning? This is important to avoid over dependence of expensive hospital care. Is there any better method on the postulations on healthcare needs here? For instance, is there consideration for the increasing life expectancy of the populace? Also, how much healthcare will those above 90 and 100 years of age need; we presently have 10,000 and 1,000 of them respectively?
Three, homecare translates into convenience and much lower costs for many and, hence, a happier situation for our people. Homecare provision will enable patients to be cared for in their own homes for as long as possible and will thus lessen reliance on acute hospital care or other community hospital care. It is time that MOH established more and better homecare facilities.
Four, sharing of best practices, preventing over servicing, maximising limited resources, avoiding duplication, better integrating public hospitals and improving productivity drive are areas that need further emphasis. MOH should facilitate and reward innovations to save costs. One important issue still remaining is for MOH to ensure the high quality of healthcare personnel, despite facing its many challenges. The training of our doctors to retain our well-known and established high Singapore standard must be preserved.
Five, my concern now is that with the increased subsidy for SOCs, as announced in the Budget, whether it will drive up demand and further stretch SOCs' capacity. Correct remuneration must be in place in our public hospitals to avoid overuse on specialists' services, over-ordering of prescriptions, or over-using and over-pricing of procedures.
As far as possible, we should empower people to take responsibility of their own health. MOH should emphasise and incentivise people to lead healthy lifestyles and keep physically and mentally well. For instance, can MediShield
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premiums be priced with refunds when certain ideal BMI is maintained, especially for the young? For those with chronic diseases, they can be incentivised for having well controlled diabetes, hypertension and high cholesterol.
We all agree on \"right-siting\" in medicine or that we need to have patients treated in the most appropriate locations by medically-competent teams at the lowest possible cost. Has MOH endeavoured to have better \"right-siting\" so far?
For example, is it correct to reward specialists in the hospitals on the numbers of patients they see? Are step-down care services incentivised enough to take the load from tertiary institutions? Are we having enough campaigns to bring out the awareness of preventive medicine? Are we having the right kind of medical care providers? For example, can we train more medical workers to take the job of nurses for homecare? This list can be non-exhaustive and we need to pursue it at all angles by all healthcare providers. Could the Minister make it a priority for all to adopt this mindset and find the best solutions?
Lastly, there are increasing numbers of psychiatric cases in Singapore. Could the Minister provide better care for them? There is an urgent need to promote awareness and to remove the prejudices on mental illnesses. Are there enough step-down care facilities for those discharged from hospitals so that we avoid sending them all directly back to the community? Can there be better provision of psychiatric diagnosis and follow-up of patients living in the community? Can there be better follow-up and care for such patients in the community by psychiatric personnel and can the families of such patients be given assistance to care for their sick family members?
Mr Low Thia Khiang (Aljunied): Madam, \"Hospitals facing severe bed crunch take unusual steps\" made the front page of The Straits Times at the beginning of this year.
The hospital bed crunch, together with the public transport \"crush\" and the riot in Little India, are stark examples of Third World problems in First World Singapore. One certainly hopes that Singapore does not make history by going from Third World to First and back to Third within one generation.
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The hospital bed crunch is not a new problem and we have been reminded of this problem on multiple occasions over the past few years. Although this problem tends to wax and wane, and some attribute it to \"seasonal variations\" dependent on infectious disease epidemics and the spike of \"social stayers\" during festive seasons, I think it has now reached a level of sufficient importance to warrant MOH to take a hard look.
At present, subsidised beds within the Government restructured hospitals comprise 81% of the total bed count, while non-subsidised beds comprise 19%. Instead of using tents and corridors, ward space currently used for the provision of non-subsidised beds can be converted to subsidised beds so as to quickly increase the bed availability within the current physical confines of the Government restructured hospitals.
The Minister for Health has noted that the conversion from non-subsidised beds to subsidised beds will entail changes in \"infrastructure design\". But these changes in \"infrastructure design\" will take less time to achieve compared to the construction of a new hospital; and the manpower needs that arise will be less than the manpower needed to run a new hospital.
A WP member told me that her 97-year-old grandmother waited for 23 hours for a bed. A former NMP also witnessed the bed crunch when her husband had to wait over eight hours before being given a hospital bed. She observed that, I quote, \"when it happens so frequently, then it's no longer a glitch; it's the new norm\".
The question is what has happened to the master plans for hospital beds five, 10 years ago? Furthermore, if we are currently playing catch-up, then the question is, \"Are Singapore public hospitals on track to meet future healthcare needs?\", given that our population is still expanding and still ageing?
Madam, many of our Government restructured hospitals are Joint Commission International (JCI) accredited. This internationally recognised accreditation is awarded to hospitals that meet certain standards for patient safety. The standards for patient safety are stringent and include a minimum distance between patient beds and adequate sinks or toilet facilities so as to reduce the rate of hospital acquired infections. Are housing patients along corridors and in tents acceptable to the JCI?
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Mr R Dhinakaran (Nominated Member): Thank you, Madam. We have made significant commitments in our recent Budget to ensure more affordable healthcare for our elders, especially to our Pioneer Generation citizens, who deserve to be helped in their twilight years. While we are ensuring financial incentives are given for the patients to get the healthcare needed, it is a matter of concern that our hospitals are ill-equipped to handle the large number of elderly citizens we have. The acute shortage of beds in our hospitals and the long queues to get the attention of doctors at A&E departments are worrying. It is necessary to have at least one or two senior doctors in the A&E department at all times to ensure immediate and right attention is given to our patients.
In the absence of beds, it is important that we establish tie-ups with private hospitals that may have facilities so that the patients can move to the private hospitals with beds. This is important to save critical patients. The Government has to come up with schemes to allow the tie-ups with private hospitals and subsidise the differential costs. It is quite possible that immediate attention can make the cure easier and avert casualties in critical cases. The immediate steps will help while the current plans to increase 11,000 beds by 2020 are realised.
With an ageing population, it is better that we run surplus beds at any point in time than wait for demand to catch up and have periods of shortage. Our aim should be to ensure that affordable healthcare is available and long waiting times for doctors and facilities do not come in the way of speedy attention and recovery ever.
Dr Teo Ho Pin (Bukit Panjang): Madam, every community must have a community hospital to save more lives. With a fast ageing population and our ageing in place society, more community hospitals must be built within the community to meet the future healthcare needs of our elderly and population.
Community hospitals can play a bigger role to support an ageing and more densely populated community by serving as a one-stop medical service facility.
Madam, we should consider expanding the range of healthcare services offered by community hospitals. Community hospitals or Integrated Healthcare Complexes should provide a complete range of services, such as emergency services, outpatient clinic, specialist outpatient clinic, hospitalisation, rehabilitation, community health education and quarantine facility in times of
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crisis.
Madam, I understand that the Ministry is planning to build four more community hospitals by 2020. But, not all community hospitals are conveniently located in HDB housing estates to provide accessible, affordable and quality care to our people.
To the elderly, the speed of response for medical emergencies will make a difference between life and death. For normal medical consultations, the travelling distance to medical facility will affect the accessibility, affordability and quality of care.
Madam, the location of community hospitals will have a direct impact on the survival rate of patients. It will also affect the convenience, and costs incurred by the elderly and their caregivers. Siting community hospitals within housing estate will have added advantages as it can be a training centre to promote healthcare education in the community.
More healthcare personnel, volunteers and caregivers can also be trained to strengthen the medical support system of the community. In addition, the community hospital can support home care services in the community, thus allowing more patients to recuperate at home.
Madam, I wish to ask the Minister the following questions.
One, what are the planning norms to build a community hospital? Are there plans to build community hospitals in HDB housing estates?
Two, can the Ministry consider providing more grant to support VWOs to set up more community hospitals?
Three, can the Ministry provide more funds to community hospitals to support community health education, such as promoting healthy lifestyle, disease prevention talks and training of caregivers?
Mr Gerald Giam Yean Song (Non-Constituency Member): Madam, telehealth is a mode of healthcare delivery that uses technology to enable remote diagnosis, consultation, treatment, education and care management of
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patients. It includes the use of home monitoring of chronic diseases, remote consultations between patients and providers, and video-conferencing between doctors in different hospitals.
Telehealth has the potential to reduce healthcare costs, increase the level of convenience for patients and improve patient outcomes.
One key barrier to a greater adoption of telehealth is the absence of an agreed-upon reimbursement model. If doctors cannot get paid for telehealth consultations, they are more likely to ask patients to come to the clinic for a face-to-face consultation. Similarly, if patients cannot use their MediSave or receive subsidies to pay for telehealth consultations, they would be more likely to choose to make the trip down to the clinic.
Given the cost savings, improved outcome and improved patient satisfaction that telehealth has the potential to bring, the Ministry should look into ways to increase its adoption in Singapore.
These include providing the infrastructure and support to healthcare providers and patients in acquiring telehealth technologies, reforming reimbursement models for telehealth and revising any legislation that unduly inhibits telehealth adoption.
Mr Liang Eng Hwa (Holland-Bukit Timah): Mdm Chair, there are currently 18 polyclinics across the island serving our population. Although there are more than 1,400 private medical clinics, many of the long-term chronically ill patients still prefer to visit the polyclinics; for fear of expensive medical costs at the GPs.
With the Pioneer Generation Package and the other healthcare subsidies, seniors felt that it would be more value for money to seek their medical care at the polyclinics. Coupled with the rapidly ageing population, we can expect demand for polyclinics to increase sharply.
Under the MOH Primary Healthcare Masterplan, new models, such as the Family Medicine Clinics (FMC), would be introduced to provide comprehensive team-based care for patients with chronic disease. MOH will also develop more neighbourhood Community Health Centres (CHC) to provide other supporting
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services.
Notwithstanding these facilities, which are necessary, judging from the feedback I have received on the ground, most seniors still prefer simple, no frills and low-cost healthcare services at convenient locations. They like the straightforward affordability offered by polyclinics. Can MOH bring forward the 12 polyclinics that are to be built by 2030? Would MOH consider perhaps building more basic and smaller versions of polyclinic at more convenient locations to meet the local needs?
Some of the existing polyclinics are located at less-than-ideal locations, such as not within the walking distance of major transport nodes or far away from the town centres. Would MOH consider relocating some of them to more convenient locations?
Also, may I also ask the Minister for an update on the plans to build more FMCs and whether the charges by the FMCs will be comparable to those at polyclinics?
Mr Low Thia Khiang: Madam, advances in medical science and technology and an expanding and ageing population contributed to the increase in overall healthcare cost.
To mitigate increasing cost, healthcare systems should not focus on specialist-centric and resource draining hospital care, instead they should focus on preventive and primary healthcare, as well as intermediate and long-term care at the community or at home.
Next, I understand that in Government hospitals, a fee for service remuneration scheme that includes surcharges for private and foreign patients not only drives up the overall healthcare cost but also encourages senior specialists to focus greater attention on serving private and foreign patients.
This behaviour places the burden of care of subsidised patients on the more junior specialists. The resultant unequal distribution of workload among specialists leads to the younger specialists leaving the Government hospitals for private hospitals.
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Recent and repeated pay increases, such as the S$1.9 billion infusion in 2008 by MOH, have succeeded in driving up healthcare cost but failed to stem the flow of doctors from Government to private hospitals.
There is a general perception that specialists in private practice enjoy sky-high earnings compared to those in the Government hospitals. I am not sure how true this is but I think greater transparency in doctors' charges is needed.
Currently, \"hospital bill size\" displayed on MOH and some private hospitals' websites has only the \"total bill size\" without revealing how much is the doctor's charges. If the actual income between doctors in private and Government hospitals is more comparable and transparent, fewer specialists may be tempted to move from Government to private hospitals.
Making known the ethical and moral limits of professional fees for doctors in private practice in the form of a fee guideline will help to contain healthcare costs. Specialists in private practice require time to build up their client base. Those who are new to private practice may find that their initial income does not match their last-drawn pay in the Government hospitals. Some may increase their consultation and surgical charges to compensate for a smaller volume of patients so as to maintain their income. A fee guideline will discourage this practice and keep a lid on healthcare costs.
Finally, Madam, prudence must be exercised in the adoption of medical advances in therapies and technology. MOH should ensure that these medical advances are evidence based before adopting them into clinical practice.
Mr Gerald Giam Yean Song: Madam, traditionally, we contain healthcare costs by curbing patients' demand for healthcare. We do this by making patients co-pay, so that they think twice before seeing the doctor or requesting for more diagnostic tests.
However, most times, it is the doctors who decide on the course of treatment for the patients. Therefore, healthcare providers, not patients, drive the bulk of healthcare spending. If we want to control costs, we need more focus on the providers.
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Can MOH explore alternatives to the current fee-for-service payment approach? Fee-for-service payment tends to give providers a perverse incentive to boost revenue by increasing patient throughput, rather than keeping patients healthy and out of hospital.
Instead, MOH could better incentivise providers to contain the overall growth of healthcare costs across the continuum of care – from primary to acute to step-down care.
Doctors and healthcare providers should be given greater financial flexibility to redesign healthcare delivery, so that proven and cost effective services can be reimbursed. For example, we could reward providers for efforts to enhance patients' medication compliance, monitor patients' weight gain or blood sugar levels in their homes, or perform follow-up consultations using web conferencing.
Second, different providers should be better integrated and made collectively responsible for providing integrated care for patients. GPs, acute hospital specialists and step-down care professionals should be rewarded for cooperating and sharing information to improve quality and control costs, not simply by the volume or class of patients that they treat.
Mr Laurence Lien (Nominated Member): Mdm Chair, if I were 90 years old and had lived a good life, and I suddenly discovered I had cancer, I would probably refuse any curative treatment. In fact, I would want to do extreme sports. If I get an acute heart attack while bungee jumping at 90, I would die happy. Do we not all wish for this – to be fully functional all the way and then, one day, God takes us away suddenly and painlessly?
Longevity per se is not the issue. Whether one dies at 60 or 100 years old, the issue is how long that terminal sickness period is, how much pain the patient and family have to go through and the effort taken to try to cure that illness. A disproportionately large amount of healthcare resources is spent on the last weeks and months of one's life. Hence, end-of-life care becomes an important discipline.
How can we encourage the thinking and practice of end-of-life as a phase in healthcare? A phase where doctors see themselves as having the responsibility for recommending when medical science is no longer going to
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help patients recover. A phase where healthcare professionals take on the responsibility to respectfully help older patients and their families make informed choices, when the goal of care is more appropriately comfort than cure.
This is the difficulty of healthcare planning. We deal with life and death issues, and unlimited wants and limited resources. To ration scarce resources in Singapore, the ability and willingness to pay both have played important roles. Price is a market-clearing mechanism, with co-payment an important guard against over-consumption.
A lot of resources, through the Pioneer Generation Package and MediShield Life, are being poured into healthcare to increase affordability and accessibility. Would this lead to a sudden surge in excess demand and price? Minister Gan had mentioned in public that one of the strategies that MOH will be adopting is \"proper gatekeeping to ensure that access to high-end acute care is on a needs basis, assessed by medical professionals\". What would this gatekeeping look like? How would needs be assessed? Would this harm doctor-patient relations?
I am certain co-payment will continue to be an important tool to incentivise co-responsibility and guard against over-consumption. But healthcare is very complex, as we all know. We do not want to reduce consumption on everything. While we hope to moderate demand for acute care, we actually want, relatively, over-consumption on merit goods, including preventative efforts, like eating healthily and exercising, and upstream chronic disease management. These will reduce the burden on acute care in the longer term.
So, can we reduce the out-of pocket co-payment component to incentivise people to seek help for important chronic diseases early, using a revitalised primary care system that is a functioning ecosystem and community partnership of GPs, community healthcare workers, grassroots agencies and neighbours? Can we incentivise proper compliance with medication and the achievement of treatment targets as part of chronic disease management?
Can we also incentivise the use of community and step-down care in a way that increases the use of proper rehabilitation and recovery of patients from acute episodes to reduce the incidence of future permanent disabilities and multiple acute-care episodes?
I know these things are easy to ask for and difficult to do. I commend the extraordinary efforts that are going into improving healthcare. But I just want
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to re-emphasise that we need to spend smart and align incentives in the right way on the right things.
The Senior Minister of State, Prime Minister's Office (Mr Heng Chee How): Mdm Chair, MediShield Life and the Pioneer Generation Package aim to relieve citizen anxiety over the affordability of healthcare. These are very bold and important moves that the Government is taking to assure citizens of peace of mind in an essential area of life. Yet, this is just one half of the story. It helps answer the question of where the money for treatment will come from when a person falls ill.
It does not answer the question of how the cost of medical treatment can be kept as low as possible. We all know that healthcare cost inflation is very real. At the same time, it is not true that nothing can be done to keep it as low as possible.
In particular, experience in other countries point to two areas that I believe merit close attention. First, what treatments are necessary, appropriate and most cost-effective for patients? While we generally expect and trust the medical fraternity to think in the interests of patients, we must also be practical to know that there are many commercial and pecuniary incentives that attach themselves to the promotion and use of certain treatments, drugs and equipment. Furthermore, patients themselves are becoming more informed over time and may demand certain treatments, drugs and tests even when their doctors have not recommended them in the first place. The risk of this happening will increase further when insurance is seen as covering the payments and premiums are assured to be affordable.
I, therefore, feel that more proactive steps need to be taken to set out as clearly as possible what necessary, appropriate and cost-effective treatments are, at least for the key diseases that experiences elsewhere show the potential of cost runaways. I would like MOH to update on whether such steps are being taken.
Second, the cost of drugs. I know that generic drugs cost less than patented drugs and are encouraged to be used to keep cost down. I also know that the Government subsidises certain drugs to make them more affordable for patients.
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I would like to ask how we can examine the benefit of national procurement and the pricing of drugs. In countries such as Australia, I understand that there is a national drug procurement scheme to keep drugs sold to hospitals and medical establishments low and known. In this regard, I would like MOH to update on whether there could be national procurement of drugs to derive more benefit from bulk buying and also clarify whether the prices of drugs at public hospitals and polyclinics are kept at the lowest possible levels.
The Chairman: Minister Gan.
The Minister for Health (Mr Gan Kim Yong): Mdm Chair, I would like to first thank Members for all their comments and suggestions. With your permission, Mdm Chair, may I display some slides on the LED screens to facilitate the debate?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Mr Gan Kim Yong: Overall, Singaporeans are enjoying longer and healthier lives. This can be attributed not just to better access to quality medical care and improvements in health technology, but also the efforts of individuals and the community in leading and promoting healthier lifestyles. Going ahead, we will need to work together to address the challenges of demographic and lifestyle changes so as to continue to improve the health of all Singaporeans.
Two years ago, I shared with Parliament our \"Healthcare2020 Masterplan\" – to guide us in our preparation for the future. Focusing on three strategic objectives of enhancing accessibility, quality and affordability of healthcare for our people, Healthcare2020 provides the roadmap to a better and more inclusive healthcare system to cater to future needs and challenges, as mentioned by Dr Lam. Let me update the House on the progress of Healthcare2020 thus far.
First, on accessibility. As our population grows and ages, demand for healthcare services will rise. Our hospitals are, indeed, seeing an increase in the number of older and frailer patients. These elderly patients tend to require longer stays in our hospitals as it takes more time for their conditions to be stabilised and to be prepared for discharge.
Our family size is also becoming smaller over time. With less family support, family members may find it increasingly difficult to take the patients home in a timely manner. These factors contribute to an overall higher demand for
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healthcare services. In addition, as I have recently explained in the House, our hospitals have to manage periodic surges in demand, accentuated by outbreaks of diseases like dengue.
Mr Low Thia Khiang asked about capacity planning. Building capacity has been a key focus of our healthcare policy. Over the last 10 years between 2003 and 2013, we have increased public acute and community hospitals as well as nursing homes beds by over 30%. This includes the building of Khoo Teck Puat Hospital (KTPH). We also started planning for the new Ng Teng Fong General Hospital (NTFGH) even when Khoo Teck Puat Hospital was still under development.
As part of Healthcare2020, we have put in place plans to add more capacity to meet the long-term demand for healthcare services – a point raised by Mr Dhinakaran. At the end of this year, we can look forward to the opening of the new Ng Teng Fong General Hospital and the new Integrated Building at Changi General Hospital (CGH). Sengkang General Hospital will be ready by 2018.
We have also been expanding our Specialist Outpatient Clinic capacities – a point raised by Dr Lily Neo. We had recently completed the NUH Medical Centre last year and the new National Heart Centre (NHC) has just taken in its first patient a few days ago.
While these facilities and services are being built, in the short term, our hospitals are actively managing the demand for hospital services. In 2013, we had added more than 300 beds to existing facilities. In addition, we have tapped into the capacity in the private sector. Mr Dhinakaran would be happy to note that we have some 50 beds from Parkway East Hospital and Westpoint Hospital and are exploring further collaborations with other private hospitals.
We have also put in place programmes to facilitate the discharge of medically-fit patients, such as the Interim Care-giver Services (ICS), under which patients who are fit to go home are provided with temporary subsidised help while their family members work out their long-term care arrangements.
Take Mrs Annah Lee, for example. When her 77-year-old mother was first discharged from CGH, Thye Hua Kwan Interim Care-giver Service helped to take care of her and Mrs Lee was able to leave home with peace of mind to work while she worked out the permanent care arrangements.
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At the A&E, protocols are in place to take care of the patients. Patients are prioritised based on the severity of their presenting conditions when they arrive at the A&E. I can assure Mr Dhinakaran that the A&E team attends immediately to urgent cases. As elderly patients can present with symptoms which are less obvious compared to the general adult population, the A&E doctors do spend more time with them.
Our hospitals also deploy inpatient medical teams to initiate prompt medical assessment and definitive care at the A&E, even before patients are admitted, so that care will not be compromised.
However, I would like to urge Singaporeans to visit GPs for non-emergency conditions, so that our Emergency Departments' resources can be focused on those who really need emergency services.
Mr Low Thia Khiang asked if private beds can be converted into subsidised beds. I have previously explained in this House the constraints of this approach. In fact, National University Hospital (NUH) had converted some of its private beds into subsidised beds in 2013. It was not a straightforward process. NUH had to reconfigure the space and carry out renovations, such as rewiring and piping works for the addition of medical gas points, nurse substations and other supporting infrastructure. We actually lost the use of the wards for more than three months during the renovation.
As a Government, we must also ensure that our hospitals can meet the needs of all Singaporeans, both private and subsidised patients, and we need to strike a careful balance. When the subsidised beds are filled up, the hospitals will allow patients to be up-lodged into a higher bed class, if necessary. Hence, these private beds are already acting as potential capacity for subsidised patients when bed demand is high.
More importantly, we need to move beyond acute beds and provide appropriate care to patients in the right setting, especially in the Intermediate and Long-Term Care (ILTC) sector as well as the home care sector, as Mr Low Thia Khiang has also pointed out. We are already doing this by increasing the number of community hospital (CH) and nursing home beds.
We agree with Dr Teo Ho Pin that community hospitals play an important role in step-down care and we are planning more community hospitals
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islandwide, including in the heartlands. These include Jurong Community Hospital in the west, Yishun Community Hospital in the north, Sengkang Community Hospital in the northeast, and Outram Community Hospital in the central part of Singapore.
Altogether, from now until end 2020, we will add over 11,000 more acute hospital, community hospital and nursing home beds. Beyond 2020, we announced last year plans for four additional new acute hospitals. One of these will be the new integrated hospital development in Woodlands that Minister Khaw Boon Wan recently announced. Comprising an acute hospital, community hospital and a nursing home, this development will have about 1,800 beds in all and will open progressively from 2022.
We are also expanding capacity and capability in the community and home-care services to complement efforts in adding beds. This includes introducing new care models, which allow our elders to age in place and live their golden years with or close to their families.
I agree with Dr Lily Neo that home care is important and it will be a priority area for MOH in the coming years. I visited Japan last September to better understand how they cope with an ageing challenge and what we learnt reaffirmed our strategy to strengthen community and home care. With an ageing profile that is about 15 years ahead of us, Japan officials told me at the very beginning of the meetings that they wished Japan had started building home-care capacity earlier.
This reinforced our decision to build up our home-care capacity. This will allow us to support the different needs of our seniors and caregivers. Dr Amy Khor, Senior Minister of State for Health, will be talking more about our plans to develop our home-care services later on.
Madam, as we develop our hardware infrastructure by building new facilities and adding beds, it is, ultimately, our healthcare professionals who are at the heart of our healthcare delivery system. We will continue to invest and grow our healthcare manpower pool and raise the capabilities of healthcare professionals. Dr Amy Khor will also be sharing more of our plans in this area.
To meet our evolving healthcare needs, we cannot just continue to do more of the same. Increasing capacity alone cannot be sustainable in the long term. If left unchecked, demand will keep increasing and we will run up against the physical limits of space and manpower. A hospital-centric system is also not
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the best in meeting the needs of an ageing population, as patients' needs become more complex and require longer-term care.
As highlighted by Dr Lam Pin Min, reforms and restructuring of the healthcare sector are needed to cater to the future healthcare needs of Singaporeans. Therefore, Healthcare2020 is not just about building capacity, but also about transforming our delivery of care and raising the quality of care for Singaporeans.
Key to this strategy is the development of Regional Health Systems (RHS) to transform our model of care to be less reliant on acute hospitals, more integrated with primary care and more centred on the patient in the community and at home, as mentioned by Dr Lam Pin Min. Our healthcare delivery should allow patients to receive care that is more effective, less costly and in more appropriate settings.
Our healthcare clusters are already embarking on some of these new programmes. One good example is KTPH's Ageing in Place (AIP) programme, which focuses on patients with three or more hospital admissions within a six-month period.
Under this initiative, community nurses visit these patients regularly and develop holistic individual care plans to manage patients' health in their homes. During these visits, the nurses not only help to monitor the patients' medical conditions, they also conduct a home and social assessment to understand and manage the needs of the patients at home. In addition, the nurses help to advise the caregiver on how to provide proper care for the patient. By getting to know the patient better, the community nurses are also able to better motivate the patient to make lifestyle changes and reduce re-admission rates for the patients.
Take Mr Quek Chiu Boy, for example. Mr Quek is 86 years old and has a long history of diabetes, high blood pressure, high cholesterol and heart problems. After three admissions into hospital within five months, he was placed on the AIP programme. When community nurses visited, they found that Mr Quek did not take his medications regularly and preferred food that tended to be quite salty and oily, and not suitable for a diabetic. Through regular visits and calls, the nurses guided him to a healthier diet and to take his medication regularly. They also worked with the doctors to reduce his medications from 19 different types to seven types when his conditions improved.
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To prevent him from falling, the community nurses helped to arrange for grab bars and ramps to be installed at his home and applied for a motorised scooter to help him move around more easily. Mr Quek has since been doing very well on the programme. He can now go out and meet his friends daily and his blood sugar level is also under control through a healthier diet and medication. He has not been re-admitted to the hospital for more than a year. We wish him well.
More work has also been done upstream, to keep our population healthy by providing preventive health services for early detection and disease management where needed.
For example, through our Eastern Health Alliance's (EHA) ECHO screening programme, one of our residents, Mr Liang, found he had extremely high blood pressure. After some persuasion by Mrs Liang, he went to see a GP and realised that the reading had in fact gone even higher. I am sure this was not caused by the GP. He was immediately put on medication for hypertension. If not for the ECHO programme, his condition would have gone unnoticed and could have resulted in very serious complications later on.
We also need to think innovatively and find new ways to do things cheaper, better, faster, as my colleague Mr Lim Swee Say will say, but in our case, not just cheaper, better and faster, but also safer, including through telehealth initiatives, as mentioned by Mr Gerald Giam.
Telehealth is a promising mode of care and, if done correctly, will improve outcomes and possibly, reduce costs. For telehealth to work well in the long run, two key conditions must be in place. First, we will need to adjust the way care delivery is organised and secondly, there must be a sustainable model to ensure that the service is affordable to patients.
Already, we have a few telehealth projects in development. For example, Eastern Health Alliance Health Management Unit has been expanding their telecare system to monitor the progress of certain chronic and long-term disease patients.
Starting out with diabetic patients from CGH in 2010, the programme was expanded to patients discharged from St Andrew's Community Hospital in 2011. In 2012, it was further expanded to include patients with chronic obstructive pulmonary disease (COPD) and heart failures. The programme has enabled its
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nurses to monitor over 3,200 patients today.
This programme triggers telecarers to follow-up if a patient's test results show a worsening condition, when the patient visits the A&E, or misses a medical appointment. It also identifies needs and coordinate support services for the patient as part of his overall care management.
Acute stroke patients who are presented at CGH and KTPH's A&E Department are also provided with timely diagnosis and treatment, where appropriate, by off-site neurologists at NNI via real-time video-conferencing and review of the patient's CT scan. We will continue to pilot new telehealth models and share successful experiences among our institutions.
One critical piece in healthcare delivery is primary care. We need to further strengthen primary care so that residents can be better cared for in the community. To add on to the existing 18 polyclinics, we are constructing two new polyclinics in Pioneer and Punggol which will be ready by 2017. Beyond these, we have made plans to develop a further four new polyclinics by 2020 and another six to eight more by 2030. We will also develop new models to improve access to services by co-locating polyclinics with compatible community facilities where feasible. For instance, the redeveloped Bedok polyclinic will be situated within an integrated Community Hub.
I note Mr Liang Eng Hwa's suggestion to speed up these polyclinic developments. MOH assesses primary care needs based on demographic trends and we will bear in mind Mr Liang's comments. Meanwhile, MOH has been introducing other initiatives to improve access to primary care.
First and foremost, we have been continuing our efforts to tap on the capacity and capability of our GPs, in line with the Ministry's vision of one family physician for every Singaporean. Through the Community Health Assist Scheme or CHAS, over half a million Singaporeans are now able to receive subsidised care at about 1,000 GP and dental CHAS clinics around Singapore.
Our clusters have been actively building their partnerships with GPs as well. Under the GPFirst initiative, for instance, Eastern Health Alliance works with GPs in the east to educate and encourage the public to tap on GPs to manage non-emergency cases.
SingHealth also transfers stable chronic disease patients from Specialist Outpatient Clinics (SOCs) to their network GPs for continued management in
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the community, under the DOT (Delivering on Target) programme. We will continue to work with GPs to explore different models and collaborations to provide good care for our patients in the community.
Secondly, MOH has been working with GPs and the private sector on introducing Community Health Centres and Family Medicine Clinics. Four Family Medicine Clinics (FMCs) have since been set up in partnership with private sector GPs – in Clementi, Ang Mo Kio, Jurong and Chinatown. At these clinics, Singaporeans enjoy a subsidy through CHAS, and they can look forward to seeing the same family physician for each visit. These clinics are well equipped and staffed by nurses and health care professionals to care for the chronic diseases holistically.
Two more FMCs will be ready in June this year and we will continue to bring more on board over time.
Beyond FMCs, our GPs are also doing good work in chronic disease management, supported by nearby Community Health Centres which provide allied health and nursing services for patients referred by the GPs. Three Community Health Centres will be opened this year, one in Bedok, another in Tiong Bahru and the third will be a mobile one, which enables it to cover a wider area, in Ang Mo Kio, Toa Payoh and Hougang.
We are also encouraging our primary care physicians to continue to improve and upgrade themselves. With the establishment of the Register of Family Physicians in 2011, the majority of our GPs have upgraded themselves to be on the Register.
A good family physician can help to manage patients' conditions within the community. Take Mr Lim, for example. He is 79 years old and suffered from complications as a result of years of diabetes, and frequently visited his five different specialists at TTSH as a result. With a family physician, who focuses on his overall health and who coordinates his care amongst the various specialists, Mr Lim now only needs to see two specialists in TTSH and his frequency of seeing them has also decreased. His diabetes control has also improved.
Beyond supporting and developing new ways to work with GPs, we will also be working with the College of Family Physicians to celebrate the role of our family doctors at the World Family Doctor Day in May 2014. This is an important tribute to the role of these critical medical professionals which we
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hope will raise the profile of GPs in Singapore and raise the awareness of their capabilities.
Mdm Chair, I have outlined my Ministry's efforts to improve our healthcare delivery system to meet future needs. Improving healthcare is, however, only part of the strategy for better health. More importantly, we have to keep ourselves healthy so that we can continue to contribute positively to our community and families and enjoy a good quality of life, even as we age.
With the twin drivers of ageing and lifestyle changes, Singapore, like many other countries, is seeing an increasing number of people with chronic conditions and related diseases, such as heart disease, diabetes, stroke and cancer. These are major contributors to ill health and premature deaths in Singapore, and will likely continue to grow if current trends continue. However, as these diseases are highly influenced by lifestyle risk factors, including obesity, cigarette smoking and physical inactivity, we can reduce the impact of these risk factors by adopting healthier lifestyles.
Healthy living starts with each one of us and we have to be responsible for our own health. To help Singaporeans adopt healthy living, my Ministry and the Health Promotion Board will work to help individuals and families to better take charge of their health and nudge all of us to make healthier lifestyle choices.
In particular, we will focus on two key priorities, namely, obesity prevention and tobacco control, and target our strategies in three settings: in schools, at the workplace and within the community. These efforts will be complemented by preventive health initiatives to encourage early screening, detection and treatment of chronic diseases. My Parliamentary Secretary, Assoc Prof Dr Faishal, will be sharing more of our plans later on.
Let me now move on to ageing. Madam, as we continue to work hard to ready ourselves and our healthcare system to meet the needs of an ageing population, we need to be careful that we do not associate ageing inadvertently with decline and obsolescence, nor sickness or disability. This is not the case today. Seniors today contribute actively in various ways – they are caregivers to their children and grandchildren at home, they are valued employees at the workplace or active volunteers in our community. As Mr Lien mentioned, they could also be bungee jumpers today.
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Ageing can be a happy and fulfilling journey. As a society, we can come together to celebrate longevity and encourage seniors to continue staying physically, socially and mentally active. Even at their golden age, seniors can continue to grow as individuals, pick up new skills, pursue new interests that they did not have the time for when they were younger.
Mr Yap Yee Tham is one such example. He retired from Building Construction Authority at the age of 55. Drawn by the opportunities to pick up new skills in the fun environment and expand his social circle, he signed up for YAH! (Young at Heart) Transformation Course and graduated in 2006. But he did not stop there. Several years later, he signed up for a Bachelor of Science programme in Construction Project Management. Mr Yap completed his programme in 2011, and now armed with a degree, he has since returned to the workforce and started a new career at the age of 65. He works full time at a construction consultancy firm as a Resident Technical Officer and is looking to contribute for many more years to come. Mr Yap demonstrates how we can continue to develop ourselves and contribute as we age. We want to enable more seniors to age positively like Mr Yap, and we have put in place programmes to support seniors in doing so. Senior Minister of State Heng Chee How will elaborate more on the ageing issues.
We can celebrate ageing together as a nation. As announced by Deputy Prime Minister Tharman, the Ministerial Committee on Ageing (MCA) will reach out to businesses and organisations to coordinate an effort to celebrate and honour our seniors in the run-up to our 50th National Day Celebration next year. In particular, we hope that through this \"SG50-Seniors\" initiative, we can engage businesses, organisations and the community to contribute programmes and privileges for seniors, such as by giving seniors discounts for entry to places of recreation and leisure and also to participate in sports and other learning activities. We hope that the special privileges will encourage seniors to go out with their families and friends and live life to the fullest. MOH, as the secretariat for MCA, will coordinate this effort.
I agree with Dr Lam that we need to engage the public for many of our key initiatives and new changes, including this \"SG50 Seniors\" programme, PG Package as well as MediShield Life, which I will be talking about later on. Many of these are significant changes that require an extensive outreach effort to Singaporeans to help them understand the benefits available to them and, more importantly, how they can access these benefits. I welcome the community to help in the outreach – grassroots leaders, neighbours, voluntary organisations and employers – to help to spread the message. We will be forming an Inter-Ministry Task Force, led by Senior Ministers of State Josephine Teo and Dr Amy
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Khor, to take a whole-of-Government approach in communicating and reaching out to Singaporeans to help them understand these benefits. I thank Dr Lam for his suggestion to engage professional experts to help in the outreach. The Government will certainly consider his idea.
Mdm Chair, all of us will grow old. But, in the process, we should keep ourselves healthy and active. And by doing so, ageing need not be a burden and can be a positive experience. I want to particularly thank Dr Lam for the beautiful poem that he has cited. Let me just respond briefly in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Madam, Dr Lam has just mentioned that an elder at home is a treasure for the family. I fully agree. I think we should now say that besides being a treasure for the family, the elders are also our national treasures. The pioneers among us are not only a treasure for the family, but also valuable assets to our country and people. They deserve to be cherished and honoured.
(In English): Madam, collectively, we can shape societal mindsets about ageing. Through SG50-Seniors as well as many other programmes, I hope all of us can each play our part in our own way to celebrate ageing with our seniors and tell them that they are not a burden, tell them that they matter to us. Together, we can work to build Singapore to be a place where all of us, myself included, can look forward to our happy golden years, leading active, healthy and fulfilling lives. Together, we can make Singapore a Nation for All Ages.
Mr David Ong (Jurong): Mdm Chair, Singapore's healthcare expenditure has averaged around 4% of GDP and this is low when compared with many developed countries. This is modest, bordering on low, but achieving fairly good outcomes. Can we achieve better outcomes? I believe we can and can do more to remove Singaporeans' anxiety over their healthcare bills as they grow older. Our healthcare system hinges on what some call personal responsibility or others label it \"co-payment\". Some have argued that because of the benefits of preventive medicine, the co-share of health or cancer screening should be kept to a minimum. I am for a smaller co-share to encourage personal responsibility and to look after oneself, but not total eradication, as this encourages a buffet syndrome on healthcare.
The Specialist Outpatient Clinics (SOCs) of restructured hospitals like SGH are highly utilised. Now, with more subsidies at SOCs, it would be quite a
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shame if the high quality of our facilities and medical professionals is dented because the kinks of high demand and long waiting time for a referral at the clinic and queues for medicine are not ironed out.
I do hope that the Government can look at alleviating transport concerns by enhancing the Seniors' Mobility Fund to include seniors who are strapped with chronic illnesses but not wheelchair ambulant and have to make frequent visits to hospitals or clinics. We need to do more to enhance eldercare and, in particular, palliative care. At the moment, they left palliative care very much to the immediate family. By which time, they may have exhausted their resources in the face of terminal chronic diseases. I urge the Ministry to do more to assist end-of-life care. Can the Ministry update us on the take-up rate of home-care services and the plan to grow such services?
With more top-ups to seniors' MediSave Accounts, it is timely for us to review its usage to render more help, with home-based care expenses, non-standardised medicines as well as nursing home fees.
On nursing homes, I urge the Ministry to step up the make-over programme and raise the bar of our existing nursing homes so as to shirk off its stigma as a place of last resort, the place to die alone or a place of abandonment by their children. Our nursing home should be a place where seniors are cared for clinically and emotionally, a place where they can age actively and with dignity. Can the Ministry update us on the progress of the make-over programme as well as the implementation of the nursing home standards?
Healthcare 2020 Masterplan comes with a holistic plan of integrated healthcare that allows for seamless treatment from acute to step-down to home-based medical or palliative care. Given challenges in terms of manpower to complement these expanded facilities, can MOH advise that the Masterplan is on track for 2020?
Finally, building an inclusive and a caring environment for our seniors where they are valued, cared for and loved by those around them, as they age in their homes and the community, is a shared responsibility. We must harness the community spirit, the strength of families and the close collaboration of the public and private sectors to collectively help our seniors to age in place with grace and dignity.
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Mrs Lina Chiam (Non-Constituency Member): Madam, healthcare insurance is not the answer to all the problems we have at the moment. Some Singaporeans are self-employed and cannot afford it. Yet, others who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover. The problem with our healthcare system goes beyond the uninsured. More Singaporeans are also worried about the premiums, which can only increase with an ageing population.
Since insurance cost is lower with a larger pool, we may need to think out of the box. An idea we had was to pool the population among ASEAN countries in order to lower healthcare costs. These are synergies. Healthcare services are lower in our neighbouring countries. The idea is to pool the financial risk from among ASEAN countries. Medical services rendered would, of course, still depend on individual ASEAN countries.
The Singapore People's Party received feedback from one of our residents at our Meet-the-People Sessions that she was asked to take multiple tests on the day she was admitted due to heart palpitation. She was frustrated that our 3M system does not cover tests. If we do nothing to slow down these skyrocketing costs, Singaporeans will suffer. Also, there is no national medical database that doctors in private practice can also tap on – the current system is not well integrated.
We can mandate employer insurance just like the US, but this may not be the best way for Singaporeans. We understand that CPF contributions are greater than MediSave expenses at the moment. Perhaps, the time is ripe for us to consider expanding the coverage of the 3M system.
A politically safe move is to keep the system status quo. But that is not what the situation calls for. This is the time to discuss expansion of the coverage of the 3M system and to have more transparency on the CPF-capped contributions made versus the MediSave expenses.
Ms Lee Li Lian (Pungool East): Madam, both the Interim Disability Assistance Programme for the Elderly, better known as IDAPE, and ElderShield were launched in 2002. Singapore Citizens and Permanent Residents with
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MediSave are automatically covered by ElderShield at the age of 40.
IDAPE is a means-tested Government assistance scheme meant for elderly citizens who suffer from severe disability and who are not eligible for ElderShield because of their age or existing disabilities.
Currently, ElderShield 400 provides a payout of $400 per month for up to 72 months. The last reform done for ElderShield was in September 2007. IDAPE provides $150 per month for per capita household income of $1,800 and below, and $250 per month for per capita household income of $1,801 to $2,600.
In the case of IDAPE, the monthly subsidies of $150 and $250 are too low. This only marginally covers the cost of supporting an elderly person who is severely disabled who would need constant and specialised care. The payout period of six years is also too short, considering life expectancy has gone up and the elderly person may live for many years with his or her disability, with an unlikely chance of additional income or means. I call on the Government to review both the payout and the subsidies.
I propose that we raise the monthly subsidies in line with the current inflation rate of 1.4% and to extend the payout period from six to 10 years.
The Pioneer Generation Package was launched to recognise the contributions of senior citizens for nation-building. Hence, it is timely for MOH to conduct a review on both the payout for ElderShield and IDAPE to better support the care of the severely disabled elderly.
The Chairman: Dr Chia Shi-Lu is not here. Mr Heng Chee How.
Mr Heng Chee How: Mdm Chair, with MediShield being reviewed and transformed into MediShield Life, citizens will enjoy lifelong, inclusive and affordable health insurance coverage and greater peace of mind.
There is another national health-related insurance programme that I wish to draw attention to. This is the ElderShield programme, which was conceived as a form of disability insurance for citizens above the age of 40. When an
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ElderShield policyholder is no longer able to perform three or more Activities of Daily Living (ADLs), the policy will make cash payments of a certain amount over a given duration, according to the version of ElderShield purchased. While the cash payment is certainly helpful for general purposes, I note that there is no guidance or recommendation to consider using the money for eldercare or disability care purposes. I see that as a gap.
With ever increasing longevity, we must also prepare for the possible scenario of a more prolonged disability amongst some. This will include evolving better guidance to help insured persons and their caregivers on how and where to get help for disability care and stepping up the supply of such services to cope with anticipated growing needs. This will help slow down the rate of deterioration of disability conditions and help the disabled seniors maintain a better quality of life longer.
I feel, therefore, that ElderShield needs to be reviewed from its current parameters in terms of payout amount, and whether the Government could also consider ways to ensure affordability as well as how the ElderShield payouts should be directed toward appropriate eldercare services instead of just general expenses. I would also like MOH to update on whether it is planning to do such a review and, if so, over what dimensions and timeframe?
Assoc Prof Fatimah Lateef (Marine Parade): Madam, there has been a gradual enhancement and liberalisation to MediSave use over the years. One of the major evolutions was its use in CDMP and the gradual extension of the list of medical conditions up to the 15 today.
However, looking at the trend of our chronic illnesses, ageing population dynamics, medical and technological developments as well as the rate of complications, I think we are going to have to review this as well.
As such, can MOH consider extending the allowable ceiling or cap per MediSave account per year to be utilised for this; also to extend the repertoire of diseases that can be covered to include more psychological or mental illnesses, dental care as well, which can be costly, causing many of our seniors to have poor dentition, which affects chewing of food and thus digestion, connective tissue and rheumatic diseases; and also doing away with the co-payment of 15% and the $30 deductible? Finally, allowing MediSave use for outpatient tests, such as MRI, MEDI scans and Cat scans, will also help because
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these are costly investigations.
Ms Lee Li Lian: Madam, MediSave currently allows withdrawals for the following outpatient cancer treatments: radiotherapy, outpatient radio surgery treatment and outpatient chemotherapy. However, it is unclear if MediSave can be used for newer cancer therapies that do not fall under these categories.
With advances in medical technology, a range of new cancer treatment options which were not classified as chemotherapy are now being offered to patients, for example, tyrosine kinase inhibitors, better known as TKI drug therapy. These options are more targeted, acting only on cancer cells. It is anticipated that this class of treatments will grow in use and importance. Whether they are covered by MediSave has become unclear, not only to the frontline healthcare staff but, more importantly, to the patients and their families.
Uncertainty and confusion about whether they can afford to pay for these new treatments out of their MediSave accounts lead to anxieties for cancer patients and their families at a time when the focus should have been on them getting appropriate treatment.
Can the Minister clarify how he decides whether MediSave can be used for cancer therapies that do not fall under the currently provided categories? If MediSave is not currently allowed for a specific cancer therapy, what is the process to appeal for MediSave to be used? How can the review be fast-tracked on these types of therapies? Could the Ministry also release guidelines for the public on the eligibility of the different treatments available in the market to make the process less uncertain and confusing?
Mr Gerald Giam Yean Song: Madam, restrictions on MediSave withdrawals sometimes result in patients facing financial difficulties even though they have balances in their MediSave accounts. MediSave should be allowed for all medically necessary treatments that are of proven value and are cost-effective.
MOH should greatly expand the list of approved outpatient treatments under the chronic disease management programme. While 15 chronic diseases are now on the list, there are many others which are not but which require long-term medication and frequent consultations which can be very costly. The
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expanded MediSave withdrawal list should be updated regularly by an independent panel consisting of doctors and healthcare researchers.
In addition, patients above the age of 75 should be allowed to use their MediSave without being subject to annual limits. This will ensure that they are not deterred from seeking treatments because of high cash payments.
The Chairman: Dr Chia Shi-Lu, not in the Chamber. Mr Png Eng Huat.
Mr Png Eng Huat (Hougang): Madam, cancer is the leading cause of death in Singapore and the number of residents diagnosed with cancer is on the rise year-on-year. There are over 56,000 cases diagnosed among the resident population from 2008 to 2012.
Cancer is preventable and treatable. A person is considered cured of cancer after five years in remission. Cancer survivors do not need to take any more medication and only need to go for yearly medical check-ups, similar to what healthy people would do. In short, life for a cancer survivor can and will return to normalcy. However, cancer survivors are no longer insurable. While the disease can be completely removed from a patient, the stigma associated with cancer is embedded, not in the mind of the survivor but that of the health insurer.
Health insurance is about risk-pooling and managing risk. Unfortunately, commercial insurers become totally risk-averse when it comes to providing health coverage for people in complete remission. Even a social enterprise insurer like NTUC Income will not walk the road less travelled. A cancer survivor wrote to me to highlight her attempt to upgrade her existing integrated insurance plan but to no success, despite being given a clean bill of health by her doctor in supporting her application with a medical report. It is ironic that cancer is not a death sentence but cancer survivors have to serve out a life sentence of being uninsurable anymore.
Healthcare cost is a major concern for Singaporeans. I am glad that the Government is coming up with MediShield Life which promises coverage for all, regardless of health conditions. I seek clarifications from the Minister that cancer survivors and citizens diagnosed with other dreaded diseases will not be left out in the cold in the review of MediShield and that commercial insurers will have to incorporate the gist of the proposed MediShield Life into their
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integrated insurance plans as well.
Mr Gerald Giam Yean Song: Madam, I would like to make a few proposals regarding MediShield Life before the scheme is introduced next year.
First, I would like to reiterate my call for premium subsidies to be extended to all vulnerable groups of Singaporeans, including elderly persons with low savings but not only members of the Pioneer Generation, people with disabilities, those who have exhausted their MediSave and those who are already qualified for Government financial assistance schemes like MediFund, Public Assistance, ComCare and CHAS.
Second, can the $70,000 annual claim limit be removed from the insured's life? On the affected policyholders, it would be financially crippling if their insurance cover were removed when they reach the claim limit since they would already have spent a lot their savings on the co-payments. As fewer than 0.1% of policyholders reach the policy year limits every year, continuing to cover them will not result in significantly higher claims or premium burdens. What it would provide is tremendous peace of mind for them.
Third, MOH should ensure that MediShield Life does not follow the practice of some private insurers who sometimes reduce coverage after policyholders are diagnosed with an illness, to prevent them from claiming again when they suffer a relapse. This should apply to the integrated Shield plans that ride on MediShield Life.
And, fourth, can we have better coordination of MediShield Life with private and company health insurance to ensure that they do not overlap? This would avoid unnecessary premium payments which benefit no one but the insurers.
Dr Lam Pin Min: Madam, I read with anticipation the preliminary recommendations by the MediShield Life Review Committee. The call for the removal of the current life-time claim, increasing the daily claim limits and covering those who are currently uninsured are steps in the right direction. In particular, I applaud the call to include Singaporeans who have pre-existing conditions who are currently uninsured and those who have allowed their premiums to lapse because of inability to pay. As a society, we should progress together and ensure that those who need more help get them.
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The increase in coverage, I am sure, will lead to increased premiums as the community takes on a larger shared risk. I am particularly concerned about this. With inflationary pressures on Singaporeans, many, especially in the lower-income group, have difficulties coping with everyday life, much less paying extra for the revamped MediShield Life. In this vein, how then can we ensure that premiums remain affordable for Singaporeans, both when it is launched and in 10 to 20 years' time?
This, I think, will be a major issue for many Singaporeans. Feedback that my GPC has gathered shows that a portion of Singaporeans, even today, has allowed their MediShield coverage to lapse. Several reasons account for this; their MediShield premiums have risen as they age till it is now sky-high; the periodic top-ups by the Government to MediSave were wiped out by hospital bill payments, either for themselves or their family members; and the advice from medical professionals is to allow their MediShield coverage to lapse and rely on MediFund. Many of these I have raised in the earlier Health GPC paper that was submitted to MOH.
As a whole, I think the affordability of MediShield premiums will be a major issue that the Government has to grapple with. While the current increase in CPF contribution rates is useful, how will those who do not have a job, for instance, housewives who contribute to Singapore differently by caring for the young, and caregivers, be taken care of? How will they afford the insurance premiums for MediShield Life?
I had also previously suggested a reverse premium structure, which was first coined by Senior Minister of State Amy Khor, as a possible policy solution to cope with the anticipated rising MediShield premiums. This is worth serious consideration for it creates individual affordability when they can afford it, that is, when they are young and working, After all, CPF contribution rates do reflect this trend. When a Singaporean is younger, his CPF contribution rates are higher, while when he is older, the rate, both personal and by his employer, falls. Will the Ministry consider the implementation of such a reverse premium structure to make MediShield Life premiums affordable for all?
Let us also not forget that with premium increases, different groups of Singaporeans will be affected differently. The rich and well-off will have less of an issue, as they have the means to afford and cushion any premium increase. The recent announcement of the subsidies for the Pioneer Generation is very reassuring.
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However, the rest of Singaporeans, especially those in the lower- and middle-income groups, will find any premium rise hard to manage. Any rise which may appear miniscule to others will be viewed as an added strain on their finances. While we endeavour to meet the medical coverage of others who are uninsured, let us not forget those who cannot afford any increases. How can we ensure that Singaporeans remain covered for healthcare, regardless of income group? Can we consider premium subsidies for the lower-income group as well?
I also hope that the Minister will look into the co-payments component of MediShield Life. This component is often paid for using MediSave and/or cash. Many Singaporeans have given the feedback that the co-payments can be prohibitive, especially in smaller bill sizes where the co-payment component makes up a significantly larger proportion of the bill compared to bigger bill sizes. Lowering the co-payment will minimise the out-of-pocket expenditure, making healthcare costs relatively more affordable.
The Chairman: Minister Gan.
Mr Gan Kim Yong: Madam, over the years, we have done well in ensuring quality care and keeping the population generally in good health. Our healthcare financing system, comprising subsidies and the 3Ms – MediSave, MediShield and MediFund – has helped us keep healthcare affordable, especially for the lower- and middle-income Singaporeans, while ensuring long-term sustainability.
As our population ages rapidly and life expectancy continues to rise, our healthcare needs and expenditure will inevitably grow. This is why we have looked ahead to restructure our healthcare financing system to ensure that it continues to meet Singaporeans' needs and is even more robust than what we have today.
Sustainability is important, not just for today's Singaporeans, but also for our children and future generations. The key to this is to encourage individuals to take charge of their own health. The concept of co-payment reinforces this discipline, but this also needs to be carefully calibrated to ensure affordability.
We can never foresee when we might be struck by illness and require medical care, but when we do, the cost can be highly variable and uncertain, depending on the illness and the treatments. To ensure that we do not need to face life's uncertainties alone, we need to better share such risks within the family and across our community, even as we continue to encourage personal
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responsibility for our own health.
I had the opportunity to talk to many Singaporeans during last year's Our Singapore Conversation sessions. They had reflected their concerns about healthcare affordability. I was also heartened that this stemmed from a strong desire for self-reliance as well as a sense of responsibility of taking care of their loved ones.
To address these concerns, my Ministry outlined three major shifts as part of the fundamental review of our healthcare financing approach which started last year.
First, increase the Government's share of national healthcare expenditure. Second, gradually expand MediSave use. Third, increase risk-pooling. These shifts will improve healthcare affordability and give Singaporeans better peace of mind by reducing their cash outlay for healthcare.
Today, I will provide an update of this review, covering the changes that we have made and will be making in the coming year and beyond.
Let me start with outpatient care. Many welcomed the significant changes to the Community Health Assist Scheme (CHAS) I announced last year. We expanded the coverage of CHAS to more chronic diseases and recommended screenings. We removed the age floor so that younger Singaporeans can now enrol in CHAS and enjoy its benefits. Since October 2013, close to 260,000 more cards have been issued, bringing the total CHAS membership near 600,000 currently. CHAS will be further enhanced for the Pioneer Generation, which I will talk about later.
As announced at the Budget, my Ministry will be enhancing subsidies or services in the Specialist Outpatient Clinics (SOCs) in public hospitals. Let me elaborate. Today, subsidised patients in the public hospital SOCs enjoy 50% subsidy on average for SOC services. These patients are able to enjoy these subsidies after they have been assessed to require specialist care and are referred to the subsidised SOCs by a polyclinic doctor or, if they hold a CHAS card, by a CHAS GP. The subsidies will be enhanced for the lower to the middle-income and span services from the consultation to the scans, tests and allied health services, such as physiotherapy, that are needed to diagnose and manage their conditions. They will enjoy higher subsidies of 70% and 60%
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respectively, and may see their bill reduced by up to 40%.
For the convenience of patients, the means-testing framework will be aligned with that of CHAS, which means that current subsidised SOC patients who already have the CHAS blue or orange cards, will automatically enjoy these higher subsidies. We will reach out to the remaining subsidised patients in the SOCs to be means-tested so that those eligible can also enjoy the higher subsidies. SOC patients who are higher income, and those who decline to be means-tested for a variety of reasons, will continue to receive the current subsidy and will not be worse off. These changes will be implemented in September 2014.
To further improve affordability of outpatient care, my Ministry will also enhance subsidies for drugs in the SOCs and polyclinics. Currently, MOH provides subsidies for standard drugs that have been assessed to be cost-effective and essential. They are mostly capped at the price of $1.40 per week or subsidised at 50% of the retail price.
From January 2015, all lower to middle income patients will enjoy a 75% subsidy for all standard drugs so that they pay less for their medication, a reduction of up to half. Dr Lam will be pleased to note that we will also extend subsidies to more drugs. From April 2014, we will add another 13 drugs to the Medication Assistance Fund and the Standard Drugs List.
Let me now move to MediSave and how we will allow greater flexibility for patients. Assoc Prof Fatimah Lateef asked about the co-payment for chronic disease MediSave claims. As I mentioned earlier, co-payment is important to encourage prudent consumption. Nevertheless, to reduce cash outlay and encourage timely treatment, we will remove the $30 deductible from July 2014. With this change, patients no longer need to pay the first $30 of each bill in cash. They can tap on MediSave from the first dollar, reducing their cash outlay.
Ms Lee Li Lian asked how we can help cancer patients who need newer types of treatment, such as tyrosine kinase inhibitors (TKIs). MediSave and MediShield can already be used for such treatments. For patients who still face difficulty paying for the remaining costs, targeted subsidies are also available through the Medication Assistance Fund, if they do not respond to less costly alternatives.
Patients can also use MediSave to pay for scans needed in the course of their cancer treatment today already. However, many Singaporeans have given
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feedback that scans needed for other illnesses can also be costly. Therefore, from the first quarter of next year, we will allow MediSave use of up to $300 a year to cover non-cancer related scans that are deemed necessary for diagnoses and treatment. With the enhanced SOC subsidies and MediSave coverage, scans will be significantly more affordable.
Dr Lam Pin Min and Mr Gerald Giam had also suggested allowing more use of MediSave for outpatient treatment. Many elderly Singaporeans who need outpatient care have shared with me their worries over depleting their cash savings and burdening their children financially. Many of them want to be self-reliant and have asked to tap on their MediSave more easily, and we hear them. While we remain concerned about the depletion of MediSave balance, we can consider more flexibility, especially for the older Singaporeans. We plan to introduce a new flexi-MediSave scheme that will allow the elderly to use their MediSave more flexibly for outpatient medical treatments at our SOCs, polyclinics and CHAS clinics. This will enable elderly patients who see their CHAS GPs for cough and cold to tap on MediSave to reduce their out-of-pocket payments. Flexi-MediSave will also supplement the $400 annual limit for chronic disease treatment, which Assoc Prof Lateef mentioned.
We intend to start by allowing up to $200 of Flexi-MediSave use per year. We will work out the details over the next few months and share more in due course. We hope to have this ready by the first half of next year.
Madam, beyond enhancing subsidies and MediSave, we also need to step up risk-pooling to share the burden. This brings me to MediShield.
We will be enhancing MediShield to become MediShield Life to provide lifetime peace of mind and better benefits for all Singaporeans, regardless of how their life and health circumstances may change. This includes extending coverage to the very elderly and those with pre-existing conditions. I am glad that many Singaporeans support the shift to provide lifetime coverage and better benefits under MediShield Life for all Singaporeans. MediShield Life is as much about giving all Singaporeans greater peace of mind as it is about us forging a new social compact – with everyone chipping in to better protect one another from having to face life's uncertainties alone. As this is a major step in transforming our healthcare financing framework, we have appointed the MediShield Life Review Committee to review and recommend the key parameters for MediShield Life, such as benefits, claim limits and co-payments – issues which Mr Giam mentioned – taking into account feedback from the
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public and key stakeholders.
Two weeks ago, the Committee shared their preliminary recommendations on how to improve benefits under MediShield Life, including removing the lifetime claim limit, and enhancing payouts through raising claim limits and lowering co-insurance rates. We welcome these recommendations as they will help to reduce the patients' share of larger bills to address their concerns about affordability, as highlighted by Dr Lam.
Dr Lam had also asked if we would consider pre-funding for MediShield Life. Many have supported the idea of pre-funding at the Committee's focus group discussions. With pre-funding, policy holders pay more premiums when they are working and earning income, which are set aside to provide premium rebates when they grow old. This improves the premium affordability at their old age.
Pre-funding is not about the younger generation cross-subsidising the older generation, because such cross-subsidy across generations would be unsustainable as our population ages. The Committee is currently reviewing the extent of pre-funding in MediShield and will provide an update when ready.
Mr Png Eng Huat and Mrs Chiam have also asked about the insurance coverage for patients suffering from pre-existing conditions or who have recently recovered from cancer. With the move towards universal coverage under MediShield Life, all Singaporeans with pre-existing conditions, including those who have cancer or who have just recovered from cancer, will be covered under the scheme. The private insurance schemes, such as Integrated Shield Plans (IPs), are different from MediShield. They provide options for better benefits above the basic protection offered by MediShield. Those who are covered by IPs will still be covered by MediShield. But the additional coverage is over and above the MediShield coverage.
As insurance is about risk-pooling across members, members have to be in good health at the point of joining insurance schemes. To protect policyholders, we require insurers offering IPs to guarantee renewals so that once policyholders take up the plan, they cannot drop them from coverage, even if they develop illnesses and incur higher claims subsequently.
But should they not be able to be insured by the private shield plans, they will continue to be insured by MediShield and MediShield Life when it comes into effect. More generally, as insurance buyers, we need to plan for our
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healthcare coverage wisely and purchase an appropriate plan that is affordable, not just when we are young, but also in old age, because in private plans, the premiums will rise as you grow older. And it will rise significantly. If you plan to seek treatment at public hospitals, a more expensive insurance plan covering the cost of care in private hospitals may not be necessary. Both the Committee and MOH have received feedback on the affordability of Integrated Plans (IPs) and will be reviewing to see how we can provide appropriate options for upgrading coverage beyond MediShield Life.
Let me now focus on the issue of MediShield Life premium affordability which some Members have expressed concerns about. With better coverage and benefits under MediShield Life, premiums will also need to increase. With this shift to MediShield Life, I want to assure Singaporeans that the Government will ensure that premiums remain affordable, especially for the low-income and the elderly, as suggested by the Committee. The cost of bringing in the currently uninsured should be shared across those with pre-existing conditions, the existing insured policy holders and the Government. Therefore, as suggested by the Committee, this cost of bringing those who are currently not covered into the MediShield Life should be shared among those who are currently uninsured as well as those who are existing insured policy holders and the Government.
However, the Government intends to support most of the initial cost of universal coverage under MediShield Life. We will also introduce permanent subsidies for the lower- to middle-income groups. The Review Committee is still discussing the key features of MediShield Life and studying the impact on premiums. But let me just share with the House the approach we intend to take to keep premium increases affordable when we shift from MediShield to MediShield Life, as follows.
Firstly, for a typical Singaporean household – comprising a working-age couple with two school-going children – MediShield Life premiums will take up no more than half of their annual MediSave inflows, including top-ups and Workfare, where applicable. In fact, for such typical households in the lower- to middle-income groups, we aim to keep their net premiums to the current level or lower, after taking into account the permanent subsidies that the Government will provide, additional MediSave contributions and the top-ups.
For older individual Singaporeans aged 55 to 64, and currently on MediShield, those up to median income will see no net premium increase, taking into account permanent subsidies and MediSave top-ups. For those aged 65 and above this year, the Pioneer Generation Package announced earlier will
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provide sufficient support for MediShield Life.
There could still be those very needy, who are unable to pay the remaining share of premiums even after the permanent subsidies and MediSave top-ups, I would like to reassure them they will be provided additional financial assistance, such as through MediFund. Our intent is that no Singaporeans will drop out of MediShield Life because of their inability to pay for the premiums. However, Government support is necessarily targeted at those groups who need help with premium payments. Those who have the means should still pay our own share. In this way, we look after one another.
Nonetheless, to further help with the shift to MediShield Life and cushion the impact on premiums, the Government will provide additional transitional premium subsidies for all Singaporeans, regardless of income.
Details on the finalised parameters of MediShield Life benefits, premiums and subsidies will be announced after my Ministry has studied the final recommendations from the Committee. The Committee is expected to complete its review and submit the recommendations to the Government in the middle of the year.
Let me now move to the Pioneer Generation Package. The Prime Minister and Deputy Prime Minister have also announced the special healthcare package for our Pioneer Generation who are a special group that built Singapore at a time where there were fewer social safety nets. They may not have had sufficient income, nor time to save up adequately for their healthcare in old age. The Pioneer Generation Package (PGP) will help to ensure that they are well covered and need not worry about healthcare during their old age.
The PGP is comprehensive. In the subsidised SOCs and polyclinics, they will receive a further 50% off their subsidised bills, on top of the enhanced subsidies that I mentioned earlier for SOC services, and standard drugs. What this means for a lower- to middle-income PG elderly is a subsidy of over 80% in the SOCs and polyclinics. All PGs will also be placed on CHAS. As Deputy Prime Minister has mentioned, we have brought forward the CHAS benefits for the Pioneer Generation to September this year. PGs who are already on CHAS will enjoy additional subsidies above what they receive today for each visit.
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Altogether, subsidy enhancements at the SOCs will benefit some 500,000 subsidised patients, including 200,000 Pioneer Generation patients. The enhancements at the polyclinics, together with the CHAS benefits for the Pioneer Generation, will benefit over 600,000 patients. These initiatives will cost the Government over $200 million in the first year.
With MediShield Life, the Government will help the Pioneer Generation with their premiums through a special premium subsidy, starting from 40% at age 65 and rising to 60% at age 90. They will also receive additional MediSave top-ups from July 2014 onwards. The Government's intent is to help PGs aged 80 and above today fully cover their premiums, through a combination of premium subsidies and MediSave top-ups. For the younger PGs who are on MediShield today, the aim is to help them through premium subsidies and MediSave top-ups, so that their share of MediShield Life premiums will be about half of their current MediShield premiums. For the younger PGs who are not on MediShield today, they should pay less than the current premiums.
For PG elderly with moderate to severe functional disabilities, we will provide more support through a new Pioneer Generation Disability Assistance Scheme from September 2014 onwards. Under this scheme, the elderly with moderate to severe disabilities or their nominated caregivers will receive additional cash assistance of $1,200 a year. This is in addition to the payouts from existing schemes, including ElderShield insurance, Interim Disability Assistance Programme for Elderly (IDAPE) and the Foreign Domestic Worker Grant.
This package will help not just the Pioneer Generation but also younger Singaporeans who support their elderly parents. More than financial benefits, this package reflects the Government's intention to recognise our pioneers.
I hope that this will encourage a whole-of-nation effort to celebrate the Pioneer Generation and all that they have done for us.
In addition to addressing acute care needs, we also need to continue strengthening long-term care financing to prepare for the future. Ms Lee Li Lian, Mr Heng Chee How asked about the review of ElderShield. We introduce ElderShield to help those who are severely disabled and need long-term care. The cash payouts from ElderShield can be used to pay for caregivers' support or formal care services, such as nursing home bills. The flexibility allows the elderly and their families to opt for the type of care that best suits their circumstances, including ageing-in-place at home, as well as informal
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caregiving.
As part of our overall long-term care review, we are looking at the key design parameters of ElderShield to provide greater protection and support for Singaporeans. This is a complex exercise as enhancements to ElderShield will affect premiums for policyholders. We, therefore, need to study and weigh carefully the benefits of any enhancements and how much they will cost to policyholders before making any major changes.
In the meantime, the PG Disability Assistance Programme will complement the existing ElderShield and provide immediate help even as we review ElderShield. We have also taken steps to enhance affordability for long-term care in recent years. Members will recall that subsidies for the intermediate and long-term care patients will increase across the board in 2012, with all lower- to middle-income households now eligible for subsidies.
Mrs Lina Chiam and Mr David Ong have also called for the 3Ms to cover long-term care and to be more flexible. We have expanded MediFund since 2012 to cover non-residential long-term care services, in addition to nursing homes and community hospitals where MediFund was already available. But we must be careful in extending MediSave to long-term care as it may risk rapidly depleting our MediSave accounts which are still needed for MediShield premiums and acute hospital stays.
What do all these changes I announce today mean to Singaporeans?
They will help many lower- to middle-income Singaporean families reduce their healthcare expenses. Let me illustrate. Take Mr and Mrs Tan, a middle-aged couple, both working and supporting two school-going children and Mr Tan's elderly parents.
As Blue Health Assist card holders, the couple now enjoy free screening tests at their neighbourhood CHAS GP clinic and subsidies for their screening follow-up consultations. The Tan children are also now able to enjoy the same CHAS benefits that their parents and grandparents already enjoy. These changes will potentially save the family more than $200 each year, assuming one follow-up consultation for each adult and four visits to the CHAS GP for each child.
For Grandpa Tan who suffers from chronic back pain, the higher subsidies will greatly help with his out-of–pocket costs for his visits to his orthopaedic
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specialist in the public hospitals, his medication and when more expensive tests like an MRI scan need to be done. He would first see his annual subsidised bill reduced by about 40%, from $460 to $280. As a Pioneer Generation elderly, he will see a further 50% reduction in his bill to $140 – a saving of $320. He can use his MediSave to further reduce the co-payment for his MRI scan which further reduces his overall out-of-pocket payment from $140 to $35.
If Grandma Tan unfortunately becomes disabled and requires long-term care at home, she will receive monthly payments of $300 from insurance, or $3,600 a year, if she is covered by ElderShield. With the new Pioneer Generation Disability Assistance Scheme, she will receive an additional $1,200 per year which will help the family pay for the long-term care arrangements.
When MediShield Life is introduced, this will mean that the entire Tan family is covered for life. This includes Grandma Tan, who was not insurable due to kidney failure, but can now look forward to benefiting from MediShield Life coverage.
Overall, with these new initiatives, the Tan family can expect to receive more than $500 in additional subsidies a year off their medical bills, and close to $2,000, if one of them requires long-term care. More flexible MediSave use will further reduce their cash outlay. With MediShield Life and premium subsidies, the family would enjoy even more savings, together with enhanced coverage under MediShield Life.
As part of this shift in healthcare financing, we have committed to increasing the Government's share of healthcare spending and also increasing collective responsibility for one another's healthcare costs. Government's direct spending on healthcare is projected to increase to $7.5 billion in FY2014, up from $4 billion in FY2011 – almost doubling in a short span of three years. If we include MediSave top-ups into Singaporeans' MediSave accounts to help with their future healthcare needs, Government's total expenditure this year is estimated to be about $8 billion, and will continue to increase in future. As a proportion of national healthcare expenditure, Government's share will increase, from 33% in 2012 to 40% or more going forward, depending on the pace of increase of healthcare costs at the national level.
With rising life expectancy, we will also need to set aside more MediSave for our old age needs. To support this, we will increase employer MediSave contribution rates by one percentage point, as announced at the Budget. This will help ensure that current and future generations of working adults have
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sufficient MediSave for their future healthcare needs, and also support more flexible use of MediSave.
To ensure that healthcare remains affordable in the long term, we need to carefully manage healthcare costs, as Mr Heng Chee How and Mr Low Thia Khiang have noted.
I am glad that in the MediShield Life Review Committee's consultations, many Singaporeans have also recognised the risk of driving up overall healthcare costs as we expand the role of MediSave and MediShield. We must continue to ensure we pay for quality and effectiveness, bearing in mind that spending more does not necessarily bring better health outcomes.
As Mr Laurence Lien and Mr Gerald Giam have suggested, we need to spend each healthcare dollar smartly, and pay providers to deliver quality care. Our current funding approach is designed to drive providers to adopt a patient- and outcome-centric approach in delivering care. In the home care sector, we are, in fact, piloting the idea of providing a fixed amount of funding per elderly per month, and Senior Minister of State Amy Khor will touch on this further.
For inpatient admissions, the public hospitals are funded to deliver a bundle of services required for a patient and a particular condition. This is then aggregated and provided as a block budget, which encourages the clusters to improve productivity, and provide high-quality and cost-effective treatments to improve outcomes. A blend of aggregated block funding and some fee-for-service component achieves a balance of incentives – managing overall costs while retaining incentives for higher productivity.
To complement the funding approach, MOH drives quality improvement using the National Standards for Healthcare (NSHC) framework. This ensures that healthcare services are appropriate for patients' needs, based on current evidence and clinical knowledge. The framework is also used to help assess the providers' own performance and prioritise their quality improvement efforts.
The Government also provides additional support for Regional Health Systems initiatives that involve the management of patients outside of acute care in the hospital setting. An example is Alexandra Health System's (AHS) Ageing-in-Place initiative, as I had shared earlier. We will carefully study how various funding approaches can be adapted to these new care models to drive cost-effectiveness.
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We will continue to maintain strong clinical protocols among public-sector healthcare providers. Drugs are subsidised if their clinical efficacy and cost-effectiveness are proven. We are also introducing Health Technology Assessment for medical devices and implants to ensure they are cost-effective. MOH also has in place a framework to assess new costly technologies, based on their track record in terms of treatment outcome and cost-effectiveness.
Mr Heng Chee How had also asked about drug procurement. To lower costs, our public health institutions procure standard drugs as a group. This has resulted in savings of $180 million since 2001, which have been passed on to patients. We will study how to build on this to achieve even lower drug prices for Singaporeans.
Mr Low Thia Khiang asked whether we can increase transparency in doctors' charges. I agree that this is essential in order to empower patients and allow market forces to work more efficiently. All clinics are required to display their charges, and hospitals must provide financial counselling at the point of admission to help patients make informed decisions. The MOH website also provides comparisons of total hospital bill sizes.
To provide additional transparency on the bill component attributed to doctors' charges, MOH is working towards publishing information on the amounts charged at our public sector hospitals under this component for common procedures. This enhanced transparency will provide more information to help patients make informed decisions.
On an individual level, we still need to preserve the focus on personal responsibility. Staying healthy is the best way to keep healthcare cost down. I also agree with Mr Laurence Lien that while seeking to enhance affordability, we still need to guard against over-consumption, by focusing on providing basic and essential healthcare for all Singaporeans. Even as we shift towards greater collective responsibility, co-payment will remain a very important cornerstone of our healthcare financing framework.
The transformation of our healthcare financing system through higher Government subsidies, greater MediSave flexibility and MediShield Life will help reduce the burden of healthcare cost on the patients and keep healthcare affordable for all. But beyond the numbers and the schemes, more importantly, this shift reflects the Government's commitment to help Singaporeans,
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especially those who are more needy and vulnerable, and build an even more inclusive and caring society. It is the Government's assurance that we will keep healthcare affordable for all Singaporeans. I am confident that with all stakeholders playing their part, we will be able to forge a closer social compact.
We will be better able to cope with future challenges and strengthen the foundations of our healthcare system for generations of future Singaporeans to come. This way, we can help Singaporeans not only to live long, but to live well and with peace of mind.
Ms Tin Pei Ling (Marine Parade): Madam, with an ageing population, MOH has responded positively and pledged to enhance and expand healthcare facilities – increases in bed spaces, step-down care and home-care capacities and putting in place additional facilities can be expected. With these investments in healthcare, demand for manpower will also rise accordingly. Moreover, with the increasing demand for high-touch services, such as home care, the need for manpower is further exacerbated as these settings have lower efficiency of scale.
Faced with an already tight labour market and increased constraints on foreign manpower, how will MOH address this need? How will MOH help the public health sector compete for local aspiring Singaporeans to take up a career in this sector? Will MOH also increase local student enrolment in medicine, nursing and other allied health areas? How will MOH leverage innovations to align with the Government's overall drive to reduce foreign manpower reliance and increase productivity? How will MOH reconcile the tension between the need for human touch in healthcare and the need for technology to raise productivity?
Ms Sylvia Lim (Aljunied): Madam, some senior doctors in public service are concerned that many Singaporean doctors are leaving for the private sector due to push factors, like having twice as many cases compared with the private sector, having to spend much time on non-clinical work and coping with stressful organisational and training changes, such as the residency programme. Nurses and other allied healthcare professionals, too, find conditions in the private sector better, with private employers spending more to attract locals due to foreign work pass quotas. While the Ministry in 2012 announced pay increases for public sector employees, many feel that this may
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not help much, especially in the long term.
Failure to stem the tide of attrition means that Singaporean patients at public health institutions are dealing more often with foreign staff and experience some language barriers. Is the Ministry concerned and are there any further reviews to look at how to better retain Singaporeans in the public sector?
Mrs Lina Chiam: Madam, the Government has acknowledged that nurses are not \"low skilled\" workers, a point brought up by the Deputy Prime Minister during the Population White Paper debate last year.
\"How important nurses are in the hospital: they are trained, they are critical to the whole system – highly skilled, highly professional,\" Prime Minister Lee said in a Straits Times report on 13 February 2013.
Florence Nightingale defined nursing as \"the act of utilising the environment of the patient to assist him in his recovery\".
A nurse is a healthcare professional who is focused on caring for individuals, families and communities, ensuring that they attain, maintain or recover optimal health and functioning. They are also the important frontline workers in the health industry.
When we compare the remuneration of nurses in Singapore with hospital nurses in other countries, they lag behind their counterparts in Europe, Australia and Japan, even though Singapore has one of the highest GDP per capita in the world.
It is time that the Government review the career pathways and salaries of our nurses to ensure that they receive a pay commensurate with their skill set and expertise after their in-house competency tests, to provide more advancement opportunities and career pathways and to value-add our healthcare system in Singapore which should be in the form of a nursing, leadership and senior specialist track.
More support should be given to healthcare in this regard. I would like to propose that the Government earmark a sum of around $40 million to enhance the competitiveness of our healthcare sector. Under such a framework, the
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Government can then consider more competitive wages for nurses.
The Government could then conduct a salary restructure and review of our nurses' salaries in accordance with their skill level, similar to the career structure that was developed, such as for teachers in the education service.
The Chairman: Mrs Chiam, please wind up your speech. Your time is up.
Mrs Lina Chiam: Thank you.
The Chairman: Mr Patrick Tay.
Mr Patrick Tay Teck Guan (Nee Soon): Madam, I wish to express my heartfelt thanks to MOH and the public healthcare clusters for embarking on a series of wage reviews and adjustments and positive collective agreement settlements for both nursing and non-nursing staff. However, the current workload at our public hospitals and polyclinics is mounting. Impending load with upcoming new hospitals and healthcare facilities that are shared will strain manpower resources. In the Graduate Employment Survey 2013 for fresh graduates released last week, nursing was ranked 74th out of 78 jobs.
I wish to ask MOH if they can embark on a more systematic and regular review of healthcare staff compensation and benefits to attract and retain staff. This should include both nursing and non-nursing staff, such as those in allied, admin and ancillary positions. I am equally concerned about the compensation and benefits of those in our private hospitals and whether they are also picking a leaf from MOH's concerted moves. By the same token, step-down care, such as eldercare and other intermediate to long-term care workers, should also have their compensations and benefits kept up to speed with the public healthcare clusters. Why? Because we need to continue to attract and retain staff in these very crucial jobs.
Finally, I congratulate the Healthcare Cluster Tripartite Workgroup's work in the past 18 months which has led to the implementation of the Progressive Wage Model (PWM) for the lower-wage healthcare staff. Besides \"upping\" productivity, they have also \"upped\" the careers and wages for more than 2,500 of them last year. I hope our tripartite partners will continue to work together to roll out the PWM for the higher level PME jobs as well.
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Assoc Prof Fatimah Lateef: Madam, families and communities form the best source of support, love and sense of belonging for those who need long-term care-giving. It is best to keep those needing long-term care in an environment they are familiar with. Home-based care provides a model for satisfying and wholesome care which can enable the affected to accept the disability, celebrate life and make it as meaningful as possible. To ensure optimal home-based care, carers and family members need to be educated, empowered and knowledgeable in the area of care-giving, its challenges, the labile emotional changes and stresses that they can face. Trained personnel and family members need to be familiar with the home-care environment, the ergonomics, where things are kept, clothes are kept, managing toileting and bathing needs, cooking, washing and even safety issues in the home. They are the ones who will need help, those needing care to adapt, for example, and we want to make them as comfortable in their home environment as possible. Those who need long-term care need assurance and confidence to cope.
With our rapidly ageing society, the elderly needing care will also continue to increase. What further resources can MOH help provide, for example, in terms of financial support, equipment, diapers, milk feeds and so on? Will we see an enhancement in the existing types of caregiver courses available? The Japanese 3Cs approach is pretty good for us to emulate, which comprises comprehensive care, capacity-building and caregiver support. It is a good model to go by. Are there any other strategies and collaborative models MOH can offer those providing and involved in home-based care?
Mr Low Thia Khiang: Madam, like other developed countries, Singapore faces the challenge of achieving a good healthcare system while controlling escalating healthcare costs. Home-based care is an integral part of right-siting of care.
Currently, a mix of private and voluntary welfare organisations provide various forms of home-based care. To realise its true value and potential requires a review on acceptance, awareness, availability, accessibility and affordability.
I believe that home-based care is acceptable and welcomed by the elderly. It saves elderly patients the trouble to travel to the clinic. Home is also an environment that patients are familiar with and conducive for their health and
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recovery.
However, home-based medical care is a departure from the normal setting in which most medical doctors provide care. Hence, a change of mind-set will be needed for the acceptance of such medical care. A new remuneration scheme for medical personnel that takes into account medical services provided in the home setting should also be effected.
For home-based care to become fully integrated into the healthcare delivery chain, greater awareness is needed. Greater publicity and outreach via the media and at hospitals, clinics, care centres and social service offices and so on are necessary.
To improve the availability and efficiency of home-based care, an effective use of infocomm technology is desirable. In the Intelligent Nation 2015 blueprint by IDA, the aim for the healthcare industry is to digitalise medical data to achieve \"seamless information exchange among different members of the healthcare network\" and improved \"convenience for patients through better and more information services\". To what extent have these been realised? Next, telemedicine is another area that can extend the reach of home-based care, but this area appears to be still in its infancy.
Currently, the points of referral for home-based care are the hospitals, clinics and medical social workers. To improve its accessibility and utility, as a start, it would be good if elderly patients with multiple diseases and impaired mobility could receive one home visit upon discharge from the hospital. Subsequent home-based care visits would be dependent on need.
Affordability of home-based care will determine its overall place and utility in the healthcare delivery ecosystem. It is encouraging to note that MOH is reviewing the financing structure for home nursing so that the financial support given to patients, especially needy patients, does not penalise them for using home-based care.
Mr Chen Show Mao (Aljunied): Madam, as our society ages, in addition to the care of Singaporean seniors, could we also look at their development and continue to invest in them as they age? This will become increasingly important, with our rising life expectancy.
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We have a variety of schemes and initiatives that help out on hospitalisation and medical costs, in the event older Singaporeans are ill or are no longer able to perform certain activities of daily living.
When it comes to development, the Lifelong Learning Endowment Fund may be an example of investing in our older citizens, but only in the context of employment. Can we facilitate and encourage the development of older Singaporeans outside their employment, including in their retirement or with a view to self-employment or entrepreneurship?
Healthy and healthier and more active older Singaporeans can continue to contribute to society outside the work place, by playing an active role in the community, by undertaking voluntary work or by providing care and support for their family members.
Could we consider setting up a Senior Development Account for Singaporeans, similar to our current schemes for young Singaporeans, such as the Child Development Account or Edusave Account? Funds in the account may be used to pay for approved products and services associated with active ageing and learning, or simply growing old, based on the choices of the seniors among goods and services that will help keep them healthy and active, offered by the public, private or people sectors. Perhaps, these may include courses to encourage lifelong learning, exercise programmes, health screening packages, alternative medical treatments to maintain well-being, and cover daily expenses, such as mobility aids, reading glasses and adult diapers.
So, perhaps, for example, middle to high-income families could receive matching funds from the Government as a form of savings by the individual and his or her family in the lead-up to old age and, perhaps, for lower-income families and individuals, the Government could provide means-tested top-ups for the development of our seniors.
Mr Sitoh Yih Pin (Potong Pasir): Madam, please allow me to declare my interest that I am a director of a healthcare company known as Talkmed Group Limited, and I have two brothers who are doctors.
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I wish to commend the Minister for Health for the many initiatives his Ministry is embarking on this year to address our healthcare needs, in particular, that of the elderly.
Much attention has been drawn to the recent bed crunch in our acute general hospitals. And with each crunch comes the calls for more general hospitals to be built. We certainly need more general hospitals. Madam, just as importantly, we also need more intermediate and long-term care facilities, such as community hospitals and nursing home beds.
Let me give you an example. In some developed economies, the community hospital may have twice the number of beds than the general hospital next to it. And then there are many more nursing home beds compared to community hospital beds. Given the much longer stays that almost all community hospital patients experience, this makes a lot of sense.
In Singapore, this numerical relationship is reversed. We have been building community hospitals next to our general hospitals, but in terms of number of beds, the community hospital is only a fraction of the general hospital.
According to 2012 MOH statistics, we had 11,000 beds in acute hospitals and specialty centres. We have roughly the same number of beds – also 11,000 – in the intermediate and long-term care sector (ILTC), of which the vast majority, about 9,500, are nursing home beds.
This ratio of roughly 1:1 between hospital and ILTC beds needs to be addressed quickly. The average patient stays in a nursing home for months if not years; a community hospital patient stays for weeks and an acute hospital patient only stays for a few days. It is not, therefore, uncommon to hear that patients in acute hospitals are waiting for days if not weeks for a bed in the ILTC sector.
Hence, I am glad to note that MOH will devote much more resources to developing the ILTC sector, especially the nursing home sector, because the need is there and also, it is far cheaper to build and run an ILTC bed than an acute hospital bed.
Madam, capacity-building in the ILTC sector is only half the answer. The next issue is that of quality of life.
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From time to time, I visit my relatives, friends and residents at our hospitals. For those that are elderly and very sick, I notice the following things are important to them: to be in as little pain as possible; to have their moments of privacy; to maintain their human dignity; and to spend time with their loved ones.
I will now dwell a bit on the second and third point – that of privacy and human dignity. These are abstract ideas that are hard to quantify but so very important, especially when a person is ill, lonely and vulnerable.
Madam, I am given to understand that MOH is now in the process of finding operators for 10 nursing homes it is currently building. Like what Minister Khaw Boon Wan mentioned about the integrated healthcare hub in Woodlands, these homes need to take into account the needs and expectations of not just today's elderly, but also those in 20 to 30 years' time. I note that the standard configuration for these nursing homes that are being built is an eight-person cubicle, similar to what has been in existence for some time.
Madam, It is one thing to stay for a few days in a six- to eight-person cubicle in a general hospital, and it is another thing altogether to spend one's final days staying for many months, if not for several years, in a nursing home also in eight-person cubicles without any personal space and privacy.
Even if the elderly of today are willing to spend their last days in such an environment, will the elderly in 20 to 30 years' time be willing to do so? Even if we cannot afford a cubicle for each resident, can we not consider housing the residents in smaller cubicles of two to three beds?
This is just one such aspect of addressing the privacy and dignity needs of our patients. The larger issues are how nursing home care is structured, delivered and funded. The sector is dominated now by VWOs and supplemented by the private sector. The majority of beds are subsidised and funding norms are determined by MOH.
In terms of operating subsidy, if I am not mistaken, the entire amount of subsidies given to eligible nursing homes in Singapore annually is less than the subsidy enjoyed by a single large general hospital, such as TTSH and NUH.
The result is that while we are planning, building and operating First World general hospitals all over the island, the ILTC sector, in particular that of nursing homes, are operating under less than First World realities. We can hold our own
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against the best general hospitals in the UK, Australia, Japan, Sweden, Denmark and so on. But when it comes to nursing homes, the impression I get is that our nursing homes lag behind the best in the world.
Madam, I would like to suggest that MOH operate a few nursing homes itself, similar to how MOE is now running a few kindergartens. Such a move will achieve a few purposes. MOH-run nursing homes can set the standards for others and be at the forefront of innovation in developing new services and systems in the nursing home sector.
With operational experience, MOH can then develop a better regulatory framework. MOH can better understand the operational constraints, funding realities and manpower shortage that nursing homes now experience. In other words, the best way to stay in touch with the real world is to do-it-yourself (DIY). There is nothing like being at the frontlines, feeling the heat of battle on a daily basis.
Madam, at the beginning of the Budget debate last week, I mentioned that politicians and public servants should not be out of touch. Since my first participation in the Budget debate in 2012, I have consistently chosen to speak on broader themes that I have felt will always be relevant in politics, whether for now or well into the future. I did the same again this year. I have chosen this COS health debate to revisit this out-of-touch topic, because the highlight of this Budget is really about the Pioneer Generation Package, which is about healthcare. The Pioneer Generation Package could not have been invented overnight. Our Government must have spent a lot of time and effort understanding the hearts, minds and the needs of our Singaporean families.
Madam, we have a common saying, \"上有高堂，下有妻儿”. Translated it means \"we have our parents above us, and our wife and children alongside us\". This package provides middle-age Singaporeans, like myself, great peace of mind knowing that our Pioneer Generation parents will be well looked after.
Madam, this year's Budget is really about healthcare. The Budget for MOH, at $7.1 billion, is the third largest, after MINDEF and MOE. Actually, if you add in the $8 billion dollars allocated for the Pioneer Generation Package, which is essentially about healthcare, the total amount comes up to $15.1 billion. So, for the first time in our history, in an oblique way, healthcare has topped the Budget expenditure list.
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Madam, as the saying goes: \"Our Government has put our money where its mouth is\". It is primarily about healthcare and it is about the people who need healthcare most – our Pioneer Generation.
The Senior Minister of State for Health (Dr Amy Khor Lean Suan): Mdm Chairman, with your permission, may I display some slides on the LED screens?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Dr Amy Khor Lean Suan: MOH has put in place comprehensive plans under Healthcare 2020 to increase healthcare capacity across various care settings, so that we can adequately meet the needs of the population.
Members like Dr Lam Pin Min and Ms Tin Pei Ling are right to highlight that the ability to attract talent and manpower into the healthcare sector will be key to our success in upscaling our healthcare capacity. As part of our Healthcare 2020 plans, we had projected that we would need about 20,000 more healthcare professionals, including doctors, nurses, pharmacists and allied health professionals between 2011 and 2020. We have since made good progress. Between 2011 and 2013, the healthcare professional workforce grew by 6,000, an increase of 13%.
Our doctor and nurse-to-population ratios have also improved as a result. While they are lower than those in most OECD countries, they are comparable to developed regional economies, such as Hong Kong and South Korea.
As we continue to expand healthcare manpower, we expect our ratios to increase further. We do not have ideal target ratios, as manpower ratios are also dependent on the structure of the local healthcare system and would shift over time with changes in technology, model of care, as well as demographic and disease profiles.
Dr Lam Pin Min asked how we plan to further build up our manpower capability. We will do so in three ways: by attracting young Singaporeans; growing new sources of manpower; and topping up our workforce with foreign recruitment.
First, to attract young Singaporeans into healthcare, we are expanding the intakes in our schools. The health and aged-care industries offer our young
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people good careers, which are meaningful and provide developmental and upgrading opportunities. The Ministry wants to build and nurture a strong core of locals among healthcare professionals.
With the opening of the new Lee Kong Chian School of Medicine at NTU, our medical intake has increased by 17% to 413 last year. Our nursing intake has also increased by 9% to 1,682.
We plan to continue growing the medical and nursing intakes to reach our targets of 500 and 2,750 respectively. This will be supported by our efforts to market nursing and allied health professions as fulfilling careers of choice through our \"Care to Go Beyond\" branding campaign.
Second, we want to attract more mid-career professionals, those who have taken a break from their careers, housewives and retirees to join the healthcare sector. Last year, 49 mid-career professionals received sponsorships for their training under the Healthcare Professional Conversion Programmes.
Besides mid-career professionals, we are also reaching out to nurses who are keen to return to active practice. Many of them had taken leave from work to have children, study or look after elderly parents. Last year, following an outreach exercise by MOH, more than 600 of them indicated interest to return to nursing. The first batch of 27 has since re-joined the nursing workforce. Refresher courses and training allowances were provided to ease the re-entry of those who have left practice for some years. We will be engaging the remaining former nurses this year to attract more to come back and serve.
As MOH aggressively expands the aged-care sector with more nursing homes and eldercare centres in the community and more home-based care services, there will be ample new jobs that offer flexible work-hours close to home. Singaporeans living in different parts of the island can walk to work if they work in these facilities. For example, Mdm Vivien Ow Wai Fong joined the Singapore Christian Home last month as a Health Attendant. She helps the home's cook to whip up healthy meals for the residents. The sprightly lady, who is 68 this year, walks to work every day. According to Mdm Ow, \"It is good to work here because it is nearby and I can save money and save time on transport.\"
This year, we will be working with aged-care providers who are opening new facilities, to proactively reach out to residents living around them and offer them new jobs within the community. Our Place-and-Train programme to train
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senior care workers has shown promising results. Under this programme, NTUC Eldercare re-designed the job functions of one full-time care worker into three distinct job roles which can be taken up by part-time workers. More than 100 Singaporeans have since been recruited by NTUC Eldercare and trained to take up jobs in their day-care and home-care services.
We need even more Singaporeans to step forward and contribute to the care and well-being of our elderly. We are working to extend the Place-and-Train programme to more providers. There will be a series of job fairs later this year and I urge Singaporeans to consider joining this very meaningful sector.
Third, even as we grow the local pipeline of healthcare workers, we still need to supplement our workforce with foreign-trained professionals. In FY2012, we awarded pre-employment grants to 102 Singaporean medical and dental students studying overseas. This is a 50% increase from the 68 students in FY2010. We will continue to encourage overseas Singaporeans to return.
We will also recruit qualified foreign professionals who can meet our registration requirements and help them adapt to our local working environment through language courses such as Mandarin, Chinese dialects and Malay courses, orientation and immersion programmes, as well as mentorship and supervision. This will help them to improve their communications with patients, a point raised by Ms Sylvia Lim. There are also interpreters in our public healthcare institutions who can help to translate when necessary.
Besides stepping up recruitment, my Ministry has been working to better retain staff in the public healthcare sector so as to maintain a strong Singaporean core of healthcare professionals, a point which Ms Sylvia Lim raised. I have heard from many public sector doctors and nurses that they enjoy working alongside other healthcare professionals to provide patient-centric, team-based care, especially to patients with complex conditions in the public healthcare institutions. Many also appreciate the opportunity to serve their fellow Singaporeans. The public sector also offers our healthcare professionals the unique opportunity to undertake research and to nurture future generations of healthcare professionals. In fact, these are key reasons why many of our healthcare professionals choose to remain in the public sector.
However, there are those who choose to leave for other reasons, such as the flexibility to choose their working hours and patient cases, the desire to own
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and manage their own clinical practices and the opportunity to earn more. While we may not be able to fulfil all these aspirations in the public healthcare sector, we can do more to recognise the important roles that our healthcare professionals play by paying them competitively, fairly, as suggested by Mr Patrick Tay and Mrs Lina Chiam, for nursing, and supporting their professional development.
In 2012, we implemented salary increases for 45,000 healthcare workers in the public healthcare sector. Come April this year, we will complete the implementation of a new remuneration framework for 4,000 senior public sector doctors. The new framework aims to reinforce the public healthcare mission and ethos. It recognises doctors not only for excellence in clinical care but also for excellence in their roles in education, research and administration.
The link between pay and performance for specialists and family physicians, as measured by the outcomes in clinical care, education, research and administration, will also be strengthened. For example, a surgeon who treats patients and also teaches specialist trainees can now be further rewarded for good outcomes if he has low, unscheduled returns to the operating theatre and if the specialist trainees he taught give him good feedback.
To keep pace with the market, to pay our doctors fairly for their tireless, selfless efforts, the base salary of senior public sector doctors will be adjusted upwards by 9% from April this year. This increase will be over and above the pay increment given in April 2012. Senior public sector dentists will also be covered under the new remuneration framework and receive the same pay adjustments as doctors.
Nurses, as Mrs Lina Chiam has noted earlier, also play a vital role in our healthcare system. They touch the lives of many individuals and, increasingly, nurses are also leading the change in healthcare, taking on new roles, such as Advanced Practice Nurses (APNs). The National Nursing Taskforce, comprising representatives from the nursing profession, public healthcare institutions and my Ministry, was convened at the end 2012 to chart the future direction of nursing. The Taskforce is working on several fronts – enhancing nurses' roles, improving nursing education and professional development, facilitating career progression and increasing recognition and rewards. The Taskforce expects to complete its review and submit its recommendations in the second half of this year.
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Allied health professionals are another integral part of healthcare. To equip our allied health professionals with greater in-depth knowledge and stronger skills to manage the increasing number of patients with complex conditions, we have been working with our tertiary institutions to open up good quality degree upgrading pathways for our diploma-trained professionals. In 2012, the Singapore Institute of Technology (SIT) launched degree programmes in physiotherapy and occupational therapy. Later this year, SIT will also introduce degree programmes in diagnostic radiography and radiation therapy. This is in addition to the existing part-time degree programmes offered by the Singapore General Hospital's Postgraduate Allied Health Institute.
Over the past two years, we have also rolled out several initiatives to enhance the attractiveness of lifelong careers in the ILTC sector. These included funding to subvented providers to hire more staff and to raise pay, enhanced subsidies to support continuous training and development of staff, as well as a centralised employment scheme for therapists. From April this year, the Agency for Integrated Care (AIC) will be raising the maximum subsidy level for training courses offered by the AIC Learning Institute from the current 80% to 90%. This will enable providers to send even more staff for training, in tandem with the sector's desire to further raise the quality of care provided to patients.
Let me now move on to the issue of productivity. Ms Tin Pei Ling and Mr Low Thia Khiang spoke about the need to drive innovation and reduce the need for manpower in healthcare. We are mindful that healthcare is a labour-intensive industry and we can never do away with the personal touch. But we agree that we can use technology and LEAN management practices to simplify workflow processes so that our healthcare workers can focus on what is most important and, that is, caring for the patients.
For example, through the use of a mobile app called Nurses Pal, nurses in SingHealth's hospitals can now more quickly identify patients who are at risk of developing pressure ulcers and carry out early interventions to prevent their conditions from deteriorating. This is designed by the SingHealth nurses themselves. The app provides a reference guide that nurses can use readily without having to leave a patient's bedside. Nurses only need to enter into their smartphones the patient's conditions, such as the state of alertness of the patient. The app then calculates the risk level of the patient developing pressure ulcers and recommends the appropriate interventions, such as changing the patient's lying position every two hours.
The National Healthcare Group Pharmacy also introduced a Multi-dose Medication Management System which uses robot machines to pack patients'
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medicines into individual sachets according to the prescribed dosages and the time they need to be taken. This is especially useful to patients with multiple chronic illnesses who have to take several different medicines a day. About 3,200 patients in 16 nursing homes are currently receiving medicines in these individual sachets. This has reduced the time spent by nurses in managing the medication. At the NHG Pharmacy, a two-week supply of medication for residents in a 200-bed nursing home can now be packed in one-and-a-half man-days, instead of 20 man-days previously.
The examples I have just quoted illustrate an enduring culture of continuous improvement and innovation that we strive to build in the healthcare sector.
Mdm Chairman, a well-trained and adequate healthcare workforce is key to the success of our healthcare system. MOH is actively building up our manpower capabilities and driving innovation and productivity in order to adequately meet the healthcare needs of our population.
Ms Ellen Lee (Sembawang): Mdm Chairman, at the PAP Women's Wing Dialogue on \"Seniors in Singapore\" held on 16 November 2013, Women's Wing members expressed concern for caregivers who often feel overwhelmed by the demands of their patients on a daily basis. But when their patients no longer need their services, some caregivers continue to feel stressed because they cannot find a job.
Many of these caregivers are single women, usually daughters or sisters, who acquired caregiving skills and knowledge by trial and error through caring for their aged parents or their siblings. Quite a number of them had received formal training under the Caregivers Training Grant and, as such, they are valuable manpower resources. They often spend many months or even years taking care of their loved ones and when their loved ones have departed, they find themselves in need of a new job and, sometimes, healthcare.
The stress caregivers feel is compounded by their lack of savings for housing and retirement, especially high healthcare costs in their own retirement years.
Does MOH maintain a database of caregivers in Singapore? What is the profile of trained caregivers? Does MOH provide job matching services for them
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when their patients no longer require their services?
Ms Lee Li Lian: Madam, one group of Singaporeans that is often left out of our Budget are caregivers. Caregivers include stay-at-home mothers, grandparents who are primary caregivers of their grandchildren, as well as individuals caring for dependant parents or relatives. Being a caregiver is a full-time job that has not just physical and emotional challenges, but financial ones, too, as many caregivers have to stay out of the workforce to manage their caregiving responsibilities or can only do part-time work.
A study commissioned by the then-MCYS found that almost half of the caregivers are unemployed. In 2013, there were an estimated 210,000 people who provide regular care to family and friends. This number is expected to grow, along with the demands for caregiving. In fact, last year, The Straits Times reported the caregiver crunch in Singapore.
Currently, the Government offers tax reliefs to help their families, for example, parent relief, handicapped dependant relief and grandparents' caregiver relief. These are good measures, but they are indirect assistance. The inherent problem is that it is regressive in nature. The lower income benefit less, compared to their higher income counterparts, despite being most in need of financial support.
I would like to recommend that direct and progressive support measures, such as subsidies, CPF or MediSave contributions, be provided directly to caregivers. A good example will be for stay-at-home mothers to be eligible for infant and childcare additional subsidies, just like working mothers.
Mr Chen Show Mao: Madam, in 2010, it was estimated that approximately 8% of Singaporean adults provided regular care to family members or friends, providing on average 6.8 hours a day of care in a typical week. Our dependence on this group of Singaporeans will only grow as our society ages.
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It is well-documented that caregivers often suffer declines in their own financial circumstances, and mental and physical health, as a result of their caregiving role. If they work, their performance suffers, too. Often, these carers may pass up opportunities and stay at home and can find themselves with little support and resources in their own old age or when their turn comes as being in need of care.
In recent years, we are starting to acknowledge and provide assistance to these informal caregivers, with several Members of this House having spoken on the issue. Perhaps, it is time to consider an overarching framework of acknowledgement and support for informal caregivers. Whether they are looking after the very young, very old or the disabled, there are certain common characteristics that informal caregivers share, such as the need for emotional support and, if they work, more flexible working hours and conditions.
Some examples of a much needed acknowledgement and support for caregivers could include the leave for caregivers that several Members in this House have called for. Or we could also consider the possibility of a right for caregivers to ask for flexible working arrangements, regardless of the category of dependants they are caring for. Better education and outreach to employers to help them understand the needs of their employees who are also caregivers can also benefit both parties, with a view to redesigning jobs creatively so as to accommodate the specific needs of the caregiver employee.
Also, we could consider CPF and MediSave top-ups for informal caregivers who are full-time carers, not because we want to monetise the act of caregiving to their loved ones, but to help ease some of the financial strains that may arise from their taking on such informal caregiving arrangements.
Dr Lam Pin Min: Madam, I have highlighted repeatedly for the past few years the need to support caregivers as they care for their loved ones. Caregivers are perpetually under constant stress and pressure, as many have to perform caregiving tasks, in addition to their daily work.
In a Straits Times' article last year, some of these caregivers were featured. Ms Joyce Lim, for instance, was featured and she has to care for her elderly mother and brother who both have health problems. I am also glad that MOH has promised to increase the places available at centre-based services to help caregivers. However, there remains an urgent need to look into the needs of
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such caregivers and provide them with the necessary support as our population ages.
I would like to ask the Minister for an update on the kind of support available to caregivers today. Also, with the implementation of a disability financial assistance for the Pioneer Generation who have moderate to severe disabilities, would the Minister also consider implementing a caregiver allowance for those who are caring for the disabled, but not of the Pioneer Generation age group?
Mr Christopher de Souza (Holland-Bukit Timah): Caring for the caregiver. Being a caregiver is not easy. Caregivers are expected to balance both working during the day, and being a primary caregiver at night. These caregivers may carry the responsibility of taking care of an elderly loved one, a family member or child with special needs, or even a relative with mental health problems.
The pressure and responsibility that fall on the shoulders of these caregivers, in the form of financial burdens, physical and emotional fatigue and time constraints, are not an easy load to carry alone. Without any support and help from the community, these caregivers may buckle under the pressure and responsibility that they have been loaded with.
Therefore, I would like to ask the Minister and his office bearers what measures can be implemented to alleviate some of the struggles that caregivers face on a daily basis. Would the Ministry consider building up manpower capabilities and capacity through the training of individuals with relevant specialised skills to be able to provide home-based care for the elderly, those with special needs or those with mental health issues?
By equipping individuals with such skills, there can be greater opportunities and possibilities for caregivers to have access to home-based respite care options and, thus, be able to have some form of relief from caregiving. This temporary reprieve for caregivers can make a world of difference and would give them a chance to refresh themselves and to recharge.
As the cornerstone of support within their families, these caregivers often have to sacrifice their own personal time and financial resources to care for their loved ones, possibly without any avenue for help or relief. While existing programmes, such as the Caregivers Always Ready and Empowered (CARE)
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programme, provide relevant skills and knowledge for caregivers, the well-being of these caregivers also needs to be taken into consideration. Much more can and should be done to alleviate some of the load that these everyday heroes grapple with on a daily basis.
Further recommendations have been made to set up a Government-led scheme for the provision of respite care for senior citizens, as well as the provision of eldercare leave. These initiatives would certainly help to alleviate the mental and physical stress and time constraints that caregivers often have to deal with. Respite care options need to be enhanced and expanded further to provide caregivers with the opportunity to have short periods of rest and relief, while not having to worry about their care recipients.
One relevant example is a case of a resident in my constituency in Ulu Pandan, who requested respite care so that she could attend her daughter's wedding. She was prepared to forgo the once-in-a-lifetime opportunity to attend her daughter's wedding as she knew that she did not want to abandon her home-bound special needs loved one who needed close supervision.
We, as a volunteer group, were able to put her in contact with the relevant agencies, and something was able to be done to allow her to attend her daughter's wedding, and to be part of that joyous occasion. How wonderful it was to be able to provide that short time of relief for a caregiver who has already sacrificed much for her loved ones.
One thing is clear – without the perseverance and resilience of these caregivers, many in our society would be left alone and without anyone to care for them. In that same vein, it is our responsibility to implement measures that would help to alleviate some of the burdens that these caregivers experience on a daily basis and to ensure that their needs are also being met.
In conclusion, as our society continues to mature and advance in both age and compassion, those who are relied on to provide care for their loved ones should never be forgotten, and a variety of options could be made available to provide necessary and timely relief to caregivers.
Assoc Prof Fatimah Lateef: Madam, psychological health and mental illness management continues to be an area that needs to be strengthened in our healthcare system and landscape. Much was achieved with our last mental
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health blueprint, and a collaborative effort is crucial between MOH, IMH, HPB, mental health VWOs, NGOs and community-based groups. Education, awareness creation and destigmatisation continue to be important. Early detection, early intervention, compliance to management and medication, and integration of care within the community are the right strategic moves forward. But the integration part seems to be needing strengthening and enhancement.
How will the resources for psychological and mental health be better coordinated and managed in the coming years? Will we be seeing more community-based services, institutions or homes for those who need to be cared for, especially where the families cannot cope with their antics and manifestations, which often cause a variety of disamenities and sometimes unintended crimes?
Will MOH also be coming up with a follow-up masterplan aligning with the comprehensive Mental Health Action Plan 2013 to 2020 by the World Health Organization? Madam, we have started the journey to reform our psychological healthcare system. We must continue to strengthen and sustain this.
Ms Tin Pei Ling: Madam, I have spoken on mental health issues in this House every year, and I am glad that MOH has actively implemented programmes to strengthen its outreach and efficacy of mental healthcare in the community, especially in recent years. Therefore, I would like to ask the MOH to provide an update on the current state of community healthcare, and also to share what are the challenges faced, and what are its plans looking ahead.
Mr Patrick Tay Teck Guan (Nee Soon): Madam, given the prevalence of psychiatric cases of varying degrees in our community, my concern is that we may not be giving sufficient emphasis on the protection of mental health of Singaporeans. In particular, there is lack of assistance to caregivers, neighbours and the community who have to constantly be faced with the fears and frustrations of being in close proximity to those with mild to severe depression and severe psychiatric cases, such as paranoia to those with anger management issues. Oftentimes, the Police are called in to manage them but, if they are not violent or behave in a disorderly manner, the Police do not have the powers to refer them for psychiatric assessment or treatment. Often, the victims – who can be neighbours, those living in the community or caregivers – are left helpless and have to bear with it without any recourse. I am aware AIC,
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in partnership with VWOs, has been successful to help counsel and get the family members of those with the condition to seek treatment. The problem arises when those with the condition refuse medical treatment and do not have family support. These sufferers require daily medication and regular check-ups but many do not go for follow-up treatments or consume their daily medication. Can MOH share how it intends to resolve such cases and ensure these sufferers are sent for treatment and are better treated?
Ms Ellen Lee: In the PAP Women's Wing's Position Paper on \"Seniors in Singapore\" which was released in February 2014, the authors highlighted the importance of educating Singaporeans to lead an active and healthy lifestyle from young. This is an increasingly urgent issue, especially for women, as our demographics revealed that women outlive men and according to media reports on women and exercise, a large number of women in Singapore, especially those aged 40 and above, do not exercise regularly. The Budget has provided generously for MediSave top-ups and higher polyclinic subsidies to assure Singaporeans that healthcare costs will be manageable. It is thus important that our national health education programme be rolled out as soon as possible.
In this connection, would the Women's Health Advisory Committee be able to update Singaporeans on the milestones achieved so far? What plans does the Committee have to underline its core message of cultivating sustainable healthy lifestyle habits from young?
The Chairman: Senior Minister of State.
Dr Amy Khor Lean Suan: Mdm Chair, with your permission, may I display some slides on the LED screens?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Dr Amy Khor Lean Suan: Madam, our population is ageing rapidly. I fully agree with Mr Sitoh and Dr Lily Neo that we cannot respond to the challenges of an ageing population by just developing acute hospitals alone. Step-down, community and home care services and facilities are just as vital, if not more so, due to an ageing population. MOH is doubling up our efforts to develop a comprehensive suite of aged care services that are accessible, affordable and
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of good quality, to help our seniors age in place gracefully.
Mr David Ong asked about our progress on nursing homes. Two years ago, we announced our plans to build 10 new nursing homes and add some 3,000 new nursing home beds by 2016. I would like to thank various Members of the House for working closely with MOH to facilitate the smooth implementation of these projects. We are on track to achieving this target. Last year, we added some 1,000 nursing home beds to our national capacity. As we speak, five more Government-built nursing homes are under development and we will begin construction of another seven by early next year.
Our approach is for the Government to build and own the infrastructure, and then tender out to the best operator who can offer quality care at affordable prices. This allows us to tap on the expertise of both the private and people sectors in operating these homes, without burdening them with the cost of having to build the infrastructure.
To complement this strategy, we need to make clear our expectations of the quality of care in nursing homes. Last year, we announced that we are developing a set of Enhanced Nursing Home Standards. These include a clearer articulation of standards for clinical care, psycho-social well-being and organisational excellence.
We have since refined and finalised the set of standards after a series of consultations with nursing home providers, caregivers of seniors and members of the public. The standards will be effective from 2015, with a one-year grace period given to providers before enforcement commences in 2016.
Mr David Ong asked about the implementation of these standards. I would like to assure nursing home providers that MOH will not just set the examination without also providing the necessary \"tuition\" to providers to meet the new standards. The Agency for Integrated Care (AIC) will introduce a full suite of assistance programmes to prepare nursing homes for 2015.
Firstly, AIC will conduct voluntary baseline assessments of nursing homes in 2014 to see where they stand as against the standards. AIC will then develop customised programmes based on the gaps identified. As of end February, 34 nursing homes had already signed up for these assessments. Of these, 12 have
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already gone through the assessments.
Secondly, AIC has developed new courses for nursing home staff. Participants may receive up to 90% subsidy on their course fees.
Thirdly, AIC will launch a guide in the second quarter of this year to help nursing home providers better understand how the enhanced standards can be implemented.
I would also like to thank Mr Sitoh for his feedback on nursing home ward design. The nursing home standards are meant to be outcome-oriented rather than prescriptive or process-driven. Given the different circumstances of various nursing homes and the different clientele that they serve, the nursing homes should be given flexibility to achieve the desired outcomes in terms of dignity of care. They should not be dictated on specific matters, such as design configuration of the homes.
Nevertheless, MOH has and will continue to improve upon the design of the nursing homes we build, recognising that the physical environment can affect caregiving. Last year, I updated Members of this House on how we have injected more public spaces, greenery and even green spaces at ward levels in our new nursing homes for patients to enjoy. We will continue to study new designs that can provide greater privacy while maintaining the operational efficiency and affordability of nursing homes.
Mr Sitoh Yih Pin, Assoc Prof Fatimah Lateef, Dr Lily Neo and Mr Low Thia Khiang spoke passionately about the development of home-care. Indeed, I very much share their aspiration, to see the majority of our seniors well cared for at home rather than in any institutional setting.
To achieve the vision of \"care at home\", Mr David Ong is right that we will need to set up a much more holistic and integrated system to promote and support the care of our seniors at home. Let me assure him that MOH places great priority on developing a more comprehensive and accessible set of care services that extend into the community and homes.
This year, MOH will focus more on home-based care development. We will be enhancing the three \"C\"s this year, as Assoc Prof Fatimah Lateef said earlier. These are expanding Capacity, making home care Comprehensive, and enhancing Caregiver support.
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First, MOH has and will continue to invest in expanding home-based care services so that more seniors and their caregivers can benefit.
We have worked with various hospitals to set up transitional care programmes to help patients who are discharged from hospitals to transit smoothly back home. These multi-disciplinary teams provide medical and allied health support for patients in their homes after they are discharged so that they can recuperate and stay well in the community, and not have to be re-admitted again.
Since 2010, we have built up a capacity to serve about 2,000 patients a year under transitional care programmes and we aim to increase this capacity to about 3,300 patients by the end of this year.
Many seniors living in the community may also have chronic diseases and functional impairment, and require long-term home-based healthcare and personal care to help them age gracefully at home.
Since 2012, new and existing home-care providers have received funding to help them scale up their home-care services. In total, our providers can now serve 5,400 seniors needing home-based healthcare, and 1,100 seniors needing home-based personal care a year. We are on track to achieve a capacity of 10,000 patients for home-based healthcare services and 7,500 patients for home-based personal care by 2020.
As part of enhancing home-care, we are also working with providers to expand home palliative care services. Mr Laurence Lien and Mr David Ong earlier asked about end-of-life care. MOH has been supporting the expansion of in-patient palliative care capacity. However, we also know that many caregivers have expressed their wish to care for their loved ones at home, even towards the end-of-life. We want to support caregivers during this period, which can be especially stressful and difficult, by further developing home-based palliative care services. MOH will be announcing more of our plans to enhance palliative care services later this year.
Second, we are enriching the scope of home-care services available and making our suite of home-care services more comprehensive so that we can better meet the diverse needs of patients and their caregivers.
We know that home visits by doctors or nurses are inadequate to enable seniors to be cared for at home. Seniors who do not have full-time caregivers
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at home need a lot more personal assistance in the day. Working caregivers are particularly stressed after their parents are hospitalised, as they have to find new care arrangements and are unfamiliar with how to care for their parents in the immediate period after discharge.
In March last year, we introduced a new Interim Caregiver Service. This provides seniors with a much longer period of care – 12 hours of personal care every day, for up to 12 days over a period of two weeks – right after they are discharged from hospital.
It has helped seniors and their caregivers to enjoy a smoother transition home and given caregivers more time to make longer-term care arrangements. With additional help for 12 hours a day, caregivers can also get some rest. This service will be available in all major restructured hospitals and community hospitals this year.
This year, MOH will also make available even more subsidised home-care services. From 1 April 2014, MOH will subsidise the provision of home-based rehabilitation as part of the suite of subsidised home-based services available.
Today, seniors can go to day rehabilitation centres for their rehabilitation needs. However, some seniors may not be able to do so because they are still quite frail and may be unable to sit through the journey to the centre, or there are physical barriers that make it difficult for them to leave the home to go to a day-care centre.
We want to catch the window where home-based rehabilitation can help improve their function. A therapist or therapy aide will visit the senior's home to assess and carry out active rehabilitation for up to four months.
The objective is to bring rehabilitation in a more timely manner to these seniors at home, enabling them to regain as much of their functional ability as possible within their daily living environment, and remain independent longer. Eligible seniors can receive subsidies for home-based rehabilitation services from April this year, up to a maximum subsidy of $97 per visit.
Take the example of Mr Zulkifli, who suffers from diabetes and had to undergo an amputation of one of his legs above the knee. He was unable to leave his house for therapy sessions because he could not climb down the steps outside his main door and he had no caregiver who was available to accompany him. He underwent intensive rehabilitation at home under Tan Tock Seng
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Hospital's Community Rehabilitation Programme, and shared that home therapy gave him the motivation to get out of bed and the confidence to keep going despite his setback. You can see that he is a happy man there in the photograph. I am indeed very pleased to hear that he is now able to negotiate the steps in front of his house with a prosthesis and crutches and has, in fact, returned to work as an administrative officer.
Home environment assessment will also be added to the suite of subsidised home-care services available. Therapists will visit the homes of seniors who are receiving home-based care services to identify home hazards and recommend home modifications to facilitate independent living, like having grab-bars or ramps for wheel-chairs. This helps them to transit safely from hospital to home.
Similar to home-based rehabilitation, eligible seniors can receive subsidies for home environment assessment. The home-care provider will also help them to tap on existing sources of funding like the HDB's Enhancement for Active Seniors (EASE) funding for the necessary home modifications.
Third, we are making home care more integrated and client-centric. Today, some seniors may find that home-care services are delivered in a fragmented manner with a lack of coordination between separate health and personal care providers. This is not ideal as an individual's health and personal care needs are closely intertwined.
The Agency for Integrated Care will be working with several homecare providers to better coordinate, if not fully integrate, home healthcare and home-based personal care for our seniors at home. For instance, Touch Home Care, NTUC Eldercare and Thye Hua Kwan, have received funding to build up their capabilities and capacity so that they can provide a comprehensive package of services according to the needs of the client.
They will be able to make a holistic assessment of a senior's needs, draw up a comprehensive care plan with integrated health and personal care services, and explain this care plan to the senior and his family members. They will also help to make applications to relevant assistance schemes, monitor the senior's medical conditions to ensure timely treatment and provide caregiver training and support.
Take Mr Low Boon Leong, for example. Mr Low is 66 years old and suffers from high blood pressure and kidney disease. He is single and lives alone in a rental flat. Mr Low currently enjoys a comprehensive, integrated package of
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services from TOUCH Home Care. TOUCH medical staff visit Mr Low twice a month to manage his medical conditions and help him pack his medications, while personal care staff visit him once a week to help him with his household cleanliness. TOUCH also helps to arrange transport for his medical appointments.
For providers who are not yet able to offer all the health and personal care services today, they will be expected to do a similar comprehensive assessment of seniors' needs and coordinate with other providers to meet these needs holistically.
Fourth, MOH will enhance the way home nursing, home medical and home-based personal care services are funded to support this integrated approach to care, as the Minister has noted earlier.
Today, MOH funds home-care providers based on the number of home medical and nursing visits made, or the number of personal care hours a client is eligible to receive each week. Such a funding approach is suitable for seniors who only need infrequent or ad hoc home-care visits when they fall sick or need help at home.
To encourage providers to take a person-centric view and to \"own\" and integrate care for their patients who need home-care as a long-term care option, MOH is studying a new way of funding. We are prepared to fund providers not on a per-visit basis, but on a per-client basis, where we will provide a fixed amount of funding per month for each senior under their care, based on individual care needs.
This new approach to funding will give home-care providers a steady stream of financial support, so that they will have the resources and flexibility to plan and deliver an integrated package of home services needed by the seniors. We expect to implement this new model of funding in the third quarter of this year.
Finally, we will enhance the quality of home-care services. The quality of home-care services is important, because we want to give caregivers peace of mind that their mum, dad or loved one will be well looked after at home when they are at work.
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MOH has worked with home-care providers to develop a set of Home-care Guidelines, to articulate the level of care expected of all home-care services. This includes good practices to enable coordination of care; enhance quality of care; promote independence; and encourage organisational excellence. MOH will be conducting a series of consultations with the home-care sector, seniors, as well as caregivers, before finalising the set of guidelines.
MOH will also be expanding eldercare centres to complement home-care services. Mobile seniors who can attend day care or day rehabilitation services at one of our eldercare centres can get out of the house, meet new friends and spend quality time interacting with others rather than staying alone at home.
We aim to more than double the centre-based care capacity by 2020, by adding more than 3,000 day care places to our current capacity. We are also developing new \"one-stop\" Senior Care Centres in the community, where our seniors can receive day care, dementia day care, rehabilitation and nursing services all under one roof. This saves them the trouble of visiting different centres for different services.
In the past two years, eight new centres in different regions across Singapore have opened, providing a total of more than 400 additional day places. This year, another eight new centres will be opened, adding some 400 day places.
Just like nursing home and home-care services, we need to pay attention to the quality of care delivery in these centres. MOH has worked with day care operators to draw up a set of Centre-based Care Guidelines to articulate the quality of care expected of the centre-based services. The guidelines emphasise safe care and promoting seniors' independence by involving them and their caregivers in making informed decisions about their own care.
This year, MOH will also be conducting a series of focus group consultations with seniors and caregivers to discuss this set of guidelines before they are finalised.
Several Members spoke about the need to invest in intermediate and long-term care and make it more affordable. Let me assure Members that we have been investing and will continue to invest in the development of affordable community care services.
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We have been increasing our support to the sector, both in enhancing affordability for patients and capital investment to scale up facilities. In July 2012, we significantly enhanced the subsidy framework for Intermediate and Long-Term Care (ILTC) to cover all lower- and middle-income households. Currently, two-thirds of households are eligible for subsidies if they need these services.
With this, MOH's funding to the ILTC sector has grown significantly in the last two years. Funding to the ILTC sector is expected to reach around $260 million for FY2013, an almost 80% increase from $145 million in FY2011. The $1 billion Community Silver Trust (CST) has also provided VWOs around $88 million of funding to date, with more applications pending processing. From July last year, we also allowed more flexibility for VWOs to use CST matching grants to meet recurrent operating expenses.
Last year, we have also enhanced the Seniors Mobility and Enabling Fund to $50 million. The Fund was expanded to include more devices, consumables, and subsidised transport services for clients receiving dialysis, dementia day care and rehabilitation services. I am pleased to inform Members that since July last year, more than $3.7 million has been disbursed and more than 5,400 seniors have benefited from the SMF enhancements.
We agree with Mr de Souza, Mr Chen, Dr Lam and Ms Lee that care-giving is no easy feat and we need to support care-givers.
The expansion in home and community-based services, taken together, will support caregivers and help them balance their caregiving and work obligations. In tandem with the expansion of services, MOH will also be working on outreach to caregivers to help them navigate the eldercare landscape and access the services that they need.
Last April, we brought all aged care functions under AIC. Caregivers of the elderly now only need to contact AIC for information and referral to eldercare services. We have also provided an online platform, Carers SG, for caregivers to show mutual support, share information, resources and experiences.
Dr Lam asked if we could consider allowances for caregivers of the elderly and disabled. We want to avoid monetising family ties and filial piety which are intangible. Instead, we provide financial help in other forms. For instance, the AIC administers the Caregiver Training Grant which provides subsidised training for caregivers to equip themselves with the necessary skills to care for
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the physical and emotional needs of their care recipients. In the past year, some 5,400 caregivers have been trained.
Ms Ellen Lee's suggestion to encourage former caregivers of the elderly to enter the aged care sector is an excellent one. Today, some 12% of the caregivers trained under the Caregiver Training Grant scheme are middle-aged locals who are looking after their elderly loved ones at home. We will certainly think about how we can also reach out to former caregivers and inform them of the eldercare job opportunities available.
This year, Deputy Prime Minister Tharman announced the enhancement of existing tax reliefs, such as parent and handicapped parent relief and handicapped spouse, sibling and child relief, which will provide greater support for working caregivers.
MOH will also go a step further and make respite services more accessible. We have rolled out the Nursing Home Respite Care (NHRC) Pilot, where subsidised Nursing Home care is provided to eligible seniors for between seven and 30 days a year. Fifteen participating nursing homes have since come on board the programme and this has benefited some 130 clients.
By the second half of this year, MOH will also partner a number of eldercare centres to pilot weekend respite services. Caregivers can drop off their seniors at these eldercare centres during the weekends, for a few hours, if they need a respite or to run errands.
Caregivers for persons with dementia may also approach ADA, NTUC Eldercare and Thye Hua Kwan Moral Charities for home-based elder-sitting services, where therapeutic activities are conducted for the senior while the caregiver takes a rest. Eligible caregivers who make use of these respite services can also receive Government subsidies.
Finally, in the third quarter of this year, we will put in place a one-stop call centre for caregivers. Caregivers only have to call this one number to access a whole variety of services, such as referral to care services, application for grants and care coordination for loved ones with multiple needs. We hope that this will help Singaporeans get the support and the services that they need to care for their loved ones in the community more easily.
To achieve the vision of ageing-in-place or care at home, we need a whole-of-society effort. For one, a supportive workplace is important. A supportive
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work environment makes it much easier for caregivers to juggle between work and caregiving. Several Members have raised the issue of eldercare leave. The Government will be reviewing this issue as part of our broader efforts to address the challenges of an ageing society.
We can also contribute to caring for our seniors as a society. Seniors will not only age gracefully but thrive, if we can build \"Communities of Care\" across Singapore, where everyone in the neighbourhood chips in to support frail seniors.
We held a focus group discussion with over 100 caregivers last year to understand how we can better support them. One thing we learnt was that having caring neighbours who help to support seniors living in the community would make a huge difference. I am very happy to say that several communities – Siglap, Marine Parade, Bedok, just to name a few – have rallied caring neighbours living in the vicinity to check on seniors who need care.
For example, under the Eastern Health Alliance's Neighbours for Active Living Programme, neighbours visit seniors with high care needs in their homes, help monitor their condition and also help out in other ways. Take the example of Ms Rohani, a 68-year-old lady who lives in Marine Parade. She has multiple medical conditions and is on many medications. During the day when her family members are either at work or school, she is alone at home. Under the Neighbours programme, the Eastern Health Alliance team works with the local Senior Activity Centre, Goodlife!, to arrange for volunteers to visit her twice a week. The volunteers befriend her and keep her company, remind her to take her medication and even help her to buy meals and groceries when needed. They also check on her regularly and alert the Eastern Health Alliance team if there are any issues.
And I hope to see more communities stepping forward to do this, because every one of us can do our bit to care for seniors within our own vertical kampongs!
Mdm Chair, let me assure this House that even as we have taken bold steps this year to enhance the affordability of both acute and outpatient care for seniors, especially for our Pioneer Generation, we are just as focused in building up our home and community care services, as we are keenly aware that this is necessary to help our seniors age gracefully in place.
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Let me now move on to issues of mental health and women's health raised by Members. As Ms Tin had said, she has raised this issue every year and I have been answering this every year. But I am glad that she has noted that things have improved. Assoc Prof Fatimah Lateef and Ms Tin asked about the progress of mental health programmes in the community. Mr Patrick Tay asked how to ensure that patients with psychiatric conditions in the community are well managed.
The National Mental Health Blueprint was launched in 2007 and the programmes are still on-going. Building on that foundation, we introduced a Community Mental Health plan in 2011 to ensure that patients continue to be well supported in the community. We have since set up various community teams, made up of mental health professionals and physicians, to better manage patients in the community. Our community teams provide clinical care and psychotherapy for patients, help to link them to other community services, and also provide education and support for patients, caregivers and the general public.
Let me illustrate how individual patients and their families are supported by these community teams. In the northern region, a patient with mental illness usually receives treatment at the Specialist Outpatient Clinic (SOC) at Khoo Teck Puat Hospital (KTPH). KTPH actively trains primary care physicians and community agencies in providing mental health care, and in this way, develops an integrated community mental health network. Even when the patient can be managed in the community, KTPH's community team and its GP partners will continue to support the clinical needs of the patient.
The patient may also be referred to other community partners like Clarity Singapore for counselling services or Singapore Anglican Community Services for urgent community response. Such community support teams have reached out to more than 2,000 patients, and in the process, reduced the number of emergency admissions among their patients by half in FY2012.
Our teams have done good work, but many in the community are still unaware of mental health illnesses or where to seek help. Thus, MOH has partnered community groups, such as Thye Hua Kwan Moral Charities and Silver Ribbon Singapore, to reach out to the public to increase awareness of mental health issues and the help available. We have also provided mental health training and education to the social service agencies and VWOs which
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can better reach out to residents. And, to date, we have trained over 100 community partners, including Family Service Centres (FSCs), Senior Activity Centres (SACs), grassroots leaders and volunteers.
Our community partners can turn to our 24-hour Mental Health Helpline for immediate support and advice in managing mental health issues. Our outreach teams have also reached out to over 18,000 residents and we aim to reach out to about 9,000 more seniors by end 2014 this year.
Last year, MOH had also reached out to grassroots advisors, to co-create local partnerships or local support networks to better support residents with mental conditions. For example, in Kembangan-Chai Chee and MacPherson divisions, we meet up with the grassroots organisations, Town Councils, voluntary welfare organisations and the Police to devise solutions to better support residents with mental conditions and who have been identified as needing help by our local grassroots or social organisations. These groups help such residents by promptly linking them up with appropriate social or health services.
I would like to take this opportunity to thank the advisors and the grassroots for their support in bringing these communities together. Ms Tin Pei Ling asked about the challenges we face. Despite our best efforts, there could still be residents who refuse to be engaged. We are unable to legally compel them to comply with treatment if they are not causing harm to themselves or others. However, we are prepared to work with community volunteers or leaders to engage and persuade this group of residents to come for treatment.
One such resident was a 51-year-old lady who displayed violent and abusive behaviours towards her father. Staff from Fei Yue FSC at Bukit Batok, who had been trained in mental health, identified and referred the resident to our community support team for assessment. Our community support team conducted several home visits and managed to persuade the resident to receive treatment at IMH. The resident has since been discharged and our community support team will continue to monitor the resident's condition and remind her to take her medication and go for her outpatient appointments.
Moving forward, we will be assessing the effectiveness of our community mental health programmes and expanding those that have been successful. We are also working towards better integration between programmes.
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Ms Ellen Lee asked about the progress of the Women's Health Advisory Committee (WHAC), which I chair. Since its establishment in May 2012, WHAC has reached out to more than 200,000 women. One of our priorities has been to provide affordable cancer screening for women, especially those from the lower-income group. Mammogram screening for breast cancer is especially important as it is the number one cause of death from cancer in women in Singapore.
I am pleased that the Breast Cancer Foundation (BCF), in partnership with HPB, launched the BCF Encouragement for Active Mammograms (BEAM15) programme in March last year. This programme provides heavily-subsidised mammograms to lower-income women through the polyclinics and a mobile bus with mammogram facilities called the Mammobus. The programme was very well-received, with over 6,000 women taking up the offer within a three-month period since its launch. With generous support from the Breast Cancer Foundation and Estee Lauder, more than 8,500 women in total have received screening to date. Of these women, about 1,200 women required further assessments after their mammograms and 48 of them were diagnosed with cancer.
Early detection and treatment of cancer through screening can lead to better long-term outcomes. WHAC will continue to promote cancer screening for women by making it more affordable and accessible, especially for lower-income women.
Last year, I was pleased to launch a Health Calendar, developed by HPB called \"Good Health, Better Life\". It teaches women from lower-income families how to choose healthier foods at lower prices for themselves and their families. As Members can see, it is full of pictures, fun and easy to read and understand. The pilot batch of calendars in Malay was distributed to about 3,000 Malay households with the help of religious organisations, such as PPIS and MUIS. Depending on its success, we will also explore producing the calendars in other languages like Mandarin and customising them for different communities.
WHAC will also work through the Healthy Living Master Plan (HLMP) Taskforce, led by the Parliamentary Secretary for Health, Assoc Prof Dr Muhammad Faishal Ibrahim, to cultivate healthy lifestyle habits from young. The Parliamentary Secretary will elaborate on this later.
Mdm Chair, to conclude, health and wellness are priceless. We hope to encourage individuals to take ownership of their health and MOH will continue
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to strengthen our efforts to foster a whole-of-society approach to build a healthier and happier society.
The Chairman: Order. I propose to take the break now.
[(proc text) Thereupon Mdm Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mdm Speaker: Order. I suspend the Sitting and will take the Chair again at 4.30 pm.
Sitting accordingly suspended
at 4.07 pm until 4.30 pm.
Sitting resumed at 4.30 pm
[Mdm Speaker in the Chair]
[(proc text) Debate in Committee of Supply resumed. (proc text)]
[Mdm Speaker in the Chair]
Head O (cont) –
Assoc Prof Fatimah Lateef: Madam, according to World Bank data, Singapore has the highest proportion of older residents and the fastest ageing population in Southeast Asia. Economists and demographers state that this means greater demand for healthcare and eldercare services and also the need for more elder-friendly infrastructure.
Seniorhood is often viewed as the years when there are multiple morbidities, often associated with multitude of chronic illnesses, adverse consequences, complications, disabilities, institutionalisation, increased utilisation of healthcare resources and poor quality of life. Well, that is all wrong and, indeed, a negative mindset.
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Being old or a senior is not a disease. It is a part of life, which can be planned, prepared for and celebrated as the golden years, with the inculcation of a positive and successful ageing vision. With early preparation, planning and focus, seniors can lead an empowered, holistic, healthy and active life. After all, many studies have shown that having a positive attitude and mindset is half the battle won against most diseases or for disease control.
Preparing for a healthy seniorhood starts now. Regular assessments and a health screening, a healthy lifestyle, correct food choices, regular exercises and positive psychological health are all important. Some of the happiest countries in the world also report a strong sense of social support, freedom to make life choices and a widespread culture of generosity and graciousness.
Integrated care and health promotion are thus critical. At the same time, regulatory and financing frameworks must align. MOH, HPB, Council for Third Age and other like-minded organisations must continue to strengthen our shared narrative on why integrated and holistic healthcare matters. Our vision must be persuasive enough to convince the most sceptical, who still think it is better to die early. Risks and needs stratification must be done in more detail to ensure meaningful results and outcomes all round.
Integrated healthcare for seniors is a combination of top-down and bottom-up approach, meeting half way. More collaborative models must be made available. Seniors must be taught to take more control of their health and well-being. It is in their hands. Can we help them understand the many policies, schemes and programmes they may not be aware of and have difficulty understanding? In the next two weeks, for example, I have got eight Pioneer Generation dialogue sessions in my constituency with the seniors to empower them and make sure they understand. Assessing the healthcare system is relatively easy, I would say, but negotiating it can be daunting for the seniors. How do we break down the barrier and simplify their job? I hope that we can actually make this a lot easier for the seniors. A positive and mature attitude is, indeed, important for seniorhood.
Finally, a quotation: \"To keep the heart unwrinkled, to be happy, hopeful, cheerful and kind – that is to triumph over ageing.\"
Mr Seng Han Thong (Ang Mo Kio): Madam, it is said that, in the coming years, Singapore's healthcare system will come under pressure from the ageing
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population. And as our population is ageing rapidly, some have even described it as a \"silver tsunami\". However, there is this Chinese saying \"家有一老，如有一宝” or an elder at home is a treasure for the family. Both are right from different perspectives. Indeed, as more and more of our aged are suffering from dementia and other ageing-related diseases, we need to gear up for this challenge.
If you visit nursing homes and hospices, and meet with the seniors who are no longer able to do simple things, you would agree that this is a real challenge. However, more and more of our senior citizens are also active agers involved in various voluntary and community activities. If you visit community clubs and neighbourhood parks and meet with seniors who enjoy line dancing and tai-ji, you tend to agree that they are our treasure and many of them are what we now call the Pioneer Generation.
Thus, the reality is in between. We need to step up our effort to engage more seniors with many more creative and innovative activities so that after each and every engagement, they will go back to their own home where all the family members treat them as treasures. If we can engage more seniors as early as possible with the right knowledge on mental health and healthy tips, more will enjoy a healthy body and healthy mind and do not need to end up in a nursing home.
HPB and the People's Association and many other voluntary welfare organisations have been working closely to engage our seniors in the areas where they work, live and play. As our population is ageing, we need to have a public education programme to promote the right image of ageing and the right approach to the issues not only among the seniors, but also within the whole population as, like it or not, we will all be old one day.
(In Mandarin): [Please refer to Vernacular Speech.] Nowadays, when we mention old people, we think of the Pioneer Generation. And if you were to address them as pioneers, they will suddenly feel \"tall\"!
In the past, whenever we talked about old people, we felt that there were a lot of problems associated with them. In fact, being old is not the problem; the problem is the way we look at them.
If you visit nursing homes or hospices and see those old people who cannot look after themselves, you tend to think that old people particularly have many problems. But if you go to the community clubs or parks and see those seniors
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dancing and practising qigong, you would think that we should look at ageing more positively.
It is a good thing that our community clubs can draw many seniors to participate in various healthy activities. But if one day they are not coming, then it is a bad thing. It is a good thing that the parks can draw many seniors to exercise voluntarily; but if one day they are not coming, you will have to visit them in the hospital, then it is a bad thing.
HPB, under MOH, and many voluntary welfare organisations will face greater challenges to ensure the physical and mental well-being of the elderly. The biggest challenge we face is how to look at the ageing problem positively. Being old is not the problem; the problem is the way we look at them. Some say they are treasures; some say they are liabilities. No matter what they are, we should all work together to make their golden years enjoyable.
Mr Yeo Guat Kwang (Ang Mo Kio): Seniors need to adopt a positive mindset towards ageing. We also need to create an environment that our seniors feel welcomed and included so that they can live a happy and healthy life. Many seniors and soon-to-be seniors also want to remain engaged and independent as they age. Madam, we need to have more programmes and initiatives that can support these seniors to stay healthy and active. Could the Ministerial Committee on Ageing (MCA) and MOH provide an update on how it is promoting active ageing and also tell us whether such programmes have benefited our seniors?
(In Mandarin): [Please refer to Vernacular Speech.] We often say that, \"An elder at home is a treasure for the family.\" We also say that health is the real treasure. If you are old and healthy at the same time, then you are really a \"double treasure\". But if you are old and sickly, then you become a medicine bag. Hence, before providing various quality healthcare services to our elderly, the Government should also provide more resources for them to stay healthy, so that our elders can become more vigorous with age, instead of being infirm and sickly.
Mr Zainal Sapari (Pasir Ris-Punggol): Madam, the Wellness Programme has been implemented nation-wide in all divisions. I would like to know how have the results and impact been so far, and has the programme been proven
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to be a good and effective platform to promote active ageing. Have any studies been done to assess the key benefits of the Wellness Programme? While the Wellness Programme is a flagship active ageing initiative, we need to also work with other partners and platform to widen the overall reach of our active ageing initiative. What are the initiatives that MCA and MOH have in place, other than the Wellness Programme, to reach a wider pool of seniors? How have these initiatives benefited our seniors? We must remember that senior citizens have spent their whole life raising families, being part of the workforce and shaping Singapore to what it is today. It is not enough that we make sure that they can retire but rather to be able to retire with dignity and passion. Being old does not mean a man should stop bettering the life of himself or those around him.
(In Malay): [Please refer to Vernacular Speech.] Madam, the wellness programme for the elderly was launched across the island with the objective of encouraging grassroots organisations to work with other sectors to organise programmes for senior citizens.
I would like to ask about the effectiveness of these programmes so far and whether it has been proven as a good and effective platform to encourage the elderly to lead active lives.
Has any study been done to assess the main benefits from this type of wellness programme? Other than the wellness programme, are there any other plans by MOH to involve more senior citizens in specific initiatives that will make them become more active?
Mr Chen Show Mao: Madam, participation in regular health screening for common chronic illnesses as we age, is one way to enable early detection and early intervention, and helps keep the individual healthy, as well as keep the long-term healthcare costs to society low.
In Singapore, we have the Integrated Screening Programme (ISP), which invites Singapore Citizens and Permanent Residents in the target age groups for health screening. However, participation rates in the programme remain low, despite attempts to encourage more to take part.
Research has found that one of the key factors preventing Singaporeans from taking part in regular health screening programmes is the cost of screening. Could the Government provide more incentives to individuals to
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overcome this barrier so that we may achieve a collective good? Perhaps, it could be in the form of subsidies to targeted age groups, or MediSave top-ups, or reduced MediShield premiums for regular participation in screening programmes, or for taking part in healthy living activities.
Ms Faizah Jamal (Nominated Member): Mdm Chair, last year, I had called upon MOH to consider the value of nature spaces in healing for preventive and rehabilitative healthcare, based on increasing literature which shows the relationship between green spaces with wellness and well-being.
In my Budget debate speech this year, I had raised my concerns over the emotional health of Singaporeans, particularly young people.
Madam, in a Parliamentary Question I submitted last November asking for the rate of breastfeeding, Senior Minister of State Amy Khor had confirmed that partial breastfeeding rates went up from 21% in 2001 to 42% in 2011. Exclusive breastfeeding rate, however, is very dismal, partly due to cultural resistance.
Madam, the nutritional and health benefits of breastfeeding have been much spoken about. However, not as much has been said about its long-lasting emotional benefits. A breastfeeding relationship cements a very strong emotional bond between mother and child. From the very start in life, because the mother is always close to the baby, the baby adapts to life outside the womb better, secure that the mother is always near. More importantly, it is well-documented that this close interaction and sense of emotional security persist not just in childhood but also in adulthood as well, helping in the make- up of well-adjusted, balanced individuals.
For this reason and to enhance the emotional health of Singaporeans, I call upon HPB to do more to promote, educate and encourage breastfeeding, provide the necessary support and facilities both at home and at work, and to remove the cultural resistance and ignorance that Senior Minister of State Amy Khor had talked about. This public education should be targeted at fathers and other members of the family as well because it is well-documented that when there is family support, mothers tend to breastfeed and for longer periods.
The other concern I have with the emotional health of young Singaporeans is reflected in the Parliamentary Question I submitted late last year on the increasing rates of suicides
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among young people. Madam, what more can be done by MOH and the community in our schools to help school counsellors and parents to identify the problems early so that emotional support can be given before it is too late?
It is interesting to me that a school in Thailand has been teaching its young students relaxation techniques at the start of the day, and it seems to have borne results. The students display a more positive mindset and have a more composed outlook towards life. I believe our young people here would benefit from such life skills. Further, it has been long established that a physical ailment is often a result of suppressed emotions, like anger and frustration, and science is only beginning to recognise this mind-body connection between what we think, how we feel and our illnesses and diseases.
Madam, at this point, I would like to declare my interest as a facilitator of self-empowerment sessions supporting individuals as they navigate their way through emotional challenges.
Invariably, these people, when given a safe, non-judgemental space to express and release their emotions and deal with the emotions in a constructive way, they report feeling enhanced self-awareness and better able to make life-affirming choices. What is even better – their physical condition improves as well. I urge MOH to think beyond exercise and diet and in discouraging smoking in our healthy lifestyle campaigns and provide life skills that support young people in dealing with their emotions because real healthcare is about dealing with the underlying causes and not just pharmaceuticals and hospitals.
Mr Gerald Giam Yean Song: Madam, age-appropriate preventive health screenings have been recognised as a cost-effective way to identify health problems before they develop further and end up being more costly to treat. However, many are reluctant to undergo health screenings because of the inconvenience, cost or fear that it will reveal health problems whose treatment may be beyond their ability to pay for.
More resources should be invested in promoting regular health screening on a wider scale. High-risk groups should be identified and greater effort made to reach out to them.
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To encourage greater adoption of health screening, I propose that all Singaporeans who reach age 40 be provided with one set of free health screening tests for common chronic conditions and cancers under HPB's Integrated Screening Programme. This should include the cost of a doctor's consultation.
Subsequent health screenings should be provided at subsidised rates and patients should be allowed to use their MediSave to pay for the remaining costs. Having more Singaporeans in high-risk groups undergo regular health screenings could reduce overall health expenditure as diseases are detected earlier, hence, requiring less costly interventions.
Assoc Prof Fatimah Lateef: Madam, lifelong health promotion and care must be planned right from early adulthood. It is too late to think about your low bone density when you are 68 years old and have already sustained an osteoporotic hip fracture from a fall. Awareness, knowledge acquisition and inculcation of healthy habits and lifestyle start early, in preparation for the latter years. Participation in health screening is also critical, as early diagnosis can lead to early intervention and of course, better rates of cure.
The Singaporean lifestyle is, unfortunately, not the most healthy and positive, and looking at our chronic illness rates, it is indeed telling that we need more focus and emphasis on health promotion and preventive care from an early age. This is also closely linked to being educated and knowledgeable in health-related issues. Certain groups, especially our seniors in low-income households, have very low health literacy rates as well. If we can rectify this, perhaps we can see some reversal in certain negative and worrying trends in healthcare.
What else will MOH be rolling out, together with HPB, in this area? Will there be more partnerships that we can see to ensure outreach and spread of information get filtered to those needing it most in the last mile and are falling through the cracks in this important focus? Will there also be more health promotion facilities that we can see?
Madam, health promotion strategies must include advocacy, surveys and research. The main thrust must be the demand for good health, rather than just good healthcare.
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The Chairman: Senior Minister of State.
Mr Heng Chee How: Mdm Chair, may I have your permission to show some pictures on the screen?
The Chairman: Yes, please, I was expecting that. [Slides were shown to hon Members.]
Mr Heng Chee How: Madam, also for avoidance of doubt, I am rising not to make further cuts on MOH but to help answer some questions on active ageing.
Madam, I thank the various Members for speaking in favour of and highlighting the importance of active ageing. All of us are ageing because that is part of life, part of growing up. Instead of associating ageing with disease or disability, we should focus on how to keep ourselves healthy, active and happy, because all of us will likely be leading longer lives going forward. In fact, a 65-year-old in 2012 has a life expectancy of 20.4 years, compared to 14.2 years for a 65-year-old in 1982. We should make the most of this increased longevity.
Ageing can be happy, fulfilling and enjoyable, if our seniors keep themselves healthy and active. Indeed, many of our seniors are already leading active lifestyles. For example, more seniors are choosing to stay employed, with the labour force participation of those aged above 65, growing from 10.4% in 2004 to 22% in 2012.
An active lifestyle keeps our seniors mentally engaged and adds a sense of purpose to their lives. We will continue to support our seniors in ageing actively and I am happy to provide an update on our programmes in response to Mr Chen Show Mao, Mr Yeo Guat Kwang, Mr Zainal Sapari and other Members who have spoken on this subject.
First, an update on the National Wellness Programme. To promote health and wellness in seniors, the People's Association has rolled out the Wellness Programme to all 87 constituencies in Singapore since 2012. Seniors can stay physically active through activities, such as brisk-walking, and socially connected through ground-up interest groups. So, that would be an example of a ground-up interest group, and as Members can see on the screen, they are having a great time.
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A 12-month impact study conducted last year in collaboration with Duke-NUS validated that seniors benefited from their participation in the Wellness Programme. Compared to the general senior population in Singapore, those seniors who participated regularly in the Wellness Programme became more physically active and socially connected. They increased their participation in physical activities by an extra 48 minutes per week, compared to the general population which reported an increase of 23 minutes a week. Wellness Programme participants also felt healthier and adopted more positive health behaviours. They were also more likely to participate in health screening – which is a point emphasised by various Members – and to follow up on any abnormal screening results.
So, to give an example, 54-year-old Mdm Jenny Yim Yuen Chun is one of the seniors who benefited from the Wellness Programme. She keeps herself healthy through brisk walking. She has also stretched herself personally by going beyond just being a Wellness participant. She now contributes as the Bukit Panjang Divisional Coordinator for the North West Brisk Walking Clubs where she organises activities for the many club members.
Mdm Yim has attended leadership and first-aid courses to better fulfil the coordinator role. Mdm Yim has demonstrated that one can certainly continue to grow personally and to lead an active, happy and purposeful life even as one ages. Being in the brisk walking club, she certainly has gone the extra mile
The Wellness programme is spreading with more seniors like Mdm Yim benefiting from the programme. By December last year, the programme had reached out to more than 310,000 seniors, and is on track to the goal of reaching out to one in two citizens aged 50 and above by 2015.
Next, on keeping our seniors mentally engaged and active, several Members have highlighted the subject of lifelong learning and seniors' development. We are, indeed, making available more lifelong learning programmes and opportunities for senior volunteerism and employability. By participating in these programmes, seniors can stay mentally engaged and enjoy greater mental well-being. Seniors can also gain a greater sense of purpose and show that ageing is a fulfilling process. And this will improve our overall societal mindsets towards ageing, which is like a point that Members like Mr Seng Han Thong and Mr Yeo Guat Kwang also emphasised.
We will continue to work through the Council for Third Age, or C3A, to promote and support lifelong learning activities. C3A collaborates with like-
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minded VWOs like YAH!, which stands for Young-at-Heart!, Community College and Fei Yue Community Services to bring lifelong learning courses to the community. C3A itself also launched the Intergenerational Learning Programme, or ILP, in 2011.
The ILP pairs senior learners with student \"teachers\" in subjects such as Information Technology and photography. It bridges intergenerational gaps and promotes mutual understanding. A survey of 804 senior and youth participants on this programme showed encouraging results. Ninety-seven percent of the youths said that the programme improved their perception of the older generation, while 94% of the seniors on the course felt the same towards the younger participants. To date, 1,040 youth and 830 seniors have participated in and benefited from this programme.
In recognition that many seniors have skills and experience, and can and will want to continue to make meaningful contributions, C3A has also funded senior volunteerism programmes, such as those by the RSVP's senior guiding programme where seniors can volunteer as guides at public places, such as airports and hospitals. The YAH! College also encourages graduates from its programmes to volunteer in different capacities.
To share another example, 68-year-old Che Ah Kau attended a YAH! programme in 2008 and, since then, has been an active volunteer. Before he retired in 2006, he worked in the previous 25 years as a hawker. At that point, he was reserved and had difficulty expressing himself freely and fully. But, after attending the YAH! College course, he became more confident and articulate. And he was inspired through that programme to volunteer and is now helping in Taman Jurong to serve elderly residents within that community. He even joined 99 other seniors and students from the Republic Polytechnic in a fun activity, a flash mob at the Jurong Point Shopping Centre, last October. So, certainly, he is much less reserved now; he is enjoying life a lot more, and he has shown us that ageing can hold many fun and exciting opportunities.
We also want to help our seniors work longer if they can and want to. The C3A collaborates with employers, unions and organisations, such as HPB, to provide talks for mature workers. These talks are aimed at encouraging workers to adopt a positive mindset towards ageing and to stay employed. It has reached out to more than 900 mature workers since June of 2013. Through these talks, we hope to help our seniors plan better for their retirement and healthcare needs so that they can enjoy ageing with the assurance that their financial needs are taken care of. We will also work on attracting seniors back into the workforce through various initiatives, such as the Place-and-Train
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programme mentioned earlier by Senior Minister of State Dr Amy Khor.
Taking care of our seniors' health. We will strengthen health promotion, screening and management of our seniors in the community and at the workplace because it is only through having good health that really one can enjoy ageing.
We are already tapping on senior volunteers to promote healthy lifestyles to other seniors within the community. Some 1,100 seniors have come forward to volunteer as community health ambassadors under the HPB's Health Ambassadors Network programme. They attend courses to learn more about healthy living and help spread this knowledge to influence others into also leading healthy lifestyles.
As several Members have highlighted, preventive health screening is key to good health – I think Mr Gerald Giam mentioned that in particular. Community health screening is already a core component of the Wellness Programme. Thirty thousand seniors have benefited from Wellness screening thus far. And we will continue to strengthen our community health screening efforts, including improving the rate of follow-ups by seniors who are detected with a health risk, and, of course, keep the entire exercise very affordable.
Six hundred and forty thousand workers aged 50 and above are in our workforce today. They need good health so that they can continue to work if they can and want to. We are, therefore, working with the HPB to deliver health promotion programmes at the workplace to reach out to seniors better. And we will take an occupation-based approach to customising the programmes to the health issues that are unique to each occupational type. So, for example, we could design ergonomics programmes for retail assistants as they tend to develop musculoskeletal disorders. We aim to start with sectors with a large proportion of mature workers, for example, in taxi driving and retail. Madam, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] Many Members have mentioned that an elder at home is a treasure for the family. In fact, our older workers have rich experiences, hence, they are also treasures at the workplace. For a senior, having a job means better financial security and a more fulfilling life. However, in order to continue working, one must stay healthy.
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In order to help these older workers to stay healthy and continue to be employed, we will launch specifically-designed health programmes in various workplaces. This year, we are going to launch a special programme to help taxi drivers and supermarket staff to stay healthy. These programmes will benefit the employees and their family, as well as the employers.
In summary, we need the whole society to give recognition to our seniors, no matter whether they are workers or our family members. We hope the elders in Singapore not only live long, but also live well and be free from worries.
Mr Patrick Tay Teck Guan: Madam, to battle rising healthcare costs and expenditure, it is crucial for MOH and its related agencies to take serious steps to enhance health promotion and preventive healthcare in Singapore. I urge MOH to do more in this area. Can MOH share details on its key thrusts and game plan in promoting healthy living in Singapore for the next decade?
Currently, I know of many schemes and health screening efforts across Singapore of varying degrees and prices. Can I suggest for MOH to provide all Singaporeans free basic health screening services when they cross 40 years of age? For more detailed screenings, can we tap on our MediSave to co-fund fully, if not partially, these screenings?
Ms Ellen Lee: Madam, it has been observed by the PAP Women's Wing members at a dialogue last November that there needs to be more public education on preventive healthcare. As our society ages quickly and as we face more challenges in keeping healthcare costs affordable, it is in the interests of Singaporeans to understand the advantages of a preventive approach towards health. The Healthy Living Master Plan will empower Singaporeans to take ownership of their own health so that they can remain active and mobile for as long as possible even after retirement.
What MOH has been sharing on the elements and initiatives related to the Master Plan is reassuring to all of us. When will the entire report be published and what can Singaporeans expect from it?
Ms Tin Pei Ling: Madam, no amount of medical subsidies and no amount of high quality medical care can match having good health. Good health
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enables us to focus on our work and families, and to enjoy life. MOH has been working on the Healthy Living Master Plan. Hence, I would like to ask MOH to give an update on its development and how the response has been towards this.
Dr Janil Puthucheary (Pasir Ris-Punggol): Mdm Chair, like other Members of this House who have spoken, I agree that, as part of a holistic approach to ensure health and prevent disease, Singaporeans should be encouraged to include healthy behaviour in their regular daily routine with respect to food, activities and exercise. These changes need to become a matter of our routine long before we become seniors.
I am glad that MOH and HPB recognise this, and actively work to intervene and change behaviour for the better. How successful has this approach been? Can the Ministry share not only the programmes and number of citizens engaged, but also, perhaps, the outcomes?
HPB launched the pilot project on healthy workplace ecosystem at Mapletree Business City last year. How successful has this programme been? How much of the workforce has been reached through the various initiatives and what was the take-up rate amongst the employees, for example, for the healthy dishes that were offered by this food court? How has this changed behaviour and affected outcomes? How many of them participated in the pre- and post-work fitness sessions? Did this translate into an overall change in activity and exercise for these participants? Would there be any more such initiatives for the community and workplace in other companies and areas, and how will MOH be looking at the effectiveness of these sorts of programmes?
Dr Lam Pin Min: Madam, while we endeavour to ensure that our healthcare system remains efficient and relevant to Singaporeans' needs, let us also remember the old adage \"Prevention is better than cure\". I am sure that many Singaporeans would like a healthy life where they do not need to use any of our public health services. I am thus glad to see that HPB has undertaken numerous programmes to help Singaporeans achieve good healthy habits. Free or cheap health screenings are also available, many organised by CCs and RCs. However, while we have achieved much, are there more plans by MOH to help Singaporeans remain healthy?
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For instance, can we perhaps \"think\" about subsidising healthy food options? Controversial though it might be, but this might be an effective method. Throughout the world, countries have taken on such \"sin\" taxes. For instance, in Denmark, there is a tax on saturated fat, and in Hungary, taxes on packaged food high in salt, fat or sugar. Can we think of ways to incentivise healthy living, rather than punishing for living unhealthily?
In Singapore, unfortunately, healthier food options generally cost more. For example, unsweetened soya milk costs about 10 to 20 cents more than the standard sweetened version and brown rice is costlier than the normal polished white rice. Studies have shown that subsidising healthier foods can be effective in modifying dietary behaviour. Will MOH consider subsidising healthy food options to encourage Singaporeans to take up healthy eating habits? In addition, will MOH also consider introducing a \"no claim bonus\" on MediShield premiums if one stays healthy and free of illnesses?
The Chairman: Parliamentary Secretary.
The Parliamentary Secretary to the Minister for Health (Assoc Prof Dr Muhammad Faishal Ibrahim): Mdm Chair, I thank Members for the points raised. As mentioned by Minister Gan earlier, healthy living starts with each of us. By staying in the pink of health, we can enjoy a good quality of life, even as we age. I will share further on how MOH intends to help every Singaporean live a healthy lifestyle. Mdm Chair, with your permission, may I display some slides on the LED screens?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Assoc Prof Dr Muhammad Faishal Ibrahim: In a 2012 study by Bloomberg, Singapore ranked first on the list of the World's Healthiest Countries. Singaporeans are among the top five longest-lived peoples in the world, according to the World Health Organization (WHO).
We should strive to ensure that this good state of health continues and improve on particular areas of concern.
Non-communicable diseases (NCDs), such as heart disease, stroke, cancer, diabetes and mental disorders, cause approximately 70% of the burden of ill-health and premature deaths in Singapore. These NCDs are highly influenced by a number of risk factors, including obesity, smoking, unhealthy diet and lack of physical activity. Fortunately, we can reduce the impact of such risk factors if
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we adopt healthier lifestyles.
MOH and HPB's role then is to help individuals and families better take charge of their health, by improving accessibility and affordability, and by leveraging peer and family influence. We will do this by working together with fellow Singaporeans, Government agencies, community organisations and the private sector.
I led a Task Force to develop the Healthy Living Master Plan (HLMP). We agree with Assoc Prof Fatimah Lateef on the need for more community involvement, collaboration and education to create a living environment that sustains healthy lifestyles. The vision of the HLMP – \"Healthy Living Every Day: Making the Connections\" – addresses these key components.
It also embodies three key elements: \"People, Place and Price\", which will allow healthy living to be accessible, natural and effortless for all Singaporeans.
First, \"People\", the heart of what we do. Assoc Prof Fatimah Lateef has also expressed concern about low health literacy rates in certain segments of our population. We are aware of their needs and will be inclusive in our outreach to all segments of society, especially the lower-income, youth and older people. The second element, \"Place\" involves creating a conducive environment by integrating the physical environments for seamless access to healthier options. Lastly, \"Price\" – which means making healthy living affordable and within the reach of everyone through lower cost and healthier options.
To ensure that this vision translates to action, we consulted widely and gathered ideas from Singaporeans who shared their views on how we could lead healthier lives. Similarly, they shared the obstacles that stood in their way. We have taken their feedback into consideration as we consolidated our findings and planned our initiatives.
I am pleased to inform Ms Ellen Lee and Ms Tin Pei Ling that we have completed the HLMP report and will be releasing it in April this year. The HLMP cannot remain static, especially with changes in the environment and new scientific discoveries. This is why the HLMP is a \"live\" action plan. We will do more as we gather more evidence on what is useful and effective.
Mr Patrick Tay had asked how we intend to translate the plan to the people on the ground. The HLMP is anchored on initiatives in three settings: firstly, community; secondly, workplace; and thirdly, school. This is so that we can
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reach out to Singaporeans from a young age to inculcate healthy habits that stay with them till adulthood.
Through our consultations, we found that screening is not a high priority for some people as they either feel well or prefer to save their money for more serious medical conditions.
This is a misconception because early detection of diseases, followed by good management, can improve health outcomes and delay or prevent the development of complications.
We are glad to inform Mr Chen Show Mao that we have worked continuously to incentivise participation in health screening by making it more affordable through the Integrated Screening Programme (ISP). The ISP encourages regular health screening for specific chronic diseases and cancers among Singaporeans aged 40 and above. The tests listed under the ISP have been proven to be clinically sound and suitable for population-wide screening.
Mr Gerald Giam had advocated that Singaporeans should be able to use MediSave to pay for the full cost of screening. Mr Patrick Tay had recommended that MediSave use be permitted for more detailed screenings instead. We would like to assure Mr Giam that screening tests under the ISP are affordable. In addition, MOH has increased the flexibility of the use of MediSave over the years to include mammograms and colonoscopies. Subsidies are also available for these procedures.
Mr Tay and Mr Giam had similar ideas in mind when they suggested that MOH provide all Singaporeans free basic health screening when they turn 40 years old. We would like to clarify that MOH has already done this for Community Health Assist Scheme (CHAS) cardholders.
From 1 January 2014, the ISP has been enhanced to offer free screening tests to CHAS cardholders from age 40 at any CHAS-registered GP clinic. CHAS cardholders will also be subsidised for GP consultations to follow up on their screening test results, up to twice a year.
As stated by Deputy Prime Minister Tharman earlier last week, all Singaporeans who qualify for the Pioneer Generation Package will be brought under CHAS from September 2014. Mr Gerald Giam can be assured that the Pioneer Generation will similarly be able to enjoy free screening tests under the ISP and subsidies for their health screening consultations. Besides the ISP,
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seniors aged 50 and above can also participate in the health screening under the Wellness Programme at each of the 87 constituencies at a nominal fee of $2 to $5.
It is important to ensure that the screening tests we undergo are safe, effective and appropriate. Screening tests that are inappropriate are not effective in detecting diseases and may cause false alarms and undue anxiety to Singaporeans. Such screening will incur unnecessary costs.
Assoc Prof Fatimah Lateef has also emphasised the importance of participating in screening. That is why we track the uptake of our screening programmes and regularly review them to see what we can do to improve the uptake. Reducing out-of-pocket costs was one strategy. Another way is working through the Women's Health Advisory Committee, led by Senior Minister of State Dr Amy Khor, to explore initiatives to promote screening for women.
Our measures to improve rates of screening have made an impact, especially for chronic diseases. Though we have worked to address the cost barrier, there are additional factors that deter others from going for screening. For some, \"ignorance is bliss\" as they may be afraid of receiving poor results. Others perceive screenings to be a \"lose-lose\" situation where they would have \"wasted\" money if they were told to be in good health. Conversely, finding out that they, indeed, had a chronic condition would lead to additional financial costs. For this group of people, we will continue with our education messages to dispel the misconceptions.
Most Singaporeans eat out at least once a day. However, Singaporeans, on average, consume 300 calories more than our daily requirements. This, together with lower levels of physical activity, leads to more people becoming overweight. Also, nine out of 10 Singaporeans did not eat enough fruit and vegetables.
Dr Lam Pin Min had proposed that MOH consider subsidising healthier food options as a way of incentivising healthier living. We have already provided such subsidies through an indirect way. The Healthy Hawker Centres and Coffeeshops were introduced in 2011, and have been successful in encouraging people to switch to healthier meals. Currently, we have 14 Healthy Hawker Centres and Coffeeshops. Under this programme, grants were given to the hawkers to buy healthier ingredients like whole grain noodles, and oils with
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lower saturated fat.
Moving forward, this grant scheme will be extended to all wholesalers selling healthier ingredients. By targeting large wholesalers who have the potential to promote healthier ingredients across the food service sectors, HPB would be able to effectively utilise the grant to reach out to more people to incentivise healthier eating. We will work with F&B companies, including canteens, food courts, fast food eateries and restaurants, to create healthier \"eat-out\" meals, by substituting food items with lower calorie versions and smaller portions. Our target is for 20% or 500,000 daily \"eat out\" meals to be healthier by 2020.
For those of us who cook, it is important that we buy healthily so that meals at home are nutritious. Singaporeans are already aware of the Healthier Choice Symbol (HCS) products, but such products make up only 10% of packaged food sales in supermarkets. We will need to drive demand for HCS products by working together with industry partners so that consumers can have more choices. Through these partnerships, we aim to increase the sales of HCS products from 10% to 20% of the market share by 2020.
Sugar-sweetened drinks are a major source of excess calories. Sixty-percent of Singaporeans consume two or more sweetened drinks a day. We will encourage everyone to replace such sugared drinks with either plain water, reduced- or non-sugar drinks. This will be done by partnering with major drink manufacturers to expand the availability of such products in the local market.
Besides food, the built environment also plays a role in enabling a healthy lifestyle. Specifically, we want people to be more physically active. For this to happen, we need to bring together many elements to enable people to live a healthy lifestyle easily and effortlessly. Assoc Prof Fatimah Lateef had also asked if there would be more health promotion facilities. MOH will leverage existing projects spearheaded by agencies like the Singapore Sports Council, LTA and NParks. ActiveSG, the new national movement for sports announced by Acting Minister Lawrence Wong, is one example of an initiative by a fellow Ministry that will contribute to healthy living.
Such interlinking of projects and infrastructure will integrate the physical and social environments so as to bring healthy living closer to the homes of all Singaporeans. Currently, the average distance from each HDB home to the nearest physical activity facility is 200m. In April this year, we will be launching
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a mobile location-based service to help locate such exercise facilities.
HPB is working with the Regional Health Systems and the community to create Healthy Community Ecosystems (HCEs). The \"Healthy City for All Ages @ Choa Chu Kang\" was launched in July 2013 and the \"Sembawang Population Health Project\" in August 2013.
These initiatives outline a three-year road map for systematic health screening and follow-up for residents aged 40 and above. Both initiatives are also supported by a health-promoting built environment in the community. For example, all 119 HDB blocks in Sembawang have visual cues that promote stair climbing. Ms Yeo Shwu Fen has noticed that many of her neighbours are using the stairs. In fact, Ms Yeo says that, unlike before, she now has a busy staircase! It is through such small nudges that we hope to inspire bigger challenges.
HPB also collaborated with NParks to bring to the community \"Sundays-at-the-Park\", an initiative which provides easy access to activities that promote both physical and mental well-being. Through such HCEs, we will increase the opportunities for physical activity in the heartlands.
We intend to build more of such HCEs. The target is to enable 50% of Singapore residents to have access to health-promoting choices, such as healthier food or exercise facilities, within 2 km of their homes by 2020. HCEs will certainly benefit the groups that Assoc Prof Fatimah had expressed concern about, as the facilities and activities provided do not require special membership and are available at their doorstep.
This Saturday, HPB will launch the \"One Million Kg Challenge\" (MKC) – the first national incentive-based weight management movement which encourages people to achieve and maintain their healthy weight. At the end of February, 16 companies have signed up early through roadshows we started at selected workplaces. From this Saturday onwards, Singaporeans can register for the Challenge at roadshows across Singapore and at the online portal (www.millionkg.sg). The Challenge intends to make weight management fun by encouraging participants to participate in lifestyle activities, track and report their weight at HPB's Wellness Kiosks or via online to win prizes.
A national programme like this, coupled with making healthy food more available, and creating a physical environment that promotes physical activity, will provide the ecosystem to encourage behavioural change among Singaporeans. The target is to achieve a collective weight loss of one million
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kilgrammes from at least 300,000 participants over the next three years.
Besides obesity, tobacco use among Singaporeans remains an ongoing concern. We will be implementing the point-of-sale (POS) display ban in response to the support we received after the public consultation in June last year. This will be carried out through an amendment of the Tobacco (Control of Advertisements and Sale) Act by the end of 2015. When combined with other tobacco control efforts, the POS display ban will protect youths from tobacco marketing.
Through the public consultations, we have found that the public was very supportive. However, tobacco retailers expressed their reservations at having to adapt their current displays to comply with the ban. MOH is mindful that such refurbishment will incur costs, especially for smaller retailers. We will work with the different types of retailers to address these concerns for the implementation. Retailers will also have a grace period to adjust and this grace period will begin only after we have amended the law.
During the consultations, many young working adults told me that it was hard to sustain the healthy behaviours they cultivated as students because of the competing priorities of working life. We intend to create healthy workplace ecosystems that will support the adoption of healthy behaviours and sustain a healthy lifestyle.
In October last year, we launched the first healthy workplace ecosystem at Mapletree Business City (MBC). Those working in MBC can now take part in workout sessions and enjoy healthier meals. Currently, over 90% of the stalls in the food court and over 50% of the F&B establishments in MBC offer healthier meal options, such as lower calorie meals (500kcal) and wholegrain options, as the default choice.
Dr Janil Puthucheary would be interested to know that since the launch of the Healthy Workplace Ecosystem, sustained demand for healthier meals has been observed. Healthier meals comprise 20% (1,800 meals) of meals served at MBC daily. Attendance for weekly yoga and running sessions was well-subscribed, at 80% of the sessions' capacities. In addition, four running interest groups have been formed.
The ecosystem is still in its early days; it shows promise, but it would be too early for a full evaluation of its effectiveness.
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The convenience does make a difference to Mdm Fauziah Mustapha, who works as an administrative executive. Since the introduction of activities in MBC, Mdm Fauziah now participates regularly in HPB's iRun programme with her colleagues. Mdm Fauziah who has begun watching her diet more closely, also has received compliments from her family members for her weight loss and now she feels more energetic. We will continue to add new initiatives to keep the programmes fresh and interesting for MBC employees.
We will work with JTC Corp and other landlords to replicate this model across other workplace clusters in Singapore. The approach will be customised to suit the needs of the different working environments. We intend to increase reach out to 350,000 workers through the eco-systemic approach by 2020.
Encouraging health promotion in the workplace will go hand-in-hand with longstanding efforts on improving workplace safety. As announced by Senior Parliamentary Secretary Hawazi Daipi, MOM, Workplace Safety and Health Council (WSHC) and HPB are working with other stakeholders to develop and implement \"Total Workplace Safety and Health\" or Total WSH. Total WSH will take an integrated and comprehensive approach to incorporate health promotion within workplace safety frameworks. MOM, WSHC, HPB and industry partners will develop guidelines on integration of workplace safety and health and pilot implementation. Concurrently, WSH professionals will be trained to enable them to achieve basic competency in workplace health promotion.
With these new developments in Workplace Health and leveraging the groundwork established by HPB and partners, a new high-level Tripartite Oversight Committee will be formed.
This Committee, chaired by Senior Minister of State for Health and Manpower, my colleague, Dr Amy Khor, will oversee and drive the development and execution of a workplace health roadmap with strong tripartite partnerships. The vision is to help workers in Singapore achieve \"Well-being through Work\" by adopting a more holistic approach to promoting employees' health and wellness, and increasing adoption of workplace health promotion programmes by employers. At the same time, we are mindful that there are sectors and groups which may benefit from more targeted initiatives, for example, the lower income workers.
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Allow me to share Mr Ong Heng Bock's story with Members. Mr Ong is 65 years old and is a cleaner with CBM Pte Ltd. Mr Ong feels that it is important to stay healthy as he would like to continue working. He does this by watching what he eats and staying positive. However, Mr Ong does not see the need to go for screening. Fortunately, Mr Ong's employer successfully persuaded him to go for health screening last April. Work coverage was arranged on the same day so he did not have to take leave or suffer a loss of salary. Mr Ong was pleased to find out that he had no chronic diseases. Now, he can continue working with the assurance that he is in good health.
CBM Pte Ltd is a workplace health champion, having been a past multiple winner of the Singapore Health Award. Mr Ong was willing to make a positive change in his life when his employer took steps to deal with the barriers that prevented him from going for screening. Mr Ong, being responsive to his employer's efforts, resulted in a win-win situation for both parties. We will continue to work with our partners to reach out to other lower income workers like Mr Ong to understand their needs and help them to take care of their health better.
Ms Faizah Jamal had suggested that MOH look at the fundamentals of healthcare, including mental health. We are happy to inform her that we have done just that. Efforts to improve health should therefore begin as soon as possible, in fact, before one is born. The \"Healthier Child, Brighter Future\" initiative provides resource toolkits and workshops for young parents and parents-to-be.
The \"Baby Friendly Hospital Initiative\" (BFHI) seeks to promote breastfeeding. In line with the BFHI, our maternity hospitals have implemented initiatives, such as the provision of training to all maternity ward staff to provide breastfeeding counselling, consultation and support to mothers. HPB and the Association for Breastfeeding Advocacy Singapore (ABAS) are also working together to encourage and advise employers on the establishment of breastfeeding-friendly workplace policies. To complement programmes that focus on healthy physical development, we also have in place mental well-being promotion programmes tailored for various segments of the population, including children, adolescents, adults, the elderly and caregivers.
Dr Lam Pin Min had also asked if MOH intended to regulate food advertising to children. We are working together with stakeholders from the media, advertising, retail and food industries, and our partners in the Advertising Standards Authority of Singapore (ASAS) to draft guidelines to restrict advertising of food and beverages high in fat, sugar and salt to children. These
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guidelines will be incorporated into ASAS' Singapore Code of Advertising Practice and will take effect from January 2015.
Just as the workplace is an important place for adults, schools remain an important place for our youth. It was highlighted that the structured environment in schools helped many of our students establish healthy habits. Our role then is to help the young ones acquire such habits early so that they may lead healthy lives as they age.
A first step would be to inculcate healthy eating habits. First introduced to Primary and Secondary schools in 2011, the healthy meals programme allows students to have convenient and easy access to healthier food and beverage options. A similar programme was introduced in childcare centres in 2012.
Currently, 240 childcare centres and 96 schools are on board the healthy meals programmes. Our intention is to extend the programmes moving forward to all MOE schools by 2016 and approximately 90% of childcare centres by 2020. To provide children with a better understanding of what right portion sizes look like, HPB has worked with MOE to incorporate \"My Healthy Plate\" into Primary and Secondary school textbooks. The incorporation of \"My Healthy Plate\" in textbooks will be done in stages from 2014 to 2016.
Additionally, we will extend our pre-school dental care programme to childcare centres. Poor dental health has a negative impact on the quality of life of a child. Our aim is to reduce the present caries rate in children at age seven to less than 50% by 2020.
Dr Lam Pin Min had asked how MOH intends to encourage healthy living among Singaporeans. Examples of healthy living are all around us already. For instance, in my constituency, if you drop by as early as 5.00 am in the morning, you will see individuals and groups of residents starting their day with their own exercise regimes in Yishun Park, Yishun Pond, Nee Soon Central Community Park and some along the footpaths.
At times, I join a group of residents, mainly ladies, who do aerobics every weekday morning. This group started from only two neighbours – two persons. Now, the group has grown to more than 100 residents, with residents from different races, ages and all walks of life. In fact, I found it hard to keep up with them during my first session.
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There are also formal groups, such as the Northwest Brisk Walking Club, programmes by the Active Ageing Committee and Wellness Programmes by People's Association, and targeted programmes by Khoo Teck Puat Hospital (KTPH) and Yishun Polyclinic. In addition, KTPH also conducts chronic disease screening under the Wellness Programme.
Madam, the HLMP will build upon this existing landscape that we have across Singapore, further strengthening it to allow healthy living to be accessible, natural and effortless for all Singaporeans. Therefore, I would like to invite everybody to join us as we strive towards \"Healthy Living Every Day\" together.
The Chairman: We have a bit of time for clarifications. Dr Lam Pin Min.
Dr Lam Pin Min: Thank you, Mdm Chair. I have several clarifications for the Minister and Senior Minister of State as well as the Parliamentary Secretary.
First, on Punggol Polyclinic. I have raised the problem of long waiting time at Sengkang Polyclinic since 2011. Recently, I think MOH has announced that the Punggol Polyclinic will only be ready in 2017. I would like to ask the Minister why it takes so long to build a polyclinic and, in the meantime, what would MOH do to ease the long waiting time at Sengkang Polyclinic.
Second clarification would be on integrated Shield plans. How will the enhanced coverage of MediShield Life affect existing integrated shield plans? And with the implementation of universal coverage in the MediShield Life plan, are the private insurance companies allowed to reject or exclude pre-existing conditions in their Integrated Shield plans? I have come across cases where the companies' underwriters actually exclude certain conditions even though doctors have already certified that the condition had already been treated and there will not be any long-term problems.
To the Senior Minister of State – I am quite intrigued to hear about the interim caregiver service. I would just like to clarify with the Senior Minister of State will that be provided by all restructured hospitals in Singapore and whether these caregivers are nurses or trained caregivers.
And, lastly, to the Parliamentary Secretary – there is this grant scheme for healthier option ingredients that you have mentioned just now. How does HPB ensure that stallholders do not charge consumers extra even though they have
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enjoyed the subsidies provided by HPB?
Mr Gan Kim Yong: Madam, I would like to thank Dr Lam for the questions. Firstly, on the polyclinic, it will take some time for us to identify the site, to prepare the site and, at the same time, to also consult the advisers involved and to prepare the ground. At the same time, to also train the people, making sure that we have sufficient manpower to staff the polyclinic. Although the polyclinic will only be ready in 2017, in the meantime, we are also working on how we can enhance access to primary care for residents in the eastern and northern area, particularly through the CHAS scheme that we have just enhanced.
Through CHAS, up to middle-income Singaporean patients will be able to access private GPs with the Government's subsidy support. When they go to the private GPs, they do not have to join the queue. This is something that we are working on.
We are also working with several possible GP groups as well as individual GPs to set up additional new FMCs in different parts of Singapore. Hopefully, with additional FMCs being set up, it will also enhance access to primary care in different locations.
With regard to the integrated Shield plans, Dr Lam has asked about what will happen to those who are currently excluded under IP plans. When MediShield Life comes into effect, how does that work out?
When MediShield Life comes into effect in 2015, it will cover all Singaporeans and all the integrated plans will then ride on MediShield Life's basic coverage. Since basic coverage covers everyone, even those who are excluded today under the IP plans will become covered under MediShield Life – but only for the basic benefits that MediShield Life will provide. Whereas the IP plans will cover additional benefits, additional coverage, additional payouts for higher wards. These additional benefits may still be subject to exclusion, depending on the commercial terms that the IP providers will work out. For Singaporeans, the assurance is that all will be covered under MediShield Life.
Dr Amy Khor Lean Suan: Madam, in my speech earlier, I said it will be made available to all restructured and community hospitals by the end of this year. Restructured hospitals and community hospitals will work with VWOs like Thye Hua Kwan, TOUCH and so on, to train caregivers to provide these interim caregiver services.
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Assoc Prof Dr Muhammad Faishal Ibrahim: Madam, I thank the Member for the question. We are also aware of the concern that when the grant is given, the price increases. We are very aware of that. We will work very closely with the grassroots leaders. As we move on to these hawker centres and encourage them to become healthier, we will work with the grassroots leaders to seek out information of whether there are increases in prices due to that. What we want to do is we want to make healthier options available to Singaporeans. As such, in my speech, I mentioned that we are moving upstream to extend to the wholesalers to see how we can make it readily available. The price is another area that we are very conscious about it and we would not want Singaporeans to be charged higher than what it is today.
Mr Low Thia Khiang: Thank you, Madam. I have four clarifications for the Minister in respect of the issue of bed crunch. First, I would like to know whether the bed crunch today is a result of MOH's policy in under-estimating demand for hospital beds.
Madam, in 2007, the former Minister for Health was quoted to have said, I quote, \"When we under-estimate demand, the result is overcrowding at hospitals as we now experience at Tan Tock Seng Hospital. If we over-estimate demand and oversupply, we end up with under-utilised excess, a costly outcome. Between the two, I prefer to undersupply than to oversupply as this will put pressure on ourselves to intensify usage and minimise over-consumption.\" So, does this represent MOH's policy, resulting in what has happened today – the bed crunch?
Second clarification, Madam, I would like to know: is having beds at hospital corridors and tentage the new normal?
Third clarification, what is the waiting time for hospital beds in Government hospitals? Do we have some figures to look at?
The last clarification, Madam: what can Singaporeans expect in healthcare 2020 in respect of hospital bed availability? Will queuing for a bed in the hospital become an activity of active ageing for the seniors?
Mr Gan Kim Yong: Thank you, Madam. First, let me explain that hospital bed projections had been done in the past, and we review it regularly, taking into account population projection, the pace of ageing, as well as the potential
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changes in disease patterns. But there are many, many variables that would determine the demand for healthcare services. Ageing is one, but lifestyle changes are also another factor that we have to take into consideration. Lifestyle changes are a lot harder to predict. What kind of diseases would occur as a result of lifestyle changes? Family structure is also another factor that we have to take into account – whether family members are more able to take care of their elderly, their frail, and their patients, or whether they would rely a lot more on the acute hospitals' facilities.
There are many factors involved and it is not only about the direct impact on demand of hospital beds, but also about how we can discharge patients from hospitals, including to step-down care facilities, and whether we are able to create sufficient capacity for the step-down care facilities or whether patients are willing to be transferred to these recovery and rehab facilities rather than to stay in hospital. It also has to do with the cost to patients. With the subsidies in hospitals, some patients may prefer to remain in the hospital rather than in a step-down facility. And we have, therefore, enhanced the intermediate and long-term care subsidies in 2012 in order to provide greater support for step-down care.
Having said that, I think the important thing for us now is in looking at hospital capacity, to at the same time look at how we can transform the care model to rely less on acute hospital capacity which is very expensive, very intensive and it is actually not in the interests of patients to remain in hospitals when they no longer need to. Many patients require some time to recover after an acute episode. It would be better for them to recover in the step-down facilities like community hospitals, nursing homes or even at home. That is why this afternoon, we spent a lot of effort talking about how we can expand home care capacity to address this issue. Looking ahead, other than building hospital capacity, we also need to continue to transform our care model. We need to continue to build community and home care so that, collectively, as a system, we would then be able to meet our healthcare demand going forward.
Mr Low also asked whether waiting at hospitals will still happen and whether there will still be queues at our acute hospitals. I think I also mentioned in my reply that hospitals not only need to cater to our long-term underlying demand needs for healthcare services, they also need to be able to respond to emergency situations when there is a surge in bed demand. This could be because of some emerging diseases, or dengue, or it so happens that, for a particular period, there are more people going to the A&E and, therefore, more hospital beds are needed. So, the hospital has ways and means to adjust itself to be able to respond to demand surges. We have seen some of these and we
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have shared with the House what are the measures the hospitals have put in place to respond to the surge in demand from time to time.
Overall, I think the key is that whatever we do, whatever responses that we introduce, we must ensure that the patient's safety and interest are looked after. When a patient arrives in the A&E, they will be triaged and assessed and, for the urgent cases, they will be attended to immediately. Even for warding, there is also prioritisation. For patients who are more urgent and require earlier warding, they will be admitted earlier, and allocated a ward earlier. So, the A&E departments in the hospitals manage patients actively. On the ground, they respond to situations when they warrant.
Dr Lily Neo: Mdm Chair, I would like to seek two clarifications from the Minister. May I ask the Minister whether he will empower people to take better responsibility for their own health by having some measures in place? One example can be incentivising MediShield premium rebate with certain ideal BMI or certain good control of chronic diseases.
My second clarification is on right siting of medicine. The Minister has said earlier the importance of right siting. May I ask him to elaborate on the measures in place right now for right siting and whether we can enhance it further to have better right siting?
Mr Gan Kim Yong: Madam, first on the MediShield rebate for achieving certain health indicators or targets. First, MOH is quite keen to encourage healthy living and to encourage Singaporeans to stay healthy, adopt a healthy lifestyle, and we will continue to evolve incentives and programmes to encourage Singaporeans to maintain a healthy lifestyle and maintain good health. But to provide a rebate for MediShield would mean that we would have to take the funds from the MediShield pool, which means the premiums will have to go up in order to be able to pay the rebate. So, it is better for us to think about other ways to encourage healthy living, and MOH is quite happy to look at alternative programmes and to provide necessary funding, if need be, to incentivise healthy living.
On right siting, it is an issue that the Ministry has been discussing over the last few years; how do we ensure that patients are given the appropriate level of care. If they do not need higher level, more expensive care, they should not be using the more expensive care because that will drive up healthcare costs. But right siting is something that we will continue to do, and all our public hospitals are very mindful of that. Whenever they prescribe certain treatment,
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they will always be very mindful of the cost involved and what is appropriate for the patient clinically. And there are regular reviews among the peers within the hospital, as well as within our polyclinics, to ensure that there are certain guidelines and protocols that they will follow, in terms of right siting.
Let me give Members one example. Many of my residents, patients or Singaporeans whom I come across ask me, \"Why do we only give subsidy to patients who have been referred by polyclinics to Specialist Outpatient Clinics, and not walk-in patients to Specialist Outpatient Clinics?\" One of the key reasons is because of right siting. We want patients to be assessed by a primary physician and if the doctor assesses that a patient requires specialist attention, he will then be referred to the SOC and he will benefit from the subsidies. Therefore, this is one way for us to encourage our patients to be assessed before they access a higher level of care. In this way, we ensure that they are provided with the appropriate level of care without over-consuming healthcare services.
Mr Gerald Giam Yean Song: Madam, I was glad to hear the Minister's assurance during his speech that private Shield plans are not allowed to refuse coverage once the policyholders are enrolled. But then his response to Dr Lam just now got me a bit worried. Can I clarify if private Shield plans are allowed to drop coverage of specific illnesses upon renewals – for example, if a patient gets prostate cancer – are the private Shield plans allowed to refuse coverage of that cancer if there is a relapse the next time? If so, is the Minister okay with this?
Second clarification: I am happy to hear the introduction of the flexi-MediSave. But I think the Minister did not address my request to expand the CDMP list of approved MediSave conditions to all medically necessary treatment that is of proven value and is cost effective.
Last clarification: I think it is good that the Eastern Health Alliance is conducting home visits for patients, or even hospital visits. Are the patients made to pay for these visits? I hope not. And are there plans to use telehealth to monitor activities like medication compliance because this can reduce costs and extend the reach of such interventions?
Mr Gan Kim Yong: Madam, let me just clarify with Mr Giam on the IP coverage. If you are covered today by the Integrated Plans and if you develop any disease, the Integrated Plan must continue to cover you. So, what I was talking about is, if you already have exclusions, you will still be covered by
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MediShield Life. So, I hope that clarifies.
The second question that he asked is about MediSave coverage for CDMP, or the Chronic Disease Management Programme. Currently, we cover 15 diseases. We continue to review them. I think we just added five recently. So, we will continue to review them and we will add additional diseases when the Review Committee thinks that it is appropriate. Even with the current 15 diseases under the CDMP, we have already covered more than 90% of the chronic diseases. So, I think it is adequate. In addition to that, because we are going to introduce flexi-MediSave, it will also be able to cover additional expenses that one does incur because of diseases not covered by CDMP. I hope that answers his second question.
On his third question, he asked about the Changi General Hospital's home visit programme. These programmes are conducted by CGH and they will assess the needs of the patients. As far as I understand, there are no charges, but I have to verify that. But even if there are charges, if the patients are not able to afford, there will be schemes that will provide the necessary assistance to ensure that affordability is not an issue for the patients, if they need to access these home visits. But for home therapy, of course, there will be therapists' charges. These therapies will be subject to the normal subsidies that already are in existence.
For telehealth, I have mentioned in my reply that we are exploring various models. And the monitoring of compliance to medication is one area that we are exploring to see whether we can step up on medication compliance. But, very often, we find that it is not just a single issue. When patients have compliance issues, they tend to be associated with other social issues as well. So, telehealth will also have to be done together with a suite of services to ensure that the patients will be looked after well at home.
Dr Janil Puthucheary: Madam, a clarification for the Minister about the acute bed situation. In Singapore, we benefit from a combination of universal access to public healthcare, as well as patients' choice. The patients can choose where they go for their acute care. In many healthcare systems, that is not the case, where either legislature or the funding structure removed some of that choice. So, I would like to ask the Minister: how much of what is perceived as acute bed crunch is a result of some asymmetry in where the bed capacity is available and where patients are going to? Going forward, as we increase the total bed capacity, are there some considerations to smoothen out the demand or redistribute some of demand to match capacity, and I am not, by the way, advocating for a restriction of access. I think that is one of the commendable
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things that we have in our public healthcare system.
Mr Gan Kim Yong: Madam, it is right that, today, we have a free choice of beds and, of course, given that the public hospitals are subsidised, many patients still come to the public hospital. And because the quality of our public hospitals is very good, the choice is, therefore, quite obvious. But going forward, even currently, we do have collaboration with the private hospitals to see how we can better spread the load and we have, as I mentioned in my reply, collaborations with Parkway Hospital and West Point Hospital to tap on their capacity. I think this is also one way of spreading the load but, eventually, I think the key is to ensure that it is not just the acute hospitals but also different settings that we need to continue to develop and also encourage patients to opt for step-down facilities for them to recover better.
Ms Lee Li Lian: Madam, two clarifications for the Minister, please. The first one – are there plans to conduct a review of IDAPE? The current payouts of $150 and $250 are too low. Next, will the Ministry consider releasing a list of what are the types of new cancer treatments not classified as chemotherapy that are currently allowed under MediSave? This will provide greater clarity for the public as well as our frontline healthcare staff.
Mr Gan Kim Yong: We are currently reviewing both ElderShield as well as IDAPE. As I explained in my reply, the review is rather complex because it involves deciding what kind of benefits ElderShield should provide and every benefit that we want to provide has an impact on the premiums. We have to ensure that the premiums remain affordable. As much as we have done for MediShield, as you can see, it is quite an elaborate exercise. Currently, we are reviewing ElderShield, together with IDAPE. In due course, we will share with Members the status of the review.
On drugs that are not covered: from time to time, we will include standard drugs that are covered under subsidy for chemotherapy. But for drugs that are not covered, there is a Medication Assistance Fund that we have provided. Even if it is not a standard drug that is included, you can still have access to the Medication Assistance Fund, if the doctor determines that this is the drug that you need to use for your specific treatment, whether it is for cancer or any other illnesses and that you are not able to afford the drug. The key is for patients to discuss with the doctor. If the drug or treatment is necessary and you cannot afford it, we would encourage you to discuss with your doctor and the
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institutions will then apply for Medication Assistance Funds where necessary.
Mrs Lina Chiam: Would the Minister consider lifting the MediSave cap of $5,000 for patients in rehabilitation at hospitals, as most patients are elderly who need longer hospitalisation and when they come out of hospital, they have to pay thousands of dollars out of their pocket, even though they are under MediShield plan?
Mr Gan Kim Yong: Madam, let me put it this way. I would suggest that for specific cases, if they have an extensive stay in our rehab hospitals or community hospitals, we will encourage them to discuss with the hospital administration. If they need help with their out-of-pocket payment, we have schemes including MediFund that would be made available to help them, especially for the low-income who are not able to afford the out-of-pocket expenses, rather than to adjust overall caps.
The overall cap on claims has an impact on the premiums. For specific cases, if we raise the overall caps, it may impact the premiums that will affect everyone. On a case-by-case basis, if the patients are needy, we will be happy to look at it. I encourage Mrs Chiam to encourage the patients to discuss with the hospital or let me know specifically, and we will look into it on a case-by-case basis.
Mr Low Thia Khiang: Madam, earlier on, the Minister explained the difficulty in hospital bed demand projection. I wonder whether MOH planned for emergencies and spikes in patient numbers who may need acute hospital care. Madam, this is not a new issue. In 2005, nearly 10 years ago, I raised the same issue in this House. The then-Minister for Health answered that, \"Our hospital beds are crowded out by foreign workers who are being dumped at Tan Tock Seng Hospital at the expense of others who require emergency care and beds.\" Today, we have a new Minister for Health telling us a different reason of difficulty in projection. Perhaps, the Minister may want to explain the factors that are taken into consideration now and 10 years ago since 2005 when the issue was raised.
The Chairman: Mr Low, just one point. Members should not use clarification time during a COS debate to ask a current Minister to clarify what a previous Minister had said in a previous Parliament sitting.
Mr Low Thia Khiang: Yes, okay. So, I ask the current Minister to clarify what he has been doing, since the issue was raised in this House in 2005. I
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would also like to know from the Minister what he thinks is a reasonable waiting time for a patient to wait for a bed in the hospital, or whether he could assure us what would be the waiting time that a patient can expect when he needs the hospital bed for admission. We have feedback that there are patients who have waited for eight hours, or some for as long as 23 hours. I think this is just too long. It is not something which we would expect in a First World country, right?
Mr Gan Kim Yong: Madam, that is why we have introduced Healthcare 2020 two years ago, having looked at the capacity planning and looking at the projection for our population, as well as the profile of our population and the pace of ageing. Healthcare 2020 will include capacity building that will meet the demand, going forward. It is not just about acute hospital beds; it is also about the entire healthcare system, as well as the model of care.
Coming back to the waiting time that Mr Low has asked, as I have explained, the waiting time will depend on the situation from day to day. For a normal day, we should not expect the patient to wait more than a few hours. For patients who are more urgent, in fact, they will be warded immediately. They may be sent to ICU immediately, even before warding.
What is more important is that even while they are waiting, their care and safety will not be compromised. We have in-patient teams that will be on hand, and even at the A&E, the observation ward, to keep watch over them, to provide them with necessary treatment. The treatment will start even before they were warded if the waiting is too long. We will have to assess the situation. When there is a spike in demand because of various factors, for short periods of time, the waiting time may be a little bit longer. So, I hope that Singaporeans will understand. Under normal circumstances, patients can expect a normal waiting time.
The Chairman: Dr Lam Pin Min, do you wish to withdraw your amendment?
Dr Lam Pin Min: Mdm Chair, first and foremost, let me congratulate the Minister for topping the COS chart with the most time allocated, most number of cuts, as well as the most number of speakers for the debate. Just like our highly acclaimed healthcare system, MOH has achieved many accolades this year.
On behalf of the GPC for Health and many Members of House who have spoken so passionately on health and ageing matters, I would like to thank the Minister, the Senior Ministers of State and the Parliamentary Secretary for
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sharing MOH's plan to keep Singaporeans healthy and healthcare affordable to all. I would also like to thank the Permanent Secretary and MOH staff for their support and advice on all health-related issues. With that, Madam, I seek leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $6,034,002,600 for Head O ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $1,081,059,200 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":null,"sectionType":"OS","content":"Mr Seah Kian Peng (Marine Parade): Madam, I beg to move, \"That the total sum to be allocated for Head I of the Estimates be reduced by $100\".
Improving the delivery of social assistance needs to be a priority for the Government. The Government's move to set up Social Service Offices (SSOs) to bring social assistance closer to residents is thus a positive move. As SSOs are relatively new, it is important for them to establish good relationships with the community partners already on the ground and to work closely with them.
[Deputy Speaker (Mr Charles Chong) in the Chair]
Still, notwithstanding the presence of SSOs and VWOs, some needy families may continue to struggle to cope with multiple issues, such as illness, marital problems and jobs.
Integrating help for such families and providing peace of mind are important and necessary. All Members will have stories to share where we have come across cases where the coordination can be better; no doubt, these are the exceptions and not the norm.
I know it is impossible to provide a one-stop service for everyone, given the complex nature of the different issues which may be involved. But for the most vulnerable and needy facing multiple challenges, we have to strive to provide
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help which is as coordinated as possible. This must be a desired outcome, a KPI for all SSOs. In fact, I would advocate even more resources be invested in these offices so that these KPIs can be met.
So, my questions on improving social service delivery are as follows.
First, I would like an update on the Social Service Offices (SSOs) in terms of their roll-out, as well as how the SSOs have improved service delivery for clients, working with partners on the ground and gathering ground feedback for local planning of services.
Second, we all know that some families have multiple needs; for example, in financial assistance, employment, family issues and so on. Therefore, they will need more coordinated support. I would like to ask what the Ministry's plans are to address issues faced by such families with multiple needs.
Sir, I know this is a very difficult issue and I want to tell you about one area which has been very well taken care of. It is at Jalan Kukoh, which is under the care of Dr Lily Neo. This is an area which is poor with many rental flats and the kids are often in the care of grandparents or relatives.
This is an area which is well served by the residents' committees. There are many tutors and well-meaning groups which help the kids with their schoolwork and study with them.
But, you know, these are families and kids, they are not subjects for study. I applaud Dr Neo and her grassroots leaders and volunteers for working on the ground for years, and, in fact, below the radar.
I also want to point out that the community itself has several strengths – a close-knit community, kids who watch out for each other, kids who stand by each other in times of despair; kids who know it is okay to cry and that you do not have to comfort or encourage, just sit by each other and help each other cry.
I think the new model of Government that I had spoken about in my Budget debate speech should take this into account – when we care for a community, we cannot just treat them at arms' length.
This is a tension and I know well this tension because there are needy residents within my own ward, too. How do we put on a policy hat and still not
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lose the helping hand? How do we care for a community sensitively, specifically, and still run a nationwide, systematic programme?
The answer, in my opinion – and I say this again – is to fund more and think less – to be more generous in funding and less centralised about how these funds are used. Accountability and corporate governance will have to be in place, of course. But the actual plans, implementation and evaluation of our care must come in greater proportion from the community itself.
Sir, I move on to my next cut. A strong core of professionals in the social service sector is key in providing better and more effective services.
Yet, VWOs find it a challenge to develop and retain good staff due to various reasons. While remuneration and benefits have been improved for some social service professionals, especially social workers, other concerns, such as professional development and career progression, remain.
The lack of a proper career progression pathway and opportunities for development, leads people to leave in search of such, and high turnover will affect the quality of services and succession to leadership positions.
I, therefore, hope that the Ministry can look into tackling this issue more systematically.
I do know that NCSS has started a Social Service Talent Development Scheme (SSTDS) and that it is aimed at developing leaders and specialists in the social services.
NCSS also helps support continuing professional development of social service professionals by offering relevant courses for current professionals and training of new professionals at its Social Service Institute.
I would like to address two points. First, strengthening leadership and organisational capabilities of the VWOs to enable them to scale up and deliver effective services. The iLeap Professional Course for Non-Profit Leaders by the Lien Centre for Social Innovation is such an initiative, but are there more? Second, what are the Ministry's plans to attract and develop professionals other than social workers? Currently, even the Social Service Talent Development Scheme (SSTDS) by NCSS only develops social workers for the specialist track.
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What about other professionals like the allied health professionals and teaching professionals in the social sector?
I urge the Ministry to look at a close collaboration with MOH on this because, often, social and health needs are closely intermingled. Many social workers do their jobs in hospitals as Medical Social Workers. At the same time, many of the issues they have to deal with in the community, as our population ages, will increasingly involve long and intermediate care or the Intermediate and Long-Term Care (ILTC) sector.
In this, community nursing, primary health care and social work will see an increasing convergence. How can and how is the Ministry working with the Agency for Integrated Care (AIC) in terms of manpower development, training and provision of home care and community services for our country in a more holistic manner?
Lastly, Sir, I have a radical idea which I wish to propose. Previously, I had spoken about funding more community-based plans; but why not fund those among the community who can help themselves? For example, a housewife within a block who can be paid a small sum, say, $300 a month, to check on her neighbours daily?
I know there are volunteers who already do this and it would sully the volunteerism to pay for it. But at the same time, we know that there is a shortage of this sort of labour, and we do have a ready supply of this.
Why not create a human resource market from our community? I know this sounds, at first blush, perhaps a socially and morally unacceptable idea – to pay people to volunteer. But to me, this is not volunteering. It is really payment for work – freelance, flexible work but work nonetheless – work that confers dignity, that requires discipline and, yes, that demands that the worker fulfils a contractual role. This is not a spit and a handshake but something that is formal and well accounted for.
Another argument is that this will \"crowd out\" volunteers who would otherwise have done this. My feeling is that there is a great need on the ground – there are more needs than there are hands.
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All of us here today know there is a vast network of retirees, housewives and even teenagers that can be tapped for work in the community – it is like working in a grocery or convenience store near your home – hours are reasonably flexible, I do not think you need a very long training period, and you can earn useful money. This \"community corps\" can be a small pilot scheme and I volunteer my own ward for this effort. If successful, I think we can make this a larger national effort.
Dr Lily Neo (Tanjong Pagar): MSF has a slew of assistance schemes in place to assist those in need. They are good but many do not comprehend them. There is also lack of coordination and sharing of information between stakeholders to help those in need. I want to illustrate this with the following example.
One 29-year-old resident came to my Meet-the-People Session (MPS) 10 days ago to collect her third ComCare cheque of $200. She proudly showed me on her mobile phone an interview, arranged by a local group, which she did last month.
I first got to know of her problems last December when her third husband with whom she had five children, aged four to 11, left her. The grassroots leaders visited her and helped her with food-ration vouchers and recommended her for ComCare Assistance. We recommended her to earn some extra income through our in-house Social Service Enterprise but she turned that down. Four of her older children, aged six to 13, had been attending our CATCH Plus programme, as mentioned by Mr Seah Kian Peng earlier. This programme provides for completely free day care with the provision of meals, tuitions, computer classes, music classes and other activities also supervised by full-time staff daily. Children who got sick were sent by staff to see doctors with no cost to their parents.
She was quoted at the interview saying that she could not make ends meet and she had not been able to afford asthma medicine for her second daughter who has been attending our classes for months. I referred her to MSF through the Social Service Office at Chinatown when she first approached us in December. May I ask MSF whether we can have a better system to know if one person is already being helped so that help can be more coordinated?
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Many low-income families are in chronic need of financial assistance due to many factors. Giving them ComCare assistance will only solve their difficulty for the short term. What they really need is micro-interventions to attain a longer-term solution. We need the system to better help them help themselves. This is particularly useful for the young families. Will MSF consider taking such an approach, especially for young families in need? This method will seek out the underlying root causes of poverty and then work with the families to change the course of their lives for the better. This may be more resource-intensive to micro-manage each case, but the possible positive permanent outcome of self-reliance will be rewarding.
MSF will need more staff, social workers and counsellors to carry out such a hands-on approach to diagnose, suggest long-term solutions and guide those in need to achieve the ideal outcome. Does MSF have enough staff capacity? May I ask MSF if there is still a shortage of social workers and how does MSF plan to solve this?
The Social Service Offices (SSOs) have been well received. My constituency has one in Chinatown and my residents find it very useful. They can visit the SSO more conveniently and receive help faster. How are the SSOs coping thus far? How fast are the response and assistance rendered to applicants? Are the remaining SSOs – 22 in total island-wide – on schedule to operate by next year?
Concerning those in poverty, especially the elderly on subsistence living, may I ask MSF if it has the figure on the number of them? I am referring to those retirees who are not eligible to receive Public Assistance and are receiving meagre monthly CPF payouts that are lower than PA amounts. How does MSF assist this group of people?
As an ageing population, many more seniors will grow older and inevitably many more will get weaker at their advanced age. For those who live in rental HDB flats with no family members to depend on, ageing at home will get tougher as they grow older and weaker. Noticeably, many prefer to live in their own homes for as long as possible.
Will MSF facilitate this group to age in their own homes gracefully with some form of home-help, such as food delivery, befriender service and homecare? Is there now any scheme to identify these cases, especially those living alone? Could MSF identify them and at least refer them for VWOs to assist them if MSF does not have homecare service provisions? I hope MSF can look into the expansion on this area to assist many more to live in their own homes
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for as long as possible in view of our demographic trend.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Sir, in January this year, I asked the Minister for information on the number of homeless families that are camping by the beaches and the assistance rendered to them. In his reply, the Minister mentioned that in the period between 2011 and 2013, support and shelter were provided to 565 individuals and 404 families. About 80% of them were of low income and had weak social support.
The Minister, in his reply, also elaborated that three out of four were previous flat owners who had sold their flats for reasons, such as settling financial or debt problems, divorces and cashing out to make a profit. After the sale of their flats, they find themselves unable to afford the purchase or rental of another flat, thus many of them ended up camping on beaches and in public areas.
The Minister also mentioned in his reply that his Ministry regularly patrols the beaches and public areas to identify and provide the necessary assistance to homeless Singaporeans in our midst. While I am heartened to note that the Ministry is diligently making efforts to ensure that the homeless in our society obtain the necessary assistance, I am of the view that the Ministry can take a more proactive rather than the reactive approach to the entire issue. Instead of allowing the problem to manifest, more preventive measures should be in place as forms of early intervention.
In view that many previous flat owners were forced by the respective circumstances to sell off their accommodation, I would like to propose that the Ministry initiate joint collaboration efforts with HDB and, in particular, the Credit Operations Department, to identify high-risk families and render the necessary and appropriate financial assistance to these families before they lose their flats. Early intervention would certainly go a long way in alleviating the complex problems of homelessness in our society.
Mr Zainal Sapari (Pasir Ris-Punggol): Hubert Humprey wrote: \"It is once said that the moral test of government is how the government feeds those who are in the dawn of life, the children; those in the twilight of life, the elderly; and
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those who are in the shadows of life, the sick, the needy and the handicapped\".
MSF has taken bold steps forward in pledging to improve service delivery in the establishment of the Social Service Offices (SSOs) to render assistance to families in need. I would like to get an update on the SSOs in terms of their roll-out. Specifically, I would like to know how the SSOs have improved service delivery for clients. What structures and processes are set up by the SSOs to work with partners on the ground and gather feedback for local planning of services for the community? Are there concrete plans of action to facilitate SSOs in carrying out their function to achieve the desired outcomes?
The SSOs are in a good position to serve as a focal point to provide targeted assistance to families in need, Hence, it is critical that they are well-positioned in the community as a centre to coordinate the assistance that can be rendered to families. An area that I believe the SSOs can also look into is families with multiple needs. For example, a certain family may require help in terms of financial assistance, employment, family issues and many others. What are the Ministry's plans to address issues faced by such families with multiple needs? Sir, in Malay, please.
(In Malay): [Please refer to Vernacular Speech.] Madam, MSF has taken steps to establish Social Service Offices across Singapore to improve the quality of service that is provided to needy individuals and families. I would like to ask about the latest development from the setting up of such Social Service Offices. What will the SSOs do to improve their service delivery for clients who come to get help, especially for families that face a multitude of problems?
Mr Laurence Lien (Nominated Member): Sir, MSF sometimes appears to be laden with dealing with the downstream consequences of social problems – like poverty, debt, juvenile delinquency, homelessness and suicides – which may be generated by root causes that come under the purview of other Ministries. How does the Ministry tackle problems holistically when it often may not have the upstream tools?
For example, dealing with gambling has three elements – industry, crime and social issues. MTI and STB have been the key proponents of welcoming casinos on our shores with its attendant tourist dollars.
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Most of the regulatory powers are in the Casino Control Act and they rest with MHA and the Casino Regulatory Authority (CRA). I do not doubt the CRA officers are trying their best to take a whole-of-Government approach, but they are ultimately accountable to their parent Ministry and crime would probably be its focus. And this seems to leave the downstream social issues to MSF and the National Council on Problem Gambling (NCPG). NCPG has some powers from the Casino Control Act and these pertain to exclusion orders and visit limits. But would using these be too little and too late?
Let us compare this with what happens in Norway. The Norwegian Gaming Authority, which is under the Ministry of Culture, regulates all forms and aspects of gambling and lotteries. This authority was established in 2001, taking over the gambling regulation once handled piecemeal by 54 different Norwegian bureaucracies. The Authority is considered an active regulator and may even appear to be a bit of a nanny state in their anti-gambling measures. For example, they banned slot machines in 2007.
Or let us take poverty as another issue. Tackling poverty and income inequality requires a strong cross-sector approach. There are the issues of low wages, employment and training – which are tackled by MOM and the Ministries implementing the Progressive Wage Model – and the issue of educating the young from less advantaged backgrounds, which is handled by MOE. Again, is MSF also having to deal with the issues downstream, where the tools are focused on financial assistance, which itself is not the most ideal type of help in the long term for these families?
In addition, is the help that we give too fragmented? The kueh lapis approach of 18 assistance schemes – perhaps more now – shows the extent of Government support and actions on the issue. But does this approach also create silos where more holistic interventions are needed?
Again, let us look at an alternative example. Hong Kong established a Commission on Poverty in December 2012, chaired by the Chief Secretary for Administration. The Commission has a very broad mandate. This includes six focused areas like social security and retirement protection; education, employment and training; societal engagement; special needs; the Community Care Fund; and the Social Innovation and Entrepreneurship Development Fund.
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I am not here to debate about the adequacy and effectiveness of anti-gambling or anti-poverty measures in Singapore – that is for another time. I am also not suggesting today that Singapore should have a gaming authority like Norway's or a poverty commission like Hong Kong's. Norway does not even have casinos. I am just using these as examples to ask whether we have a structural issue in the way our Government organises itself to tackle social issues.
More than 10 years ago, I was once a Director in the then Ministry of Community Development and Sports, many parts of which are now in MSF. Back then, there was an internal joke saying that the Ministry should be called the Ministry of Everything Else because it seemed to receive so many diverse, downstream pieces of work.
I am glad that the new Ministry has progressed well and been given new importance, delivering many critical functions of social policies and programmes. MSF continues to grow very substantially. For instance, it had 1,100 staff in FY2012 and is growing to an estimated 1,750 in FY2014. But the nagging concern that continues in my mind is whether MSF has sufficient tools and resources to do its work optimally and tackle each issue at its root cause.
Would MSF not be able to do its work much better if there was more of a whole-of-Government approach to solving important social problems? There has been good progress in regulating all early childhood agencies with the establishment of ECDA. But what if we had an agency looking after vulnerable families and the issues they face? Even better than the whole-of-Government approach, are we able to take a truly whole-of-society approach by involving the community even more deeply?
Let me just end by commending Minister Chan and his team for their dedication and commitment to developing the social sector. None of what I have just said should be taken as criticism in any way of any of his MSF officers.
Miss Penny Low (Pasir Ris-Punggol): I declare my interest as a volunteer in the social innovation sector. I wish to recognise MSF's support for social enterprises (SEs) which recognise the power of dignity and self-worth and leverage on market opportunities to unleash its value.
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Last year, the Social Innovators Policy Shapers Network (SIPN) was launched by the Social Innovation Park. Through it, we found that direct handouts are giving way to a global rise in social enterprise and social innovation as new strategies for solving significant and complex social problems. We also found that where market failure is eminent, the Government's role is pivotal to get more traction to accelerate inclusive growth. SIPN did a quick scan of the world and this is what we found.
In Hong Kong, Chief Secretary Carrie Lam launched a HK$500 million Social Innovation and Entrepreneurship Development Fund under the Commission on Poverty, which she chairs, with a clear view to avoid and not just alleviate poverty.
In US, President Obama's Office of Social Innovation and Civic Participation has disbursed more than half-a-billion dollars through the Social Innovation Fund to support bottom-up, collaborative social innovation.
In Alberta, Canada, very recently, a US$1 billion Social Innovation Endowment Fund will support collaboration and create opportunities for solution makers to come together to address complex issues, strengthen and renew Alberta's social and cultural sector.
In South Korea, its Ministry of Employment and Labour enacted a Social Enterprise Promotion Act that provides holistic support for SEs – covering regulation and assessment, infrastructural development, funding and public procurement for quality sourcing.
In the UK, the Social Value Act requires all public bodies to take into account the social value created in contracts which provide a market for SEs.
The world recognises the value of this social innovation wave. Sir, are we prepared to go big in SE and social innovation? Can we consider the likes of the Social Value Act? Can we include technological, artistic and creative innovations to this agenda of finding new solutions to unmet needs?
I will repeat my call to the Government to adopt a full industry incubation model, a whole-of-Government approach. Will the Minister consider investing into a park for social innovation or social enterprise for a start? It is not just about the money but about recognising intermediary organisations, about putting an ecosystem in place and boldly boosting the social economy to put people and social innovation at the heart of our development agenda in
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Singapore.
Ms Denise Phua Lay Peng (Moulmein-Kallang): Sir, since July 2013, 10 Social Service Offices (SSOs) have been rolled out throughout Singapore to be nearer to those who need them. I am very pleased to have the services of an SSO in the Jalan Besar vicinity led by an excellent SSO General Manager and her team.
A recent encounter reminded me again of the need for a better overall system to better coordinate service providers and volunteers on the ground so that those in need will not be over-served, under-served, or worse, fall through the cracks and not served at all.
I had recently convened a meeting with more than 10 voluntary and Government social service providers. The goal was to adopt a more strategic approach to coordinate the many kind helping hands who, on their own, were providing some 300 to 400 free meals and free food vouchers on a daily basis. Most of the helping hands were unaware of one another's programmes or are reluctant to collaborate if left on their own.
Another phenomenon I observe is the common response of some fellow Singaporeans when they see other people who may be in need – be it an elderly person pushing a trolley of cardboards on the street or a destitute sleeping at a void deck. Instead of contacting parties that may directly and more effectively study the need and render the appropriate support, one common response is to take a photo or video and then send it to social or traditional media and lament how sad or bad the situation is. Whilst some people do this for reasons that are less than noble, I would like to believe that there are many kind Singaporeans out there who do not know readily who and how to contact in order to get more direct and timely help for those in need.
I, therefore, have three suggestions for the Minister.
(a) Clarify who and what the roles of the key players are now in the social service sector – the Community Development Council (CDC), the Family Service Centres (FSC), the Social Service Offices (SSOs), the People's Association (PA), the grassroots volunteers and other volunteer organisations and individuals.
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(b) Officially empower and resource the SSOs so that they can effectively work with the many key players to develop a social service needs analysis and delivery map to coordinate the many helping hands.
(c) To develop a more aggressive and user-friendly Communications Plan to inform helpful members of the public and persons in need so they know who, what, where and how various types of social help are available.
Mr Ang Hin Kee (Ang Mo Kio): Mr Chairman, last year, the Government announced plans to provide 20,000 more childcare places by 2017, and to this end, 45 new childcare centres will be built this year. I would like to ask: can the Ministry provide an update on the search for locations? What are the challenges it faces in finding these locations? And do the childcare operators face constraints to ramp up and build these centres?
Secondly, with more childcare centres, we will need more qualified early childhood education professionals. How has the Ministry worked with operators to ensure that we have sufficient and quality teachers attracted into and stay in this profession? And what can parents and the rest of us do to support such a goal?
Mr Muhamad Faisal Bin Abdul Manap: Sir, the Singapore Day 2014 will be held in London later this month. Catered by Singaporeans for Singaporeans, Singapore Day is organised by the Overseas Singapore Unit (OSU) to bring overseas Singaporeans together and celebrate the Singapore spirit. Inaugurated in 2007, Singapore Day is certainly an exciting fixture for many Singaporeans who yearn for a slice of home. But for many overseas Singaporean parents with young children, the Government may have to do more than annual events such as this.
Under the present arrangement, Singaporeans who are based overseas would not be able to enjoy the basic infant care and childcare subsidies that their citizenship has rightfully entitled them to enjoy. The privileges of citizenship should not be contingent on geography and, certainly, should not be restricted to the physical boundaries of the Singapore state.
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To overseas Singaporean parents, this is unfair as the present arrangement penalises them for riding the waves of globalisation which Singaporeans have all this while been encouraged to do so by the Government.
I would like to ask the Minister whether his Ministry would consider administering the basic infant care and childcare subsidies to overseas Singaporeans via a registration and reimbursement facility that the cost of childcare expenditure incurred in a non-Singaporean jurisdiction can be subsequently claimed back.
Dr Janil Puthucheary (Pasir Ris-Punggol): Mr Chairman, in new and rapidly growing estates, such as Punggol, there is an increase in demand for childcare and infant care. This is seen as long waiting lists persist at most centres even as new facilities are being opened; and we do welcome the new facilities.
As families relocate to new towns, access to assistive care arrangements, such as grandparents or extended families, can become problematic, especially for families that do not own a car. Many parents in the demographic in constituencies like Punggol are young and they are dual-income working households and many of them work irregular hours. There is an increase in demand, not just for childcare, but also for full-day childcare facilities.
Apart from distance, there are other issues that affect the ability of grandparents to assist in the care of their grandchildren. For some, the problem is that they are still working as the retirement age, both in law as well as in our social norms, goes up. There is another group of grandparents who have a very large age gap between them and their grandchildren. For these seniors, their own health and physical mobility limit their ability to help.
Overall, the number of grandparents who can effectively help in the care of their grandchildren may be significantly lower than we had planned for and may be a decrease in the proportion of families as we go forward. Some of the old social norms and social assumptions may be changing as our demographic is changing. This may need some new planning norms about the proportion of families for whom we have to provide subsidised childcare.
If I could just provide two examples, Mr Chairman. I have two families. One, the father is a regular in the SAF and the mother was a nurse who took some
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time off to bring up their newborn baby. Getting full-day childcare was a limiting step for her to return to work. We do not have enough nurses and here is a nurse that needs to go back to work. The longer she stays away from the workforce, the higher the chances that she is de-skilled and the more difficult she would be in reintegrating. The thing preventing that from happening was the provision of full-day childcare. Even as a new centre opened in her estate, there was just not enough teachers to ensure maximum capacity.
I have another family living in a rental block. This is the family I mentioned in my initial Budget debate speech where the father is quite unwell and is on dialysis and unable to work. The mother was supporting the family until she became pregnant and had a baby. This family, through the good work of various Social Service Officers, was receiving a lot of help. But if she could go back to work, so much less help would be needed and the long-term future of this family would be much more secure. Again, we found a place for the child, but it was not full-day childcare. This meant that she could not go back to the types of jobs she was skilled for as they require her to work longer shifts and have her child in full-day childcare. There is a real and urgent need for this provision.
We need physical spaces for childcare centres as it has already been mentioned. But we also need an increase in the number of teachers and staff and a model of support in subsidies to ensure that this service remains affordable for Singaporeans. I would like to ask what steps are the early childhood development agencies and the Ministry taking to achieve these outcomes.
One final point, Mr Chairman. It is not directly related to my cut, but I would like to record my appreciation and thanks to the Social Service Officers on the ground. They do hard frontline work and I have always been impressed that they have served with humility and a real sense of helping fellow Singaporean in need and being part of the society that they serve. I just want to take this opportunity to record my appreciation and thanks for these frontline SSOs.
Er Dr Lee Bee Wah (Nee Soon): I have 11 new BTOs in Nee Soon South. The lack of childcare and infant care centres is a pressing issue. If we are to encourage young Singaporeans to have children at an age when many of them are trying to make their mark in their careers, it is important to step up our efforts to cater to this inadequacy.
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Despite the Government's current efforts, wait lists for such centres are long, from personal observations and as observed by residents who have been sending me emails almost every week.
It is challenging to engage and retain suitable staff in the profession when centres do not offer much in terms of career to our childcare teachers. On the other hand, we expect our teachers not only to be professionally-trained in childcare with proper recognised qualifications but who also must have the right attributes for the job, such as good character, patience and be able to handle children well.
At MOE, teachers are offered comparatively much higher salaries – rightly so, as they teach at different levels. However, I think we have a lot to reflect on what should be done to grow our childcare industry and, in turn, groom and care for the little ones. More training and better benefits must be made available to childcare teachers and potential teachers and supervisors. And, until this is done, only then can we expect the quantity and quality of child service providers to go up.
I would also like to bring up the issue of special needs children, whose parents are having even greater difficulty getting suitable childcare facilities for them. I really empathise with the parents. Given the costliness of their medical bills, their parents have to work hard to relieve the financial burden and having to run about looking high and low for a childcare centre is really a pain.
In Nee Soon, most of the parents will turn to Rainbow Centre for help. I was told that the wait list at Rainbow is very long and sometimes they can wait for years. Childcare is essential in ensuring the children are well taken care of by professionals when parents are working. I hope more can be done to help these parents and children. We must get the sequence right. We have more childcare centres and we will have more babies, but not the other way round.
Mr Yee Jenn Jong (Non-Constituency Member): Sir, I refer the Minister to the KiFAS portion of my Budget debate speech. I am puzzled that after review, KiFAS can only be used on kindergartens operated by MOE and anchor operators. Those that qualify for KiFAS form less than half of the some 500 kindergartens here. More than 95% of qualifying kindergartens belong to
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just PCF. Other than PCF and MOE centres, are there actually any other centres that are KiFAS-approved today?
There are many good kindergartens, some with long history, like the ones my siblings and I attended some 40-50 years ago. KiFAS should apply to all registered kindergartens, just like its sister scheme, CFAC. CFAC can be used on all childcare centres. MOE also saw it fit to support aided schools with religious affiliations. This Government has prided our recent Budgets for being inclusive. I believe we can be more inclusive to allow more, if not all, kindergartens to be KiFAS-supported.
Mr Baey Yam Keng (Tampines): Mr Chairman, presently, Government subsidies for infant care programmes range between $220 and $600, depending on the type and duration of care. For childcare, the subsidies are between $110 and $300. I would like to request that the Ministry reconsider the suggestion to allow parents to claim these subsidies when their children are cared for by grandparents. My parliamentary colleagues had made similar suggestions over the years, the latest just last year, but have always been turned down for the reason that such care, although highly valued and appreciated, is not quantifiable and that there is already symbolic recognition in the Grandparent Caregiver Relief of $3,000 per year given to working mothers.
Sir, I do not understand why the Government is indirectly subsidising infant care and childcare operators, which are mostly commercial, but not the grandparents. I feel strongly that this important service should be recognised for what it is, regardless of the source and type of the service.
If the Ministry's concern is that the level of grandparent care is not the same as that provided by professional or institutional caregivers, we could organise childcare training courses at community centres for these grandparents. They can be certified on an annual basis, if necessary, before they can claim the monthly subsidies. Not only will this help to ensure that they are up-to-date with the latest healthcare and childcare information, such courses can also help ensure that grandparents and parents are on the same page on childcare practices today and reduce the potential for conflict. The training classes would also provide a wonderful platform for grandparents in a neighbourhood to interact with one another and strengthen community bonding.
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Actively engaging grandparents in this role promotes active ageing and strengthens family and intergeneration bonding. This will also help alleviate the shortage of caregivers for young children. Many areas, including Tampines, face a shortage of childcare and infant care services and capacity.
In fact, it would be even better if the subsidy could be extended to non-related caregivers, that is, babysitters. This will also help unlock the latent workforce in our heartlands: housewives whose children are grown up and for some reason are not taking care, or not yet taking care of grandchildren. There are housewives who could also cope even when their own children are still very young. My mother, for example, was a babysitter to our cousins when I was in primary school.
I guess an area of concern could be the difficulty of enforcement or checks that the grandparents are, indeed, the caregiver. I think as long as the child is below seven years old and both parents are working, we can safely assume that there will be an adult caregiver. For a start, we can disqualify parents who employ a domestic helper. It is quite certain the child would be under the care of a grandparent or babysitter if he is not already in an infant or childcare centre.
This change would recognise the contribution grandparents and babysitters make in bringing up the future generation and the hard work involved. I appeal to the Ministry to reconsider this.
Mr Patrick Tay Teck Guan (Nee Soon): Sir, one often forgotten and forsaken group of our community are the stay-at-home mums. As of 2013, there are 312,000 females not working due to childcare, caregiving and home tending. There is still a lack of societal and Governmental cognisance of the critical role stay-at-home mums play in our society supporting the basic family unit and, sometimes, even the extended family. They should not be seen as unproductive or contributing less to society. From those with infants to those with kids in primary school and those with older children or even with elderly parents to care for, these mothers need targeted support at different life stages and I ask that society, community and the Government reward, recognise and reassure them.
We should look at how we can fund pro-family measures to recognise the economic and social value provided by the stay-at-home mums. The measurement of her economic and nation-building contributions should not be
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understated. Stay-at-home mums who are expecting their second and subsequent children could be given benefits in lieu of maternity leave as there are currently no direct subsidies or support for stay-at-home mums who plan to have more children. There are also no transport subsidies for stay-at-home mums as they bring their children along while running different errands for the family.
As both a pro-family and procreation support, it would be worthwhile to add on a stay-at-home mums package to the current Marriage & Parenthood Package. It would be even better if we can equalise some of the stay-at-home mum benefits to match those that working mothers receive, especially those relating to childcare or kindergarten subsidies and maid levies. Childbearing and child-caring are a 24/7 labour of love. Try looking after two or more children at home. It is as demanding as any job in the marketplace. I seriously suggest the Government consider granting childcare subsidies for those who wish to send their third or subsequent children to childcare while they look after their first two. Without domestic help, looking after them is no joke.
Another area in which we can do more for them is in terms of tax reliefs or rebates for stay-at-home mums. The working mother's child relief can be extended to stay-at-home mums and these reliefs can be shared with their spouses to alleviate the financial burdens of a single-income family.
I am also worried about the future medical needs of stay-at-home mums. They do not have regular CPF and Medisave contributions. Hence, I would like to repeat my calls again this year for the stay-at-home mums to be given top-ups in their Medisave and Special Accounts to meet their healthcare and retirement needs. One way is to provide Government dollar-matching top-ups if the stay-at-home mum's working husband is contributing to her CPF account instead of the working mother's child relief, which may not benefit a mother who does not even earn a taxable income.
Some stay-at-home mums with older children also need part-time jobs and freelance positions to supplement their income or even work-at- or work-from- home alternatives and that can be considered as employment. I urge companies and businesses to embrace that and have work re-entry programmes for stay-at-home mums.
If I may end with a quote from CS Lewis: \"The homemaker has the ultimate career. All other careers exist for one purpose only – and that is to support the ultimate career\". I wish to acknowledge, recognise and salute all mothers,
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especially stay-at-home mums! Thank you for raising a generation of Singaporeans!
The Chairman: Mr Ang Hin Kee. You have three minutes for your two cuts.
Mr Ang Hin Kee (Ang Mo Kio): Mr Chairman, let me first declare my interest as an Executive Secretary of the Education Services Union. Many early childhood educators that I spoke with are passionate about their jobs and want to do better in their roles. We need to quickly implement solutions to attract, develop and retain them. The Minister last year announced a Continuing Professional Development Masterplan for Early Childhood Educators to update their skills, knowledge, attain key competencies and gain experience. In last year's COS, I also proposed designing incentives for teachers who complete certain professional development courses. I am heartened to know that this component is included in part of the Masterplan. My question is: will the Minister be able to share more details of the recognition and incentive scheme, and its implementation dates?
My second cut is on stress management. Teaching can, indeed, be rewarding and stressful at the same time. For example, many childhood educators share that they face lack of resources at the workplace, not enough break time, tight manpower at the centre, lack of recognition at the workplace and having to deal with unreasonable demands from various individuals and groups. Can the Ministry share if there are better measures or new measures in place to help them better manage stress faced at the workplace? Of course, this should not be the sole responsibility or domain of MSF and I hope that whatever solution that the Ministry comes up with will involve the roles and participation of other stakeholders as well.
Mr Alex Yam (Chua Chu Kang): Sir, allow me to move on to children who are a little bit older. With changing demography, leading to smaller family sizes and the rising trend of dual-income families, the phenomenon of latchkey kids has once again become an area of concern. There has, therefore, been a corresponding increase in demand for care arrangements for school-going children as both parents are in the workforce.
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The transit from childcare to kindergarten now has another element, that of preschool to primary school. Childcare afforded the flexibility to parents to have a formalised care-giving arrangement while they are at work. Similarly, families using full-day childcare services today will likely also require student care for their children, to provide for homework supervision, as well as before and after-school care.
The current 407 Student Care Centres (SCCs) across the island cater to this growing need. However, I would like to know if the Ministry deems this to be sufficient capacity and if there are plans to further boost available places. How are standards being upheld as the industry is not required to be licensed? MOE has increased the number of school-based SCCs from 50 to 80, with 14 of the centres set up in January of this year. How does the Ministry and MOE plan to better engage the industry to provide for more SCCs and ensure that the majority of operators outside of schools continue to provide affordable services?
Mr Yee Jenn Jong: Sir, we have seen a huge rise in the demand for childcare. Of late, the Government has put a lot of resources in that area. However, I do not see the same being done for student care. The same young working parents that use childcare services will need student care for their children, at least for the first few years of school.
Commercial SCCs are unattractive to run, given the high cost of rent and lack of Government support, compared to childcare. The MSF website listed 207 student care centres, of which a good number are tuition or childcare centres. These may take only a small number for student care, if at all, as their other operations are generally more profitable. Good student care services could eliminate the need for tuition. Is the current supply of student care places sufficient for our increasing needs for this area?
Student care operators are also not subjected to the Ministry's supervision for quality, unlike childcare. SCCs are not required to be licensed and are not subjected to regular checks by MSF. Their staff need not attain minimum qualifications and training.
I urge the Government to extend better funding and resource support to this sector, create more places, work with MOE to have more SCCs in all schools, and to provide closer supervision of the quality of operations.
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The Chairman: Mr Seah Kian Peng, you have four minutes for your two cuts.
Mr Seah Kian Peng: Sir, over the years, I have highlighted and championed many aspects and issues that families face. For this year, I wish to raise the following points.
First, I would like a progress update on the Family Matters Initiative which was launched last year with the intent of providing more support for people to pursue a positive family life. A sum of $40 million was set aside to help provide funding to schools and workplaces to run pro-family programmes. How many companies or organisations have taken up this funding and to what extent has this helped promote pro-family programmes?
Second, I would like to also ask for more support for families that are undergoing divorce and post divorce, as their children may be affected when relationships turn sour. Currently, parents who are in the midst of divorce proceedings must attend mediation and counselling at Family Court if they have at least one child below 14 years old. I feel such a restriction is unnecessary. In any divorce, all children would be affected, and so I opine that the need for mediation and counselling should be made compulsory as long as they have any children who are aged 18 years or below.
Currently, there is one FSC – Help Every Lone Parent (HELP) FSC – which is providing socio-emotional support to single parents and the children from single parent families. I think more agencies are needed to also provide support in this aspect. Beyond mandatory mediation and counselling, there could be better support for the family and children, both in terms of financial assistance and socio-emotional support. Could the Ministry share its views and the measures on this? My next cut, on single parents.
Sir, with changing demographics and strain on families, we expect to see more households headed by single parents.
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Some recent studies have indicated that the number of low-income single-person headed households ranged between 21,000 and 88,000. I can imagine many of them facing increasing challenges in having to earn a living and raise a family. Such challenges include housing, employment, childcare and parenting issues.
Given this, it is important that we also ensure that their children are not unnecessarily disadvantaged due to their family circumstances.
I am heartened by the policy change last year which extended childcare and infant leave to single parents. Six days of childcare leave a year for children below the age of seven, two days for those aged between seven and 12, and six days of unpaid infant care leave a year if they have a child below the age of two. These are now available to single parents.
Beyond the childcare leave and childcare subsidies, however, I would like to know the Ministry's plans to provide further support to single parents and their children. This is a group that needs more attention and deserves our fullest support.
Finally, I also want to single out another group of single parents for special attention. These are the unwed mothers and their children. For whatever reasons and circumstances, they are in that difficult and challenging situation where, based on current policies, they are not entitled to certain benefits for the simple reason that the unwed mother and her child or children are not, by policy definition, considered a family. Can the Ministry start a whole-of-Government approach and process to review this?
Ms Lee Li Lian (Punggol East): Chairman, l welcome the changes made last year to include single parents for both infant care and childcare leave.
In last year's COS, I called for the same maternity leave to be extended to single parents. Currently, a married woman is entitled to 16 weeks of paid maternity leave while an unwed mother is only entitled to eight weeks of paid maternity leave. Maternity leave is particularly important for the child as well as the mother to recuperate physically and emotionally from child bearing. A mother's marital status is irrelevant. Because of this, single mothers will have to quickly get back to their workplace while they are still struggling and recovering to find infant care assistance for their very young babies.
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Apart from maternity leave, a single parent below the age of 35 and her child do not qualify as a family nucleus when applying for a new HDB flat or rental flat. They are also not eligible for housing subsidies. Housing is a basic necessity and single parents need to provide themselves and their child a roof over their heads, too. This often leaves them with no choice but to rent or purchase from the open market. With hefty rental rates, such families may have to cut back on other expenses, such as medical and food for their children. I have come across cases in Punggol East where they have difficulties looking for a place to stay. They have to stay in an overcrowded flat or move from month to month to stay with their relatives or friends.
Single parents are also not eligible for baby bonus. Raising children is not an easy task financially, even if one is married and has two incomes. The cash component and money in CDA will certainly come in handy to help the single parent manage early childhood expenses.
I think we can all agree that parents are parents all the same, whether they are single or married. Their parental responsibilities and the needs of their children do not differ. I would urge the Ministry to seriously consider equalising their benefits.
Mr Alex Yam: Sir, in the course of my work in the community, there are many moments of joy in seeing happy families. But there are also heart-wrenching encounters with families broken by divorce. The impact on children is often the worst.
The trend of divorce is alarming. In 2012, although the number of marriages rose slightly to just under 28,000, there were 7,237 divorces in the same year. A crude statistical calculation would, therefore, mean that 25% of marriages end in divorce. More importantly, the median duration of marriage at divorce is about 10 years, at the critical time when children are just beginning to fully comprehend the dynamics in a family.
As we continue to promote a pro-family society, I would like to ask the Ministry how it intends to ensure that the unit of the family is safeguarded. Would the Ministry consider better pre-marriage counselling and perhaps, more importantly, dedicate more resources to address the concerns of couples facing separation or divorce so that there is a better focus on the children?
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A family is like musical notes, some high, some low, but the important thing is how to make the notes come together to form a beautiful song. The strains of society often add to the challenges of keeping a family together. We, therefore, need concerted efforts to protect the family and do all we can to ensure we have more beautiful songs.
Ms Mary Liew (Nominated Member): Sir, the Home Ownership Plus Education Scheme was introduced back in 2004 to help improve social mobility of small families from the younger generation.
One of the eligibility criteria was that the wife or mother has to be aged 35 or below. I would like to ask: how many families have benefited from the HOPE scheme? What is the amount spent on this scheme? When was the last review of this HOPE scheme?
Sir, as women are getting married and having children at a later age, would the Government consider reviewing the eligibility criteria to extend it to those beyond 35 years old? With Singapore having a low fertility rate, would the Minister consider helping families with more than two kids?
Moving on to special needs children, very often, mothers with special needs children are unable to take on full-time jobs due to a lack of schools that provide full-day care. There is also a lack of resources within schools to provide individual attention for these children. I would like to ask the Minister a few clarifications.
Firstly, what is the number of children with special needs and how many teachers are trained to teach them? Is the number of teachers sufficient?
Secondly, some schools with early intervention programmes for infant and child can only offer two or three school days each week for special needs children. Would the Minister consider putting in more resources to provide five full-day care in school for these special needs children?
Thirdly, what are the training schools, centres and places for the special needs children with different needs, and are there sufficient and suitable training for those children beyond 18 years of age?
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Lastly, many special needs children will have medical conditions and require long-term medical care. Would the Minister consider giving more subsidies for these special needs children?
Dr Lily Neo: Mr Chairman, the reported cases of elderly abuse are about 200 yearly, since 2004. This number is more likely to be just the tip of an iceberg and more importantly, it is unacceptable because no person should be abused. Many abused elderly may not report for various reasons. For example, they may feel shameful, they may not want to jeopardise their source of providers, they may be too weak or too sick to protest, or they may not know the channels to get help and so on.
We have the Mental Capacity Act to protect the mentally incapacitated elderly and the Maintenance of Parents Act to obtain financial support for parents from their children. Is it time to further introduce more laws to stamp out elderly abuse? The perpetrators must be brought to task with better provision of deterrents in place and laws that have more teeth to prosecute. There must be better legal protection for abused elderly, especially the infirm elderly. Perhaps, we can have an Act similar to the Children and Young Persons Act (CYPA). CYPA prescribes counselling, psychotherapy, assessment and treatment. CYPA also requires care centres to report suspected cases of abuse. CYPA protects informants on suspected cases of those being abused from personal liability. This is particularly useful to encourage social workers, relatives, friends and grassroots leaders to report abused elderly because the victims themselves usually keep their silence.
There is a need for raising public awareness on elderly abuse. There are various kinds of abuses and they include infliction of physical pain and injury, debilitating mental anguish, unreasonable confinement, wilful deprivation by caretakers of services necessary to maintain physical health and mental health, as well as financial abuses.
It is very important to have better provisions to assist this group. Could MSF make available support services to give respite to caregivers and prevent burnt-out syndrome of those service providers, such as dementia caregivers, at home?
May I ask MSF whether enhanced measures – either financial assistance or homecare assistance to assist low-income and middle-income families care for
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their dependent elderly members at home better – can be put in place?
Ms Tin Pei Ling (Marine Parade): Sir, the Maintenance of Parents Act (MPA) was first passed in Parliament in 1994 and later amended in 2010, as tabled by hon Member Mr Seah Kian Peng. There was much debate, and I believe issues were comprehensively argued to derive at its current form.
I am in support of the Act and I would like to raise some points about this Act to further strengthen the Act, hopefully.
By definition, filial piety cannot be forced. But with this Act, we are setting the right tone to the society that filial piety, kinship and caring for our old continue to be important values to us as an Asian society.
Budget 2014's overwhelming focus on honouring and caring for our Pioneer Generation and support for seniors in Singapore further underlined these values. Looking at the statistics, I know that the new Tribunal applications have steadily decreased since 2009. Cases with the Commissioner for the Maintenance of Parents have, however, increased since 2010. It seems to suggest that the option for conciliation has helped to promote amicable resolutions between elderly parents and children, as this option gives them the chance to talk it out before things get ugly.
However, there are cases of outright abandonment that MPA is not yet able to cover, not least because this again requires one of the elderly parents to be willing to apply for maintenance. This creates the opportunity for financially competent but irresponsible children to abandon their parents, knowing that they can get away with it.
I have heard of many irresponsible comments, such as \"Go to see your MP. Find her. Government sure will help you.\" I have met so many elderly residents who came to MPS to beg for welfare and rental flats because their children would not give support despite themselves owning 4- or 5-room flats or even private condominium units.
In one recent case, a woman in her late 30s came to seek help with supporting her elderly mother. Her two elder brothers in their late 40s – and they have kids of their own – refused to share any financial obligation to care for their mother. When the Judge asked the brothers during their parents'
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divorce just a few years ago whether these brothers were supporting their elderly mother, these brothers went missing in action for a few months – for many months, in fact. Just for Members' information, the father was abusive and, hence, the mother filed for divorce despite their old age, so it is not a matter of the mother not playing her part. At last, the elderly mother was unwilling to apply for MPA for fear of straining an already strained relationship. The brothers continued scot-free, knowing fully that nobody can do anything about it. Suddenly, filial piety is being outsourced to the Government.
Of course, there are cases that are complex and the children may have valid reasons for wanting to keep their parents at arm's length. It should be considered. But this cannot happen if there is no opportunity to do so. For instance, it can be done during mediation where a neutral mediator can be witness. Hence, will the MSF consider allowing neutral third parties to apply for MPA on their elderly parents' behalf? Proper guidelines can be established. For example, before an application is approved, the third party needs to help show proof that the children have neglected or abandoned their elderly parents to the extent that the elderly's survival or well-being has been compromised. Alternatively, can MSF share what measures it has in place to address the issue of abandonment by children?
Finally, Sir, MPA itself is a bold move to impose on children to care for their parents. I am pushing this further, because I feel strongly about this. It is about defending important values to us as an Asian society for generations of yesterday, today and tomorrow —
The Chairman: Ms Tin, your time is up. Ms Denise Phua.
Ms Denise Phua Lay Peng: Sir, the focus on the disabled or those with special needs in Singapore has grown from strength to strength. Under the Enabling Masterplan 2012 to 2016 and the one before, support, indeed, has been enhanced, thanks to the good work of the Ministry, NCSS, SG Enable and the various partners.
As expected, support for the adults, especially those who are moderate to severely disabled, tends to fall behind support for the younger and the milder. As a volunteer activist who helps to build services for the young and older ones, I have observed many challenges in the adult space.
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At a macro level, the quality of services is uneven and usually lacks depth and scale. There is the issue of manpower constraint, as not many Singaporeans choose to work in jobs that support the more severely disabled. And then, the issue of insufficient funding – funding for most adult programmes is means-tested and not tiered to reflect the higher support needed for those who are more severe. Hence, any qualified provider who chooses to operate, for instance, an adult centre, must be prepared to raise funds to cover its expected operating deficits for as long as the programme runs. There needs to be both funding and options, such as what was announced by MOH just now on home-care support packages.
On the family front, parents of adult disabled children are getting on in age themselves and many are in a state of anxiety, helplessness or paralysis regarding the future of their children. It is clear that while the state feels it is doing more, the beneficiaries do not yet feel the same way.
Not many of these ageing parents have clarity of the end-goal for their child's adult life or if they know how to get there. Some would like the Government and the VWO to take over the entire care, but not everyone wishes to abdicate their parental duty. The consistency of engagement and support is not evident during the adult days, compared to those in the younger days; yet, adulthood is the season that lasts for a good many years beyond childhood and youth.
For this COS, I would like to surface five pointers for the Minister to consider.
(a) An update of the Enabling MasterPlan and how this update might be better presented and made more accessible to, especially, stakeholders outside this House.
(b) A specific sharing of the Ministry's plan for the adults with moderate to severe disabilities in view that there are not many options other than day activity centres which are expensive to run and which face serious manpower constraints due to lack of appeal.
(c) Tiered funding for services that support those who are more severe, especially for those in DACs, the home-based services and residential homes, even if the duration of service is not for full-day attendance.
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(d) Structured and stronger family support by having paid and trained Life or Family Coaches from either disability organisations, Family Service Centres or SG Enable to work out with families of such adults what is commonly called \"Person-Centred Individual Life Plan\" during transition from youth to adult and then on a periodic basis. The Plan can serve as a signpost and roadmap to clarify what the end-goal is; and what services are available and what families themselves can do to get closer to the end-goal. The vision should be a user-friendly plan that maps how families and other stakeholders can work towards such Quality of Life goals like financial well-being, physical fitness, social and community inclusion, and continued education and training.
(e) Finally, I ask for the development and communication of a clear continuum of disabled adult service models from respite service, home-based service to day activity centres, to employment and residential homes for those with no family support.
Mr Png Eng Huat (Hougang): Sir, the cost of raising a child with cerebral palsy from infancy to adulthood is very high. When such a child grows in size and weight, caring for one who is totally dependent on a caregiver to do the basic activities of daily living is a huge challenge and a full-time job.
These caregiver parents have to prepare milk feeds for their children every few hours, change diapers for them throughout the day, shower them, change sitting and sleeping positions for them frequently to prevent bedsores, and more. For working parents, they will have to hire a domestic helper to care for such children full-time.
Cerebral palsy is a long-term chronic medical condition that requires long-term supportive care services. Those with cerebral palsy often have other associative and co-mitigating medical conditions.
The family of an individual with cerebral palsy is likely to incur significant expenses related to the on-going need for medical care, early intervention, special education services, developmental assistance and assisted living. More often than not, the parents themselves may also incur additional medical expenses. I know of parents who are suffering from chronic back pains after years of caring for their grown-up handicapped children.
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Day-to-day living cost is also high for these families. Daily needs like diapers and milk powder are not subsidised. Thus, I would like to ask the Minister if more assistance can be given to families with members who are totally dependent on caregivers.
Currently, there is no official record kept on the number of people in Singapore who suffer from cerebral palsy. However, l am heartened to know that the Cerebral Palsy Alliance of Singapore (CPAS) had announced last year that they had started compiling the first such central registry in Singapore and will have it up and running in 2015. Having such a registry is a good start as help and assistance schemes for people with cerebral palsy can now be more targeted.
Although SG Enable started operations in the third quarter of 2013 as a one-stop centre for persons with disabilities, many may still not be aware of its existence and what it does. I hope the Ministry will work closely with CPAS and its supporting central registry to reach out to more people with disabilities so that their families will know where to seek appropriate assistance in times of need.
","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 Chan Chun Sing): Sir, 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 Chan Chun Sing]. (proc text)]
[(proc text) Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Mr Chan Chun Sing: Mr Deputy Speaker, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2014/2015, and ask leave to sit again tomorrow.
\tPage: 176
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.\" – [Dr Ng Eng Hen]. (proc text)]
Adjourned accordingly at 7.22 pm.
\tPage: 177
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