[(proc text) Order read for consideration in Committee of Supply [6th Allotted Day]. (proc text)]
[Mdm Speaker in the Chair]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head O (Ministry of Health)","subTitle":null,"sectionType":"OS","content":"[(proc text) Resumption of Debate on Question [12 April 2016], (proc text)]
[(proc text) \"That the total sum to be allocated for Head O of the Estimates to be reduced by $100.\" – [Dr Chia Shi-Lu]. (proc text)]
[(proc text) Question again proposed. (proc text)]
Ms Sylvia Lim (Aljunied): Mdm Chair, MediShield Life provides Singaporeans and Permanent Residents some coverage for hospitalisation bills and certain outpatient treatments, without age limit and for life. While the scheme benefits those of us based here, requiring all overseas Singaporeans to pay for compulsory coverage does not seem fair to some of them and merits a review.
The Ministry of Health (MOH) has stated that overseas Singaporeans should contribute to the national risk pool as \"part of collective responsibility\". The Ministry says this will also enable them to benefit from MediShield Life protection anytime they choose to return to Singapore.
This stand makes sense for those overseas Singaporeans who know that they expect to return to Singapore to live. However, there are Singaporeans who have made their home in other countries for decades. These include Singaporeans married to foreigners and raising children overseas, sometimes because the foreign spouses are not able to find suitable work in Singapore. They enjoy high standards of healthcare in these countries, which they pay taxes for. Others have emigrated as families and now have access to healthcare at prices more affordable to them. Some chose to live abroad because they could only obtain adequate coverage for their serious health conditions there. These Singaporeans are better covered overseas and will probably never tap on MediShield Life.
Will the Government review how it could allow such overseas Singaporeans to opt out of the scheme? Is there a compelling case that no opt-out should be allowed at all?
Mr Pritam Singh (Aljunied): Mdm Chairperson, the prospect of rising healthcare costs is a cause for concern, especially for the middle-income or the sandwich class. In fact, rising MediShield Life premiums will be a reality for many Singaporeans as the subsidy threshold is progressively reduced from this year up to the year 2019, when MediShield Life subsidies come to an end.
MediShield Life means coverage for all, including the most vulnerable among us. In fact, when MediShield Life was introduced, it was expected to account for a bigger chunk of Integrated Shield payouts. However, this prospect was quickly put to rest with the announcement by the various insurers that any rise in the top-up portion of premiums would only be frozen for 12 months. As this moratorium will only last until November this year, what are the prospects of higher premiums next year? Can the Ministry consider informing the insurer that the moratorium should also include a freeze on riders as well, since this would have been a backdoor to work around the moratorium, insofar as keeping healthcare costs affordable as a whole?
Secondly, while rising healthcare costs for a number of public reasons, such as larger bills, greater healthcare consumption and costly procedures, are a reality, can the Ministry share how it intervenes, if at all, to ensure that any rise in premiums from the Integrated Shield providers are audited by the Government? How does the Government work with the insurers to check on any unjustified rise in premiums and to what extent can the Government intervene, if and when premiums are unjustifiably raised?
In view of this new environment of data analytics, will the Ministry release more data in conjunction with the insurance companies so that the public will be in a better position to track and appreciate the rising trend of claims and specifically identify areas of over-consumption? What does the Ministry do to ensure that private hospitals and doctors do not take maximum advantage of private insurance plans? Does the Ministry consider this to be a growing problem and how does it plan to mitigate it?
Finally, details of the standardised B1 plan were recently made public. Prior to launch, the plan was framed as an affordable Integrated Plan providing greater choice to consumers. To this end, will the Ministry consider increasing the MediSave withdrawal limit amount for Singaporeans of all ages, especially older Singaporeans who choose this plan, so that they can be paid for completely through their MediSave account?
Dr Lily Neo (Jalan Besar): Mdm Chairman, \"prevention is better than cure\" is a dictum that we would accept wholeheartedly. Preventive medicine is a topic I am passionate about and I have been advocating this preventive healthcare.
In the year 2000, I was privileged to spearhead the two-year islandwide \"Check Your Health\" programme to screen those above 50 years of age for diabetes, hypertension and high blood cholesterol. Some 40,230 people were screened. About 60% of them had never attended any screening before and 60% of them, who had no past history, were detected with abnormal results. Although we are in a better situation now with more people readily going for regular health screening, we must continue to push for the detection and treatment of these three chronic diseases, and especially so for diabetes.
Diabetes is a killer disease that slowly steals life away. It can slowly destroy body organs, resulting in blindness, lower-limb gangrene, kidney failure, stroke, cardiac disease and so on. If we can promote better control of diabetes, we will see less of these complications that cause pain and burden upon sufferers and their family members. Presently, one in three diabetics has poor control of their diabetes.
Non-compliance is a serious problem in diabetes. Patient non-compliance is not only limited to the failure to take medications, but also the failure to make lifestyle changes, undergo tests or keep appointments with physicians. Non-compliance can be due to factors that are patient-centred, therapy-related or healthcare system-associated. The patient-centred factors can be demographic, such as age, gender, educational level and marital status, and psychological, such as patients' beliefs and motivation towards the therapy, negative attitudes, patient-prescriber relationship, patients' understanding of health issues and general knowledge.
The therapy-related factors include the route of medication, duration of treatment, complexity of treatment and the side effects of the medicines. The healthcare system-related factors include availability or accessibility of care and the physician. Could MOH address these non-compliance factors and mitigate them in order to have better success with diabetes?
An area that can make a difference is to enhance lifestyle-change reinforcements. Thus, would MOH consider promoting less-calorie food intake within our population, such as disclosure of calorie content in the food available? Would MOH also incentivise people to stay healthy with token rewards?
Dr Tan Wu Meng (Jurong): Our home palliative care services do good work for Singaporean patients from all walks of life. I have seen it myself when I visit residents and attend funeral wakes in Clementi. They tell me about how their loved ones were helped at home during terminal illness. I have seen how they looked after my own cancer patients that I see in a professional capacity. And I also saw how they brought comfort to my father, during his last days, as a cancer patient, terminally ill.
These nurses and doctors make the greatest difference because of the human touch. A human touch for patients at home, patients from all walks of life. Home visits, listening to patients and their families, giving advice and guidance to caregivers. And they can teach us as well, at the systems level, how to look after other patients at home – the chronic sick, the frail, the very elderly – because travelling to a clinic takes time. It can be challenging for some patients and their families if the patient is bed-bound after a stroke or if your loved one cannot sit up for long because of pain.
Can MOH give an update on our home-care and community care plans? Can MOH tell us how we can further empower and support caregivers? And can MOH advise us on how we can ensure care can be delivered near to home – or even at home – in a holistic, integrated, sustainable way so that we can look after all our Singaporean patients, those who are mobile, those less mobile and those who are unable to leave the home easily?
Ms Joan Pereira (Tanjong Pagar): Mdm Chair, the Action Plan for Successful Ageing report contains several initiatives to improve healthcare for seniors in areas, such as health and wellness, active ageing and aged care services.
For many seniors, age becomes almost irrelevant when they are physically, mentally and socially healthy, and they will have the freedom to do as many things as the young can do. I would like to know what are the initiatives to help our elderly live healthy lifestyles, monitor their health conditions and exercise.
As a firm believer in preventive health, I would like to know how the Ministry can encourage and enable medical follow-ups of seniors found to have at-risk conditions. I have always found it challenging to encourage our seniors to go for their follow-up treatments and therapies. Some are worried that they would discover more serious medical conditions and would prefer not to know. Others are concerned about costs. And yet others claim they have no time.
Whatever medical conditions they have, if treated early, it can prevent deterioration, escalating healthcare costs and poor quality of life. An idea I would like to propose is to tap on the community network of seniors, where elderly neighbours and friends can encourage their peers to see their doctors for follow-ups.
Seniors want to age in familiar environments surrounded by people they know and who understand and care for them. They also need easy access to care centres and doctors. Their caregivers also need support from the community in caring for their senior family members. What are the major initiatives for aged care services?
Assoc Prof Fatimah Lateef (Marine Parade): The Action Plan for Successful Ageing includes about 60 initiatives covering 12 areas. The Action Plan, \"A Nation for All Ages\", is targeted at the individual level, the community level, as well as the city level.
Can I ask about MOH's action plan for community level health promotion for our seniors and what community networks they can tap on, bearing in mind that we also want to align with those that are existing in the constituencies?
As we know, we cannot disengage an individual from his/her community and, in fact, the latter has a value-added effect and positive impact on well-being, mental wellness and happiness. Having a trusted group of friends and \"kakis\", the seniors can be made to feel differently and a lot better.
Will we see a more well integrated range of services and networks, readily available to our seniors at no or low cost, up close and personal, near their residences? Can we make these stimulating, broad ranging and exciting as well for our seniors in their active ageing years?
As we also plan to integrate the seniors with their multigeneration families and extended families, can the Ministry also consider family-friendly activities and networks which will be appealing to all ages, in order to target multi-generational involvement? One of the initiatives that has been announced include co-locating eldercare and childcare facilities in new Housing and Development Board (HDB) developments to maximise opportunities for interaction among the different generations.
Ms Joan Pereira: Mdm Chair, it is important to promote good health in seniors so that they can enjoy and spend their longer years meaningfully. One of the initiatives of the Action Plan for Successful Ageing is the National Seniors' Health Programme. The programme will include healthy lifestyle campaigns, community activities and interventions for mature workers at workplaces.
I welcome these initiatives for I have encountered many elderly who may not know how to select nutritious food and do the appropriate physical activities to keep fit. Would the Ministry consider providing general guidelines, taking into account age bands, that show the recommended types of physical activities that a senior can do if he has certain medical conditions?
Teaching them, their family members and community volunteers to recognise signs of illnesses, including dementia, is also important as early detection and intervention will contribute to more effective treatment.
Would the Ministry share further details of the National Seniors' Health Programme to promote good health in seniors? What kind of interventions will be introduced at their workplaces? How does the Ministry plan to encourage more seniors to participate in such programmes and activities?
The Chairman: Ms Tin Pei Ling, please take your two cuts together.
Ms Tin Pei Ling (MacPherson): Madam, there is a concerted push for active ageing amongst our seniors in Singapore. One critical aspect that we must not neglect is the health of our seniors. Without health, our seniors cannot be active and lead a meaningful life. We must also ensure that seniors do not think that active living is only for the young and fit. That would undermine this important exercise. Therefore, I would like to ask the Minister to share and update what is his plan in promoting and supporting seniors to keep healthy.
I am heartened by the slew of pro-elderly measures introduced over the past years. These are needed to enable a graceful and meaningful retirement for all Singaporeans. But to achieve a truly caring society, we cannot rely only on the Government or a few charitable organisations. Every one of us has to do our part.
I see the Community Networks for Seniors being critical in this aspect, as they have the potential to ensure our seniors continue to be plugged in to social and support networks. It also ensures that the human touch will not be lost as we work towards more efficient eldercare and as we embrace greater use of technology.
I would like to ask the Ministry, firstly, how does the Ministry see the Community Networks for Seniors fit into the Action Plan for Successful Ageing?
Secondly, does the Ministry see scope within this initiative for the more abled seniors to be recruited to reach out to and help other seniors? I believe this is a very meaningful way of engaging seniors who are fit and keen to do something constructive in their retirement. This keeps them active. Moreover, seniors can also relate to seniors better, as they may share common challenges and language. Perhaps, this initiative can be akin to the Pioneer Generation Ambassador (PGA) programme in which volunteers are empowered through proper training and given a modest honorarium. Some of the PGAs in my constituency are Pioneers themselves and they take great pride in their work as ambassadors.
Thirdly, can the Community Networks for Seniors help to simplify the process of delivering assistance and care to our elderly, so that the elderly only need to approach one touch point? The coordinating nature of the Community Networks for Seniors can also ensure that resources and support are fairly distributed to all seniors.
The Chairman: Minister Gan Kim Yong.
The Minister for Health (Mr Gan Kim Yong): Mdm Chairman, I would like to thank Members for their comments and suggestions. With your permission, may I display a few slides to facilitate the discussion?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Mr Gan Kim Yong: Madam, our healthcare system has served Singaporeans well. The average lifespan of Singaporeans born in 2014 is now 82.8 years, 7.5 years longer than in 1990. Life expectancy in Singapore is among the highest in the world and our Health Adjusted Life Expectancy, which measures years lived with \"full health\", is among the top three globally. In short, Singaporeans can expect to live longer and healthier.
There are encouraging signs that more Singaporeans are choosing a healthier lifestyle. The proportion of adult smokers fell from 18.3% to 13.3% over the last 20 years. We are also choosing healthier foods. Today, more than a quarter of Singaporeans consume at least one serving of wholegrain products per day, more than three times the rate in 2004. But the picture is not all rosy. There are some worrying trends which I will elaborate later.
But, first, let me give an update on our Healthcare 2020 Master Plan.
First, on accessibility. Over the last five years, MOH has expanded our capacity in all sectors. In 2015 alone, we opened three new acute and community hospitals progressively and added over 900 beds − Ng Teng Fong General Hospital and Jurong Community Hospital in the West, and Yishun Community Hospital in the North. The three hospitals will continue their ramp-up this year and are expected to bring online another 270 beds.
Mr Low Thia Khiang asked about wait times for our Specialist Outpatient Clinics (SOCs). From 2013 to 2015, SOC attendances increased by 5%, largely due to the increase in subsidised attendances by our seniors, which grew by 26%. These patients would have benefited from higher subsidies, especially for the Pioneer Generation (PG). During the same period, private SOC attendances actually fell by 5.3%.
Despite the increasing workload, the median wait times for subsidised new appointments remained fairly constant, at about 29 days over the past three years, while the 95th percentile wait times increased from 110 to 125 days. For private patients, median wait times stayed about the same at eight days, while the 95th percentile wait times also increased, from 47 to 58 days.
Nevertheless, we have made improvements in the 50th percentile and 95th percentile wait times for specialties, such as Rheumatology and Immunology, Gastroenterology, Ophthalmology and Neurology, despite increasing attendances at these SOCs.
SOC wait times vary across hospitals. At Alexandra Hospital, for example, the overall median wait time is less than a week and, at the 95th percentile, 12 days. So, patients who need an earlier appointment can ask their doctor to refer them to hospitals with a shorter wait time.
For patients with more serious and time-sensitive conditions, our hospitals and polyclinics have protocols in place to arrange for faster appointments at our SOCs. For example, the median wait time for new subsidised appointments for urgent cardiac conditions and suspected cancers was around one week. In fact, for cardiology and cardiothoracic surgery, the median wait time has improved from 14 days to six days.
We have been managing the wait times for our SOCs in three ways. First, we optimise the SOC appointment system to give priority to urgent cases. We also reduce \"no-shows\" by reminding our patients of their appointments via messages. Second, we are working with polyclinics and general practitioners (GPs) to ensure that only patients who need a specialist's care are referred to our SOCs and, for patients who have recovered and are well, to help them transition back to primary care. Third, we have added new SOC capacity through developments, such as the Nnational University Hospital (NUH) Medical Centre, National Heart Centre and Ng Teng Fong General Hospital.
Mr Low Thia Khiang cited the case of a patient experiencing a long wait for an appointment and biopsy results. I would like to explain that the usual turnaround time for laboratory biopsy results is around three days. So, I would be happy to look into the circumstances of the specific case if Mr Low can provide the details.
Mr Low also asked about the time taken for computed tomography (CT) scans. For the first quarter of 2016, the median wait time for a routine subsidised outpatient CT scan was between one and three weeks for most hospitals and has remained stable over the past three years. I should explain that the timing of the CT scans may also be a result of scheduling to coincide with the reviews by doctors. For conditions that require urgent scans, hospitals are able to fast-track these cases, whether in the wards, in the SOCs or at the accident and emergency (A&E), on the same day or the following day.
Other than hospital capacity, we have also added about 1,200 nursing home beds and 60% more home-care, day care and home palliative care places between 2011 and 2015.
Looking forward to 2020, we are on track to add more than 6,600 places in community care, home-care and palliative care, as well as 7,900 beds in acute hospitals, community hospitals and nursing homes.
Mr Leon Perera asked about wait times at our polyclinics. Polyclinic attendances have been growing over the years, from 4.5 million attendances in 2011 to 4.9 million in 2015. Median consultation wait times have improved from 32 minutes in 2011 to around 14 minutes in 2015. Mr Perera is correct that wait times for patients with appointments is, indeed, lower than wait times for walk-in patients. Over the past few years, polyclinics have been encouraging more patients to use the appointment system. Currently, all patients with chronic conditions, many of whom are elderly, are offered appointments for their next chronic visit. In 2015, 70% of these chronic patients visited the polyclinics by appointments. We will continue to help more patients use the appointment system.
In the meantime, we are adding capacity and improving processes to meet the primary care needs of our population. The last four years, we redeveloped the Geylang and Tampines Polyclinics and have just completed an expansion of Marine Parade Polyclinic. Currently, we are redeveloping Bedok, Ang Mo Kio and Yishun Polyclinics and are on track to open new polyclinics in Jurong West, Punggol and Bukit Panjang, and a new primary care facility in Sembawang by 2020.
Madam, many Singaporeans choose to visit polyclinics, instead of private GPs, because of the significantly lower costs at polyclinics as a result of Government subsidies. Lower and middle income patients and all PG patients now have an alternative as they can tap on the PG package and the Community Health Assist Scheme (CHAS) to enjoy subsidised primary care at private GP clinics instead.
Madam, our healthcare professionals are at the heart of delivering quality patient care. To meet the increasing healthcare demand, we have grown the healthcare professional workforce of doctors, nurses, pharmacists and allied health professionals by 24% from 46,000 to 57,000 between 2011 and 2015.
We have also made significant moves in addressing Singaporeans' concerns over affordability. In 2014, we launched the PG Package which provided 450,000 Singaporeans with more help with their healthcare costs.
For lower- to middle-income Singaporeans, we have raised the subsidies for outpatient drugs and specialist care. As of December 2015, 715,000 Singaporeans have benefited from these enhanced subsidies.
With CHAS, I spoke about this just now, about 1.4 million Singaporeans, including Pioneers, are able to benefit from Government subsidies at participating GPs and dentists close to their homes. Since 2012, we have more than doubled the number of participating clinics to 1,500.
We have introduced more flexibility in the use of MediSave to help Singaporeans with their healthcare costs. Today, Singaporeans can also use up to $400 per MediSave account per year to pay for their outpatient chronic disease management.
Last November, we introduced MediShield Life to provide better protection for all, for life. To date, many Singaporeans have benefited from MediShield Life. Take, for example Mdm Sung, a Pioneer living in Ang Mo Kio. Late last November, Mdm Sung had a stroke and her family brought her to Tan Tock Seng Hospital where she was warded for 11 days. She continued her rehabilitation and recovery for eight days at the Ang Mo Kio Thye Hwa Kwan Community Hospital near her home.
The total bill for the stay came up to $16,900 and, after subsidies, Mdm Sung needed to pay $6,400. Before MediShield Life, Mdm Sung, who was uninsured, would have had to pay the full $6,400, but with MediShield Life coverage, she only had to pay about $3,300, close to half the original bill. And all of this was paid through her MediSave.
Today, Mdm Sung is back to living with her son and his family. She has four children, 10 grandchildren and six great grandchildren – a great example for our population strategy. A few weeks ago, the whole family came together to celebrate her 85th birthday. We wish Mdm Sung and her family the best of health.
Overall, from last December to February this year, MediShield Life approved about $136 million for 95,000 claims, or about $45.3 million per month. This is a 29% increase, compared to the average monthly claim for MediShield in 2015. MediShield Life, together with Government subsidies, MediSave and MediFund, will continue to help many Singaporeans like Mdm Sung and low-wage workers mentioned by Nominated Member Thanaletchimi in her Budget speech earlier, giving them greater peace of mind that their medical treatment will be affordable.
Ms Sylvia Lim asked about the coverage for overseas Singaporeans. MediShield Life was introduced to give all Singapore Citizens and Permanent Residents assurance of universal healthcare coverage, regardless of their health condition, situation and background. MOH is aware that Singaporeans based overseas are concerned that MediShield Life coverage is mandatory. We recognise that the overseas Singaporean community is diverse and individual circumstances vary considerably.
The MediShield Life Council will conduct targeted engagements with overseas Singaporeans as part of their MediShield Life coverage review, while bearing in mind the principle of universal coverage.
Madam, the report on the Action Plan for Successful Ageing released in February outlined our strategy to develop a senior-friendly nation and a caring community.
The effort to pilot Community Networks for Seniors announced by the Minister for Finance earlier, is a whole-of-Government approach to \"close the last mile\" in supporting successful ageing for seniors in our community. As highlighted by Assoc Prof Fatimah Lateef and Ms Tin Pei Ling, this pilot is not about introducing another new service for seniors in the community, but an effort to strengthen partnership and coordination among key stakeholders, such as agencies and community organisations, so that we can work together, as a team, to better meet the needs of our seniors and build a stronger community for our seniors to age in place.
We have studied the system in other countries. Many developed countries with ageing populations are facing similar challenges as us. One important lesson we can learn from them is that doing more of the same cannot be the solution. We need a paradigm shift in our approach to ageing and health.
Singapore can and must be different. It will take time, but we must start now. We must make good use of the next few years to plan ahead and design a system that meets our growing needs in a cost-effective and sustainable manner beyond 2020. We can do so, with three paradigm shifts: first, to move beyond the hospital to the community; second, to move beyond quality to value; and third, to move beyond healthcare to health. Let me elaborate.
Beyond hospital-centric to community-based care, we are transforming our healthcare delivery system from one that is built around the hospital, to one that is directed at meeting the needs of Singaporeans. We will make it easier for patients to access appropriate care, help them recover faster and enhance health outcomes while keeping costs affordable and sustainable. To do this, we need to reshape our health delivery system.
The first aspect in reshaping our system is to link up care through the Regional Health System (RHS). Over the last few years, we have done this by building up the primary, intermediate, long-term and home-care sectors, and the networks between hospitals and these care partners. These have helped to streamline processes, enable shorter hospital stays and support faster recovery for patients. We will need to further strengthen the integration of RHS.
An example of this is to develop structured care pathways to better care for patients across settings. Let me illustrate. The Eastern Health Alliance RHS has introduced an integrated care pathway for patients with hip fracture, across providers. Patients who have sustained hip fractures are quickly identified and put on the hip fracture pathway. The pathway organises the different care providers in the RHS into a coherent workflow to efficiently care for the patients, allowing for a more timely surgery, shorter acute hospital stays, and faster transition to rehabilitation at St Andrew's Community Hospital next door. This is crucial, as starting the rehabilitation process early leads to better mobility outcomes. Upon discharge, patients attend day rehabilitation near their homes, as needed, to optimise their functional outcomes.
Such pathways require various partners in the RHS, and sometimes among RHSes, to work closely to deliver seamless care to patients, for better outcomes.
Our vision of \"One Singaporean, One Family Doctor\" remains relevant. We want to transform primary care to be the first and continuous line of care so that Singaporeans can access good quality care in the community. As Dr Chia Shi-Lu pointed out, the key is to build a trusted relationship between GPs and Singaporeans, so that your family doctor has a deeper understanding of you and your family's health needs and can, therefore, provide better guidance and more appropriate treatment when needed. Minister of State Lam Pin Min will elaborate on how we are strengthening the primary care sector later on.
As we reshape our health delivery system and move beyond the hospital to the community, we need to make similar shifts in how we develop and deploy our healthcare workforce. Our healthcare workforce must be future-ready, so that healthcare professionals can continue to enjoy fulfilling careers and can readily acquire new skills and capabilities. Senior Minister of State Amy Khor will talk about how we are creating good healthcare jobs for Singaporeans and fostering industry-relevant skills through the national SkillsFuture framework.
MOH, together with our public healthcare institutions, will be looking into job redesign and the use of technology to not just simplify the work for our healthcare teams, but to also work in a different way to deliver care to our patients. Minister of State Chee Hong Tat will share how productivity and innovation can support our healthcare workers and improve patient care.
Dr Chia Shi-Lu said we must care for Singaporeans from birth to death, and I agree. The issue of death is a sensitive one, especially in our \"pantang\" Asian society. These are difficult conversations which we must have, not just among family members, but also at the national level, that is, if we want our loved ones and family members to have dignity, comfort and peace of mind as they walk through their last journey. This requires a whole-of-society approach and we are encouraged to see organisations, such as the Lien Foundation, raise these topics at the national level.
Through the Agency for Integrated Care (AIC), we have also been working with our hospitals and community partners to raise the awareness of Advance Care Planning (ACP). ACP allows individuals and their families to better understand their preferences towards the end of life and to fulfil their wishes.
Take, for example, the late Mr Phang who was admitted to Dover Park Hospice after being diagnosed with terminal cancer. Through ACP, the hospice staff were able to establish that his preference was to pass on at home, so that he was able to spend his last days in a familiar environment, together with his wife. This was a great source of comfort to his wife. She was grateful to the hospice staff for establishing his end-of-life wishes.
Madam, we need to continue this conversation. Minister of State Chee Hong Tat will be elaborating on further enhancements we are making in palliative care.
As we transform our healthcare system, we have to be mindful of the long-term implications on sustainability. Our healthcare budget has more than doubled from $4.7 billion in financial year (FY) 2012 to $11 billion this year. This has come about partly because of ageing and the need to invest in infrastructure, but also because of the Government's policy shift to take on a greater proportion of healthcare costs.
The current challenging economic outlook is a timely reminder of the need to ensure sustainability, not just for ourselves but for future generations. Therefore, we need to choose care that is appropriate to needs, so that we can make the best use of our limited resources.
It is for this reason that we have a co-payment feature throughout our healthcare system. For example, MediShield Life has co-payment features like claim limits, deductibles and co-insurance to help guard against over-consumption or over-provision of services. However, many Singaporeans have private Integrated Shield Plans that are \"as charged\", which means they have no claim limits, and some buy extra riders to cover the deductibles and co-insurance.
Such features could lead to a \"buffet syndrome\" since all the cost will be paid for by third parties, by someone else. This contributes to rising healthcare costs for everyone and eventually pushes up premiums. We will need to study this carefully to ensure sustainability.
Emerging healthcare technologies are becoming increasingly expensive and we need to ensure that the outcomes derived from these technologies are commensurate with the costs. As part of the \"Choosing Wisely\" campaign, medical bodies in the United States (US), Canada, the United Kingdom (UK), Australia and Japan have identified 400 areas of unnecessary or low value tests and treatments.
We, too, have recently set up the Agency for Care Effectiveness (ACE) to expand our capacity in evaluating the clinical and cost effectiveness of health technologies. ACE will look into high-cost treatments and technologies, systematically evaluate and develop guidance to guide the proper use of such treatments and technology, and encourage providers to manage costs while providing quality care.
This will help patients, care-givers and physicians to make more informed decisions on treatment and avoid over-provision of services that will eventually drive up costs.
As we move beyond hospitals to the community and beyond quality to value, we also have to move beyond delivering healthcare and focus on providing good health to nurture a healthy nation and a healthy people. To do this, we need to arrest the causes of ill health early and reduce the progression of long-term chronic diseases.
While the Health Adjusted Life Expectancy has improved over the years, as I mentioned earlier, Singaporeans are also living with ill health longer – one-and-a-half years longer than in 1990. We have observed several worrying trends in recent years. Decreasing activity across all age groups and the increasing consumption of excessive calories and fat leading to a rising obesity rate. Obesity is the major risk factor for chronic diseases, such as Type 2 diabetes.
As noted by Dr Lily Neo and Dr Chia Shi-Lu, diabetes is, indeed, fast becoming a major global healthcare concern. The World Health Organization (WHO) recently announced that the global number of adults living with diabetes has quadrupled since 1980 to over 400 million in 2014; and of this 400 million, over 400,000 are in Singapore – they are Singaporeans. Among Singaporeans, about 400,000 have diabetes, and one in three Singaporeans has a lifetime risk to develop diabetes; 30% lifetime risk.
What is one in three? When I sat in my seat, I looked to my left and I looked to my right. On my left is Mr Lim Swee Say and on my right is Ms Grace Fu. I looked at Mr Lim. I asked him yesterday, \"Do you have diabetes?\" He proudly declared, \"No\". So, I turned to Ms Grace Fu. I was too polite to ask her, but she does not look like she has diabetes. That is the good news. The bad news is: one in three means I have the highest risk of getting diabetes. [Laughter.] That is one in three.
But the good news is: we can change. We do not have to accept it and we can reduce the risk. Of those who have diabetes, one in three Singaporeans has not been diagnosed. And among those diagnosed, one in three has poor control of their condition.
The following images on-screen may be graphic but they are examples of what some Singaporeans endure daily. Left undetected, untreated or poorly managed, diabetes can lead to heart disease, stroke, kidney failure, blindness and amputations. In fact, four Singaporeans a day lose a limb or appendage due to diabetic-related complications. These complications reduce the quality of life for the patient and increase the burden on the individual, families and society as a whole.
A Saw Swee Hock School of Public Health study estimated the total economic burden of diabetes for working-age adults at more than $1 billion a year. However, the long-term cost of diabetes, taking into account the psycho-social burden, is far more than this.
We need to tackle the diabetes challenge. Therefore, I am declaring War on Diabetes. We want to help Singaporeans live lives free from diabetes, and for those with the disease, to help them control their condition to prevent deterioration.
This is a multi-year effort. We will engage stakeholders and develop detailed action plans together, but let me outline our broad strategy.
First, we will work on upstream prevention to promote a healthy lifestyle and reduce obesity rates in order to cut down on new diabetes cases. Broadly, we are doing this by ramping up our health promotion efforts through a twin food-and-exercise strategy. We will improve the dietary quality in schools, communities and workplaces, and learn from successful international regulatory strategies.
To encourage more people to exercise, we will expand ongoing programmes, such as the National Steps Challenge and Sundays@The Park, as well as introduce new programmes and bring them to schools, workplaces and our community. The risk of developing diabetes is 30% to 40% higher among active smokers than non-smokers, and we will be doing more to curb smoking rates as part of this plan.
Healthy habits start young. Minister of State Lam Pin Min will be leading our efforts in developing the NurtureSG Plan to tackle many of the preventable risk factors for our youths. We will be working closely with the Ministry of Education (MOE) to develop and implement this plan.
Second, we will strengthen early screening and intervention to identify the disease early, especially those at risk. Screening plays an important role in our war by picking up cases earlier, starting interventions and, thus, reducing the likelihood of the gory images I showed you previously. This is like intelligence in warfare. But, follow-up after screening is equally important.
We hope that earlier intervention and basic lifestyle changes can even reverse the pre-diabetes state and get such individuals back to health.
In a US study published in the New England Journal of Medicine, pre-diabetics can reduce the overall incidence of diabetes by 58% through diet, exercise and behaviour modification. That is why I said we still have hope. These lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by up to 71%. So, you are never too old to make lifestyle changes and take back your health.
Third, we will support better disease control to slow disease progression and reduce complications. For those with diabetes, we need to do our best to help them have a good quality of life, at all stages, by having good control over their disease. This can help to reduce or delay complications and give patients better quality of life. Madam, let me speak in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] This year, we are going to declare war on diabetes. Many of my colleagues asked me, \"Why so serious? Why do you want to say, 'declare war'? Why so aggressive?\"
Diabetes is a problem that is getting more serious by the day. Our Singaporeans have a one-third possibility of contracting diabetes during their lifetime. The possibility of them contracting diabetes as they grow older also increases. And it is not just them who suffer. Their families and relatives will also suffer. Therefore, we have no choice but to mobilise the entire population to declare war on diabetes. We should not just talk. We should also, each of us, play a part by eating responsibly and exercising and ensuring our own health. At the same time, we also need to do intervention earlier and do screening much earlier. Together, we can also seek help if we need to. Together, nationwide, we can have a healthier lifestyle.
(In English): The key to winning the war on diabetes is for all Singaporeans to be engaged in the battle. The key partners in this war are the individuals, his family and the community. By working together, we hope to create an environment that makes healthy choices easy, but Singaporeans also need to play their part by eating healthily, exercising often and going for the recommended screenings and follow-ups. We can also play a part in encouraging and helping others to do so. We will be increasing public awareness about diabetes and empowering individuals to take control of their health.
To coordinate the strategies on the war on diabetes, I will be co-chairing a Diabetes Prevention and Care Taskforce together with Mr Ng Chee Meng, Acting Minister for Education. The task force will include representatives from Government agencies, private sector, patient advocacy and caregiver groups and will: (a) develop and implement a multi-year action plan for the war on diabetes; (b) reach out and mobilise the nation to fight the disease together; and (c) monitor and evaluate the outcomes of our efforts.
The war on diabetes will not be a quick battle, but a long war requiring sustained efforts. Results of our efforts can only be seen in the long term, but we must persevere. And if we succeed in shifting mindsets and changing habits, we will be able to curb not just diabetes but other related chronic diseases, such as heart disease, as well. And we will improve the lives of Singaporeans and reduce the burden on their families.
Madam, health is, ultimately, a personal responsibility. All Singaporeans need to play an active role in their health journey and in the war on diabetes. We all need to make sensible lifestyle choices and informed decisions in our health. The Government will do its part to provide a supportive environment, but we cannot do this alone. If we are able to do this together, we will achieve better health, better care and a better life for all Singaporeans.
The Chairman: Dr Lily Neo.
Dr Lily Neo: Mental health is very much an integral part of general health. Good or normal mental health is a state of well-being in which the individual, amongst other things, can realise his or her own abilities, can cope with the normal stresses of life, can work productively and is able to function normally in the community.
May I beseech MOH to review mental healthcare and to improve it? This is especially urgent for community mental healthcare which is almost non-existent. There is a problem of undiagnosed and under-treated mental patients in the community. They tend to be more prevalent in lower-income households and they usually cannot cope with employment and cannot fit well in society. Those that suffer from substance abuse also have violent tendencies. As the majority of Singaporeans live in densely populated HDB estates, we must be cognisant of the harm that mental patients can bring not only to themselves and their family members but also to neighbours and people in the community. There are many types of mental disorders; from mild ones like anxiety, personality disorder and depression, to moderate ones like kleptomania or compulsive stealing, compulsive gambling and substance abuse, to other severe psychotic diseases. In general, mild cases have good prognosis if treated early.
Is it possible for MOH to maintain a staff of psychiatric nurse practitioners or psychologists at Social Service Offices (SSOs) to diagnose and refer undiagnosed mental patients for follow-up? Many such mental patients also need other social assistance and thus SSOs can facilitate that simultaneously.
I know that there is a Community Mental Health Team set up by the Institute of Mental Health (IMH) to provide psycho-social rehabilitation for people suffering from mental disorders in the community. However, the purpose of the team is to facilitate patients to be discharged from and not to be re-admitted to IMH. I am concerned in this respect, as there are already too many undiagnosed and untreated mental cases in the community. Will it be better for IMH to discharge such patients to community hospitals or psychiatric nursing homes instead? I really hope IMH is not so psyched up to prematurely discharge patients without considering the overall implications.
Non-compliance has been a problem, especially for mental patients, to the detriment of the patients themselves and the community. Will MOH consider an \"outpatient commitment\" law, similar to Kendras' Law in the US, where there is some restrictive form of commitment for a mentally ill individual, whereby the individual is free to live in the community, provided he is subject to close monitoring by a physician or agency?
Ms Tin Pei Ling: Madam, I have been speaking up on mental healthcare issues in this Parliament for many years now. And I would say that Singapore has made progress in mental healthcare over the years; I have seen it. There is greater awareness, better intervention and more support. I would also say that few, if any, in our society would dispute the importance of ensuring mental wellness. However, there is still much that we can do. One critical obstacle to effective mental healthcare is the stigma faced by sufferers.
Stigma may be perpetuated by the lack of understanding and media portrayal, but also, by real day-to-day problems that are left unsolved. I have raised examples about this in my speech last year, so I will not touch on it again this year. Together, these threaten to deepen the prejudices that people have of those suffering from mental health issues. The animosity, in turn, makes it more difficult for those suffering from these conditions or even their family members to consider the issue and seek professional help.
Therefore, I would like to ask the Minister, looking ahead, what does the Ministry plan to do to de-stigmatise mental health? Meanwhile, efforts to strengthen community mental healthcare must not stop, so that those who need care will continue to get the care they need. Hence, I would also like to ask: one, whether there is any update on the Community Mental Health Masterplan; two, how are patients who have \"graduated\" from IMH reintegrated back into the community and workplace; and third, and lastly, some communities have implemented networks involving voluntary welfare organisations (VWOs), Government agencies and grassroots leaders. MacPherson, for instance, has a Community Mental Health Programme supported by AIC, IMH and the South East Community Development Council since 2012.
There has been some positive feedback. At the very least, amongst the volunteers and staff who have to frequently face residents, there is greater awareness of the signs and symptoms which aid early detection, greater appreciation of the challenges people with mental health issues face and greater sensitivity in how to engage them. I am wondering if there are plans to roll this out more extensively to more communities.
Mr Low Thia Khiang (Aljunied): Madam, as our society ages, we have been paying close attention to our healthcare costs as an ageing population. It is also time for us to put more focus on mental health.
Mental illness, while perhaps less understood, is no less real than physical illness. There is also the stigma and lack of understanding which patients and their loved ones combat daily. Some studies estimate that one in six of our population would suffer from mental health issues at some stage of their lives.
Currently, our MediSave, MediShield and MediFund (or 3Ms) framework allows support for mental illnesses, but it is limited. For example, MediSave has a withdrawal limit of $150 per day for inpatient psychiatric treatment, with an annual cap of $5,000. Compare this with a daily limit of $450 for other patients who have been hospitalised.
For MediShield Life, the difference is even greater, with a daily coverage of $700 in a normal ward, but $100 for a psychiatric ward. Mental illness is as real and debilitating as other illnesses. Funding from the 3Ms and other insurance plans should be on par with coverage for other conditions. Companies, too, need to be encouraged to provide equal levels of support and coverage for employees who suffer from mental health issues.
Another equally important issue is how prepared is Singapore to deal with the rising numbers of patients with dementia. It was recently estimated that 10% of us aged above 60 suffer from dementia, with a rise in younger patients being diagnosed.
This may not always be classified as a mental or even physical illness, but the strain on our healthcare costs and infrastructure can be massive. Can the Minister give an update on what has been done in the last few years to ensure our care systems are able to deal with the future increase in the number of dementia sufferers and whether there are plans to expand pilot projects, such as \"dementia-friendly\" town?
Assoc Prof Fatimah Lateef: Madam, mental health is as important as physical health. As there is stigma, many are not coming forward to be diagnosed early enough or for follow-up regular treatments. Thus, it is important to have services and counselling in the community, in a less threatening environment, compared to being in an institution or a ward.
At Geylang Serai, I have got Silver Ribbon sited at my community club (CC) at My Wellness Centre and they do house visits and counselling at the CC as well as the residents' homes. Therefore, we need to have more such programmes. What we do at Geylang Serai is we create awareness of mental health problems. We give talks, organise mental wellness seminars, hold World Mental Health Day celebrations annually, launch suitable books and educational materials, mental health road shows and we even have a Geylang Serai Mental Wellness Taskforce operating for the last several years, comprising 10 partners from the relevant industry. Therefore, we hope that this model can be initiated and replicated elsewhere as well. This is under the initiative of WeCare@geylang Serai.
In fact, this year, we are actively involved in organising and partnering other agencies in The Asia Pacific Mental Health conference in October. My grassroots leaders (GRLs) will be sharing programmes, experiences and initiatives and we need such initiatives in the community. What are MOH's plans to strengthen community mental health support network and framework at the national level? Will we be seeing a new blueprint as well?
Miss Cheng Li Hui (Tampines): As we face the silver tsunami, the number of seniors who suffer from dementia is expected to rise. One in 10 people aged 60 and above, and half of those aged 85 and above have dementia. The number is projected to increase from 28,000 in 2012 to 80,000 in 2030.
What preventive measures can we introduce to the public so as to reduce or temper the expected surge in dementia cases? In Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] As we face the silver tsunami, the number of seniors who suffer from dementia is expected to rise. What preventive lifestyle changes can Singaporeans be encouraged to adopt to reduce the risk of getting dementia?
An MOH study shows that the risk of dementia is 25 times higher for housewives and retirees than the working people. This figure deserves our attention. Working and participating in community activities actively may help to slow down brain degeneration. Hence, we should encourage and help more housewives and retirees to stay active and healthy.
(In English): Would the Ministry share with us the latest initiatives for the early detection and treatment of dementia? Also, what is the Ministry's long-term plan to support persons with dementia who are living in the community? Research has shown that allowing them to age-in-place would be less costly to society.
Those who care for dementia sufferers are three times more distressed than other caregivers. Many have to stop work, which may put them in financial situation. What kinds of support schemes are there to help and relieve family caregivers?
Will MOH consider allowing standard health screening, including dementia screening, to be done at private GPs at subsidised rates?
Dr Tan Wu Meng: Mdm Chair, with an ageing population, we will see more Singaporeans with dementia. Not all will need institutional care; many will still want to live in the community. We must find ways to help our senior Singaporeans with dementia, such as helping them to lead as normal a life as possible, reducing their risk of getting lost or confused during their daily activities, and ensuring they do not become socially isolated because ongoing mental stimulation is healthy for the ageing brain.
These issues will affect all our housing estates, especially mature estates, with many Pioneers, many senior citizens. Can MOH tell us what the Ministry is doing to support Singaporeans with dementia who are living in the community, as well as their caregivers and loved ones?
Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): Mdm Chair, it is expected that the demand for palliative care at home will double by 2020 to more than 10,000 patients. However, some reports suggest that the current supply of nurses providing home-based care may not be sufficient to meet the expected increase in demand. Several providers of home nursing care are employing foreign nurses on foreign domestic Work Permits. This could compromise the quality and development of home-based care in Singapore. Furthermore, the 10,000 patients only refer to those needing palliative care.
I would like to raise two suggestions for the Ministry to consider in their efforts to expand home-based care service and raise standards.
First, there were over 5,700 registered and enrolled nurses who were not active in 2014, comprising over 15% of the total number of nurses. This is an existing pool of qualified nurses that can be tapped on if appropriate flexibility, allowances and incentives are given to encourage them to provide home-based healthcare within their neighbourhoods and communities.
I ask the Ministry to consider developing a community nursing core to attract retired, inactive or underemployed nurses to return to active nursing and to cater to existing active nurses who need job flexibility due to family or other reasons, so that they do not leave active nursing. These nurses can be provided with the right training to become professional community nurses attached to hospitals to provide home-based care.
Second, will the Ministry consider developing a comprehensive Hospital and Home Programme modelled on the programme in Australia? Under the Hospital and Home Programme, hospitals will provide inpatient treatment for acute care patients whose conditions allow them to receive treatment in their own homes. This is not limited to seniors or the terminally ill. The community nurses could then act as key care providers, conducting medical check-ups and providing portable medical services to the home-based patients. The community nurses could also make use of telehealth technology to engage in non-site consultations with hospital-based doctors in the homes of the patients.
Dr Lily Neo: Mdm Chair, our homecare services are almost non-existent at present. I am repeating my call in this House again to make this service available quickly in order to lessen the need for high-cost stay in the tertiary institutions, especially the acute hospitals. With our ageing population, homecare, where many discharged patients can be looked after in their homes, will be an increasing demand and an important part of our healthcare structure.
Whilst I agree that homecare will incur many medical personnel to visit patients in their own homes, MOH should relook the usage of healthcare workers and consider using not only full-time paid personnel but also family members, community volunteers and so on. Such healthcare workers can be trained in a matter of weeks. In England, it takes only three weeks of intensive training to equip them with the necessary skills. They are certified at the end of their courses, which teach them skills like assisted feeding, catheter care, prosthesis use, simple dressings and simple grooming, as in toenail cutting for non-diabetics using sterile techniques.
There is one pilot homecare model in my constituency supported by MOH and funded by Temasek called Ageing Gracefully At Home. A team of staff and nurses look after the elderly weak and partially disabled seniors with medical conditions in their homes. They assist them with their daily and medical needs in three HDB rental blocks. Some of the healthier senior neighbours are recruited and reimbursed as befrienders to keep watch, befriend and report on weak and sick residents in their charge to the Seniors Activity Centres (SACs) downstairs. I find this scheme useful as it keeps the residents in their own homes for as long as possible, without which, many of them would have invariably ended up in acute hospitals. Perhaps MOH can duplicate such a homecare model in other constituencies, too.
Assoc Prof Fatimah Lateef: Madam, as a developed nation, with the challenge of a rapidly ageing population and also a longer lifespan, which means longer duration of chronic illnesses and thus, more potential complications, the need for homes, day care and rehabilitation centres will continue to increase.
For specific problems, specific services will be required, for example, day care rehabilitation, physiotherapy, speech therapy, nursing care and even for mental diseases and dementia as well as mood management services.
How is MOH planning to ramp up some of these services, which means not just the infrastructure but also the needed manpower and trained personnel? For those with significant physical disability and mental health issues, their families need to make arrangements for their care, as the former would have to go out to work. With the call for a later retirement age and also more active employment for our seniors and women, therefore, more day care facilities will be required in the future.
With these centres, we will also have to ensure that care standards are met and the ratio of patient-to-caregiver is acceptable. Here is where I would like to suggest that perhaps we seek and tap on the retired nursing pool as well as train active retirees so that they can help to contribute a few hours a day at least to this required pool.
Ms Joan Pereira: Mdm Chair, as our seniors grow frail, they develop multiple health problems and will need varying care needs and repeated visits to various medical specialists and therapists. This can be very tiring for them as well as for their caregivers. It is important that they have access to integrated and holistic care so that they will not end up shuttling from one place to another. What are the Ministry's plans to enable senior-centric care to take place?
An example of an ideal situation would be like this. A senior goes to an SAC daily to take part in activities, socialise and exercise. The staff at the centre are familiar with his general health conditions and problems, and assist him to take his medications. When the elderly exhibits certain health symptoms, they are able to take note and alert his family members or, if he lives alone, to refer him to the appropriate agencies.
When he goes for his medical appointments, the tests and treatments are preferably arranged on the same trip to minimise travelling. In addition, when he needs to move around different departments within the hospital, there will be volunteer guides to help him, especially for an elderly who can only communicate in his vernacular language.
When he grows more frail and has to stay at home, he or his family will be able to get assistance from day/night nurses or part-time care-givers at affordable rates.
With reference to this scenario, I would like to ask the Minister and the Ministry if we will have enough eldercare centres, step-down community hospitals and hospices to cope with an increasing number of seniors. How will we recruit, train and retain enough volunteer carers, volunteer guides, nurses, nursing assistants, professional caregivers and therapists? What kind of support or resources can we provide their families and caregivers, especially if they have long-term patients, to take care of challenges like dementia or depression?
Ms Tin Pei Ling: Madam, with an ageing population, demand for eldercare services and facilities will increase as well. Also, the incidence of dementia will rise, too, making care for our elderly even more challenging as this requires certain care specialisation and adjustments in the communities.
Hence, could the Ministry share the projected demand for eldercare services and facilities, such as day rehabilitation centres, dementia day care centres and home-care? What is the Ministry's plan in meeting this demand? What are the constraints or challenges anticipated, if any?
Also, are there lessons that we can draw from countries more experienced in caring for the aged? For instance, Japan is the world's fastest ageing society and it was said that the \"epidemic of dementia\" had already arrived. Given that it had to address this challenge much earlier, what can we learn from Japan about the needs of our old, especially those with dementia, and what can we do to address these needs?
Dr Lily Neo: With an ageing population, demand for palliative care will be expanding. I would like to declare that my daughter is a palliative care doctor with HCA Hospice Care.
Many terminally ill patients prefer to be at home with their family members and staying in their familiar surroundings in their final days. They feel more comfortable compared to being hospitalised. But for hospice care at home, cost is always an issue, besides other factors. Many families are apprehensive about how to cope with their terminally ill family members even though they want to fulfil the final wishes of their loved ones. Thus, they may be more prepared to do so, if they can get more support on hospice care at home.
This is also right siting, compared to occupancy of acute hospital beds by such patients. Thus, could MOH review the subsidies for hospice care? Could MOH expand palliative care with more personnel and facilities? These terminally ill patients need home visits by palliative care doctors to control symptoms, such as pain. They need social workers to support the psycho-social needs of patients and their family members as well as recognising and facilitating the final wishes of the patients. Many patients and their family members also need counselling. The purpose of palliative care is to make life more comfortable for these patients by adding life to their days.
There is an urgent need to expand the number of palliative care doctors, nurses and social workers, as the shortage now will be even more pronounced in years to come with our ageing population. Presently, not many doctors and nurses are interested in palliative care. Increasing numbers of terminally ill patients will also impose an increasing demand on palliative care in-patient beds and services. Hence, we need an expansion in these facilities as well.
Palliative care can be costly and it may be a strain for many patients. Therefore, I urge MOH to consider ways to reduce the burden of patients of hospice care.
Mr Low Thia Khiang: Madam, inpatient hospices and palliative care facilities charge patients on a day-by-day basis, and it has been estimated that a month's stay at a hospice will cost about $7,000 before means testing. I understand that patients whose families have a per capita monthly household income of $2,601 and above will not receive any subsidies for inpatient hospice care.
With one in four Singaporeans estimated to be over 60 by 2030, the demand for such specialised care will increase. The additional factors of increases in healthcare material costs and remuneration for healthcare workers will also drive up the costs of hospice and palliative care.
I would like to know what the average length of stay in a hospice was from 2012 to 2015. How many people have benefited so far from the last increase in the income ceiling? And how many have written in to appeal for subsidies for the high costs of inpatient charges at the hospices? In light of the gradual increase in gross monthly income and the increase in cost of living, I would like to know if the Ministry is considering raising the income ceiling so as to allow more families to benefit.
I would also like to propose that ElderShield be extended for the use of hospice and palliative care. A thorough review of the ElderShield scheme is long overdue and it is perhaps the right time for the Ministry to not only include hospice and palliative care under the scheme, but to also review the adequacy of the subsidies and payout period of the ElderShield scheme.
The Chairman: Ms Kuik Shiao-Yin, you have two cuts, please take them together.
Ms Kuik Shiao-Yin (Nominated Member): I declare my interest as an educator in empathy awareness. According to the 2015 Quality of Death Index, Singapore is the 12th best place in the world to die. Benchmarked against 80 countries, we are sixth in the affordability of care, eighth in the quality of care, and our weakest score was in community engagement at 22nd.
By 2020, more than 10,000 people a year here are expected to need palliative care. Yet, a 2014 survey by Lien Foundation showed that two in three Singaporeans still do not even understand what palliative care is. Only about 20% to 30% of those who pass away each year use palliative care services when research shows that up to 70% to 80% of all deaths might have actually benefited from such care. This lack of public awareness and hospice referral is partly because our doctors and nurses struggle with handling death. A Lien Foundation survey showed that six in 10 doctors and four in 10 nurses said their basic training did not prepare them to handle patients with life-threatening illnesses.
I can testify to what it is like to encounter such a statistic in real life. A junior doctor that attended to my father in a hospital here exhibited zero empathy in the way he broke the news to us that my dad had terminal cancer. This highly educated, articulate young man told us, \"Here is the result, it is not good. You know what that means? You know, right? You know? You know?\" I am not kidding. Even when we broke down in front of him, he was completely blank and indifferent, and that is very disturbing to me.
Thankfully, the rest of the doctors I encountered on the journey were much more sensitive. My dad passed away in a hospice and it was a very gentle place for him to die, thanks to the staff there. So, I am deeply grateful to every Singaporean who is involved in palliative care. It is an incredible gift to the dying, as well as the living. My experience made me wish that more families here could experience the mercy of a good death.
So, I have just two simple requests: one, keep up the good work of making palliative care even more accessible and affordable; two, make socio-emotional awareness a core component of training for all healthcare professionals. Training our next generation of doctors and nurses in the art of navigating complex human conversations with humility and kindness should not be treated as less important than technical training.
Madam, innovation is not just about investment in expensive technologies, data and subsidies. Those are necessary. But sometimes, innovation can also be found in simply going back to mastery of the basics. In the case of healthcare, it is the art of treating people beyond the science of treating disease.
Renowned surgeon, Dr Atul Gawande, contends in his ground-breaking book \"Being Mortal\" that courageous doctors who help patients explore these three questions achieve far better outcomes for end-of-life care. One, what is more important to you than living longer? Two, what are you scared of? And three, what are you willing to give up to get the life you want in the time you have left?
Madam, many of our young doctors and nurses today will get the extraordinary power to write something in the last chapters of our own lives. May we give them the ability to write something that is worth remembering?
Second, support for caregivers. Much has already been said by other Members of this House before about legislating caregiver leave and giving financial support, so I will not dwell on that but focus on issues of emotional and psychological support. Navigating a fragmented landscape of caregivers' subsidies and services can be frustrating and intimidating to an average Singaporean, let alone one who is already acutely stressed by caregiving or limited in their English language proficiency.
Currently, AIC plays intermediary between caregiving bodies and care receivers. Could AIC consider having a team of AIC coordinators who can journey with our caregivers, especially those from the lower-income bracket, from start to end? These coordinators can serve on two fronts.
First, making sense of the system. Caregivers need practical help to figure out where to start and how to end. Just trying to make sense of the system might compound the emotional stress they are already under. Frustrated caregivers might not have time or space to explore their options objectively. When they randomly cobble together their own solutions, they end up providing haphazard and even inappropriate care for their own loved ones. So, they do need someone experienced in the system to come alongside, help them coordinate their piecemeal needs to ensure the full range of needs of both caregiver and care receiver are adequately met.
Also, though there is a good range of formal care services already being offered in the landscape, from home therapy to adult day care, a Ministry of Social and Family Development (MSF) survey of 20,000 caregivers shows that usage of these services is surprisingly still very low. The coordinators' intervention can not only help to increase the take-up rates, it can also investigate the real reasons why utilisation remains low in the first place.
Second, monitoring psychological well-being. The Organisation of Economic Cooperation and Development (OECD) 2011 report found that long-term caregivers were 20% more likely than non-caregivers to suffer mental illness. That same MSF survey discovered that spousal caregivers and caregivers of lower socio-economic status are more likely to be badly impacted by caregiving. Under siege, these caregivers may slip into depression or even some form of extreme behaviour like abuse of patient or abuse of self.
An AIC coordinator can spot early signs of caregiver mental or physical breakdown and provide timely intervention. If we believe family should be the first line of support, we must keep finding ways to better support the very people trying their utmost to live out that value, especially those who are far less financially privileged than us.
Ms K Thanaletchimi (Nominated Member): Mdm Chair, I declare my interest as the President of the Healthcare Services Employees' Union. I would like to touch on the topic of progressive wage and career model.
In 2012, the National Nursing Taskforce (NNT) was set up by MOH to look into strengthening the development of the nursing profession to better meet the population's healthcare needs. This helped to push for better career progression for the nurses and helped overcome many issues. We acknowledge that the review of non-nursing staff group, Admin, Ancillary and Allied Health, is currently ongoing at the various cluster levels and would like MOH to play a larger role in the coordination and implementation of Progressive Wage/Career Model for the Admin, Ancillary and Allied Health Workers across the healthcare clusters in the public healthcare sector.
On the jobs of the future and being future-ready, as our economy transforms itself against the cyclical headwinds and structural changes, jobs need to be redesigned and keep pace with technology. The questions I have are: what are the jobs that will be at risk in the healthcare sector as a result of automation, robotisation and job redesign? How can we better manage the foreseeable challenges to protect the interest of workers who will be affected? What kind of programmes will be rolled out to assist affected workers to transit to other roles within and outside the industry? What measures are taken and which policies are refined to attract more Singaporeans to work in the Intermediate Long-term Care (ILTC) sector?
In order to raise the overall standards of the healthcare industry, there is a need to refresh and refine the industry as a whole. As our healthcare model evolves, the ILTC services will play a larger role. Hence, there is a need to make sure that this sector's services step up, transform and grow so that the standards of healthcare can also improve dramatically over a short period of time.
Through our interactions with healthcare workers in the ILTC sector, we know that there are locals who have switched careers to the ILTC sector and found meaning in their work. However, as their income and career pathways are not as clearly defined compared to those in the mainstream hospitals, some have struggled to sustain with these incomes and eventually left the industry. I would like to urge MOH to support the aspirations of our locals who want to carve a meaningful career in the growing industry by enhancing their skills and career progression pathways and providing wage support.
From my involvement in the Healthcare Cluster Tripartite Workgroup, I have seen how collaboration on productivity improvement projects has brought benefits to the hospitals, employees and patients. I believe that closer collaboration amongst the ILTC organisations, MOH and healthcare union will help raise the level of ILTC industry practices and bring benefits to patients, too.
I would like to call upon the industry to consider forming an association for ILTCs to champion a progressive movement for ILTC organisations. Such an association will help foster an ecosystem for the ILTC community to thrive in and enhance the professionalism of healthcare workers. It will serve to provide a platform for industry players to network, share concerns and challenges, and allow them to collaborate with one another. As a start, MOH, through AIC, could provide manpower and resource support to speed up its formation.
Madam, on flexible work arrangements (FWAs) in public healthcare. To promote FWAs, the Government introduced the Work-Life Grant which provides funding and incentives for companies. As the demand for the healthcare sector rises, more needs to be done to encourage the public healthcare sector to make FWAs more pervasive across all institutions and all job types.
At the same time, there is a need to comply with the legislation and tripartite guidelines. We could share more stories and examples of staff who have successfully converted to FWAs. Increasingly, healthcare workers are facing more challenges to switch to FWAs due to higher expectations and demands at work. FWAs should be one that supports a pro-family environment and staff who decide to request for FWAs should also be accorded an equal level of recognition and opportunity for the work they produce. Whilst the need of the organisation needs to be fulfilled, many are struggling to cope with caring for their families. We need to help them so that they can continue to work and contribute meaningfully to care for our patients.
I would like to touch on the review of the MediSave withdrawal limit. The Chronic Disease Management Programme was first introduced in October 2006 to reduce out-of-pocket cash payment for outpatient bills. It now covers 19 disease conditions. I would like to propose a review of the current MediSave withdrawal limit, especially to help those below 65 years of age, in view of the high costs of medications for managing these chronic diseases. This is particularly critical for those who need advanced care and are treated with non-standard drugs.
During this volatile economic period, many of the mature workers are concerned about the uncertainty of their continuous employment and therefore the fear of losing their employers' medical benefit. Alternatively, MOH could regularly review the list of non-standard drugs to standard drugs to bring down the costs of medication.
Long-term healthcare models in Nordic countries focus on home-care, rather than on hospital-based care for the sick elderly. With reference to this, I would like to ask the Minister if there are plans to study further on these models.
Assoc Prof Fatimah Lateef: Madam, I know MOH is proactively looking at manpower ratios and numbers. We have also now got three medical schools, but the output of doctors will, of course, take time due to training duration. In the various sectors, such as acute and ILTC care, there is an ongoing demand for staffing. I would also go on to say that we have manpower deficits in many departments across many disciplines. Even with our residency programmes, aligning with the US' Accreditation Council for Graduate Medical Education (ACGME) guidelines, we do always have to grapple with explaining our heavy patient load to our site visitor every accreditation year.
Our doctor-to-patient ratio quoted seems to fall within the global range given, as in a previous response to our Parliamentary Questions. But when it comes to work on the shop floor, we are really, really, very busy and very heavily loaded. With the newer institutions being built and the opening of their doors, the manpower competition is from the same central pool and, thus, it is the same warm bodies that we are competing for.
And in healthcare, Madam, the words automation, value chain, productivity and quality will have to take a customised definition. What plans and framework does MOH have to handle this manpower situation?
Dr Chia Shi-Lu (Tanjong Pagar): Mdm Chair, I am glad with the clear intent in the 2020 Masterplan to strengthen the ILTC sector and, like many of the Members here, I would like to ask what measures the Ministry is considering to address the expanded manpower needs as this sector is particularly labour-intensive.
We all know that our nurses play an essential role in the ILTC sector and the National Nursing Taskforce's recommendations for the future of the nursing profession have already been accepted by the Ministry.
Would the Ministry share details about how it will provide our nurses with more career advancement opportunities, greater authority and autonomy, and implement flexible and part-time work arrangements? What can be done to improve their work conditions and remuneration? In addition, what will the Ministry do to protect our nurses from abuse from patients and their family members? This comes about because there was a worrying report in the Annals of the Academy of Medicine that estimated that about seven in 10 of our healthcare workers have suffered from such abuse.
Ms Tin Pei Ling: Madam with an ageing population, demand for manpower in the ILTC sector will increase. However, the labour market is already tight across all industries and sectors. There is stiff competition for workers and control over foreign manpower will only get tighter. Moreover, even as we look to leverage technology more, the human touch cannot be replaced in delivering quality care.
Therefore, I would like to ask, firstly, what is the Ministry's plan in tackling the manpower challenges in the ILTC sector. Secondly, how has the response been in terms of attracting mid-career professionals? How does the Ministry intend to attract more? Would scholarships with bonds be helpful? Thirdly, will the Ministry consider requiring and assisting ILTC providers to redesign their processes and systems where necessary, so that more older or retired workers can join to supplement the manpower needs?
The Chairman: Senior Minister of State Heng Chee How.
The Senior Minister of State, Prime Minister's Office (Mr Heng Chee How): Thank you, Madam. I have the privilege of giving a response to Ms Joan Pereira and Ms Tin Pei Ling for their earlier cuts.
Mdm Chair, Ms Joan Pereira and Ms Tin Pei Ling asked how the Government would promote good health in seniors and how we plan to encourage more seniors to participate in these health programmes. Indeed, health promotion is a key plank of our active ageing initiatives under the Ministerial Committee on Ageing. This is because good health is the basic condition for successful ageing. We will expand our efforts to promote seniors' health both in the workplace and in the community.
Many of our seniors are still gainfully employed and this is a good thing. It is a good thing also in relation to mental health maintenance, as pointed out by many Members earlier. In order to further extend their longevity in the workforce, MOH and the Health Promotion Board (HPB) are bringing health screening and health education to the workplace and going \"deeper\" by customising the programmes for seniors working in different work environments.
HPB started with a programme at the taxi service centres for taxi drivers of the ComfortDelGro group in June 2014. HPB knows that taxi drivers are always on the road and, therefore, have very little time to attend health-related activities. By observing their schedule, HPB found that taxi drivers need to send in their taxis for servicing every month and the golden opportunity to reach out to taxi drivers is, therefore, during this time when their taxis are being serviced and the taxi drivers are waiting for the taxis to be serviced.
HPB brought health screening to the service centres and stationed health coaches there. Taxi drivers get to check in with the health coaches every month when they send their taxi for servicing. The health coaches will help the drivers understand their health screening results and customise a health action plan with specific health goals, working together with the taxi drivers.
The programme was extended subsequently to bus captains and it was customised to address other issues that are pertinent to bus captains, such as hydration, ergonomics and stress management. As the bus captains have even more challenging work schedules, HPB and the National Transport Workers' Union (NTWU) had to organise the health screening at bus depots very early in the morning with the active support of the Public Transport Operators, namely, SBS Transit and SMRT. I was there at one of these screenings, at 4.00 in the morning and I saw for myself the bus captains coming in, reporting for work. They were excited about getting screened so that they could know about their health status. After that, we followed up with a series of workshops and coaching at bus interchanges over a few months in order to improve their health outcomes.
This sustained effort paid off. Mdm Chair, I am pleased to share that in less than two years, some 15,000 mature workers in the transport, retail, cleaning and security sectors have participated in this series of workplace health programmes. More importantly, it is not only about activities, it is also about outcomes. The outcomes, in terms of their health screening results, have improved. Almost half of the bus captains with abnormal screening results initially showed at least one improvement, either in their blood pressure, blood glucose or cholesterol at their second health screening which was about eight months after the first one. And of these, about half achieved normal health status in all aspects of their health screening.
We are very encouraged that many of our mature workers have made a real transition into a healthier lifestyle. An example is Mr Loh Ah Tee. An SMRT bus captain who has been driving buses for the last 32 years, he took part in HPB's \"Healthier Workers, Happier Workers\" programme in June 2015. Following a first screening where he found out that he had borderline high blood pressure and a high body mass index (BMI), Mr Loh was followed up upon by his polyclinic doctor and he attended health coaching sessions at the bus interchange almost every month. From doing little exercise, he progressed to performing about 30 sit-ups and 40 push-ups every morning. Mr Loh and his wife have also made changes to their diet, swapping for wholemeal options and reducing their food intake. Over a period of eight months, Mr Loh has already lost 4.5 kilogrammes, which was a big step towards a healthier BMI. At the recent health screening in January 2016, Mr Loh's blood pressure returned to normal.
We will continue to customise workplace health programmes for mature workers in other sectors, such as healthcare, logistics and education. Our target is to reach out to 120,000 mature workers in seven sectors by 2025.
Next, about the efforts in the community. In the community, we are systematically promoting seniors' health education via the People's Association's (PA's) Wellness Programme. In particular, we want to multiply and expand the access to health education programmes by leveraging the PA's existing community and social nodes. We hope that more seniors will be encouraged to participate in preventive health and health education activities, if these are just a few steps from where they live. So, bring it closer, make it more convenient and, at the same, really urging our seniors to come and participate.
In several communities, we are bringing preventive health and seniors' health education right down to the Resident's Committee (RC) centres. For example, in Bedok, a \"Wellness Time\" has been set aside each week in each of the four RCs in Bedok. Seniors are invited to come to the RC regularly to take part in workshops run by community organisations on caregiving tips, mental wellness, preventive health and chronic disease management. This is the seniors' personal wellness time and they also build strong friendships and provide peer support to one another.
For example, Ms Celia Teo, a retired teacher who lives in Bedok, lives alone and often found herself staying at home feeling restless. Since starting to attend the Happy Kopitiam programme as part of the Sunflower RC's Wellness Time on Fridays, Ms Teo has gained a better understanding of various health-related topics, including dementia. She also says that she feels happier because she has something to look forward to every week at the RC, and the RC is close to her home.
Beyond physical health, cognitive activity and social interaction are also important for overall health and wellness amongst our seniors. In Tampines Central and several other locations, we have started a weekly news sharing programme done in collaboration with journalists from the Singapore Press Holdings. These journalists from Lianhe Zaobao and Lianhe Wanbao volunteer their time to drop by the Neighbours' Hub which is a cosy corner in the void deck every Friday. They go there to read news articles from the newspapers to our seniors and to engage our seniors in discussions over current affairs.
In addition, MOH partners organisations to bring preventive health services to the doorstep of our seniors. We are experimenting with putting health checks, vaccination, dental, eye and foot checks and even hearing tests on wheels so that they can come to locations closer to our seniors in the community. For instance, many seniors find it inconvenient to travel to SOCs to get a proper hearing test or for the fitting out of hearing aids, even though the Seniors' Mobility and Enabling Fund subsidises such hearing aids.
The National University Health System has thus retrofitted two Hearing Buses to bring audio checks to different neighbourhoods instead. This mobile Hearing Bus has started its journey of screening hearing for our seniors in Yuhua, Bukit Panjang, Nee Soon Central, Whampoa and Tampines West as a pilot and we will see how that goes.
An example of an integrated system of preventive health, health education and social wellness activities have also been rolled into one at Paya Lebar. PA has worked with The Goodlife Cooperative (TGLC) in Paya Lebar to integrate preventive health services with social outreach and wellness programmes. Seniors can access basic health monitoring services weekly at the Paya Lebar Wellness Centre where retired volunteer nurses provide health advice and help seniors take their blood pressure, monitoring their blood glucose level, their height and weight measurements. Therefore, they know their BMI.
TGLC actively reaches out to the community to encourage them to drop by to check their health. This is complemented by daily programming and interest groups at the Paya Lebar Wellness Centre to encourage seniors to take part in physical exercise whilst keeping in touch with neighbours and friends.
Mdm Chair, the best way to enable seniors to age well is to enable them to stay healthy. This is a meaningful effort that can succeed only with the support of everyone – community-based organisations, grassroots, healthcare providers, family members, employers, unions and, most of all, our seniors themselves. By working together in every workplace and in every neighbourhood, we can and will build a nation for ages.
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[Mdm Speaker in the Chair]
Head O (cont) –
Ms Tin Pei Ling:\tMadam, women play multiple roles at home, at work and in the community. It is, therefore, easy for women to neglect their own health.
Diabetes is a common chronic disease and it is only becoming more common. It adversely affects a patient's life and can lead to complications. Being a chronic disease, the long-term medical financial burden can be high, too.
Hence, we need to actively help women, especially pregnant women, prevent diabetes. This is because many children of mothers who had gestational diabetes mellitus (GDM) while pregnant are at higher risk of suffering obesity and diabetes later on in life. Studies have been reinforcing this finding. Therefore, whether it is for the well-being of women or our young, we must step up our efforts to actively manage and prevent diabetes.
In this regard, I would like to ask what is the Ministry's plan in promoting better women health and preventing diabetes, especially gestational diabetes, in women.
Assoc Prof Fatimah Lateef: Madam, women play a crucial role in the health of our Singaporean families. They are usually the central figure in families, taking charge of the cooking, health appointments, caregiving activities and childbearing as well. It is thus important to ensure our women stay healthy and happy. They are also the gender with the longer lifespan, which means they may also face the brunt of the complications of chronic illnesses.
For those who are working, there will be, of course, added responsibilities to prioritise their commitments. Can I ask MOH what is the role of the Women's Health Advisory Committee and also on the following issues which, hopefully, can be reviewed?
First, a more integrated package for women's health screening at subsidised rates and more publicity as well. Two, tracking and monitoring our Singaporean women's health statistics which can be shared openly. I hope that this can be a motivational element for our ladies to see the positive changes. Thirdly, more education and outreach for our ladies with diabetes since we are all on a war path against diabetes. The prevalence is high and even higher amongst some ethnic groups.
As mentioned, our women play important roles and we do not want them to be prematurely debilitated by the complications of diabetes. The other group to assist will be our women with gestational diabetes and a proportion of them, we know, do go on to become pre-diabetic or overt diabetic. Therefore, I think a proactive approach to handle this will be necessary.
The Chairman: Dr Tan Wu Meng, you have two cuts. Please take them together.
Dr Tan Wu Meng: Mdm Chair, in countries like the UK, patients see the same family doctor for many years, building a deep doctor-patient relationship: holistic care, individual touch, a doctor knowing the patient well, walking together for years in sickness and in health. It helps the doctor make better decisions, because they understand the patient over months and many years.
A familiar face is often key to changing lifestyle and fighting chronic disease. A smoker is more likely to stop when it is a familiar face who has known him for many years asking him to quit. A diabetic patient is more likely to comply with medication when it is an old friend explaining why the medication is needed to save his life and to save his limbs and his organs in future.
Yet, today, there is still doctor-hopping. There is still a culture of patients going from doctor to doctor, often within the course of a single illness. Sadly, this means no single doctor may have the full picture of the patient's condition and no single doctor may have understood the patient's illness over time. This can lead to delays in diagnosis and treatment. It does not help the patient. It does not help the doctor. It does not help our control of chronic diseases.
Our family physicians have a very important role to play and it is crucial that MOH supports family medicine and primary care, including enhancing primary care subsidies. These subsidies, in addition to being enhanced, can also be structured and communicated, so that patients have peace of mind and are not afraid to be screened for chronic diseases.
I look forward to MOH sharing its vision for primary care and how we can empower our doctors and support our patients.
Madam, our population continues to age. With more seniors, and even with the best preventive efforts, we can expect more chronic diseases in the years to come. The demand for primary care is going to continue increasing.
We already see this in Clementi where I serve: the Clementi polyclinic is very busy. I was informed that their headcount of chronic disease patients has increased: 32,600 in 2012; just over 35,070 in 2015; a 7% increase in three years. The nearby Family Medicine Centre sees chronic disease cases, too, and they are also very busy. Indeed, Madam, I am told that the Clementi Polyclinic has the highest patient attendance per gross floor area (GFA) in the National Healthcare Group (NHG) chain of polyclinics. They hope to expand, but there is a shortage of available HDB tenant space elsewhere in the block. Clementi, I am sure, is not the only town facing these challenges. Mature, built-up estates have fewer greenfield sites, and this constrains how easily an existing polyclinic can expand.
As such, it will be important for MOH to work together with other agencies to set aside space for polyclinic expansion in our mature housing estates. I am sure the agencies are all working hard on this very important issue and I look forward to whatever updates MOH can provide in this Committee of Supply debate or at a later date.
Assoc Prof Daniel Goh Pei Siong: Mdm Chair, primary healthcare at GP clinics should be seen as a form of preventive healthcare to arrest the development of illnesses before they escalate to the needs for costly hospitalisation. Costly, that is, to the public purse and the public, given universal hospitalisation insurance or MediShield Life.
The monthly household income per member capped to qualify for CHAS subsidies should be raised from $1,800 to the prevailing median monthly income from work for an individual which stands at $3,900 in 2015. This is so that retirees who live with their working children, who are themselves parents, are not excluded. This would also provide some relief for the children of the retirees, who belong to the sandwich middle-income group. Another benefit is that this would provide support for and promote multigenerational households, where the elderly would not be disincentivised to live with the children and grandchildren.
Assoc Prof Fatimah Lateef: Madam, primary care has been on MOH's radar for a while and there are initiatives being planned. However, there are still some gaps that need to be addressed.
One area is the need for service and its siting. For example, in the eastern part of Singapore, the polyclinics are very heavy in terms of patient load. Bedok, Geylang East and the newly renovated and opened Marine Parade polyclinics are all very busy clinics, besides the Clementi one that I just heard about. The waiting times, too, are affected by this. I am sure we know.
Some seniors tell me they have to place an item or stand in line from as early as 6.30 in the morning. I tell them to make an appointment because we know that it is a lot easier and more efficient. Can MOH consider having another polyclinic in the Geylang, Eunos, Haig Road and Ubi vicinity to meet the needs of the patients there? The need and demand for Government primary care services will continue to rise, especially with the introduction of the PG Package, the CHAS programme and other subsidy schemes.
The Senior Minister of State for Health (Dr Amy Khor Lean Suan): Mdm Chair, population ageing presents a unique opportunity for us to redefine ageing and make Singapore an icon of successful ageing. Ms Joan Pereira asked about our Ministry's detailed plans under the Action Plan for Successful Ageing. We have planned a suite of initiatives along two directions.
First, going beyond healthcare to health by investing more in health promotion and active ageing to help seniors live longer and live well. Second, going beyond hospital to home and community by building up a good system of home and community-based care that can provide person-centric care for our seniors. Let me elaborate on each of these.
Health is wealth. I always tell my seniors that they need to achieve three \"wellness\" for successful ageing: physical wellness, mental wellness and social wellness.
Under the Action Plan, we will step up efforts to promote seniors' health education at different levels: at the national level, in the community and at workplaces. At the national level, MOH and HPB will embark on a series of public education campaigns on seniors' health issues this year. HPB will roll out campaigns on topics, such as Seniors' Nutrition, Falls Prevention and Dementia, to raise awareness among seniors on how they can keep healthy.
We will launch a new National Seniors' Health Programme which is a set of \"healthy ageing 101\" programmes on health issues important to seniors, such as nutrition, exercise, mental wellness and chronic disease management. Seniors will be encouraged to go through this series of six basic health workshops as a start and then they can attend other additional workshops depending on their interest.
This set of programmes will be delivered in the community and that was elaborated earlier by Senior Minister of State Heng Chee How.
To enable seniors to be cognitively and socially active as well, MOH has worked with MOE to establish a new National Silver Academy to enable seniors to pursue learning in diverse areas according to their interest.
The Academy is not a physical campus, but made up of a network of education institutions and VWOs offering courses in various fields to seniors. I am pleased to announce that the National Silver Academy will offer over 10,000 learning places across 500 courses this year and that seniors aged 50 and above can start to register for courses from next month onwards. The Academy will offer new learning opportunities for seniors in three areas.
First, Singaporeans will be able to take selected courses offered by the Institute of Technical Education (ITEs), polytechnics and universities without taking exams. The post-secondary education institutions are making selected modules from their full qualification courses available for seniors to attend without being assessed, for a token fee. Seniors will be able to sit in the same classroom and learn together with the regular students attending the course.
Second, seniors can now receive subsidies for short courses offered by these post-secondary education institutions as well as VWOs that cover a whole range of topics. Today, such courses offered by the post-secondary education institutions are largely unsubsidised by the Government. Under the Academy, Singaporeans aged 50 and above will receive a subsidy of up to 50% off the course fee.
Third, seniors can look forward to a wider range of courses. The Academy will not only include courses from educational institutions, including the two art colleges LaSalle and NAFA, but also those from community-based organisations and other ad hoc learning opportunities as well. For instance, seniors can also attend intergenerational learning programmes conducted by students in school after school hours on topics, such as technology and music.
We hope that the Academy can not only fulfil seniors' aspirations to keep learning, but also help shape a new mindset regarding ageing. I think having seniors learn with younger students in the same classroom will foster intergenerational interactions and also, at the same time, inspire our younger generation that learning does not stop at any age.
Mdm Chair, together, we can give health and wellness to more seniors and extend the health span of Singaporeans even as their lifespan increases. But when our seniors grow frail eventually, we need a comprehensive range of care options to enable seniors to age in place. Assoc Prof Fatimah Lateef, Ms Tin Pei Ling and Ms Joan Pereira asked about ramp-up plans for eldercare services. In the past five years, as my Minister has noted earlier, we have expanded home and community care capacities to 6,900 home-care places and 3,500 day care places today.
We will continue to work hard to develop more infrastructure and manpower needed to grow our services and we are on track to meet the projected demand of 10,000 home care and 6,200 day care places by 2020.
I agree with Assoc Prof Fatimah Lateef that beyond capacity, we need to continually enhance the quality of care. We introduced the Guidelines for Home and Centre-based Care last year and are committed to supporting providers in working towards these Guidelines. In addition to training courses and capability building programmes, AIC is also developing a voluntary baseline assessment framework based on the Guidelines to help our providers understand how they can improve.
MOH and AIC regularly engage the sector on various fronts, such as in the development of these Guidelines and the Enhanced Nursing Home Standards, in our manpower and quality improvement councils for the sector, as well as through dialogues, such as with the Association of Private Nursing Home Operators.
We will study ways to further strengthen our tripartite partnerships, including the suggestion by Ms K Thanaletchimi to set up an ILTC association.
Dr Tan Wu Meng and Ms Joan Pereira also spoke about delivering home and community care in an integrated manner. Indeed, this is one of our key strategies going forward. MOH will pilot a number of new initiatives under a new Home and Community Care Masterplan this year to better support seniors to age at home.
First, we want to train and assess a new \"corps\" of domestic elder carers so that they can anchor good care for seniors at home. We have introduced a Foreign Domestic Worker Grant and lowered the concessionary levy so that it is more affordable for caregivers of frail seniors to hire foreign domestic helpers. But some caregivers still find it difficult to obtain domestic helpers who are proficient in eldercare.
MOH will launch a new \"Eldercarer\" pilot to provide comprehensive training to domestic helpers before they are deployed to the families' homes. The new training programme, developed in consultation with experienced nurses from nursing homes and community hospitals, includes four days of classroom learning and on-the-job training. Trainers will go to the homes to observe the domestic helpers at work and check that they can perform the required eldercare tasks competently. These pre-trained elder carers can then be deployed to families in need. Existing employers who want to send their domestic helpers for this in-depth training can also contact AIC.
Second, we will complement domestic maids with informal caregivers in the community. Dr Lily Neo and Ms Joan Pereira spoke about befriending and support for seniors at risk of isolation. MOH piloted a community befriending programme a year ago where seniors are paired with befrienders living in the neighbourhood who can visit them often, keep an eye on their condition and help them with their needs.
Since the start of the programme, some 15 communities have come on board with over 230 befriendees and almost 90 befrienders. These befrienders are given a small token to cover the costs of their befriending work. Our target under the Action Plan for Successful Ageing is to grow the befriending movement to 50 communities by 2020, which means more than 1,000 befrienders and some 3,000 befriendees.
Third, we will further strengthen our community-based home and day care services. To serve the needs of seniors more holistically, MOH has worked with some providers to pilot new Integrated Home and Day Care packages that bundle both home and centre-based care services together. Today, we have such a combination and that is the Singapore Programme for Integrated Care for the Elderly (SPICE) programme for frail seniors. We are now expanding the original SPICE package to pilot three or more new care packages which offer different combinations of care services to meet the needs of seniors with a wider range of frailty.
Let me illustrate this with an example. Mdm Lim Miau Chew has multiple health conditions, including Parkinson's disease, which makes it challenging for her to walk, perform activities of daily living as well as keep track of her multiple medications.
During the day, Mdm Lim attends the Peacehaven Bedok Multi-Service Centre, where she receives rehab and nursing care and does recreational activities. The centre will also help her pre-pack her medications. On days when she is feeling unwell, the centre's staff will check on her at home. They will also arrange for basic housekeeping services and meals delivery for her during the weekends, which are additional add-on services not included within the current SPICE. All these services will be conveniently bundled within a single, comprehensive care package for Mdm Lim.
Some three eldercare providers will be offering these packages with a capacity of over 300 places in the pilot phase. If successful and well received by caregivers, we will scale up the packages. We will also test a new tool to capture seniors' needs – functional, cognitive and social – holistically, for better matching with services.
Fourth, we will build more and better centres to support the new care services. Under the Action Plan for Successful Ageing, MOH is working with HDB to pre-build larger spaces within new Build-To-Order HDB developments to serve as \"Active Ageing Hubs\" or AAHs. These are one-stop centres for seniors that can serve a range of needs, from active ageing programmes for ambulant and healthy seniors, to day care and rehab services for frail seniors, to \"assisted living\" services, such as grocery delivery.
The size of these AAHs will depend on the space available in the developments but can be up to twice as large as the eldercare centres today. We launched the first Request-For-Proposal (RFP) for operating two AAHs at Kallang-Whampoa last month. At least 10 future HDB housing developments will have these AAHs by 2020.
Fifth, to close the last mile, we need to improve the system of transportation to care services. In the past year, AIC piloted a programme with ComfortDelgro to engage taxi drivers to send seniors from home to their care centres. The effort is off to a promising start with 25 taxi drivers on the scheme. More than 130 seniors have benefited from the service, and we hope to expand the service to serve 200 more seniors this year.
Sixth, Regional Health Systems are piloting new programmes to strengthen their support for frail patients in the post-discharge period. For instance, SingHealth is piloting a new system of deploying its nurses to provide home nursing care to its patients living nearby, starting with Bukit Merah.
Finally, we are investing in research and innovation to pioneer new models of home and community care. We have set up a National Innovation Challenge (NIC) on Active and Confident Ageing to support research and innovation in ageing-related issues, including the use of technology. Last year, MOH made two grant calls under NIC to seek innovative ideas to improve manpower productivity of home-care services and enhance dementia care in the community. We received close to 100 proposals and we will select the best ideas to be implemented on the ground.
Ultimately, home and community care must work together with good residential care options to form a robust system of care for our seniors. Thus far, we have largely tendered out our aged care facilities individually or in pairs. Going forward, we need to better integrate different forms of aged care services so that seniors can receive continuous, seamless and person-centric care even as their care needs evolve. To give integration of care a bigger push, MOH will pilot a new Integrated Operator (IOP) scheme this year. MOH will launch Request for Proposals (RFPs) to appoint operators for bundles of \"three-in-one\" care facilities and services, comprising nursing homes, eldercare centres and home-care, within the same area. Under this new IOP scheme, the sector may see up to 500 nursing home beds, 240 day care places and 150 home-care places, within one tender.
There are a few objectives to this IOP scheme. First, we want to encourage a single operator to integrate residential and non-residential aged care services into patient-centric care options.
Second, we hope that these large tenders will enable us to grow bigger players with the economies of scale to provide better and more affordable care for our seniors.
Third, by packaging different care services in a region into a single tender, we hope to develop strategic partners who can then partner our Regional Health Systems to provide integrated and seamless care from the acute sector to community hospital to long term care, for Singaporeans.
IOPs will need to demonstrate that they are able to achieve higher standards of care. They are also expected to do more in terms of workforce development, that is, to train and build up the manpower capabilities in this sector. We will start with an RFP for one bundle – for the South region – later this year, but subject to market conditions.
I assure Members that even while we roll out IOP bundles, we will continue to call smaller tenders with individual facilities and services to cater to providers who may prefer to specialise in a particular care setting. Our eventual aim is to develop a sizeable, diverse and resilient sector. We will continue to support all players, both big and small, in developing their capabilities in this sector.
MOH and AIC have partnered SPRING Singapore to reach out to the private sector aged care providers and enable them to tap on the Capability Development Grant to embark on new manpower development or productivity initiatives.
Beyond individual services, we need to better integrate the programmes, services and resources within each community to build a strong \"community of care\". And it is for this reason that we are piloting community networks for seniors, as mentioned by Assoc Prof Fatimah Lateef and Ms Tin Pei Ling. Let me elaborate more on this new initiative and the Ministry's role in this.
The aim of the community network for seniors is to enable more systematic collaboration between Government agencies and community-based stakeholders, enabling them to leverage each other's strengths and resources to jointly support our seniors. A small group of staff from different agencies will work together to drive the development of this network and there are three objectives of this community network.
First, we want to expand outreach. The Government agencies will coordinate our efforts with local VWOs and grassroots so that we combine forces and collectively reach out to a bigger pool of seniors, rather than visit the same seniors a few times over. For instance, PGAs can inform the Pioneers of relevant active ageing and social activities in the community, as part of their current house visits to explain Government schemes.
Second, we want to link the programmes and services across Government agencies, VWOs and grassroots organisations together so that we can serve our seniors better. For instance, we can join up the healthcare services provided by Regional Health Systems with the social care provided by community-based organisations to support our vulnerable seniors better in the community.
Third, we want to engage stakeholders and recruit more resident volunteers in a particular community, to help their fellow elderly neighbours. As part of this pilot, MOH wants to work with different partners in the community to recruit and train more neighbour carers that can include the more able and active elderly, as suggested by some Members, who can be paired with the seniors living alone in the community.
With Community Networks for Seniors, we hope to build kampungs for all ages, where our seniors can age happily, healthily and actively in place, for as long as possible. If we build up strong community networks over time, caregivers will also have greater peace of mind that their elderly loved ones will have many caring neighbours and agencies on the ground looking out for them.
Assoc Prof Fatimah Lateef, Dr Chia Shi-Lu and Ms Tin Pei Ling asked about our plans to grow the healthcare workforce. In the midst of a more uncertain economic climate, the growth in the healthcare sector will provide good job opportunities and meaningful new careers for Singaporeans. MOH is stepping up efforts to attract fresh school leavers and mid-career professionals to join the healthcare industry. For instance, we are enhancing information and outreach through career talks and exhibitions, engaging the education and career guidance (ECG) counsellors to secondary school students.
We will also continue to support providers to recruit nurses, allied health professionals and care staff for the aged care sector. We launched the online ILTC Careers Portal in 2013 and a branding campaign earlier this year to raise awareness of opportunities in this sector. We have facilitated the recruitment of 107 locals through our job fairs over the past one year.
MOH has also provided funding support to enhance the pay competitiveness of healthcare workers in VWO providers, in tandem with the pay increases in the public healthcare sector. We will do even more this year, to enhance recruitment for the aged care sector.
Assoc Prof Daniel Goh suggested recruiting retired nurses to deliver home and community care. Today, some of our home-care providers are already doing so. To better attract non-practising local nurses back to work in the growing aged care sector, we have enhanced the Return-To-Nursing scheme in April this year. We have strengthened training in areas, such as geriatric and palliative care, in a three-month refresher course and enhanced the training allowances. There will also be a new one-time Community Care Placement Bonus at $3,000 for Enrolled Nurses and $5,000 for Registered Nurses who join the aged care sector.
There is also an increasing need for professionals, managers, executives and technicians (PMETs) who can take on management and supervisory positions in new aged care facilities. We have, therefore, launched a new Senior Management Associate Scheme to attract mid-career talents with supervisory or managerial experience, who are interested to explore a career switch to the aged care sector. We aim to recruit 10 mid-career talents per year. They will undergo three months of training with AIC to understand the sector before taking up senior positions like Centre Directors in the institutions. MOH will provide funding support to the institutions for the remuneration and benefits given to these mid-career talents.
Even as we explore more initiatives to grow local workforce participation in the sector, there is still a need to bring in foreign healthcare workers to augment our local supply. We will continue to help these workers adapt to our practices and working environment, so that they can be effective members of our teams. Assoc Prof Daniel Goh spoke about home nursing providers who bring in foreign nurses under foreign domestic worker permits.
Let me clarify that providers can only deploy nurses registered under the Singapore Nursing Board (SNB) to deliver home nursing services. The providers Assoc Prof Daniel Goh mentioned are employment agencies who bring in care aides to assist senior clients and they hold foreign domestic worker permits.
In parallel with efforts to grow the workforce are efforts to deepen skills and build new capabilities. To date, more than 7,000 ILTC staff have undergone various training, from care skills training to leadership programmes under the AIC Learning Institute.
Under the national SkillsFuture initiative, we will introduce the Healthcare Skills Future Study Awards to support skills upgrading of the healthcare workforce. The $5,000 study awards will support learning and development in the areas of aged care, healthcare IT, analytics and healthcare system design, organisation and delivery, and will benefit 50 healthcare staff this year. The awards will be opened for application from June this year.
MOH will also champion initiatives within the public healthcare sector to make our healthcare institutions age-friendly and enhance the longevity of our older experienced staff. Our healthcare institutions will be systematically introducing mechanisation to take away the physical strain of healthcare jobs. We will also redesign jobs, introduce FWAs and provide retraining to create more opportunities for older Singaporeans to work in the healthcare sector.
For instance, NUH has started a flexi-work pilot for Singaporeans to help ward nurses with basic care duties, so that the nurses can focus on clinical nursing work. NUH targets to have up to 50 of such Basic Care Assistants and has already hired 16 under the pilot phase.
Ms Thanaletchimi and Dr Chia Shi-Lu will also be pleased to note that all healthcare clusters today have FWAs in place to help workers balance work and personal demands. These include part-time employment, compressed work week, flexible work schedules and hours.
Last year, four hospitals piloted new FWAs for nurses in selected wards, where the timing of the afternoon shift was brought forward to allow the nurses to spend more time with their families and friends after work. MOH is currently working to facilitate electronic rostering systems, so that more FWAs for nurses can be scaled up to all public healthcare institutions.
Our healthcare institutions will also strengthen workplace health programmes and introduce new retirement planning programmes for their mature workers. These include pre- and post-retirement workshops, to guide older healthcare workers through career transition issues.
In short, despite the current economic uncertainty, the health and aged care sector is expanding and will be able to offer many different good jobs to Singaporeans of all ages.
Assoc Prof Fatimah Lateef and Ms Tin Pei Ling asked for an update on community mental health. Last year, I updated the House that we will systematically strengthen our community mental health efforts in a few ways and I am pleased to report that we are making steady progress.
First, to enhance the mental well-being of Singaporeans, HPB has rolled out initiatives to equip the public with knowledge and skills to keep mentally well and seek help early, if needed. For example, their \"Working Minds\" talks and workshops in workplaces impart skills on managing stress and developing resilience so that employees can perform at their best and 4,500 employees from 90 small and medium enterprises (SMEs) have participated in these workshops since they started in 2013.
Second, to help detect and support the treatment of mental health patients in the community, AIC has trained and partnered over 100 GPs and set up six specialist-led community-based teams to guide our primary care providers in managing patients with more complex issues. Six allied health-led community teams have also been set up to support GPs by providing counselling and psycho-education to clients and caregivers. This is an increase from the 70 GP partners and nine specialist and allied health-led teams last year. As at end-2015, these teams have seen over 7,000 clients, an increase from 4,700 in the previous year.
Third, we have reached out to 36 constituencies; 16 in the past one year alone. Over 800 grassroots leaders, volunteers and community partners have been trained in basic mental health knowledge and symptoms of mental illness, which allows them to identify, respond and support residents with mental health challenges. Again, this is an increase from the 400 trained in 2014. AIC has also trained over 500 staff from the ground agencies, such as HDB, Town Councils, the Singapore Police Force (SPF) and Family Service Centres.
In addition, advisors in all 89 divisions have been given a single AIC contact point for easier referral to assist residents with suspected mental health issues. AIC will be the first responder and lead in coordinating further assessment and care. To address Dr Lily Neo's suggestion, SSOs today can refer persons with suspected mental health issues to AIC for assessment, as well as help provide the necessary support if needed, as part of the overall care plan.
Fourth, IMH is strengthening its after-care services to better support clients post-discharge, so that they could be better managed and supported to continue to live in the community. Together with AIC, IMH is piloting an integrated model of after-care case management for clients with moderate to complex social and healthcare needs. Case managers assigned to these clients will assist in their transitional care upon discharge and link them to community support partners. These after-care teams have reached out to over 150 clients since 2015.
IMH is also enhancing its capability to monitor higher risk patients post-discharge and ensure that they comply with follow-up treatment. If a patient refuses or defaults on treatment, IMH will work closely with family members, caregivers and other community partners to engage the patients. Currently, the Mental Health (Care and Treatment) Act does not provide for enforced treatment of psychiatric patients in an outpatient setting. We can study Dr Lily Neo's suggestion on whether to compel outpatient mental health treatment, taking reference from overseas models, such as Scotland, England and Australia.
Nonetheless, the experience of these countries is mixed so far, and there is no robust evidence to show that community treatment orders are effective in achieving key outcomes, such as reduced hospital re-admissions, improved medication adherence and patients' quality of life. Even as we study such an approach, it is important that we continue to enhance access to mental health services and continuity of care.
We share Mr Low Thia Kiang's concern about funding for mental health, and take a calibrated approach in ensuring comparability in coverage. Patients requiring inpatient treatment can enjoy Government subsidies similar to other medical treatments.
The MediShield Life claim limit and MediSave withdrawal limit for psychiatric treatments are lower, as Mr Low has said, because its bill size is generally lower as well. The median post-subsidy bill per day in 2014 was $60 for psychiatric treatment, compared to $350 for non-psychiatric treatment.
Taken together, the MediShield Life and MediSave limits were sufficient to cover seven in 10 subsidised inpatient psychiatric bills. MediFund assistance is also available for those who are unable to afford treatment, even after subsidies and MediSave and MediShield. Patients requiring outpatient mental health treatment can receive Government subsidies at our SOCs and polyclinics, which were recently enhanced for lower- to middle-income patients, who also enjoy CHAS subsidies at CHAS GP clinics.
Pioneers can receive special subsidies at SOCs, polyclinics and CHAS GPs. All patients can also use MediSave for psychiatric conditions under the Chronic Disease Management Programme (CDMP) and our seniors can further tap on Flexi-MediSave.
We recognise the stresses of caregiving, as highlighted by Miss Cheng Li Hui and Ms Kuik Shiao-Yin, and have enhanced support for caregivers to make it easier for them to navigate our care system.
Caregivers can approach AIC's AICarelinks at AIC's office and our hospitals. These are one-stop points to get information and advice on the appropriate services for their loved ones. They can also contact AIC's Singapore Silver Line for support on all matters relating to mental health and eldercare services. Besides the four major languages, there are dialect-speaking agents available for seniors who are more comfortable speaking in their native dialects. We have also put in place programmes to help patients and their caregivers transit more smoothly from the hospital to home.
Since 2008, AIC has care coordinators who helped patients look for services required after discharge and follow up with them to provide further support post-discharge through phone calls, home visits or both. To ensure their well-being, we have also made respite care more accessible for caregivers and enhanced subsidies to help defray the costs of caregiving. AIC also works closely with community touch points to look out for caregivers who may be stressed and render assistance where needed.
As noted by Mr Low Thia Kiang, Miss Cheng Li Hui and Dr Tan Wu Meng, the focus for our community mental health efforts going forward will be on dementia. With a fast-ageing population and a dementia prevalence rate of about 10% amongst seniors aged 60 and above, we can expect the number of seniors with dementia in Singapore to grow with time.
We are strengthening community-based support for persons with dementia and their caregivers. We have three home intervention teams to support caregivers in managing challenging behaviours of their loved ones with dementia at home, which have reached out to close to 200 clients and caregivers to date. The 10 outreach CREST teams have also reached out to more than 39,000 seniors at risk islandwide. We are also expanding capacity of dementia care services in the community. By 2020, we will have 3,000 dementia day care places, 1,970 dementia nursing home beds and 160 eldercare sitters.
Mdm Chair, we need to rally the whole Singapore kampung to play a part in supporting seniors with dementia and their care-givers within our communities. Last month, I launched an effort to build a Dementia-Friendly Community in Hong Kah North, after the first such community was launched at Chong Pang. We are working with other divisions, such as MacPherson, Queenstown and Bedok, to embark upon this initiative, too.
Under this initiative, we will build up networks of Dementia Friends who are trained to recognise and provide assistance where necessary to persons with dementia. We will also pilot a safe return system for lost seniors and step up efforts to raise public awareness, such as through AIC's dementia toolkit. We hope to encourage more communities to come together to build a dementia-friendly Singapore.
Moving on to women's health issues, I am pleased to update that I will be chairing a revamped Women's Health Committee to focus on three key health issues among women. These are increasing cancer screening uptake, promoting bone health and, of course, women cannot be left out of the war on diabetes. So, the third focus will be on fighting diabetes, particularly diabetes linked to obesity and gestational diabetes, which Ms Tin Pei Ling and Assoc Prof Fatimah Lateef asked about.
Specifically for gestational diabetes, the Committee will complement the work of the diabetes task force and look into providing support for women with gestational diabetes to reduce the risk of complications during pregnancy and risk of Type 2 diabetes and cardiovascular disease for the child.
Promoting bone health is also important for women who are at higher risk of osteoporosis than men. The Committee will also encourage women to promote good health in our families, such as by breastfeeding our infants, which may reduce the risk of obesity and, hence, diabetes for them later in life, provide them with the best possible nutrition and protect them against illnesses and allergies.
Mdm Chair, the Action Plan for Successful Ageing is our blueprint to prepare for rapid population ageing. A Nation for \"All Ages\" has to be built by all Singaporeans together. With many hands and many hearts, I am positive that we can face population ageing confidently and successfully.
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling: Madam, childhood obesity has been described by WHO as \"one of the most serious public health challenges of the 21st century\". It is also on the rise in Singapore. A major concern is that obese children are more at risk of suffering from chronic diseases and stroke later on in life.
However, this can be prevented if intervention is done right and early. We must keep our young healthy and fit, for their own sake and for the sake of a healthy Singapore. Hence, what is the MOH's plan to address childhood obesity? What is the Ministry's plan also in promoting and supporting our young to stay healthy?
Mr Darryl David (Ang Mo Kio): Mdm Chair, I would like to speak on the mental well-being of youths. Mdm Chair, young students today face many different challenges.
First, they have to deal with the pressures of school. Assessment and homework are followed by more assessment and homework. Then, you have enrichment classes and tuition and everything culminates in examinations at the end of primary and secondary school.
They are also increasingly exposed to the digital world. While infocommunication technology can be a great learning tool if employed correctly, this digital world also presents its own set of challenges, such as the exposure to too much unfiltered knowledge. And the pervasiveness of social media also means that these young students sometimes find themselves the victims of cyber-bullying.
Such issues used to be typically associated with teenagers, but we have to acknowledge that pre-teen students are facing these challenges as well. I have personally spoken to a few parents of children from this age group who are seeing psychologists to help their children deal with the stress. In fact, some parents feel that they should see a psychologist as well.
On the risk of falling into mental health problems, it is usually precipitated by experiencing simultaneous multiple stressors in life. In addition to those stressors mentioned above, these could also arise from problems in their family and personal relationships.
I would like to ask what the Ministry is doing to help students build up their mental resilience and mental well-being to better prepare them to cope with these stressors in life. Also, would the Ministry consider having a decentralised community-based mental wellness facility not just for students, but for others, too?
Miss Cheng Li Hui: Madam, last July, in a written answer to a question by Assoc Prof Fatimah Lateef, Mr Tan Chuan-Jin shared that, \"For children above the age of six, KKH and NUH provide diagnostic services for a range of developmental disabilities, such as autism and speech and language delays, while IMH provides assessment for Autism and Attention Deficit Hyperactivity Disorder (ADHD). In 2014, the average waiting time for subsidised patients was between one week and two months.\" I would like to ask how are the children identified for these tests and how many of them were assessed in the last three years.
IMH runs two Child Guidance Clinics located at Buangkok Green and Outram Road. I heard about the good team of doctors and staff in these premises and I thank them for their passion in caring for their clients. I understand that children with mood and anxiety-related concerns, including eating disorders and relationship problems, may be referred there for therapy. Would the Ministry also provide figures on the number of children and youths below age 18 seeking treatment at Buangkok Green?
Our conservative society still exerts considerable social stigma to the family and children suffering from autism and other mental health issues. Will the Ministry consider relocating the Buangkok Green unit to our heartlands or start new units in other locations to strengthen support for mental wellness?
Ms Tin Pei Ling: Madam, the rise in dengue cases in recent years and the spread of Zika in other parts of the world are worrying. While the Government is proactively working to prevent mosquito breeding, it is not foolproof. Singapore is an international hub. The risk of an infection brought in by an unsuspecting foreign carrier is always present. We, therefore, need to look at other prevention methods.
Could the Ministry share whether there are plans to integrate dengue vaccination with other dengue control and healthcare strategies in Singapore? Could the Ministry also share whether it will invest in research into Zika, its treatment and vaccination?
The Chairman: Dr Chia Shi-Lu, you have two cuts, please take them together. Take the first two cuts, and take the third one, when I indicate so.
Dr Chia Shi-Lu: Yes, Mdm Chair. While we are understandably concerned about the impact of chronic diseases on the population, such as diabetes, which we have been hearing about, we must remain vigilant to the continued threat of infectious diseases, in particular, new and emerging ones.
Our experience with severe acute respiratory syndrome (SARS) at the turn of the millennium has shown us the devastating impact of a previously unrecognised infectious disease and the immense human, social and economic cost.
More than a decade later, the world continues to be besieged by the threat of emerging infectious pathogens: bird flu, swine flu, Middle East respiratory syndrome (MERS), Ebola and, more recently, the Zika virus. MERS remains a threat in the Middle East and had a devastating though fortunately limited outbreak in South Korea last year. Ebola cut through entire populations in West Africa and infected close to 30,000 people worldwide and claimed over 11,000 lives worldwide.
Now, we face the spectre of Zika, which is not fatal but behaves in a far more sinister fashion, affecting unborn babies and potentially condemning them to a lifetime of mental disability. I commend the Ministry on how it has increased our preparedness to deal with such threats since the SARS epidemic, and Singapore has thus far been spared similar crises, through a combination of vigilance, border controls and perhaps through a measure of good fortune.
I would like to ask the Ministry to provide an update on its plans to protect Singapore from the threat of infectious diseases, such as the new and emerging ones which I have just mentioned, and also persistent ones like dengue and resurgent ones like tuberculosis.
Madam, I am glad that, over the years, the Ministry has been actively pursuing greater transparency with regard to issues related to healthcare and healthcare delivery. Results of quality-of-care reviews, patient satisfaction surveys, average costs of hospitalisation for common procedures are readily available, and patients can now access their personal health information online.
I would like to ask what further steps the Ministry is taking to allow even better transparency across the whole chain of healthcare delivery. Can this added transparency be harnessed to improve healthcare delivery, in terms of efficiency, quality and also cost containment?
Healthcare costs are on the rise. Does MOH have any plans to enhance transparency of healthcare fees or to introduce fee guidelines to help contain healthcare inflation?
MediShield Life now provides comprehensive and universal hospitalisation coverage, but about two-thirds of Singaporeans still have integrated insurance plans (IPs) that cover them for medical services by private healthcare providers.
Many are concerned about the cost of private healthcare and also of IP premiums, notwithstanding the recently announced Standard B1 plans that aim to provide a reasonable benchmark for IPs. What is the Government doing to manage rising charges in the private healthcare sector?
The Minister of State for Health (Dr Lam Pin Min): Mdm Chair, with your permission, may I display some slides during my speech?
The Chairman: Yes, please. [Slides were shown to hon Members.]
Dr Lam Pin Min: Thank you. MOH remains committed to reinforcing the core pillars of a quality healthcare system for our population. This encompasses taking a closer look at the fundamentals of our healthcare system, including developing better preventive health services for our young and strengthening primary care.
There is a rising prevalence of chronic diseases amongst our population. One in four Singaporeans aged 40 and above has at least one chronic disease. We are concerned about this increasing prevalence, as these conditions can lead to serious complications if not well-managed. For example, complications faced by poorly-controlled diabetic patients include kidney failure, stroke, heart attack, blindness and even lower limb amputations.
The risk of chronic diseases in general can be lowered through simple lifestyle changes. Choosing to live healthily is a habit that we should inculcate from a young age. As pointed out by Ms Tin Pei Ling, it is vital that we go upstream and enhance preventive health services that encourage the formation of healthy habits in our children and youths, even as we continue to step up our efforts in promoting health screening among older adults. All of us have a role to play in keeping our young healthy and fit, especially parents and caregivers. They role-model healthy living, nurture a healthy home environment, influence and guide children to form healthy habits, which, hopefully, will continue through adulthood.
In Singapore, we have had a comprehensive school health service since 1921, which underpins the good public health achieved today. The HPB's current strategies and close collaboration with the schools in encouraging students to adopt a healthy lifestyle have served us well. For example, trained professional nurses are stationed full-time in selected secondary schools and post-secondary institutions under the Student Health Advisor (SHA) programme, to provide advice on weight management and smoking cessation.
One successful story is that of Ms Tan Su Kheng. For many years, Su Kheng put up with jokes and comments about her weight, which affected her self-esteem. Last year, she joined her school's weight management intervention programme, which helped to kick-start her journey towards a healthier life. On top of receiving many practical tips on healthy living, Su Kheng found additional support through her SHA, who taught her how to incorporate exercise into her busy student life. Apart from exercising thrice a week, she walks home and takes the stairs every day, instead of taking the bus and using the lift respectively.
The journey to staying healthy can be challenging. However, I am inspired by what Su Kheng relates to us about her experience. And I quote, \"Whenever I feel like giving up, I will tell myself that although I may not be there yet, I am one step closer to success than yesterday.\" I am happy to share that with her perseverance and encouragement from her SHA, Su Kheng has lost over 20 kilogrammes in just one year. I hear that family and friends have even started approaching her for tips on healthy living. My heartiest congratulations to Su Kheng!
Despite these efforts, it worries me that we still see the proportion of overweight children and youths increasing over the past five years. Studies have shown that childhood obesity is likely to persist and progress into adulthood. This results in individuals being at higher risks of developing chronic diseases, such as diabetes and hypertension. An overseas study revealed that those with childhood obesity are four times more likely to be at risk of developing hypertension in adulthood when compared to their non-obese peers. It is, therefore, critical that we curb the rising rates of childhood obesity.
A local survey showed that most students are engaging in less physical activities and becoming more sedentary. More than 80% of the students surveyed exceeded the recommended screen time of no more than two hours a day. This is exacerbated by inadequate physical activity. Based on past surveys, only about 10% of mainstream or ITE students and 20% of polytechnic students had sufficient physical activity.
In addition, the prevalence of myopia in our children is one of the highest in the world. More than 60% of our Primary 6 students have myopia today. This is undesirable as poor eyesight from myopia can impact learning. And as the condition progresses, it may result in sight-threatening complications as well.
We have also found that about half of all our Primary 1 students have dental caries. Poor oral health affects the nutrition, growth and development of our children. We are concerned and are keen to tackle the pervasion of these trends among our young. Apart from their physical growth and development, we will also further strengthen our efforts to help our young to build up their mental resilience to better cope with the stressors of life.
Mr Darryl David raised concerns on the mental resilience and well-being of our youths. To comprehensively address the multifaceted aspects of student mental health concerns, we have adopted a three-pronged approach, comprising knowledge and skills-building, facilitating access and referral to mental health services, and parental engagement.
MOE and HPB have introduced programmes to provide educators with basic knowledge on common issues faced by our youths. Educators are also equipped with the ability to detect early warning signs and skills to provide appropriate support and referrals to services and resources in the school setting. These programmes have also groomed youth opinion leaders on health, by arming them with knowledge on health and well-being, mental health concerns and youth advocacy.
Mr Darryl David also suggested having community-based mental wellness facilities. As Senior Minister of State Amy Khor mentioned earlier, we are steadily building up our mental health services and support networks within the community to identify and help persons with mental health concerns.
It is important for us to work upstream to lay strong foundations for our young to lead healthier and more productive lives, starting from those as young as two years old. To this end, I will lead an inter-agency NurtureSG Taskforce with Minister of State for Education Dr Janil Puthucheary. The task force comprises representatives from various Ministries, HPB, Sport Singapore and the ECDA, as well as medical professionals and academics. It will guide the development of the NurtureSG Plan to enhance the health outcomes among our young.
The NurtureSG Taskforce will focus on three main areas. First, we will look into developing new strategies and strengthening existing programmes to address salient health issues and negative trends among children and youths. Next, we want to reinforce health promotion efforts at the tertiary institutions so that young Singaporeans will maintain healthy habits beyond the school-going age and well after entering the workforce. Last but not least, we aim to bring health promotion for the young beyond the school and into their families and the community.
We will launch a public consultation later this month to seek ideas on how we can encourage and enable our young to adopt and maintain healthy lifestyles. In particular, we will engage students, educators, parents, caregivers and even the private sector, such as food establishments, to create a healthier environment for our children.
To Miss Cheng Li Hui's comments, children are referred to the hospitals for both developmental and mental health conditions by polyclinics, GPs, paediatricians, primary schools and REACH, which stands for Response, Early Assessment and intervention in Community mental Health teams. Besides the Child Guidance clinics at Buangkok View and Outram Road, mental health services for children and youths are also available in other hospitals, such as NUH, Singapore General Hospital (SGH) and KK Hospital.
These services typically include assessment, diagnosis and multidisciplinary management of patients up to the age of 18, but may continue to follow up with them beyond this, where appropriate. The subsidies for these services are in line with existing SOC subsidies. From 2013 to 2015, there were about 50,000 psychiatric SOC attendances for patients up to 18 years old, of which two-thirds were seen in IMH.
Empowering and teaching our young to lead healthier lives are only one part of the equation. As our population ages and healthcare needs continue to rise, we must reshape the way we approach healthcare.
Primary care is the foundation of any healthcare system. We aim to strengthen its place in our healthcare system, to be the first and continuous line of care. Dr Tan Wu Meng asked about the role of the family doctor. My response is encapsulated in our vision \"One Singaporean, One Family Doctor\".
Overseas studies have shown that care continuity by a regular family doctor results in better care outcomes for patients. These include decreased hospitalisations and emergency department visits. Our family doctor can be our partner in helping us stay healthy and in providing us with good and affordable care close to us. Many Singaporeans see a doctor when we come down with an illness, such as a bad cold. With a regular family doctor, such visits can develop into a strong doctor-patient relationship over time. As our family doctor develops a holistic understanding of our family's medical profile and health needs, they will become our health advocate in identifying risk factors and can offer more targeted, timely and individualised advice and plans to manage our health.
For those with chronic diseases, we can manage our condition better by having a family doctor who understands our condition well and supports us with quality management and treatment. Our family doctor must also have some understanding of our family, social and work situation to advise us on making lifestyle changes and adhering to treatment. They can also refer us appropriately if we require more specialised medical attention and help coordinate our care with other providers.
I would like to share a story of a family doctor being one's trusted health partner. Mr Tan Heok Lim has been seeing his family doctor, Dr Leong Choon Kit, for the past 14 years. He feels comfortable with Dr Leong's care and has continued seeing him for his medical needs. This enables Dr Leong to care for Mr Tan holistically – from health screening to diagnosis and management of chronic conditions, such as hypertension.
With deeper understanding of the family, Dr Leong has recommended suitable health screening for Mr Tan's wife, who has a strong family history of diabetes. Mrs Tan was found to be borderline diabetic and Dr Leong was able to intervene early through advice on lifestyle modifications, to prevent the progression of diabetes. Currently, Dr Leong manages the chronic conditions of Mr Tan, his wife and his son. And I am happy to hear that both Mr Tan and his son have also successfully quit smoking, with encouragement from their family members and Dr Leong.
I believe that there are many such positive stories to illustrate the benefits of having a regular family doctor. However, only two in five Singapore residents aged 18 to 69 have a regular family doctor today. We want to call on Singaporeans, especially those with chronic conditions, to take the first step in identifying and sticking with a regular family doctor.
To facilitate this, we will review our policies to help strengthen doctor-patient relationships in primary care. As we progress on the journey to realise our vision of \"One Singaporean, One Family Doctor\", we will continue to engage our GP and polyclinic colleagues to co-create the future primary care landscape, in particular, to achieve better chronic disease management in the community.
We are mindful to ensure sufficient primary care capacity with the ageing of the population and a growing chronic disease burden. Our polyclinics will continue to play a key role, especially in the management of complex chronic diseases. In recent years, we have announced the development of new polyclinics and redevelopment of existing ones.
Since 2012, we have also strengthened partnerships with private GPs to provide subsidised care to Singaporeans. Today, the CHAS provides lower- to middle-income Singaporeans and all Pioneers access to subsidised care at private GP and dental clinics, and 900 GP clinics and 650 dental clinics islandwide have signed up for CHAS. We value their partnership.
We have also developed new models of primary care, such as the Family Medicine Clinics or FMCs, since 2013. The FMCs are multi-doctor practices, with onsite nurses and other allied health professionals, delivering comprehensive team-based care, especially for chronic disease management.
As part of our continual efforts to better serve our residents, we have been redeveloping existing polyclinics. The new polyclinics in Punggol and Jurong West will open in 2017. I am pleased to announce that we will build another polyclinic in Eunos, in response to Assoc Prof Fatimah Lateef's query on new primary care facilities. The new polyclinic is expected to be operational by 2020 and will be designed to cater for future primary care needs.
Today, there are seven FMCs in operation. By early 2017, we will develop two more FMCs: one in Tampines and another one in Keat Hong. We will continue to review and evaluate FMC development as part of our efforts to strengthen and improve primary care.
With these range of developments, we have tried to support the growing needs in primary care. To address Dr Tan Wu Meng's concerns, residents in the West can look forward to three new facilities – the new polyclinics in Jurong West and Bukit Panjang, as well as a new FMC in Keat Hong. These will help to relieve the load in existing polyclinics in the West, such as Clementi Polyclinic.
We will continue to review the regional primary care needs of our population and work closely with the Urban Redevelopment Authority (URA) and HDB to review and ensure the adequacy of the space needed for primary care facilities in HDB estates.
A good primary care system can help to reduce costly interventions in the hospital setting. To keep primary care affordable, CHAS and PG cardholders at the FMCs and CHAS clinics receive Government subsidies for their care. Dr Tan Wu Meng and Assoc Prof Daniel Goh commented on enhancing subsidies for primary care. Since 2012, we have significantly enhanced CHAS so that more Singaporeans can benefit. In 2013, we raised the income criterion from per capita monthly household income of $1,500 to $1,800. In 2014, the age floor of 40 years was also removed. These changes have helped more Singaporean households to benefit from CHAS.
I thank Assoc Prof Daniel Goh for his suggestion to change the qualifying criteria for CHAS. Assoc Prof Goh suggested that we change the per capita household income criterion of $1,800 to an individual's prevailing median monthly income of $3,900. The current CHAS income criterion of $1,800 ensures that lower- to middle-income Singaporeans, or Singaporeans in about half of all resident households, can qualify. This means that a household of four, with the breadwinner earning $7,200, is eligible.
A household-based approach ensures that subsidies are equitably distributed to extend more benefits to individuals with more dependants. In determining our income criterion, we will need to strike a balance, bearing in mind the need to target subsidies at those who need it most and Government budget availability. We will review CHAS regularly and enhance the scheme where needed to ensure that care remains affordable.
Dr Chia Shi-Lu asked for measures to improve transparency in the charging of healthcare services. We have implemented various measures to this end. Hospitals are required to provide financial counselling to patients to ensure that they are informed of the charges likely to be incurred for their treatment. For outpatient care, patients are also provided with information on estimated charges for consultation.
Since 2013, hospital bill sizes for common conditions and procedures at both public and private hospitals have been progressively published on the MOH website. In 2014, the publication of \"Total Operation Fees\" for common procedures in public hospitals was introduced.
I am pleased to announce that the publication will be expanded to cover \"Total Operation Fees\" for private hospitals later this year. There will be further breakdown of the \"Total Operation Fees\" into \"Surgeon Fees\", \"Anaesthetist Fees\" as well as \"Facility Fees\". The expanded publication will provide added transparency on the private hospital bill components attributed to performing the procedure and serve as a point of reference for both healthcare professionals and the general public.
Safeguarding public health is another fundamental aspect of maintaining population health. Even as we tackle the increasing prevalence of chronic diseases, we need to remain cognisant of our external environment.
In line with the Minister's call for us to remain vigilant, we need to constantly improve our public health system to promote health, prevent diseases and prolong life among our population. Dr Chia Shi-Lu asked about the measures that we are taking to protect Singapore against emerging diseases. We have adopted a three-pronged approach to external public health threats, namely, reducing the risk of importation, early detection and containment.
We perform local and global surveillance to ensure situational awareness for endemic diseases, such as tuberculosis and influenza, and emerging diseases overseas, such as MERS and Zika. We also fund research to evaluate the effectiveness of surveillance and response plans to infectious diseases. These include looking at potential areas for collaboration with the relevant institutions on Zika virus diagnostics, transmission and its association with microcephaly and Guillain-Barre Syndrome. We conduct regular preparedness exercises to practise our responses and identify potential areas for improvements. We also maintain a surge capacity for isolation beds and a national stockpile of personal protective equipment.
In the community, we work with about 640 GP clinics which have volunteered as Public Health Preparedness Clinics, or PHPCs, to help manage public health emergencies, such as haze and influenza pandemics. While all GPs play important roles to provide care in such situations, PHPCs take on additional roles, such as providing subsidised care for conditions related to the public health emergencies.
Coordinated efforts across multiple Government agencies, as well as with other countries and international organisations, are also vital in protecting Singapore against external public health threats.
In relation to Ms Tin Pei Ling's query regarding dengue vaccination, HSA has received the regulatory filing for Sanofi's dengue vaccine in March 2016 and is expediting the review, given the dengue situation in Singapore and recognising that this is the first dengue vaccine available.
The key focus in the Health Sciences Authority's (HSA's) review is to ensure that the vaccine is safe, of good quality and is effective for use in our local population, taking into consideration the local prevalent strains of dengue and its potential risks and adverse effects. Nonetheless, there is currently no vaccine that confers 100% protection against all known strains of the dengue virus.
If it is found to be efficacious locally and subsequently introduced, dengue vaccination should be coupled with other dengue control and healthcare strategies in Singapore, such as having a strong disease surveillance system and maintaining effective vector control measures, to keep the mosquito population low. All of us still have a part to play in staying alert and fighting dengue.
Mdm Chair, we see an increasing need to shift the focus from healthcare to health. However, we cannot do this alone. Let us encourage one another, including our children and youths, to adopt a healthy and active lifestyle to keep chronic diseases at bay. Our regular family doctor shall be our trusted health partner throughout the different stages of our lives.
At the same time, we introduce further measures for greater fee transparency at the hospitals. Not forgetting our vulnerabilities in an increasingly connected global community, we will remain vigilant in responding to public health emergencies. On this note, I urge Singaporeans to partner us in building strong foundations for better care and better health.
The Chairman: Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Mdm Chair, according to a recent study that was published in the Lancet, which is a very well-respected medical journal, there are more than 640 million obese people globally. The threat of severe obesity noted in this paper was considered too severe to be tackled with medications or by exercise alone. The study recommended taxing foods that are high in sugar or that are highly processed. WHO has also recently come out in support of such a move.
The level of obesity, as we have just heard, is also rising in Singapore. Our adult obesity rate increased from 6.9% in 2004 to 10.8% in 2010. It is probably higher today.
Obesity increases the risk of diabetes, heart disease, stroke, joint problems, high blood pressure, high cholesterol and certain types of cancer. Not only does obesity have a negative impact on personal well-being; it is costly to the nation. We have to spend more money on obesity-related healthcare. And an unhealthy workforce is also likely to be less efficient, affecting our economic productivity.
We should certainly not sugar-coat this problem. Hence, I would like to renew a call I first made in 2011 that the Ministry consider implementing increased taxation on unhealthy foodstuffs, such as those containing excessive fat or sugar, to discourage their consumption.
Other nations have imposed taxes on sugared beverages and on food which is high in saturated fats. I understand that such general taxes will raise prices and may disproportionality affect Singaporeans with lower incomes who spend a greater part of their income on food. Unfortunately, unhealthy, processed food is often cheaper and more affordable.
But just as taxes on alcohol and tobacco have nudged people into reducing their consumption, taxes on unhealthy food should be effective as well. Sugar is arguably as significant a threat to public health as alcohol or tobacco, if not more.
My rudimentary understanding of military strategy informs me that a key to winning a battle is to cut off the supply lines to the enemy and as we have just declared war on diabetes, I think such a move is tantamount to cutting the supply lines to the enemy, which is diabetes.
Finally, I would also like to suggest that healthy food, such as fresh fruits and vegetables, be made cheaper through targeted subsidies. By making healthier food cheaper than unhealthy food, hopefully, our people would start to change their eating habits.
Assoc Prof Daniel Goh Pei Siong: Mdm Chair, the harmful effect of excessive sugar consumption has led to Britain recently introducing a sugar tax. Singapore, like the UK, is experiencing an ageing population and the prevalence of obesity and heart disease. There are also local characteristics to the problem as Asians are at a higher risk of developing Type 2 diabetes. In fact, over 10% of adult Singaporeans are currently diabetic and it is the second highest proportion in the developed world. It will, therefore, appear that we should seriously consider a sugar tax.
However, the effectiveness of the sugar tax is questionable, at least in Singapore, as it will likely turn out to be a requisite tax on vulnerable Singaporeans. We should focus instead on empowering Singaporeans towards making healthier choices and adjustments to their lifestyle. I request the Government to consider mandating the labelling of free-sugar content in processed foods where the calories and percentage of daily intake of free-sugar need to be prominently displayed on food packaging.
The sugar content should also be colour-coded with green, amber and red. Labelling should be in line with WHO guidelines of cutting free-sugar consumption to less than 10% of daily calorie intake. This can be rolled out in phases, starting with canned and packet drinks. For example, a can of Coca Cola contains added sugar amounting to 80% of the current WHO guidelines and should be labelled red.
Health warnings that read \"Drinking beverages with excessive added sugar contributes to obesity, diabetes and tooth decay\" should be attached to drinks that are labelled red. Studies to track whether labelling has resulted in consumers making better choices should be conducted to improve the labelling and gauge its success before we even consider a sugar tax.
Dr Lily Neo: ElderShield is a severe disability insurance scheme with the purpose of providing basic financial protection to those who need long-term care, especially during old age. This is an important insurance scheme nowadays and will be even more so down the road in view of our ageing population.
However, in its present form, the ElderShield which was introduced in 2002 is not adequately addressing the long-term needs of the severely disabled for which it was intended. This is the 10th time I am speaking on ElderShield in this Chamber since 2002. I have raised ElderShield inadequacies even then. Mdm Halimah Yacob had also raised ElderShield 12 times in this Chamber before. I hope MOH will review ElderShield and make it more relevant towards addressing the long-term care of the severely disabled.
Cash payouts of $300 are paid to non-upgraders for up to a maximum period of five years, and $400 are paid, for upgraders, for up to a maximum period of six years to patients who are unable to perform at least three out of six activities of daily living (ADL). These activities are washing, dressing, feeding, toileting, mobility and transferring.
It is obvious that such patients are totally dependent on others for their daily living. They need full dependent-care. Therefore, how will $300 to $400 be enough to care for such patients in one month? Even having a domestic helper to assist them will cost more than double in one month.
I am concerned for those patients, especially the elderly, who do not have savings or family members who can afford their dependent-care costs. Some families take the option of sending their dependent members to hospitals or overstaying in acute hospitals even when they do not require to be hospitalised anymore. Their actions not only deprive other patients who need hospital care, but they also incur tremendously high hospital costs. The patients may not feel the burden of the higher costs in acute hospitals, but it is to be noted that the bills are usually being paid by MediShield or MediFund for needy patients.
The tenure of ElderShield payouts of a maximum of five to six years is also not adequate. These patients with three ADLs, especially those as a result of old age, are unlikely to get back to normal since they have reached the stage of inability to perform the daily activities. Even for other sick patients with severe disabilities due to illnesses, such as stroke or cancer, reaching the stage of inability to perform daily activities, it will usually mean that their illnesses are too severe for them to regain normal activities again. Thus, the insurance coverage of five to six years will leave them in a lurch at the end when their conditions could have deteriorated and should they require even more dependent-care at higher costs.
Presently, ElderShield excludes those aged 70 and above in 2002 and those with existing illnesses. These are the groups who are more likely to get severe disability. They are badly in need of ElderShield but are not eligible for this insurance. For those aged 60 to 64, the annual premiums payable to join ElderShield are from $1,000 to $3,000 respectively. These are unaffordable premium amounts for many seniors and, therefore, many seniors are not in the scheme.
One of the main reasons for people to take insurance is for peace of mind, knowing that finance is available should eventuality strike. Thus, I hope MOH will review ElderShield to give better protection and assurance to the insured.
MediShield Life had been revamped to give that assurance with its many improved features. Maybe, now, MOH will consider revamping ElderShield to ElderShield Life, similarly as MediShield was improved to MediShield Life. The many new features of MediShield Life had been well thought out and they are very good. Will MOH consider adopting these good features for ElderShield Life as well? I shall mention a few examples.
Lifelong coverage like MediShield Life is essential to give people the reassurance of coverage when they need the insurance most. Patients usually reach their inability to perform ADL towards the end of their lives. Therefore, it is good not to have the age limit on claims.
The risk pool feature of MediShield should be adopted for ElderShield to make ElderShield more viable with non-opt out and as a comprehensive national scheme. I hope our Government will also give subsidies to those who cannot afford the premiums.
Presently, ElderShield is being administered by three private insurers. It will be better if CPF board takes over the role as in MediShield Life.
Mr Louis Ng Kok Kwang (Nee Soon): Madam, with increased cost of living and added healthcare cost, I am concerned that the poor and vulnerable elders in Singapore will fall through the cracks. While MediShield Life is a good measure to cover all Singaporeans, it does not help with their living expenses when they are in recovery or out of the hospital.
This is where ElderShield comes in. However, there are some improvements that I would like to suggest. The premium costs are high for the lower-income families and the process to file claims may be overly burdensome, especially for the elderly. Does the Ministry have plans to review the premiums and also simplify the claim process? Can the Ministry also tap on the PG Office (PGO) to reach out to the other 35% of the resident population who are currently not covered by ElderShield?
Lastly, while the payout period has been extended to 72 months, will the Ministry consider extending the payout period for ElderShield to end of life instead, since there is no reason to assume that care needs would decrease after 72 months?
Dr Tan Wu Meng: May I declare first that I am a doctor who has served in the public and private sectors.
Medical records are essential to good patient care. Better information means better quality diagnosis, more timely treatment and better patient safety. Yet, today, when patients move around across public hospitals, private hospitals, polyclinics and their local GP clinics, it can take time to get a full picture of the patients' medical records. Even within the same public or private hospital, information can be spread between paper and digital, sometimes in multiple digital databases, and not all databases are in the National Electronic Health Record (NEHR). Sometimes, it can be almost like opening a different web browser app to view each different website.
We should look at ways to enhance the use and user-friendliness of information technology (IT) in healthcare to improve productivity and patient safety everywhere.
The Chairman: Minister of State Chee Hong Tat.
The Minister of State for Health (Mr Chee Hong Tat): Mdm Chair, with an ageing population, it is not feasible for Singapore to meet future healthcare demand by simply building more and more hospitals, hiring more and more healthcare workers and providing more and more subsidies. We must also focus on developing a sustainable healthcare system. If we shift too far to the right, we will not be doing right by our fellow Singaporeans. If we overspend and shift too far to the left, our children will have nothing left in the future.
Today, I shall talk about three areas to develop a sustainable healthcare system. First, promoting healthy living. Second, transforming our care models by bringing care beyond hospitals into the community. Third, enhancing value through innovation and productivity improvements.
Let me start with initiatives to promote healthy living and to reduce diabetes prevalence. To fight diabetes, we need a supportive environment to encourage Singaporeans to eat healthily and exercise regularly. Under the Healthy Living Master Plan, we introduced healthier dining options and provided more exercise options in the community, workplaces and schools.
One such initiative is the Healthy Community Ecosystem, which has been implemented in six neighbourhoods since 2014, including my own Group Representation Constituency (GRC) in Bishan-Toa Payoh. Group exercises are held in 40 community spaces, with an average of 1,000 residents participating each week. Lifestyle modification programmes have reached 14,000 residents in these neighbourhoods.
To benefit more Singaporeans, we will be extending the Healthy Community Ecosystem programme to nine more neighbourhoods this year, including Jalan Besar, Pasir-Ris Punggol and West Coast.
Eating right is key to fighting diabetes. Excessive consumption of sugar and refined carbohydrates can lead to weight gain and cause spikes in blood sugar levels. Such spikes increase the risk of developing Type 2 diabetes, if they happen frequently over time.
Dr Chia Shi-Lu asked about measures to discourage consumption of unhealthy food products. Assoc Prof Daniel Goh asked if we could introduce colour-coded labels for sugar content in processed food and drinks. I thank Dr Chia and Assoc Prof Goh for their useful suggestions. We will study their proposals as part of the fight against diabetes.
Many food manufacturers already practise back-of-pack nutritional labelling. HPB's Healthier Choice Symbol (HCS) helps consumers make healthier purchases, through an identifiable front-of-pack symbol. There are currently 2,500 HCS products across 70 food categories. These products contain less sugar, saturated fat or salt. A 2015 consumer survey showed a high level of awareness of HCS products. Nine in 10 said they recognised these products as healthier options and eight in 10 said they use HCS to guide their food purchases.
HPB has worked with close to 240 supermarkets on in-store promotions, such as lucky draws, food sampling and cooking demonstrations. I am glad to know that HCS products are gaining market share. Sales of HCS products are growing at 9% annually. Our target is to increase the total market share for HCS products to 25% by 2020, up from the current 17%.
Some Members are concerned that healthier food may be more expensive. I understand these concerns. We need to work together with industry partners to provide affordable healthy options for Singaporeans. As of March this year, we have 52 food and beverage partners participating in the Healthier Dining Programme involving nearly 1,600 food stalls. Under the programme, we collaborated with restaurants to offer lower calorie meal options and to incorporate healthier ingredients, such as whole grains, fruits and vegetables, as part of their core menu offerings. Major food court chains, including Kopitiam, Koufu and NTUC Foodfare, offer at least one dish below 500 calories at each stall. They also promote reduced-sugar drinks. The number of lower calorie meals sold has doubled from 7.5 million in 2014 to 15 million last year.
I am encouraged by the industry's efforts to produce versions of staple foods, like bread and noodles, which are healthier and taste just as good. Gardenia, for example, uses finely textured wholemeal flour to retain the health benefits of whole grains, while keeping its bread soft and easy to chew.
Besides eating right, we need to encourage Singaporeans to exercise regularly. The recommendation is to have at least 150 minutes of physical activity per week. These 150 minutes can be achieved through simple daily activities like walking to the bus stop, using the stairs instead of the lift, doing household chores or taking a brisk walk at the park.
In 2013, one in four Singaporeans between the ages of 18 and 69 did not meet the 150 minutes per week target, and this was an increase from one in five in 2007. We need to reverse this trend. Leading an active lifestyle can be simple and inexpensive. It is also something we can enjoy with our family and friends.
Mdm Jessie Jee is a Pioneer and one of HPB's Health Ambassadors. She is a regular participant at our Sundays at the Park programme. Every Sunday morning, she joins others in workout classes at the Firefly Park near her home in Clementi. We hope to encourage more Singaporeans, including our seniors, to adopt active lifestyles like Mdm Jee. To support this, HPB will double the number of exercise sessions available in the community and workplaces from the current 100 to 200 by the end of this year.
Another initiative is the National Steps Challenge. Through the use of wearable technology and simple data analytics, users can receive feedback on their daily progress and also receive rewards when they reach certain milestones.
The National Steps Challenge has been well-received since its launch in November 2015. One in three participants have clocked 10,000 steps a day on average. In addition, 70% of previously inactive participants now average more than 7,000 steps per day.
This is a good start, as studies have shown that walking at least 7,500 steps a day can contribute to lower blood pressure and cholesterol levels and help those with diabetes keep their blood sugar levels in check.
Mr Mohd Aidil Bin Sufyan found the Steps Tracker easy to use and a good way to motivate him to stay healthy. He now takes the stairs more often and alights one bus stop earlier to walk home. He also brings his children for weekend walks. Praising the National Steps Challenge as a good initiative, Mr Aidil said he hopes this programme can be extended to more Singaporeans. Thank you, Mr Aidil, for your support and active participation. We are preparing for a second season of the National Steps Challenge. So, akan datang.
Apart from eating right and exercising more, it is important for Singaporeans to go for evidence-based health screening at recommended intervals. Under HPB's Screen for Life programme, Singaporeans 40 and above are recommended to be screened for diabetes once every three years and, very importantly, to follow up with their family doctors after the screening.
Early detection and treatment are important in the fight against diabetes, to keep the disease under control and prevent serious complications. Individuals with diabetes can benefit from lifestyle changes to prevent their condition from worsening. In addition, pre-diabetics could lower their risk of getting diabetes if they detect the problem early and improve their diet and lifestyle.
We plan to reach out to certain groups of Singaporeans below 40. For example, those who are obese and those whose immediate family members have diabetes. They face a higher risk of getting diabetes and may need to start the screening at an earlier age.
We will extend our screening outreach at the workplaces to bring diabetes screening to more workers. These include those who may find it difficult to schedule screening appointments due to the nature of their jobs. We will also review ways to strengthen post-screening follow-up to initiate early treatment and care when needed.
Next, I will touch on efforts to move care beyond hospitals into the community. MOH has co-located several community hospitals with acute hospitals to facilitate care integration for patients. We are helping patients to shorten their stays at community hospitals and return home earlier. For example, by allowing them to do their rehabilitation follow-ups at day rehabilitation centres. This is what many of our patients prefer. They do not want to stay in the hospitals longer than necessary.
As our population ages, it is inevitable that some of us will become frail and disabled and require support in activities of daily living. For some, this may be a few years before they pass on. For others, the duration could be longer, as Dr Lily Neo and Mr Louis Ng highlighted.
I thank Dr Lily Neo, Mr Low Thia Khiang and Mr Louis Ng for their suggestions on ElderShield. There were also earlier proposals from the People's Action Party (PAP) Seniors Group. MOH will study these suggestions carefully, as part of our ElderShield review.
Mdm Chair, one point I wish to highlight is that increasing the payouts and coverage of ElderShield will require, in the end, higher premiums for the scheme to remain viable. So, this higher cost will, ultimately, be borne by everyone, whether directly through ElderShield premiums or indirectly through tax-funded subsidies.
Hence, there is a need to balance enhancements in ElderShield with the potential cost increases, so that the scheme can remain affordable for all Singaporeans. ElderShield payout is one important source of payment but it is not the only source. Pioneers, for example, can receive Pioneer Generation Disability Assistance Scheme (PioneerDAS) on top of ElderShield. So, we will look at different ways of helping our seniors, especially those who are disabled.
Other important issues for the review include whether ElderShield should be made mandatory for every Singaporean. It is now an opt-out scheme, as some Members have pointed out, and how do we provide coverage for older cohorts of Singaporeans who, today, may not have ElderShield?
Similar to how we enhanced MediShield into MediShield Life, MOH will need to carefully review ElderShield in consultation with experts and key stakeholders. Our end in mind is to provide Singaporeans with peace of mind when we grow old, while keeping the scheme affordable for all.
Mdm Chair, ageing well also means having access to affordable end-of-life care. MOH is working in partnership with the palliative care sector under the National Strategy for Palliative Care. Since 2014, we have ramped up capacity and improved the quality of palliative care in Singapore.
Dr Lily Neo asked for better provision of hospice care, including training of hospice care personnel. We have introduced guidelines for the palliative care sector and will work with the Singapore Hospice Council to encourage industry players to adopt these guidelines.
Dr Lily Neo and Mr Low Thia Khiang asked about the financing framework for hospices. MOH regularly reviews funding for the palliative care sector to ensure end-of-life remains affordable for patients and sustainable for providers.
In July 2012, we raised the threshold for per capita household monthly income to cover up to two-thirds of Singaporean households, up from half previously. This has benefited more than 1,000 additional patients. We will continue to review and adjust the income threshold, like what we have done before.
We have also enhanced financial support for hospice care services. In 2014, we improved funding for home palliative care providers. Last year, we increased the MediSave withdrawal limit for inpatient hospice and home palliative care. Just last month, we increased subsidies for eligible inpatient hospice patients and introduced subsidies for day hospice care.
Overall, with coverage from Government subsidies, charity assistance and MediSave, most patients do not face out-of-pocket payments for hospice and palliative care. Let me share some data for FY2011 to 2015 on the length of stay. For inpatient hospice, the median length of stay is 15 days. For home palliative care, the median care period is around two months. And in terms of affordability, for inpatient hospice, eight in 10 patients have zero out-of-pocket payments and for home palliative patients, nine in 10 did not have to make out-of-pocket payments. Last year, MOH received three appeals on hospice care costs.
Later this year, MOH will further enhance financial support for palliative care by extending the $2,500 MediSave lifetime withdrawal limit for home palliative care to include day hospice services. Similar to home palliative patients, day hospice patients diagnosed with terminal cancer or end-stage organ failure will not be subject to this withdrawal limit if the claim is made from the patient's own MediSave account.
I agree with Ms Kuik Shiao-Yin that it is important for end-of-life care to be provided with empathy. We do have training for our healthcare professionals in this area and will look at ways to further improve and do better. In addition, MOH is supportive of other efforts to improve the quality of our end-of-life care, for example, Assisi Hospice's new facility, where the design of wards resembles a home rather than an institution. Outdoor gardens and green spaces are also included as part of the development.
VWOs play an invaluable role in the end-of-life care sector to provide quality and affordable care. We want to preserve this strong community support and involvement.
Programmes by volunteers also help patients to live their last days fully. This includes befriending and psycho-social support for patients and their families. We will support innovations in palliative care and will continue to work with providers, like Assisi Hospice and others, to pilot new ideas that can benefit patients and caregivers.
Mdm Chair, allow me to now respond to cuts from Mr Dennis Tan and Mr Pritam Singh. Mr Tan asked whether existing private patients in SOCs are allowed to switch to subsidised care without a polyclinic referral. Let me explain what our policy is.
If a private SOC patient wants to switch to subsidised care, a medical social worker will assess his request. These assessments are done on a case-by-case basis. This is to ensure that we target our subsidies at patients with the greatest financial need.
For new patients seeking subsidised specialist care, they will first go through a primary care doctor to assess if they need specialist care services. This can be done at a polyclinic or CHAS GP clinic, if he is a CHAS or PG card holder.
We know there are some private SOC patients who choose to be discharged from private SOC and go through this route to switch to subsidised SOC, instead of going through a medical social worker at the hospital. Strictly speaking, this is not part of the policy for patients to downgrade from private to subsidised SOC. This is perhaps why Mr Tan pointed out that the arrangement is not very neat and tidy. However, our hospitals want to be flexible and they have accommodated these private patients, so that they are not treated differently from new patients who go through the polyclinic.
Taking a broader view, our priority is to transform the way we care for patients, by bringing it beyond the hospital into the community. I shared about how we are integrating care between acute and community hospitals. In addition, MOH is piloting new models where specialists work closely with polyclinics and GPs to co-manage patients who have chronic conditions and need ongoing care. We are also building up primary care so that more SOC patients who are stable can be discharged and cared for by the polyclinics or GPs. This is a more impactful and sustainable way to have a win-win arrangement for everyone.
Mr Pritam Singh asked about Integrated Shield Plans, or IPs. These are private insurance plans which work together with MediShield Life.
IP premiums have two components: there is a MediShield Life component, which is sufficient for basic, subsidised healthcare services, and there is an additional private insurance component. MOH sets the premiums for the MediShield Life component and we will keep MediShield Life premiums affordable for all Singaporeans.
The private insurance premiums are decided by insurers based on commercial and actuarial considerations. They will review and adjust these premiums based on factors, such as claims experience. If claims were to increase significantly over time, the insurers will likely increase their premiums, as some have recently done so with the premiums for riders. Singaporeans who want to keep their insurance premiums affordable, including at older ages when premiums tend to go up, should carefully consider if you want to purchase private insurance like IPs and riders. Some of my residents in Bishan-Toa Payoh told me that they think MediShield Life is adequate to provide them with good quality subsidised care. It is an individual choice.
I agree with Mr Pritam Singh that it is important to guard against over-consumption and over-charging. These will exert upward pressure on healthcare costs and insurance premiums over time, a concern that was shared by Dr Chia Shi-Lu. This is why MediShield Life and all IPs have co-payment features. We will work with insurers to review existing features in private insurance schemes to mitigate the risk of over-consumption and over-charging, while providing sufficient coverage and peace of mind for policyholders.
Other important initiatives to keep healthcare costs and premiums affordable include: promoting healthy living and active ageing because we know prevention is better than cure; finding ways to improve productivity in the healthcare sector; encouraging appropriate care to reduce over-treatment or over-prescription; and, providing more information on fees and charges to help patients decide which hospital and doctor they want to visit.
Mr Pritam Singh also asked to increase the MediSave Additional Withdrawal Limits, or AWLs, to be sufficient for Standard IP premiums at all ages.
MediSave is sized for basic healthcare expenses. MediShield Life premiums can be fully paid for by MediSave. Singaporeans who wish to purchase private insurance can use their MediSave to pay for the additional private insurance component, up to the AWL. We need to set a limit for the use of MediSave for private insurance, including the Standard IP, so that Singaporeans will have sufficient MediSave balances to support their healthcare needs when they grow old.
Mdm Chair, let me now touch on the final area of enhancing value in healthcare through innovation. MOH will work closely with our healthcare institutions and the Healthcare Services Employees' Union to encourage and support ideas that can enhance patient care and service quality, improve the work environment for our healthcare workers and make our healthcare system more productive and sustainable.
Dr Tan Wu Meng asked about enhancing the use of information technology, particularly in the sharing of medical records. I agree with Dr Tan that this will help to improve productivity and patient care.
We rolled out NEHR in 2012 for participating healthcare institutions to view their patients' events and summary health records. As at March 2016, there are more than 900 healthcare institutions with access to NEHR and we would like to include more healthcare institutions over time.
Technology is a key enabler to improve the work environment for healthcare workers. When I visited NUH, I saw their pilot project to remotely monitor patients' vital signs. With this system, the time nurses spend monitoring patients' vital signs has reduced by half.
I am also very happy to know that there are other areas where we can support such technology, including a chair that I saw. It is a portable toilet from Japan. It looks like a normal chair but when you use it, and if you press a button, it will automatically wrap and seal the waste products. So, this makes it easier for the nurses and caregivers, as there is no unpleasant smell and the waste disposal can be done more conveniently.
Ms Thanaletchimi asked about the training for healthcare workers as we implement automation and robotics. The public healthcare employers are committed to redesigning jobs and supporting our workers to gain new skills so that they can stay employable. In fact, through technology and productivity improvements, we want to enable healthcare workers to remain longer in service by making the work less physically demanding for them. This is a win-win arrangement – workers can continue working for more years, while patients can benefit from their service and experience.
Jamiyah Nursing Home is a good example. They partnered the AIC to do a job redesign and, through the various changes they have made, the staff were able to save up to 20% of their time. They also introduced FWAs so as to allow staff more flexibility in managing their work hours.
Our healthcare workers play a pivotal role in supporting productivity initiatives and we appreciate and recognise their efforts.
Ms Thanaletchimi suggested extending the Progressive Wage Model which we currently have in the healthcare system to other groups of healthcare workers. I fully support her proposal. MOH will work with the union on this. We want to retain our healthcare workers and upskill them to provide quality care for our patients.
Mdm Chair, we have made steady progress over the years to provide quality healthcare for all Singaporeans. This is reflected in the improvements in our life expectancy and health outcomes. Credit must go to our committed healthcare workers, who have put in a lot of dedication and hard work to care for their patients. They do it with a caring heart. We must continue to show appreciation for their efforts, support them in their work and also stand by our healthcare workers during difficult times.
For future generations of Singaporeans to continue having affordable, accessible and quality healthcare, we need to transform our care models and keep our healthcare system sustainable.
To succeed, it will require the involvement of all Singaporeans − from individuals, families and the community. It will require changes in habits and behaviours. And, most importantly, it will require all stakeholders to work together in close collaboration and partnership.
The Chairman: We have a bit of time for clarifications. Dr Chia Shi-Lu.
Dr Chia Shi-Lu: Mdm Chair, I have three clarifications. The first concerns the Health Products Act. As I understand it, it now regulates medical devices and cosmetic products and I also understand there have been some public consultations on this about whether it is possible to transfer the control of other pharmaceutical products under this Act. Could I ask the Minister for an update on the status of this transfer and whether it is likely that we will see an amendment to the Act in the near future?
The second clarification concerns this threat of infectious diseases, and it is directed to Minister of State Dr Lam Pin Min. In view of the potential cost of an epidemic, should it occur, do we have provision for a fund to deal with the cost of tackling the epidemic and also the resultant economic cost?
If we look at the US, for instance, they set up a fund to combat Ebola. Now that the threat has passed, they are porting some money over to combat the threat of Zika and expanding on that fund. So, I am just wondering whether we have a provision for a fund to tackle such public health crises.
The final clarification is with regard to my cut on transparency. I thank the Minister of State for his answer.
The Chairman: Dr Chia, can you keep your clarification short.
Dr Chia Shi-Lu: Yes. Could I just ask if there are any more concrete steps that we can take to, perhaps modulate the cost of private healthcare?
Mr Gan Kim Yong: Madam, let me just address the first clarification on the Health Product Act. Dr Chia is right that we are looking at health product regulations and looking at the pharmaceutical products that are currently regulated under the Medicines Act.
Pharmaceutical products will be ported over to the Health Products Act to be regulated under the Health Products Act as therapeutic products, in addition to the medical devices and cosmetic products that are already under the Health Products Act. This is in line with our plan to update our legislation and to consolidate the regulation of health-related products in one Act for greater clarity.
We have conducted extensive stakeholder engagement. We held two rounds of public consultation recently. The feedback has been supportive and we hope to be able to finalise the review shortly and to bring over the therapeutic products into the Health Products Act by the end of this year.
The Chairman: Mr Low Thia Khiang.
Dr Lam Pin Min: Sorry, Mdm Chair, can I answer the other two questions asked by Dr Chia Shi-Lu?
The Chairman: Yes, please.
Dr Lam Pin Min: I would like to thank Dr Chia Shi-Lu for the two clarifications. I would like to say that we do not have a big war chest fund like in the US. Having said that, MOH does build in contingency requirements into our service contracts to respond to health emergencies. And in the event of a disease outbreak, MOH will reprioritise our budget to ensure that we are able to implement all these control measures.
In addition to that, like I have mentioned in my reply, we do stockpile medical equipment and supplies like our personal protective equipment, anti-microbials and even vaccines, if necessary. I would like to reassure Dr Chia that we take a whole-of-Government approach to tackle disease outbreaks and, if additional funds are needed, we will definitely work with MOF to ensure that there will be sufficient funding support to implement our efforts.
With regard to the second clarification on the control of costs in the private sector, in my speech, I did mention that we have published the professional fees on our MOH website which include total hospitalisation fees both in the public and private sector, the total operation fees in the public sector. And most recently, like I have just announced, we will be publishing the total operation fees of the private hospitals, and this will actually serve as a point of reference for both the healthcare professionals as well as the general public, so that they can make an informed decision.
Minister Gan Kim Yong has also announced the setting up of ACE, and this agency will evaluate the clinical and cost effectiveness of health technologies and all the different expensive treatment modalities.
Thirdly, our healthcare insurance financing features like co-payment and deductibles are built into our MediShield Life as well as some private healthcare plans and this will, hopefully, discourage the \"buffet syndrome\".
Last but not least, which is the most important, is that I would like to remind all doctors that we are bound by the Singapore Medical Council and Singapore Dental Council's ethical code and ethical guidelines and that we should not abuse the doctor-patient relationship for our own personal gains.
The Chairman: Mr Low Thia Khiang.
Mr Low Thia Khiang: I would like to ask the Minister whether he will require hospitals to publish on their website waiting times for SOCs by medical speciality.
Mr Gan Kim Yong: Madam, we will take onboard the suggestion and study what are the implications. There are pros and cons. From the patients' point of view, whether the data is meaningful or not, is something we need to consider. From the patients' point of view, what we do for SOC services is to prioritise their needs and fix their schedule according to the seriousness of their conditions. For those who have more serious and time-sensitive conditions, we will give them priority.
The published wait time may not mean a lot to them and may create more confusion, because some of them may have to wait longer than the median wait time because their conditions are less critical, and some may have earlier appointments because of their serious conditions. From the patients' point of view, we have to be careful with the data we publish. But we do monitor the wait times at our SOCs for our hospitals. Whether they are published or not, it is a performance indicator that we keep track of.
The Chairman: Ms Tin Pei Ling.
Ms Tin Pei Ling: Madam, I have four clarifications. The first one, just now, Senior Minister of State Amy Khor had mentioned and provided some explanation about the community networks for seniors. I would like to register my very strong interest to have it piloted in MacPherson and, if yes – please say yes – I hope, I would like to ask if there is any room for the local grassroots to be involved in the set up so that we can provide the local context to customise the scope of work for the community network.
At the same time, I am just wondering if the Ministry will also consider establishing something like an eldercare relationship management system so that there is a more systematic way for the different stakeholders to integrate our efforts and to synchronise in how we can reach and better care for our elderly.
Second, I would like to ask whether there is any plan to leverage more on technology to enable ageing-in-place so that our elders in their retirement can live in a more independent manner.
The third query is on the Trim and Fit (TAF) programme. I understand that, in the past, in the schools, there is the TAF programme to encourage the young to be healthier. So, just wondering why this has been discontinued and what is the reason for that.
Lastly, on Zika, just yesterday, there was news from the US that it is worse than it has been previously thought. It affects the entire pregnancy period and so this is quite worrying. I would like to ask what are the measures in place to better protect pregnant women in Singapore. Also, I fear that awareness about Zika in Singapore is still very much lagging, especially compared to dengue.
The Chairman: Ms Tin, can you keep it trim and fit, please?
Ms Tin Pei Ling: Thank you, I will. So, may I ask the Ministry what is it going to do to increase awareness towards Zika?
Dr Amy Khor Lean Suan: I will take the first two. Firstly, on community networks, I would just like to explain that we will be piloting this in about three areas across the island, different regions and also looking at slightly different demographic profiles as well as socio-economic status so that we can learn from the pilots before scaling up. We will try and look at what the gaps are and so on.
With regard to the Member's suggestion about getting grassroots involved, indeed, community networks will involve all stakeholders in the community. It is just that it will be facilitated by a small team of staff together with the various Government agencies, the VWOs, community-based organisations and, of course, including grassroots.
Because we are piloting the project, we will certainly take into account the Member's strong interest in setting up a community network. Let us pilot it and learn from it before we can scale up.
Regarding eldercare relationships, in fact, this is what we have been doing under the Action Plan for Successful Ageing. After learning from implementing the many ground-up ideas, we have put it into a guide and sent it to all the divisions. When we learn through the community networks, we can also put up some of these as guiding principles for use.
Technology for eldercare, certainly. That is why I have said in my speech earlier that there is a National Innovation Challenge where we have made two grant calls and we will be calling for more. The first two are on new models of home-care and enhancing care for dementia.
Along with these, we will be looking at technology, too. In fact, there are some pilots, with regard to technology, say in Marine Parade, where they are piloting a home-monitoring system to monitor the health as well as the lives of the elderly to make sure they are taken care of. If something happens, they can actually alert the senior care centres.
Dr Lam Pin Min: Mdm Chair, I would like to thank Ms Tin Pei Ling for the two clarifications. On the issue of the TAF programme, it was implemented in 1992 and discontinued in 2007. Ms Tin is probably young enough to have either personally experienced the TAF programme or have witnessed her classmates going through it. The objective of the TAF programme is to enable all our overweight and obese students to achieve a healthy weight and while it showed success in reducing obesity rate from 14% to about 9.8% in 2002, MOE did receive quite a number of feedback, both from parents as well as students, that some of the students felt stigmatised by this programme.
Since it was discontinued in 2007, MOE replaced it with a different programme called the Holistic Health Framework (HHF) which is a more holistic approach towards health, rather than just focusing on weight alone. It addresses other aspects of physical health as well as mental and social health. So, that is the reason and the answer to the Member's first clarification.
For the second one on Zika, just like any emerging diseases, including Zika, MOH adopts a three-pronged approach which I have mentioned in my reply. One, to reduce the risk of importation; two, early detection; and three, containment. In reducing the risk of importation, MOH issues travel advisories on affected countries for Singaporeans who are travelling out of Singapore. Even for women who may get pregnant, they are advised strongly not to travel to these affected countries unless there is a strong reason to do so.
To enhance early detection, we have enhanced vigilance amongst our healthcare providers as well as public healthcare institutions. We also have to step up public education amongst the general public about this disease.
If we do have a first case of positive Zika infection, then isolation will be necessary to prevent its spread through the bites on this infected person by the Aedes mosquito. So, we try to contain it. But, of course, not forgetting the good old effective vector control. I think all of us have a part to play in performing the 5-step Mozzie Wipeout routine.
To manage pregnant patients who may be affected by Zika, MOH has also set up a clinical advisory group on Zika virus infection and pregnancy and it comprises obstetricians, public health specialists as well as infectious disease specialists who advise MOH on the different aspects of management of a pregnant patient who may be suspected of being infected with Zika.
So, I want to reassure Ms Tin Pei Ling that MOH will closely monitor the development of Zika infection overseas as well as the development of other potential treatment modalities including vaccines.
The Chairman: Ms Thanaletchimi.
Ms K Thanaletchimi: I have four clarifications to make.
The Chairman: Keep it short, please, since you have four questions.
Ms K Thanaletchimi: Sure, Madam. On healthy living and preventive health, could I check with the Minister if there are any plans to roll out the holistic electronic health record of a Singaporean from birth to school, work and through retirement in a holistic way?
The second clarification is on promoting healthy eating habits. How can we help low-wage and vulnerable workers eat healthily, to have better healthy options for choice, if the cost of healthy choice options is rather high at workplaces or in industry sectors?
The third clarification is whether the Minister would consider reviewing the MediSave withdrawal limit, especially on flexi-MediSave capped at $200, so that those affected patients who are seeking specialist treatment can better manage their chronic disease or illness.
Lastly, would MOH revive or further explore the possibility of a portable medical benefits scheme which employers can offer workers in the early stage of employment so that workers can carry with them the medical benefit plan even if they were to be retrenched or lose their jobs?
The Chairman: Please keep replies short and succinct as well. Thank you very much. Who is going first?
Mr Gan Kim Yong: Madam, yes, I will try to keep it short. I had been working with the unions and the employers' group when I was in the Ministry of Manpower, to look at the portable medical benefits, and I continue to do so after I have moved over to MOH. I am very supportive of these portable medical benefits and I think it is a great thing. The most portable medical benefit is really MediShield Life. I would encourage employers to think about helping their employees with their MediShield Life, either by topping up their MediSave so that they can use their MediSave top-up to pay for the MediShield Life premiums, or purchase IPs for their employees. These are possibilities, and we do have tax incentives for them. They can claim up to 2% tax deductions for the cost of the portable medical benefits.
I will now ask my colleague, Minister of State Chee Hong Tat, to talk about MediSave withdrawal limits that the Member has asked about, as well as healthy eating habits, how to help the low-wage workers.
On the health records from birth to school, adult and retirement, we have introduced an app called \"My Health Hub\" which draws data from your personal health records, including your screening and vaccination records from birth to the end of life. So, I would encourage you to download this app which you can carry in your handphone and it is available to you 24/7 all the time. It is something that we are working on and we will continue to enhance this app. This is just a pilot application and it is still at the beta stage. We encourage you to download it, use it and let us have your feedback on how it is working and we will continue to enhance its features to make it useful for individuals. We want to use this to empower our individuals to lead a healthy lifestyle.
Mr Chee Hong Tat: Mdm Chair, I will answer the question on how to encourage our workers to eat healthily, especially our low-wage workers, and also the other question about MediSave.
First, on eating habits. Indeed, we have to find ways to make healthier food options affordable. There are different ways of doing this. In some of the institutions and companies, in their cafeteria or canteen, they do offer healthier options. When I visited Khoo Teck Puat Hospital, they were showing me the food court. They do a few things. First is pricing. If you eat brown rice, it is cheaper than if you eat white rice. It Is not the case in all places, but at the food court in Khoo Teck Puat Hospital, that is the pricing incentive that they give to encourage people to eat healthily. They also give a discount if you order drinks with less sugar. If you order kopi-C, it is more expensive than if you order kopi-C xiu dai, and it is more expensive than if you order kopi-C kosong. So, they try to find different ways to nudge people to eat healthily.
They also use design to try and place the different food items. So, this is not just pricing. It is also about how you encourage good behaviours, eating habits. The economic rice stall, for example, they will put the healthier options at the beginning of the queue, so that when you choose these options, by the end of the queue where some of the less healthy foods are, your plate would be full and, therefore, you may not have as much incentive, desire or temptation to order the less healthy food.
Through this combination of ways, they are trying to help the visitors, patrons and also their own staff to eat more healthily. We need to work with employers. We also need the help of the unions and our Labour Movement to help us to work together to try and encourage all Singaporeans, including our workers, to eat healthily.
Ms Thanaletchimi also asked about MediSave. Today, we have a withdrawal limit of $400 per person for management of chronic diseases. In 2014, when we looked at the amount, it was sufficient for the majority of patients. For eight in 10 patients, this amount was sufficient. But in certain cases where the need may be greater, they can actually share with their spouse. So, it is not just your own individual account. You can use it to help your spouse. This also gives greater flexibility in cases where they need a little bit more.
Very importantly, while we look at ways to provide more flexibility through the use of MediSave, we must also bear in mind that MediSave, at the end, is also used for long-term healthcare needs when we grow old. It is used to pay for our healthcare costs and to pay for our insurance premiums, including MediShield Life premiums. So, there is a need to strike a balance. But we will look at ways to try and make it flexible for people to use and to keep the cost affordable for chronic disease management.
The Chairman: Mr Leon Perera.
Mr Leon Perera: Madam, just two brief clarifications and I will keep it short. One, for the Minister, is whether the Ministry will consider the suggestion I made to publish the waiting times separately for walk-in versus appointment for polyclinics, and to lower the key performance indicator from 100 minutes to 45 minutes.
My second clarification point is to Minister of State Chee Hong Tat regarding the outreach efforts to companies through health talks and healthy living promotion. One of the best ways to reach out to adults is through their employers. I know HPB does programmes, such as screening and talks, with large employers. But the SMEs often get left out. What more will HPB be doing to reach out to SMEs to conduct this kind of programmes, perhaps working together with the trade associations and chambers?
Mr Gan Kim Yong: Madam, I may take a little bit longer. Usually, I try not to reject ideas and suggestions, so we will consider Mr Leon Perera's suggestion carefully and see whether we could enhance our indicators and publish the wait times for both appointments and walk-ins.
In saying that, I should also clarify that in the primary sector, such as polyclinics that the Member was referring to, we have more critical issues at hand because we are in the process of restructuring the whole primary care sector, as Dr Lam has outlined. Over time, we should look at primary care not just between polyclinics and GPs. In primary care, polyclinics and private GPs should work together. We have also introduced Family Medicine Clinics which are still in the pilot phase. We have six or seven of them and we hope to expand and have more. They play a very important role.
We are in the process of restructuring and revamping the primary care sector. Our indicators and performance targets have to be in line with the new model that we are evolving. We will take on board the Member's suggestion and study very carefully but, at the same time, bear in mind that the sector is going through a transformation.
This is not just between polyclinic and GPs. We are also trying to integrate SOCs with primary care, so that we minimise the need to refer cases to the SOCs and to also facilitate discharge of SOC patients to primary care, so that they can be taken care of in a primary care setting.
One example is orthopaedics. In orthopaedics today − I think Dr Chia Shi-Lu would be very familiar with − primary care and polyclinic patients cannot have direct access to physiotherapy without being referred to orthopaedic specialists because we are concerned about the missed-diagnosis. But we have developed protocols to facilitate primary care doctors to make a preliminary diagnosis and, in many cases, you do not require the services of a specialist and you can refer patients directly to a physiotherapist.
This is still at the pilot stage. We want to try it out to see whether this works well for us. If it does, we will encourage more in the primary sector to take on this responsibility.
In doing so, you will find that between GPs and polyclinic, between primary care and specialist care, it is going to be more and more integrated. The indicators that we use will also have to take that into account. How do we measure the outcome, not in a segmented way, each individual department's or setting's performance, but an integrated performance measurement? It is something that is evolving, and we will consider the Member's suggestions and incorporate some of them.
The Chairman: Dr Lily Neo.
Dr Lily Neo: Mdm Chair, one clarification, please. Madam, may I first declare that my two children are doctors with MOH.
My clarification is on the expansion of healthcare demand which the Minister spoke about earlier. May I ask the Minister whether he will prioritise the traineeship of Singapore Core doctors? Are there sufficient resources given to this area? For long-term benefits and future needs, will the Minister not curtail, for whatever reasons, the specialist training of local doctors? May I also ask how many private specialist doctors are being employed in our public hospitals and is it not better to train our local doctors to fill these positions rather than employing foreign specialist doctors in our public hospitals?
The Chairman: May I remind Members that we only have two minutes left.
Mr Gan Kim Yong: Madam, I will keep it short. Our priority is to train our own doctors, to provide them with opportunities to go into specialist training if they are able to. But we do also want to ensure that there are sufficient numbers of local doctors that go into family medicine because family medicine is going to play an increasingly important role. As I explained just now, family medicine will play a very important role in our review of primary care. Therefore, we want to encourage our doctors to pursue further education, both in specialist as well as family medicine training.
Having said that, despite the expansion in the pipeline, expansion in our training capacity, we will still need to look at the need of supplementing our local manpower with foreign trained manpower. The first part of foreign trained manpower is our own Singaporeans who are trained overseas. We have a lot of programmes to reach out to them, including our Pre-employment Grant (PEG), where we work with our students who are receiving training overseas to attract them back to Singapore to serve in our public sector.
Our greatest allies are the parents because the parents do want their children to return. So, we work with them to bring them back. I have one parent who came to me to say, \"Can you please give my son the PEG? I will fund you, but make sure he signs the contract to come back.\" We do go out of our way to reach out to them, engage them, provide them with the opportunity to return. In between their studies, if there are opportunities, we will also want to bring them back for internship, training and so on, so that they remain connected to Singapore. We hope to be able to do more of this, going forward.
The Chairman: End of clarification time. Do you wish to withdraw your amendment, Dr Chia Shi-Lu?
Dr Chia Shi-Lu: Mdm Chair, I would like to thank all Members who have contributed to the lively and considered debate. I am certain the feedback and suggestions will be useful as we work to strengthen our healthcare system. On behalf of Members, I would like to thank the tireless staff of MOH and, of course, Minister Gan, Senior Minister of State Amy Khor, Minister of State Lam Pin Min and Minister of State Chee Hong Tat for their meticulous replies and clarifications. I would be very happy to proffer them all a cup of teh-O kosong or kopi-O kosong for all their efforts! So, Mdm Chair, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $9,202,218,100 for Head O ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $1,797,678,900 for Head O ordered to stand part of the Development Estimates. (proc text)]
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 at 4.05 pm.
Sitting accordingly suspended
at 3.45 pm until 4.05 pm.
Sitting resumed at 4.05 pm
[Mdm Speaker in the Chair]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Committee of Supply – Head U (Prime Minister's Office)","subTitle":null,"sectionType":"OS","content":"[(proc text) Debate in Committee of Supply resumed. (proc text)]
[Mdm Speaker in the Chair]
Mr Ang Hin Kee (Ang Mo Kio): Mdm Chair, I beg to move, \"That the total sum to be allocated for Head U of the Estimates be reduced by $100.\"
Many Singaporeans have high expectations of the quality of service delivery by our public officers. There has also been greater emphasis on whole-of-Government coordination and no-wrong-door access for public enquiries and requests for service.
The Municipal Services Office (MSO) is one such targeted effort by the Government to coordinate and ensure smoother delivery of municipal services, as well as to make public service more citizen-centric.
Besides MSO, officers in the Public Service, especially those doing front-line work, should be equipped with the right skills and competencies to deliver good service. At the same time, there should be developmental opportunities for service staff so that they can acquire and broaden their capabilities and be specialists in these areas.
With rising expectations on the Public Service to better serve Singaporeans, how is the Public Service Division preparing public officers to help them continue to deliver quality services and continually seek to improve their service delivery? Is there a recognisable training and competency framework targeted at enhancing service delivery? Can the officers look forward to clear career progression pathways for service-related and frontline jobs within the Public Service? Are there also plans to leverage technology to spearhead innovative service initiatives to augment service delivery format?
I also want to urge the Prime Minister's Office (PMO) to continue with its efforts to protect our officers from abuse and unfair treatment meted out to them by the public. The few offending members of the public can cause great distress to the officers and further delay others from receiving the same type of services. We must do our best for a more cordial engagement between our Public Service officers and members of the public.
[(proc text) Question proposed. (proc text)]
Mr Seah Kian Peng (Marine Parade): Mdm Chair, it was recently reported that a nurse was kicked in the chest by a patient that she was trying to help. Because it is a patient, the burden is placed on nurses, that we are supposed to \"take it in our stride\", that we ought to be long-suffering in these matters. Imagine how this would play out in the social media if a nurse had tried to defend herself physically against an attacker. But we must bear in mind that physical abuse by anyone is not acceptable.
This same asymmetry applies to the poor, the needy, residents and anyone, indeed, whom the public officers are trying to help. They are the customers and they are always right. That they are the Davids against the Goliaths of this world.
It is estimated that 70% of healthcare professionals here have faced physical abuse. What does that say about our patients and the family of our patients? Being sick does not entitle one to be violent or disrespectful. But how many nurses can say this to their patients?
I believe there is severe under-reporting. In reply to my Parliamentary Question earlier, Deputy Prime Minister Teo Chee Hean has said that among the restructured hospitals, there were 31 reported cases in 2013 and 34 cases in 2014.
Let me take this into the Public Service as a whole. In this, the public servants cannot be ignored. We need to continue identifying, assessing and mitigate the factors that lead to abuse, to bring about a safe workplace for our public officers. Can the Minister let me know if there has, indeed, been a rise in occurrences of abuse or harassment towards public officers, especially frontline staff?
The Public Service is the backbone of the provision of all services to Singaporeans. We should respect public servants and protect them from abuse or harassment. Other than criminally prosecuting the perpetrators, I feel that non-confrontational styles of approach can be taught to Public Service workers to respond adequately to these occurrences before they turn into offences.
Have we trained staff to recognise early stages of occurrences and alert them to potentially abusive intent? Are staff already trained in any security measures or devices to alert fellow workers?
I know there are closed circuit television (CCTV) cameras installed in many places now, partly to provide monitoring capabilities, but also to provide evidence for \"just in case\" moments. In many places, CCTVs are now the bastion between behaving decently and terribly. I have no policy fixes, and CCTVs or body worn cameras are a poor substitute for basic courtesy. But if they are necessary and they help the public officials, I say, go ahead, let us have more of them.
I know of many public servants serving on the frontline, residents and friends alike. They have felt that incidents of verbal and physical abuse towards them are on the rise and this is, indeed, worrying in spite of efforts to mitigate them. What else can be done to support their needs?
The Chairman: Ms Jessica Tan; not here. Mr Liang Eng Hwa.
Mr Liang Eng Hwa (Holland-Bukit Timah): Mdm Chair, several reasons led to the decline in the number of professional engineers in the Public Service.
Among others are the increase in the outsourcing of engineering services over the years, the privatisation of Government engineering units into commercial entities and the change in the way the Government functions; moving away from paddling to steering, to borrow a boating analogy.
While I can see the merits of outsourcing and the hiving off of engineering units as private entities, I believe the Public Service still needs to retain a high level of engineering capabilities and core competencies.
Whether it is in the administering of engineering projects, contract management, regulation, technical grants allocation or even policymaking with regard to very technical areas, such as automation and robotics, the Public Service clearly needs to possess key domain expertise to carry out the functions of the Government. The Government must never be in a position where it is overly dependent on the private sector for engineering advice and loses its ability to do internal engineering appraisals.
We need to attract and recruit more engineers into the Public Service and to ensure that the fresh cohorts of younger engineers continue to be inducted to succeed the retiring engineers so as to strengthen the organic capabilities. Anecdotally, when I interact with many public sector engineers, it seems that there are more white-hair engineers now. It seems that the professional engineers in the public sector are ageing.
Here, I would like to make a special mention of two very competent and experienced senior engineers that I have the pleasure of working with in the Government Parliamentary Committee for the Environment and in my constituency work.
They are Mr Tan Nguan Sen and Mr Yap Kheng Guan from the Public Utilities Board (PUB). Both men and many other engineers in PUB epitomise the passion and competency of PUB engineers as well as the deep expertise they have on how to sustain Singapore's self-sufficiency in water resource. It is always a reassuring experience whenever I seek assistance from both of them on constituency-related engineering problems. They show deep knowledge and experience on PUB-related matters and will always offer good practical solutions to local problems.
I hope that the Public Service continues to bring about such passionate, resolute and capable engineers to the ranks and inculcate in them the pioneer values and the can-do spirit to turn our vulnerability or whatever adversity we encounter into strengths.
I have a few questions for PMO. How is the Public Service growing its engineering capabilities and developing its engineering workforce in the years to come? Are there fulfilling career paths for public sector engineers and are they competitively compensated?
Given that the Public Service has outsourced and already privatised many of its engineering activities in the past, will there be sufficient engineering jobs in the public sector and where are the areas of growth?
Er Dr Lee Bee Wah (Nee Soon): Mdm Chair, when I entered university in 1980, engineering was a much sought-after discipline. Top science students either studied medicine or engineering. Many of my seniors proudly told me their contribution and involvement in our nation-building. They practically helped build Singapore.
As Singapore enters the next lap of its nationhood, do we still have passionate and committed engineers? We will need many computer engineers and information technology (IT) experts to make us a Smart Nation. We need engineers to develop robots. We need engineers to keep our Mass Rapid Transit (MRT) system, airport and seaport working in tip-top conditions. We need engineers to build smarter homes, clean supply of water and even security system for protection of our country. In fact, it is estimated that half our economy relies on inputs from engineers.
Do we have enough engineers to bring our nation to the next level? Unfortunately, the answer is no. In 2015, among the top 10 jobs that went unfilled for six months, four were engineering related.
Our engineering faculties are unable to attract enough locals and have to fill the vacancies with foreign students. In fact, one local student was joking: whenever he says that he is from engineering, he has to quickly specify he is Singaporean, otherwise people will assume he is a foreigner. How did the situation get so bad?
First, there is the perception that studying engineering is boring and tough. Students have to slog long hours. Next, is the remuneration. Those engineers who have accountant, lawyer or doctor wives told me that their wives earn more than them. Hence, many left their engineering career.
Many also feel being an engineer is tough. Not only do they have to spend long hours in their job, there is also the feeling that when things go wrong, everybody blames the engineers. When things go right, they are forgotten. There is no recognition. In fact, there is a saying: a scientist can fail all his life. He just needs to have one success to win the Nobel Prize. Whereas engineers you have to do it right all your life. You just need to have one failure to end up in jail. Jin bo hua, or not worth it.
It is timely for our Government to relook into the pay, career path, jobscope and recognition of engineers in the Civil Service. To maximise the Government's efforts, I urge the Government to also influence the private sector through the contracts it awards. When asking for engineering-related tenders, instead of simply award to the lowest, the engineering innovation and local Singaporean Core workforce should carry much higher weightage.
The Chairman: Mr Cedric Foo; not here. Mr Patrick Tay.
Mr Patrick Tay Teck Guan (West Coast): I am glad when Deputy Prime Minister Teo Chee Hean recently announced that the Government is hiring 1,000 engineers for the public sector. Can Deputy Prime Minister Teo share with us which Ministries and Statutory Boards these 1,000 jobs come from? Also, what kind of engineering jobs are these? What levels of the hierarchy are these jobs and what are the skills and experience required? I also hope the Deputy Prime Minister will look at the career progression of engineers, both current and future, in the public sector and beyond, and how we can upgrade them.
We need to ensure that the public sector is able to attract and retain the best engineering and technology capability. What investments is the public sector making to attract, develop and retain these talents? This is critical in giving the increasing role that technology is playing in all aspects of our economy, society and life, and our focus towards a Smart Nation. What efforts and plans does the public sector have to ensure we have both the skills base and capacity to support the transformation of Singapore towards a Smart Nation?
The Deputy Prime Minister and Coordinating Minister for National Security (Mr Teo Chee Hean): Mdm Chairperson, first, I would like to thank Members for their interest in and strong support for the Public Service. The Public Service has continually reviewed and reorganised itself to be ready for the future.
Last July, we set up the Strategy Group under PMO. It is headed by the Head of Civil Service. Its role is to identify emerging priorities early and tackle medium- to long-term issues. The Strategy Group looks at the impact of future trends on our external and domestic environment, the policies we might need, and the capabilities we need to build in Government to address the challenges. It has also coordinated the plans and programmes across Ministries to set out the policy agenda for this term of Government.
This year, we are reorganising four Statutory Boards to deepen capabilities and better tackle emerging challenges. SkillsFuture Singapore (SSG) and Workforce Singapore (WSG) will support our citizens in acquiring useful skills to remain employable. The Info-Communications Media Development Authority (IMDA) will develop and regulate the converging info-communications and media sectors in a holistic way, while the Government Technology Agency (GovTech) will transform Government services using technology. These changes allow the Public Service to develop and deliver better policies, services and programmes for Singaporeans.
Mr Ang Hin Kee asked about our efforts to deliver good services to citizens. Our public agencies have made progress in working together to serve Singaporeans better. For example, the 24 Social Services Offices (SSOs) under the Ministry of Social and Family Development (MSF) partner other public agencies to offer integrated services. Members would know that when a family needs temporary financial help, housing rental assistance and employment assistance, they can go to the nearest SSO, which will coordinate with the Workforce Developement Agency and the Housing and Development Board (HDB) to provide this help in a holistic way.
At the Ministry of National Development's (MND's) Committee of Supply debate, Members were updated about the work of the MSO to improve the coordination and delivery of municipal services across public agencies.
The Ministry of Finance also highlighted recent e-initiatives by several Ministries during its COS debate. We will continue to use technology more effectively to enhance the delivery of Government services, for example, by making more services available online and on mobile platforms, so that they are accessible at any time, from anywhere. This recently has been tax-filing season, and many Members would have filed their taxes. The Inland Revenue Authority of Singapore (IRAS) has quite an efficient system to make paying taxes as painless as possible. Never a pleasure, but, at least, as painless as possible.
We are also doing more to communicate Government policies and programmes in a simple and clear manner. For example, our Pioneer Generation Ambassadors go door to door to help our Pioneers and their families better understand how they can benefit from the Pioneer Generation Package and MediShield Life by using different languages and dialects most comfortable to our Pioneers. The Central Provident Fund (CPF) Board has added an illustrated summary in CPF members' annual statements so that we can see at one glance our own CPF contributions, account balances and transactions. CPF Board also provides personalised financial tips on retirement planning targeted at different segments.
Mr Ang Hin Kee also asked about our plans to help our public officers do a better job at the frontline. In line with SkillsFuture, we will continue to raise the skills of all our public officers and provide them with learning and career development opportunities. This applies to our frontline service officers as well. We have developed a service competency framework to spell out the skills that our frontline service officers need. These include partnering members of the public to address concerns and working across organisations to manage cross-cutting issues. For a start, five public agencies – CPF Board, HDB, the Immigration and Checkpoints Authority, National Environment Agency and National Library Board – have adopted this service competency framework.
We have also provided additional learning and development opportunities for service staff to acquire these skills. For example, the Civil Service College runs a suite of programmes for service staff and these service staff come from different levels of responsibility. Some of these modules count towards a UniSIM certification programme in public sector service management. Officers can also use these credits to count towards a minor in public sector service management from UniSIM, if they wish to pursue a degree. This helps to raise the professionalism of the service role and provides avenues for our officers to deepen their knowledge and skills. The Public Service Division (PSD) is also working with agencies to develop competency-based service career paths and introduce more leadership positions for service professionals.
Besides upskilling individual officers, agencies are also improving their organisational ability to improve service delivery and this includes integrating key components of service delivery, such as customer experience, data analytics and operations planning. This helps our agencies to serve Singaporeans more effectively.
Mr Seah Kian Peng and also Mr Ang Hin Kee asked about harassment towards public officers and the measures to protect them. The Public Service is committed to providing good service to the public, based on the principle of mutual courtesy and respect. Indeed, the vast majority of the many millions of transactions between the public and our officers take place in a courteous and professional manner. In 2015, there were 437 cases of hurt or verbal abuse against public officers that were reported to the Police. As mentioned during the Ministry of Home Affair's COS debate, 344 of these were from the Home Team agencies. So, we have to take this in perspective. The remaining 93 were from other public agencies. This is a very small proportion of the millions of interactions between public officers and members of the public every year. However, we take each of these cases seriously and will take a very firm approach to those who hurt or abuse our public officers.
Agencies have already taken steps to protect our officers and prepare them better for their public-facing roles. For example, officers with frontline responsibilities are trained to manage difficult situations. Our agencies have also established safe work environments that encourage positive interactions with the public, for example, by installing CCTVs at service counters, assist buttons for the service staff and, for those who are on the move, body-worn cameras. We also display service charters at many of the service counters so that the expectations that the public bring and our frontline officers have, are better matched.
Where the facts justify this, we will take legal action against those who abuse public officers in the course of their duties. The Protection from Harassment Act which came into effect in November 2014 provides for stiffer penalties against such perpetrators. But I would emphasise that we will do so only when the facts of the case justify this. And we will and must continue to promote a culture of mutual courtesy and respect. As Mr Seah Kian Peng says, it is more developing this culture than laws or sanctions or body-worn cameras or CCTVs. It is this culture of mutual respect and courtesy that we should make the norm in Singapore.
Mdm Chairperson, I will now answer Mr Patrick Tay, Mr Liang Eng Hwa and Er Dr Lee Bee Wah's questions about our plans to build up engineering capabilities in the Public Service. This is an important area, as we depend on science and technology to overcome our resource constraints, such as water and land. These constraints will bite even more in the coming years once the climate change agreement takes effect. So, we will have to make sure that what we do is, indeed, sustainable from a carbon emissions point of view.
We will need to use technology more strategically in the next phase of Singapore's development in infrastructure, housing and transport to make Singapore a highly liveable and desirable city, to make full use of the revolution in info-comms technology to improve business efficiency and public services, and to protect our people and our country.
Our water story is well-known. So, I will use land-related examples today of how science and technology have played a role in our development. Our geotechnical engineers built the world's first large-scale Underground Ammunition Facility, which opened in 2008, and it freed up space above ground for other uses. The professionalism and thoroughness of the analysis, design and testing by our engineers have been internationally recognised. The safety standards developed by our engineers for underground ammunition storage have been adopted by the North Atlantic Treaty Organization (NATO) as the standard.
In 2014, we opened the Jurong Rock Caverns, Southeast Asia's first commercial underground liquid hydrocarbon storage facility on Jurong Island. There are nine storage galleries with a total capacity almost 100 times the size of this Parliament Chamber. So, each storage gallery is about 10 to 11 times the size of this Parliament chamber and it is about 130 metres under the seabed. Today, our engineers are looking to further exploit underground spaces, such as the feasibility of an underground reservoir.
The Singapore Land Authority, National Research Foundation, and GovTech are working together on Virtual Singapore, a dynamic 3D city model and collaborative data platform with 3D maps of Singapore. With a diverse range of realtime and static data, this platform will allow authorised public and private users to run simulations, plan new infrastructure, design new solutions, in line with our Smart Nation vision.
We will need more engineers in the Public Service to drive these efforts. I spoke about building up engineering capabilities across the Public Service at the Institution of Engineers in February and will provide more details today.
First, the Public Service will employ an additional 1,000 engineers this year, which will grow our current pool of some 7,700 engineers by more than 13%. About 70% of these 1,000 additional engineers will support our infrastructure development needs, including transport and water systems. The rest will support our Smart Nation efforts. Public agencies are also now in the process of studying their medium-term engineering manpower needs and are working towards building up a sustainable pool of engineers in key engineering clusters in the Public Service.
Second, we will raise the salaries of our public sector engineers to attract and retain engineering and information and communications technology (ICT) officers in the Public Service. Salaries for engineers and ICT professionals vary across different public agencies today. Some of our agencies are already paying salaries that are largely competitive with the market, while the salaries in other agencies lag significantly. We will review our salaries regularly to ensure that they are competitive with the market. In specific areas, we will pay a premium for engineers with skills that are in high demand and short supply, such as cyber forensics and malware analysts, or those with niche skills that are critical and specific to the Government but for which there may be little market demand. But we still need them and they are critical to us.
Taking reference from the market starting salaries of good engineering graduates, we will set the salaries for good engineers joining the Public Service upon graduation starting from $3,800 per month and those in ICT starting from $4,000 per month. This means an increase in starting salaries, on average, of about 20%.
We will also review the salaries of our serving engineers and raise them where needed, to ensure that public sector engineering salaries remain competitive at every job level and not just at the starting level. Agencies will implement new starting salaries and make the necessary salary adjustments from the middle of 2016.
But improving pay is not enough. So, third, we will offer our engineers good learning and development opportunities to build deep technical expertise throughout their careers. We will start by developing competency frameworks for engineers from seven public agencies, such as PUB and HDB, in the second half of 2016. This framework will articulate the knowledge and skills that our public sector engineers require as they progress in their careers. Our engineers can use this framework to identify their own training needs and develop expertise and mastery in specific areas. So, we hope to have many more engineers of the type that Mr Liang Eng Hwa talked about – people who love their jobs, who thoroughly know their jobs, and who can serve the public very well.
In addition, we will build on existing programmes that agencies have in place for technical specialists and make a more concerted effort to identify and develop engineers with deep technical expertise to take on key scientific, engineering and technical leadership positions in Ministries and public agencies. They will be given greater support in their career development and growth, for example, mentoring by senior technical experts, working on exciting interagency engineering projects, and networking across the engineering community.
Through such training opportunities and exposure, good public sector engineers will be prepared to take on positions, such as Chief Engineers, Chief Technology Officers and the like, in the Public Service. We will be expanding the scope of some of the existing technical leadership positions in our agencies and creating more new ones. These technical leaders will champion R&D efforts to develop new solutions, improve performance and service, and help build deep technical expertise in key capability areas. They will act as the bridge with industry and research partners to supplement public sector engineering expertise and help our Ministries and agencies use technology strategically for the future.
Fourth, we will establish Centres of Excellence for key engineering knowledge clusters, building them around agencies which already have a strong base of engineering capabilities. These centres will aggregate key capabilities and build deep engineering expertise in critical areas of need. They will support other Government organisations, optimise scarce engineering resources and invest in R&D to build cutting-edge engineering expertise.
We have established three such Centres of Excellence: (a) JTC: for infrastructure projects and facilities management services, and R&D in innovation, safety and construction productivity; (b) Defence Science and Technology Agency (DSTA): in the areas of sensors, robotics and the integration of command systems, to boost our Smart Nation efforts; and(c) GovTech: for the digital transformation of the public sector, including nurturing ICT officers, to improve the delivery of public services for Singaporeans. We are in the process of establishing other Centres of Excellence in geospatial information science and cybersecurity.
Taken together, these measures will attract more Singaporeans to take up engineering as a meaningful, fulfilling and exciting long-term career in the Public Service and deepen our public sector engineering capabilities over time.
Mdm Chairperson, let me take this opportunity to thank Members again for their support for the Public Service. Our public officers have worked closely with Singaporeans to contribute to nation-building in our first 50 years. To ensure that the Public Service remains ready for the future, we will continue to identify key priorities early and invest in strengthening the capabilities of our officers in new and important areas, such as emerging technology, data analytics, leadership skills, service management and public engagement.
Beyond skills and capabilities, our officers must have the heart and passion to do their best for Singaporeans and Singapore, to derive their satisfaction from seeing other Singaporeans happy and fulfilled. Our Public Service values of Integrity, Service and Excellence provide an anchor for our officers as they carry out their duties every day. I am confident that our public officers will continue, with your support, to work hand in hand with Singaporeans to build an even better Singapore in the future. [Applause.]
The Chairman: Ms Sylvia Lim.
Ms Sylvia Lim (Aljunied): Madam, according to the Corrupt Practices Investigation Bureau (CPIB), Singapore is one of the least corrupt countries in the world. The number of corruption cases registered for CPIB investigations is at 30-year lows. This, the CPIB says, is testament to Singapore's continued vigilance, commitment and zero-tolerance approach in our fight against corruption.
While CPIB's low caseload is one thing, it seems that, internationally, there are some doubts as to whether we have been as vigilant and intolerant towards corruption as claimed. In particular, it has been suggested that we have a certain double standard – intolerance towards corruption within Singapore, but permissiveness towards corruption committed abroad.
One of the main factors is Singapore's position as a global financial centre and its reputation for having strong banking secrecy laws that could shield those who have broken laws overseas. Articles have been written, mostly abroad, accusing Singapore of \"asking no questions\" or \"turning a blind eye\" to sources of funds being managed from here.
Since about 2009, the Government has progressively implemented regulations requiring more vigilance, increased reporting and exchange of information with other countries. These are guided by international standards set by the Organisation of Economic Cooperation and Development and the Financial Action Task Force (FATF). For instance, Singapore now has in place some anti-money laundering measures. But how effective are they to prevent the inflow of corrupt monies?
The 1 Malaysia Development Berhad (1MDB) is a case in point. It was reported that the Monetary Authority of Singapore (MAS) is currently probing into 40 banks operating here for possible money laundering offences linked to 1MDB. Concerns have also been raised about locally-based firms, such as Portcullis Trustnet, which purportedly specialise in setting up offshore companies and trusts and hard-to-trace bank accounts in Singapore and other offshore financial centres.
Another weakness in Singapore's fight against corruption from abroad seems to be our lack of extradition treaties with other countries. Is the Government concerned that Singapore's anti-corruption reputation has thus been eroded?
The Minister, Prime Minister's Office (Mr Chan Chun Sing): Mdm Chair, let me answer on behalf of the Prime Minister. We totally agree with Ms Sylvia Lim that while our corruption numbers are low, we must continue to maintain our vigilance. As we always say, \"low corruption does not necessarily mean no corruption\".
The nature of corruption is a constantly evolving challenge and we must always maintain our vigilance. Our reputation for being against corruption is hard fought and hard won but that does not mean that we can let our guard down.
The Member asked about our fight on the financial front. Singapore is well-known for our policy of zero-tolerance against corruption. We have a robust and comprehensive anti-corruption framework. Our Prevention of Corruption Act provides for extraterritorial jurisdiction, such that acts of Singapore Citizens, even if it is done overseas, will be dealt with in the same manner as if they were committed in Singapore.
As an international financial centre, Singapore has an important part to play in the global effort against money laundering, including that related to corruption. MAS has put in place a robust preventive regime that combines tough licensing requirements, strict regulations and rigorous supervision. MAS requires financial institutions here to put in place adequate controls to detect and deter the flow of illicit funds through Singapore's financial system. Financial Institutions are required to report any suspicious transactions that they come across.
Our law enforcement agencies proactively engage their foreign counterparts and investigate both money laundering and related offences when there is sufficient information to suggest that illicit proceeds have flowed into or through Singapore.
In addition, Singapore's Financial Intelligence Unit – the Suspicious Transaction Reporting Office (STRO) – plays an important role in detecting illicit funds entering our financial system. STRO receives and analyses reports of suspicious transactions and other financial intelligence. Where possible offences are detected, STRO disseminates the intelligence to relevant domestic law enforcement agencies and STRO's foreign counterparts. Such intelligence has assisted both local and foreign jurisdictions to bring corrupt persons and other criminals to justice and recover proceeds of crime.
If any Member of the House has any information relating to possible acts of corruption, I would strongly urge everyone to help CPIB by providing such information for us to investigate, so that we can get to the bottom of it.
Mdm Chair, while our ranking is good now, we must never take it for granted. Ultimately, the best test of how good we are and how good our reputation is lies in the fact whether people will put their trust in us, do business with us or place their money here. It is in our collective interest to make sure that we not only maintain our reputation but to continuously strengthen that trust for people to put their assets and intellectual property with us.
The Chairman: Dr Lim Wee Kiak.
Dr Lim Wee Kiak (Sembawang): Mdm Chair, one of the biggest challenges that Singapore will continue to face in the coming years is that of maintaining our population to prevent our population from shrinking. How do we grow our population so that there will always be the numbers to ensure that our Singapore identity, culture and beliefs form the nucleus of the next generation?
Low birth rate is not a problem unique to Singapore alone. Many other developed countries, too, are confronted with this issue. Giving various cash incentives, or baby bonuses, or extended parental leave for parents may help somehow. But we still need more babies to replace ourselves. Thanks to the SG50 \"rah rah\" which brought on a feel-good factor, coupled with enhanced parental perks, 2015 ended with at least 33,793 new babies – the highest in 13 years! This even exceeded the 33,238 births in 2012, the auspicious Year of the Dragon.
As a parent of three growing up children, I know what it is like starting a family and to juggle this responsibility with a career. To encourage young married couples to start a family, we need to adopt a holistic approach with coordinated efforts by a multi-Ministry task force.
Families with both parents working need caregiver assistance to help look after their children. Bringing up a child needs a lot of support and there are some that are fortunate who they can turn to their parents for help. But many do not have that luxury. I urge the Government to do more to assist young parents in childcare, especially in the first six years after birth.
Can the Minister update the House on what is our Government's strategy towards creating a favourable environment for Singaporeans to start families and raise children? Is the offer of monetary incentives the best option? Did the Government do any survey to find out why more couples decided to have children last year?
Mr Vikram Nair (Sembawang): Mdm Chair, as is the case with many developed countries, Singapore faces a declining birth rate. According to the United Nations, Singapore is one of the bottom 10 countries in terms of the total fertility rate (TFR). Our TRF is around 1.25. Many other countries in this group are developed economies, which include Hong Kong, Taiwan and Korea.
On the other hand, the countries with the best TFRs appear to all be the developing world, with Sub-Saharan Africa having nine of the top 10 slots, with TFR greater than six. Are there any lessons we can learn from other countries? There seems to be an inverse relationship between development and population growth.
Amongst the developed countries, there are some that are not doing too badly. I understand France is leading the pack, with a TFR of around two; not quite the same as Sub-Saharan Africa but much better than us. I wonder if there are any lessons that we can learn from developed countries that seem to have been able to deal with the TFR. The best performers, as I understand, are France with a TFR of 2; and Ireland, Iceland, New Zealand, all of whom have a TFR of above 1.5.
The Chairman: Ms Tin Pei Ling, take your two cuts together.
Ms Tin Pei Ling (MacPherson): Yes, Madam. Singaporeans today are sophisticated, well-educated and have diverse and ambitious aspirations. Many look forward to enjoying a good family life while building their careers as well. These are worthy of our support and we must do what we can to support them.
Some young Singaporeans find themselves struggling to balance their roles as a responsible parent and a performing employee, often compromising one for the other. However, parenthood and career-building need not be mutually exclusive.
Beyond Government initiatives, we need a whole-of-society movement to secure a win-win outcome. We, as a society, need to celebrate marriage and parenthood. At the same time, the culture and structure at the workplaces need to also complement such efforts.
For instance, employers should promote fairer appraisal systems that do not mark down mothers or fathers because they had to be taken out of action for a few months or if they took childcare leave. Focus the appraisals on outcomes and the quality of work product.
We should also continue to promote flexi-work: incentivise the use of technology to reduce the need for face time so as to enable working parents to work just as effectively out of the office.
Given the challenges we face and the aspirations of young Singaporeans, could PMO share what is its \"game plan\" in encouraging marriage and parenthood amongst Singaporeans, while not compromising on their pursuit of career aspirations?
And speaking of support for young parents, we have always been talking about infant care and childcare centres, but we know that supply is still chasing demand. Manpower in this area has also been tight and will continue to be challenging. Therefore, I would like to ask if we could have a rethink about how we want to help young working parents in this aspect. Can we consider alternatives other than care centres and family support which not everyone has?
For example, and I have mentioned this before, could we organise and tap on \"informal sources of labour\", such as the nannies and volunteers within the community, to supplement infant and childcare centres? These can be experienced women or we know them as \"aunties\" or trained part-time caregivers who want to take care of infants and children and earn an income at the same time. These potential caregivers may be keen but have not been able to find the families who need them.
The Government can help match demand with supply by creating an online directory to facilitate this. Interested parents who cannot secure a placement at the infant care or childcare centre can look to this platform for potential caregivers within the neighbourhood. Basic profiles and credentials of these caregivers can be published in the directory. Interested caregivers can also be offered a refresher course customised to match their educational background. Given their experience, the course need not be over an extended period and, therefore, their \"time-to-market\" would be shorter. Their completion of such a course or other comparable certification, assuming they attended institutional training, can be published in the directory as part of their credentials.
Parents can browse through the directory on their own and decide for themselves who they want to engage. They can then negotiate the price privately with the caregivers listed. In essence, the directory serves as just a platform for demand to find supply.
As such, could PMO study the feasibility of such an idea and, at the same time, could PMO also share what other solutions it is considering?
Mr Leon Perera (Non-Constituency Member): Mdm Chairperson, our TFR has been declining for several decades and remains low by the global standard of 1.24 in spite of the billions spent on Marriage and Parenthood Packages over the last 15 years or so. The reasons for this and, hence, the policy tools to address this are necessarily complex and multifaceted.
Madam, while some East Asian developed countries have low TFRs, some other developed countries have fared much better, including most of the Nordic countries and the US, at around 1.9. Even Japan and Switzerland are doing better at 1.4 and 1.5 respectively.
There is only so much we can and should do to nudge Singaporeans to marry and have babies. Perhaps, our focus can be on encouraging those parents who do have one or two children to have more. In this regard, I think policies to ease the difficulties of having more children when one already has some, infant care and access to childcare, in particular, may be crucial. When a family already has one or two children, the logistical issues of having a third child or fourth child tend to weigh heavily.
Other countries do have programmes where the states sponsor some parents in a particular neighbourhood to provide quasi, informal child and infant care to their neighbours, as in Denmark; or sends part-time helpers to help mothers with new-borns to cope for a month or two, as in France.
In the Singapore context, the key may be to ensure there is enough infant and childcare capacity in the estates and towns with many young couples, building infrastructure ahead of demand, as it were. While there may be sufficient childcare capacity nationwide, it is unevenly distributed, as has been discussed in the House this year. This should be tracked very closely.
There is also scope to experiment with the Danish model of private child-minders in specific blocks, precincts or estates. I hope this is something we can look at seriously, taking a whole-of-Government approach.
Mr Louis Ng Kok Kwang (Nee Soon): Madam, taking care of your child in Singapore is no easy task, coupled with the fact that many households in Singapore are dual income to keep up with the cost of living. As such, taking time off work is considered a luxury by most working parents.
While the Government can encourage extended family closeness by giving out grants and building more 3-Gen flats, it is definitely also important for immediate family members to spend time together and for parents to look after their child when they are sick or in need of help.
As the Government advocates working adults to have a better work-life balance, will PMO consider increasing the amount of extended childcare leave and pegging the amount of extended childcare leave to not only the age of the child, but also the number of children one has?
Ms Sun Xueling (Pasir Ris-Punggol): Mdm Chair, I still remember when I mentioned among colleagues my desire to start a family, a senior woman executive's first response had been \"But why?\" To which I answered, \"Why not?\" And then she said, \"The correct question should be 'But why?'\" This conversation stuck in my mind and, as I pondered what we can do to promote parenthood, I realised the drivers behind her question.
With growing gender equality and the ability for women in Singapore to self-actualise through their careers, the perceived downsides to parenthood are immediate and quantifiable − time and effort to take care of one's children, potential impact on one's career, and that is not counting stretch marks and potential weight gain from pregnancy − while the benefits or joys of parenthood seem vague in comparison.
How then do we make the positives more apparent and parenthood less daunting? While the Government pushes out policies to help with the costs of raising children, if we look around us, even those who can afford to have children are not having children. So, targeting costs, though key, is but one way of lowering the threshold for those considering to have children.
We talked of a whole-of-Government approach to promoting innovation and a business-friendly environment. Can we consider a whole-of-society approach to promoting parenthood? For instance, at the corporate level, while we acknowledge short-term changes in work arrangements due to maternity leave, can we ensure that our human resource processes are such that there is proper communication with new mothers so that they do not feel that they are penalised for having a baby.
Second, at the community level, can we develop more child-friendly community spaces, for instance, indoor playgrounds, where parents can have a cup of coffee as they watch their children play, or nursing rooms and baby-changing rooms decorated to be a little haven for parents and children, with soft music and alluring hues?
Young parents can be made to feel special and not so alone in their endeavour. We have set aside resources to develop trade associations and chambers to encourage industry self-help and transformation. Can we put in resources to promote self-help groups for young parents, from promoting breastfeeding to use of online resources to organise play groups and make possible voluntary child-minding arrangements for young children?
Parenthood should be celebrated. We have joined the parents' club. If we can change mindsets towards parenthood, hopefully, the question will be \"Why not?\"
Mr Alex Yam (Marsiling-Yew Tee): Mdm Chair, today, family life is seen to intrude on life itself, that marriage and parenthood are seen as unnecessary obligations that are impediments to personal growth and space.
Societal views do not help – we idolise the successful, we individualise the achiever, we are motivated to be the first to reach the finishing line, preferably alone. We do not celebrate family enough, not in the same way we celebrate individual success.
Since 2001, we have committed billions of dollars in our Marriage and Parenthood Packages. If there is one thing we have learnt, money is not the motivating factor. In fact, I am uncomfortable even with the term \"baby bonus\". The baby itself is the bonus, a bonus from a happy marriage that forms the basis for joy and hope in family life.
The top-ups, bonuses if we have to call them that, help, but they can never be the motivation for having children. To support that, the whole society must undergo de-evolution, to return to our focus on the family as a core unit of the nation, that children complete us, not conflict with us.
As they say, it takes a village to raise a child. In metropolis Singapura, the kampung network of support has slowly faded away. Even at our workplaces, those on maternity leave are sometimes vilified, shunned and demotivated by unsupportive employers and co-workers. Motherhood, that most noble of vocations, is debased as a burden on the bottom line, a weighty problem for progress.
One employer recently complained to me: \"Your zheng hu (government) keeps extending this leave, that leave. Very soon, everyone on leave, I have to leave the business and my business will zup lup (close down).\"
Well, the question is: has any company actually zup lup because of pro-family leave policies? The laws of probability are more than likely to prove otherwise. So, perhaps it is time for us to stop making excuses.
I welcome the legislating of the two weeks' paternity leave. For those who feel that this and our maternity leave are too generous, I think it bears reminding ourselves that not too long ago, our own mothers would not have had maternity benefits. So, we should advocate the impossible and dream the improbable as, in one generation, we have achieved much in changes to our pro-family policies.
Fathers should also be encouraged to play bigger roles not because they want to but because they should. Charles Ballard, an American fatherhood advocate, described fatherhood as such: \"Have no fear. It isn't easy, it's the hardest thing you'll ever do and you would probably feel very, very lonely but know that you make a great difference.\"
Fathers should not be seen just as breadwinners. They should be encouraged to have shared parenthood responsibilities. For that to happen, society and infrastructure must change. The worship of male machismo must be replaced by respect for fathering. As a father myself, I have faced many logistical nightmares when heading out with my boys. I have even changed nappies on my knees in the toilet for the lack of facilities for fathers. Usually, they are in the female toilets. In some places, even brand new baby rooms are perpetually locked up. When I ask why, the answer is, \"prevent abuse\". So, why build the baby room in the first place?
We should work with the Institute of Architects, the Building and Construction Authority (BCA), the Real Estate Developers' Association of Singapore and even legislate requirements for new commercial buildings to provide family-friendly facilities in the same way we enforce barrier-free access. Encourage employers to set aside proper nursing rooms for mothers, too.
On that, breastfeeding, the benefits are undeniable. But this most natural of instincts seems to sometimes illicit fear and revulsion even amongst members of the public. We, on the one hand, allow the disgraceful debasement of the female body and yet, we cry foul when half a bosom is exposed by a nursing mother.
Single mothers received a much welcome boost yesterday. Their children deserve the same start as others. I, therefore, echo the call by Mr Christopher de Souza to correspondingly strengthen our adoption framework to allow those conflicted about the future of their children to know that adoption into a caring family is an option. While we spend billions on encouraging couples to have babies, why do we not do something for those already conceived?
Mdm Chair, my wife and I were devastated when we lost our first child. It felt like that one piece of the puzzle that would have made this mosaic complete was missing. But we have been blessed. We now have two wonderful young boys. I will be the first to say that, along the way, with joy comes responsibilities and lots and lots of hard work. I would not give that up for anything in this world. We will regret not having spent enough time with our children and not the other way around.
Mr Melvin Yong Yik Chye (Tanjong Pagar): Mdm Chair, in 2014, Singapore witnessed the highest number of marriages since 1997, where over 24,000 marriages involving at least one citizen were registered. We also welcomed more than 33,000 Jubilee babies last year as we celebrated SG50. Singaporeans do want to get married. Singaporeans do want to have babies. Can the Government share its strategy towards creating a conducive environment for Singaporeans to get married and have children?
One area which the Government can look further into is housing. Many young couples whom I have spoken to prefer to have their own homes before they get married and have children. However, the average waiting time for a Build-To-Order (BTO) HDB flat is about four years today. On some occasions, this may even stretch to five years.
I think the waiting period for a BTO flat is too long. With our young Singaporeans getting married at a later age, the child-bearing years are also getting shorter. Can the waiting time for flats be reduced significantly for young couples who have registered their marriages?
Also, for couples who are still waiting for their flats to be ready, can they be offered an interim rental flat under the Parenthood Provisional Housing Scheme (PPHS)? Since 2013, what is the average number of applications received from couples under PPHS? How many flats are currently available under PPHS? Can the Government allocate more flats to this scheme, especially in mature estates, so that couples can choose to stay close to their parents living in the same town or near to established infant-care centres?
Mr Saktiandi Supaat (Bishan-Toa Payoh): Mdm Chair, the Government has implemented many measures aimed at lightening the financial implications of having children. I think there must be a balance in the approach so that as we provide support for Singaporeans to go for marriage and parenthood, we do not overlook career aspirations and heartware, such as better family-friendly environment and infrastructure. I agree with the hon Member, Mr Melvin Yong, about the waiting time for a new BTO flat. So, I strongly support the reduction of the waiting time.
The second point I want to raise is that recently, I have resident mothers who approached me to give feedback about the inability to carry baby prams or strollers on board buses with several kids and groceries in tow, and I have personally experienced it with my children as well. Can PMO look into a whole-of-Government approach to improve family-friendly environment and services in our public transport system in the hope of enticing more young parents who have children with ease of family travel and reduce the logistical pains of parenthood whilst on public transport?
For career aspirations, how can we walk the talk to eliminate discrimination in the workplace, in particular, for expectant mothers? Can the Ministry of Manpower (MOM) and PMO explore the possibility to ensure that the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) continues to have teeth to effectively weed out workplace discrimination and advocate fair employment, in particular, for expectant mothers, in the workplace?
Mr Thomas Chua Kee Seng (Nominated Member) (In Mandarin): [Please refer to Vernacular Speech.] Chairman, fellow Members of Parliament, the Government has been enhancing policies to increase the birth rate, including helping singles to find life partners, housing, encouraging procreation, childcare, work-life balance, getting husbands and wives to share responsibilities. Indeed, all possible ways and means have been used to address the issue of our country's ageing population and declining birth rate.
On the relationship between population and a nation's strength, I would like to share a story from ancient China. During the Song Dynasty, there was a small kingdom called Western Xia, or 西夏. The soldiers were valiant and good at fighting, winning numerous battles against the Greater Song. However, Western Xia, despite having a strong army with great fighting spirit, ultimately had to make peace with the Greater Song because of its small population and lack of manpower.
This story illustrates how a small, but tough nation lost because of its shrinking population, reminding us that the size of Singapore's population and its demographic structure is related to its economic development, social stability and national defence. The strong Western Xia survived for close to 200 years and, similarly, as a small nation surrounded by bigger nations, how long can Singapore survive?
Having just celebrated 50 years of nation-building, we are beginning our journey towards the next 50 years. If we are unable to solve the issues of an ageing population, businesses would eventually face a more severe manpower challenge. Thus, supporting the country's population policy would mean supporting the sustainable development of businesses. However, businesses do face difficulties during the implementation. There is a conflict between implementing lean management, increasing productivity and promoting family-friendly and flexible working arrangements. How should this conflict be resolved?
At the same time, on the topic of increasing the birth rate, how is the Government going to communicate even more effectively with the citizens? Demographic structure affects the survival of Singapore. We should handle the population issue with the same perseverance we have in resolving the water issue. As the saying goes: \"Everyone is responsible for the rise and fall of the country\". Marriage and parenthood should be, from now on, a national concern.
Mr Desmond Choo (Tampines): Mdm Chair, I am pleased to note that the Government will legislate the second week of paternity leave. This should be an important pillar in supporting family-centric workplaces. I would like to propose how the tripartite partners can further catalyse the fostering of family-centric workplaces.
But first, let me address some concerns on paternity leave. Senor Minister of State Josephine Teo has said that the Government will give firms time to adjust and phase in the second week of paternity leave. But some companies are saying that the tight labour market and a weakening global economy might be obstacles during implementation. I would like to ask if the Government could consider extending further support to companies beyond giving a phasing-in period.
It was reported that only 40% of fathers used their one week paid paternity leave in Singapore last year. This might be due to a combination of manpower constraints and the mindsets of workers and employers. How will the Government help our young fathers deal with such constraints to improve the consumption rate of paternity leave? How can we promote and share best practices?
Broad legislation, such as extended paternity leave is an important signpost of the Government's intent. However, we should also consider alternative tripartite frameworks to catalyse the proliferation of family-centric workplaces. And especially as hon Member Mr Thomas Chua has pointed out, we also need to balance between what the company needs and how they can put in place family-centric workplaces in a tight labour market.
We can consider a sectoral approach to tackling structural differences in implementing flexible work arrangements (FWAs). For example, telecommuting will work quite well for office-based workers but less so for production-based ones. Mothers who work shifts will find it quite challenging to get on board the FWA journey. Small and medium enterprises (SMEs) find it very difficult to adopt FWAs because of their small workforce.
Taking a sectoral approach, the Government can develop targeted measures for companies, unions or trade associations. This will be akin to ICT being used as a means to catalyse and spread innovation under the industry transformation programme. With similar companies grouped together, the tripartite partners can implement a flexible career system for mothers in the first year of their maternity in this system, for example, a mother on workshifts can find alternative office hour careers with the companies, unions or trade associations supported by the Government, of course. Even industries with civic childcare centres catering to the working hours of the specific industry could be possible. Can the Government consider developing sectoral solutions with our tripartite partners?
Family-centric workplaces are possible but it requires both legislation and the inventiveness and boldness of our tripartite partners. In fact, the sectoral manpower plans (SMPs) being developed by the sectoral tripartite committees (STCs) should value family-centric work practices as a core element in developing human capital. Can the Government work with STCs to incorporate family-centric strategies within the SMPs?
The Chairman: Mr Darryl David, please take your two cuts together.
Mr Darryl David (Ang Mo Kio): Mdm Chair, unlike some other countries and societies, our Singaporean socio-cultural norms dictate that marriage typically precedes having children. First, couples would get married. Then they would decide whether or not to have children. Once they have had a child, they would then decide whether or not to have more children.
These three key decision-points in a couple's life also correspond to three different demographic groups, each of which, in my opinion, requires a different approach and strategy in terms of encouraging them to have more children. I would like to suggest that the National Population and Talent Division (NPTD) take this into consideration when coordinating and planning their strategies to improve Singapore's TFR.
Madam, as a parent of two young children, I will say that children are life's greatest blessings and they are truly a joy. However, the reality is that the process of raising a child can also be a challenging one at times, especially for first-time parents. Expenses aside, there are times when first-time parents are grappling with new experiences that can seem rather stressful. I know, like my Parliamentary colleague Mr Yam, I have changed my fair share of diapers, too.
I feel that the Government has done well to help with child-raising expenses via initiatives, such as the Child Development Account (CDA) and this year's First Step Grant. However, I feel that perhaps more could be done to enhance the entire ecosystem to provide more holistic support for parents, especially during pregnancy and in the first year after birth.
Mdm Chair, I think we all will agree that, ultimately, the decision to have children is a matter of choice and we respect that choice. However, for those who have made the choice to have children, I believe that we can certainly help to make the child-raising experience a smoother and more enjoyable one. This would then have a positive effect on parents' decision to have more children in the future. To echo what my colleague Ms Sun Xueling said, \"Children, why not?\" Or better still, \"Children, of course!\"
I would thus like to ask NPTD what can be done to foster more supportive social norms and positive mindsets towards marriage and parenthood in the future.
I think we all agree, Madam, that Singapore needs to have talent from all over the world to benefit our economy and support our economic growth. And I agree that many of these foreigners add to the richness and diversity of our society as well. Singapore has been, and always must be, a multiracial and multicultural society, with each group retaining its own identity while remaining cohesive as One Singaporean People.
I would like to ask NPTD how we can sustain social cohesion as Singapore's society becomes more diverse with immigration and foreigners. And also, would NPTD consider working with ICA to perhaps implement certain assimilation criteria before we grant Singaporean citizenship?
Ms Rahayu Mahzam (Jurong): Mdm Chairman, over the years, we have seen many different communities come and make Singapore their home. Our forefathers were immigrants and we continue to see new communities join our social fabric. We have seen differences in culture and practices from among the new groups and even among Singaporeans born in Singapore. Sometimes, the differences and lack of understanding of the different practices cause friction. There is, therefore, a need to ensure that there are sufficient platforms to foster greater mutual understanding and promote integration across the different groups in our population, including citizens, new citizens and foreigners.
As a first step, I think it is important to reflect on the contact points that assisted with integration previously and if they are still relevant or applicable to the different demographics today. I note three main platforms for integration, through, namely, (a) the Ethnic Integration Policy in HDB estates; (b) education in schools; and (c) National Service.
Through the Ethnic Integration Policy, the Government sought to address the emergence of enclaves and helped people of various racial and religious backgrounds to integrate. Children from a particular estate largely went to the schools in the vicinity, thus helping to cement their common experiences.
Today, we see a fair share of new citizens and Permanent Residents (PRs) electing to live in private housing. There may be a preference to stay amongst their own community and this leads to enclaves being formed. They may not have the opportunity to interact on a daily basis with other Singaporeans and do not share similar experiences. Their children also may attend international schools. This means that we can have children who have lived in Singapore but have very little common experiences.
We must, therefore, be conscious of the challenges in promoting organic integration. We should consider how we can develop our urban infrastructure to facilitate the common touch-points of integration. We may also wish to ensure regular engagement with students from international schools so that there are opportunities to share local norms and values.
I believe creating common experiences is key. I would like to find out from the Ministry about the existing efforts in place to create the platforms for meaningful interactions and to promote integration. In addition, are there more ways we can create platforms for open and candid discussions about our differences and learn how to celebrate and embrace our diversity?
The Senior Minister of State, Prime Minister's Office (Mrs Josephine Teo): Mdm Chair, I thank Members for their thoughtful questions and comments. If I may, in the course of my presentation, I will also screen some slides, Madam.
The Chairman: Yes, please. [Slides were shown to hon Members.]
Mrs Josephine Teo: It is near to the end of the debate and I started to reflect. On numerous occasions during this debate, Members spoke about the \"Singaporean Core\". Clearly, it is something we all care deeply about.
In fact, the work of NPTD has very much to do with strengthening our Singaporean Core. In promoting marriage and parenthood, we are growing the Singaporean Core from within. Through efforts to keep in touch with Overseas Singaporeans and catalyse integration of new citizens, we aim to keep Singapore cohesive and open, to become stronger as one even as we spread our wings and as we welcome new members to our Singaporean family to supplement and expand the core.
Members know by now that I would very much like to share some thoughts on how we can strengthen support for marriage and parenthood because it is of vital importance that we can grow the Singaporean Core from within. But please allow me to start by first giving an update on our efforts to keep in touch with Overseas Singaporeans, integrate new citizens and stay open as a society.
There are now more than 210,000 Singaporeans living, working or studying overseas for extended periods of time. Ten years ago, it was just 160,000. This is remarkable; 30% more over 10 years. It shows how Singaporeans are increasingly mobile and welcomed by employers and educational institutions internationally.
One interesting result is that we now have more \"Singapore Citizens by Descent\". What does this mean? This refers to children born overseas to fathers or mothers who are Singapore Citizens. The only difference with Singaporeans by birth is that they are born overseas. As more Singaporeans work and live abroad, the number of such babies has increased by about 15% in the last 10 years. From 2006 to 2010, the average number of \"Singapore Citizens by Descent\" was around 1,200 annually. In the first half of this decade, the number was around 1,400 annually, on average. So, it is a 15% increase over 10 years.
The Overseas Singaporean Unit (OSU) reaches out to our Overseas Singaporeans to connect them back to Singapore, through nurturing close-knit, vibrant Singaporean communities overseas. Whenever Ministers have official duties overseas, we make it a point to catch up with our Overseas Singaporeans. Here is a picture of Deputy Prime Minister Teo Chee Hean in Brazil. It surprised me that there were so many Singaporeans in Brazil. And this is a picture of Overseas Singaporeans in Copenhagen, whom I met in March. So, we must make an effort to keep in touch.
Similarly, we must make an effort to help all citizens, the new and the not-so-new, to gel as one. Mr Darryl David asked about this.
As Members know, immigration helps us to top up and improve the age balance in our citizen population. Our aim is to prevent our citizen population from shrinking. What that means is that we have kept a calibrated pace of immigration. Last year, 20,815 Singapore Citizenships were granted, and this included 1,600 or 8% of those \"Singapore Citizens by Descent\".
The population of PRs remained stable – 29,955 new PRs were granted. By the time they are conferred citizenship, most new citizens have been living here for years and many have also established family ties with other Singaporeans. They are quite assimilated as it is. In fact, one reason Singapore feels like home to them is the openness and sense of welcome that many Singaporeans generously extend to newcomers.
It is not surprising because in many Singaporean families, it is quite common nowadays to have in-laws who are foreigners. More couples these days have wedding receptions in two or more countries because that is where the family networks extend.
Nonetheless, the Government must do its part to help new citizens deepen their sense of belonging. Therefore, since 2011, all new citizens have been asked to participate in the Singapore Citizenship Journey. This is a programme that reinforces Singapore's values and norms and facilitates further involvement in the community. It also properly welcomes new citizens into the Singaporean family.
But it is clearly not enough. New citizens need to get involved in all aspects of local life, such as learning to speak local languages, and, some say, Singlish also; interacting with their neighbours; adapting to local behavioural norms; and taking an interest in issues that concern their fellow citizens. Most important of all, they must understand our roots as a multiracial and multicultural society, where each community enjoys our common space and interacts respectfully with one another. In fact, they must imbibe it and make it part of their identity. That is a multiracial, multicultural identity.
At the same time, Singaporeans have an important contribution to make. Besides reaching out to new citizens and strengthening cohesion, we should stay open as a society to people of diverse backgrounds, which both Mr Darryl David and Ms Rahayu Mahzam spoke about. It goes hand in hand with being a society that is open to new ideas and innovation and capable of positive change and the capacity for excellence.
The open-mindedness of young Singaporeans gives us reasons to be hopeful. Sometime last year, a group of undergraduates at the Nanyang Technological University's (NTU's) Wee Kim Wee School of Communications started a campaign with a simple yet inviting slogan \"Come, Let's Eat\". This initiative brought a great diversity of people together through the universal language of food, one language that we all understand.
Singaporeans shared our local flavours at cooking classes. And the foreigners reciprocated by hosting local foodies at restaurants serving their hometown cuisines. At the signature event which they named \"Global Potluck\", 80 participants tasted dishes, such as Turkish meatballs, German potato salad and, of course, our very own \"popiah\" and \"satay\". Although the campaign lasted just a few months, participants made new friends and still keep in touch through social media.
These ground-up initiatives are modest but sincere efforts by individuals and groups to keep Singapore an open society. The Government provides support through the Community Integration Fund. Since 2009, we have disbursed $13 million to over 660 projects to about 270 organisations.
But it is really the passion for Singapore, the conviction that we have something special to share, the spirit of generosity and openness that have motivated the organisers to keep the projects going. I want to thank the organisers and urge them to keep up their very good efforts.
Mdm Chair, even with the addition of new citizens and PRs, our population does not fully meet our growing workforce needs. However, instead of growing our population more quickly, we have decided to press on with the restructuring of our economy towards one that is less dependent on manpower for growth. As a result, the growth of our foreign workforce has slowed considerably. Last year, it was the slowest since the Global Financial Crisis of 2009.
Finance Minister Heng Swee Keat and Manpower Minister Lim Swee Say have spoken about the support that the Government is giving to businesses to ease the crunch. Minister Lim also outlined the many measures that MOM is introducing to help Singaporeans adapt and grow. One such example is the Human Capital Partnership (HCP) with the \"triple strong\" companies to nurture local talents into regional and global talents through skills transfers.
[Deputy Speaker (Mr Charles Chong) in the Chair]
These efforts are aimed at strengthening the Singaporean Core in our workforce so that we can better manage the need to supplement our workforce and, as much as possible, keep them to specific job roles, such as those requiring skills that are hard to find among Singaporeans.
At the same time, MOM is stepping up efforts to build a strong Singaporean Core in the workforce and to strengthen our global competitiveness. For example, through tightening work pass applications for employers who are identified to be \"triple weak\". In addition, through the SkillsFuture initiative led by Minister Ong Ye Kung, we will help Singaporeans stay relevant and participate meaningfully in the workforce at every stage of their lives.
Our vision must be a Singapore that is cohesive and open, where Singaporeans feel a sense of connectedness wherever they are in the world, confident to move forward as one and, at the same time, have the capacity to welcome new additions to our family, whether for a period of time or for good. Such a Singapore will be a worthy place for each one of us to nurture our families in.
Let me now turn to marriage and parenthood, and how we can grow the Singaporean Core from within. But first, let me thank Mr Thomas Chua for sharing with us the story of Western Xia (西夏). He has very poignantly reminded us that marriage and parenthood, birth rates and population are, ultimately, about economic vitality, even our defence capacity and, in the long term, our nation's survival.
First, some good news. Last year, we had 23,805 citizen marriages. This was the second highest in more than a decade, only very slightly lower than the high of 24,037 in 2014. We welcomed nearly 34,000 Golden Jubilee babies, which was the highest in more than a decade, more than even the 2012 Year of the Dragon. Our TFR in 2015 was 1.24, slightly above the average TFR of 1.22 in the first half of the decade.
The question on Members' minds is, naturally, can we boost our TFR further? This is not a trivial question, as I explained in an Op-Ed for The Sunday Times recently. I shall not belabour the points. But besides researching other countries' experiences, I have taken a few months to consult people, including parents, some with a few kids and others with many, whether they are young or grown-up. I have consulted young people who have yet to date or marry and I have also asked scholars who have studied the subject for years.
The short answer to this question is, yes, I believe our TFR can go up, but if and only if the whole of Singapore society gets behind this effort.
I am optimistic because aspirations for marriage and parenthood remain very strong. However, there is no silver bullet, no single policy intervention, not even a set of policy interventions that will boost TFR. We need the collective efforts of the whole of society, by which I mean employers, co-workers, community organisations and businesses, all being supportive in words and deeds.
Ultimately, people now marry and have kids because they want to, not because they have to. This being the case, it is my belief that there are three important elements that help individuals decide in favour of marriage and parenthood and, that is, when they feel that marriage and parenthood are achievable, enjoyable and celebrated. Let me elaborate.
First, ensuring that marriage and parenthood are achievable. I find the strong sense of responsibility among young Singaporeans that was admirable. They want to have stable jobs and build up some financial resources before settling down. Actually, that is achievable in Singapore. Our unemployment rate has been among the lowest in the world, consistently. Employment levels are high across all age groups. Income growth may have moderated as our economy matures, but it is still positive. With the efforts we are making to restructure industries and update skills, good jobs and income growth remain within reach, including for future generations.
A second important factor for young Singaporeans is home ownership. Thankfully, we have an extensive public housing programme that has kept home ownership affordable. Many young couples are able to own their first marital homes through the BTO programme, something unheard of in most cities. The majority of those who purchase BTO flats in non-mature estates do not pay anything out of pocket for their mortgage instalments. That is a great help to family finances.
Mr Melvin Yong and Mr Saktiandi Supaat have asked if we could shorten the average waiting time for BTO flats. Waiting times are currently about three to four years, depending on the design and site constraints of the project. HDB builds flats ahead of orders, but in a measured way. The Government understands Singaporeans' aspirations for home ownership and MND will continue to focus on helping young couples own their first home.
HDB also introduced PPHS in 2013 for couples waiting for their flats to be completed. PPHS offers HDB flats at below market rental rates. About 1,800 families have benefited from PPHS. The PPHS rental homes were the first homes for 270 babies! Not bad. PPHS flats have been offered in a range of mature and non-mature estates. Currently, we have about 150 PPHS flats available for application in Tiong Bahru and Jurong. Thus far, the supply of PPHS flats has been sufficient to meet demand and we will continue to monitor the take-up rate.
There are also measures to help families live closer to one another for caregiving support, a point Mr Louis Ng raised. He mentioned the 3-Gen flats. The priority for BTO housing to couples who want to live with or near to their parents has also been offered. Resale flats are another option and, with the new Proximity Housing Grant for those buying a resale flat near their parents, couples can enjoy up to $90,000 in housing grants for their first home. And we saw in the papers today that more than 2,000 families have benefited from the Proximity Housing Grant.
Another key factor is quality childcare that is accessible and affordable, as noted by Ms Tin Pei Ling and Mr Leon Perera. Parents want to have peace of mind knowing that their children are well looked after while they work. They also want their children to socialise and learn.
MSF, the Early Childhood Development Agency and the Ministry of Education (MOE) have been working jointly to increase childcare provision. More than 30,000 childcare places have been added since 2013, most of which are in HDB estates. There will be 10,000 more by the end of next year, especially in the newer estates. This will help to improve accessibility and make it closer to homes. About 30% of childcare centres are also located near workplaces. Childcare subsidies are available to all parents and additional means-tested subsidies are available to help lower- and middle-income families with childcare costs.
However, there are gaps that we can plug. For example, there are parents with infants who have no family support. I thank Ms Tin Pei Ling for the creative approaches that she has suggested, for example, the online directory and linking up aunties in the estates to the parents who need infant care support. NPTD will study these ideas together with MSF.
Our goal is to improve childcare provision so that all parents who need it can access and afford it. This is the way for couples and even singles to see that their aspirations for parenthood are achievable. Much progress has been made and I know Minister Tan Chuan-Jin is fully committed to this goal. Similarly, Minister Ng Chee Meng and Minister of State Dr Janil Puthucheary are also doing their best to support this effort in MOE.
Mr Darryl David made important points about giving parents a sense of support throughout their parenting journeys. In particular, we will give greater support to new parents in the year before and after the birth of their babies.
Minister Heng Swee Keat had announced earlier that we will double the MediSave withdrawal limits for pre-delivery costs from the current $450 to $900. As a result, the majority of subsidised deliveries in public hospitals will have their bills fully covered by MediSave, including pre-delivery expenses.
We have also enhanced CDA. Previously, parents had to first save into CDA to receive the dollar-for-dollar matching by the Government. We have introduced the CDA First Step to provide the first $3,000 into CDAs, without parents having to save first. Parents who deposit savings into their children's CDAs will continue to enjoy dollar-for-dollar matching, up to the remaining Government contribution caps. These two initiatives complement the other marriage and parenthood benefits like the Baby Bonus Cash Gift and parenthood tax rebates and reliefs.
Families are also supported in other areas. Education is of high quality and heavily subsidised, from primary to post-secondary and even tertiary levels. An increasing number of student care centres help address the caregiving needs of working parents. MOE has said that all primary schools will have student care centres by 2020, not so far away. More help is also provided to needy families, including through new measures like KidSTART and the Fresh Start housing scheme.
Taken together, there is significant support for marriage and parenthood. Sir, may I have your permission to distribute a compilation of the Government's key support to families?
The Chairman: Yes, please. [Handouts were distributed to hon Members.]
Mrs Josephine Teo: As Members can see, there are many programmes and initiatives implemented by different agencies that support marriage and parenthood. They show the Government's strong commitment to make Singapore a \"Great Place for Families\". With the additional efforts and resources we are putting in, I hope more Singaporeans will see that marriage and parenthood are achievable. As Ms Tin says, marriage, parenthood and career are not mutually exclusive.
However, all the above are necessary but probably insufficient.
Mr Vikram Nair asked what we can learn from the developed countries. The example of South Korea suggests that even with abundant resources poured in by the Government, couples may still not want children or have more children. It has to do primarily with the lack of support by employers and co-workers. There are also unhelpful workplace practices and cultures, resulting in long hours away from home. In Korea, there is a very strong sense of \"presentee-ism\", in other words, being present, and, especially not leaving work until your boss has done so.
There is also a very prevalent culture of \"hoesik\". And what is \"hoesik\"? It literally means \"staff company dinner\" but basically it means that after work, let us all go out and have a drink, socialise. But it takes time away from the family. So, these are workplace cultures that are not always helpful.
Dr Lim Wee Kiak pointed out that child-raising costs continue to be a concern. And I recognise that. But there are several factors at play. Some have to do with the lack of family-support and, therefore, the need to pay for help; whereas previously you could always count on your wife who was not working, or mum, or mother-in-law, who would stay at home.
Some have to do with consumption choices. Parents opting to pay for more than the basics, in every respect. It could also be due to the tendency to practise an intensive style of parenting which we see a lot of in Korea. In Korea, the parents put a lot of resources in helping the child prepare for school and even prepare for what happens after school. These contribute to making parenting more stressful and less enjoyable. In the UK, childcare cost is actually not that low, but their TFR is good. It is something that Ms Sun Xueling observed, that targeting parents' cost concerns alone will not be sufficient. I agree with that.
Another important lesson is that employers did not implement family-friendly practices purely out of altruism or charity. Instead, they saw these practices as a competitive advantage, necessary to attract and retain capable staff and helpful for productivity.
For example, the Hertie Foundation in Berlin pioneered a work and family audit that is endorsed by the German government and adopted in Austria, Hungary and Italy. The audit findings indicate that family-friendly employers with scores in the top quartile had significantly better business outcomes than companies in the bottom quartile. What are these better outcomes? Forty-one percent lower absenteeism rates, 32% higher motivation rates and 23% higher employee productivity. Therefore, in response to Mr Thomas Chua's comment, family-friendly practices may, in fact, complement efforts to improve productivity and we would like to see how this can be strengthened.
Germany's TFR is, however, not as high as the Nordic countries and France. Researchers believe that it has to do with traditional expectations held in Germany until very recently, that is, that good mothers must stop work to care for their children. This has made it harder for German women to enjoy both career and parenthood, even if they did not face discrimination at work.
In contrast, women in the Nordic countries and France do not face similar pressures. They can continue to pursue their career aspirations, which as Mr Saktiandi rightly pointed out, should also be the case in Singapore.
I agree with Mr Saktiandi and Ms Tin that discrimination against pregnant women or parents is not acceptable. In 2013, we enhanced legal protection for pregnant women against retrenchment or dismissal without sufficient cause. Beyond legislation, TAFEP has also stepped up efforts to promote fair, responsible and progressive employment practices.
I also agree with Ms Tin and Mr Desmond Choo that FWAs help employees better manage work and family commitments and, as a result, they make parenting a more enjoyable process. MOM offers businesses the Work-Life Grant, which provides up to $160,000 to support companies in piloting, implementing and sustaining FWAs. The take-up of the Work-Life Grant is improving, but I do think more can be done. We support Mr Choo's suggestion, in particular, to work with the tripartite partners to explore how FWAs can be promoted in a more targeted manner in different sectors.
We should also support and show understanding towards nursing mothers, a point Mr Alex Yam has made. Senior Minister of State Dr Amy Khor had spoken earlier about the health benefits of breastfeeding. However, a 2011 survey showed that only 1% of mothers in Singapore have been able to sustain exclusive breastfeeding to the six-month mark. This is much lower than in other developed societies, including Australia, which has it at 18%, South Korea, 11% and Taiwan, a whopping 50%.
During my focus group discussions with parents, many shared that they would like greater employer and community support for breastfeeding. One enlightened local company Yang Kee Logistics is a good example. Breastfeeding mothers enjoy the privacy of a nursing room. Employees can also use a specially designed Children's Corner if they need to take the children to work, for example, when the childcare centre is closed for the day.
Ahead of legislation, fathers who are working in Yang Kee Logistics already enjoy two weeks of paternity leave and an extra two days to spend more time with their newborns. Mind you, Yang Kee is not a big company. They have just about 250 employees.
When parents feel supported by their employers and co-workers, they tend to enjoy parenthood more and, therefore, be more motivated to have more children. Their single colleagues, too, take the cue and will likely be more favourable towards marriage and parenthood.
The wider community, too, plays an important role. Mr Alex Yam shared his difficulties about changing diapers. Therefore, we hope that there will be more developers of shopping malls and commercial buildings who will improve facilities for parents. They can take advantage of BCA's Accessibility Fund which provides 40% of the construction costs of family-friendly features. But after they build these facilities, I agree with Mr Yam that the buildings must open them and let people use them.
Mr Saktiandi talked about the ease of travel on public transport for young parents and, indeed, the Land Transport Authority (LTA) introduced priority lanes which apply to pregnant women as well as families with children in strollers. But I agree with him that we should do more in this area.
Ms Sun Xueling suggested having more child-friendly community spaces and self-help community groups for parents. I recently came across an online support group called \"Daddy Matters\". It is all men, just young fathers, and the group told me that sometimes they \"just need a listening ear and to share tips\". Indeed, parents' best coaches and confidantes are often other parents. So, I hope there will be more of such organic support groups.
Sir, one aspect of my investigations was puzzling. France, the UK and the Nordic countries all provide strong support for parents. But even then, their TFRs differ. Among them, as Mr Vikram Nair has pointed out, France has consistently had the highest TFR of nearly 2. The UK, where childcare is actually less well organised and state support less generous than in the other countries, has a sustained TFR of 1.83. This is higher than the average TFR in Finland and Denmark, of about 1.7, where childcare is actually very well organised and fully supported.
For reasons that are not completely understood, it seems that there are other factors that influence TFR, such as historical, geographical and other socio-economic factors. Another factor could be the way society values and celebrates families and children that make people want to have kids.
Respected sociologist and former Nominated Member, Prof Paulin Straughan, once observed that \"no one is going to give you a prize for getting married and having kids!\" She believes this explains why some people are not taking proactive steps to find a partner, settle down and start families. I, therefore, fully support calls by Ms Sun Xueling and Mr Alex Yam for a whole-of-society effort to foster positive mindsets towards marriage and parenthood and shaping supportive social norms.
Those of us who have had the privilege of being parents know how transformational the experience is. There are, indeed, many sacrifices parents make – sleep, personal time, freedom and stretch marks – to name a few. But nothing quite compares to the joy of holding your own child, the knowledge that you gave life and the relationship with a precious human being. And as Mr Alex Yam and Mr Darryl David have pointed out, fathers feel these emotions just as strongly as mothers do.
So, we must, as a society, continue to celebrate parenthood, celebrate having babies and celebrate families. It is in this spirit that I am announcing some enhancements to our parental leave provisions.
We will legislate a second week of paternity leave for all fathers of Singapore Citizens born from 1 January 2017. So, if you start now, there is good time. In addition, we will increase flexibility for couples in caring for their newborns by increasing shared parental leave from one week to four weeks for citizen children born from 1 July 2017.
As with the current one week of shared parental leave, the four weeks will be shared from the mother's maternity leave. With the enhancements to paternity leave and shared parental leave, fathers will be able to take up to eight weeks of leave, about two months, in the baby's first year.
To support couples who adopt, we will increase adoption leave for adoptive mothers, from the current four weeks, to 12 weeks for infants younger than one year old. This will be effective for children adopted from 1 July 2017 onwards. Adoptive fathers will also be able to share four weeks of their spouse's adoption leave.
I am aware that even as parents-to-be cheer these leave enhancements, some businesses, including SMEs, with higher concentrations of male staff may have concerns, as Mr Thomas Chua and Mr Desmond Choo have highlighted. In fact, the Association of Small and Medium Enterprises has also shared concerns with us. It is also out of concerns for businesses and the employability of parents that we assess Mr Louis Ng's suggestion for extended childcare leave, or to peg a parent's childcare leave entitlement to the number of children, to be impractical for now.
We have timed this round of leave enhancements to give employers some time to adjust and plan. In addition, the Government will fully fund the enhancements to the paternity and shared parental leave.
We hope employers who are in a position to do so will start to extend paternity leave even before legislation kicks in so that parents of children born earlier can also benefit. As I shared earlier, the extra benefits should be thought of as important and powerful signals to their employees about their commitment towards family-friendly practices.
(In Mandarin): [Please refer to Vernacular Speech.] Chairman, we are enhancing our support to help Singaporeans fulfil their marriage and parenthood aspirations, by increasing paternity leave and offering more flexibility for fathers to share their wives' maternity leave. However, it is clear that in order to make Singapore a \"Great Place for Families\", we cannot simply rely on Government policies alone. We urgently need to mobilise the whole community, so that the entire society supports and celebrates parenthood.
We especially hope that more employers can recognise that it is in fact a wise move to help their employees take care of their family because this will not only increase productivity, but also help attract and retain talent.
(In English): Sir, this is the first time during the COS debate that I am wearing the NPTD hat. I have chosen to focus on two main aspects of our work: how we can promote marriage and parenthood so that we can grow the Singaporean Core from within; and how we keep Singapore cohesive and open, where Singaporeans feel connected and confident, as we supplement and expand the Core.
Our overall vision for Singapore is a sustainable population that enables all our citizens to enjoy a good standard of living, for this generation and long into the future. It starts with making sure that Singapore is a \"Great Place for Families\" so that marriage and parenthood are achievable, enjoyable and celebrated. But it does not end there. The continued story of Singapore and all of us who have chosen to make it our home is best described by former Deputy Prime Minister S Rajaratnam, when he said, \"Being a Singaporean is not a matter of ancestry. It is conviction and choice.\"
Our vision requires conviction and choice. It will take all of our collective efforts to build on our Pioneers' legacy, to keep Singapore our best home – Cohesive and Open, and a Great Place for Families. I invite you to be a partner on this journey. [Applause.]
The Chairman: Any clarifications from hon Members? Er Dr Lee.
Er Dr Lee Bee Wah: Chairman, I have two clarifications. I am very happy to note that engineers receive attention from our leaders. The Deputy Prime Minister mentioned about 1,000 engineers that the Public Service sector is going to employ. I would like to ask: does the Civil Service employ only Singaporeans? And what is the age group, whether we are getting the young ones or is it a combination? And whether the Deputy Prime Minister thinks that there are sufficient engineers out there for the Public Service sector to recruit?
The second clarification is on the salary. It is good to note that the starting salary will be increased by 20%. But I think as they progress, that is equally important. So, is there a review on the career path and the remuneration package?
Mr Teo Chee Hean: Mr Chairman, the recruitment will be over a range of experiences, a combination of all the things Er Dr Lee Bee Wah described. Some will be beginning engineers, some will be experienced engineers. And some will be Singaporeans, but not all. For salaries, we will review salaries not just at the starting level, but also throughout their careers to make sure that progression is good. But I think it is also important that this is not just about salaries. We want to develop their careers so that we have the types of engineers which we are all proud of.
The Chairman: Ms Sylvia Lim.
Ms Sylvia Lim: Sir, I have a clarification for Minister Chan Chun Sing concerning the anti-corruption cut which I filed.
Earlier, the Minister mentioned that the Government has a robust framework in place to detect money laundering, including offences related to corruption. He also mentioned STRO, which I think has been in place for quite a number of years.
Despite that, in February this year, our Commercial Affairs Department and the Monetary Authority of Singapore announced that they froze a large number of bank accounts for suspected money laundering and other offences connected with 1MDB.
From what I know from investigations, you would only seize accounts if you have some prima facie grounds to suspect that there have been offences committed. So, I would like to ask the Minister whether this may suggest that the framework in place may need a review because it may not really be robust enough for its purpose.
Mr Chan Chun Sing: Mr Chairman, let me respond to that. Any framework must be constantly reviewed and updated. We are never complacent. Whenever we receive any information, whether domestically or from our foreign sources, we will undertake the necessary investigation to get to the bottom of it. So, this is how we do things in Singapore. Once we get any information, we will get to the bottom of it.
Having done the investigation for the specific case, we will always follow up and ask ourselves is there a need for us to strengthen our framework. So, it is a continuous process and we will never let our guard down. But I will not be able to comment on any of the investigations because I think it is not correct for us to make any specific comments while investigations are ongoing.
The Chairman: Mr Ang Hin Kee.
Mr Ang Hin Kee: Mr Chairman, Sir, I have two clarifications for the Deputy Prime Minister. One, the Deputy Prime Minister earlier mentioned the 400 over cases of harassment against Public Service officers. I would like to find out whether it was virtual harassment or face-to-face harassment, a physical presence. If it was a physical presence, then is PSD also checking the virtual harassment \tvis-a-vis things like email, Facebook posting or letters that were sent? The public officer may feel there was a harassment to them as far as how they have conducted themselves fairly. Secondly, will PSD also do more to celebrate courteous engagement between public servants and members of the public, in case we just focus on harassment cases alone?
Mr Teo Chee Hean: These were cases which were reported to the Police. So, they would be the more serious cases. There might well have been harassment cases of other types, but perhaps not serious enough to be reported to the Police.
As Mr Ang has correctly pointed out, if there are threats made to public officers, as we have seen in the media recently, where certain individuals have been taken to task and brought to Court because they were inciting the public to take matters into their own hands against certain Police officers and public officers, they will be taken to task even if that was done on the Internet.
We will take these matters seriously, whether they are face-to-face or whether they are on the Internet, when incitement to violence against public officers is made. These are matters which we will take very seriously.
The Chairman: Mr Ang Hin Kee.
Mr Ang Hin Kee: The second question relates to whether we will do more to celebrate the courteous engagement between the two, rather than focusing only on harassment cases alone.
Mr Teo Chee Hean: It is not just courtesy but we also, at each Public Service Week, give awards to members of the public who have contributed to not just positive engagement but to helping the Public Service do their work well. So, we do have such awards.
The Chairman: Ms Sun Xueling.
Ms Sun Xueling: Mr Chairman, I was in a student forum recently and a student asked if having a technical engineering background will still allow him to aspire to a C-suite level job. I found the question both telling and sad. I personally think that the rise of technopreneurs will help to correct this trend. But I was wondering if the Minister could shed some light on what we can do further to change mindsets about engineering as a profession.
Mr Teo Chee Hean: Engineering is a very noble profession. You were asked about whether people can get to the C-suite. Well, you can get to the M-suite if you are an engineer. There are quite a few in the front bench who are engineers.
I can cite a few examples of outstanding Singaporean corporate leaders who are engineers themselves. People like Mr Koh Boon Hwee, Mr Liew Mun Leong who runs CapitaLand, Mr Chew Choon Seng who ran Singapore Airlines. These were all engineers.
I would say that we should have a good combination of people with technical skills as well as good financial and marketing skills to run companies in which technical knowledge, technical competence are an important part of making that company competitive.
If you run a company or an organisation which requires technical competence in order to make it succeed and work, and you do not look after the financials and the marketing, you are not going to be able to sell your product no matter how good it is. It does not sell itself.
On the other hand, if you have only financial people and marketing people and they ignore the need for a good product, then you can easily run the company to the ground.
So, you do need a combination of both. The advantage that engineers have is that they tend to be very numerate and are able to bring that quality of problem-solving to the problems that they are faced with in companies, whether it is the financial or technical type of problems.
So, I would say to a young engineer, \"Press on, keep an open mind, make use of the skills that you have. With an engineering and technical background, you are equipped with many of the skills that you need to be successful in life.\"
The Chairman: Mr Louis Ng.
Mr Louis Ng Kok Kwang: Sir, I appreciate that maybe now is not the time to review the extended childcare leave. But I hope that in the near future, it will be reviewed. It is really from feedback of residents who have about three kids, because the current two days of leave is really insufficient. And I will join Members and fellow fathers in this House to declare that I have also changed my fair share of nappies.
The Chairman: I am not sure that was a clarification, but are there any more? Er Dr Lee Bee Wah.
Er Dr Lee Bee Wah: Chairman, I would like to ask the Deputy Prime Minister who mentioned \tjust now that not all the 1,000 engineers will be Singaporean. I would like to ask why not? Under what circumstances will you employ foreign engineers?
Mr Teo Chee Hean: I think even Er Dr Lee would want to employ a person who can do the job best for your customer and, in this case, our customer is a Singaporean. If there are areas in which we need expertise in order to execute public projects well, we will employ them. If we do not have enough Singaporeans to do the job, we will employ foreigners.
But clearly, we want to develop a strong engineering core in the Public Service in those areas which I have described. For that, we will train Singaporeans to be able to take leadership roles and build expertise in those areas. Also, they could well be immigrants who have joined the core and become Singaporeans, like yourself, Er Dr Lee.
The Chairman: Mr Vikram Nair.
Mr Vikram Nair: This clarification is for Senior Minister of State Josephine Teo. One of the big differences between France and many other countries is that they are traditional socialists in many ways and that includes education. So, they start from a very early age, preschool, I believe from the age of three or so, that is institutionalised care for children. How big a factor do you think that plays?
On this particular issue, I will just plant my flag and say that when it comes to education, I do sit with the socialists. I think that that is one of the great equalisers. Singapore has done well because from primary school onwards, there is a fairly level playing field. Everyone gets into largely government schools. But now, I think things start a bit earlier and, in preschool, there is a much greater diversity of services. Do you think there is a role – I think right now, we have the anchor operators – for them to have a much larger share of the preschool market, so that more people will have access to it?
We judge success by the number of people who take up preschool education as opposed to just a number of new centres that are set up. So, the aspiration should be: can we get all children enrolled, for example, in nursery or even earlier, if necessary?
Mrs Josephine Teo: Mr Chairman, Mr Vikram Nair has asked a very interesting question. In fact, when we interacted with our French counterparts, one of the things that was very consistent, whether it was meeting with the policymakers in their MSF, MOE or CPF equivalent which is involved in the disbursements of the benefits, every single one of them, in giving us the background to France's policies when it came to childcare, mentioned the year 1945.
Why did they mention the year 1945? I do not understand French, but from the interpretation and the conversation, the year was significant for them because in 1945, the French state was brought to its knees as they lost so many citizens. There was a collective sense of urgency that has stayed with them to this day, that you need to reproduce, you need to have more of your own. It is exactly the same kind of mentality which Mr Thomas Chua described would have been needed for 西夏, that is, even though they were superior in their capabilities, they just could not defeat their enemies by sheer disadvantage of numbers.
In fact, historical factors also contribute to French society's great sense of comfort with allowing other people to look after their children. I was told by French counterparts that already in the 19th century, women went to work. When they went to work, someone had to look after the children. From those very early days, the beginning of the industrial revolution, they already had ideas that related to a creche or childcare. So, they have had a very long tradition.
The Member is quite right that, by now, their childcare provision is very extensive. From three years old onwards, the equivalent of the MOE in France cares for all children placed there by the parents. From age three, four, five, six, it is preschool, and they have a curriculum in the morning and lunch is within the school environment. After that, they have play and nap. This provision is very extensive.
I would say that the French model is something that we ought to study very, very carefully, simply because it has allowed many more of their women to stay in the workforce. I think this is also an aspiration that we will find within Singapore families. I think it is not just the women, as, very often, the husbands quite appreciate the fact that there are two sources of income. It provides resources for the family that is more than one person can bring to bear. Indeed, it is a model that we are studying very carefully. We think that there are elements of that model that are worth us emulating.
The Chairman: Mr Darryl David.
Mr Darryl David: Mr Chairman, I would like to direct my clarification to Senior Minister of State Josephine Teo who mentioned that there will be a lot of support that is given in the period just before birth. And perhaps in the first, second year of pregnancy, I think the Government has done a wonderful job and I hope it will continue to do a good job in the area of providing that financial support.
What about other support in the area of, say, services like counselling, and more support groups to even advise new parents on how to raise their children? Currently, there is a plethora of such courses but they are expensive sometimes. If you have the means, I know many young parents who have signed up for such courses. But parents from the lower-income groups may find it a bit prohibitive.
So, would then Government please, either working with the grassroots or through other organisations, set up more support systems in the area of parenting classes, parenting workshops and so on, especially for new parents?
Mrs Josephine Teo: Chairman, brevity is a virtue. So, the answer is yes, we will certainly look into those.
The Chairman: If there are no other clarifications, Mr Ang Hin Kee, would you like to withdraw the amendment? You do not need to thank the whole front bench.
Mr Ang Hin Kee: Just the back bench. Mr Chairman, I beg leave to withdraw my amendment.
[(proc text) Amendment, by leave, withdrawn. (proc text)]
[(proc text) The sum of $428,699,800 for Head U ordered to stand part of the Main Estimates. (proc text)]
[(proc text) The sum of $59,366,600 for Head U 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 X (Ministry of Culture, Community and Youth) ","subTitle":null,"sectionType":"OS","content":"Dr Lim Wee Kiak (Sembawang): Mr Chairman, I beg to move, \"That the total sum to be allocated for Head X of the Estimates be reduced by $100\".
Last year, we witnessed the year-long SG50 celebrations which were held to mark the 50th anniversary of our Independence. More than 500 initiatives were organised to celebrate Singapore's 50th year of Independence, including the biggest National Day Parade and the Future of Us exhibition. What is heartening is that about 400 of the initiatives were started by ordinary Singaporeans. They were all ground-up. The SG50 celebration fund disbursed about $10 million to organisers of these ground-up projects. Each project was evaluated on its ability to raise awareness of our Singaporean identity, our sense of belonging to Singapore, outreach to engage the community; as well as to show potential in successful completion and execution according to plan.
The ground-up initiatives saw many new innovative projects that rallied Singaporeans together and touched our hearts. There were many short films and documentaries produced by individuals and groups.
One such documentary is \"And So They Say\", a documentary project showcasing an honest narrative on life's construct from interviews with 25 seniors, allowing an intimate glimpse into the legacy of Singapore's Pioneer Generation. Another is \"Singapore, My Home\". It is an effort to foster a sense of community and belonging. It features a video collection of stories from Singaporeans and people who have come to call Singapore home.
With food being a favourite Singaporean past-time, there were also projects with a food theme, such as #SgEatWithUs. It is a ground-up movement that celebrated the stories and values of Singaporeans surrounding local home-cooked food by building a community which shares, cooks and appreciates local home-cooked food. There was a series of food carnivals organised to bring people together.
There is another project called \"jiakSimi.sg\", a website documenting recipes of top 50 local hawker dishes from the major races in Singapore, accompanied by a short write-up on each dish's origin, history and where we can find them.
These celebrations led Singaporeans to appreciate the Pioneer Generation and the country's past and to reflect on how Singapore overcame the odds.
The variety of activities touched the hearts of many and it helped to bring a sense of belonging and bonding to everyone. People were encouraged to come together and build the future together, to share their memories of the past and contribute ideas on what future they want. Many other pieces of feedback were given during dialogue sessions, young people shared their aspirations and these were subsequently captured in The Future of Us exhibition. Indeed, one important discussion dwelt on the need to build on the trust and confidence among different races in the light of challenges posed by religious extremists.
The important point is: now that we have aroused so many good vibes, elicited so much feedback, thoughts and ideas, where do we go from here? How do we make good use of the goodwill and gems arising from the SG50 celebrations so that we do not miss out on the opportunities to grow and nurture them to take us into the next 50 years?
I am glad and excited on the proposed Our Singapore Fund that was announced in this year's Budget. Our Singapore Fund will support projects that build the spirit of caring and resilience, nurture our can-do spirit and promote unity and our sense of being Singaporean. The total fund size will be up to $25 million and will be set up by the second half of this year.
Can the Minister shed more light and details on this new fund? Is this a continuation of the SG50 Celebratory Fund? What valuable lessons have we learnt from the SG50 Celebratory Fund that we can apply to Our Singapore Fund? Will the Government increase the fund size if there is an overwhelming demand?
I am confident that the Our Singapore Fund will be welcome and well-utilised. I would like to quote Minister Heng Swee Keat in an interview that was published in December last year, \"I hope that we will build on the Singapore spirit, stay united and... build an even more endearing home for every Singaporean.\"
That summarises and captures the essence of Our Singapore Fund. Sir, I beg to move.
[(proc text) Question proposed. (proc text)]
Mr Zainal Sapari (Pasir Ris-Punggol): Sir, in light of an ever-changing economic landscape, we need to improve opportunities for our citizens and help them prepare for the future ahead. Global competition will not get any easier and the needs of companies from the workforce are ever-changing.
In October last year, MENDAKI set up the Future Ready Unit to help the Malay/Muslim community to better prepare for the future economy by optimising opportunities arising from the SkillsFuture initiative. In Malay, Sir.
(In Malay): [Please refer to Vernacular Speech.] MENDAKI's Future Ready Unit comprises members who are experts in their respective fields and they can share their experience to help the community benefit from the national SkillsFuture initiatives.
One of the tasks of this unit is to identify strategies that can equip Malay/Muslim workers, including students, with the relevant skills, in addition to encouraging Malay/Muslim workers to identify the various pathways that they can take in order to deepen their knowledge in a certain area.
This will help them to acquire future skills that are relevant so that they will stay employable when the industries here undergo the transformation to improve productivity and stay competitive.
(In English): I would like to ask the Minister what are some of the plans that the Future Ready Unit will be working on for the coming year.
Mr Saktiandi Supaat (Bishan-Toa Payoh): Mr Chairman, Sir, in Malay, please.
(In Malay): [Please refer to Vernacular Speech.] Singapore is gearing itself for the Future Economy that will be challenging and offers many opportunities. There will be structural changes in our economy and this will invariably affect jobs and the skill demands of the workforce among the Malay/Muslim community.
Retraining and staying relevant to the needs of the economy are necessary if the workers wish to find jobs and keep pace with the changing economic environment. The whole country will have to work hard to stay competitive in the global market. Many businesses are jostling for market share with lower profit margins, as they try to retain their clients or even when getting new customers on board. I believe our Government will do everything within its means to help Singapore's workforce, including Malay/Muslim workers, to be retrained and to keep them relevant to the Future Economy.
Can the Minister outline what is MENDAKI and SENSE College doing to help the various segments of the Malay/Muslim workforce so that they can cope with the short- to medium-term challenges, apart from other national initiatives that are available now?
The Chairman: Mr Azmoon Ahmad; not here. Mr Amrin Amin.
Mr Amrin Amin (Sembawang): Our Singapore Malay/Muslim community is in a better educational standing compared to five years ago, as suggested by the General Household Survey 2015 report. This progress was made possible through the efforts of the Government, our Malay/Muslim organisations, families and parents.
But the world is changing and there are many new challenges. As a community, we have to respond to this changing landscape. What are MENDAKI's plans to further strengthen its educational programmes and outreach, especially with the increased Mosque Building and MENDAKI Fund (MBMF)?
I was a tutor in the flagship MENDAKI tuition scheme (MTS) for many years. I enjoyed my weekly tuition classes tremendously. MTS centre supervisors and tutors play a very critical role in ensuring the success of MTS. How can we better support and equip our tutors so that they can ensure even better educational outcomes for our students? Mr Chairman, with your permission, I will speak in Malay.
(In Malay): [Please refer to Vernacular Speech.] The achievement and progress of our community were made possible through the efforts and dedication of parents and families within our community, as well as the strong support from the Government and Malay/Muslim organisations.
The Malay/Muslim community in Singapore has undeniably achieved much progress. The General Household Survey 2015 report found that the Malay/Muslim community in Singapore is doing better in terms of education, compared to five years ago. This is good progress. However, the world is changing and will continue to change. Challenges are becoming more daunting.
Recently, an announcement was made about the increase in the MBMF contributions. The fund supports the development and enhancements to mosques, religious programmes as well as various educational and social programmes by Malay/Muslim bodies like the MENDAKI Foundation and the Association of Muslim Professionals (AMP).
On the issue of education, this fund is crucial so that our children can succeed in school and enhance their knowledge in order to have a brighter future. We must work with parents, teachers, schools and community leaders so that our children have the opportunity to achieve their potential through education.
May I ask what are MENDAKI's plans to further strengthen its education and community engagement programmes, especially with the increase in the MBMF contributions?
MTS provides tuition classes for subjects like English Language, Mathematics and Science. Many Malay/Muslim students have benefited from it. The success of this scheme surely depends on the abilities of its tutors.
Hence, may I know how we can provide better support and equip the MTS tutors with the necessary skills so that they can perform their duty to ensure that our children can excel further in education?
Assoc Prof Fatimah Lateef (Marine Parade): Sir, families represent the basic unit of society. Strong families make for strong nations.
Our community has been putting in a lot of effort trying to reduce the disamenities faced by disrupted and reconstituted families. The \"Many Helping Hands\" approach is certainly helpful towards this. There may be a need to continue to enhance resources, empowerment as well as the take-up rate and regular attendances at counselling and nurturing sessions. Currently, there are some generic as well as targeted programmes for these families that are being offered but we hope that more can come forward. How else will Majlis Ugama Islam Singapura (MUIS) and MENDAKI assist and also sort out the root causes faced by these families and also provide more support for them in a targeted way? Also, can I find out what proportion of our annual zakat collection is being disbursed to such families? Has this proportion remained stable or has it changed over the last three to five years?
The Chairman: Mr Azmoon Ahmad; not present. Mr Muhamad Faisal.
Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Sir, in Malay.
(In Malay): [Please refer to Vernacular Speech.] In his reply to my query in this Chamber on whether the Malay/Muslim Community Development Fund (MMCDF) can be extended to the mosques, the Minister said that this cannot be done as mosques are not considered to be Malay/Muslim bodies. However, he added that mosques can receive this fund if their social programmes are run in cooperation with Government bodies or other Malay/Muslim organisations.
I really admire the efforts of the Muslim community in Singapore in the administration of mosques. The management board and staff of every mosque work hard to run these mosques, while the Muslim community also plays a role to achieve stability for the mosques by contributing their money and energy. As we know, mosques welcome contributions from the community in any shape or form, especially financial contributions. This is because, as I understand it, all the expenses incurred in running a mosque like utility bills, payment of monthly salaries and so on are also funded with money contributed by the community.
This spirit of partnership is born out of the intent and sincere effort to achieve a shared objective that is to help mosques in Singapore prosper. The stability of mosques, which is built on this spirit of partnership, will turn mosques into one of the important and main contributors not only in spiritual development, but also in the social development of our Muslim community.
Sir, one of the themes of this year's Budget is the spirit of partnership. In the name of this spirit of partnership, I would to like to ask that the Minister and the Government consider the proposal that this fund be extended to the mosques, so that this MMCDF can bring further benefits towards the development of the Malay/Muslim community in Singapore. This will also strengthen the spirit of partnership between the Government and Malay/Muslim bodies.
Sir, I have two questions for the Minister. First, can the Minister clarify what are the criteria that are being used to categorise an institution or organisation as a Malay/Muslim organisation (MMO)? Secondly, who decides on these criteria?
Assoc Prof Fatimah Lateef: Mr Chairman, the numbers of underage and teenage marriages have always been on the radar of our community. This is because observations, studies and statistics have shown a significant proportion of them to have family financial problems, as well as a higher rate of divorce, and subsequent remarriages, resulting in many challenges and disruptions for the children of such families.
Efforts have been proactive and have been put forth to contain their numbers. Marriage counselling has also been targeted towards this group of people.
Can we have an update on the current numbers that we face in the community and to assess if targeted interventions that have been implemented along the way have been positive and have impacted these families? How are we tracking them and the existing couples who need assistance and continue to need assistance? Are there further interventions and new initiatives underway?
The Chairman: Ms Rahayu Mahzam, you can take your three cuts together.
Ms Rahayu Mahzam (Jurong): Thank you, Chairman. In Malay, please.
(In Malay): [Please refer to Vernacular Speech.] Strong families are the foundation of a resilient community. Hence, efforts should be made to help families stay strong. It is important for the Government to provide specific programmes to help the community with this, especially for young couples.
There are already Marriage Preparation Courses that couples who intend to get married have to attend. These courses are useful in preparing these couples so that they can receive some guidance and are encouraged to think about the important aspects of marriage.
In order to ensure the effectiveness of this programme, a review and assessment should be done to see whether this programme has achieved its objectives and is well-received by couples who attend the courses.
In addition, it is also important to ensure that there is a follow-up programme to help couples in the early years of their marriage. They may face challenges when dealing with issues like finances, relations with in-laws, plans for their children and so on. I hope that attention can be given to this group in order to help them go through the challenging times during their marriage and ensure that they stay together.
(In English): Strong families are the foundation of a resilient community. It is thus important to invest in programmes to help families stay strong. I note that there are already in place Marriage Preparation Courses for couples to provide the guidance and support for those who intend to be married.
Apart from these courses, I believe that it is also imperative that we give some support to couples with young children in the early years of their marriage. These couples have to cope with significant changes in their lives and may face some challenges.
At last year's Committee of Supply (COS) debate, the Minister-in-Charge of Muslim Affairs mentioned that the Ministry of Social and Family Development will be developing a Cinta Abadi enrichment framework targeted at Malay/Muslim couples in their first 10 years of marriage. Can the Minister give an update on this development?
(In Malay): [Please refer to Vernacular Speech.] Divorce rates have remained steady over the past few years. I believe that the Syariah Court's efforts in conducting counselling programmes have helped. However, usually, couples who go to the Syariah Court would have already decided to proceed with divorce and it is hard to save their marriage.
Even so, it is important for us to ensure that their family relationship is preserved, especially if the couple have small children. The couple should discuss in a mature manner and come up with a plan for their children after they are divorced. Based on my past experience as a lawyer and as the Deputy Registrar at the Syariah Court, divorced couples are usually still angry and have difficulty talking to each other.
This behaviour will have a negative effect on their children. Hence, efforts should be taken to provide support for these couples. The Syariah Court has embarked on several initiatives like discussing parenting plans during counselling and information sessions for those who have divorced.
I think that there should be a sustained effort in this matter to provide support to couples who are divorcing, in order to take care of their children's well-being. It is also important for counsellors and lawyers who are assisting divorcing couples to be trained and equipped with the necessary skills, so that they can give effective support and guidance to divorcing couples.
(In English): Divorce rates have remained steady over the past few years. I believe that the Syariah Court, through its Marriage Counselling Programme, has helped in this regard. But not all marriages can be saved and the Syariah Court has embarked on several measures to help divorcing couples and to ensure the best interests of the children are met. Can the Minister-in-charge of Muslim Affairs give an update on some of these measures?
We have also seen some developments in the Family Justice Courts in respect of child-centric initiatives, such as the introduction of Parenting Coordinators. Are there plans to mirror some of these developments and, in particular, in enhancing the capabilities of our practitioners, such as lawyers and the marriage counsellors?
The Syariah Court is a key institution in the Muslim community, dealing primarily with Muslim divorces. The powers of the Syariah Court are set out in the Administration of Muslim Law Act (AMLA) and the specific procedures are detailed in the Muslim Marriage and Divorce Rules (MMDR). The Court deals with couples and families and it has, over the years, developed its procedures to enhance its services to the community.
I believe that efforts can be put in place to further enhance the Court's delivery of services in two areas, namely: (a) through improvements to the Court's processes; and (b) through a review and update of AMLA and MMDR.
Firstly, in respect of Court processes, I believe there is a need to review the processes and incorporate the use of technology, where appropriate. In particular, the Court may wish to consider introducing electronic or online filing of Court documents like how it is done in the Family Justice Courts and the State Courts.
This is also in keeping with the national approach of embracing technology to improve productivity and enhancing service to the community. Processes like the registration process can be made simpler and faster and data collected can be stored and used at the next stage of proceedings, without requiring parties to provide the same information again.
Secondly, there is a need to review and update AMLA and MMDR. The last amendment of AMLA came into effect in 2009. It is important to review whether the provisions match the existing circumstances of the community, as well as the current practice of the Court.
Issues, such as jurisdiction, the hakam process, the talak declaration process, may be some of the areas that the Court may wish to review. It is useful to look at the existing procedures and forms and amend AMLA and MMDR accordingly, to make the process more expedient. It is important to do so, so that the Court can better serve the community.
In light of the above, could the Minister share if there are plans to review and enhance the Syariah Court processes and amend AMLA or MMDR to clarify and streamline the legal procedures?
Assoc Prof Dr Muhammad Faishal Ibrahim (Nee Soon) (In Malay): [Please refer to Vernacular Speech.] Sir, our mosques play an important role in the lives of our community. Our mosques are not only a place where we seek tranquillity, but also a place for us to acquire religious knowledge.
Mosques are also the key to a broader network in the provision of social assistance, including zakat, and to refer cases to the Social Service Offices (SSOs) and Family Service Centres (FSCs), if necessary. There is a very strong gotong royong spirit in our mosques. Many youths serve as volunteers in various mosque activities and operations, especially during Friday prayers. I am heartened to see such strong support from the community, because everyone in the community has a role to ensure that our mosques are safe and comfortable for all.
The Minister announced an increase in the MBMF contributions last month and shared plans to improve the mosque institutions in the coming years, by increasing prayer space and improving the infrastructure for the convenience of the congregants, especially the elderly.
Can the Minister elaborate on the progress of the Mosque Development Programme? In addition, can the Minister give an update on construction of the Maarof Mosque in Jurong West and the Yusof Ishak Mosque in Woodlands?
During last year's COS, the Minister announced that we will build the Tampines North mosque and are looking at ways to deal with the shortage of prayer space in the Al-Istighfar mosque in Pasir Ris. Can the Minister provide more details about these plans and share with us what the community can expect in the next few years?
Dr Intan Azura Mokhtar (Ang Mo Kio): In Malay, please, Mr Chairman.
(In Malay): [Please refer to Vernacular Speech.] The Joint Madrasah System (JMS) that was implemented in 2009 has come a long way in levelling up our full-time Madrasah education system and developing it into a world-class education system. Many changes have been made to strengthen our Madrasah education, including the revamp of secondary education for Madrasah Al Arabiah, where from 2015, the students are able to choose between a four-year direct GCE \"O\" Level route; or a five-year GCE \"N\" Level route, followed by the GCE 'O' Level examinations.
In the light of abundant opportunities in the information technology and other growth sectors, I would like to know how our Madrasah curriculum will be modified and strengthened to better prepare our full-time Madrasah students, so that they can seize the available opportunities when they join the workforce.
I would also like to ask the Minister-in-charge of Muslim Affairs if he can provide an update on the progress of the JMS and what else can be done to make our full-time Madrasah system more holistic.
My two other concerns are: firstly, students in our mainstream schools who come from lower-income families can tap on the Ministry of Education (MOE) Financial Assistance Scheme (FAS). However, for full-time Madrasah students who may come from less privileged or lower-income families, are there similar financial assistance schemes provided by MUIS or the madrasahs? Secondly, I understand that the land lease for Madrasah Al Arabiah will be expiring soon. There are concerns in the community about where the Madrasah will be relocated and whether a longer term lease can be obtained, so that proper facilities can be built and implemented for the students and asatizahs of Madrasah Al Arabiah.
Mr Saktiandi Supaat: Mr Chairman, in Malay, please.
(In Malay): [Please refer to Vernacular Speech.] The religion of a person can play an important role because it is a form of guidance, especially in times of crisis. It is a good sign that more Malay/Muslim youths and adults are actively seeking out a better understanding of Islam. This is evident from the relatively good demand for part-time Islamic Studies in Singapore, from both public and private institutions.
One of the key thrusts of MUIS' fifth three-year plan is to focus on increasing the community's participation in Islamic Education, particularly among our young. This will help to ensure that our young remain rooted to the proper values, based on the foundations of Islam.
The actions of extremists in the Middle East have generated a lot of curiosity and controversy. Subsequently, there is a prevalence of flawed online resources masquerading as Islamic teachings.
These resources are often dynamic and provocative, and youths who do not have a good understanding of the religion would run the risk of being susceptible to erroneous teachings and become misguided.
An effective curriculum in Islamic Studies can help to empower a cohesive and progressive Muslim community. It is important that all institutions offering Islamic Studies provide legitimate curriculum and content that are true to Islam, easily absorbed and understood.
Could the Minister elaborate on plans and strategies for part-time religious education in the coming years?
Mr Zainal Sapari: Sir, visitors are highly impressed by our ability to maintain a high level of cohesion amongst the various races and religions. This is what makes Singapore united as a nation. It is the focal point of our national identity. Unfortunately, we are facing challenging times where falsehood is being hailed as the truth and it is becoming increasingly difficult to counter such propaganda. As a Muslim, I am worried that people of other faiths may have a biased view of Islam in light of recent events around the world. There is an urgent need to counter any possible negative perception.
I would like to reiterate that inter- and intra-religious cohesion is of paramount importance to Singapore. We have closed ranks and stood together to speak out against extremism and against those who could threaten our security. In Malay, Sir.
(In Malay): [Please refer to Vernacular Speech.] Our asatizahs, or religious teachers, can play an important role to discuss the issue of terrorism and also guide our community about life in a multireligious society like ours. I am heartened to see that many of our asatizahs are aware that it is important that we practise tolerance and give and take with other religious groups.
Hence, in order to play this role better, it is imperative that we provide training for our asatizahs and equip them with secular knowledge that is updated and relevant, so that they have a wider perspective of issues pertaining to society and the world.
Our asatizahs must also possess an open mind and a willingness to acquire the latest secular knowledge in their effort to help the community understand the challenges that can damage a harmonious plural society.
I would like to hear the Minister's views on the role that our asatizahs can play and how our community can stay together in these challenging times.
Mr Zaqy Mohamad (Chua Chu Kang) (In Malay): [Please refer to Vernacular Speech.] Mr Chairperson, I am pleased and proud to see so many of our madrasah students progressing in education, with some of them even going on to achieve excellence in the mainstream schools.
Many have also continued their studies in Islamic institutions overseas like Cairo and Jordan. This group will potentially become future community leaders and, hence, we should continue to engage and communicate with them, so that they will stay rooted here. The knowledge that they acquire overseas, together with an understanding of the multiracial and socio-economic situation in Singapore, will be crucial.
How will MUIS and our religious leaders shape the relationship and ties with this group and how are they being prepared for their return to our shores? I hope that we can make good use of their potential and ensure that every graduate has ample opportunity to serve our community, religion as well as our economy in the future.
Diversity will always be part of our lives, and these young people will also play an important role in maintaining our solidarity. In this era, the education of our young is not solely done in schools because we must also expose them to a broader mindset and perspectives, including life values, especially with the influence of social media.
So far, we have been able to increase understanding through various initiatives, but due to the presence of many influences and challenges, including within the Muslim community itself, the situation may be different for future generations. The ability to give and take, and being tolerant, does not happen automatically.
What is the Minister's view on the type of life values that our young people should display and advocate and how can we encourage more Malay/Muslim youths to play a part in nation-building and provide leadership opportunities for them in the community as well as at the national level?
Ms Sylvia Lim (Aljunied): Sir, the People's Association (PA) has evolved since its inception in 1960. Its original role was countering communist activities and fostering social stability and national security. PA has gone from community centres to community clubs, from providing television sets and simple sports facilities to holding courses and large-scale activities. I am concerned with two aspects: the PA's ever-increasing budget and whether PA has, in some respects, deviated from its mandate.
First, the budget. While we understand that the financial year (FY) 2015 Budget was much larger than usual due to the SG50 activities and building residents' facilities, the FY 2016 budget is still very high, at nearly $900 million. This is a significant 34% increase from FY2014. How is the high expenditure justified?
Second, it seems to me that some PA activities have exceeded its mandate. To recap, the People's Association Act states that PA is incorporated for the purpose of promoting community recreation and incidental matters. Its objects are stated to relate to fostering cohesion and bonding and to promoting group participation that transcends sectional loyalties. The PA's role then is to unite, receiving heavy taxpayer funding for such.
An unhealthy culture seems to have developed within some quarters of PA who sees its role to include advancing the Ruling Party politically and undermining the work of Opposition Members of Parliament. PA activists being mobilised to campaign for People's Action Party (PAP) candidates at elections is just one aspect. As Opposition Members, when we try to advance our residents' welfare through infrastructure projects, we learn that Government agencies like the Ministry of National Development (MND) and the Housing and Development Board will only recognise PA organisations, such as Citizens Consultative Committees (CCCs) and Residents' Committees (RCs) as \"the proper channels\". When I tried to simply get information from MND on the plans for private estate upgrading projects within Aljunied Group Representation Constituency (GRC), the Ministry referred me to the CCC. I then wrote several times to the CCC, but it seems that my letters do not even merit a reply.
The Chairman: Mr Alex Yam, you can take your two cuts together.
Mr Alex Yam (Marsiling-Yew Tee): Mr Chairman, the founding fathers of modern Singapore placed a huge premium on multiculturalism and racial harmony to help chart Singapore's course forward towards success and prosperity. But in our journey towards these goals, did we leave behind the resilience that we had in us and which served us so well, when standing up to the communists and communalists in our formative years?
What has happened along the way? Did our new-found prosperity and confidence in ourselves lead us to losing our fundamental principle of being Singaporeans as one united people?
Our children are taught the importance of unity and racial harmony in schools. But how much of it is retained in their later years? How big an impact is information gleaned online, so much so that intolerance takes root in our young?
For those who are somewhat surprised by what I have said, I would, however, give in that when we look online, this is the situation that we see. The online chatter is disconcerting, to say the least, and leads us to wonder how digital communications may have poisoned the chalice.
I hope the Ministry would be able to shed some light on this recent phenomenon and advise the House on the measures being taken to engage young people so that we understand their concerns and lead them on to become better Singaporeans who care for their own and the community at large. Only by doing so would we be able to chart our way forward to SG100.
And moving on to the growing threat of radicalisation amongst the young due to the pervasiveness of online disinformation, what are the Ministry's plans to continue to build up national resilience and cohesiveness to safeguard unity in Singapore?
Mr Chairman, art challenges us, inspires us, enables us and provokes us. Over the years, Singapore has made tremendous progress in growing, promoting and nurturing a cultural landscape, curating both world-class museums and the performance arts. Even as we grow this scene and put in the investments, how do we make sure that just such a landscape is accessible and relevant to Singaporeans and our own local culture?
Accessibility also lies beyond whether art is comprehensible but also whether fundamentally it is physically accessible. Often, we hear of people talking about visiting the museum, watching the latest theatre production. But for people with disability, attending a concert is not as simple as buying a ticket and turning up, and going to an exhibition may not be as simple as an impromptu visit to the galleries. In addition, the less fortunate, especially children, deserve a stake in our nascent arts scene.
Arts hold tremendous remarkable learning opportunities for the young, and no one should be left behind. Could the Ministry share how it has made it possible for the disabled, the less well-off and the vulnerable young to be engaged in the arts scene and how the Ministry plans to expand this so that they can contribute to and fully experience the arts and cultural life?
I further urge the Ministry to extend more funding to worthy ground-up initiatives to engage the less fortunate in arts.
On the subject of potential digital platforms, has the Ministry also looked at the potential for it to transform and expand the arts scene and in reaching out to more Singaporeans? How has the Ministry been tapping on this and what plans does the Ministry have, especially in engaging our youths with arts, heritage and culture?
The Chairman: Dr Lim Wee Kiak, take your two cuts together.
Dr Lim Wee Kiak: Chairman, in the past decade, we have seen many commendable infrastructure developments to boost our arts and culture scene for Singapore. We have over 40 galleries. There is an almost inexhaustible number of arts venues listed in the Singapore Art Gallery Guide. There are also more than 20 heritage centres and museums about history and culture. Our newly revamped museums with state-of-the-art technology and our National Gallery opened last year were all welcomed. These cultural infrastructures were significant investments by our Government. However, they need to be complemented and supported by programmes that can engage, enhance and excite our public. Otherwise, they will remain nothing more than just impressive infrastructures.
I am not sure if we are getting the support from the ground that we are targeting. Are we getting more people involved and engaged in arts and culture or have we hit a plateau?
But how do we measure the amount of arts activities in Singapore? How do we currently stand, compared to five years ago, for instance? And how do we stand, compared to other countries? Artnet, for example, has listed Oslo, Brussels and Mexico City as the best cities for the modern-day artist. What can we learn from these artistic countries to close the gap and make arts more accessible and pleasurable for Singaporeans? What does the Ministry of Culture, Community and Youth (MCCY) see as the next step, in our efforts to develop our city centre as a lively arts and cultural belt that is distinctively Singaporean, and that Singaporeans can be proud of and enjoy?
Raising the level of appreciation of our traditional arts can help Singaporeans better understand our roots, promote cross-cultural understanding and help make sense of \"What does it mean to be Singaporean?\" How can MCCY help more young Singaporeans to be exposed to and learn to appreciate traditional arts in schools and forge cross-cultural understanding?
To support and promote Singapore traditional arts, we need to have greater focus or attention on the development of artistic and management capabilities, as well as to cultivate new audiences across different genres of traditional arts. We need to identify the training needs of the traditional arts scene, showcase homegrown talents, encourage active cultural and knowledge exchange and provide networking opportunities among artists, both locally and regionally. These initiatives will complement the existing total range of support provided for traditional arts groups, ranging from grants and arts house subsidies, to the national competitions to identify and nurture young talents in traditional arts and music. Can the Minister give an update on how the National Arts Council's (NAC's) traditional arts plan has helped to nurture and deepen traditional arts practice in Singapore and what are the plans ahead?
In 2015, the Government announced that it would put some $25 million in funding for traditional arts over the next five years. These funds are used to foster audiences both at home and abroad and to improve research and documentation of traditional Asian art forms. Where are we now in promoting traditional arts in Singapore today? Can the Minister give the House an update on the progress?
Mr Low Thia Khiang (Aljunied): Sir, I believe that the learning and understanding of Singapore history can contribute to having a stronger national identity and of being Singaporean. This is especially so when young minds in schools are exposed early to the history of Singapore.
I am of the view that this can only be achieved if history is presented to encourage students to consider multiple perspectives and engage in critical thinking. This will also reduce students' and parents' perceptions of using history as Government propaganda.
I believe the same should apply to the representations of history in exhibitions curated by the National Heritage Board (NHB). This would include exhibitions at museums such as the National Museum and interpretive centres, such as the Malay Heritage Centre and Nanyang Memorial Hall.
It is time we move away from representations of a \"standard\" or \"official\" history. We should allow different interpretations of history with the goal of encouraging critical thinking and promoting citizenship education to guide NHB exhibitions.
For example, the recent Parliament in Singapore History exhibition could take on different interpretations as seen from the multiple perspectives of the Pioneer statesmen, ruling party backbenchers, opposition party Members, women Members, minority Members and so on.
NHB now provides grants to organisations and individuals keen to conduct historical research and curate exhibitions on history. An independent commission made up of professional historians and heritage specialists from different institutions should be set up to oversee the grants, with the mission to encourage critical thinking through different interpretations of history.
An independent commission would signal to the public that the Government is not here to control and censure history. The historical exhibitions will have more legitimacy with the public and, therefore, promote citizenship education.
Mr Chen Show Mao (Aljunied): Sir, local heritage is becoming increasingly important as Singapore matures and our national identity develops. Our heritage is key to understanding who we are and where we came from.
In the past few years we have seen several public debates over heritage and what we should preserve. We have also seen several archaeological excavations, for example, in Fort Canning, St Andrew's Cathedral, Adam Park, Cathedral of the Good Shepherd, the site of the National Gallery Singapore and most recently, Empress Place. These excavations are signs of our interests in our past and the Government's efforts to support heritage awareness. Sir, we can do more.
Strengthen the existing legal framework over heritage impact assessments, or HIAs, and over artefacts from archaeological excavations. Currently, the Urban Redevelopment Authority (URA) Planning Act does make it mandatory for persons seeking to develop land to carry out HIAs. Without these assessments, we would not know if such development would put historically significant buildings, structures or artefacts at risk. We should make HIAs mandatory. These are assessments that will help URA or the Minister make better informed decisions over development.
Another crucial gap in the legal framework is the issue of ownership of artefacts that are discovered in the course of archaeological excavations. The law is currently unclear on who owns the artefacts, the landowner or the state, with different implications for their protection.
I call on the Government to establish an inter-Ministerial working committee to develop HIA requirements and review the current state of heritage protection, in consultation with civil society groups like the Singapore Heritage Society, Nature Society and the International Council on Monuments and Sites (ICOMOS) Singapore.
The Chairman: Mr Kok Heng Leun, you have two cuts, you can take them together.
Mr Kok Heng Leun (Nominated Member): Let me, first, declare my interests. I am the Artistic Director of a theatre company that is very much involved in creating and curating socially-engaged and community-engaged art. I am also a member of the examination board of the Intercultural Theatre Institute.
Mr Chairman, in 2011, the Arts and Culture Strategic Review (ACSR) report was unveiled. It outlined a vision for 2025. I quote: \"...a nation of cultured and graceful people, at home with our heritage, and proud of our Singapore identity\". To achieve this vision, two strategic directions were identified: one, to bring arts and culture to everyone, everywhere, and every day; two, to build capabilities to achieve excellence.
In response to the report, the Government has committed $270 million worth of programmes under three master plans, rolled out over five years from 2012 to 2016. This would mean that come 2017, we can look forward to a comprehensive review of what has been achieved.
This review will be an important document to help us determine the approaches we should take for the next eight years as we move into 2025. Hence my two cuts will deal with these two strategic directions for the future.
The community engagement master plan that was rolled out since 2012 has seen a proliferation of arts programmes organised by PA, NAC, NHB and the National Library Board (NLB). It has increased the number of art activities and brought the arts closer to our doorstep. This has provided livelihoods for some artists who are very committed to working with the community. Going forward, I would like MCCY to look at the following issues.
Firstly, engagement on a deeper level. Let me share about a project entitled \"Unseen: Constellation\" which is currently being exhibited at the Chapel Gallery of Objectifs along Middle Road. Initiated by artist Alecia Neo, the project involves seven students living with visual impairment from Ahmad Ibrahim Secondary School. Over two years, under the guidance of mentors from a diverse range of professions, the students were immersed in a very deep process of discovery, which resulted in them creating works that explore their lives and dreams. The various artworks now displayed at the gallery comprise music videos about friendship and discrimination, a short film about vulnerability of love and boyhood, a motivational speech, amongst others.
In the motivational talk, student Dallon Au revealed his insecurity as someone with impaired vision, I quote, \"Many times, I just feel like giving up and killing myself. This is so unbecoming of a motivational speaker, right? You have no idea how many times people have said this to me. ‘If you cannot even keep yourself motivated, how are you going to motivate others?' Believe me, I agree. But I am working on it and I am getting better.\"
Through the work, you can see how these students had learnt so much about themselves through a highly engaged process facilitated by very thoughtful and sensitive artists and mentors. The process has resulted in the creation of artworks that are moving and of high quality.
\"Unseen\" is deeply engaging and impactful. Its engagement is deep and life-changing. As we move towards the future, we should encourage more of such deep and engaging work. The depth and process will result in profound learning experiences for the community and will also result in artistic work that is aesthetically rich. It moves the audience, changes their sensibilities, by making the invisible visible and the unheard heard.
Secondly, development of intermediaries. Facilitation and organisational skills are specialties that not all artists possess. Artists need a different set of skills to encourage and inspire community participants to express their creative selves. At the same time, artists may need to organise and mobilise resources from different agencies to make projects happen.
For example, if you are going to do a project on end-of-life issues, we may require the involvement of the Agency for Integrated Care, hospitals, nursing homes, caregiver communities, amongst many others. Many of these agencies are not familiar with arts. Hence, when artists partner them to create community work, dialogue and processes are important so as to avoid miscommunication and distrust.
This requires specialisation, an intermediary role that bridges artists and communities. A good example of such a good intermediary would be the group ArtsWok Collaborative. They facilitated and produced \"The Rite of Spring\", a dance performance choreographed by Cultural Medallion recipient Angela Liong of Arts Fission. The performance was presented at Esplanade Theatre, featured four different elderly groups like AWWA Seniors Activity Centre, AWWA Community Home for Senior Citizens, National Trades Union Congress (NTUC) Eldercare and Henderson Senior Citizens' Home, as well as children.
To accomplish such an intergenerational work, a lot of facilitation and organisation need to be done. The intermediary needs to be someone who is well-versed in the process of art-making but, at the same time, understands the art of community engagement deeply. Many artists who work in the community tend to operate as individuals, without the backing of administrative and organisational support. As such, to encourage more participation and engagement from the community, more intermediaries must be made available to facilitate fruitful collaborations among artists, related agencies and the community. I, therefore, urge the Ministry to look into developing these specialists.
Thirdly, creative place-making. To bring arts closer to the community, such that it becomes an everyday presence, we should begin looking at creative place-making.
Creative place-paking makes the arts a part of community living. It is not a place or venue management. It is not about presenting performances and programmes to create buzz. The key word is \"place\".
According to Tuan Yi Fu, a well-known geographer, a place comes into existence when there is a \"moment of pause\", which provides people within the space to reflect and connect with others around them. It is created not by transactional needs, but by relational needs.
In creative place-making, the arts are an essential mediator that helps to bring the community together. It is also important for artists to want to be involved in place-making; they must want to see community engagement very much as part of their work.
Creative place-making will only be sustainable if it is ground-up. It must not be forced. It must not be \"hip\". It must not be short-sighted. If planned and executed properly, it will not only foster community bonding and identity, build capacity in a community, it also empowers the community to action and change, it will also solve one of the problems that artists and arts groups face in Singapore: the lack of physical space to work.
In examining the Ministry's key performance indicators, I noted that there is an emphasis on the instrumentalisation of art: what art can do for society. I would like to thank the Government for acknowledging that the arts can have such an extensive impact on society, which I hope will also help to convince more Singaporeans of the importance of arts to be part of our lives.
But I would also like to recall a Chinese saying: 工欲善其事，必先利其器. That is, to do a good job, the artisan must have the best tool to do it. In this case, the art must be good.
Besides having institutions to provide the best arts education for emerging artists, there must also be arts centres or venues that will help young or mature artists develop their craft without the pressure of market forces. Institutions that pay attention to developmental objectives must be seen differently from, say, a theatre company that sells tickets to their work. In a way, they are revenue generating.
But for institutions with a developmental objective, their focus should be on process over results, experimentation over tried-and-tested products. One is reminded of what the late Kuo Pao Kun had said before: \"Better to have a worthy failure than a mediocre success.\"
The Substation, founded by Mr Kuo, was such an arts centre: it provided infrastructure support and resources for young artists to kickstart projects and, at the same time, provided an environment to encourage artists to take creative risks. In other words, The Substation was a home for the arts, a place for artists to learn, a safe space within which they could venture to explore, that is, to innovate.
Many young artists have begun their careers there, including filmmakers Royston Tan and Boo Jun Feng, and theatre director Goh Boon Teck. Artists like Lee Wen and Amanda Heng created some of their most interesting works there and these artists later became Cultural Medallion recipients, honoured by the nation.
Institutions like this, such as Centre 42, Intercultural Theatre Institute and the up-and-coming Traditional Arts Centre, are important in the development of Singapore's arts scene. I hope there will be more of such centres; and some of them can support interdisciplinary and intercultural experimentation, developing ways of art-making that incorporate science and technology, as well as different kinds of genres and cultures.
Singapore is in a unique position. Being such a globalised economy and a connector among different regions, we can take advantage of our status to be a facilitator for exploration and exchange.
I would also like to advocate for such institutions to have a different funding model. For example, the Intercultural Theatre Institute (ITI), are funded under the three-year Major Grant Scheme, just like other arts organisations. The key performance indicators of these kinds of developmental centres are different from a typical arts organisation. I would urge MCCY and NAC to develop a different model for these institutions that will encourage experimentation, creative processes and learning.
The very fact that we have a Ministry and affiliated agencies that look specifically at the arts and what it can do for society means that the arts and politics are not strange bedfellows. Yet, the arts should be viewed for its intrinsic worth, and not merely to serve political purpose. Here, I think it is apt for me to quote from the great author Lu Xun who spoke about the relationship between arts and politics, I will say this in Mandarin, but I will translate later.
\"…两者之间，倒有不安于现状的同一。惟政治是要维持现状，自然和不安于现
状的文艺处在不同的方向......政治想维系现状使它统一，文艺催促社会进化
使它渐渐分离…\"
That is to say, while the arts and politics are frequent fellow travellers because both seek change, at some point on this journey, they will take divergent paths. It is in the nature of art to examine change, to pursue truth. In doing so, art may raise uncomfortable questions, and may seem to divide, but it is through these questions that society can progress.
Dr Teo Ho Pin (Bukit Panjang): Mr Chairman, Sir, MCCY has been very supportive in promoting arts in the community. Since the formation of the Community Arts and Culture Club (CACC) in Bukit Panjang in 2014, we have organised many arts and culture activities to benefit more than 7,000 residents.
These activities have added much vibrancy and inclusiveness in our community where arts and culture become more accessible to everyone, everywhere and every day. I wish to ask the Ministry whether it will continue to promote community arts by providing more funding support to CACCs in the community.
Sir, MCCY has brought greater vibrancy to the community by creating a space where people can develop a greater emotional connection to our heritage and society. In line with this, I am pleased to share with Members that Bukit Panjang constituency has started work to build a \"Bukit Panjang Arts Street\" at Bangkit neighbourhood centre. Arts streets are often found in important towns and cities. It is a place where local artists frequent, display their arts craft and engage the local community. The Bukit Panjang Arts Street will not only promote arts and culture. It will also generate greater vibrancy in the community and be a pride of place for our residents.
Sir, can I have your permission to show a slide on the LED screen?
The Chairman: Yes. [A slide was shown to hon Members.]
Dr Teo Ho Pin: Sir, the Bukit Panjang Arts Street with its colourful motif and vernacular arts design on the tiles, themed-business signage lining the street, and designed walkway, will also see a more environment-friendly canopy to shelter residents from unpredictable weather and interesting lighting to reflect the mood and many festivities in Singapore.
Sir, we plan to use the arts street to root arts as part of everyday life and get local artists and more residents to participate in the arts and culture activities. One day, the Bukit Panjang Arts Street in the heartland may find a place on the Singapore tourist map.
Ms Rahayu Mahzam: Chairman, our Singaporean children are our gems and the hope for the nation. We should endeavour towards making their education and development holistic. I trust we can all agree that the education and development for the young are not limited to what is taught in school and through the school curriculum. It is our duty to make available as many learning opportunities as possible for our children so that they may be able to gain experience and exposure in different fields and grow up to be well-rounded individuals.
One aspect of this learning journey must be exposure to the arts and culture. Early exposure to the arts and culture helps develop creativity, a strong sense of aesthetics and confidence in children. It also helps sustain their interest and appreciation for culture into adulthood. In the local context, this learning journey also serves as a platform for them to understand and appreciate the different cultures in Singapore and build their national identity.
I also believe that the arts and culture should be made accessible to all children, including those from lower-income families. This endeavour could be a social leveller as all students, regardless of social background, are given the knowledge and exposure that contribute towards their holistic development.
I am, therefore, of the view that there should be targeted efforts on the part of the Ministry to reach out to students and families with children to promote interest in the arts and culture. I would, therefore, like to find out more about the existing programmes that are in place for students and families and the Ministry's plans to reach out to this group.
Er Dr Lee Bee Wah (Nee Soon): Chairman, a five-storey regional library, a 20-court badminton hall, six swimming pools and a 5,000-seat stadium with a Fédération Internationale de Football Association (FIFA)-approved football pitch are some of the facilities residents can enjoy when the new Town Hub at Tampines opens progressively from the end of 2016.
Whenever there is such news reported in the media, do you know what is the reaction of my residents? I will receive lots of emails. Yishun is one of the largest and fastest growing towns in Singapore. We have over 50,000 households today and nearly 6,000 households moving in this year and next. These new households will consist mainly of young adults and young families. They will have a very large demand for sporting facilities. Already, our existing facilities are not enough to cope with the population. Residents are finding it difficult to have access to their favourite venues and sports on a regular basis. Yishun urgently needs more sports facilities and in greater variety.
There is only one swimming complex to serve the entire Yishun Town. It has only three pools which consist of one competition pool, one teaching pool and one wading pool. By contrast, Queenstown, which has about 20,000 fewer residential units, has a swimming complex with five pools. On top of that, residents told me that the pool is very rundown. When they go swimming with their friends and relatives in other parts of Singapore, they feel very envious of the beautiful and modern swimming pools elsewhere. They look forward to water play facilities like those in Jurong East Swimming Pool.
I have been bringing up this request for a few years. The Yishun Swimming Complex urgently needs to be refurbished, redesigned and expanded. Under the $1.5 billion Sports Facilities Master Plan announced in 2014, community sports facilities are supposed to be upgraded and rebuilt. Could the Minister clarify if there are any plans, especially for the swimming complex? Certainly, I hope that the next big announcement on sporting facilities will be for Yishun.
Mr Kwek Hian Chuan Henry (Nee Soon): Mr Chairman, first of all, I would like to echo Er Dr Lee's sentiments. I would like to file a cut on sports for life. I think we can all agree that sports are important. Sports keep us fit and bring our people together. Sports are also fun and helps us to relax after a long day.
But we also live in a fast-paced society. And when we start work, start a family and embark on other transition points in life, it is not easy for us to continue our passion for sports because of life's many demands.
Moving forward, it will be good if MCCY and SportSG can finetune our programmes to ensure a continuum of quality opportunities for Singaporeans to participate more actively in sports. I look forward to hearing from MCCY about the latest developments in these areas.
Mr Alex Yam: Chairman, I declare my interest as the Deputy President of the Singapore Table Tennis Association (STTA). The National Youth Sports Institute (NYSI) was announced in November 2015 and the first centre was officially launched at the Singapore Sports School (SSP) in January 2016. Aimed at grooming the \"Champions of Tomorrow\", NYSI is supposed to cover both athletes from SSP as well as mainstream schools' student-athletes.
How would NYSI support athletes within and outside SSP? It indicates that its mission is in the four functional areas of Talent Identification and Development, Coaching, Sports Science and Athlete Life Management. How will these functional areas benefit young sportsmen and women?
In addition, what role would NYSI play in relation to the National Sports Associations? For example, STTA runs a Junior Development Squad with student-athletes from mainstream schools as well as those in the School Within School programme, a collaboration that STTA has with SSP. Will both groups have equal access to NYSI?
As NYSI is a new entity, it would also be interesting to know its goals and KPIs and the cost involved in setting it up. Do we have the required number of qualified sports scientists and sports personnel to oversee the running of these courses?
There is also the Singapore Sports Institute (SSI), set up in 2011 to drive the high performance pathway in our local sports ecosystem. How will NYSI complement SSI and are there overlaps?
Mr Ganesh Rajaram (Nominated Member): Sir, today, Singapore has world-class sporting facilities, such as the $1.3 billion Sports Hub, as well as many programmes to groom sporting talent: the Sports School; the Direct Schools Admission programme; the Singapore High Performance Sports System; Sports Excellence Scholarships; and the list goes on. Given all of this support, it seems like a wonderful time to pursue a sporting career. But is it really?
While facilities and Government support are in abundance, have Singaporean attitudes towards sports really changed over the years? Do parents see a sporting career as a viable, respectable career goal? Are Singaporean parents going to be \"sporting\" about their child choosing football, swimming or table tennis over medicine, law and banking?
This is a very real scenario that parents face today, a logical next step in a nation that has invested billions of dollars in world-class facilities and programmes. I think that more can and needs to be done to address the way people, particularly parents, think about sports.
I know of parents who send their children for intensive coaching to get them into elite schools through the Direct School Admission (DSA) programme, and how these children end up hating the sport they gained direct admission for, as it is not their passion but they are forced into it.
How many of these children admitted into DSA schools actually continue to pursue the sport beyond school/junior college/polytechnic. Likewise, at the Sports School, what has become of all the fantastic young talents unearthed during the 2010 Youth Olympic Games? I remember how the whole country came together to cheer on the boys in the national under-16 football team and how we were all mesmerised by their sheer passion and talent. Are these boys still together as a team or have they given up on their passions to pursue what would be considered \"normal careers\" in Singapore?
But there are children who yearn to pursue a professional career in a sport that they are very good in. How should we support them? Is there a way the Singapore community, from parents, grandparents, teachers and opinion leaders, can be moved to a point where we see a career footballer or golfer with as much societal value and respect as you would an airline pilot or an architect?
There is nothing wrong with kids pursuing their passion for sports. We should let them live their dreams and support them to the fullest. Society should not stigmatise a child who wants to pursue a sports career, regardless of whether the child ultimately makes it or not. When children are passionate about their dreams, are willing to be disciplined, hardworking and focused to achieve their goals, they are already displaying qualities that any parent should be proud of. On the flipside, we should avoid over-coaching children to the point where they lose the love for sports. Sports should be about passion, fun and joy!
So, what happens when your child says he wants to be a professional footballer? Well, after the initial alarm, periods of insomnia, and long heart-to-heart conversations, we told our son that he has our fullest support. To build a strong sporting spirit, and a sporting nation, parents and society at large need to learn how to be good sports, too.
Mr Darryl David (Ang Mo Kio): Chairman, SG50 was notable for many things, not least the Southeast Asian (SEA) Games and Association of Southeast Asian Nations (ASEAN) Para Games. Then, we saw the entire country come together as one family to support our national athletes who truly did us proud. Indeed, one enduring memory of that period was when the entire country almost seemed to sing our National Anthem a capella after the sound system failed at one of the venues. We have seen how our athletes have inspired a palpable sense of national pride in Singaporeans through these Games, often at great personal sacrifice.
I would like to ask MCCY how they will continue to support our athletes in their pursuit of sporting excellence? What support will be provided to Team Singapore athletes who will be competing in this year's Rio 2016 Olympic and Paralympic Games?
The Chairman: Mr Melvin Yong, you can take your two cuts together.
Mr Melvin Yong Yik Chye (Tanjong Pagar): Sir, the ASEAN Para Games held in Singapore last year was a rousing success and a game-changer for disability sports in Singapore. Our para-athletes trained hard and competed with international para-athletes of outstanding calibre. Backed by strong support from our fellow Singaporeans, our para-athletes achieved an outstanding medal haul at the Games.
I was at the National Stadium for the deciding football match between Singapore and Malaysia. Both teams were competing for the bronze medal. The energy in the stadium was palpable. Singaporeans of all ages were cheering their hearts out in support of Team Singapore. What moved me deeply was the determination shown by our para-athletes. Despite their physical challenges, they displayed grit and resilience. Many of them are residents of Tanjong Pagar GRC. The stadium shook when Mr Muhammad Mubarak scored the winning goal.
There is so much potential for disability sports to flourish in Singapore. The task at hand would be to keep on encouraging participation, as well as to identify, groom and support potential talents so that, one day, we will have a stronger team of para-athletes to represent our country in disability sports.
Moving forward, I would like to ask what will MCCY and SportSG be doing to further engage persons with disability within our community to participate in sports. What other measures are in place to create more social awareness about disability sports among the public? And what more can SportSG do to provide the necessary support for our para-athletes?
Sir, I move on to volunteerism. Last year, Singapore hosted the 28th SEA Games and the 8th ASEAN Para Games. In both sporting events, our athletes created history by winning a record number of medals. Their historic achievements brought the nation together in celebration.
Organising such major events and making sure everything runs smoothly and according to plan are no easy feat. Thankfully, there were thousands of volunteers who responded to the call for help and sacrificed their time to ensure that all aspects of the Games went smoothly.
We witnessed a sense of camaraderie among these volunteers, who hail from all walks of life. Friendships were forged over the months of working and training together, and many of the volunteers have continued to stay in touch with one another since.
To build on this momentum, I would like to ask: what will MCCY be doing to encourage more Singaporeans from various backgrounds to participate or volunteer at sporting events or activities? Besides volunteering in sporting events, are there plans to extend this to the arts and heritage communities as well?
Dr Lily Neo (Jalan Besar): Work and family commitments prevent many volunteers from continuing, let alone putting in more involvement or time. This is a pity because there is an ever-increasing need for more volunteers in our society. The social needs of the society are plentiful in our ageing population. As we progress socio-economically as a country, we need to uplift our lowest income strata groups, such as the less-advantaged families and children.
It is necessary for us to better care for them, and this requires more social workers and volunteers. Befriender volunteers do prevent the seniors from isolation and depression by visiting them in their homes. Befriender volunteers are useful in keeping seniors healthier by reminding them to take their medicines, taking them for medical check-ups or early treatment before illnesses get worse.
Although I agree that volunteers are altruistic individuals, I would like to suggest that we do more to recognise them and motivate them to stick with their volunteerism. May I request MCCY to consider nominal allowances for volunteers who can commit certain hours and who can visit residents at their homes, similar to how Pioneer Generation Ambassadors are being reimbursed? The reimbursements are for transport and meal allowance in the course of their roles.
The growth of volunteerism cannot be left to chance alone. Let us take whatever steps are necessary to expand and sustain volunteerism.
Mr Kwek Hian Chuan Henry: Mr Chairman, I would like to touch on the Singapore Roadmap for Corporate Giving.
Many of us would agree that Singaporeans are a generous people. I would also like to add that many business owners and corporations I have come across have a heart to give. There is, of course, more we can do to make Singapore an even more caring and inclusive society. So, I am heartened to hear that MCCY and the National Volunteer and Philanthropy Centre (NVPC) started developing a Singapore Roadmap for Corporate Giving. Such a roadmap will provide much needed clarity to employers, employees and voluntary welfare organisations.
Can I ask MCCY on the status of this development? How will it help companies, including small and medium enterprises (SMEs), to do more to encourage employer-organised volunteerism? I look forward to inputs from MCCY.
Mr Thomas Chua Kee Seng (Nominated Member): Mr Chairman, in Mandarin again.
(In Mandarin): [Please refer to Vernacular Speech.] Chairman, fellow Members of Parliament, the Government has rolled out tax incentives to encourage enterprises to do more charitable work and set up the \"Our Singapore Fund\" to promote social cohesion and a caring spirit. This is the right societal guidance.
In fact, many enterprises, including SMEs, do actively participate in all kinds of charitable activities, except that these were not widely publicised by the media. By introducing tax incentives, the Government is endorsing the charitable work by enterprises. Moving forward, this could enable enterprises to do even more. Companies which organise charitable activities can \"kill two birds with one stone\".
Firstly, it inculcates the spirit of giving back to society, builds up the corporate image, establishes shared values among employees and strengthens employees' sense of loyalty.
Secondly, it would improve company bonding and help to cultivate mutual understanding among management and employees. Staff who work in different departments do not usually have the chance to interact with other colleagues. Participating in charitable activities organised by the company gives them the chance to work together and deepen understanding.
However, when companies plan for such activities, it would be more effective if they could take reference from some successful experiences. Hence, I would urge the relevant agency to provide cases of some successful corporate social responsibility projects as a reference point. While companies could learn by example more easily, charitable organisations would also stand to benefit.
The Chairman: Ms Joan Pereira, you can take your two cuts together.
Ms Joan Pereira (Tanjong Pagar): Mr Chairman, according to the Individual Giving Survey in 2014 released by the NVPC last year, one in five employers organised volunteer activities but one in two employees expressed interest in employer-organised volunteering. Clearly, there is room for our companies to increase volunteer opportunities for their staff.
Businesses are an important part of our community. By contributing to good causes together with their staff, they build goodwill and gain respect from the public and their customers. Their employees also have better job satisfaction and a stronger sense of corporate identity. Many employees I have come across admire corporate leaders who have the heart to give back to society.
We have many examples of corporates contributing money, time and effort to good causes, such as Singapore Airlines (SIA), Singapore Press Holdings (SPH) and Mediacorp. In my constituency, Mr Peter Ng of Sin Kian Choon Fruits Trading is a good example of a business owner from Bukit Merah who has stepped forward to help needy residents in my constituency. He not only sponsors the fruits and rations for needy households, but helps out in the distribution, too. For these big companies and SMEs, the employees share with me that they gain great satisfaction seeing the happy and appreciative faces of the residents who received help.
In May 2015, MCCY announced that the NVPC would be developing a Singapore roadmap for corporate giving. How has this plan helped to increase donations, both in cash and in kind, as well as volunteering from our corporations? Have companies been receptive so far? Some companies, particularly SMEs, need help or advice in how they can contribute. What plans does the Ministry have to engage and assist such companies?
Sir, our seniors have a lifetime of skills and experience to contribute to our society. They can also benefit from volunteering. In fact, studies have shown a positive association between volunteering and mental, physical and social well-being.
An example of a senior volunteer is Mdm Doh, aged 70, who has been a long-time volunteer with Thong Kheng Welfare Services, Lions Befriender and the RC in Bukit Merah View in my Division. She has learnt that many elderly value, above all, relational connections – a listening ear, a shoulder to lean on. She had to respond to a few emergencies and gained great satisfaction in being able to help.
However, some, especially those who are just starting out as new volunteers, may face challenges in volunteering. For example, they may have difficulty in getting a good match between their skills or interests and the segments of need and, most challenging, balancing family and personal commitments.
There are also some volunteers who cannot find a good fit with the volunteer host organisations or who find that their volunteering experience could have been better managed.
What are MCCY's plans in managing our pool of talented and active volunteers? Is there a portal or a point of contact where they can go to and register their interests and expertise, and be matched to appropriate volunteer host organisations? After registration, are there volunteer consultants they can turn to for advice and guidance? And, finally, for areas which need sustainable pools of volunteers so that they can be rostered for their duties, is there a system to organise them?
Ms Foo Mee Har (West Coast): Chairman, Sir, I applaud the Government for its continuing efforts to promote a spirit of charity and volunteerism in our society. The introduction of the Business and Institution of a Public Character (IPC) Partnership Scheme in this Budget is likely to spur more corporations to encourage volunteerism amongst their employees and to contribute to the community. To encourage giving by wealthy individuals in Singapore, we should review the laws governing the setting up of charitable trusts by Singapore Citizens and residents.
Sir, Singapore is well-positioned to become an international hub for philanthropy, because of our robust legal system, strong governance and a trusted and stable Government. To this end, we have launched such initiatives as the Economic Development Board's (EDB's) International Organisations Programme Office (IOPO) for the setting up of International Non-Profit Organisations (INPOs) in Singapore, and the Commissioner of Charities' Foreign Charitable Purpose Trust (FCPT), under which charitable trusts set up by non-Singapore citizens or residents are exempted from registration and eligible for tax exemption.
Sir, we should also cater to Singapore-based high net worth individuals, served by the private wealth industry, who want to give back to their country of residence by setting up charitable trusts. Often, these persons do not wish to be associated with any conspicuous, high-profile foundation. All they want is giving and preferring their contributions to be discreet, they just want to leave behind a legacy or satisfy some personal and private sense of duty and gratitude. However, if they wished to set up a charitable trust in Singapore, they would be subject to greater administrative burdens and more onerous governance structures than FCPT, just because they are Singapore Citizens or residents.
While these philanthropists have the option to register their charities as \"Qualifying Grant Makers\", ostensibly subject to \"lighter touch\" supervision by the Commissioner of Charities, but even this \"lighter touch\" option is comparatively unattractive, because traditional offshore jurisdictions, such as the Channel Islands and the Caribbean, do not impose such requirements that incur additional administrative costs which eat into the net proceeds which were intended for their beneficiaries. Whilst I do not have actual figures, anecdotal evidence from my interactions with the private trust industry suggests this \"shrinkage\" is quite significant.
Sir, I call on the Minister to consider applying the same set of rules under FCPT to trusts set up by Singapore Citizens and residents, so long as the necessary safeguards are in place. This includes being prohibited from soliciting public funds and ensuring that all gains and income are reserved for charitable causes only. To qualify, the charitable trust must be administered by a Singapore-licensed trust company to ensure strict governance and regulatory oversight by the Monetary Authority of Singapore.
The harmonisation of treatment for charities set up by foreigners with those set up by locals will encourage more charitable trusts to be set up in Singapore. The assets of local trusts are likely to be held and managed in Singapore, and likely to benefit more needy Singaporeans. Expertise built up in this sector can help Singapore develop yet another global centre of excellence, this time, in a field that connects those who cannot help themselves with those who can and want to help them. And we will do well by doing good.
The Chairman: Ms Kuik Shiao-Yin, you have five minutes for your two cuts.
Ms Kuik Shiao-Yin (Nominated Member): There have been two principles that have helped us maintain a decent level of social cohesion thus far. One, we have always been determined to respect freedom of religion; and, two, we have also been equally determined to let that freedom be limited by our respect for the secularity of the state, as well as our sense of responsibility towards the common good.
My concern is that these two fundamental principles are not being effectively passed down to our youths and this gap is showing up in the kind of conversations, or lack of conversations, they are having about religion in society.
A lot of our public education efforts at the school and grassroots levels are still mostly modelling the form of religious tolerance rather than the substance of religious harmony. Checking out different places of worship and sharing religious meals during religious festivals are just the tip of the iceberg. What lies underneath is a far more complex conversation about our beliefs on relationships, life, death, time, work, money, power and more that we need to learn to talk about and listen to. Yes, we have Social Studies and Civic Moral Education, but many youths will tell you few teachers want to discuss race and religious issues in depth. Many teachers deliberately keep discussions at the surface level because they are scared that the answers could be offensive and get them into legal trouble. And that is not a healthy sign.
If we do not model for our youths what respectful conversation about religion looks like, someone arbitrarily and potentially dangerous will fill the gap for us. It could be a fundamentalist thought leader, a bigoted website or just prejudiced, ill-informed peers. In some sense, Religious Knowledge (RK) has never been taken out of schools. It has been ongoing, except everyone is managing it by themselves and cherry-picking their own curriculum and their own teachers. And there are definitely echo chambers forming within exclusionary religious and non-religious communities online and offline.
If we do not teach our young people how to build bridges, they will naturally build walls. I understand the resistance to introducing anything resembling RK in the school curriculum ever again because implementation will always be complicated by the challenge of proselytisation. So, can I suggest we develop a faith-and-reason modular programme to be run across schools as well as external community platforms reaching young people?
A faith-and-reason programme could have three key characteristics that distinguish it from the old RK programme. First, it is not about understanding religion in isolation but understanding why preserving freedom of religion and preserving the secularity of the state both matter to the common good. Real-life Singapore case studies of clashes between different ideologies, like the Association of Women for Action and Research (AWARE) saga should be discussed and the different stakeholders' responses respectfully debated over.
Second, it makes room for the views of the non-religious community. Both religiosity and secularism are growing in Singapore and the region. The non-religious make up 18.5% of our population and more than half are youths. Many in this group do hold the controversial view that religion is irrational and not beneficial to society. It matters that both the non-religious minority and the religious majority learn how to uncover their commonalities and also discuss their differences with compassion.
Third, it goes beyond building inter-religion to intra-religion understanding as well. There is a dangerous lack of conversations between conservatives, moderates and liberals within the same religion. Religious teachers do not typically initiate engagement of leaders from their own community on the opposite spectrum for fear of looking like they are softening their standards. Such a conversation needs to be encouraged by outsiders as well as insiders.
Sir, let us have the courage to learn from one another how to have scary conversations. When we create safe spaces where we can be honest about the differences that we disagree over and yet open towards the commonalities that bind, we will reap true religious harmony.
According to the Centre of the Developing Child at Harvard, the best way to understand how we develop resilience is to visualise a see-saw. On one side sits positive experiences, coping skills and at least one stable committed adult relationship. On the other side sits adversity.
The more protective experiences, coping skills and strong relationships we provide, the more we can counterbalance the piling on of adversity on the other end. It is this holy trinity that develops resilience in a child and no singular organisation can achieve this effectively by itself.
When Minister Heng Swee Keat shared about having bespoke plans for the industrial transformation of more than 20 specific economic sectors in Singapore, it struck me. Do we also have bespoke plans for the generational transformation of, say, 20 or more specific archetypes of youths?
The Outward Bound School (OBS) @ Coney is but one part of what must be a whole-of-sector strategy. I hope MCCY can develop a strategic roadmap that will guide the whole ecosystem of youth organisations from the public, people and private sectors to see their role in developing resilience in youths together. The sector is still fragmented and working in silos. I believe the sharing of such a roadmap will help all of us stakeholders within the youth sector to know our place in the resilience value chain and thus realise how to collaborate more effectively for our common goal.
Ms Rahayu Mahzam: Chairman, as we write the next chapters for the next 50 years of Singapore, we will need to look at how, as a mature society, we handle diversity of views. Diversity can be a strength if energies can be synergised and used for the good of the people. However, it is also a potential divisive factor that can tear our social fabric.
I am particularly concerned that we are starting to see vitriolic debates and conversations happening in the online space. I understand that these toxic exchanges do not necessarily reflect the current state of affairs offline or the mentality of the larger majority. However, I cannot help but worry that such airing of views reflects the unspoken thoughts of many. I am also concerned that the young, who grow up exposed to and dependent on information they obtain from the Internet may be impacted by the views online.
It is, therefore, imperative that we create real-life platforms to bring youth from different backgrounds together so that they may interact, learn about one another and have open and frank conversations about their differences. I, therefore, laud efforts like the development of the OBS @ Coney Island which has the great potential of being the platform to encourage healthy and organic interactions amongst our youths. The SGFuture engagements have also been an excellent platform for discussions.
Our hope lies with the young. We need to engage youths on matters that are important to them, especially since they will inherit the nation and should have a say in how the society develops. Beyond creating the platforms and spaces for them to interact, for there to be real discourse, I believe there also needs to be opportunities for more open debates and discussions. I would, therefore, like to ask what specific measures the Ministry would take in ensuring meaningful social mixing, interactions and discussions through the youth activities. What more can be done to ensure a sustainable and continued engagement and interaction among youths from diverse backgrounds, beyond just the activities which they participate in?
Our call for embracing diversity and maintaining our multireligious and multicultural values need to go beyond platitudes. We need to make diversity our strength and not cause our fall. I have faith that we will be able to achieve this. But there needs to be effort by all to make a constant and conscious effort to encourage and embrace diversity.
Mr Darryl David: Chairman, while we can debate the role of education or parenting in growing young people with strength and fortitude, I believe that experiential learning is critical to developing our youths holistically in this area. I was thus heartened to hear that the Government will soon be building a new OBS on Coney Island to enhance the OBS experience for our youths.
I believe that every child should, at some point, be given the opportunity to spend time in OBS. The experience of being in a natural setting, away from urban familiarity, to have one's physical and mental abilities stretched to the fullest, should be offered to all Singaporean youths. Indeed, I was just at OBS on Pulau Ubin few days ago on Sunday and just being there for few hours really helped alleviate pressures of being in an urban environment and brought back fond memories also of my time in OBS.
Many of us who have also spent time in OBS would attest to the benefits of that experience, not only because of the confidence that they gave us but also the resilience and strong bonds of friendship, camaraderie and teamwork that we build up not only among our school mates but also across schools.
What is my wish? That going for an OBS experience could thus be something that all Singaporean youths eventually go through as a \"rite-of-passage\", the same way that all male Singaporeans go through National Service.
One element of National Service which is important is the social mixing that it involves. Singaporeans of all races, religions, socio-economic groups and educational backgrounds get to mix together, and this strengthens and enhances the social fabric of our community.
I am happy to hear that the Acting Minister for Education said at an earlier COS debate last week that all Singaporean youths would have the chance to experience OBS within the next few years.
In this light, I would like to suggest that the next batch of students from not just different schools but also from different types of academic systems and institutions get to undergo their OBS experience together. For example, students from the Institute of Technical Education, could undergo their OBS with their peers from an International Baccalaureate (IB) through train school. And those from a Special Assistance Plan (SAP) school could go for OBS with unique schools like School of the Arts or even NorthLight.
While this would require some logistics and planning, I believe that it would also be beneficial as students now not only get stretched physically and mentally, they also get to develop their emotional quotient and empathy by learning how to interact and cooperate with other young Singaporeans who are different from them.
In addition to continuing their collaboration with MOE, I hope that MCCY can share with the House how we can all work together to create a new generation of Singaporeans who are physically and mentally tougher and ready to accept any challenge that comes their way.
Ms Sun Xueling (Pasir Ris-Punggol): Mr Chairman, I still remember the experience I had at OBS when I was in secondary school. It was especially memorable because I was from an all-girls' school and it was my first time interacting with boys of the same age, solving problems and battling the rugged outdoors.
It was also an opportunity for girls to push their physical limits, challenge their fears and bond with students from other schools and other races, especially since girls do not serve National Service. I found the experience extremely valuable and was thus delighted to hear that such an experience would be available to all in the cohort.
However, just as OBS @ Coney Island was greeted with much excitement, given that all in the cohort will be given the opportunity of outdoor learning, there were also concerns raised by many parents who feel that their child is not ready or suited for such outdoor activities and that OBS should not be made compulsory. It is, therefore, critical for parents to buy in and support this initiative in order to ensure that it successfully achieves its objectives.
Can the Ministry provide greater details of the activities that OBS will embark on and what it tries to achieve? If in their daily interactions with their children, parents are able to compliment and reinforce what OBS sets out to achieve, we are more likely to achieve longer-term benefits of this programme.
Also, in order to maintain the quality of the OBS experience for students, can the Ministry take steps to educate students ahead of the programme so that all will do it with the right attitude and enthusiasm? OBS has, in the past, been seen as a star programme for student leaders. Even as it is now made available to all, the experience of the programme should be upheld and all students should come away from it feeling proud of themselves and their achievements.
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[Deputy Speaker (Mr Charles Chong) in the Chair]
Miss Cheng Li Hui (Tampines): Sir, OBS was set up by Dr Goh Keng Swee in 1967. Dr Goh's vision was for OBS to help build a rugged society. True to his vision, the fundamental philosophy underlining the operations of OBS has not changed over the past nearly 50 years. I am glad that OBS is now being expanded to strengthen our rugged society.
At the official opening of Coney Island, Minister Khaw Boon Wan said in his speech, \"We will, of course, keep the island rustic and keep to its natural state, as much as possible. Coney Island is home to a wide variety of habitats, including coastal forests, grasslands and mangroves. It is also a stop for migratory birds and features rare flora and fauna that are not seen on our mainland.\"
I am, therefore, concerned whether the rustic nature of the island can, indeed, be preserved. I understand that 12 hectares represent 10% of Coney Island. I would still like to ask what are the measures taken to minimise the impact to the environment and how the rustic nature of the island can be preserved.
The cost of $250 million seems to be rather high, considering cost of other infrastructure projects like the Nanyang Technological University (NTU) Sports and Residential Halls cost $230 million.
Will the Minister share the details of the development plans and the components which account for the high costs? I would also like to ask what are the plans for the current OBS and adventure campsites.
","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 Culture, Community and Youth (Ms Grace Fu Hai Yien):\tSir, may I seek your consent to move that progress be reported now and leave be asked to sit again tomorrow?
The Chairman: I give my consent.
[(proc text) Resolved, \"That progress be reported now and leave be asked to sit again tomorrow.\" − [Ms Grace Fu Hai Yien]. (proc text)]
[(proc text) Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House. (proc text)]
Ms Grace Fu Hai Yien: Sir, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2016/2017 and ask leave to sit again tomorrow.
Mr Deputy Speaker: So be it.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Adjournment","subTitle":null,"sectionType":"OS","content":"[(proc text) Resolved, \"That Parliament do now adjourn.\" – [Ms Grace Fu Hai Yien]. (proc text)]
Adjourned accordingly at \t8.01 pm.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null}],"writtenAnswersVOList":[],"writtenAnsNAVOList":[],"annexureList":[],"vernacularList":[{"vernacularID":1976,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Thomas Chua Kee Seng","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Thomas Chua(1).pdf","fileName":"Thomas Chua(1).pdf"},{"vernacularID":1977,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mrs Josephine Teo","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Josephine Teo(1).pdf","fileName":"Josephine Teo(1).pdf"},{"vernacularID":1978,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Zainal Sapari","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Zainal Sapari(1).pdf","fileName":"Zainal Sapari(1).pdf"},{"vernacularID":1979,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Saktiandi Supaat","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Saktiandi Supaat(1).pdf","fileName":"Saktiandi Supaat(1).pdf"},{"vernacularID":1980,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Amrin Amin","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Amrin Amrin(1).pdf","fileName":"Amrin Amrin(1).pdf"},{"vernacularID":1981,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Muhamad Faisal Bin Abdul Manap","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Muhamad Faisal Abdul Manap(1).pdf","fileName":"Muhamad Faisal Abdul Manap(1).pdf"},{"vernacularID":1982,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Ms Rahayu Mahzam","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Rahayu Mahzam(1).pdf","fileName":"Rahayu Mahzam(1).pdf"},{"vernacularID":1983,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Ms Rahayu Mahzam","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Rahayu Mahzam(2).pdf","fileName":"Rahayu Mahzam(2).pdf"},{"vernacularID":1984,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Assoc Prof Dr Muhammad Faishal Ibrahim","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Muhammad Faishal Ibrahim(1).pdf","fileName":"Muhammad Faishal Ibrahim(1).pdf"},{"vernacularID":1985,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Dr Intan Azura Mokhtar","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Intan(1).pdf","fileName":"Intan(1).pdf"},{"vernacularID":1986,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Saktiandi Supaat","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Saktiandi Supaat(2).pdf","fileName":"Saktiandi Supaat(2).pdf"},{"vernacularID":1987,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Zainal Sapari","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Zainal Sapari(2).pdf","fileName":"Zainal Sapari(2).pdf"},{"vernacularID":1988,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Zaqy Mohamad","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Zaqy Mohamad(1).pdf","fileName":"Zaqy Mohamad(1).pdf"},{"vernacularID":1989,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Thomas Chua Kee Seng","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Thomas Chua(2).pdf","fileName":"Thomas Chua(2).pdf"},{"vernacularID":2576,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Gan Kim Yong","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Gan Kim Yong(1).pdf","fileName":"Gan Kim Yong(1).pdf"},{"vernacularID":2577,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Miss Cheng Li Hui","filePath":"d:/apps/reports/solr_files/20160413/vernacular-Cheng Li Hui(1).pdf","fileName":"Cheng Li Hui(1).pdf"}],"onlinePDFFileName":""}